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Nick's MD2 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Which drugs are used for rhythm control in AF?

A

Amiodarone, flecanide, sotolol

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2
Q

What drugs are used to treat hyperkalaemia?

A

Calcium gluconate

Insulin + dextrose

Risonium

Ventolin (nebulised)

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3
Q

Which drugs are used for rate control in AF?

A

Beta blockers, CCB or digoxin

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4
Q

What are the treatments for SVT?

A

Vagal manoeuvre (eg blow into syringe)

  • -> Adenosine
  • -> CCB eg verapamil
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5
Q

Rx for AMI?

A 
MONA
Morphine IV
Oxygen if SpO2 less than 95%
Nitrates
Aspirin 300mg
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6
Q

What are some common causes of AF?

A

IS HIP AF

Infarction
Stress eg post surgery

Hypoxia
Infection
PE

Anaemia
Fluid and electrolyte imbalance

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7
Q

What are 3 causes of SVT?

A

Atrial flutter, junctional tachycardia or AF

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8
Q

What is the treatment for pericarditis?

A

NSAIDs

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9
Q

How does pericarditis appear on ECG?

A

Global ST elevation

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10
Q

Which drug regime should be used for hypertension in DM?

A

CCB + ACEi

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11
Q

What is the drug regime for HTN + heart failure?

A

Beta blocker + ACEi

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12
Q

What is the drug regime for HTN post AMI?

A

ACEi + beta blocker

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13
Q

How does digoxin work?

A

Increases vagal tone thus parasympathetic drive

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14
Q

What does CHADSVASC stand for?

How do you decide whether to anticoagulate or not?

A 
CCF
Hypertension
Age older than 75 = 2 points
DM
Stroke previously = 2 points
Vascular disease (PVD, aortic plaque, MI)
Age 65-74 
Sex (female = 1)

Anticoagulate if 2 points or more
If male: 1 point maybe coagulate

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15
Q

How is HASBLED calculated and what score indicates increased risk of bleeding?

A

Hypertension 160/90 or on treatment
Abnormal renal (1 point) or liver function (1 point)
Stroke
Bleeding (prior major bleeding or predisposition to bleeding)
Labile INRs
Elderly >65
Drugs (aspirin, anticoagulants 1 point) or alcohol (1)

If 3 or more, indicates greater risk of bleeding

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16
Q

What does a large v wave of JVP suggest?

A

Tricuspid regurgitation

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17
Q

What are the signs of tricuspid regurgitation?

A 
Pulsatile liver
Raised JVP (large V wave)
Right ventricular heave
Pansystolic murmur
Jaundice
Ascites
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18
Q

pharmacological approach to CHF with reduced LVEF

A

Beta blocks
ACEi
Diuretics
digoxin and nitrates for refractory Sx

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19
Q

signs of Aortic regurgitation

A

collapsing pulse

wide pulse pressure

early diastolic murmur

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20
Q

What CXR sign points towards aortic dissection?

A

Widened mediastinum

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21
Q

Treatment of acute pulmonary oedema?

A 
LMNOP
Lasix
Morphine
Nitrates
O2
Positioning
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22
Q

What is 3rd degree heart block?

A

Complete dissociation of the QRS from the p wave

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23
Q

What is the concern about long QT interval?

A

Can predispose to torsades de pointe

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24
Q

What are the shockable rhythms?

