Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 3B > Cardiology 2 > Flashcards

Cardiology 2 Flashcards

1
Q

What is atrial fibrillation?

A

The most common sustained cardiac arrhythmia
Characterised by irregularly irregular ventricular pulse and loss of association between the cardiac apex beat and radial pulsation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the adverse effects of the loss of active ventricular filling in AF?

A

Stagnation of blood in the atria –> thrombus formation

Reduced cardiac output may lead to heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the types of AF?

A 
Acute: onset within 48h
Paroxysmal: spontaneous termination
Recurrent: 2+ episodes
Persistent: not self terminating but successful cardioversion
Permanent: resistant to cardioversion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the aetiology of AF?

A 
11% idiopathic
Coronary/valvular heart disease
Hyperthyroidism
Diabetes
Lung cancer
Excess caffeine and alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does symptomatic AF present?

A 
Dyspnoea
Palpitations
Syncope/dizziness
Chest pain
Stroke or TIA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the signs of AF?

A

S3 heart sound

Irregularly irregular pulse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is seen on ECG in AF?

A

Variability in R-R intervals

No P waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What other investigations are important in AF?

A

24h ambulatory ECG
Bloods: TFTs, FBC, biochem, electrolytes esp K, coagulation screen (pre warfarin)
CXR for structural causes
Baseline TTE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the indications for urgent admission in AF?

A

Pulse >150BPM or systolic BP<90mmHg

Loss of consciousness, severe dizziness, ongoing chest pain, progressive dyspnoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the treatment of acute AF with and without haemodynamic instability?

A

With: emergency electrical cardioversion

Without: Electrical cardioversion or pharmacological cardioversion (flecainide or amiodarone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

In which patients is rhythm control preferred to rate control in AF?

A

AF has a reversible cause
HF is present and caused by AF
New onset AF

Rate control= >65 years, history of ischaemic HD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the first line monotherapy rate control in AF, and the contraindications?

A

Atenolol/bisoprolol (CI: COPD, asthma, bradycardia, heart block)

Diltiazem/verapamil (CI: heart failure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the second line rate control treatment of AF?

A

Combine two medications: a beta blocker, diltiazem, digoxin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why should sotalol be avoided in AF?

A

Long QT Syndrome and toursades des pointes risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Detail rhythm control of AF.

A

Electrical cardioversion with amiodarone before and after
OR
Drug treatment: amiodarone (if structural heart disease) or flecainide/amiodarone (if no structural heart disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the treatment of AF if drug treatment has failed to control symptoms?

A

Left atrial/AVN ablation and/or pacing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which score assesses stroke risk in AF patients?

A

CHA2DS2VASc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which score assesses risk of bleeding in patients on anticoagulation?

A

HAS-BLED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the thromboprophylaxis treatment of AF?

A

Warfarin or a NOAC.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the main subtypes of heart block?

A

AV block: block in the AV node or bundle of His

Bundle branch block: block lower down.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What does the Bundle of His split into?

A

Left bundle branch (which has anterior and posterior divisions) and right bundle branch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is shown on an ECG in complete bundle branch blocks (left or right)?

A

Wide QRS (>0.12s), normal axis

RBBB: RSR in V1 (M) and W in V6 (marrow)

LBBB: septal depolarization is reversed so change in initial direction of QRS (William).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the pathological effects of complete bundle branch blocks?

A

LBBB: late activation of the left ventricle

RBBB: late activation of the right ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is a hemiblock?

A

Block in the separate divisions of the left bundle produces a swing of depolarization (electrical axis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is seen in left anterior hemiblock, and left posterior hemiblock?

A

LA: left axis deviation, Q waves in I and aVL, small R in III

LP: right axis deviation, small R in I, small Q in III

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is first degree AV block?

A

Prolongation of PR interval >0.2s

Every atrial depolarization conducts to ventricles but it is delayed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the types of 2nd degree AV block?

A

Mobitz type I

Mobitz type II (2:1 or 3:1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is Mobitz type I heart block?

A

Progressive lengthening of the PR interval with eventual dropped ventricular contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How long is the QRS complex in Mobitz type II block?

A

> 0.12s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Where is the blockage in Mobitz type II block?

A

Bundle of His

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What has occurred when there is complete dissociation between the atria and ventricles?

A

3rd degree AV block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are five causes of heart block?

