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Essential shit > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What are the chordata Tendinae?

A

strong fibrous connection between valve leaflets and papillary muscles

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2
Q

what is the fossa ovalis

A

reminant of the foramen ovale

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3
Q

name the layers of the heart (outer to inner)

A
  1. pericardium
  2. epicardium
  3. myocardium
  4. endocardium
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4
Q

what structures does the RCA supply?

A
  • inferior heart
  • RA and RV
  • SA and AV node
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5
Q

What structures does the LAD supply?

A
  • anterior heart
  • LA and anterior LV
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6
Q

What structures does the left Circumflex Artery supply?

A
  • Lateral Heart
  • Lateral LV
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7
Q

What is the main function of the coronary sinus?

A

To drain deoxygenated blood from the heart muscle into the right atrium

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8
Q

Histology of blood vessels?

A
  • Tunica intima
    Edothelial cells
    (internal elastic membrane)
  • Tunica media
    Muscle
    (external elastic membrane)
  • Tunica adventitia
    Supportive connective tissue
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9
Q

What is the Stroke Volume?

A

the volume of blood pumped out of the left ventricle of the heart during each systolic cardiac contraction.

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10
Q

What are some examples of extrinsic factors

A

Nerves
sypathetic and parasympathetic
Hormones
Adrenaline
- Alpha receptors (vasoconstriction)
- Beta receptors (vasodilation)

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11
Q

What are some examples of intrinsic factors

can override extrinsic controls

A

Chemicals
- Vasodilation (inc. CO2, decr. O2, histamine, bradykinin, NO)
- Vasoconstriction (leukotrines)
Physical

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12
Q

What is MAP and how is it measured?

A

the average arterial pressure throughout one cardiac cycle

CO x SVR

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13
Q

What is the frank starling curve describing?

A

stroke volume of the left ventricle will increase as the left ventricular volume increases due to the myocyte stretch causing a more forceful systolic contraction.

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14
Q

Describe the arrangement of muscle fibres in the heart

A

Muscle Fibre > Myofibril > ACTIN (thin) + MYOCIN (thick) [arranged into sarcomeres]

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15
Q

What are desmosomes?

A

Provide mechanical adhesion between cardiac cells

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16
Q

What is the only point of electrical contact between the atria and the ventricles?

A

AV node

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17
Q

What are specialised cardiac pacemaker cells?

A

cells which can generate action potentials spontaneously due to their membrane potential being unstable

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18
Q

what is the spontaneous pacemaker potential?

A

the slow, positive increase in voltage across the cell’s membrane (the membrane potential) that occurs between the end of one action potential and the beginning of the next action potential.

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19
Q

Describe the phases of a pacemaker potential curve

A

Phase 0 = depolarisation
- Activation of L-type Ca channels opening resulting in calcium influx

Phase 3 – repolarisation
- Calcium channels close
- Activation of K+ channels resulting in potassium efflux

Phase 4 – slow depolarisation
- Funny current – mixed Na/K inward current resulting in slow depolarisation

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20
Q

How are electrical impulses transported from cell to cell in the heart?

A

gap junctions

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21
Q

Describe the phases of the contractile muscle action potential curve

A

Phase 0
Depolarisation due to Na influx

Phase 1
Closure of Na channels and transient K efflux

Phase 2 - Plateau phase
Ca++ influx through L-type Ca++ channels

Phase 3
Closure of Ca channels and K efflux

Phase 4
Resting potential (Repolarisation) due to K efflux

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22
Q

Describe the segments of an ECG wave

A

P wave
Atrial depolarisation

PR Segment
AV node delay

QRS Complex
Deposarisation of the ventricles (<0.1s)
Beginning of the Q wave to the end of the S wave
Atrial repolarisation superimposed

ST Segment
Time between ventricular depolarisation and repolarisation
Ventricles are contracting

T wave
Repolarisation of the ventricles

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23
Q

How to read an ECG?

A

Is there electricity activity present
Is the rhythm regular or irregular
What is the HR
Are P waves present
What is the PR interval (0.12 - 0.2s)
Is each P wave followed by a QRS complex?
Is the QRS duration normal (<0.1s)

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24
Q

what leads and blood vessels show and supplies the anterior part of the heart?

