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Cardiology 2 Flashcards

1
Q

What drug should all potential ACS patients be started on regardless of aetiology?

A

Aspirin 300mg

this is given regardless if it is actually an ACS

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2
Q

Name the two murmurs which are ejection systolic and louder on inspiration?

A

Pulmonary stenosis

Atrial septal defect

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3
Q

What is Bifurans pulse and what is it associated with?

A

When palpating the pulse there feels like a double pulse.

Anything aortic related can cause it: -

  • aortic stenosis
  • aortic regurgitation
  • Obstructive cardiomyopathy
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4
Q

What is the criteria for angina?

A

Reproducible pain on exercise

Central chest pain

Relieved by GTN spray

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5
Q

What ambulatory home reading of BP do you always treat?

A

Any age over >150/95 you should treat

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6
Q

What is the management should thrombolysis fail?

A

If still symptomatic and ST elevation stil present then PCI should be conducted

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7
Q

In the setting of a suspected P.E, if a CTPA comes back negative, what should the next investigation be?

A

US of the proximal legs to search for DVT

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8
Q

Which drug is contraindicated in VT?

A

Calcium channel blockers

- reduces contractibility too much

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9
Q

If a pateint is unstable with Fast AF and has signs of ischemia (ST elevation) what is your initial management?

A

DC Cardioversion

- you cannot start PCI etc without first stabilising rhythm

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10
Q

What is the S3 sound and S4 Sound?

A

S3: Abnormal flow of blood into an already distended ventricle. Sound of turbulence as two bodies of blood mix
- first sound of heart failure

S4: A atrium struggling to force blood into a stiff ventricle during late diastole. The ventricle does not want to stretch.
- often heard alongside an S3 which causes a galloping rhythm

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11
Q

What type of splitting is heard in Atrial septal defect?

A

Fixed splitting of second heart sound

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12
Q

What are the two broad aetiologies of a wide splitting of S2?

A

Delay in P2 closure:

  • RBBB
  • Pulmonary stenosis

Early closure of A2:

  • Mitral valve regurgitation
  • Ventricular septal defect
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13
Q

What is a useful mnemonic for remember CHA2DS2VACS score?

A

A score used to assess the need for anti-coagulation. Often used in the context of AF.

Mnemonic: 
SADCHAVS 
- Stroke (2 points) 
- Age 75 (2 points) 
- Diabetes 
- Congestive heart failure 
- Hypertension 
- Age 65 
- Vascular history 
- Female
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14
Q

What is the complication that can occur with a inferior STEMI leading to bradycardia:

A

third degree heart block

- QRS may be narrow or wide depending where the escape rhythm is

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15
Q

List some common viruses which cause pericarditis:

A

Coxsackieviruse virus

Mumps

Rubella

Hep B

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16
Q

What are some risk factors for aortic dissection?

A

Atherosclerotic aneurysm disease

Smoking

Ehler’s -Danlos syndrome

Marfan’s syndrome

Co-arctation

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17
Q

What is the diagnostic test of choice for a suspected aortic dissection, and what test can be done if the patient is not stable enough?

A

CT angiogram of Chest/ Abdomen/ Pelvis

TOE should be conducted if too unstable

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18
Q

How should an aortic dissection be managed?

A

Type A:

  • Oxygen
  • IV access - with bloods off
  • IV labetalol to reduce Blood pressure
  • try stabilise blood pressure to 100-120mmHg
  • GTN
  • Morphine

*open surgery or endovascular graft stent repair

Type B:

  • Bed rest
  • Labetalol blood pressure control
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19
Q

What are some of the complications of aortic dissection?

A

Aortic regurgitation

M.I

Peripheral ischemia

  • AKI
  • Mesenteric

Paralysis
- anterior spinal artery can be compromised

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20
Q

What is the wave called in WPW syndrome?

A

Delta wave

*there is also a reduced PR interval

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21
Q

What heparin is given for NSTEMI and for STEMI?

A

LMWH for NSTEMI

Unfractionated for STEM

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22
Q

What are the general aetiologies of the heart block?

