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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
what leads and blood vessels show and supplies the inferior part of the heart?
II,III,aVF Right coronary artery
26
what leads and blood vessels show and supplies the Lateral part of the heart?
I, aVL, V5-V6 left circumflex
27
what neurotransmitter does noradrenaline act on?
B1 receptors
28
parasympathetic innervation is supplied by the...
vagus nerve
29
effect of parasympathetic innervation on the heart?
negative chronotropic effect (rate)
30
what neurotransmitter does acetylcholine act on?
M2 repectors
31
What causes the frank starling curve to shift to the left?
increased contractility of the heart | decreased shifts the curve to the right
32
33
Does SV increase as EDV increases?
yes | ventricles fill with more blood during diastole, larger volume ejected
34
Where are V1-V6 leads placed on an ECG?
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
35
What do the cardiac sympathetic nerves innervate?
SA node, AV node & Myocardium
36
What nerve impulse decreases AV nodal delay?
Sympathetic
37
what does the vagus nerve do in the heart
decreases heart rate
38
when is renin released in the kidneys?
in response to low Na+ or low BP
39
what does angiotensin act on?
adrenal glands to produce aldosterone
40
tell me about ACEi
ends in -pril avoid in pregnancy SE - dry cough use for **hypertension**
41
tell me about ARBs
same effect as ACEi, no dry cough ends in -artan | avoid in pregnancy induced hypertension
42
tell me about CCBs
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
42
what are thiazide diuretics used for? | side effects
hypertension (block Na-Cl transporter) SE are hypo Na/K, hyperglycaemia | bendrofluazide
43
what are loop diuretics used in?
heart failure SE are hypo Na/K | e.g. furosemide
44
MOA of statins?
Inhibits HMG-CoA reductase
45
Side effects of Statins
myopathy, rhabdomyolisis
46
what are anti-cholestrol drugs
Statins, Fibrates, PCSK9 inhibitors | Stupid Fucking Prick
47
what are anti-hypertensive drugs
**vasodilators** Alpha blockers, ACE inhibitors (ACEI), Angiotensin Receptor Blockers (ARB), Calcium antagonists Diuretics, Beta blockers, mineralocorticoid antagonist, alpha 2 adrenoreceptor agonist | AAAABCDM
48
what are anti-anginal drugs?
**Vasodilators→** nitrates, nicorandil, calcium antagonists **Slows heart rate→** beta blockers, ivabradine, calcium antagonists **Metabolic modulator→** ranolazine (beta blocker and ccb is first line) | **n**ah **n**o **c**hance **b**enni **i**s **CR**istened
49
what are anti-thrombotic drugs?
**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
what are fibrinolytics used for?
STEMI
51
what are anti-arrhythmic drugs?
For AF→ amiodarone, adenosine, beta blockers, rate-limiting CCBs, digoxin | ABCD
52
what is digoxin used to treat?
congestive heart failure, AF
53
what are the different classes of anti-arrhythmics?
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
what is gold standard test for hypertension?
ABPM
55
treatment of hypertension if below 55?
ACEi/ARB '' + CCB or TD triple treatment consider spironolactone
56
how does treatment of hypertension vary if above 55 or afrocarribean
CCB first line
57
what is virchow's triad?
stasis of blood flow, endothelial injury, hypercoagulability | thrombosis
58
symptoms fo PE?
chest pain - typically, pleuritic dyspnoea haemoptysis tachycardia tachypnoea respiratory examination classically the chest will be clear
59
what is PVD presentation?
intermittent claudication - legs (exertional discomfort, relieved by rest) critical limb ischaemia
60
investigations for PVD?
ABPI
61
when would you do a CABG?
left main coronary artery stenosis, angina
62
difference in diagnosing unstable angina and NSTEMI
**troponin** raised in NSTEMI, not in unstable angina
63
Complications of ACS?
D – Death R – Rupture of the heart septum or papillary muscles E – “oEdema” (heart failure) A – Arrhythmia and Aneurysm D – Dressler’s Syndrome
64
what is dresslers syndrome? | what, presentation, management
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
what score to assess risk of mortality after ACS?
GRACE
66
Initial management of ACS?
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
ECG for branch blocks which can indicate STEMI?
wiLLiam maRRow | leads V1 and V6
68
Management of STEMI?
Aspirin 300mg loading dose immediately, O2 if sats <94%, Morphine, Nitrate PCI within 2 hours of presenting or Thrombolysis
69
Different types of Heart Failure?
