Cardiology ❤️ Flashcards
Patients who have recurrent AF, and cannot tolerate anticoagulation, what can we do for them
Left atrial appendage ablation
Rhythm control versus rate control in AF which provides a mortality benefit
Rate
If patient opts for rhythm control for the AF, and the AF generation was more than 48 hours. And rather than doing TEE they did three weeks of anticoagulation. Once cardioverted how long do they need more anticoagulation for
One month
Patient with supraventricular tachycardia and a background of wolf Parkinson white, patient a stable. What medication do I give
Procainamide. Not adenosine. And if they have AF, not beta blockers either
If for superventricular tachycardia, when you give adenosine, and the arrhythmia gets worse? What should you be thinking
WPW
If symptomatic bradycardia does not improve with atropine. What kind of other steps can I take
Temporary passing (transcutaneous). Dopamine or epinephrine can also be considered. A big step up would be transvenous passing. Permanent pacemaker for these patients going forward
What percentage and below is reduced ejection fraction which percentage What percentage of the body is preserved
40% is reduced. Above 50% is preserved
New York Heart Association classification heart failure
One is no limitation of activity. Four is discomfort on activity and rest. Class two and three is in between
Electrolyte disturbance parallels the severity of heart failure
Sodium is low
Give me a brief discussion on heart failure with reduced versus preserved ejection fraction
Reduced ejection fraction is your systolic heart failure. This is the main heart failure, and is usually caused by the whole elevation in our ESS and SNS systems, to eventually cause eccentric hypertrophy.
Preserved ejection fraction is yours diastolic heart failure. This is usually due to an actual event (prior MI, restrictive cardiomyopathy, scarring of the heart, chronic hypertension)
Answer these hard acute heart failure scenarios:
Wet and cold, systolic blood pressure less than 90
Wet and cold, systolic blood pressure more than 90
Dry and cold
Inatropic agent initially, then we can do diuretics after
Diuretics first, inatropic agent if refractory
Consider initial fluid challenge, but usually inatropic agent
 Best initial treatment for wet and warm CHF
Diuretics and vasodilators
Name two contraindications for manitall
kidney disease or heart failure 
Heart failure with severe hypertension, we could consider which medication
nitroprusside
Do you need to give VTE prophylaxis in acute heart failure
Yes
When to give ivabradine in heart failure
Patient on maximum beta blocker dose, pulse above 70 bpm. And needs more help
If patient is on heart failure regime and has potassium above five. Can I add on spironolactone
Of course not
When somebody says heart failure, which one are we usually talking about
Reduced ejection fraction
Quick overview of treatment for heart failure with preserved ejection fraction
Flow Zen are the only ones to reduced mortality. Try and treat specific cause. Did oxen and spironolactone do not benefit at all. Beta blockers an ace inhibitors are good for blood pressure control of his patients
What is the most common cause of dilated cardiomyopathy
Myocardial ischaemia. But this is really a phenotype, and is classified as a separate condition to proper dilated cardiomyopathy
Some rarer causes of dilated cardiomyopathy
Pheochromocytoma, HIV, zidovudine, cocaine
Can HCM cause a change in the S2
It can cause paradoxical S2
Septal Q waves are seen in which cardiomyopathy
HCM
What are some echo signs that distinguish HCM from athletes heart
Enlarged left atria, decrease in the left ventricle cavity size, focal step to hypertrophy, evidence of diastolic dysfunction
Advice to a HOCM patient about exercise
Avoid intense athletics and training
Treatment of HCM in fetus secondary to hyperinsulinaemia from maternal diabetes
IV fluids, beta blockers. It should regress by age 1
Just some random details of the echocardiograph findings of cardiac amyloidosis
(Usual restrictive signs) and relative sparing of longitudinal strain, thickened valves, speckled appearance of the myocardium.
