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
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
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)
4
Q
What is atrial flutter?
A
A type of SVT which is characterised by a rapid atrial rate
5
Q
What are the ECG findings of atrial flutter?
A
Narrow QRS complex
Regular rhythm
Sawtooth pattern
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
7
Q
List the mx of atrial flutter in haemodynamically unstable patient?
A
DC cardioversion +/- Amiodarone
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
9
Q
What condition is HCM associated with?
A
Hypertrophic obstructive cardiomyopathy is associated with Wolff-Parkinson White and Friedrich’s ataxia
10
Q
What conservative management is offered in patients with HFrEF?
A
Annual influenza vaccination
Once only pneumococcal vaccine
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)
12
Q
List the SE of ACEI?
A
Dry cough
Hyperkalaemia
Angioedema
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
14
Q
What drugs are used in rate control of afib?
A
Bisoprolol
CCB- Diltezam
Digoxin
15
Q
What drugs are used in rhythm control of afib?
A
Flecainide
Amiodarone
Dronedarone
16
Q
What is the MOA of Warfarin?
A
A vitamin K antagonist. Inhibits epoxide reductase
17
Q
List 2 SE of Warfarin?
A
Haemorrhage
teratogenic
Skin necrosis
Purple toes
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
19
Q
What is AV block?
A
result of impaired conduction between atria and ventricles
20
Q
What is 1st degree HB?
A
Prolonged PR interval >0.2 secs + Asymptomatic pt
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
22
Q
What electrolyte abnormalities can cause long QT syndrome?
A
Hypokalaemia
Hypocalcaemia
Hypomagnesia
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
24
Q
What is the 1st line mx for Bradycardia?
A
Atropine 500mcg IV
25
What is the 2nd line mx of bradycardia if patients has not responded to 1st line?
Adrenaline infusion or Transcutaneous pacing
26
What valve is most commonly affected in Infective endocarditis?
Mitral valve
27
List 3 RF of infective endocarditis?
IVDU- tricuspid lesion
Congenital HD
Prosthetic valve
Rheumatic valve disease
28
What is the most common infective organism in an IVDU that cause IE?
Staph aureus
29
What is the most common infective organism in a patient with poor dental health that cause IE?
Strep Viridians
30
What is the most common infective organism in a prosthetic valve that cause IE?
Staph epidermidis
31
What is the most common infective organism in a patient with colorectal cancer that cause IE?
Strep Bovis
32
What is the 1st line mx for HTN in <55 and T2DM?
ACEI e.g. Ramipril
33
What is the 1st line mx for HTN in >55 and black African?
CCB e.g. Amlodipine
34
What is step 3 in managing HTN?
ACEI/ARB + CCB + Thiazide like diuretic (Indapamide)
35
What is step 4 of managing HTN?
ACEI/ARB + CCB + Thiazide like diuretic +
- Low dose spiranolactone if K+ <4.5
OR
-Alpha/Beta Blocker if K+ >4.5
36
What is a feature of a SVT?
Narrow complex tachycardia
37
What is the acute mx of a SVT (1st, 2nd and 3rd line)?
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
38
When is the choice of drug used for the management of SVT CI, and what is the alternative?
Adenosine- CI in asthmatics
Verapamil is the preferable option
39
What are the methods for preventing episodes of SVT?
Beta Blocker
Radio-frequency ablation
40
List the SE of adenosine?
Chest pain
Bronchospasm
Transient flushing
41
What does the heart sound S1 indicate?
Closure of mitral and tricuspid valves
42
What does the heart sound S2 indicate?
Closure of aortic and pulmonary valves
43
What murmur is heard in Aortic Stenosis?
Ejection systolic
44
What murmur is heard in Aortic Regurgitation?
Early diastolic
45
What murmur is heard in Mitral Stenosis?
Mid-diastolic
46
What murmur is heard in Mitral Regurgitation?
Pan/Holosytolic
47
How is the murmur for mitral regurgitation and tricuspid regurgitation differentiated upon auscultation?
Both have a holosytolic murmur (High pitch and blowing)
TR murmur intensity increases on inspiration, however MR stays the same
48
What is the murmur heard in patent ductus arteriosus?
Continuous Machine like murmur
49
Which murmurs are heard louder on inspiration and expiration?
