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Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is the HR for tachyarrhithmia?

A

> 100

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2
Q

What is the HR for bradyarrhythmia?

A

<60

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3
Q

Roughly, how do you manage tachyarrhythmia?

A

Give amiodarine (CCB)
If SVT, give adenosine instead

If haemodynamically unstable then DC cardioversion

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4
Q

How might you categorise tachyarrhythmia?

A

SVT
Ventricular arrhythmias
Hereditary channelopathies

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5
Q

Name 6 types of SVT

A

SAN tachy
AF
Atrial flutter
Multifocal atrial tachycardia
Paroxysmal SVT
WPWS

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6
Q

What are the features of AF on ECG?

A

Irregularly irregular rate and rhythm

No discrete p waves

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7
Q

How would you manage AF?

A

Rate - CCB
Rhythm - DC cardioversion, amiodarone, flecainide

Definitive - pulmonary vein ostia ablation

Anticoagulation

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8
Q

What are the features of Multifocal atrial tachycardia on ECG?

A

Irregularly irregular rate + rhythm

at least 3 distint p wave morphologies (multiple atrial foci)

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9
Q

What causes atrial flutter?

A

Activity from re-entry circuit around tricuspid annulus in the RA

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10
Q

What causes AF?

A

Activity from automatic foci near pulmonary vein ostia in LA

SMITH
Sepsis
Mitral valvulopathy
IHD
Thyrotoxicosis
HTN

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11
Q

What causes paroxysmal SVT?

A

Re-entrant tract between A and V, most commonly in AVN

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12
Q

How does Paroxysmal SVT present?

A

Sudden palpitations
Syncope
Diaphoresis

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13
Q

What is the cause of WPWS?

A

Bundle of Kent accessory conduction pathway bypasses rate-slowing AVN

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14
Q

What are the signs of WPWS on ECG?

A

Delta wave

Shortened PR

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15
Q

How do you treat WPWS?

A

procainamide

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16
Q

What is another name for ventricular arrhythmias?

A

Wide-complex tachycardia

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17
Q

What are the management principles of ventricular arrhythmias?

A

syncope/ischaemia/HF - DC cardioversion

Not - amoidarone

Polymoprhic - magnesium sulphate

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18
Q

What are the 3 causes of ventricular tachycardia?

A

Ventricular tachycardia
Torsades de points
VF

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19
Q

What causes ventricular tachycardia?

A

structural heart disease

e.g. cardiomyopathy, scarring post MI

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20
Q

What might cause Torsades de Pointes?

A

Drugs
Hypokalaemia
Hypocalcaeima
Hypomagnesia
SAH

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21
Q

How do you manage Torsdaes de Pointes?

A

Stable - Magnesium sulphate
Unstable - defibrillation

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22
Q

How do you manage VF?

A

IMMEDIATE CPR AND DEFIBRILLATION

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23
Q

Name 2 hereditary channelopathies

A

Brugada syndrome
Congenital long-QT syndrome

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24
Q

How is Brugada syndrome inherited?

A

AD

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25
Q

What is the ECG pattern in Brugada syndrome?

A

Pseudo-RBBB
STE V1-V2

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26
Q

What channel is affected in Brugada syndrome?

A

Na+ channels

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27
Q

What channel is affected in Congenital long QT syndrome?

A

K+ channels

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28
Q

What are the 2 sub-types of Congenital long-QT syndrome?

How are the inherited, and how might you differentiate them?

A

Romano-Ward syndrome - AD, purely cardiac

Jervell and Lange-Nielsen syndrome - AR, sensorineural deafness

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29
Q

What are the 2 types of bradycardic arrhythmias?

A

Conduction blocks
Premature beats

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30
Q

What are the 5 types of conduction blocks?

A

1st degree AV block
(the rest are 2nd degree)

Mobitz type 1 (Wenckebach)
Mobitz type 2

3rd degree (complete) AV block

BBB

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31
Q

How will a 1st degree AV block present on ECG?

How would you treat it?

A

Prolonged PR (>200msec)

No treatment required

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32
Q

How would a Mobitz type 1 (Wenckebach) present on ECG?

How would you treat it?

