Cardiology Flashcards
1
Q
hypertension is a risk factor for
A
Stroke - ischaemic and haemorrhagic MI HF CKD Cognitive decline Premature death Peripheral vascular disease
2
Q
What are optimal, normal and high blood pressures
A
Optimal < 120 / 80
Normal 120 - 139 / 80-89
high >140/90
3
Q
How often should healthy patients have BP checked routinely
A
At least every 5 years until age 80
4
Q
Define postural hypotension
A
A fall in SBP >20mmHg
5
Q
1st step in investigation once BP >140/90
A
Ambulatory BP monitoring / at home BP monitoring
Assess CV risk and target organ damage
6
Q
Define stage 1, 2 and 3 hypertension
A
Stage 1 - 140-159 /90-99
Stage 2 - 160-179 /100-109
Stage 3 - >179
7
Q
Features suggesting phaeochromocytoma
A
Labile / postural hypertension Headache Palpitations Pallor Diaphoresis (excessive sweating)
8
Q
1st line anti-hypertensives in over 55s
A
Calcium channel blocker
9
Q
2nd line anti-hypertensives in over 55s
A
Calcium channel blocker
AND
Ace inhibitor / angiotensin receptor blocker
10
Q
2nd line anti-hypertensives in under 55s
A
Ace inhibitor / angiotensin receptor blocker
AND
calcium channel blocker
11
Q
3rd line anti-hypertensives
A
Ace inhibitor / angiotensin receptor blocker AND Calcium channel blocker AND Diuretic (thiazide-like)
12
Q
CV risk factors
A
> 75 yo Male CV disease Hypertension Hypercholesterolaemia DM Smoking Obesity Sedentary lifestyle Familial hypercholesterolaemia Peripheral vascular disease Polycythaemia rubra Vera LV hypertrophy
13
Q
Lifestyle interventions In Hypertension
A
Diet Exercise Relaxation Decrease alcohol Decrease caffeine Decrease salt Smoking cessation
14
Q
Examples of ACE inhibitors
A
Ramipril Captopril Enalapril Lisinopril Perindopril
15
Q
SE of ace inhibitors
A
Dry cough (^bradykinin)
Rare - angioedema, proteinuria, neutropenia
Can –> CRF in bilateral RAS
16
Q
Examples of angiotensin II receptor blocker
A
Losartan
Valsartan
Candesartan
17
Q
Examples of calcium channel blockers
A
Amlodipine
Nifedipine
Nimodipine
Felodipine
18
Q
SE of calcium channel blockers
A
Dizziness, hypotension, flushing, ankle oedema
19
Q
Examples of thiazide-like diuretics
A
Chlorothiazide
Chlortalidone
Indapamide
20
Q
Examples of thiazide diuretics
A
Bendroflumethiazide
Hydrochlorothiazide
21
Q
When may beta-blockers be considered
A
- intolerance of ACEi and ARB
- F of childbearing age
- pt with increased sympathetic drive
22
Q
most common cause of hypertension
A
essential hypertension
80-90%
23
Q
Factors contributing to essential hypertension
A
genetic fetal - low birth weight environmental - obestity - alcohol intake - sodium intake - stress insulin resistance
24
Q
causes of secondary hypertension
A
renal disease endocrine disorders congenital coarctation of the aorta drugs pregnancy
25
renal causes of secondary hypertension
```
Diabetic nephropathy
Chronic glomerulonephritis
Adult polycystic kidney disease
Chronic tubulointerstitial disease
renovascular disease
```
26
endocrine causes of secondary hypertension
```
Conn's Syndrome
Adrenal hyperplasia
Phaeochromocytoma
Cushing's syndrome
Acromegally
```
27
Define malignant hypertension
Rapid increase in BP to severe levels >180/120
Associated with end organ failure.
E.g. Renal failure, encephalopathy.