A

VT and VF

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25
What are the X ray findings with someone in acute cardiac failure?
``` ABCDE A - alveolar opacity B - Kerley B lines C - cardiomegaly D - dilated apical blood vessels E - effusions ```
26
Pharmacological treatment of hypertension
ACEi (or ARB) 2nd line: + CCB or thiazide 3rd line: + CCB and thiazide
27
How long do troponins stay elevated for post MI?
7-10 days
28
Treatment algorithm for hypertension
1 ACEi, CCB or thiazide diuretic 2 ACEi or ARB + CCB or thiazide 3 ACEi or ARB + CCB + thiazide diuretic
29
Treatment algorithm for dyslipidaemia
1 Statin 2 Statin + ezetemibe (decreases chol absorption in gut) 3 Statin + ezetemibe + fibrate
30
Treatment algorithm for heart failure
1 ACEi 2 ACEi + beta blocker 3 ACEi + beta blocker + spironalactone
31
Hhere is the pain of aortic dissection classically localised to?
Interscapular
32
How is the quality of the pain of aortic dissection classically described?
Tearing
33
Which cause of chest pain is classically relieved by leaning forward?
Pericarditis
34
What is a positive Levine sign and what does it suggest?
Patient clenches fist over sternum when describing chest pain. Suggests cardiac pain.
35
Which cause of chest pain is worse on inspiration?
Pleuritic chest pain
36
What is the classic defining feature of pleuritic pain?
Worse with inspiration
37
What are the RFs for PE?
Travel, OCP, malignancy, surgery, immobility, steroids, FHx of factor V leiden mutation MIS LOTS
38
What is the treatment protocol for acute Mx of an AMI?
MONASH | morphine, oxygen, nitrates, aspirin, statin, heparin
39
What is the treatment protocol for discharging someone who he just had an AMI?
SAAB statin ACEi aspirin beta blocker
40
If you hear a murmur, where else should you auscultate?
Carotids and axilla
41
Where will a murmur from aortic stenosis 'radiate' to on auscultation?
Carotid arteries
42
Which murmur will radiate to the carotid arteries?
Aortic stenosis
43
Where will a murmur from mitral regurgitation 'radiate' to on auscultation?
Axilla
44
What triad of signs is found in cardiac tamponade? (called Beck's triad)
Muffled heart sounds Hypotension Increased JVP
45
What kind of LV hypertrophy occurs with mitral regurgitation?
Eccentric hypertrophy
46
What type of murmur does aortic stenosis cause?
Ejection systolic (or crescendo-decresendo)
47
Which valve event corresponds to S1?
Closure of AV valves (mitral and tricuspid)
48
Where does the murmur of aortic stenosis radiate to?
Carotid arteries
49
What kind of hypertrophy occurs with aortic stenosis?
Concentric hypertrophy
50
What type of murmur does aortic regurgitation cause?
Early diastolic
51
What happens to the apex beat in aortic stenosis?
It is heaving but not displaced
52
What type of murmur does mitral regurgitation cause?
Pansystolic
53
What is the best method to measure severity of aortic stenosis?
Echocardiography
54
What kind of hypertrophy occurs with aortic regurgitation?
Eccentric hypertrophy
55
If present, where will the thrill of aortic stenosis be felt?
Over upper right sternal edge
56
What is the most common cause of aortic stenosis in Australia>
Calcification
57
Rheumatic fever occurs after infection with which pathogen?
Strep pyogenes (Group A/ Beta haemolytic)
58
Inspiration causes murmurs from which side of the heart to sound louder?
Right
59
Expiration causes murmurs from which side of the heart to sound louder?
Left
60
What are the 6 signs of severe AS?
``` Pulmonary oedema Weak pulse/slow rising carotid pulse Narrow pulse pressure S4 Soft or absent S2 A2/P2 reversal ```
61
What is a typical EDV?
110 to 120ml (Guyton and Hall, 1996)
62
What effects does parasympathetic stimulation of the heart have?
Decrease HR
63
What effects does sympathetic stimulation of the heart have?
Increased heart rate and force of contraction
64
What is the molecular target of heparin?
Heparin enhances activity of antithrombin III, which inhibits factor Xa and thrombin
65
What is a typical ejection fraction?
60% (Guyton and Hall, 1996)
66
What are 4 distinguishing features of the phrenic nerve course?
1 Runs along scalenus anterior muscle 2 Passes between subclavian artery and vein 3 Passes anterior to lung root 4 Pierce diaphragm
67
Where does the parasympathetic nervous system innervate the heart?
SA node and AV node
68
At the level of which thoracic vertebrae does the heart sit?
T5-T8
69
Where is the sternal angle?
Horizontal line between manubriosternal joint and T4/T5
70
What is a typical SV?
70ml (Guyton and Hall, 1996)
71
What is the average heart mass of a healthy young adult?
160g
72
How do Ca2+ channel blockers improve arrhythmias?
Reduce heart rate and conduction through SA and AV node
73
Where does the sympathetic nervous system innervate the heart?
SA node, AV node and ventricles
74
What percentage of the blood is in the veins?
65%
75
What is the most lateral structure in the mediastinum?
Phrenic nerves
76
At what vertebral level does the aorta pass behind the diaphragm?
T12
77
What is a typical ESV?
40-50ml (Guyton and Hall, 1996)
78
At what vertebral level does the inferior vena cava pass through the diaphragm?
T8
79
Where does left anterior descending artery supply?
LAD supplies anterior surface and anterior 2/3 of interventricular septum
80
Where does circumflex artery supply?
lateral wall of LV
81
Where does posterior interventricular artery supply?
Inferior part of LV and posterior 1/3 of interventricular artery
82
How soon after an AMI must repurfusion be to be effective?
6 hours
83
Which artery most commonly supplies the atrio- | ventricular node?
Right coronary artery
84
Which bacteria classically causes subacute bacterial endocarditis?
Viridans strep
85
What is empirical Rx for infective endocarditis?
BFG = Big Friendly Giant Benzylpenicillin Flucloxacillin Gentamicin
86
What are the two most important Ix for infective endocarditis?
ECHO and blood cultures
87
What type of murmur does infective endocarditis typically cause?
Regurgitant

Nick's MD2 (21 decks)

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