Cardiology Flashcards
If the anterolateral leads are showing ischaemic changes on ECG, what artery is occluded?
Left anterior descending artery
If the infero/posterolateral leads are showing ischaemic changes on ECG, what artery is occluded?
Left circumflex artery
If a haemodynamically unstable patient with signs of heart failure is also in atrial fibrillation, how are you going to manage the patient?
Treat the atrial fibrillation by giving oxygen and rate control using bisoprolol.
What can a patient with atrial fibrillation also present with? (hint:not palpitations)
Signs of congestive heart failure and chest pain
A patient faints after micturition or stress, what do they have and how do you manage them? When would you follow them up?
Vasovagal syncope
Reassure and discharge. No need to follow up unless a postural drop > 20 SBP or >10 DBP.
What is the most appropriate management for a patient with a BP of >180/120
investigate for target organ damage
A patient with a BP >180/120 was found to have an increased albumin: creatine ratio. What is the most appropriate management>?
Start anti-hypertensive management immediately.
A patient with a BP >180/120 was found to have retinal haemorrhages, chest pain, AKI, HF. What is the most appropriate management>?
Malignant hypertension so refer to secondary care on the same day.
A patient with a BP >180/120 was found to have no target organ damage. What is the most appropriate management>?
Repeat clinic reading within 7 days or ABPM and review within 7 days. If BP >180/110, start anti-hypertensives.
A patient has fever, joint pain, a murmur and blood+ protein on a urine dipstick. What does this suggest?
Infective endocarditis
List 4 signs of rheumatic fever and what is the first line treatment.
- strep pyogenes throat
- erythema marginatum
- polyarthritis
- evidence of vasculitis e.g. regurgitation murmur
-> give oral penicillin
What medication is contraindicated in heart failure and why?
Rate limiting CCB e.g. verapamil as it can worsen heart failure and make them more breathless.
A patient with a mechanical heart valve on warfarin is about to have surgery. What should they do about their warfarin?
A mechanical heart valve increases risk of thrombosis so stop warfarin 2 days before surgery and give heparin instead.
What is seen on fundoscopy in stage 3 hypertensive retinopathy?
Flame haemorrhages
Cotton wool spots
What is the stepwise treatment for familial hypercholesterolaemia?
- atorvastatin
- fenofibrate + ezetimibe
- PCSK9 inhibitor
What is the management for Mobitz 2 heart block?
Discontinue AV blockers and consider pacemaker/CRT/ ICD
What could cause a displaced apex beat to the axilla in a young person with chest pain?
Myocarditis leading to dilated cardiomyopathy
A patient with aortic stenosis has a valvular gradient >40. What is the management?
Young/ low risk-> surgical AVR
Old/ high risk-> transcatheter AVR
not fit for AVR-> balloon valvuplasty
What is the first thing to do in a patient with AF who is haemodynamically unstable ( low BP) with a low potassium?
give IV fluids
What about the murmur can show the severity of mitral stenosis?
length of murmur
opening snap after S2
What about the murmur can show severe aortic stenosis?
a soft or absent S2
Is furosemide or bendroflumethiazide more likely to cause palpitations?
Low potassium from furosemide compared to high calcium from bendroflumethiazide
A patient collpased after they raised their arm and they have a lump in their supraclavicular fossa. What do they have?
Subclavian steal syndrome
Is bilateral ankle oedema a minor or major criteria in the Framingham criteria for congestive cardiac failure?
Minor
What does syncope in a young person with a family history of heart disease and a jerky carotid on examination suggest?
HOCM
What pulse is found in severe LVF?
pulsus alternans
What pulse is found in aortic stenosis?
pulsus parvus et tardus (slow rising pulse)
What pulse is found in HOCM/ mixed aortic valve disease?
pulsus bisfirens
In a patient with ischaemic heart disease presenting less than 48 hours with AF, what rhythm control medication is given?
Amiodarone
What kind of breathing can be seen in patients with heart failure during sleep?
Cheyne-Stokes breathing. Deep then shallow then apnoea.
In a patient without ischaemic heart disease presenting less than 48 hours with AF, what rhythm control medication is given?
Flecainide
Why is indomethacin contraindicated in heart failure?
NSAIDs can cause peripheral vasoconstriction
What is given to asthmatics who are contraindicated to adenosine?
Verapamil
What 3 electrolyte abnormalities causes long QT syndrome?
- low calcium
- low potassium
- low magnesium
Is clubbing seen in infective endocarditis?
Yes
What is Barlow syndrome and what murmur is heard?
Mitral valve prolapse
mid systolic click
What kind of murmur can be heard in LVH?
crescendo systolic murmur
aortic stenosis causes LVH
What is a complication of ventricular septal defect?
Endocarditis
What can be used instead of fondaparunix in unstable angina?
LMWH
What symptoms can digoxin toxicity cause?
nausea
anorexia
yellow rings around lights
What early ECG changes can be seen in an MI?
hyperacute T waves
A patient has a BP of >180/120 with hallucinations, what are they experiencing?
Hypertensive encephalopathy
What congenital defect of the heart can lead to an ischaemic stroke?
patent foramen ovale
What kind of drug is doxazosin?
alpha blocker
Name four things in Marfans cardiovascular criteria
aortic dissection
aortic dilation
mitral valve prolapse
mitral valve calcification
What murmur does an atrial myxoma cause?
A loud S3
What is the BP target of a CKD patient?
120-130 mmHg
A diabetic patient presents with nausea, sweating and epigastric pain. What are you concerned about?
Silent MI
What does a summation gallop rhythm (S3 and S4) with tachycardia suggest?
Left Ventricular Failure
What antithrombin is given after thrombolysis with alteplase for an MI?
IV heparin
What is the treatment for beta blocker overdose causing bradycardia?
Atropine
glucagon
What is given to treat life threatening benzodiazepine leading to cardiorespiratory arrest?
Flumazenil
Briefly describe the NYHA classification for heart failure
- asymptomatic
- mild symptoms, slight limitation, asymptomatic at rest
- symptoms with day to day activities, significant restrictions, asymptomatic at rest
- severe limitation symptomatic at rest
Why is a past medical history of angina important when considering ACS?
Can predispose to unstable angina
What ECG changes suggest dextrocardia?
inverted p waves
What does cerebral abscess count as in Duke criteria for embolic phenomenon?
Embolic phenomenon
What valve defect for it to count as a major Duke criteria?
Regurgitation
Name an ionotropic drug
Digoxin
What is a cause of aortic stenosis in a young person?
Bicuspid heart valve
What is a bifascicular block?
RBBB and LB hemiblock
What Hb level do we transfuse blood in ACS?
Hb <80 (usually it is <70)
What medication is useful to treat heart failure secondary to severe hypertension?
IV sodium nitroprusside (nitrates) or GTN
What medication is contraindicated in severe aortic stenosis?
GTN
HTN and peripheral oedema when eGFR <30 what diuretic can you give?
Furosemide > indapamide
End stage heart failure to relieve dyspnoea. What analgesia can you give to help them?
IV morphine