A

leads : V1-V6
LAD artery

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25
Q

what leads and blood vessels show and supplies the inferior part of the heart?

A

II,III,aVF
Right coronary artery

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26
Q

what leads and blood vessels show and supplies the Lateral part of the heart?

A

I, aVL, V5-V6
left circumflex

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27
Q

what neurotransmitter does noradrenaline act on?

A

B1 receptors

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28
Q

parasympathetic innervation is supplied by the…

A

vagus nerve

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29
Q

effect of parasympathetic innervation on the heart?

A

negative chronotropic effect (rate)

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30
Q

what neurotransmitter does acetylcholine act on?

A

M2 repectors

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31
Q

What causes the frank starling curve to shift to the left?

A

increased contractility of the heart

decreased shifts the curve to the right

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32
Q
A
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33
Q

Does SV increase as EDV increases?

A

yes

ventricles fill with more blood during diastole, larger volume ejected

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34
Q

Where are V1-V6 leads placed on an ECG?

A

V1 & V2 = 4th ICS sternal edge

V3 = between 2 and 4

V4 = 5th ICS mid clavicular

V5 = between 4 and 6

V6 = inline with 4 and 5, mid auxilary

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35
Q

What do the cardiac sympathetic nerves innervate?

A

SA node, AV node & Myocardium

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36
Q

What nerve impulse decreases AV nodal delay?

A

Sympathetic

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37
Q

what does the vagus nerve do in the heart

A

decreases heart rate

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38
Q

when is renin released in the kidneys?

A

in response to low Na+ or low BP

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39
Q

what does angiotensin act on?

A

adrenal glands to produce aldosterone

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40
Q

tell me about ACEi

A

ends in -pril
avoid in pregnancy
SE - dry cough
use for hypertension

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41
Q

tell me about ARBs

A

same effect as ACEi, no dry cough
ends in -artan

avoid in pregnancy induced hypertension

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42
Q

tell me about CCBs

A

treat hypertension and angina
two classes dihydropines e.g. amodipine(both relax and widen arteries) Non-dihydropidines can also control tachycardias E.g. verapamil, diltiazem AVOID WITH BB

SE - swollen ankle (dihydropine) and peripheral oedema

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42
Q

what are thiazide diuretics used for?

side effects

A

hypertension (block Na-Cl transporter)
SE are hypo Na/K, hyperglycaemia

bendrofluazide

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43
Q

what are loop diuretics used in?

A

heart failure
SE are hypo Na/K

e.g. furosemide

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44
Q

MOA of statins?

A

Inhibits HMG-CoA reductase

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45
Q

Side effects of Statins

A

myopathy, rhabdomyolisis

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46
Q

what are anti-cholestrol drugs

A

Statins, Fibrates, PCSK9 inhibitors

Stupid Fucking Prick

47
Q

what are anti-hypertensive drugs

A

vasodilators
Alpha blockers, ACE inhibitors (ACEI), Angiotensin Receptor Blockers (ARB), Calcium antagonists

Diuretics, Beta blockers, mineralocorticoid antagonist, alpha 2 adrenoreceptor agonist

AAAABCDM

48
Q

what are anti-anginal drugs?

A

Vasodilators→ nitrates, nicorandil, calcium antagonists

Slows heart rate→ beta blockers, ivabradine, calcium antagonists

Metabolic modulator→ ranolazine

(beta blocker and ccb is first line)

nah no chance benni is CRistened

49
Q

what are anti-thrombotic drugs?

A

Anti-platelet drugs→ aspirin, clopidogrel, prasugrel, ticagrelor
Anti-coagulants→ heparin, warfarin, fondaparinux, rivaroxaban, dabigatran, edoxaban
Fibrinolytics→ streptokinase, tPA
Assassins Captured Purple Turkeys

Hot Women fucked damp rough electricians

stupid thot

50
Q

what are fibrinolytics used for?

A

STEMI

51
Q

what are anti-arrhythmic drugs?

A

For AF→ amiodarone, adenosine, beta blockers, rate-limiting CCBs, digoxin

ABCD

52
Q

what is digoxin used to treat?

A

congestive heart failure, AF

53
Q

what are the different classes of anti-arrhythmics?

A

Class 1: reducing Na channel current

Class II: B-Adrenergic antagonists

Class III: action potential prolongation

Class IV: Ca channel antagonists

I & III rhythm, II & IV rate

54
Q

what is gold standard test for hypertension?