A

Progressive lengthening of PR until a beat is ‘dropped’

No treatment required

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33
Q

How would a Mobitz type 2 present on ECG?

How would you treat it?

A

Dropped beats that are not preceded by a change in PR interval

Pacemaker

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34
Q

How would a 3rd degree (complete) AV block present on ECG?

How would you treat it?

A

P and QRS dissociated
A and V beat independently of each other

A rate > V rate

Pacemaker

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35
Q

What disease may cause 3rd degree (complete) AV block?

A

Lyme disease

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36
Q

What causes a BBB?

A

Interruption of conduction, affected V depolarises slowly

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37
Q

How do you treat a new LBBB?

A

Treat as if it were an MI

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38
Q

Name 2 types of premature beats

A

Premature A contraction
Premature V contraction

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39
Q

How would premature A contraction present on ECG?

A

Extra beats from ectopic foci

Narrow QRS w/ p wave

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40
Q

What may cause premature A contraction?

A

Secondary to ^ adrenergic drive (e.g. caffeine)

benign

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41
Q

How would premature V contraction present on ECG?

A

Wide QRS, no preceding P wave

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42
Q

What is paroxysmal AF?

A

episodes of AF which resolve back to sinus rhythm

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43
Q

How is Paroxysmal AF managed?

A

Flecainide PRN

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44
Q

What risk is associated with Flecainide?

A

turns AF to flutter, with 1:1 conduction to V, so very high ventricular rate

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45
Q

What score is used to assess if a patient with AF needs anticoagulation?

A

CHA(2)DS(2)-VASc

0 - none
1 - consider in men (women automatically score 1)
2 - offer

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46
Q

What is used to asess the risk of major bleeding in patients with AF taking anticoagulation?

A

ORBIT score

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47
Q

How do you manage SVT acutely?

A

Non-life threatening (try each step then move on)
1 - vagal manoeuvres
2 - adenosine
3 - verapamil or BB
4 - synchronised DC cardioversion

Life-threatening
- Synchronised DC cardioversion under sedation / GA
- if unsuccessful - IV amiodarone

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48
Q

What doses of adenosine are used in acute SVT?

A

1 - 6mg
2 - 12mg
3 - 18mg

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49
Q

How does adenosine work?

A

slows conduction through AVN

Resets to ‘sinus rhythm’

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50
Q

What are the 4 types of IHD?

A

MI
Angina pectoris
Chronic IHD
Sudden cardiac death

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51
Q

What is the difference between angina and MI?

A

MI - cell death ^trops + CK

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52
Q

When does troponin peak post-MI?

A

7-10 days

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53
Q

When does CK peak post-MI?

A

3 days

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54
Q

How soon after an MI do troponins and CK rise?

A

4-8 hours

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55
Q

What is the main cause for IHD?

A

Atherosclerosis of coronary arteries

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56
Q

What factors affect the risk of disease progression?

A

Number of vessels involved
Distribution - proximal LAD, proximal LCX, whole RCA
Degree of narrowing - 75% critical stenosis
Stable vs unstable plaque

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57
Q

What are the most dangerous types of atherosclerotic plaques?

A

50-75% stenosis

Lipid-rich core and minimal fibrous cap

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58
Q

What is the difference between a Transmural Mi and a Subendocardial MI?

A

Transmural - full thickness

Subendocardial - inner 1/3 to 1/2 of myocariumWh

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59
Q

When are histological changes of MI seen?

A

4 hours post symptom onset

macroscopic changes 12 hours post symptom onset

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60
Q

What is a stunned myocardium?

A

Reperfusion injury following thrombolysis in MI

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61
Q

What is protective for stunned myocardium?

A

Repetitive, short lived ischaemia

‘preconditioning mechanism’

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62
Q

What do pathological Q waves suggest?

A

Transmural infarction

6 or more hours after symptom onset

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63
Q

What are the ECG findings of a STEMI?

A

STE
New LBBB

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64
Q

What are the ECG findings of an NSTEMI?

A

ST depresion
T wave inversion

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65
Q

How do you diagnose STEMI?

A

ECG findings

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66
Q

How do you diagnose NSTEMI?

A

^troponins

+ either
Normal ECG
Pathological ECG

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67
Q

How do you diagnose Unstable angina?