28
Effects of malignant hypertension
Fibrinogen necrosis of vessel wall
Progressive renal failure, proteinuria and haematuria
Retinal haemorrhages, cotton wool spots, hard exudates and papilloedema
Untreated - 80% die within 1 year
29
What commonly causes a slow rising pulse
Aortic stenosis
30
What commonly causes a collapsing pulse
Aortic regurgitation
31
Causes of a bounding pulse
CO2 retention
hepatic failure
sepsis
32
Cause of radiofemoral delay
Coarctation of the aorta
33
Causes of pulsus paroxidus
```
cardiac tamponade
pericarditis
chronic sleep apnea
croup
asthma
COPD
```
34
Caused of raised, fixed JVP
Superior vena cava obstruction
35
JVP raising on inspiration
Cardiac tamponade
| Constrictive pericarditis
36
Cause of cannon 'a' waves in JVP
Complete heart block
Atrioventricular (AV) dissociation
Ventricular arrhythmias
37
Signs of Mitral stenosis
Tapping apex beat
Loud first heart sound
Rumbling mid-diastolic murmur at apex (louder in left lateral position on expiration)
38
Signs of Aortic regurgitation
Wide pulse pressure
Displaced, volume-overloaded apex beat
Early diastolic murmur at lower sternal edge (best heard in expiration leaning forward)
39
Signs of Mitral regurgitation
Displaced, volume overloaded apex beat
Soft first heart sound
Pansystolic murmur at apex radiating to axilla (louder in expiration)
40
Signs of Aortic stenosis
Narrow pulse pressure
Heaving undisplaced apex beat
Soft second heart sound
Ejection systolic murmur heard in aortic area radiating to carotids and apex
41
Signs of a Ventricular septal defect
Harsh pansystolic murmur lower left sternal edge
| Left parasternal heave
42
What is the difference between Osler’s nodes and Janeway’s lesions.
In what condition do they occur?
Osler’s nodes = painful hard swellings on fingers/toes
Janeway’s lesions = painless erythematous blanching macules seen on palmar surface
In Infective Endocarditis
43
Most common complications of acute MI
```
Sudden death
Arrhythmia
Cardiogenic shock
HF
Cardiac rupture
Pericarditis
Depression / anxiety
```
44
Inferior ECG leads
II, III, aVF
45
Anterior ECG leads
V2-V4
46
Possible symptoms of acute AF
```
Asymptomatic
Palpitations
HF
angina
SOB
Embolic episodes
```
47
ECG features of AF
No clear p waves
Baseline fibrillation
Rapid and irregularly irregular QRSs
48
Management of AF
Treat precipitating cause e.g. Hyperthyroidism
Acute = Rate control or Cardioversion
Long term = warfarin + rate /Rhythm control
49
Major and moderate risk factors in AF which indicate anticoagulation (not chads vasc)
```
Major = prosthetic valve / rheumatic mitral valve disease / past stroke or TIA
Moderate = >75 / hypertension / HF / DM
```
50
What is CHADS VaSc
```
Congestive HF = 1
Hypertension = 1
Age >75 = 2
65-74 = 1
DM = 1
Stroke = 2
Vascular dis. = 1
Sex - F = 1
```
51
What is the most common cause of secondary hypertension?
Renal disease
| E.g. Renal artery stenosis, glomerulonephritis
52
Management of AF lasting > 48 hours
Anticoagulate the patient With warfarin for one month.
Then attempt cardioversion.
Then continue warfarin for 1 more month.
Rate control with beta-blocker or calcium channel blocker.
53
Management of severely compromised acute persistent AF
Immediate DC shock
| Heparin
54
What drug would aid the diagnosis of an unidentifiable regular narrow complex tachycardia?
Adenosine
Causes AV block -Short half life
(Can cause chest pain)
55
What is torsade de pointes?
Ventricular tachycardia with varying QRS axis and a prolonged QT interval
56
What may Torsade de pointes degenerate into?
Ventricular fibrillation
| Leading to cardiac arrest
57
Causes of torsade de pointes?
Drugs,
electrolyte disturbance,
congenital long QT syndrome.
