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Finals (HV) > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is a cardiac tamponade?

A

Accumulation of pericardial fluid in the intra-pericardial space, thus leading to compression of the heart

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2
Q

What are the signs and symptoms of Cardiac tamponade?

A

Symptoms- SOB, Confusion, Chest pain, Abdominal pain

Signs- BECKS TRIAD- Raised JVP, Hypotension, Muffled heart sounds

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3
Q

What is the mx of cardiac tamponade?

A

Pericardiocentesis (needle insertion site is in the fifth left intercostal space close to the sternal margin)

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4
Q

What is atrial flutter?

A

A type of SVT which is characterised by a rapid atrial rate

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5
Q

What are the ECG findings of atrial flutter?

A

Narrow QRS complex
Regular rhythm
Sawtooth pattern

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6
Q

List 3 causes of atrial flutter?

A

Atrial flutter most likely occurs with pulmonary disease (COPD, Pulmonary HTN, OSA), Sepsis, Thyrotoxicosis, Alcohol, Cardiomyopathy, Ischaemia

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7
Q

List the mx of atrial flutter in haemodynamically unstable patient?

A

DC cardioversion +/- Amiodarone

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8
Q

List the mx of atrial flutter in haemodynamically stable patient?

A

1st line- Rate control- BB (Bisoprolol) or CCB (Dialtezam, verapamil)

2nd line- If rate control fails, consider cardioversion- electrical or pharmacological (Sotalol, Digoxin, Amiodarone)

3rd line- Catheter ablation

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9
Q

What condition is HCM associated with?

A

Hypertrophic obstructive cardiomyopathy is associated with Wolff-Parkinson White and Friedrich’s ataxia

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10
Q

What conservative management is offered in patients with HFrEF?

A

Annual influenza vaccination
Once only pneumococcal vaccine

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11
Q

In which patients is ACEI CI?

A

Patients with:
-Renovascular disease e.g. bilateral renal artery stenosis
-Aortic stenosis
-Pregnancy- + breast feeding (avoid)

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12
Q

List the SE of ACEI?

A

Dry cough
Hyperkalaemia
Angioedema

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13
Q

What is the mx of an acute presentation of Afib in a haemodynamically stable and unstable patient?

A

Unstable- EC cardioversion

Stable-
<48 hours- Rate/Rhythm control
>48 hours- Rate control

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14
Q

What drugs are used in rate control of afib?

A

Bisoprolol
CCB- Diltezam
Digoxin

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15
Q

What drugs are used in rhythm control of afib?

A

Flecainide
Amiodarone
Dronedarone

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16
Q

What is the MOA of Warfarin?

A

A vitamin K antagonist. Inhibits epoxide reductase

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17
Q

List 2 SE of Warfarin?

A

Haemorrhage
teratogenic
Skin necrosis
Purple toes

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18
Q

What is Dressler’s Syndrome, and how does it present on ECG?

A

A form of post-infarct pericarditis that presents ~2-5 weeks after an MI. presents with SOB and CP

ECG- Saddle shape STE + widespread STE

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19
Q

What is AV block?

A

result of impaired conduction between atria and ventricles

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20
Q

What is 1st degree HB?

A

Prolonged PR interval >0.2 secs + Asymptomatic pt

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21
Q

What is 2nd degree heart block, type 1 and type 2?

A

Type 1/Wenkibach- Progressive prolongation of PR interval till dropped beat

type 2- PR interval constant + P wave often not followed by QRS complex

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22
Q

What electrolyte abnormalities can cause long QT syndrome?

A

Hypokalaemia
Hypocalcaemia
Hypomagnesia

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23
Q

What is the tx for trosades de pointes in a haemodynamically stable and unstable patient?

A

Stable- 2mg IV magnesium sulphate over 1-2 minutes

Unstable-DC cardioversion

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24
Q

What is the 1st line mx for Bradycardia?

A

Atropine 500mcg IV

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25
Q

What is the 2nd line mx of bradycardia if patients has not responded to 1st line?

A

Adrenaline infusion or Transcutaneous pacing

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26
Q

What valve is most commonly affected in Infective endocarditis?

A

Mitral valve

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27
Q

List 3 RF of infective endocarditis?

A

IVDU- tricuspid lesion
Congenital HD
Prosthetic valve
Rheumatic valve disease

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28
Q

What is the most common infective organism in an IVDU that cause IE?

A

Staph aureus

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29
Q

What is the most common infective organism in a patient with poor dental health that cause IE?

