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General Medicine > Cardiology > Flashcards

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
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2
Q

What are optimal, normal and high blood pressures

A

Optimal < 120 / 80
Normal 120 - 139 / 80-89
high >140/90

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3
Q

How often should healthy patients have BP checked routinely

A

At least every 5 years until age 80

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4
Q

Define postural hypotension

A

A fall in SBP >20mmHg

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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

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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

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7
Q

Features suggesting phaeochromocytoma

A 
Labile / postural hypertension
Headache
Palpitations
Pallor
Diaphoresis (excessive sweating)
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8
Q

1st line anti-hypertensives in over 55s

A

Calcium channel blocker

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9
Q

2nd line anti-hypertensives in over 55s

A

Calcium channel blocker
AND
Ace inhibitor / angiotensin receptor blocker

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10
Q

2nd line anti-hypertensives in under 55s

A

Ace inhibitor / angiotensin receptor blocker
AND
calcium channel blocker

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11
Q

3rd line anti-hypertensives

A 
Ace inhibitor / angiotensin receptor blocker 
AND 
Calcium channel blocker
AND 
Diuretic (thiazide-like)
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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
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13
Q

Lifestyle interventions In Hypertension

A 
Diet
Exercise
Relaxation
Decrease alcohol
Decrease caffeine
Decrease salt
Smoking cessation
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14
Q

Examples of ACE inhibitors

A 
Ramipril
Captopril
Enalapril
Lisinopril
Perindopril
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15
Q

SE of ace inhibitors

A

Dry cough (^bradykinin)

Rare - angioedema, proteinuria, neutropenia

Can –> CRF in bilateral RAS

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16
Q

Examples of angiotensin II receptor blocker

A

Losartan
Valsartan
Candesartan

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17
Q

Examples of calcium channel blockers

A

Amlodipine
Nifedipine
Nimodipine
Felodipine

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18
Q

SE of calcium channel blockers

A

Dizziness, hypotension, flushing, ankle oedema

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19
Q

Examples of thiazide-like diuretics

A

Chlorothiazide
Chlortalidone
Indapamide

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20
Q

Examples of thiazide diuretics

A

Bendroflumethiazide

Hydrochlorothiazide

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21
Q

When may beta-blockers be considered

A
  • intolerance of ACEi and ARB
  • F of childbearing age
  • pt with increased sympathetic drive
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22
Q

most common cause of hypertension

A

essential hypertension

80-90%

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23
Q

Factors contributing to essential hypertension

A 
genetic
fetal - low birth weight
environmental 	- obestity
			- alcohol intake
			- sodium intake
			- stress
insulin resistance
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24
Q

causes of secondary hypertension

A 
renal disease
endocrine disorders
congenital coarctation of the aorta
drugs
pregnancy
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25
Q

renal causes of secondary hypertension

A 
Diabetic nephropathy
Chronic glomerulonephritis
Adult polycystic kidney disease
Chronic tubulointerstitial disease
renovascular disease
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26
Q

endocrine causes of secondary hypertension

A 
Conn's Syndrome
Adrenal hyperplasia
Phaeochromocytoma
Cushing's syndrome
Acromegally
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27
Q

Define malignant hypertension

A

Rapid increase in BP to severe levels >180/120
Associated with end organ failure.
E.g. Renal failure, encephalopathy.

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28
Q

Effects of malignant hypertension

A

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

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29
Q

What commonly causes a slow rising pulse

A

Aortic stenosis

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30
Q

What commonly causes a collapsing pulse

A

Aortic regurgitation

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31
Q

Causes of a bounding pulse

A

CO2 retention
hepatic failure
sepsis

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32
Q

Cause of radiofemoral delay

A

Coarctation of the aorta

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33
Q

Causes of pulsus paroxidus

A 
cardiac tamponade
pericarditis
chronic sleep apnea
croup
asthma
COPD
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34
Q