A

ABPM

55
Q

treatment of hypertension if below 55?

A

ACEi/ARB
‘’ + CCB or TD
triple treatment
consider spironolactone

56
Q

how does treatment of hypertension vary if above 55 or afrocarribean

A

CCB first line

57
Q

what is virchow’s triad?

A

stasis of blood flow, endothelial injury, hypercoagulability

thrombosis

58
Q

symptoms fo PE?

A

chest pain
- typically, pleuritic
dyspnoea
haemoptysis
tachycardia
tachypnoea
respiratory examination
classically the chest will be clear

59
Q

what is PVD presentation?

A

intermittent claudication - legs (exertional discomfort, relieved by rest)
critical limb ischaemia

60
Q

investigations for PVD?

A

ABPI

61
Q

when would you do a CABG?

A

left main coronary artery stenosis, angina

62
Q

difference in diagnosing unstable angina and NSTEMI

A

troponin
raised in NSTEMI, not in unstable angina

63
Q

Complications of ACS?

A

D – Death
R – Rupture of the heart septum or papillary muscles
E – “oEdema” (heart failure)
A – Arrhythmia and Aneurysm
D – Dressler’s Syndrome

64
Q

what is dresslers syndrome?

what, presentation, management

A

occurs 2-3 weeks after an acute MI, inflamation of pericardium
presents with pleuritic chest pain, pericardial rub
manage with NSAIDS (aspirin and iboprufen - severe steriods

65
Q

what score to assess risk of mortality after ACS?

A

GRACE

66
Q

Initial management of ACS?

A

B – Base the decision about angiography and PCI on the GRACE score
A – Aspirin 300mg stat dose
T – Ticagrelor 180mg stat dose (clopidogrel if high bleeding risk, or prasugrel if having angiography)
M – Morphine titrated to control pain
A – Antithrombin therapy with fondaparinux (unless high bleeding risk or immediate angiography)
N – Nitrate (GTN)

67
Q

ECG for branch blocks which can indicate STEMI?

A

wiLLiam maRRow

leads V1 and V6

68
Q

Management of STEMI?

A

Aspirin 300mg loading dose immediately, O2 if sats <94%, Morphine, Nitrate
PCI within 2 hours of presenting or Thrombolysis

69
Q

Different types of Heart Failure?

A

HF with preserved ejection fraction (diastolic dysfunction)

HF with reduced ejection fraction (systolic dysfunction)

70
Q

signs of Right heart failure

A

peripheral oedema, distented JVP

LEGS AND LIVER

71
Q

signs of Left heart failure

A
  • exertional dysopnea, paroxysmal nocturnal dyspnea
  • pink frothy sputum
  • orthopnea

LUNGS

72
Q

1st line investigation for Heart failure?

A

NT-pro-BNP

73
Q
A
74
Q

NYC classification of heart failure?

A

Class I: No limitation on activity
Class II: Comfortable at rest but symptomatic with ordinary activities
Class III: Comfortable at rest but symptomatic with any activity
Class IV: Symptomatic at rest

75
Q

chronic heart failure management?

A

1st line - ACEi +BB dual therapy
loop for fluid overload

76
Q

what are S1 + S2 caused by?

A

S1 caused by closing of AV valves (tricuspid + mitral) “lub”

S2 caused by closing of semilunar valves (pulmonary + aortic) “dub”

77
Q

how to remember systolic murmurs?

A

MRS ASS

Mitral Regurg Systolic, Aortic Stenosis Systolic

78
Q

Causes of Aortic Stenosis?

A

Rheumatic heart disease

79
Q

Presentation of Endocarditis?

A

Fever + finger clubbing
Roth’s spots
Osler’s nodes
Murmur (new)
Jane-way lesions
Anaemia
Nail (splinter) haemorrhages
Emboli

80
Q

Sings of mitral regurgitation?

A

peripheral oedema

pansystolic murmur which radiates to axilla

81
Q

signs of mitral stenosis?

A

malar flush

mid diastolic murur localised to apex

81
Q

sing of aortic regurgitation?

A

collapsing pulse

early diastolic on left sternal edge, rumbling

81
Q

what is most common valve affected in endocarditis?