HF with preserved ejection fraction (diastolic dysfunction) HF with reduced ejection fraction (systolic dysfunction)
70
signs of Right heart failure
peripheral oedema, distented JVP | LEGS AND LIVER
71
signs of Left heart failure
- exertional dysopnea, **paroxysmal nocturnal dyspnea** - pink frothy sputum - orthopnea | LUNGS
72
1st line investigation for Heart failure?
NT-pro-BNP
73
74
NYC classification of heart failure?
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
chronic heart failure management?
1st line - ACEi +BB dual therapy loop for fluid overload
76
what are S1 + S2 caused by?
S1 caused by closing of AV valves (tricuspid + mitral) “lub” S2 caused by closing of semilunar valves (pulmonary + aortic) “dub”
77
how to remember systolic murmurs?
MRS ASS | Mitral Regurg Systolic, Aortic Stenosis Systolic
78
Causes of Aortic Stenosis?
Rheumatic heart disease
79
Presentation of Endocarditis?
Fever + finger clubbing Roth’s spots Osler’s nodes Murmur (new) Jane-way lesions Anaemia Nail (splinter) haemorrhages Emboli
80
Sings of mitral regurgitation?
peripheral oedema | pansystolic murmur which radiates to axilla
81
signs of mitral stenosis?
malar flush | mid diastolic murur localised to apex
81
sing of aortic regurgitation?
collapsing pulse | early diastolic on left sternal edge, rumbling
81
what is most common valve affected in endocarditis?
mitral
82
Diagnosis of Endocarditis?
Duke’s Criteria At least 2/3 blood cultures must be positive to meet major criteria
83
causiative organism of mitral valve endocarditis?
staph aureus | most common
84
causiative organism of mechanical valve endocarditis?
staph epidermidis
85
causiative organism of poor hygeine/dental work endocarditis?
strep viridans
86
causiative organism of IV drug users endocarditis?
staph aureus
87
when should blood cultures for suspected infective endocarditis be taken?
within 1 hour prior to empirical treatment
88
empirical treatment for native and prosthetic valve endocarditis? | valve dependent
Native valve: Amoxicillin, Gentamicin Prosthetic valve: Vancomycin, Gentamicin
89
treatment for staph aures endocarditis ? | valve dependent
Staph. aureus: Flucloxacillin
90
empirical treatment for sepsis /+ MRSA suspected endocarditis?
Sepsis: Flucloxacillin Sepsis + MRSA suspected (treat as per prosthetic valve)
91
treatment for MRSA endocarditis?
MRSA: Vancomycin, Gentamicin
92
treatment for strep viridans endocarditis?
Strep. viridans: Benzylpenicillin, Gentamicin
93
treatment for enterococcus endocarditis?
Enterococcus: Amoxicillin/Vancomycin, Gentamicin
93
treatment for staph epidermidis endocarditis?
Staph. epidermidis: Vancomycin, Gentamicin
94
presentation of pericarditis?
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
ECG findings of pericarditis?
widespread saddle shaped ST elevation
96
components of becks triad?
hypotension raised JVP muffled heart sounds
97
management of cardiac tamponade?
urgent pericardiocentesis
97
ECG finding of AF?
irregularly irregular pulse, no p waves
97
management of AF?
**rate control** 1st line: Bisoprolol OR Diltiazem **rhythm control** | rate or rhythm onset < 48hr, rate only >48hr
98
what is CHADS-VASc score?
**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
ECG finding of Atrial flutter?
sawtooth
99
when to shock with cardiac arrest?
VF, pulseless VT
100
Tx of narrow complex tachycardia (non-emergency)? | AFlutter, sinus tach, AVRT/AVNRT
1st line - vagal manouvres 2nd line - IV adenosine 3rd line - veramapil (CCB) or BB 4th line - Syncronised DC cardioversion
101
Treatment of pulsed VT?
IV Amiodarone
102
Treatment of pulseless VT
unsynchronised shock IV andrenaline and **IV amiodarone (main)**
103
different types of heart block
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
treatment of bradycardias
1st line - 500mg atropine IV 2nd line - Transcutaneous pacing, isoprenaline or adrenaline further transcutaneous pacing
105
a young athlete drops dead from sudden cardiac death, what did they die of?
hypertrophic cardiomyopathy
106
what is spiranolactone used for?
heart failure
107
signs of RHF
peripheral oedema Raised JVP Pitting peripheral oedema (ankle to thighs to sacrum)
108
signs of LHF
orthopnea fatigue pink frothy sputum PND Tachypnoea Bibasal fine crackles on auscultation of the lungs Cyanosis
109
heart valves for lub (s1) and dub(s2)
- S1 = tricuspid and mitral - S2 = aortic and pulmonary

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