Caused of raised, fixed JVP

A

Superior vena cava obstruction

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35
Q

JVP raising on inspiration

A

Cardiac tamponade

Constrictive pericarditis

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36
Q

Cause of cannon ‘a’ waves in JVP

A

Complete heart block
Atrioventricular (AV) dissociation
Ventricular arrhythmias

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37
Q

Signs of Mitral stenosis

A

Tapping apex beat
Loud first heart sound
Rumbling mid-diastolic murmur at apex (louder in left lateral position on expiration)

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38
Q

Signs of Aortic regurgitation

A

Wide pulse pressure
Displaced, volume-overloaded apex beat
Early diastolic murmur at lower sternal edge (best heard in expiration leaning forward)

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39
Q

Signs of Mitral regurgitation

A

Displaced, volume overloaded apex beat
Soft first heart sound
Pansystolic murmur at apex radiating to axilla (louder in expiration)

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40
Q

Signs of Aortic stenosis

A

Narrow pulse pressure
Heaving undisplaced apex beat
Soft second heart sound
Ejection systolic murmur heard in aortic area radiating to carotids and apex

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41
Q

Signs of a Ventricular septal defect

A

Harsh pansystolic murmur lower left sternal edge

Left parasternal heave

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42
Q

What is the difference between Osler’s nodes and Janeway’s lesions.
In what condition do they occur?

A

Osler’s nodes = painful hard swellings on fingers/toes
Janeway’s lesions = painless erythematous blanching macules seen on palmar surface
In Infective Endocarditis

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43
Q

Most common complications of acute MI

A 
Sudden death
Arrhythmia
Cardiogenic shock
HF
Cardiac rupture
Pericarditis
Depression / anxiety
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44
Q

Inferior ECG leads

A

II, III, aVF

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45
Q

Anterior ECG leads

A

V2-V4

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46
Q

Possible symptoms of acute AF

A 
Asymptomatic 
Palpitations
HF
angina
SOB
Embolic episodes
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47
Q

ECG features of AF

A

No clear p waves
Baseline fibrillation
Rapid and irregularly irregular QRSs

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48
Q

Management of AF

A

Treat precipitating cause e.g. Hyperthyroidism
Acute = Rate control or Cardioversion
Long term = warfarin + rate /Rhythm control

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49
Q

Major and moderate risk factors in AF which indicate anticoagulation (not chads vasc)

A 
Major = prosthetic valve / rheumatic mitral valve disease / past stroke or TIA 
Moderate = >75 / hypertension / HF / DM
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50
Q

What is CHADS VaSc

A 
Congestive HF  = 1
Hypertension    = 1 
Age >75            = 2
        65-74        = 1
DM                   = 1 
Stroke              = 2
Vascular dis.    = 1 
Sex - F             = 1
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51
Q

What is the most common cause of secondary hypertension?

A

Renal disease

E.g. Renal artery stenosis, glomerulonephritis

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52
Q

Management of AF lasting > 48 hours

A

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.

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53
Q

Management of severely compromised acute persistent AF

A

Immediate DC shock

Heparin

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54
Q

What drug would aid the diagnosis of an unidentifiable regular narrow complex tachycardia?

A

Adenosine
Causes AV block -Short half life
(Can cause chest pain)

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55
Q

What is torsade de pointes?

A

Ventricular tachycardia with varying QRS axis and a prolonged QT interval

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56
Q

What may Torsade de pointes degenerate into?

A

Ventricular fibrillation

Leading to cardiac arrest

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57
Q

Causes of torsade de pointes?

A

Drugs,
electrolyte disturbance,
congenital long QT syndrome.

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58
Q

Treatment of torsade de pointes?

A

IV magnesium sulphate.
Ventricular pacing.
Correct hypokalaemia.

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59
Q

Management of malignant hypertension?

A

Gradual uncontrolled production of BP

Labetalol.

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60
Q

What causes a slow rising pulse?