RILE
Right sided- best heard on inspiration
Left side- Best heard on expiration
50
How does warfarin affect coagulation studies?
Prolonged PT
Normal APTT
51
What coagulation factors does warfarin affect?
10, 9, 7, 2
52
What pathway does Prothrombin time affect?
Extrinsic pathway (Contains Factor 3 (aka Tissue factor), Factor 7 and 7a)
53
What pathway does APPT affect?
Affects Intrinsic pathway (Factors 12, 11, 9, 8)
54
What is an aortic dissection?
A tear in the tunica intima of the wall of aorta
55
List 5 RF of Aortic dissection?
HTN **
Trauma
Bicuspid aortic valve
Marfan's/Ehlers-Danlos
Turner's/ Noonan's
Pregnancy
Syphyllis
56
List the features of an aortic dissection?
Tearing chest pain radiating to back
Pulse deficit
Aortic regurgitation
HTN
57
What would an ECG show in someone with aortic dissection?
Non specific, in some rare cases STE in inferior leads
58
What is the GS Ix for Aortic dissection and what would it show?
CT angio CAP- False lumen of ascending aorta
59
What would an CXR of an aortic dissection show?
Widened mediastinum
60
What 2 classifications are used in Aortic dissection?
DeBakey or Stanford
61
What leads will feature ECG changes in Antero-septal Infarct, and what coronary artery is indicated?
Leads V1-V4
Artery- LAD
62
What leads will feature ECG changes in Inferior Infarct, and what coronary artery is indicated?
Leads II,III, aVF
Artery- Right coronary artery
63
What leads will feature ECG changes in Anterolateral Infarct, and what coronary artery is indicated?
Leads I, aVL, V1-V6
Artery- Proximal LAD
64
What leads will feature ECG changes in lateral Infarct, and what coronary artery is indicated?
Leads I, aVL, +/- V5-V6
Artery- Left circumflex
65
What features are present in Aortic stenosis?
Narrow pulse pressure
Slow rising pulse
Murmur radiates to carotids
Soft/absent S2
66
What are the sx of aortic stenosis?
Chest Pain
SOB
Syncope/Pre-syncope (exertional)
67
List 3 causes of aortic stenosis?
Degenerative calcification (>65)
Bicuspid aortic valve (<65)
HOCM
Rheumatic disease
68
What features are present in Aortic regurg?
Collapsing pulse
Wide pulse pressure
Eponymous signs
69
List 3 eponymous signs present in AR?
Quinkes sign-nail bed pulsation
De Musset's- Head-bobbing
Corrigan sign - Carotid pulsations
Traubes- Pistol shot on femoral.a
70
List the sx of AR?
CP/Angina
Palpitations
SOB
71
List 2 acute and chronic causes of AR?
Acute- IE, Aortic dissection
Chronic- Rheumatic fever, CT disorders, Ank spon, Takayasus
72
List the features of Mitral stenosis?
Loud S1
Malar flush *
Low volume pulse
73
What's the most common cause of mitral stenosis?
RHEUMATIC FEVER
74
What may a CXR of a patient with MS show?
Left atrium enlargement
75
List the features that would be present in Mitral regurgitation?
soft/absent S1
76
List the sx of MR?
Most patients are asymptomatic
Fatigue
SOB
Oedema
77
List 3 causes of MR?
Papillary muscle rupture/dysfunction post MI
MV prolapse
RHD
IE
78
Where is the best place to hear a mitral regurg murmur?
At apex-> murmur radiates to carotids
79
What is rheumatic fever?
Precipitated by Group A Beta haemolytic Streptococcus infection that occurs 2-4 weeks post infection
80
What is the criteria that is used in Rheumatic fever?
JONES criteria
81
List the 5 major criteria of rheumatic fever?
* Arthritis
* Pericarditis (New murmur)
* Sydenham's chorea
* Erythema marginatum
* Subcutaneous nodules
82
List the minor criteria for rheumatic fever?
Fever
Arthralgia
Raised ESR/CRP
Prolonged PR
83
What is the mx of Rheumatic fever?
Stat dose of IV Benzyl penicillin + 10-day course of phenoxymethylpenicillin
84
What is the most common cause of myocarditis?
Viral cause- Coxsackie virus
85
What is the typical features of myocarditis in a question stem?