A

ACS symptoms, normal troponin

+ either
Normal ECG
ECG changes

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68
Q

What is the initial management of ACS?

A

CPAIN

Call and ambulance
Perform an ECG
Aspirin 300mg
IV morphine
Nitrate (GTN)

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69
Q

How would you manage a STEMI?

A

if within 12 hours of onset then

PCI (if available within 2 hours)

Thrombolysis (if PCI not available in 2 hours)

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70
Q

Name 3 examples of thrombolytic agents

A

Alteplase
Tenecteplase
Streptokinase

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71
Q

How do you manage NSTEMI?

A

BATMAN

Base decision about angiography and PCI on GRACE score

Aspirin 300mg STAT
Ticagrelor 180mg STAT
Morphine
Antithrombin therapy (fondaparinux)
Nitrate (GTN)

Grace score 3-4% -> coronary angiography within 72 hours
Grace score

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72
Q

When treating an NSTEMI, when would you not use Ticagrelor?

A

Bleeding risk - use clopidogrel

Angiography - use prasugrel

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73
Q

When treating an NSTEMI, when would you not use Fondaparinux?

A

Bleeding risk or imediate angiography

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74
Q

What is use to assess 6 month probability of death after NSTEMI?

A

GRACE score
3% or less - low risk

> 3% - medium to high risk (early angiography + PCI within 72 hours)

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75
Q

What secondary prevention is offered for cases of ACS?

A

6 A’s
Aspirin 75mg
Another Antipletelet for 12 months
Atorvastatin 80mg OD
ACEi
Atenolol
Aldosterone agonist (if w/ clinical HF)

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76
Q

What aldosterone agonist might be used as secondary prevention for ACS?

A

Eplerenone 50mg OD

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77
Q

What are the complications of ACS?

A

DREAD

Death
Rupture (septum / papillary muscles)
oEdema (HF)
Arrythmia / aneurysm
Dressler’s syndrome

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78
Q

What is another name for Dressler’s syndrome?

When does it occur?

A

Post-MI syndrome

2-3 weeks post MI

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79
Q

What causes Dressler’s syndrome?

A

Pericardial inflammation

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80
Q

How does Dressler’s syndrome present?

A

pleuritic chest pain
low grade fever
pericardial rub

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81
Q

How do you diagnose Dressler’s syndrome?

A

ECG - global STE + T wave inversion

Echo - pericardial effusion

^inflammatory markers

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82
Q

What are the management options for Dressler’s syndrome?

A

NSAIDs
Steroids
Pericardiocentesis

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83
Q

What is stable angina?

A

symptoms come on only with exertion and are always relieved by rest or GTN

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84
Q

Name 3 special tests for stable angina

A

Cardiac stress testing
CT coronary angiography
Invasive coronary angiography

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85
Q

How do you use GTN for stable angina?

A

Take when symptoms start, then every 5 minutes if symptoms remain.

If still there after 15 mins take again and call and ambulance

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86
Q

What does GTN do?

A

vasodilation

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87
Q

Name 2 SEs of GTN

A

Headaches
Dizziness

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88
Q

What ar the 2 options for long term symptomatic relief of stable angina

A

BB
CCB

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89
Q

What 4 other drugs might be conidered by a specialist when managing stable angina?

A

Long acting nitrates (e.g. isosorbide mononitrate)
Ivabradine
Nicorandil
Ranolazine

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90
Q

What secondary prevention methods might be used for stable angina?

A

4 As

Aspirin 75mg OD
Atorvastatin 80mg OD
ACEi
Already on a BB for symptoms

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91
Q

How much exercise do NICE reccomend for preventing cardiovascular disease?

A

Aerobic activity - 150 mins moderate intensity or 75 mins vigorous intensity per week

Strength - 2x weekly

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92
Q

What score is used to assess the percentage risk that a patient will have a stroke or MI in the next 10 years?

A

QRISK

> 10% -> statin

Atorvastatin 20mg at night

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93
Q

Atorvastatin is offered as a primary prevention to all patients with…?

A

CKD

T1DM >10 years or are over 40 years

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94
Q

How do statins work?

A

reduce cholesterol production in the liver by inhibiting HMG CoA reductase

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95
Q

How do you monitor patients on statins?