Patient with restrictive heart failure in the midst of easy bruising, proteinuria, hepato-megaly, macroglossia
I
amyloidosis
Cardiac sarcoidosis has which main presentation
AV block
Generally the best diagnostic test for cardiac sarcoidosis, amyloid dosis, haemachromatosis
Obviously biopsy is usually best for all of these. Haemochromatosis really benefits from an MRI which can quantify the iron overload in the myocardium
Heart failure in the midst of arthritis, diabetes, liver problem
Haemochromatosis
Heart failure in the midst of bilateral hilar lymphadenopathy
Sarcoidosis
ECG with low voltages, yet echo shows increase thickness of ventricle
Sign of restrictive cardiomyopathy, especially Amyloidosis
What is the main prognostic Determinant for AL amyloidoses
Cardiac involvement
Peripartum cardiomyopathy. How to manage if patients to intrapartum
Diuretics, beta blockers or hydralazine plus nitrate. Just avoid RASS drugs. Avoid future pregnancies of persistent low ejection fraction.
What are the different types of neurally mediated syncopes
Carotid hyperstimulation, vasovagal, situation at
Head up tilt testing can be used to rule out which syncopes (more than you think)
Vasovagal, situational, orthostatic
Patient with syncope, that is worse or initiated with arm exercises.
Subclavian steal syndrome
Patient who has tacky cardia on assuming an upright posture, and even has syncope. However there is no orthostasis what is the diagnosis
Postural tachycardia syndrome. Doesn’t need syncope in symptoms
General overview of management for lymphoedema
Symptom management Like massage, exercise, pressure garments. Do not give diuretics. Hypervigilance for cellulitis
What is critical limb ischaemia
Chronic limb threatening ischaemia. PAD, with pain at rest, and evidence of gangrene or ulceration for more than two weeks
Can we see muscle atrophy in chronic ischaemia
Yes, alongside shiny skin, cyanosis, gangrene, pallor, lack of sebaceous glands
Normal range for ABPI
1 to 1.4
An ABPI of less than what is usually correlated to pain at rest
0.4
Best initial test for peripheral arterial disease (chronic or acute limb ischaemia). Than which are the two most accurate tests
ABPI. Then the most accurate test is either angiography or CTA, but these are only needed if you’re planning to revascularise
Medication often used for intermittent claudication
Cilostazol. Contraindicated in heart Phalia
Aortic stenosis with fusion at the commissure
Rheumatic heart disease
Vasodilators for aotic regurgitation.
They are good, but they don’t delay progression
What medications can we give for mitral stenosis
Beta blockers and CC bees are quite good to essentially increase the diastolic filling time
Recall difference in murmur intensity between mitral prolapse and mitral
regurgitation
Prolapse equals softer when you squat (anything decreasing the size will increase murmur)
regurgitation equals louder with increase venous return
Quick fact
Any regurgitation can have medical therapy using vasodilators. Aortic stenosis doesn’t have much medical therapy. mitral stenosis can use beta blockers or CCB
If someone has a functional mitral regurgitation (due to deleted ventricles) how can we medically treat
Diuretics to decrease the size of the ventricle Anthos stop the regurg
List me the cardiovascular conditions are contraindicated in pregnancy
Any valve stenosis. Heart failure with an injection fraction of less than 30%. Unstable/dilated aorta . Pulmonary hypertension
Ascending versus descending aortic aneurysm. Which is more cystic medionecrosis/connective tissue disorder in which is more atherosclerosis
In that order
Most common association with AAA
Atherosclerosis. But smoking is the strongest predictor of rupture. HTN main association with dissec
Can an uruptured but symptomatic AAA cause limb ischemia 
Yea
Patient who has unstable AAA (could be ruptured), but no history of AAA recorded. What should be done
Do the ultrasound first. If they have a history of AAA can go straight to repair
What is considered a rapidly expanding AAA
Expanding more than 5 mm in six months
What question do I ask in stand for B sorted dissection, to know whether to do surgery or not
If there is evidence of ischaemia do surgery, if not just continue with your beta blocker. Of course if there’s leak, then do Sx
What is phlegmasia alba dolens and phlegmansua cerulea dolens
The first is oedema pain and white blanching skin
The second is oedema pain and blue skin
Both are potential signs of DVT
Remember we always said provoked three months anticoagulation, unprovoked six months anticoagulation. What does first aid say about DVT treatment
Provoked, or first occurrence of unprovoked three months only. Cancer or second unprovoked, Indefinit
Patient following a DVT, has severe venous insufficiency, varicose vein, recurrent DVT, heaviness in the leg
Post thrombotic syndrome.