A 
Acute MI
SLE
Endocarditis
Cardiomyopathy
Hypokalaemia/hypomagnesaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How is heart block treated?

A

Pacemaker

Acute bradycardia: atropine, isoprenaline/adrenaline, temporary pacing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What occurs in preserved ejection fraction heart failure?

A

Impaired LV relaxation - diastolic, normal LV ejection fraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Define reduced ejection fraction heart failure, and what it leads to.

A

Ejection fraction below 40%

Impaired contraction –> reduced cardiac output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Give three causes of high output heart failure?

A

Anaemia
Paget’s disease
Hyperthyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Low output heart failure is where output is decreased and fails to increase with exertion. Give the three types and an example.

A

Chronic excessive afterload: AS/HTN

Excessive preload: MR/fluid overload

Pump failure: systolic/diastolic failure, anti-arrhythmics are negatively ionotropic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How does acute heart failure present?

A

Pulmonary or peripheral oedema without peripheral hypoperfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Give five signs and symptoms of left ventricular failure.

A 
Dyspnoea/PND/orthopnoea
Poor exercise tolerance
Fatigue
Wheeze
Nocturnal cough with pink frothy sputum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Give five signs and symptoms of right ventricular failure.

A 
Peripheral oedema
Ascites
Pulsation in neck and face from tricuspid regurgitation
Nausea and anorexia
RV heave from PHTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How is heart failure initially investigated?

A

ECG and BNP

If any abnormalities, then echo and/or CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is seen on CXR in heart failure?

A 
Alveolar oedema
Kerley B lines (interstitial oedema)
Cardiomegaly
Dilated prominent upper lobe vessels
Pleural Effusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What criteria is used to diagnose congestive heart failure?

A

Framingham criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is the New York classification of heart failure?

A
  1. No dyspnoea but heart disease present
  2. Comfortable at rest, dyspnoea on ordinary activities
  3. Less than ordinary activity causes dyspnoea, which is limiting
  4. Dyspnoea present at rest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Why should alcohol be reduced in managing heart failure?

A

Can act as a negative inotrope, increases BP and risk of arrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the treatment of preserved ejection fraction heart failure?

A

Loop diuretic

Any other treatment of CV disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is the three step treatment of reduced ejection fraction heart failure?

A

1) ACEI and BB
2) Aldosterone antagonist/ARB/hydralazine AND nitrate
3) Digoxin/Ivabradine

Loop diuretic for fluid overload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Which drugs should be avoided in heart failure?

A

Verapamil, diltiazem, short acting dihydropyridine agents

49
Q

Which additional drug can be used in heart failure and when?

A

Sacubitril valsartan

For patients who are symptomatic on ACEIs or ARBs

50
Q

What is included in the acute coronary syndrome?

A

Unstable angina
NSTEMI
STEMI

51
Q

Name some non-modifiable risk factors for ACS.

A 
Male
FH of premature CHD
Premature menopause
Ethnicity: S.Asian
Increasing age
52
Q

What symptoms is ACS chest pain associated with?

A

Sweating
Nausea
Dyspnoea
Palpitations

53
Q

How might atypical ACS present?

A

Women and elderly

Abdo discomfort or jaw pain

54
Q

What are three signs of ACS?

A

Low grade fever
Hypo or hypertension
S3 and S4
Signs of CCF

55
Q

What is seen on ECG in ACS?

A

New ST segment elevation
Initially peaked T waves then T wave inversion
New Q waves

56
Q

What is seen on ECG in myocardial ischaemia?

A

ST depression

57
Q

What other investigations are important in ACS?

A 
FBC, potassium, magnesium, eGFR, lipid profile, CRP
Cardiac troponins T and I
Myocardial creatine kinase
CXR and Echo
Pulse oximetry and blood gases
Cardiac angiography
58
Q

What is the pre-hospital or initial management of ACS?

A

Oxygen
SL glycerol trinitrate
IV morphine
300mg Aspirin

59
Q

How is reperfusion achieved in STEMIs or NSTEMIs?

A

Primary PCI is superior to fibrinolysis

Before, give aspirin, ticagrelor, and unfractionated/LMW heparin

If not suitable, then fibrinolysis

60
Q

What is the treatment of patients post-MI?

A 
Clopidogrel and aspirin
Beta blocker
ACEI
Statin
Eplerenone if signs of HF
61
Q

What is the gold standard diagnosis of Prinzmetal’s angina?