A

Check lipids 3 months after starting statins (aim for >40% reduction in non-HDL cholesterol)

Check LFTs within 3 months of starting statin, again at 12 months

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96
Q

Why do LFTs need to be check with patients on statins?

A

may cause transient and mild ^ALT/AST in first few weeks

Don’t bother stopping if the rise is less than 3 times the upper limit of normal

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97
Q

What needs to be checked before increasing the dose of statins?

A

Adherence to current regime

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98
Q

What are the SEs to be aware of with statins?

A

Myopathy
Rhabdomyolysis
T2DM
Hamorrhagic stroke

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99
Q

What drug interaction do you need to be wary of in patients on statins?

A

Macrolides (clarithromycin, erythromycin)

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100
Q

Name 3 cholesterol lowering drugs

A

statins
Ezetimibe
PCSK9 inhibitors

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101
Q

What dual antipletelet therapy is offered post-MI?

A

Aspirin 75mg OD (indefinitely)

Clopidogrel / ticagrelor (12 months)

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102
Q

What is the antiplatelet of choice in PAD following ischaemic stroke?

A

Clopidogrel

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103
Q

How is Familial Hypercholesterolaemia inherited?

A

AD

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104
Q

What 2 criteria might be used ot diagnose Familial Hypercholesterolaemia?

A

Simon Broome criteria

Dutch lipid Clinic Network Criteria

105
Q

How do you manage Familial Hypercholesterolaemia?

A

Specialist referral
Statins

106
Q

What are the 4 types of systolic mumurs?

A

Aortic stenosis
Mitral regurg
Tricuspid regurg
Mitral valve prolapse
VSD

107
Q

What happes during AS?

A

LV pressure > aortic pressure during systole

108
Q

What are the causes of aortic stenosis?

A

Bicuspid aortic valve (2% live male births)

Calcified valve (most commonly)

Rheumatic aortic stenosis

109
Q

What are the symptoms of AS?

A

ABCD

Angina
Breathlessness or HF
Collapse / syncope
Death

110
Q

How is AS managed?

A

Valve replacement

May be surgical or percutaneouswhat

111
Q

What are the options for percutaneous aortic valve replacement?

A

TAVR - transcutaneous aortic valve replacement
TAVI - implantation

112
Q

What happens in MR?

A

Blood leaks back through the mitral valve on systole

113
Q

What are the primary causes of MR?

A

MItral valve prolapse
RHD
IE
Collagen vascular disease

114
Q

What are the secondary causes of MR?

A

IHD
Non-ischaemic caridomyopathy

115
Q

How does MR present?

A

SOB, fatigue, RHF

Onset of symptoms in late disease

116
Q

What type of murmur is MR?

A

pansystolic

117
Q

What ECG finding is seen in MR?

A

Broad P wave (atrial enlargement)

118
Q

What CXR finding is seen in MR?

A

Cardiomegaly
Enlarged LA and LV

119
Q

Why is replacing the mitral valve harder than the aortic valve?

A

Deeper in the heart

120
Q

What would a mitral valve prolapse sound like?

A

Midsystolic click after carotid pulse

causes by sudden tensing of chordae tendinae as mitral leaflets prolapse into the LA

121
Q

What does aortic regurgitation sound like?

A

High pitched diastolic murmur

122
Q

What might cause AR?

A

BEAR

Bicuspid aorti valve
Endocarditis
Aortic root dilation
Rheumatic fever

123
Q

What are the symptoms of AR?

A

CoWHEaD

Collapsing pulse
Wide BP difference
Head nodding
Early diastolic murmur
Displaced apex beat

124
Q

What type of murmur is associated with connective tissue disorders such as Marfans and Ehler’s Danlos?

A

AR

125
Q

What is the most effective management option for AR?

A

Mechanical valve replacement

126
Q

What does MS sound like?

A

Diastolic

Opening snap caused by an abrupt halt in leaflet motion in diastole after rapid opening due to fusion at leaflet tips

LA pressure is far greater than LV pressure in diastole

127
Q

How would you treat MS?

A

Anticoagulation

128
Q

Name a cause of a continuous murmur

A

PDA - patent ductu arteriosus

129
Q

What is paroxysmal Nocturnal Dyspnoea?