A

mitral

82
Q

Diagnosis of Endocarditis?

A

Duke’s Criteria

At least 2/3 blood cultures must be positive to meet major criteria

83
Q

causiative organism of mitral valve endocarditis?

A

staph aureus

most common

84
Q

causiative organism of mechanical valve endocarditis?

A

staph epidermidis

85
Q

causiative organism of poor hygeine/dental work endocarditis?

A

strep viridans

86
Q

causiative organism of IV drug users endocarditis?

A

staph aureus

87
Q

when should blood cultures for suspected infective endocarditis be taken?

A

within 1 hour prior to empirical treatment

88
Q

empirical treatment for native and prosthetic valve endocarditis?

valve dependent

A

Native valve: Amoxicillin, Gentamicin

Prosthetic valve: Vancomycin, Gentamicin

89
Q

treatment for staph aures endocarditis ?

valve dependent

A

Staph. aureus: Flucloxacillin

90
Q

empirical treatment for sepsis /+ MRSA suspected endocarditis?

A

Sepsis: Flucloxacillin

Sepsis + MRSA suspected (treat as per prosthetic valve)

91
Q

treatment for MRSA endocarditis?

A

MRSA: Vancomycin, Gentamicin

92
Q

treatment for strep viridans endocarditis?

A

Strep. viridans: Benzylpenicillin, Gentamicin

93
Q

treatment for enterococcus endocarditis?

A

Enterococcus: Amoxicillin/Vancomycin, Gentamicin

93
Q

treatment for staph epidermidis endocarditis?

A

Staph. epidermidis: Vancomycin, Gentamicin

94
Q

presentation of pericarditis?

A

Pleuritic (sharp, sudden, intense) chest pain – retrosternal -> radiates to neck and shoulders
- Relieved by sitting forward

Aggravated by lying down + deep inspiration

Pleural rub – High pitched scratching sound

Fever

95
Q

ECG findings of pericarditis?

A

widespread saddle shaped ST elevation

96
Q

components of becks triad?

A

hypotension
raised JVP
muffled heart sounds

97
Q

management of cardiac tamponade?

A

urgent pericardiocentesis

97
Q

ECG finding of AF?

A

irregularly irregular pulse, no p waves

97
Q

management of AF?

A

rate control
1st line: Bisoprolol OR Diltiazem
rhythm control

rate or rhythm onset < 48hr, rate only >48hr

98
Q

what is CHADS-VASc score?

A

used to stratify risk of stroke in AF patients
Score 0: No treatment

Score 1: Consider AC in males

Score 2: Offer AC (DOAC)

98
Q

ECG finding of Atrial flutter?

A

sawtooth

99
Q

when to shock with cardiac arrest?

A

VF, pulseless VT

100
Q

Tx of narrow complex tachycardia (non-emergency)?

AFlutter, sinus tach, AVRT/AVNRT

A

1st line - vagal manouvres
2nd line - IV adenosine
3rd line - veramapil (CCB) or BB
4th line - Syncronised DC cardioversion

101
Q

Treatment of pulsed VT?

A

IV Amiodarone

102
Q

Treatment of pulseless VT

A

unsynchronised shock
IV andrenaline and IV amiodarone (main)

103
Q

different types of heart block

A

1st PR interval >120ms
2nd:
Mobitz 1 = progressive increase in PR length leading to dropped QRS
Mobitz 2 = regular dropped qrs complex,
3rd degree = no association between p wave and qrs complex

104
Q

treatment of bradycardias

A

1st line - 500mg atropine IV
2nd line - Transcutaneous pacing, isoprenaline or adrenaline

further
transcutaneous pacing

105
Q

a young athlete drops dead from sudden cardiac death, what did they die of?

A

hypertrophic cardiomyopathy

106
Q

what is spiranolactone used for?

A

heart failure

107
Q

signs of RHF

A

peripheral oedema
Raised JVP
Pitting peripheral oedema (ankle to thighs to sacrum)

108
Q

signs of LHF

A

orthopnea
fatigue
pink frothy sputum
PND
Tachypnoea
Bibasal fine crackles on auscultation of the lungs
Cyanosis

109
Q

heart valves for lub (s1) and dub(s2)

A
  • S1 = tricuspid and mitral
  • S2 = aortic and pulmonary

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