58
Treatment of torsade de pointes?
IV magnesium sulphate.
Ventricular pacing.
Correct hypokalaemia.
59
Management of malignant hypertension?
Gradual uncontrolled production of BP
Labetalol.
60
What causes a slow rising pulse?
Aortic stenosis
61
Collapsing pulse
Aortic regurgitation
62
Bounding pulse
Acute CO2 retention
Hepatic failure
Sepsis
63
Radio femoral delay
Coarctation of aorta
64
What causes Pulsus bisferiens
Mixed aortic valve disease
| HOCM
65
What causes Pulsus paradoxus
Constrictive pericarditis
| Cardiac tamponade
66
What is pulsus bisferriens
Double pulse
67
What is Pulsus paradoxus
Abnormally large decrease in SBP and pulse during inspiration.
68
What is pulsus alternans
Alternating strong and weak beats
69
What causes pulsus alternans
Left ventricular systolic impairment (Heart failure)
| Poor prognosis.
70
Cause of a raised fixed JVP
SVC obstruction
71
JVP rising on inspiration
Cardiac tamponade
| Constructive pericarditis
72
Large v waves on JVP
Tricuspid regurgitation
73
Absent a waves on JVP
AF
74
Canon a waves on JVP
AV Dissociation
| Ventricular Arrhythmia
75
Cardiac condition associated with malar flush
Mitral stenosis
76
Cardiac condition associated with pulsatile hepatomegally
Tricuspid regurgitation
77
Cardiac condition associated with carotid pulsation (corrigan's sign)
Aortic regurgitation
78
Cardiac condition associated with head nodding (De Musset's sign)
Aortic regurgitation
79
Cardiac condition associated with Capillary pulsations in nailbed (quincke's sign)
Aortic regurgitation
80
Cardiac condition associated with Pistol shot heard over femorals (Traube's sign)
Aortic regurgitation
81
Cardiac condition associated with Roth spots (Boat shaped retinal haemorrhage)
Infective endocarditis
82
What are Oslers nodes
Painful hard swellings on fingers or toes
83
What are janeway lesions
Painless erythematous blanching macula on palmar surface of hand
84
Features of ASD
Wide, fixed, split 2nd heart sound
| Ejection systolic murmur in 3rd ICS
85
Patent ductus arteriosus
Continuous machinery murmur below L clavicle
86
Features of transposition of the great vessels
Cyanosis on 1st day of life
| X-ray = egg shaped ventricles
87
Features of tetralogy of fallot
Cyanosis in 1st month of life
| X-ray= boot shaped heart
88
Saw tooth ECG occurs in:
Atrial flutter
89
Absent p waves on ECG occurs in:
Atrial fibrillation
| Sinoatrial block
90
Bifid P-wave on ECG occurs in:
Left atrial hypertrophy (mitral stenosis)
91
Peaked p wave on ECG occurs in:
R atrial hypertrophy (Pulmonary hypertension, tricuspid stenosis)
92
ST depression on ECG occurs in:
MI
93
ST elevation on ECG occurs in:
MI
| LV aneurysm
94
Saddle shaped ST elevation on ECG occurs in:
Constrictive pericarditis
95
sI, qIII, tIII on ECG occurs in:
PE
96
Tented T-waves on ECG occurs in:
Hyperkalaemia
97
Flattened t waves + prominent u waves on ECG occurs in:
Hypokalaemia
98
Long Q-T interval on ECG occurs in:
Hypocalcaemia
Inherited (Romano-ward and Jervell Lange-Nielsen)
Drugs (antihistamines, diuretics, antibiotics, anti-depressants, anti-psychotics)
Hyponatraemia
99
What is wergener's granulomatosis
Small artery vasculitis
100
Features of wergener's granulomatosis
Vasculitis
Granuloma deposition
Involves URT, lungs and kidneys.
Eye signs in 50%
101
What is the Ziehl-neelsen stain positive for
TB
102
What is carotid sinus syncope?