A

Sudden wake at night with SOB, cough, and wheeze

Improves over a few minutes

Suggests HF

130
Q

What 6 investigations are required in a patient suspected of having HF?

A

NT-proBNP
ECG
Echo
Bloods
CXR
Lung function tests

131
Q

How do you grade the severity of HF?

A

New York Heart Association Classification

1) no limitation on activity
2) Symptomatic with ordinary activities
3) Sympomatic with any activity
4) Symptomatic at rest

132
Q

What are the 5 principles of management of HF?

A

RAMPS

Refer to cardio
Advise
Medical tratment
Procedural / surgical interventions
Specialist HF MDT input

133
Q

What does the result of an NT-proBNP test suggest about the urgency of a referral for HF?

A

400-2000 -> echo in 6 weeks

> 2000 - echo in 2 weeks

134
Q

What is the medical management of HF?

A

ABAL

ACEi
BB
Aldoterone antagonist
Loop diuretic

135
Q

When should an aldosterone antagonist be used to treat HF?

A

If not managed by ACEi or BB

136
Q

How is HTN diagnosed?

A

Clinical - 140/90
Ambulatory / home - 135/85

137
Q

What are the causes of HTN?

A

Primary - 90%

Secondary - ROPED
Renal
Obesity
Pregnancy / pre-eclampsie
Endocrine
Drugs

138
Q

What are the stages of HTN?

A

1 - 140/09 (135/85)
2 - 160/100 (150/95)
3 - 180/120

139
Q

What is step 1 management for HTN?

A

<55yrs - A
>55yrs or black - C or D

140
Q

What is step 2 management for HTN?

A

A+C OR A+D

141
Q

What is step 3 management for HTN?

A

A+C+D

142
Q

What does step 4 of HTN management depend on?

A

K+ </= 4.5 -> spironolactone (K+ sparing)

> 4.5 -> alpha blocker (doxazosin) or BB (atenolol)

143
Q

What are the treatment targets for HTN?

A

<80 - 140/90
>80 - 150/90

144
Q

What is the definition of malignant HTN?

A

> 180/120 w/ retinal haemorrhages or papilloedema

145
Q

How would you manage malignant HTN?

A

IV options include
Sodium nitroprusside
Labetalol
GTN
Nicardipine

146
Q

What is the treatment for Pulmonary Oedema?

A

SOD Off

Sit up
O2
Diamorphine
OFFload (IV diuretics)

147
Q

What are the signs of pulmonary oedema on CXR?

A

Batwing sign (alveolar oedema)
Kerley B lines
Pleural effusions
Cardiomegaly

148
Q

How might we divide types of Congenial Heart Disease?

A

R-L shunts
L-R shunts
Other

149
Q

What are the 5 types of R-L shunts?

A

5Ts
Truncus arteriosus (1 vessel)
TGA (2 switched vessels)
Tricuspid atresia (3=tri)
Tetralogy of fallot
TAPVR

150
Q

Name 4 causes of L-R shunts

A

ASD
VSD
PDA
Eienmenger syndrome

151
Q

Name 2 other causes of congenital heart disease

A

Coarctation of the aorta
Persistent pulmonary HTN of the newborn

152
Q

What sorts of pathologies tend ot be R-L shunts?

A

Valvular or outflow tract pathologies

Do requirea septal defect to be viable

153
Q

What sorts of pathologies tend to be L-R shunts?

A

Septal defects

154
Q

What is the definition of postural hypotension?

A

> /= 20/10 drop on standing

155
Q

What systems are affected by Rheumatic Fever?

A

Joints
Heart
Skin
Nervous system

156
Q

What causes Rheumatic Fever?

A

Abs against streptococcus bacteria also target the body

157
Q

When does Rheumatic Fever typically present?

A

2-4 weeks after a strep infection (tonsilitis)

158
Q

How does Rheumatic Fever affect the joints?

A

Migratory arthritis

159
Q

What is the neurological presentation of Rheumatic Fever?

A

Chorea

160
Q

What investigations are used to support a diagnosis of Rheumatic Fever?