A

Strep Viridians

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30
Q

What is the most common infective organism in a prosthetic valve that cause IE?

A

Staph epidermidis

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31
Q

What is the most common infective organism in a patient with colorectal cancer that cause IE?

A

Strep Bovis

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32
Q

What is the 1st line mx for HTN in <55 and T2DM?

A

ACEI e.g. Ramipril

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33
Q

What is the 1st line mx for HTN in >55 and black African?

A

CCB e.g. Amlodipine

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34
Q

What is step 3 in managing HTN?

A

ACEI/ARB + CCB + Thiazide like diuretic (Indapamide)

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35
Q

What is step 4 of managing HTN?

A

ACEI/ARB + CCB + Thiazide like diuretic +

  • Low dose spiranolactone if K+ <4.5
    OR
    -Alpha/Beta Blocker if K+ >4.5
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36
Q

What is a feature of a SVT?

A

Narrow complex tachycardia

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37
Q

What is the acute mx of a SVT (1st, 2nd and 3rd line)?

A

1st- Vagal manoeuvres e.g. valsalva or carotid massage

2nd- IV adenosine 6mg -> if unsuccessful give 12mg -> if unsuccessful give further 18mg

3rd- Electrical cardioversion

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38
Q

When is the choice of drug used for the management of SVT CI, and what is the alternative?

A

Adenosine- CI in asthmatics

Verapamil is the preferable option

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39
Q

What are the methods for preventing episodes of SVT?

A

Beta Blocker
Radio-frequency ablation

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40
Q

List the SE of adenosine?

A

Chest pain
Bronchospasm
Transient flushing

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41
Q

What does the heart sound S1 indicate?

A

Closure of mitral and tricuspid valves

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42
Q

What does the heart sound S2 indicate?

A

Closure of aortic and pulmonary valves

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43
Q

What murmur is heard in Aortic Stenosis?

A

Ejection systolic

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44
Q

What murmur is heard in Aortic Regurgitation?

A

Early diastolic

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45
Q

What murmur is heard in Mitral Stenosis?

A

Mid-diastolic

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46
Q

What murmur is heard in Mitral Regurgitation?

A

Pan/Holosytolic

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47
Q

How is the murmur for mitral regurgitation and tricuspid regurgitation differentiated upon auscultation?

A

Both have a holosytolic murmur (High pitch and blowing)

TR murmur intensity increases on inspiration, however MR stays the same

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48
Q

What is the murmur heard in patent ductus arteriosus?

A

Continuous Machine like murmur

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49
Q

Which murmurs are heard louder on inspiration and expiration?

A

RILE
Right sided- best heard on inspiration

Left side- Best heard on expiration

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50
Q

How does warfarin affect coagulation studies?

A

Prolonged PT
Normal APTT

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51
Q

What coagulation factors does warfarin affect?

A

10, 9, 7, 2

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52
Q

What pathway does Prothrombin time affect?

A

Extrinsic pathway (Contains Factor 3 (aka Tissue factor), Factor 7 and 7a)

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53
Q

What pathway does APPT affect?

A

Affects Intrinsic pathway (Factors 12, 11, 9, 8)

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54
Q

What is an aortic dissection?

A

A tear in the tunica intima of the wall of aorta

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55
Q

List 5 RF of Aortic dissection?

A

HTN **
Trauma
Bicuspid aortic valve
Marfan’s/Ehlers-Danlos
Turner’s/ Noonan’s
Pregnancy
Syphyllis

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56
Q

List the features of an aortic dissection?

A

Tearing chest pain radiating to back
Pulse deficit
Aortic regurgitation
HTN

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57
Q

What would an ECG show in someone with aortic dissection?

A

Non specific, in some rare cases STE in inferior leads

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58
Q

What is the GS Ix for Aortic dissection and what would it show?

A

CT angio CAP- False lumen of ascending aorta

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59
Q

What would an CXR of an aortic dissection show?

A

Widened mediastinum

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60
Q

What 2 classifications are used in Aortic dissection?

A

DeBakey or Stanford

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61
Q

What leads will feature ECG changes in Antero-septal Infarct, and what coronary artery is indicated?

A

Leads V1-V4
Artery- LAD

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62
Q

What leads will feature ECG changes in Inferior Infarct, and what coronary artery is indicated?

A

Leads II,III, aVF
Artery- Right coronary artery

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63
Q

What leads will feature ECG changes in Anterolateral Infarct, and what coronary artery is indicated?