Above how much fluid in the pericardial sac would constitute an infusion (millimetre
Above 3 to 4
On ECG of pericarditis what do we see you later on
Can see diffuse T-wave
After initial acute symptoms of pericarditis have resolved, what do we do with the NSAIDs and colchicine in
Type of the NSAIDs to weekly to reduce recurrence. Colchicine can be used for up to 3 months
Preferred treatment of pericarditis if due to SLE
Steroids
Septal bounce on echocardiograph is seen in which disease
Chronic/constrictive pericarditis
Main two causes of pericardial knock
Constrictive pericarditis and restrictive cardiomyopathy
Can hypothyroidism cause pericardial effusion
Weirdly yes
Ewart sign
Dull percussion at the base of the left inferior scapular border, and tubular breath sounds/egophony in this area. Seen in pericardial effusion
If idiopathic pericardial effusion has been going on for more than three months, what can we do
Consider putting in a drain (maybe peritoneal?)
Cardiac tamponade. Is the pulse pressure changed? What are the lung fields like on examination?
Narrowed. And clear (high yield)
Echo free zone around the heart
Effusion
Other than urgent pericardiocentesis for Tampa nard, what else do we have to do
Aggressive volume expansion with IV fluids
Infective endocarditis after GI or GU procedure in old man
Enterococcus
Endocarditis affecting both sides of the valve, is a sign of what
Marantic or Lipman sacks endocarditis
We all know about strep office, but what about clostridium septicum
Also associated with endocarditis in colon cancer
Man recently had TURP, now has a subacute endocarditis. What’s the most likely cause
Enterococcus
Treatment failure for IE, can do what
Can do ECG to check for new AV block, maybe paravalvular abscess?
Contrast the time antibiotics given IV for left versus right infective endocarditis
Four left it’s given for a month. For right it’s given for two weeks
You know that for MSSA Infective endocarditis we could try oxacillin, nafcillin. If it’s a prosthetic valve we do the same but we just add which antibiotic
Gentamicin
You know that for MRSA Infective endocarditis we could try VANCO. If it’s a prosthetic valve we do the same but we just add which antibiotic
Gentamicin
Entra cockers for fecalis versus enterococcus feacium 
Ampicillin and gentamicin. Vancomycin and gentamicin.
Strep virodans infective endocarditis treatment
Foxy
HACEK or Coxiella/Bartonella infective endocarditis. Treatment
Foxy
Consider these circumstances of IE:
Prosthetic valves
Paravalvular extensions
Fistula formation
Highly resistant microbes or persistent symptoms for more than a week, despite being on antibiotics
Vegetations of more than 10 to 15 mm
Acute heart failure due to valve damage
Fungal infective endocarditis
All of the circumstances need surgical intervention
Regarding our infective endocarditis antibiotic prophylaxis. Which are the qualifying cardiac issues the patient should have
Prosthetic valve, or history of endocarditis, or unrepaired congenital heart disease, or a cardiac transplant
Regarding our infective endocarditis antibiotic prophylaxis. Which are the qualifying procedures the patient should have
Dental work, even bleeding. All respiratory base stuff (biopsy incision et cetera). Skin or musculoskeletal tissue stuff like incisions and biopsies. Cardiac surgery with any prosthetic material
What is the infective endocarditis prophylaxis protocol (Abx)
 amoxicillin is usually given 30 to 60 minutes prior to procedure. Consider allergy (macrolide, ceph, doxy).
In our endocarditis antibiotic prophylaxis, or mitral valve prolapse, or native mitral valve stenosis qualifying conditions?
No
Regarding a infective endocarditis antibiotic prophylaxis. Our routine GI endoscopy, cystoscopy qualifying procedures?
No
And in terms of family history CAD risk factors for your own CAD. What is the age of a father versus a mother having CAD being a risk factor
Men less than 55 in the family or women less than 65 and the family.