A

Throat swab
ASO Ab titres
Echo, ECG, CXR

Jones criteria

161
Q

What are the 2 key presenting features of pericarditis?

A

Pleuritic chest pain
Low grade fever

162
Q

What ECG changes are associated with pericarditis?

A

saddle-shaped STE
PR depresion

163
Q

How do you manage pericarditis?

A

NSAIDs
Colchicine (3 months)

Consider pericardiocentesis in effusion or tamponade

164
Q

What drug might cause myocarditis?

A

Anthracycline

165
Q

What parasitic disease may cause myocarditis?

A

Chagas disease

166
Q

How is Chaga’s disease contracted?

A

Triatomin bug
Bites victims, then poos and rubs poo on skin of victims

Poo contains Trianosoma cruzi parasite

167
Q

What are the 2 most common causes of infective endocarditis?

A

Streptococcus
Enterococcus

168
Q

What are the examination findings of endocarditis

A

New / changing murmur
Splinter haemorrhages
petechiae
Janeway lesions
Osler’s nodes
Roth spots
Splenomegaly
Finger clubbing

169
Q

What criteria is used to diagnose infective indocarditis?

A

Modified Duke Criteria

170
Q

How are patients with Infective Endocarditis managed?

A

IV broad spectrum Abx
(e..g amoxicillin +/- gentamicin)

4 weeks with native heart valves
6 weeks with prosthetic heart valves

171
Q

What vaccinations should be offered to someone with chronic HF?

A

Annua influenza
One off pneumococcal

172
Q

What is the target INR in AF?

A

2-3

173
Q

What does an INR of 2 mean?

A

Prothrombin time is 2x that of an average healthy adult

(takes them 2x as long to form a blood clot)

174
Q

What medications should be prescribed for fibrinolysis in STEMI management?

A

Alteplase (fibrinolytic)
Fondaparinux (antithrombin)

175
Q

What dermatological SE is associated with Warfarin use?

A

Skin necrosis

176
Q

How might you differentiate SVT and sinus tachycardia?

A

HIstory

SVT can appear at rest with no apparent cause

Sinus tachy - will have a gradual onset

177
Q

In stable angina, if a patient doesn’t respond to verapamil, what should you try next?

A

Isosorbide mononitrate

178
Q

What is the mechanism behind LQTS1 and 2?

A

defects in alpha subunit in slow rectifier K+ channels

179
Q

Name 2 congenital syndromes causing LQTS

How might you differentiate them?

A

Jervell-Lange-Nielsen syndrome (deafness)

Romano-Ward syndrome (no deafness)

180
Q

What drug might be offered to a patient with HFrEF?

A

SGLT-2 inhibitors

181
Q

What sort of stroke may cause torsades de pointes?

A

SAH

182
Q

What is the 1st line investigaiton for stable chest pai of suspected coronary artery disease aetiology?

A

Contrast-enhanced CT

183
Q

What is the MOA of Indapamide?

A

Thiazide diuretic

184
Q

How should you manage patients on warfarin undergoing emergency surgery?

A

Give four-factor prothrombin complex concentrate 25-50 units/kg

If in 6-8 hours then 5mg vitamin K IV

185
Q

What are the 3 main cuases of pansystolic murmurs?

A

MR
TR
VSD

186
Q

When might you stop BBs in acute HF?

A

HR <50
2/3rd degree HB
Shock

187
Q

Which HTN patients don’t require treatment?

A

Stage 1 HTN >80

188
Q

Which artery supplies the lateral heart?

A

Left circumflex

189
Q

Which artery supplies the anterior heart?

A

LAD

190
Q

Which artery supplies the right heart?

A

RCA

191
Q

Which cardiovascular drugs might cause sexual dysfunction?

A

BBs

192
Q

Which cardiovascular drug is associated with GI ulcers?

A

Nicorandil

193
Q

What score is used to determine whether a PE patient can be managed as an outpatient?

A

PE Severity Index (PESI)

194
Q

When might a new LBBB be considered normal?

A

Never

It’s always pathological

195
Q

Where and why is BNP produced?

A

LV myocardium

In response to strain

196
Q

What are the effects of BNP?

A

Vasodilation

Diuretic / natriuretic

Suppresses sympathetic tone and RAAS

197
Q

How would you differentiate a posterior STEMI and an anterior NSTEMI?