Young adult presenting with acute chest pain, SOB, with recent hx of viral infection
86
What is the mx of severe and mild myocarditis?
severe- ITU + vasopressors
mild- corticosteroids
87
How does the mx of PE differ in stable and unstable patients?
Stable patients- DOAC 1st line for ~3-6months
Unstable patient- Thrombolyse with IV alteplase
88
What is the MOA of alteplase?
Activates plasminogen into plasmin
89
What is the score used to determine if anticoagulation is required in AF?
CHADS2VASC
Congestive HF
HTN
Age (>75-2, 65-74 1)
Diabetes
Prior stroke/TIA (2)
Vascular
Sex (F)
90
What is an atrial myxoma?
Primary cardiac tumour
91
What will an echo show for an atrial myxoma?
pedunculated heterogenous mass
92
What are the pharmacological cardioversion options in A-fib?
Amiodarone or Flecainide (if no structural heart disease)
93
What is the mx of an unprovoked PE?
6 months of DOAC
94
What is the mx of a provoked PE??
3 months of DOAC
95
What is Coarctation of the aorta and its associations?
the congenital narrowing of the descending aorta
CoA is associated with Turner's syndrome, Bicuspid AV, Berry aneurysms, Neurofibramatosis
96
What are the sx of coA?
* HF
* HTN
* Radio femoral delay
* Mid systolic murmur (heard best over back, scapula, and left apex)
97
What is seen on CXR in someone with coA?
notching of inferior border of ribs
98
List the ECG changes in pericarditis?
*PR depression* - most specific
Saddle ST elevations
99
What is HOCM?
HOCM is an autosomal dominant condition characterised by LV hypertrophy w/o an apparent cause
100
What is the definitive Ix of HOCM and what would it show?
Echo
(MR SAM ASH)
Mitral regurgitation
Systolic Anterior Motion of MV leaflets
Asymmetrical septal hypertrophy
101
What acute mx should all patients with ACS be treated with?
Aspirin 300mg
Oxygen if required
Nitrates (CI in hypotension)
Morphine IV
102
What is the role of the ductus arteriosus in utero?
Shunts blood from PA to aorta-bypassing lungs
103
What is the pathophysiology behind PDA?
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
What murmur is associated with PDA?
Gibson Murmur (Machinery murmur)
105
What is the mx of PDA?
1st- Indomethacin or Ibuprofen
2nd- Surgical ligation
106
What murmur is associated with ASD?
Ejection systolic murmur
107
What is Eisenmenger's syndrome?
Reversal of shunt from L>R to R>L due to increase pressure in RV due to pulmoanyr HTN
108
What is VSD commonly associated with?
Foetal Alcohol Syndrome
Down's Syndrome
109
What murmur is commonly associated with VSD?
Holosystolic murmur
110
List the features found in TOF?
1. VSD
2. Right ventricular hypertrophy
3. Right ventricular outflow tract obstruction (Pulmonary stenosis )
4. Overriding Aorta
111
List 5 sx/signs of TOF?
Tet spells
Cyanosis
Clubbing
FTT
Ejection systolic murmur
112
What is the GS Ix of TOF?
Echo
113
What may show up on a CXR with TOF?
Boot shaped heart
114
What genetic syndrome is closely associated with coA?
Turner's syndrome
115
What is CoA?
A congenital malformation defined by narrowing of the aorta
116
What is the most common site of coA ?
At the site of insertion of ductus arteriosus, distal to L.Subclavian A
117
What is the name of the remnant of ductus arteriosus?
Ligamnetum arteriosusm
118
List 3 sx/symptoms of coA?
HTN at a young age
Diminished lower extremity pulse
Different upper and lower BP
Ejection systolic murmur
Claudication
Headache
119
What is the mx of Stanford type A and Stanford type B aortic dissections?
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
What is an AAA?
A permanent pathological dilation of abdominal aorta >3cm
121
List 5 RF for AAA?
Smoking
Increasing age
HTN
COPD
CT disorders
122
Who is the AAA screening targetted to?
All men >65 are offered an USS to detect asymptomatic AAA
123
List sx/signs of a ruptured AAA?
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
What is the mx of an AAA?
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
When should the DVLA need to be informed regarding AAA?
