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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
Q

What are the X ray findings with someone in acute cardiac failure?

A 
ABCDE
A - alveolar opacity
B - Kerley B lines
C - cardiomegaly
D - dilated apical blood vessels
E - effusions
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26
Q

Pharmacological treatment of hypertension

A

ACEi (or ARB)
2nd line: + CCB or thiazide
3rd line: + CCB and thiazide

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27
Q

How long do troponins stay elevated for post MI?

A

7-10 days

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28
Q

Treatment algorithm for hypertension

A

1 ACEi, CCB or thiazide diuretic
2 ACEi or ARB + CCB or thiazide
3 ACEi or ARB + CCB + thiazide diuretic

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29
Q

Treatment algorithm for dyslipidaemia

A

1 Statin
2 Statin + ezetemibe (decreases chol absorption in gut)
3 Statin + ezetemibe + fibrate

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30
Q

Treatment algorithm for heart failure

A

1 ACEi
2 ACEi + beta blocker
3 ACEi + beta blocker + spironalactone

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31
Q

Hhere is the pain of aortic dissection classically localised to?

A

Interscapular

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32
Q

How is the quality of the pain of aortic dissection classically described?

A

Tearing

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33
Q

Which cause of chest pain is classically relieved by leaning forward?

A

Pericarditis

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34
Q

What is a positive Levine sign and what does it suggest?

A

Patient clenches fist over sternum when describing chest pain. Suggests cardiac pain.

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35
Q

Which cause of chest pain is worse on inspiration?

A

Pleuritic chest pain

36
Q

What is the classic defining feature of pleuritic pain?

A

Worse with inspiration

37
Q

What are the RFs for PE?

A

Travel, OCP, malignancy, surgery, immobility, steroids, FHx of factor V leiden mutation
MIS LOTS

38
Q

What is the treatment protocol for acute Mx of an AMI?

A

MONASH

morphine, oxygen, nitrates, aspirin, statin, heparin

39
Q

What is the treatment protocol for discharging someone who he just had an AMI?

A

SAAB
statin

ACEi

aspirin

beta blocker

40
Q

If you hear a murmur, where else should you auscultate?

A

Carotids and axilla

41
Q

Where will a murmur from aortic stenosis ‘radiate’ to on auscultation?

A

Carotid arteries

42
Q

Which murmur will radiate to the carotid arteries?

A

Aortic stenosis

43
Q

Where will a murmur from mitral regurgitation ‘radiate’ to on auscultation?

A

Axilla

44
Q

What triad of signs is found in cardiac tamponade? (called Beck’s triad)

A

Muffled heart sounds
Hypotension
Increased JVP

45
Q

What kind of LV hypertrophy occurs with mitral regurgitation?

A

Eccentric hypertrophy

46
Q

What type of murmur does aortic stenosis cause?

A

Ejection systolic (or crescendo-decresendo)

47
Q

Which valve event corresponds to S1?

A

Closure of AV valves (mitral and tricuspid)

48
Q

Where does the murmur of aortic stenosis radiate to?

A

Carotid arteries

49
Q

What kind of hypertrophy occurs with aortic stenosis?

A

Concentric hypertrophy

50
Q

What type of murmur does aortic regurgitation cause?

A

Early diastolic

51
Q

What happens to the apex beat in aortic stenosis?

A

It is heaving but not displaced

52
Q

What type of murmur does mitral regurgitation cause?

A

Pansystolic

53
Q

What is the best method to measure severity of aortic stenosis?

A

Echocardiography

54
Q

What kind of hypertrophy occurs with aortic regurgitation?

A

Eccentric hypertrophy

55
Q

If present, where will the thrill of aortic stenosis be felt?

A

Over upper right sternal edge

56
Q

What is the most common cause of aortic stenosis in Australia>

A

Calcification

57
Q

Rheumatic fever occurs after infection with which pathogen?

A

Strep pyogenes (Group A/ Beta haemolytic)

58
Q

Inspiration causes murmurs from which side of the heart to sound louder?

A

Right

59
Q

Expiration causes murmurs from which side of the heart to sound louder?

A

Left

60
Q

What are the 6 signs of severe AS?

A 
Pulmonary oedema
Weak pulse/slow rising carotid pulse
Narrow pulse pressure
S4
Soft or absent S2
A2/P2 reversal
61
Q

What is a typical EDV?

A

110 to 120ml (Guyton and Hall, 1996)

62
Q

What effects does parasympathetic stimulation of the heart have?

A

Decrease HR

63
Q

What effects does sympathetic stimulation of the heart have?

A

Increased heart rate and force of contraction

64
Q

What is the molecular target of heparin?

A

Heparin enhances activity of antithrombin III, which inhibits factor Xa and thrombin

65
Q

What is a typical ejection fraction?

A

60% (Guyton and Hall, 1996)

66
Q

What are 4 distinguishing features of the phrenic nerve course?

A

1 Runs along scalenus anterior muscle
2 Passes between subclavian artery and vein
3 Passes anterior to lung root
4 Pierce diaphragm

67
Q

Where does the parasympathetic nervous system innervate the heart?

A

SA node and AV node

68
Q

At the level of which thoracic vertebrae does the heart sit?

A

T5-T8

69
Q

Where is the sternal angle?

A

Horizontal line between manubriosternal joint and T4/T5

70
Q

What is a typical SV?

A

70ml (Guyton and Hall, 1996)

71
Q

What is the average heart mass of a healthy young adult?

A

160g

72
Q

How do Ca2+ channel blockers improve arrhythmias?

A

Reduce heart rate and conduction through SA and AV node

73
Q

Where does the sympathetic nervous system innervate the heart?

A

SA node, AV node and ventricles

74
Q

What percentage of the blood is in the veins?

A

65%

75
Q

What is the most lateral structure in the mediastinum?

A

Phrenic nerves

76
Q

At what vertebral level does the aorta pass behind the diaphragm?

A

T12

77
Q

What is a typical ESV?

A

40-50ml (Guyton and Hall, 1996)

78
Q

At what vertebral level does the inferior vena cava pass through the diaphragm?

A

T8

79
Q

Where does left anterior descending artery supply?

A

LAD supplies anterior surface and anterior 2/3 of interventricular septum

80
Q

Where does circumflex artery supply?

A

lateral wall of LV

81
Q

Where does posterior interventricular artery supply?

A

Inferior part of LV and posterior 1/3 of interventricular artery

82
Q

How soon after an AMI must repurfusion be to be effective?

A

6 hours

83
Q

Which artery most commonly supplies the atrio-

ventricular node?

A

Right coronary artery

84
Q

Which bacteria classically causes subacute bacterial endocarditis?

A

Viridans strep

85
Q

What is empirical Rx for infective endocarditis?

A

BFG = Big Friendly Giant

Benzylpenicillin
Flucloxacillin
Gentamicin

86
Q

What are the two most important Ix for infective endocarditis?

A

ECHO and blood cultures

87
Q

What type of murmur does infective endocarditis typically cause?

A

Regurgitant

Nick's MD2 (21 decks)

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