A

A NSTEMI - inferior ST-depression

198
Q

What medications reduce hypoglycaemic awareness?

A

Beta-blockers

199
Q

What might tall R waves in V1-V2 suggest?

A

Posterior MI

(Right at the back)

200
Q

In ALS, what drug should be given ASAP in non-shockable rhythm

A

Adrenaline ASAP

201
Q

What are the ECG findings of MI?

A

Hyperacute T waves for a few minutes
Then maybe STE
T wave inversion within 24 hours (may last days-months)

Pathological Q waves after hours-days, persists indefinitely

202
Q

What is the preferred management option for HF patients not responding to ACEi, BB, and aldosterone antagonist therapy?

A

Cardiac Resynchronisation Therapy (CRT)

203
Q

What is the most common cause of Mitral Stenosis?

A

Rheumatic Fever

204
Q

What is the main ECG finding seen in hypercalcaemia?

A

shortening QT interval

205
Q

What are the statin regimes for prevention in CVD?

A

Primary prevention - Atorvastatin 20mg

Secondary prevention - Atorvastatin 80mg

206
Q

In ALS, what drug should be given to patients who are in VF/pulseless VT after 5 shocks have been administered?

A

Amiodarone 150mg

207
Q

In ALS, what drug should be given following 3 shocks in a cardiac arrest where the patient has a shockable rhythm?

A

Amiodarone 300mg

208
Q

When would you give someone on Warfarin Vitamin K?

A

INR >8

Bleeding - IV
No bleeding - oral

209
Q

Major bleed, pt on warfarin, INR >8, what do you do?

A

Stop warfarin
Give IV vit K 5mg
Give Prothrombin Complex Anticoagulant

210
Q

If somone presents with acute pulmonary oedema on a background of HF, what do you do?

A

IV furosemide

211
Q

What is the DVLA advice post MI?

A

Cannot drive for 4 weeks

212
Q

Generally, what might a bifid p wave suggest?

A

Atrial enlargement

213
Q

Name a urological SE of indapamide

A

Erectile dysfunction

(as with all thiazide-like diuretics)

214
Q

How would you manage a regular broad-complex tachycardia in a peri-arrest setting?

A

Amiodarone loading ose
24hr infusion

215
Q

How would you manage an irregular broad-complex tachycardia in a peri-arrest setting?

A

Seek expert help

216
Q

How would you manage a regular narrow-complex tachycardia in a peri-arrest setting?

A

Vagal manoeuvres followed by IV adenosine

If the above is unsuccessful then considera diagnosis of atrial flutter and control rate (e.g. BBs)

217
Q

How would you manage an irregular narrow-complex tachycardia in a peri-arrest setting?

A

Probably AF

If onset <48h consider electricla or chemical cardioversion

Rate control - BBs are usually 1st line unless there is a contraindication

218
Q

What nailbed sign is associated with aortic regurgitation?

A

Quincke’s sign

219
Q

What is the next step in the case of a witnessed cardiac arrest while on a monitor?

A

Up to 3 successive shocks before CPR

220
Q

What additional drug should STEMI patients undergoing fibrinolysis be given/

A

Antithrombin (e.g. Fondaparinux)

221
Q

What ECG finding is pathognomic of hypokalaemia?

A

U waves

222
Q

How would you manage an NSTEMI patient with GRACE >3%?

A

Coronary angiography within 72 hours of admission

223
Q

What annual treatment should patients with HF be offered?

Why?

A

Annual influenza vaccine

Influenza infection increases the risk of major cardiovascular events

224
Q

What is Beck’s triad of cardiac tamponade?

A

Falling BP
Rising JVP
Muffled heart sounds

225
Q

What type of diuretic may cause hypercalcaemia and hypocalciuria?

A

Thiazide diuretics

226
Q

Which diuretic type has not been shown to improve mortality in patients with chronic heart failure?

Can you name an example?

A

Loop diuretics

e.g. Furosemide

227
Q

What DM medications have been shown to provide benefit to HFrEF patients?

Can you name an example?

A

SGLT2-inhibitors

Dapaglifozin

228
Q

How might a patient having gout affect HTN management?