A

Type I and Mobitz type I are medical causes

Type II Mobitz and third degree heart block are structural due to ischemia usually

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23
Q

When are U waves seen?

A

Hypokalaemia

Bradycardia
- can be seen as a normal in certain individuals

24
Q

What are the indications for CABG, where should you look for scars and what vessels may be used?

A

Indications:

  • Triple vessel disease
  • Critical left main stem disease (>50% stenosis)
  • Heart failure/ poor LV function

Midline sternotomy scar.
Saphenous scar.

Other vessels which may be used:
- Left Internal mammary artery (LIMA)

25
Q

What are the common complications of CABG?

A 
Bleeding 
Arrhythmia 
Stroke 
Poor cardiac output 
Wound infections
26
Q

What may occur in endocarditis which leads to bradycardia?

A

Abscess formation

- compressing on the AV node leading to heart block

27
Q

What drugs are given for hyperkalaemia and what are the ECG findings?

A

Calcium carbonate - 10% in 10mls over 10mins
Salbutamol
Insulin and Dextrose
Calcium resonium for absorptions

ECG:

  • tall tented T waves
  • PR elongation
  • Widening of QRS
  • Sinusiodol wave formation
28
Q

What are some causes of hyperkalaemia?

A 
Renal Failure 
K+ sparing drugs 
Rhabdomyolysis 
Metabolic Acidosis 
Massive blood transfusion 
Addison's disease
29
Q

What features would make PCI non-favourable?

A

Extreme stenosis
Tortuous vessels
Blockage near entrance to vessel

30
Q

What are the causes of mitral valve prolapse following an M.I and how is it diagnosed?

A

M.I of posterior wall causing dysfunctional papillary muscle

M.I of papillary muscle

TOE is needed for diagnosis and urgent surgery is required.

31
Q

What are the types of M.I and list several things that can increase you’re troponin not related to an M.I:

A 
Type: I - thromboembolic 
Type II - Arrhythmias, high output 
Type III - Sudden death 
Type IV - PCI 
Type V - Surgery related

Troponin rises:

  • Chronic renal failure
  • Sepsis
  • P.E
  • Tachyarrhythmias
  • Aortic dissection
32
Q

What is the classification system used to assess heart failure in patients post M.I and list some other common complications following an M.I:

A

Killip classification
- prognostic indicator of heart failure following an M.I

Common complications:

  • Myocardial Rupture
  • VSD
  • Arrhythmias
  • Mitral regurgitation
  • Dressler’s syndrome
  • Psychological effect
33
Q

Where do the coronaries branch off the aorta?

A

Aortic sinuses

- just above the valves

34
Q

What is the definitions of a STEMI?

A

ST elevation of >2mm in chest leads, 1mm in limb leads
or
New Left Bundle branch block

**this is why its so important to look at previous ECGs

35
Q

What other biochemical markers could be tested for in ACS other than troponins?

A

CK

LDH

36
Q

Advice to patient post M.I?

A 
Cardiac rehabilitation 
Smoking cessation 
Diet 
Work return in 1-2 months 
Driving 4 weeks (unless PCI where 1 week) 
Vigorous exercise is graded 
Sex - 2/4 weeks
37
Q

What blood tests and investigations do you want into AF?

A

FBC - infection?
U&Es - Electrolyte dysfunction?
Troponins - Ischemia/ M.I?
TFTs - Thyrotoxicosis

CXR - pneumonia causes it?
Echocardiogram
- assess for chamber sizes and valvular pathologies

38
Q

If a patient is unstable with AF - what is the management?

A

DC cardioversion

  • irrespective of Anti-coagulation
  • do not delay in order to anti-coagulate

*if clinical appropriate a TOE can be conducted to assess

39
Q

What are the types of AF?

A

Acute onset <48 hours

Chronic:

  • Paroxysmal (<7 days but reoccurs)
  • Persistent (>7 days and reoccurs)
  • Permanent (never goes away)
40
Q

What is the newyork classification of heart failure?