Increased sensitivity to external pressure
| Leads to syncope on head turning.
103
What 2 cardiac conditions cause syncope on exertion?
Aortic stenosis
| HOCM
104
What is pre-syncope + it's symptoms
Presyncope is a state consisting of lightheadedness, muscular weakness, and feeling faint.
Nausea, sweating, ringing in ears.
105
What are triggers for vaso-vagal syncope
Heat
Fear
Stress
(Excessive activation of parasympathetic NS)
106
What happens after a vaso-vagal syncope?
Rapid recovery
107
What is situational syncope
Vasovagal episodes triggered by specific situations.
| E.g. Coughing, urinating, having blood taken
108
Routine invitations in suspected vaso-vagal syncope
```
Full hx
Collateral hx
ECG
Blood glucose
Lying and standing BP
```
109
What is Wolff-Parkinson-White syndrome
Abnormal accessory conduction pathway connecting atria to ventricles = bundle of Kent.
Accessory pathway conducts faster than AV node
-> supra-ventricular re-entrant tachycardia / VT / VF
110
Syx of Wolff-Parkinson-white syndrome
```
Dizziness
Palpitations
Chest pain
Syncope
Sudden cardiac death
```
111
ECG changes in Wolff-Parkinson-white syndrome
Short PR
Wide QRS
Slurred upstroke of the R wave (delta wave)
112
Between which heart sounds does diastole occur?
Between s2 and s1
113
Between which heart sounds does systole occur?
Between s1 and s2
114
What causes s1 heart sound?
Mitral and tricuspid closure
115
What causes s2 heart sound?
Pulmonary and aortic valve closure
116
Why does a 4th heart sound occur?
Atrial contraction into a non-compliant or hypertrophied ventricle.
Occurs in HF, MI, cardiomyopathy, hypertension
Always abnormal
Le-lub dub
117
Why does a 3rd heart sound occur?
Normal in children / young adults / pregnancy
Rapid filling if ventricles
Can occur in a stiff or dilated ventricle e.g. HF, MI, cardiomyopathy, mitral regurgitation, aortic regurgitation, constrictive pericarditis
Lub-de-dub
118
signs of endocarditis
```
Splinter haemorrhages
Clubbing (late)
Oslers nodes / janeway lesions (rare)
Changing / new murmur
Splenomegally
Microscopic haematuria
Roth spots
```
119
What can splinter haemorrhages indicate
Nail bed trauma
Infective endocarditis
Vasculitis
120
Stages of clubbing
1. Increased fluctuance of nail bed
2. Loss of nail bed angle
3. Curvature of the nail
4. Expansion of the terminal phalynx
121
Causes of AF
```
Hypertension
Ischaemic heart disease
Hyperthyroidism
HF
Dilated cardiomyopathy
Rheumatic heart disease
Idiopathic
```
122
2 possible causes of an irregularly irregular pulse
AF
| Ventricular ectopics
123
Best management of Wolff-Parkinson-White syndrome?
Radio-ablation of the accessory pathway
124
What features may suggest a silent MI
```
Atypical chest pain / epigastic pain
SOB
Acute pulmonary oedema
Collapse
Elderly / diabetic
```
125
What is brain natriuretic peptide a marker for?
Impaired LV function
126
Useful investigations in assessing HF
```
ECG
BNP
FBC
U+E
TFT
C-XR
Trans-thoracic echo
```
127
ECG features of hypokalaemia
Flattened or inverted t wave
ST depression
U wave =upward deflection following t wave
128
ECG changes in hyperkalaemia
Flat p wave
Broad QRS
Tented T waves
129
ECG changes in hypothermia
```
Bradyarrhythmias
J waves (Osborne Waves) - upward deflection following R wave
Prolonged PR, QRS and QT intervals
Shivering artefact
Ventricular ectopics
Cardiac arrest due to VT, VF or asystole
```
130
What is Dressler's syndrome
Tiad of pericarditis, fever and pericardial effusion.
| Occurs 1-2 week spots MI
131
Why does coarctation of the aorta cause secondary hypertension
Mechanical obstruction to blood flow.