A

Aortic stenosis

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61
Q

Collapsing pulse

A

Aortic regurgitation

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62
Q

Bounding pulse

A

Acute CO2 retention
Hepatic failure
Sepsis

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63
Q

Radio femoral delay

A

Coarctation of aorta

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64
Q

What causes Pulsus bisferiens

A

Mixed aortic valve disease

HOCM

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65
Q

What causes Pulsus paradoxus

A

Constrictive pericarditis

Cardiac tamponade

66
Q

What is pulsus bisferriens

A

Double pulse

67
Q

What is Pulsus paradoxus

A

Abnormally large decrease in SBP and pulse during inspiration.

68
Q

What is pulsus alternans

A

Alternating strong and weak beats

69
Q

What causes pulsus alternans

A

Left ventricular systolic impairment (Heart failure)

Poor prognosis.

70
Q

Cause of a raised fixed JVP

A

SVC obstruction

71
Q

JVP rising on inspiration

A

Cardiac tamponade

Constructive pericarditis

72
Q

Large v waves on JVP

A

Tricuspid regurgitation

73
Q

Absent a waves on JVP

A

AF

74
Q

Canon a waves on JVP

A

AV Dissociation

Ventricular Arrhythmia

75
Q

Cardiac condition associated with malar flush

A

Mitral stenosis

76
Q

Cardiac condition associated with pulsatile hepatomegally

A

Tricuspid regurgitation

77
Q

Cardiac condition associated with carotid pulsation (corrigan’s sign)

A

Aortic regurgitation

78
Q

Cardiac condition associated with head nodding (De Musset’s sign)

A

Aortic regurgitation

79
Q

Cardiac condition associated with Capillary pulsations in nailbed (quincke’s sign)

A

Aortic regurgitation

80
Q

Cardiac condition associated with Pistol shot heard over femorals (Traube’s sign)

A

Aortic regurgitation

81
Q

Cardiac condition associated with Roth spots (Boat shaped retinal haemorrhage)

A

Infective endocarditis

82
Q

What are Oslers nodes

A

Painful hard swellings on fingers or toes

83
Q

What are janeway lesions

A

Painless erythematous blanching macula on palmar surface of hand

84
Q

Features of ASD

A

Wide, fixed, split 2nd heart sound

Ejection systolic murmur in 3rd ICS

85
Q

Patent ductus arteriosus

A

Continuous machinery murmur below L clavicle

86
Q

Features of transposition of the great vessels

A

Cyanosis on 1st day of life

X-ray = egg shaped ventricles

87
Q

Features of tetralogy of fallot

A

Cyanosis in 1st month of life

X-ray= boot shaped heart

88
Q

Saw tooth ECG occurs in:

A

Atrial flutter

89
Q

Absent p waves on ECG occurs in:

A

Atrial fibrillation

Sinoatrial block

90
Q

Bifid P-wave on ECG occurs in:

A

Left atrial hypertrophy (mitral stenosis)

91
Q

Peaked p wave on ECG occurs in:

A

R atrial hypertrophy (Pulmonary hypertension, tricuspid stenosis)

92
Q

ST depression on ECG occurs in:

A

MI

93
Q

ST elevation on ECG occurs in:

A

MI

LV aneurysm

94
Q

Saddle shaped ST elevation on ECG occurs in:

A

Constrictive pericarditis

95
Q

sI, qIII, tIII on ECG occurs in:

A

PE

96
Q

Tented T-waves on ECG occurs in:

A

Hyperkalaemia

97
Q

Flattened t waves + prominent u waves on ECG occurs in:

A

Hypokalaemia

98
Q

Long Q-T interval on ECG occurs in:

A

Hypocalcaemia
Inherited (Romano-ward and Jervell Lange-Nielsen)
Drugs (antihistamines, diuretics, antibiotics, anti-depressants, anti-psychotics)
Hyponatraemia

99
Q

What is wergener’s granulomatosis

A

Small artery vasculitis

100
Q

Features of wergener’s granulomatosis

A

Vasculitis
Granuloma deposition

Involves URT, lungs and kidneys.
Eye signs in 50%

101
Q

What is the Ziehl-neelsen stain positive for

A

TB

102
Q

What is carotid sinus syncope?

A

Increased sensitivity to external pressure

Leads to syncope on head turning.

103
Q

What 2 cardiac conditions cause syncope on exertion?

A

Aortic stenosis

HOCM

104
Q

What is pre-syncope + it’s symptoms

A

Presyncope is a state consisting of lightheadedness, muscular weakness, and feeling faint.
Nausea, sweating, ringing in ears.

105
Q

What are triggers for vaso-vagal syncope

A

Heat
Fear
Stress
(Excessive activation of parasympathetic NS)

106
Q

What happens after a vaso-vagal syncope?

A

Rapid recovery

107
Q

What is situational syncope

A

Vasovagal episodes triggered by specific situations.

E.g. Coughing, urinating, having blood taken

108
Q

Routine invitations in suspected vaso-vagal syncope

A 
Full hx
Collateral hx
ECG
Blood glucose
Lying and standing BP
109
Q

What is Wolff-Parkinson-White syndrome

A

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
Q

Syx of Wolff-Parkinson-white syndrome

A 
Dizziness
Palpitations
Chest pain
Syncope
Sudden cardiac death
111
Q

ECG changes in Wolff-Parkinson-white syndrome

A

Short PR
Wide QRS
Slurred upstroke of the R wave (delta wave)

112
Q

Between which heart sounds does diastole occur?

A

Between s2 and s1

113
Q

Between which heart sounds does systole occur?

A

Between s1 and s2

114
Q

What causes s1 heart sound?

A

Mitral and tricuspid closure

115
Q

What causes s2 heart sound?

A

Pulmonary and aortic valve closure

116
Q

Why does a 4th heart sound occur?

A

Atrial contraction into a non-compliant or hypertrophied ventricle.
Occurs in HF, MI, cardiomyopathy, hypertension
Always abnormal

Le-lub dub

117
Q

Why does a 3rd heart sound occur?

A

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
Q

signs of endocarditis

A 
Splinter haemorrhages 
Clubbing (late)
Oslers nodes / janeway lesions (rare)
Changing / new murmur
Splenomegally 
Microscopic haematuria 
Roth spots
119
Q

What can splinter haemorrhages indicate

A

Nail bed trauma
Infective endocarditis
Vasculitis

120
Q

Stages of clubbing

A
  1. Increased fluctuance of nail bed
  2. Loss of nail bed angle
  3. Curvature of the nail
  4. Expansion of the terminal phalynx
121
Q

Causes of AF

A 
Hypertension
Ischaemic heart disease
Hyperthyroidism
HF
Dilated cardiomyopathy 
Rheumatic heart disease
Idiopathic
122
Q

2 possible causes of an irregularly irregular pulse

A

AF

Ventricular ectopics

123
Q

Best management of Wolff-Parkinson-White syndrome?

A

Radio-ablation of the accessory pathway

124
Q

What features may suggest a silent MI

A 
Atypical chest pain / epigastic pain
SOB
Acute pulmonary oedema
Collapse
Elderly / diabetic
125
Q

What is brain natriuretic peptide a marker for?

A

Impaired LV function

126
Q

Useful investigations in assessing HF

A 
ECG
BNP
FBC
U+E
TFT
C-XR
Trans-thoracic echo
127
Q

ECG features of hypokalaemia

A

Flattened or inverted t wave
ST depression
U wave =upward deflection following t wave

128
Q

ECG changes in hyperkalaemia

A

Flat p wave
Broad QRS

Tented T waves

129
Q

ECG changes in hypothermia

A 
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
Q

What is Dressler’s syndrome

A

Tiad of pericarditis, fever and pericardial effusion.

Occurs 1-2 week spots MI

131
Q

Why does coarctation of the aorta cause secondary hypertension

A

Mechanical obstruction to blood flow.
Causes hypo perfusion of the kidneys.
Causing activation of the renin-angiotensin-aldosterone cascade

132
Q

Features of coarctation of the aorta

A

Proximal hypertension
Absent or reduced femoral pulses
Radio-femoral delay
Inter-scapular systolic murmur

133
Q

Murmur of mitral regurgitation

A

Pansystolic murmur at apex radiates to axilla

134
Q

Murmur of aortic sclerosis

A

Ejection systolic murmur at second intercostal space only

135
Q

Murmur of aortic stenosis

A

Ejection systolic murmur at second intercostal

Radiates to carotids

136
Q

Heart sounds in pericardial effusion

A

Muffled

137
Q

When is an Austin flint murmur heard

A

Severe aortic regurgitation

Mid-diastolic low pitched rumbling murmur - loudest at apex

138
Q

Murmur in aortic regurgitation

A

Early diastolic
High pitched
Left sternal edge

Leaning forward in held expiration

139
Q

What is Libman-Sacks endocarditis

A

Noninfective endocarditis

Associated with SLE

140
Q

What is CHA2DS2 VaSc used for

A

Determining risk of stroke in AF patients
And need for aspirin / anticoagulation.

Score 0 = nothing
Score 1 = aspirin
Score 2+ = warfarin

141
Q

What are fibrates and when are they used

A

Hypo-lipidaemic agents - to lower cholesterol

Not used 1st line
Only used when statins are CI or not tolerated

142
Q

ECG features of first degree heart block

A

Delay in AV conduction.

Prolonged PR - >0.2s (5small squares)

143
Q

ECG features in second degree heart block - mobitz type II

A

P wave not always followed by QRS
No pattern to dropped beat
PR interval is constant

144
Q

ECG features in second degree heart block - mobitz type I

A

AKA wenckebach
Progressive lengthening of PR interval then a dropped QRS
After dropped beat PR is shortest then gets longer each time again.

145
Q

ECG features in third degree heart block

A

No AV conduction

P waves and QRS are completely independent

146
Q

Patient signs of complete heart block

A

Bradycardia ~25 - 50 bpm

Cannon a waves in JVP

147
Q

Which types of familial hypercholesterolaemia is more common

A

Heterozygous

1 in 500

148
Q

Presentation of subacute bacterial endocarditis

A

Febrile illness
New cardiac murmur
Vasculitic rash
Microscopic haematuria

149
Q

What criteria is used in the diagnosis of endocarditis

A 
Duke criteria 
Major 
- +ve blood culture 
- echo evidence
Minor 
- risk factors
- fever >38
- vasculitic disease
- blood culture or echo not meeting major criteria
150
Q

Management of 3rd degree heart block

A

Dual chamber pacemaker = definitive

Acutely - ABC, temporary pacing wire, atropine, external pacing

151
Q

When is a pistol shot over the femorals heard

A

aortic regurgitation.
pistol shot crack in time with systole.
= Traube’s phenomenon

152
Q

What is sick sinus syndrome

A

Dysfunctional SA Node

Bradycardia interspersed with tachycardia and AV block

153
Q

Management of sick sinus syndrome

A

Pacemaker

Anticoagulation

154
Q

Most common cause of bacterial endocarditis

A 
Viridans streptococcus
Staphylococcus aureus (IVDU)
staphylococcus Epidermidis (prosthetic valves) 
Enterococcus faecalis (Catheter, cystoscopy, coloscopy)
155
Q

Management of pericarditis

A

NSAIDs

156
Q

Commonest cause of cardiac chest pain in the <35s

A

Cocaine associated angina

157
Q

What are the shockable rhythms

A

Pulseless VT

VF

158
Q

What are the non-shockable rhythms

A

Pulseless electrical activity

Asystole

159
Q

Causes of dilated cardiomyopathy

A 
Post viral myocarditis 
Alcohol
Drugs
Familial
Thyrotoxicosis
Haemochromatosis
160
Q

Management of a supra ventricular tachycardia (SVT)

A

Vagal manoeuvres - valsalva, carotid sinus massage
Adenosine
Cardioversion
(Then prevention with beta-blockers or verapamil)

General Medicine (25 decks)

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