Inform DVLA is aneurysm >/=6.0cm
Stop driving is >/= 6.5cm
126
What is WPW syndrome?
A congenital accessory pathway between the atria and ventricle across the mitral/tricuspid annulus
127
What are the ECG features of WPW syndrome?
Short PR intervals
Wide QRS
Delta wave
128
What is the 1st line mx for WPW syndrome?
Radio frequency catheter ablation
129
What is the 2nd line mx for WPW syndrome?
IV adenosine or AVN blocking drugs (Verapamil)
130
List 4 sx and signs of IE?
SX- Fever, RIgors, Night Sweats, Petiechie, WL
Signs- Janeway lesions, Roth spots, Osler nodes, Splinter haemorrhages
131
What is the 1st line Ix in IE?
Blood cultures x3
ECG
FBC, U&Es
132
What is the GS Ix IE?
Transesophageal Echo (TOE)
133
What criteria is used in IE?
Dukes Criteria
134
What is pharmacological mx of IE
If staph- Flucloxacin + Gentamicin + Rifampicin
MRSA-Vancomycin + Gentamicin + Rifampicin
Not staph- Benzylpenicillin + Genatmicin
135
What is the definitive mx of IE?
Replace valve and remove vegetation
136
What are sx/signs of pericardial effusion?
Dyspnoea
Raised JVP
Chest pain
Orthopnea
137
What features of pericardial effusion would be present on
a- CXR
b- ECG
a- large globular heart
b- Low voltage QRS complexes and alternating QRS morphologies
138
What is the most common cause of acute pericarditis?
Idiopathic and viruses (Coxsackie) ~ accounts for 90%
139
What nerve and artery supply the pericardium?
N- Phrenic N
A- Internal mammary A
140
What are the triad of sx for acute pericarditis?
Chest pain (sharp and pleuritic, worsened by inspiration and relief by sitting forward)
Pericardial friction rub
Serial ECG changes
141
What ECG changes are seen in acute pericarditis?
Saddle ST segment elevations w/ PR segment depression
142
What is the 1st line Ix for acute pericarditis?
ECG- saddle STE
143
What are the complications of acute pericarditis?
Pericardial effusion
cardiac tamponade
HF
Arrhythmias
144
What is the mx for acute pericarditis?
NSAIDs and Colchicine
145
What is the 1st line Ix for constrictive pericarditis?
CXR- pericardial calcification
146
What is the GS Ix for constrictive pericarditis?
Echocardiogram
147
What are the sx of constrictive pericarditis?
Fever
Chest pain
oedema (RHF w/ increase JVP)
Kaussmal breathing
pericardial knock
hepatosplenomegaly
Ascites
148
What is the GS mx for constrictive pericarditis?
Pericardiectomy
149
What is the GRACE score?
assesses the risk of future cardiovascular events and 6-month mortality rate.
150
What is the immediate initial management of NSTEMI/UA?
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
What further management should be offered to an unstable patient with NSTEMI/UA?
Offer immediate coronary angiography
152
What further mx should be done if the grace score is calculated to be >3%?
Perform coronary angiography (+/- PCI) within 72 hours
153
What is the immediate mx of a STEMI?
Aspirin 300mg
Primary PCI if <120minutes AND presentation is within 12 hours
If PCI not possible > Fibronylysis
154
What is the secondary mx of a STEMI?
Aspirin 75mg
DAPT
ACEI
Statin
BB
Spiranolactone w/ pt HFrEF
155
What is the most common cause of death post MI?
Ventricular Fibrillation
156
List 3 other post MI complications?
V-fib
Arrhythmias
Dressler's syndrome
Left ventricular aneurysm
LV free wall rupture
VSD
Mitral regurg
Pericarditis
157
How would left ventricular anuerysm present as a post MI complication?
Persistent ST elevations and sx of LV failure
-Tx with NOAC
158
How would LV free wall rupture present as a post MI complication?
Occurs 1-2 weeks post MI. Presents with cardiac tamponade
159
What is unstable angina?
myocardial ischaemia without infarction - negative troponins, worsening angina symptoms including at rest/minimal exertion.
160
What are the 6Ps of acute limb ischaemia?
Pale
Pulseless
Paraesthesia
Perishingly cold
Painful
Paralysed