A

Leads I, aVL, V1-V6
Artery- Proximal LAD

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64
Q

What leads will feature ECG changes in lateral Infarct, and what coronary artery is indicated?

A

Leads I, aVL, +/- V5-V6
Artery- Left circumflex

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65
Q

What features are present in Aortic stenosis?

A

Narrow pulse pressure
Slow rising pulse
Murmur radiates to carotids
Soft/absent S2

66
Q

What are the sx of aortic stenosis?

A

Chest Pain
SOB
Syncope/Pre-syncope (exertional)

67
Q

List 3 causes of aortic stenosis?

A

Degenerative calcification (>65)
Bicuspid aortic valve (<65)
HOCM
Rheumatic disease

68
Q

What features are present in Aortic regurg?

A

Collapsing pulse
Wide pulse pressure
Eponymous signs

69
Q

List 3 eponymous signs present in AR?

A

Quinkes sign-nail bed pulsation
De Musset’s- Head-bobbing
Corrigan sign - Carotid pulsations
Traubes- Pistol shot on femoral.a

70
Q

List the sx of AR?

A

CP/Angina
Palpitations
SOB

71
Q

List 2 acute and chronic causes of AR?

A

Acute- IE, Aortic dissection

Chronic- Rheumatic fever, CT disorders, Ank spon, Takayasus

72
Q

List the features of Mitral stenosis?

A

Loud S1
Malar flush *
Low volume pulse

73
Q

What’s the most common cause of mitral stenosis?

A

RHEUMATIC FEVER

74
Q

What may a CXR of a patient with MS show?

A

Left atrium enlargement

75
Q

List the features that would be present in Mitral regurgitation?

A

soft/absent S1

76
Q

List the sx of MR?

A

Most patients are asymptomatic
Fatigue
SOB
Oedema

77
Q

List 3 causes of MR?

A

Papillary muscle rupture/dysfunction post MI
MV prolapse
RHD
IE

78
Q

Where is the best place to hear a mitral regurg murmur?

A

At apex-> murmur radiates to carotids

79
Q

What is rheumatic fever?

A

Precipitated by Group A Beta haemolytic Streptococcus infection that occurs 2-4 weeks post infection

80
Q

What is the criteria that is used in Rheumatic fever?

A

JONES criteria

81
Q

List the 5 major criteria of rheumatic fever?

A
  • Arthritis
  • Pericarditis (New murmur)
  • Sydenham’s chorea
  • Erythema marginatum
  • Subcutaneous nodules
82
Q

List the minor criteria for rheumatic fever?

A

Fever
Arthralgia
Raised ESR/CRP
Prolonged PR

83
Q

What is the mx of Rheumatic fever?

A

Stat dose of IV Benzyl penicillin + 10-day course of phenoxymethylpenicillin

84
Q

What is the most common cause of myocarditis?

A

Viral cause- Coxsackie virus

85
Q

What is the typical features of myocarditis in a question stem?

A

Young adult presenting with acute chest pain, SOB, with recent hx of viral infection

86
Q

What is the mx of severe and mild myocarditis?

A

severe- ITU + vasopressors

mild- corticosteroids

87
Q

How does the mx of PE differ in stable and unstable patients?

A

Stable patients- DOAC 1st line for ~3-6months

Unstable patient- Thrombolyse with IV alteplase

88
Q

What is the MOA of alteplase?

A

Activates plasminogen into plasmin

89
Q

What is the score used to determine if anticoagulation is required in AF?

A

CHADS2VASC
Congestive HF
HTN
Age (>75-2, 65-74 1)
Diabetes
Prior stroke/TIA (2)
Vascular
Sex (F)

90
Q

What is an atrial myxoma?

A

Primary cardiac tumour

91
Q

What will an echo show for an atrial myxoma?

A

pedunculated heterogenous mass

92
Q

What are the pharmacological cardioversion options in A-fib?

A

Amiodarone or Flecainide (if no structural heart disease)

93
Q

What is the mx of an unprovoked PE?

A

6 months of DOAC

94
Q

What is the mx of a provoked PE??

A

3 months of DOAC

95
Q

What is Coarctation of the aorta and its associations?

A

the congenital narrowing of the descending aorta

CoA is associated with Turner’s syndrome, Bicuspid AV, Berry aneurysms, Neurofibramatosis

96
Q

What are the sx of coA?

A

HF
HTN
Radio femoral delay
Mid systolic murmur (heard best over back, scapula, and left apex)

97
Q

What is seen on CXR in someone with coA?