A

Thiazide-like diuretics and thiazides can worsen gout so avoid these

229
Q

How soon should PCI be offered to those with a STEMI?

A

120 mins of time when fibrinolysis could have been given

230
Q

In which patients are nitrates contraindicated in?

A

Hypotensive patients

231
Q

What heart sound is associated with hypertrophic obstructive cardiomyopathy?

A

S4

232
Q

In a patient with a suspected PE and renal impairment, how would you confirm your diagnosis of a PE?

A

V/Q scan

CTPA uses contrast so don’t use in renal impairment

233
Q

How many sets of blood cultures are recommended when investigating infective endocarditis?

A

3

234
Q

In clinically unstable patients wth suspected aortic dissection, what is the investigation of choice?

A

Transoesophageal echocardiography

CT angio would be good but they’re unstable so not ideal for CT

235
Q

What are the most common side effects of GTN spray?

A

Hypotension
Tachycardia
Headache

236
Q

What might cause a pansystolic murmur shortly after an acute MI?

A

VSD

237
Q

Which foods are high in vitamin K?

A

Spinach
Kale
Sprouts

238
Q

How do ALT levels affect statin dosing?

A

Treatment with statins should be discontinued if serum transaminase concentrations rise to and persist at 3 times the upper limit of the reference range

239
Q

How do you treat patients with bradycardia and signs of shock?

A

500mcg Atropine

(repeat up to a max of 3mg)

240
Q

What urological drug is contraindicated with GTN use?

A

Sildenafil (PDE-5 inhibitors)

Causes severe refractory hypotension

241
Q

How do you manage mitral stenosis?

A

ok - anticoagulate

bad - pecutaneous mitral commissurotomy

242
Q

In cardiac catheterisation, how would you differentiate an ASD from a VSD?

A

ASD - oxygenation at atrial level

VSD - oxygenation at ventricular level

242
Q

In cardiac catheterisation, what is the O2 saturation level expected in the RA, RV, and PA?

A

70%

243
Q

In paediatrics, is a quiet murmur or loud murmur more concerning?

A

Quiet - means the hole is pretty big and hence less turbulent flow

244
Q

What class of drugs should be considered during CPR if a PE is suspected?

A

Thrombolytic drugs (like Alteplase)

245
Q

Why should you perform a baseline CXR in patients commencing amiodarone?

A

Risk of pulmonary fibrosis / pneumonitis

246
Q

What ECG sign is seen in hypothermia?

A

J waves

247
Q

How might you differentiate cardiac tamponade and constrictive pericarditis?

A

Kussmaul’s sign seen in constrictive pericarditis

(raised JVP that doesn’t fall with inspiration)

248
Q

How do you diagnose orthostatic hypotension?

A

Drop in SBP of at least 20mmHg
and/or
Drop in DBP of at least 10mmHg

AFTER 3 MINS OF STANDING

249
Q

What murmur is heard in those with PCKD?

A

Mitral Valve Prolapse

250
Q

Chest pain + neurology

What do you want to rule out?

A

Aortic Dissection

251
Q

When might you use Ivabradine to manage a patient with HF?

A

Patient has sinus rhythm >75, and a LVEF <35%, and have not responded to an ACEi, BB, or aldosterone antagonist therapy

252
Q

What is the 1st line investigation for stable chest pain of suspected coronary artery disease aetiology?

A

CT coronary angio

253
Q

What anti-angina medication requires a standard-release form?

Why?

A

Isosorbide mononitrate

To prevent nitrate tolerance

254
Q

Can you summarise the management principles behind thoracic aortic aneurysm?

A

ASS and BooBs
Type A - Systolic management and Surgery
Type B - BBs and Bed rest

255
Q

In tachyarrhythmia, what BP threshold prompts immediate DC cardioversion?

A

Systolic <90

256
Q

In uncontrolled HTN, already on an ACEi and a CCB, what should be added?

A

Thiazide-like diuretic

NOT THIAZIDE

e.g. Indapamide

257
Q

Which pulse-type is associated with mixed aortic valve disease?

A

Bisferiens pulse

2 distinct systolic peaks separated by a mid-systolic dip

257
Q
A

Medicine (21 decks)

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