Causes hypo perfusion of the kidneys.
Causing activation of the renin-angiotensin-aldosterone cascade
132
Features of coarctation of the aorta
Proximal hypertension
Absent or reduced femoral pulses
Radio-femoral delay
Inter-scapular systolic murmur
133
Murmur of mitral regurgitation
Pansystolic murmur at apex radiates to axilla
134
Murmur of aortic sclerosis
Ejection systolic murmur at second intercostal space only
135
Murmur of aortic stenosis
Ejection systolic murmur at second intercostal
| Radiates to carotids
136
Heart sounds in pericardial effusion
Muffled
137
When is an Austin flint murmur heard
Severe aortic regurgitation
Mid-diastolic low pitched rumbling murmur - loudest at apex
138
Murmur in aortic regurgitation
Early diastolic
High pitched
Left sternal edge
Leaning forward in held expiration
139
What is Libman-Sacks endocarditis
Noninfective endocarditis
| Associated with SLE
140
What is CHA2DS2 VaSc used for
Determining risk of stroke in AF patients
And need for aspirin / anticoagulation.
Score 0 = nothing
Score 1 = aspirin
Score 2+ = warfarin
141
What are fibrates and when are they used
Hypo-lipidaemic agents - to lower cholesterol
Not used 1st line
Only used when statins are CI or not tolerated
142
ECG features of first degree heart block
Delay in AV conduction.
| Prolonged PR - >0.2s (5small squares)
143
ECG features in second degree heart block - mobitz type II
P wave not always followed by QRS
No pattern to dropped beat
PR interval is constant
144
ECG features in second degree heart block - mobitz type I
AKA wenckebach
Progressive lengthening of PR interval then a dropped QRS
After dropped beat PR is shortest then gets longer each time again.
145
ECG features in third degree heart block
No AV conduction
| P waves and QRS are completely independent
146
Patient signs of complete heart block
Bradycardia ~25 - 50 bpm
| Cannon a waves in JVP
147
Which types of familial hypercholesterolaemia is more common
Heterozygous
| 1 in 500
148
Presentation of subacute bacterial endocarditis
Febrile illness
New cardiac murmur
Vasculitic rash
Microscopic haematuria
149
What criteria is used in the diagnosis of endocarditis
```
Duke criteria
Major
- +ve blood culture
- echo evidence
Minor
- risk factors
- fever >38
- vasculitic disease
- blood culture or echo not meeting major criteria
```
150
Management of 3rd degree heart block
Dual chamber pacemaker = definitive
Acutely - ABC, temporary pacing wire, atropine, external pacing
151
When is a pistol shot over the femorals heard
aortic regurgitation.
pistol shot crack in time with systole.
= Traube's phenomenon
152
What is sick sinus syndrome
Dysfunctional SA Node
| Bradycardia interspersed with tachycardia and AV block
153
Management of sick sinus syndrome
Pacemaker
| Anticoagulation
154
Most common cause of bacterial endocarditis
```
Viridans streptococcus
Staphylococcus aureus (IVDU)
staphylococcus Epidermidis (prosthetic valves)
Enterococcus faecalis (Catheter, cystoscopy, coloscopy)
```
155
Management of pericarditis
NSAIDs
156
Commonest cause of cardiac chest pain in the <35s
Cocaine associated angina
157
What are the shockable rhythms
Pulseless VT
| VF
158
What are the non-shockable rhythms
Pulseless electrical activity
| Asystole
159
Causes of dilated cardiomyopathy
```
Post viral myocarditis
Alcohol
Drugs
Familial
Thyrotoxicosis
Haemochromatosis
```
160
Management of a supra ventricular tachycardia (SVT)
Vagal manoeuvres - valsalva, carotid sinus massage
Adenosine
Cardioversion
(Then prevention with beta-blockers or verapamil)