We always learnt that in evaluation of stable angina, to know whether to do exercise ECG or exercise imaging stress test, we needed to know if they had underlying ECG problem. What does this actually mean
Doesn’t necessarily mean if they have some ischaemia an ECG, it means are they able to read potential ischaemia. So patient with left bundle branch block paced ventricular rhythm you cannot
Name me for instances where the dipyridamole and adenosine stress tests are contraindicated
Asthma, bronchospasm
Severe low heart rate, second or 3rd° heart block, sick sinus syndrome
Systolic blood pressure less than 90
Methylxanthine
When is coronary angiography OCTA used m to diagnose stable angina
If the ECG or stress testing is equivocal (not what my flowchart said). Or if the patient is high pretest probability
Is hormone replacement therapy protective postmenopausal women for angina and coronary artery disease
No
My two drugs are contraindicated in variant angina
Aspirin and beta blockers
Impatience with unstable angina, why do we have to do ECGs every 15-30 minutes
To assess if there is progression to an MI
MONA for unstable angina or NSTEMI. What are a couple of things that are potentially missing from this
Beta blockers should be given in less contraindicated. And low molecular weight heparin as well
 Generally in NSTEMI and unstable angina, who usually always gets coronary angio
Haemodynamically unstable, refractory, electrical instability. Is the unstable do very very quickly, otherwise you have 24 hours
Chest pain and a new S4
Often a sign of an STEMI
Best predictor of survival in STEMI
Left ventricular ejection fraction
why is it important to do x-rays before treating M I
Just in case it is aortic dissection, you need to roll this
In am I does the ST segment or T-wave normalise first
ST first
Alongside MONA What to give if left ventricle heart failure sign
Ivy loop
Alongside MONA If patient has unstable sinus bradycardia consider what

Ivy atropine or transcutaneous pacing
In STEMI patient has sublingual nitro glycerin but yet they’ve persistent chest pain. Can add what
Ivy nitroglycerin
If going to have fibrinolysis instead of PCI… give which antiPLT
CLoppy (floppy = not the best option). Tiggy and prasgruel are kinda CI
If going to have PCI, which anticoag we give
Tiggy (biggy = big win for the patient), or prasgruel
 talk to me about thrombolyse sis and its place in STEMI
Obviously PCI is better. If PCI cannot be done within 120 minutes, we do thrombolyses. Thrombolyses best performed within three hours, but essentially can be used up until 12 hours. It’s actually contra indicated if beyond 24 hours
Patient had an STEMI. A stent was placed. They were on dual antiplatelet therapy for 30 days. What stent was placed
Bare metal
Patient had an STEMI. A stent was placed. They were on dual antiplatelet therapy for 12 months. What stent was placed
Drug eluting
What is the indication to do a CABG
Left main CAD, triple vessel disease, two vessel disease in diabetic, Max medical therapy and still symptomatic, PCI not able to fix obstruction
Full right ventricle infarction, we know we have to avoid diuretics and nitrates. What can we give to boost the preload
IV fluids
What does first-aid say is a carotid artery disease symptomatic type
Sudden onset of focal Neuro in the past six months
Give me some examples of high cholesterol patients that should be evaluated for primary causes of hyperlipidaemia
LDL above 190, triglyceride above 500, family history, obvious physical signs (xanthomas for example)
Recall hyperlipidaemia screening
Everyone above 35. Everybody above 20 if they have risk factors for ASCVD. Repeat every five years. Or smokers should be evaluated to
Went to give statin:
Anyone with atherosclerotic disease
LDL above 190
LDL above 160 family history of ASCVD
40 years old and diabetes mellitus
If a patient has high triglycerides, what’s the overview of management
Do lifestyle and treat causes first. If the ASCVD risk is above 7.5% start statins.
If above 1000 triglycerides give vibrate
Went to give PCS K9 inhibitors
This is evil Ali. Used for family or hypercholesterolaemia or statin resistant/statin intolerant patients
We both know that weight loss in a fat person, and dash diet are the best to lower blood pressure. What comes after
Exercise then reduce salt then alcohol limitation
 Hypertensive crisis treatment goals
25% reduction of blood pressure from baseline or to less than 160/100. This is a rule for both urgency and emergency. However with emergency we want to do 20% within the first hour.
What’s more important in diagnosis of hypertensive emergency, the end organ damage or the actual blood pressure reading
The end organ damage. Blood pressure reading doesn’t actually matter that much