A

Coronary angiography with provocative tests (ergonovine/acetylcholine/dopamine)

62
Q

Define postural hypotension.

A

Drop in BP>20/10mmHg within three minutes of standing

63
Q

Why does postural hypotension occur?

A

Normal pooling of the blood in the lower limbs is not correctly regulated by the CV system when moving to a vertical position

64
Q

Give five causes of postural hypotension

A 
Multi-system atrophy
Pregnancy
Diuretics/vasodilators
Aortic stenosis/AF
Heart failure
65
Q

When do you refer to cardiology in postural hypotension?

A

If the ECG is abnormal, or heart disease is suspected

66
Q

What self measures can be taken to improve postural hypotension?

A

Stand up slowly and dorsiflex the feet first
Cross legs whilst upright
Raise head of the bed
Morning caffeine

67
Q

What is the first line management of postural hypotension?

A

Increase intravascular fluid volume with large daily salt intake until weight has increased by 1.3-2.3kg

68
Q

What is second line management of postural hypotension?

A

Fludrocortisone 0.1-0.2mg/day

Still requires high salt diet and adequate fluid intake

69
Q

What is the main consequence of renal artery stenosis?

A

Renal hypoperfusion leads to hyperactivation of the renin-angiotensin-aldosterone axis, causing hypertension

70
Q

Give three causes of renal artery stenosis.

A

Atherosclerosis
Takayasu’s arteritis
Fibromuscular dysplasia of the renal artery - string of beads appearance on MR angiography

71
Q

Describe the hypertension of renal artery stenosis.

A

Abrupt onset and severe
Resistant to standard medical therapy
With hypokalaemia

72
Q

How else may renal artery stenosis present?

A

Decompensatoin of CCF in an already hypertensive patients e.g. flash pulmonary oedema

73
Q

What is the main finding of renal artery stenosis on examination?

A

Systolic-diastolic bruit heard over the flank

74
Q

How is RAS diagnosed?

A

U&Es, glucose, lipids
24h urinary protein excretion, presence of RBC
Duplex renal USS and Doppler
CT/MR angiography

75
Q

How is RAS managed?

A

Avoid ACEIs, ARBs, and other nephrotoxic drugs

Angioplasty with stenting

76
Q

Where are the most common locations for peripheral vascular disease?

A

Subclavian artery

Brachiocephalic trunk

77
Q

Give five possible symptoms of PVD.

A 
Intermittent claudication
Critical limb ischaemia
Skin ulceration
Paraesthesiae and coldness
Hair loss
78
Q

How is PVD diagnosed?

A

BP both arms difference>15mmHg
Duplex USS
Palpation of pulses
ABPI

79
Q

What are the different scores of the Ankle-brachial pressure index?

A

Normal=1
Claudication=0.6-0.9
Rest pain=0.3-0.6
Impending gangrene=0.3 or less

80
Q

How is PVD treated?

A

Antiplatelets
Peripheral vasodilators such as naftidrofuryl oxalate
Endovascular surgery

81
Q

What is ventricular tachycardia?

A

A broad complex tachycardia originating from a ventricular ectopic focus

Defined as 3+ ventricular extrasystoles in succession at a rate of more than 120BPM

82
Q

What are the types of VT?

A

Fascicular
Right ventricular outflow tract
Toursades des pointes
Polymorphic ventricular tachycardia

83
Q

What is the cause of VT?

A

Coronary and structural disease
Low K, Mg, Ca
Caffeine or cocaine

84
Q

How does VT present?

A

Symptoms of ischaemic heart disease, or haemodynamic compromise from poor perfusion

85
Q

What is seen on ECG in VT?

A

Rate 150-200BPM
Wide QRS complexes>120ms
AV dissociation
Fusion beats

86
Q

What is the treatment of pulseless VT?

A

Treated as for VF (CPR, assessment of rhythm, unsynchronised defibrillation)

Post cardiac arrest treatment:
ABCDE approach
SpO2 94-98%
12-lead ECG
Treat cause and control temp
87
Q

What is the treatment of unstable VT with reduced cardiac output?

A

Synchronised cardioversion

Advanced cardiac life support

88
Q

What is the treatment of haemodynamically stable VT?

A

IV 300mg Amiodarone/IV Lidocaine
2nd line cardioversion

If poor left ventricular dysfunction, then amiodarone

89
Q

How is VT prevented against in patients with a history?