A

I: Heart disease present but no symptoms
II: Comfortable at rest. dysnpea on normal activities
III: Comfortable at rest but marked symptoms on mimimal activities
IV: Dyspnea at rest

41
Q

List 4 features of Left ventricular heart failure:

A 
Fatigue 
Dyspnea 
Paroxysmal nocturnal dyspnea 
Orthopnea 
Cardiac wheeze 
Frothy - sputum/ cough
42
Q

What hormone is significantly risen in heart failure?

A

NT - Pro-BNP

43
Q

Electrolyte abnormalities of Furosemide?

A

Hypo:
Na2+/ K+/ Ca2+/ Mg+

Hyperucaemia

44
Q

What two electrolyte abnormalities does Digoxin cause?

A

Hyperkalamia

Hyponatramia

Metabolic acidosis

45
Q

What are some important abnormal waves to be aware of in the JVP?

A

Large A wave
- Fullness in atrium (HF, pulmonary stenosis)

Large V wave (last wave)
- Tricuspid regurgitation

46
Q

How would you investigate ischemic heart disease/ Angina?

A 
ECG 
CT angiogram - 1st line investigation 
Functional imaging 
- stress echo 
- Cardiac MRI

Bloods

  • FBC
  • U&Es
  • Lipids
  • HbA1c
  • TFTs
47
Q

What are the findings on ECG of WPW syndrome? and how is it managed?

A

ECG findings:

  • upsloping QRS - delta wave
  • Shortened PR
  • Flipped T wave
  • note that it may only appear with SVT and need to be slowed to be seen

Management:
- Radio ablation - definitive

medical Management:

  • amiodarone
  • Flecainide
  • beta blockers (which are contraindicated if AF)
48
Q

What are the specific leads of the chest?

A

V1 - V2 = septal leads

V3-V4 = Anterior Leads

V5- V6 = Lateral leads

*typically V1-V4 are called the anterior-septal leads

49
Q

What are the indications for a heart transplant in the setting of heart failure?

A

Severe functional impairment

Dependence on IV inotropic

Recurrent life threatening arrhythmias

Angina not responding to any medical therapy

50
Q

Why does the thickness of the heart increase in heart failure?

A

Laplace’s Law:

Decreases tension.

Equation is:
Tension = Pressure x Radius / Thickness

increased pressure due to increased volume and reduced ability to get rid of fluid. therefore increase the thickness reduces the tension

51
Q

Define heart failure:

A

Abnormal cardiac function which results in the inability of the heart to meet the metabolic needs of the body resulting in:

  • breathlessness
  • Fatigue
  • Oedema
52
Q

When starting sacubitril and valsartan what must be done with a particular medication?

A

Discontinue ACE inhibitor

53
Q

List some signs of heart failure:

A 
Orthopnoea 
Paroxysmal nocturnal dyspnoea
Oedema 
Hepatomegaly 
Ascites
Raised JVP 
Displaced Lateral Apex beat - ventricular enlargement 
Gallop rhythm (S3 and S4)
54
Q

List some causes and signs of Pulmonary hypertension:

A

Pulmonary hypertension >25mmHg

  • idiopathic
  • Connective tissue disease
  • Chronic lung disease (remodels the epithelium increasing resistance)
  • Left sided heart failure (systolic dysfunction)
  • ASD/ VSD
  • Haemolotolgical disease (polycyethmia)

Signs:

  • Congestion signs (JVP, hepatomegaly etc)
  • left parasternal heaves
  • Loud P2 (pulmonary valve snapping shut)
  • Soft Pansystolic murmur (tricuspid regurgitation)
55
Q

What are some causes of reduced ejection fracture and preserved ejection fracture heart failure?

A

Reduced ejection fracture:

  • Ischaemic heart disease (atherosclerosis)
  • Post M.I
  • Dilated cardiomyopathy
  • younger patients
  • males

Preserved ejection fracture:

  • Long term hypertension
  • Aortic stenosis
  • obstructive cardiomyopathy
  • constrictive cardiomyopathy
  • older patients
  • females

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