A

notching of inferior border of ribs

98
Q

List the ECG changes in pericarditis?

A

PR depression - most specific
Saddle ST elevations

99
Q

What is HOCM?

A

HOCM is an autosomal dominant condition characterised by LV hypertrophy w/o an apparent cause

100
Q

What is the definitive Ix of HOCM and what would it show?

A

Echo
(MR SAM ASH)
Mitral regurgitation
Systolic Anterior Motion of MV leaflets
Asymmetrical septal hypertrophy

101
Q

What acute mx should all patients with ACS be treated with?

A

Aspirin 300mg
Oxygen if required
Nitrates (CI in hypotension)
Morphine IV

102
Q

What is the role of the ductus arteriosus in utero?

A

Shunts blood from PA to aorta-bypassing lungs

103
Q

What is the pathophysiology behind PDA?

A

The ductus arteriosus is kept open by prostaglandin E2. Shortly after birth, the levels of PE2 falls, therefore closing the ductus arteriosus.

Additionally, bradykinin is also released by lungs thus causing smooth muscle constriction?

104
Q

What murmur is associated with PDA?

A

Gibson Murmur (Machinery murmur)

105
Q

What is the mx of PDA?

A

1st- Indomethacin or Ibuprofen

2nd- Surgical ligation

106
Q

What murmur is associated with ASD?

A

Ejection systolic murmur

107
Q

What is Eisenmenger’s syndrome?

A

Reversal of shunt from L>R to R>L due to increase pressure in RV due to pulmoanyr HTN

108
Q

What is VSD commonly associated with?

A

Foetal Alcohol Syndrome
Down’s Syndrome

109
Q

What murmur is commonly associated with VSD?

A

Holosystolic murmur

110
Q

List the features found in TOF?

A
  1. VSD
  2. Right ventricular hypertrophy
  3. Right ventricular outflow tract obstruction (Pulmonary stenosis )
  4. Overriding Aorta
111
Q

List 5 sx/signs of TOF?

A

Tet spells
Cyanosis
Clubbing
FTT
Ejection systolic murmur

112
Q

What is the GS Ix of TOF?

A

Echo

113
Q

What may show up on a CXR with TOF?

A

Boot shaped heart

114
Q

What genetic syndrome is closely associated with coA?

A

Turner’s syndrome

115
Q

What is CoA?

A

A congenital malformation defined by narrowing of the aorta

116
Q

What is the most common site of coA ?

A

At the site of insertion of ductus arteriosus, distal to L.Subclavian A

117
Q

What is the name of the remnant of ductus arteriosus?

A

Ligamnetum arteriosusm

118
Q

List 3 sx/symptoms of coA?

A

HTN at a young age
Diminished lower extremity pulse
Different upper and lower BP
Ejection systolic murmur
Claudication
Headache

119
Q

What is the mx of Stanford type A and Stanford type B aortic dissections?

A

Stanford Type A- surgical management, but blood pressure should be controlled to a target systolic of 100-120 mmHg whilst awaiting intervention

Type B
conservative management
bed rest
reduce blood pressure IV labetalol to prevent progression

120
Q

What is an AAA?

A

A permanent pathological dilation of abdominal aorta >3cm

121
Q

List 5 RF for AAA?

A

Smoking
Increasing age
HTN
COPD
CT disorders

122
Q

Who is the AAA screening targetted to?

A

All men >65 are offered an USS to detect asymptomatic AAA

123
Q

List sx/signs of a ruptured AAA?

A

Severe, central abdominal pain radiating to the back
pulsatile
Expansive mass in the abdomen
Patients may be shocked (hypotension, tachycardic) or may have collapsed

124
Q

What is the mx of an AAA?

A

Lifestyle changes
- Screening yearly if AAA 3.4-4cm
- Screening 3 monthly if 4.5-5.4cm
- Surgical repair if symptomatic or >/=5.5cm

125
Q

When should the DVLA need to be informed regarding AAA?

A

Inform DVLA is aneurysm >/=6.0cm
Stop driving is >/= 6.5cm

126
Q

What is WPW syndrome?

A

A congenital accessory pathway between the atria and ventricle across the mitral/tricuspid annulus

127
Q

What are the ECG features of WPW syndrome?

A

Short PR intervals
Wide QRS
Delta wave

128
Q

What is the 1st line mx for WPW syndrome?

A

Radio frequency catheter ablation

129
Q

What is the 2nd line mx for WPW syndrome?

