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AKT > Cardiology 2 > Flashcards

Cardiology 2 Flashcards

1
Q

Wells score likely Ix
Wells score unlikely Ix

A

CTPA, if will be delayed then anticoagulate with a DOAC
If negative then consider US to r/o DVT

If unlikely - arrange d-dimer, if +ve then for CTPA

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2
Q

Wells score
Likely versus unlikely

A

> 4 PE likely
=<4 PE unlikely

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3
Q

PERC criteria (8)

A

> =50
Haemoptysis
Unilateral leg swelling
Recent surgery
HR >=100
Sats <=94%
Prev DVT use
Oestrogen use

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4
Q

What is the PERC rule?

A

Pulmonary embolism rule-out criteria (PERC)

all the criteria must be absent to have negative PERC result, i.e. rule-out PE

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5
Q

Acute hypotension and pulmonary oedema post MI?

A

Mitral regurg

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6
Q

Within 1 week post MI acute heart failure associated with a pan-systolic murmur =

A

ventricular septal defect

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7
Q

2-6 weeks post MI complication
48 hours

A

Dresslers syndrome
Pericarditis

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8
Q

Most common cause of death post MI

A

VF

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9
Q

Mitral stenosis features (7)

A

Dyspnoea
Haemoptysis
Mid- late diastolic murmur
Loud S1
Low volume pulse
Malar flush
AF

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10
Q

Mitral stenosis
Causes (3)

A

RhF, RhF, RhF

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11
Q

Mitral regurg murmur (4)

A

Pan systolic murmur
Blowing
Radiates to axilla
Quiet S1

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12
Q

Mitral regurg causes (5)

A

Collagen disorders
Mitral valve prolapse
Infective endocarditis
Post MI
Rh F

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13
Q

Minor Criteria (4)
Rheumatic fever

A

raised ESR or CRP
pyrexia
arthralgia (not if arthritis a major criteria)
prolonged PR interval

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14
Q

Rh Fever Dx criteria

Major Criteria (5)

A

1 major 2 minor or 2 major

Major
Erythema marginatum
Subcutaneous nodules
Sydenhams Chorea
Polyarthritis
Pancarditis

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15
Q

Rheumatic fever bacteria –>
Rx (2)

A

strep pyogenes
Rx NSAIDs, penicillin V

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16
Q

What is Kussmaul’s sign?
Seen in which condition?

A

paradoxical rise in JVP during inspiration seen in constrictive pericarditis

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17
Q

1st line management of isolated systolic hypertension

A

thiazides

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18
Q

Explain the heart sounds
S1 closure of which valves, soft and loud in which valvular disease
S2 closure of which valves, soft in which valvular disease
S3 name two conditions
S4 name three conditions

A

S1 closure of mitral and tricuspid
soft if mitral regurg
loud in mitral stenosis

S2 closure of aortic and pulmonary valves
soft in aortic stenosis

S3
Heard in dilated cardiomyopathy or constrictive pericarditis.

S4 aortic stenosis, HOCM, HTN

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19
Q

Causes of inverted T waves (6)

A
  1. MI
  2. Dig tox
  3. SAH
  4. Arrhythmogenic right ventricular hypertrophy
  5. PE
  6. Brugada syndrome
20
Q

Causes of ST elevation (7)

A
  1. MI
  2. Pericarditis
  3. Normal variant (high take off)
  4. Left ventricular aneurysm
  5. Prinzmetal’s angina
  6. Takotsubo cardiomyopathy
  7. SAH
21
Q

Causes of ST depression (3)

A
  1. Ischaemia
  2. Digoxin
  3. Hypokalaemia
22
Q

Causes of prolonged PR (7)

A

IHD
Dig toxicity
Low K+
Rheumatic fever
Endocarditis
Lyme disease
Sarcoidosis

23
Q

Increased P wave amplitude =
Bifid P waves

Two causes

A

Cor pulmonale
Mitral stenosis

24
Q

Acute hypotension and pulmonary oedema post MI =

A

Mitral regurg

25
Q

1st degree heart block
2nd Type 1, type 2 (mobitz I + II)
Third degree

A

Prolonged PR
Type 1 progressive prolongated PR with dropped QRS
Type 2 long PR, random QRS dropped
Third degree no association

26
Q

Canon waves JVP in neck
Wide pulse pressure
Regular brady

A

Complete heart block

27
Q

NYHA classification

A

NYHA Class I
no symptoms
no limitation: ordinary physical exercise does not cause undue fatigue, dyspnoea or palpitations

