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MSRA > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Drugs than prolong QT

A

Antiarrhythmics (amiodarone, sotalol)
Antibiotics (erythromycin, clarithromycin, ciprofloxacin)
Psychiatric medications (SSRI, Tricyclics)

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2
Q

Electrolyte abnormalities that cause long QT

A

Hypocalcaemia, Hypomagnesaemia, Hypokalaemia

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3
Q

Management of torsades de pointes

A

IV Magnesium Sulphate

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4
Q

Features of severe aortic stenosis

A

Narrow pulse pressure
Slow rising pulse
Delayed ESM
Soft/absent S2
Fourth heart sound
Thrill
Left ventricular hypertrophy

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5
Q

Most common mutation seen in HOCM

A

Mutation in the gene encoding Beta myosin heavy chain proetin or myosin binding protein C

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6
Q

Does HOCM cause systolic or diastolic dysfunction

A

Diastolic dysfunction (Left ventricular hypertrophy causing decreased compliance therefore decreasing cardiac output

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7
Q

What do you see on a biopsy of HOCM?

A

Myofibrillar hypertrophy with chaotic fashion myoctes and fibrosis

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8
Q

ECG changes in HOCM

A

Left ventricular hypertrophy
Progressive T wave inversion
Deep Q waves

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9
Q

Which antibiotic can cause polymorphic VT?

A

Macrolides (eg azithromycin) due to prolongation of the QT interval

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10
Q

Diastolic murmur + Atrial fibrillation

A

Mitral stenosis.

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11
Q

Diastolic murmur loudest over the apex and accentuated with the patient in a left lateral position

A

Mitral stenosis

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12
Q

Diastolic murmur loudest over the aortic area

A

Aortic regurgitation

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13
Q

Pansystolic murmur loudest over the apex and radiating to the axilla

A

Mitral regurgitation

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14
Q

Systolic murmur over the tricuspid area

A

Tricuspid regurgitation

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15
Q

What are the components of the GRACE score?

A

Age
Heart rate
BP
Renal function
Cardiac arrest
ECG
Troponin

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16
Q

What does the GRACE score tell you?

A

Predicted 6 month mortality

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17
Q

What are the components of the CHADVASC score?

A

Congestive Heart failure - 1
Hypertension - 1
Age (over 75) - 2
Age (65 - 75) - 1
Diabetes 1
Stroke, or TIA 2
Vascular Disease - 1
Female sex - 1

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18
Q

Over what CHADVASC score do you need anticoagulation?

A

1 - Consider
2 - Offer

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19
Q

What scoring system is used to assess bleeding risk in AF and what does it contain?

A

ORBIT scoring system:
Haemaglobin less than 130 (male) or 120 (female) - 2
Age over 74 - 1
Bleeding history 2
Renal impairment eGFR less than 60 1
Treatment with anti platelets 1

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20
Q

Managment of VT with a pulse (stable patient)

A

Amiodarone
Second line - Lidocaine

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21
Q

What drug in contraindicated in VT with a pulse?

A

Verapamil

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22
Q

What valve is most commonly affected by endocarditis in drug users?

A

Tricuspid valve

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23
Q

Most common bacterial cause of endocarditis

A

Staph aureus

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24
Q

What is the strongest risk factor for getting endocarditis

A

Previous endocarditis

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25
Q

Which is the most common valve affected in endocarditis (NOT IVDU)

A

Mitral

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26
Q

What bacteria in endocarditis is associated with colorectal cancer?

A

Strep bovis - streptococcus gallolyticus

27
Q

Persistent ST elevation and left ventricular failure after MI

A

Left ventricular aneurysm

28
Q

Patient presents 2 weeks after MI with acute heart failure an cardiac tamponade

A

Left ventricular free wall rupture

29
Q

Eary to mid diastolic murmy after posterior MI

A

Acute mitral regurgitaion (usually due to ischaemia or rupture of the papillary muscle

30
Q

ECG features of hypokalaemia

A

U waves
Small or absent T waves (or inverted)
Long PR
ST depression
Long QT

31
Q

What is the PESI score?

A

Pulmonary embolism severity score - can be used to identify patients with a PE than can be managed as Outpatients. Predicts 30 day mortality.
Includes age, sex, cancer, heart failure, lung disease, HR, BP, RR, Temp, Mental status and 02 sats

Very low or low risk - can be managed as OP

32
Q

Factors that raise BNP

A

Heart failure
Myocardial ischaemia
Valvular disease
CKD

33
Q

Factors which reduce BNP?

A

ACE inhibitors
ARBs
Diuretics

34
Q

Echo findings in HOCM

A

Mitral regurgiation
Systolic anterior motion of the anterior mitral valve leaflet
Asymmetric hypertrophy

35
Q

What are the features of coartation of the aorta in an adult?

A

Hypertension
Radio femoral delay
Mid sytolic murmur maximal over the back
Apical clicking from the aortic valve
Notching of the inferior border of the ribs

36
Q

What is the most specific ECG change associated with pericarditis

A

PR depression

37
Q

Describe the 2 types of aortic dissection (Stanford classification)

A

A: Ascending aorta
B: Descending aorta - distal to the left subclavian origin

38
Q

Management of aortic dissection in the ascending aorta

A

Surgical managment (control BP in the meantime) Control to 100 - 120 systolic

39
Q

Management of an aortic dissection in the descnding aorta

A

Conservative managment
Bed rest and BP control

40
Q

Explain coronory angiography management of NSTEMI using GRACE score

A

Immediate - Unstable patient
Within 72 hours if GRACE score shows predicted mortality of over 3%

41
Q

Early diastolic murmur high pitched and blowing in character

A

Aortic regurgiation

42
Q

What are janeway lesions

A

Erythematous macular or nodular lesions caused by septic emboli
Non tender

43
Q

What are osclers nodes

A

Painful erythematous lesions caused bu immune comples deposition

44
Q

What are roth spots

A

Retimal haemorrhages seen in endocarditis

45
Q

What is pulsas alterans and what does it indicate?

A

A strong and weak beat occurring alternately due to alternate rather than regular contraction of muscle fibres of the left ventricle
Caused by left ventricular failure

46
Q

What is a collapsing pulse and what causes it?

A

A large bounding pulse that quickly dissapears. Best felt in the radial artery with the arm elevated. Seen in aortic regurgitation

47
Q

What is bisifrens pulse and when is it seen

A

Rapid rising twice beting pulse where both waves are felt during systole. Seen in mixed aortic stenosis and incompetence

48
Q

What is pulsus paradoxacus and what causes it

A

Alternate large and small amplitude beats and is found when taking BP. Seen in left ventricular failure

49
Q

What is a plateau pulse and what causes it?

A

Low amplitude pulse and has a low size and fall. Seen in aortic stenosis

50
Q

What is a 4th heart sound and what does it signify?

A

Causes by powerful atrial contraction filling and abnormally stiff ventricle. Causes include left ventricular hypertrophy and HOCM.

51
Q

What is a 3rd heart sound and what does it signify?

A

Caused by turbulant blood flow when too much blood is pumped into the ventricle too quickly. Caused by heart failure

52
Q

Describe the murmur associated with HOCM

A

Early peaking systolic murmur worse and valsalva and reduced on squatting

53
Q

Describe the murmur associated with a VSD

A

Pansystolic murmur heard loudest at the left sternal edge

54
Q

When does aortic aneurysm screening start

A

65th birthday for men

55
Q

Describe the follow up after AAA screening

A

If AAA less than 3cm - discharge
If AAA between 3 - 4.4cm - Yearly screening
Between 4.5 - 5.4cm USS every 3 months
Above 5.5cm referred to a vascular surgeon

56
Q

At what size does a AAA need to considered for surgery?

A

Over 5.5cm

57
Q

What is the most common cardiovascular complication seen in marfan syndrome?

A

Aortic root dilatation.

58
Q

Most common heart defect associated with downsyndrome?

A

AVSD

58
Q

Do patients who have had a catheter ablation for Af still require anticoagulation

A

Yes. They require lifelong anticoagulation (Catheter ablation does not reduce the stroke risk)

59
Q

What heart valve abnormailty is associated with polycystic kidney disease

A

Mitral valve prolapse

60
Q

Treatment for HOCM?

A

Amiodarone
Beta blocker or verapamil
Cardiac defib
Dual chamber pacemaker

61
Q

What drugs are contraindicated in patients with HOCM?

A

Nitrates
ACE inhibitors
Inotropes

62
Q
A

MSRA (23 decks)

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