A

IV adenosine or AVN blocking drugs (Verapamil)

130
Q

List 4 sx and signs of IE?

A

SX- Fever, RIgors, Night Sweats, Petiechie, WL

Signs- Janeway lesions, Roth spots, Osler nodes, Splinter haemorrhages

131
Q

What is the 1st line Ix in IE?

A

Blood cultures x3
ECG
FBC, U&Es

132
Q

What is the GS Ix IE?

A

Transesophageal Echo (TOE)

133
Q

What criteria is used in IE?

A

Dukes Criteria

134
Q

What is pharmacological mx of IE

A

If staph- Flucloxacin + Gentamicin + Rifampicin

MRSA-Vancomycin + Gentamicin + Rifampicin

Not staph- Benzylpenicillin + Genatmicin

135
Q

What is the definitive mx of IE?

A

Replace valve and remove vegetation

136
Q

What are sx/signs of pericardial effusion?

A

Dyspnoea
Raised JVP
Chest pain
Orthopnea

137
Q

What features of pericardial effusion would be present on
a- CXR
b- ECG

A

a- large globular heart

b- Low voltage QRS complexes and alternating QRS morphologies

138
Q

What is the most common cause of acute pericarditis?

A

Idiopathic and viruses (Coxsackie) ~ accounts for 90%

139
Q

What nerve and artery supply the pericardium?

A

N- Phrenic N

A- Internal mammary A

140
Q

What are the triad of sx for acute pericarditis?

A

Chest pain (sharp and pleuritic, worsened by inspiration and relief by sitting forward)

Pericardial friction rub

Serial ECG changes

141
Q

What ECG changes are seen in acute pericarditis?

A

Saddle ST segment elevations w/ PR segment depression

142
Q

What is the 1st line Ix for acute pericarditis?

A

ECG- saddle STE

143
Q

What are the complications of acute pericarditis?

A

Pericardial effusion
cardiac tamponade
HF
Arrhythmias

144
Q

What is the mx for acute pericarditis?

A

NSAIDs and Colchicine

145
Q

What is the 1st line Ix for constrictive pericarditis?

A

CXR- pericardial calcification

146
Q

What is the GS Ix for constrictive pericarditis?

A

Echocardiogram

147
Q

What are the sx of constrictive pericarditis?

A

Fever
Chest pain
oedema (RHF w/ increase JVP)
Kaussmal breathing
pericardial knock
hepatosplenomegaly
Ascites

148
Q

What is the GS mx for constrictive pericarditis?

A

Pericardiectomy

149
Q

What is the GRACE score?

A

assesses the risk of future cardiovascular events and 6-month mortality rate.

150
Q

What is the immediate initial management of NSTEMI/UA?

A

Aspirin 300mg

DAPT- depends on high or low bleeding risk (Clopidogrel if high risk, Ticagrelor if low risk)

Anti-thrombin therapy (Fondaparinux/unfractionated heparin)

151
Q

What further management should be offered to an unstable patient with NSTEMI/UA?

A

Offer immediate coronary angiography

152
Q

What further mx should be done if the grace score is calculated to be >3%?

A

Perform coronary angiography (+/- PCI) within 72 hours

153
Q

What is the immediate mx of a STEMI?

A

Aspirin 300mg
Primary PCI if <120minutes AND presentation is within 12 hours
If PCI not possible > Fibronylysis

154
Q

What is the secondary mx of a STEMI?

A

Aspirin 75mg
DAPT
ACEI
Statin
BB
Spiranolactone w/ pt HFrEF

155
Q

What is the most common cause of death post MI?

A

Ventricular Fibrillation

156
Q

List 3 other post MI complications?

A

V-fib
Arrhythmias
Dressler’s syndrome
Left ventricular aneurysm
LV free wall rupture
VSD
Mitral regurg
Pericarditis

157
Q

How would left ventricular anuerysm present as a post MI complication?

A

Persistent ST elevations and sx of LV failure

-Tx with NOAC

158
Q

How would LV free wall rupture present as a post MI complication?

A

Occurs 1-2 weeks post MI. Presents with cardiac tamponade

159
Q

What is unstable angina?

A

myocardial ischaemia without infarction - negative troponins, worsening angina symptoms including at rest/minimal exertion.

160
Q

What are the 6Ps of acute limb ischaemia?

A

Pale
Pulseless
Paraesthesia
Perishingly cold
Painful
Paralysed

Finals (HV) (19 decks)

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