NYHA Class II
mild symptoms
slight limitation of physical activity: comfortable at rest but ordinary activity results in fatigue, palpitations or dyspnoea

NYHA Class III
moderate symptoms
marked limitation of physical activity: comfortable at rest but less than ordinary activity results in symptoms

NYHA Class IV
severe symptoms
unable to carry out any physical activity without discomfort: symptoms of heart failure are present even at rest with increased discomfort with any physical activity

28
Q

Stress induced, family member dies then develops chest pain and features of heart failure.
Rx apical ballooning of the myocardium

A

What is Takotsubo cardiomyopathy?

29
Q

Name four causes of dilated cardiomyopathy

A
  1. Cocksackie virus B
  2. ETOH
  3. wet Beri Beri
  4. Doxorubicin
30
Q

HOCM ECHO findings (3)

A
  1. MR
  2. Systolic anterior motion of the anterior mitral valve (SAM)
  3. Asymmetrical septal hypertrophy
31
Q

Which two types of cardiomyopathies are AD?
Mx

A

HOCM and arrhythmic right ventricular dysplasia
ICD

32
Q

Statins - when do you increase the dose in the context of primary prevention?

A

increase the dose if non-HDL has not reduced by >= 40%

33
Q

Long QT1
Long QT2
Long QT3

A

Syncope following:
Long QT1 exertional syncope e.g swimming
Long QT2 emotional stress, exercise or auditory stimuli
Long QT3 often at night or at rest

34
Q

Cause of long QT

A

SSRIs
TCAs/ terfenadine
Ondansetron
Methadone/ MI/ myocarditis/ macrolides
Amiodarone
Chloroquine, ciprofloxacin
Hypothermia/ haloperidol
Low K, Mg, Ca
Erythromycin
SAH
Sotalol

STOMACHLESS

35
Q

Long QT can lead to?
Mx (2)

A

VT or torsade de pintes
BB
ICD if high risk

36
Q

Choking
First question to ask
How to differentiate between mild and severe
3 steps for mild
If unconscious (2)

A
  1. Are you choking? (if responds - mild, otherwise severe)

If mild
1. Encourage patient to cough
2. Five back blows
3. Five abdominal thrusts
Then repeat

If unconscious
1. Call for an ambulance
2. CPR

37
Q

Stable angina investigations (3)

A

1st line CT coronary angiography
2nd line myocardial perfusion scan, OR stress ECHO
3rd line invasive coronary angiography

38
Q

When do you give oxygen with CP?

A

Sats <94% who are not at risk of hypercapnia
OR
COPD patient aiming sats 88-92%

39
Q

CP referral
CP within 12 hours with an abnormal ECG
CP 12-72 hours ago
CP >72 hours ago

A

ED
Refer to hospital for same day assessment
Perform full ECG and troponin

40
Q

Hypokalaemia ECG findings (5)

A

U have no Pot and no T, but a long PR and a long QT
And ST depression

U waves, small or absent T waves, long PR, long QT

41
Q

Digoxin toxicity findings on ECG (4)

A

Down sloping ST depression
Flattened/ inverted T waves
Short QT
Long PR

42
Q

Causes of LAD (6)

A

Left bundle branch block
MI (inferior)
Wolff-Parkinson-White syndrome - right-sided accessory pathway
Hyperkalaemia
Congenital: ostium primum ASD, tricuspid atresia
Obesity

43
Q

RAD causes (8)

A

RVH
MI lateral
Chronic lung disease → cor pulmonale
PE
Congenital ostium secundum ASD
Wolff-Parkinson-White syndrome* - left-sided accessory pathway
Normal in infant < 1 years old
Tall people

44
Q

Coronary territories
Anteroseptal ECG and artery
Anterolateral
Lateral
Inferior
Posterior

A

V1-V4 LAD
V4-V6, I, aVL LAD or left circumflex
I, aVL +/- V5-V6 Left circumflex
II, III, aVF right coronary
V1-V3 Left circumflex

45
Q

What can decrease BNP? (5)

A

Obesity
Diuretics
ACE inhibitors/ ARBs
BB
Aldosterone antag

46
Q

BNP, NTproBNP
Values of high, raised and normal

A

High >400, >2000
100-400, 400-2000
<100, <400

47
Q

Chronic heart failure 1st line investigation

A

NTproBNP

AKT (52 decks)

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