A

Implantable cardioverter defibrillator

90
Q

What are the types of SVTs?

A

AV nodal re-entry tachycardia
AV re-entry tachycardia
Atrial tachycardia

91
Q

What are some causes of SVTs?

A

Accessory bypass pathways e.g. WPW is most well known type of AVRT
Fast conducting and slow conducting pathways
Abnormalities of impulse conduction

92
Q

What is seen on ECG during an attack of SVT?

A

P waves may not be visible

Short PR<0.12s and delta wave - WPW pattern, evidence of pre-excitation

93
Q

What is the treatment of haemodynamically unstable SVT?

A

DC cardioversion

94
Q

What is the treatment of haemodynamically stable SVT?

A

Vagal manoeuvres e.g. carotid massage or Valsalva
IV adenosine
Cardioversion 3rd line

95
Q

What is the function of adenosine and are there any contraindications?

A

Blocks conduction through the AV node

CI: severe asthma

96
Q

What is the ongoing management of SVT?

A

Radiofrequency ablation of the slow/accessory pathway

Rate limiting CCB, flecainide

97
Q

What are the symptoms of aortic stenosis?

A

Asymptomatic even if moderate (but still susceptible to SCD)

Dyspnoea on exertion, angina, syncope

98
Q

What are the signs of AS?

A

Pulsus parvus et tardus
Narrow pulse pressure
Crescendo-decrescendo systolic ejection murmur loudest at apex, 2nd IC space, radiation to carotids

99
Q

What is the gold standard diagnosis of valvular disease?

A

Echo with Doppler

100
Q

What is the treatment of AS?

A

Treat any HF

Aortic valve replacement

101
Q

What are the complications of calcific cardiac valves?

A

Infective endocarditis

Small systemic emboli

102
Q

What are the causes of aortic regurgitation?

A

Rheumatic heart disease
Bicuspid aortic valve
SLE

103
Q

What is the AR murmur?

A

Early diastolic murmur heard best in the aortic area, with the patient sitting forward and in expiration

104
Q

What is the treatment of AR?

A

Vasodilators and inotropic agents prior to aortic valve replacement

105
Q

What are the effects of mitral stenosis?

A

Increased left atrial and pulmonary arterial pressure, which leads to RV dilation and tricuspid regurgitation

106
Q

What are three causes of mitral stenosis?

A

Rheumatic fever
Degenerative calcification
Lutembacher’s syndrome

107
Q

How does mitral stenosis present?

A

AF, progressive dyspnoea, palpitations, haemoptysis
Malar flush, raised JVP, signs of RV failure

Mid-late diastolic murmur, best heard in left lateral position with bell

108
Q

What is the treatment of mitral stenosis?

A

Percutaneous mitral commissurotomy (balloon valvuloplasty)

109
Q

What is the murmur of mitral regurgitation?

A

Pansystolic murmur at the apex

110
Q

Which patients are at risk of having a silent MI?

A

Elderly

Diabetic

111
Q

When are Q waves pathological?

A

> 40ms (1mm) wide
2mm deep
Seen in leads V1-V3

112
Q

What are the symptoms of neutrally mediated (reflex) syncope?

A

Prodrome of sweating, pallor, nausea and vomiting

Transient loss of consciousness

113
Q

What is seen on ECG in hypothermia?

A

J waves - notch in the downward portion of the R wave in QRS complex

114
Q

Which beta blockers can be used in heart failure?

A

Bisoprolol
Carvedilol
Nebivolol

115
Q

What is stage 1 hypertension?

A

Clinic reading of 140/90 AND home reading of 135/85

116
Q

What is stage 2 hypertension?

A

Clinic reading of 160/100 AND home reading of 150/95

117
Q

When should stage 1 hypertension be treated?

A

Age under 80 and:

  • Q risk over 10%
  • diabetes/renal/CV disease
  • Target end organ damage
118
Q

Outline the management of hypertension for patients aged under 55 or type 2 diabetics.

A

1) ACEI/ARB
2) ACEI/ARB + CCB/thiazide like diuretic
3) ACEI/ARB + CCB + thiazide like diuretic
4) If K+ <=4.5, low dose spironolactone; if K+ >4.5, alpha or beta blocker

119
Q

What is the difference in management in Afro Caribbean patients or patients aged over 55 at presentation?

A

First step is a CCB

Phase 3B (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions