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CP3 Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

List the cardiac DDx for chest pain (3) + non-cardiac causes (6)

A

Cardiac:
ACS (UA/NSTEMI/STEMI)
Peri/myocarditis
Aortic dissection

Non-cardiac:
Oesophageal
Pneumothorax
PE
Costrochondritis (MSk)
Trauma
Mediastinitis
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2
Q

How are the 3 different types of ACS diagnosed?

A

UA = T inversion + no troponin rise

STEMI = troponin rise + ST elevation/new LBBB
NSTEMI = troponin rise + new LBBB/no ST
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3
Q

What are the 3 diff presentations of ACS that may be seen O/E?

A

Symp:
Tachy / HTN / Pallor / Sweaty

Vagal:
Brady / Vomiting

Myocardial impairment:
Hypotension / Narrow PP / JVP rise / Basal creps / HS3

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4
Q 
Which areas does the R coronary aa supply?
An occlusion (MI) in this aa would cause changes in which leads?
A

RA / RV / Posterior Septum
AVN (80%) / SAN (60%)

II, III, aVF (posterior/inferior)

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5
Q 
Which areas does the L circumflex aa supply?
An occlusion (MI) in this aa would cause changes in which leads?
A

LA / LV

I, aVL, V5-6

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6
Q 
Which areas does the LAD aa supply?
An occlusion (MI) in this aa would cause changes in which leads?
A

LV / Anterior Septum

V1–4

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7
Q

What Ix must be done in ?ACS (5)

A 
ECG (every 15mins whilst pain / continuous if ACS Dx)
Cardiac troponin I (4-8hrs/peak 24hrs)
Bloods: FBC / UEs / Glucose / Lipids
CXR (megaly / oedema / wide mediastinum)
Transthoracic ECHO - if in doubt / DDx
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8
Q

Describe the acute management of ACS

A 
Reassurance / A–E
O2 (if sats <94)
Morphine (5mg+) + Metoclopramide (10mg)
Aspirin 300mg
Nitrates (unless hypo)
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9
Q

Outline the long term management after an MI

A 
48hrs admit + continuous ECG + daily UEs/Trop
Start ABC
Aspirin 75mg od life
Bisoprolol life
Clopidogrel 75mg od 1yr

After 48hrs, RAN:
Ramipril (2.5mg bd)
Atorvastatin (80mg on)
± Nitrate oral (isosorbide - if angina)

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10
Q

What Ix should be done in suspected pulm oedema

A 
ABG
FBC / UEs / Glucose
CRP
D-dimer
CXR
ECG
ECHO
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11
Q

Outline acute management of acute pulm oedema

A 
Upright
15L O2
IV furosemide / IV diamorphine
SBP >100 = GTN/IV nitrate
SBP <100 = ICU/Ventilate (cardiogenic shock)
Hx/Ex/Ix
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12
Q

Outline acute management of acute pulm oedema

A 
Upright
15L O2
IV furosemide / IV diamorphine
SBP >100 = GTN/IV nitrate
SBP <100 = ICU/Ventilate (cardiogenic shock)
Hx/Ex/Ix
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13
Q

List direct + indirect causes of ARDS (4+6)

A

Direct:
Aspiration / inhalation / near-drown
Pneumonia

Indirect:
Sepsis
Anaphylaxis 
Tranfusion reaction / ADR
Multiple trauma
Pancreatitis
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14
Q

List direct + indirect causes of ARDS (4+6)

A

Direct:
Aspiration / inhalation / near-drown
Pneumonia

Indirect:
Sepsis
Anaphylaxis 
Tranfusion reaction / ADR
Multiple trauma
Pancreatitis
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15
Q

How is ARDS managed?

A

Treat as acute pulm oedema
But use CPAP as initial
± Aminophylline if bronchospasm

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16
Q

List direct + indirect causes of ARDS (5+7)

A 
Direct:
Aspiration 
Smoke inhalation / near-drown
Pneumonia
Lung contusion
Indirect:
Sepsis
Anaphylaxis 
Tranfusion reaction / ADR
Multiple trauma
DIC
Pancreatitis
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17
Q

How is ARDS managed?

A

Treat as acute pulm oedema
But use CPAP as initial
± Aminophylline if bronchospasm

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18
Q

List some signs O/E that may be seen in infective endocarditis (2+7)

A

Fever**
Changing/new murmur**

Microscopic haematuria (70%)
Splenomegaly (40%)
Osler's nodes
Clubbing
Roth spots (retina)
Petechial rash
Digital infarcts / splinter haemorrhages
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19
Q

List some signs O/E that may be seen in infective endocarditis (2+7)

A

Fever**
Changing/new murmur**

Microscopic haematuria (70%)
Splenomegaly (40%)
Osler's nodes
Clubbing
Roth spots (retina)
Petechial rash
Digital infarcts / splinter haemorrhages
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20
Q

What Ix should be done if suspecting endocarditis

A 
FBC
UEs
CRP/ESR
Blood cultures X3
Urinalysis
CXR
ECG regularly
Transthoracic ECHO
21
Q

What Ix should be done if suspecting endocarditis

A 
FBC
UEs
CRP/ESR
Blood cultures X3
Urinalysis
CXR
ECG regularly
Transthoracic ECHO
22
Q

List the Duke Major / Minor criteria for endocarditis

How is a Dx made from these criteria

A

Major:
+ve cultures
+ve ECHO

Minor:
Fever >38
Clinical signs (imm/vasc)
Predisposition
Cultures/ECHO insufficient for Major

2 Major // 1 Major + 3 Minor

23
Q

List the Duke Major / Minor criteria for endocarditis

How is a Dx made from these criteria

A

Major:
+ve cultures
+ve ECHO

Minor:
Fever >38
Clinical signs (imm/vasc)
Predisposition
Cultures/ECHO insufficient for Major

2 Major // 1 Major + 3 Minor

24
Q

What Empirical Abx are given in acute management of endocarditis (3)

A

Fluclox
Ben-Pen
Genta

(Consult micro)

25
Q

What Empirical Abx are given in acute management of endocarditis (3)

A

Fluclox
Ben-Pen
Genta
IV 4wks

(Consult micro)

26
Q

What Empirical Abx are given in acute management of endocarditis (3)

A

Fluclox
Ben-Pen
Genta
IV 4wks

(Consult micro)

27
Q

List some causes for 1st degree heart block

A

CAD
Electrolyte disurbances
Digoxin toxicity
Acute rhematic fever

28
Q

List some causes for 1st degree heart block

A

CAD
Electrolyte disurbances
Digoxin toxicity
Acute rhematic fever

29
Q

Outline the management of Bradycardias

A

A–E / Treat reversible causes

Assess for any adverse features:
• Syncope
• Shock
• Heart failure
• Myocardial ischaemia
If so; Atropine 500mcg IV / transcutaneous pacing

If none; Assess risk of systole (prev asystole / 2nd II / 3rd)
If no risk; transcutaneous pacing

30
Q

Outline the management of Bradycardias

A

A–E / Treat reversible causes

Assess for any adverse features:
• Syncope
• Shock
• Heart failure
• Myocardial ischaemia
If so; Atropine 500mcg IV / transcutaneous pacing

If none; Assess risk of systole (prev asystole / 2nd II / 3rd)
If no risk; transcutaneous pacing

31
Q

List cardiac (4), respiratory (3) + systemic (5) causes for AF

A

Cardiac:
HTN / IHD / HF / Valvular

Resp:
PE / Lung cancer / LRTI

Systemic: 
Infections
Thyrotoxicosis
DM
Electrolyte depletion
XS alcohol
32
Q

List cardiac (4), respiratory (3) + systemic (5) causes for AF

A

Cardiac:
HTN / IHD / HF / Valvular

Resp:
PE / Lung cancer / LRTI

Systemic: 
Infections
Thyrotoxicosis
DM
Electrolyte depletion
XS alcohol
33
Q

List differential causes of secondary hypertension (9)

A

Adrenal:
Conn’s / Cushings / Acromegaly / PCC

Renal: CKD / Renal aa stenosis

Pregnancy
Neurogenic
Coarctation of Ao

34
Q

List differential causes of secondary hypertension (9)

A

Adrenal:
Conn’s / Cushings / Acromegaly / PCC

Renal: CKD / Renal aa stenosis

Pregnancy
Neurogenic
Coarctation of Ao

35
Q

Classify the stages of hypertension (3)

A

Stage 1: >140/90 (135/85 ABPM)
Stage 2: >160/100 (150/95 ABPM)
Stage 3 (severe): SBP >180 // DBP >110
Malignant HTN: SBP >200 // DBP >120 AND bilat retinal

36
Q

What is Beck’s triad?

A

Sign of tamponade: (Dx by USS)
↑JVP
↓BP
Muffled heart sounds

37
Q

List 3 common causes for heart failure?

And some rarer causes (6)

A

IHD*
Dilated cardiomyopathy
HTN

Intrinsic:
Congenital
AF/Heart block
Valvular

Extrinsic:
Alcohol/Drugs
Anaemia
Cor pulm

38
Q

Classify the diff stages of heart failure (4)

A

Stage I: disease but no SOBOE
Stage II: SOBOE
Stage III: SOB on non-exertional
Stage IV: SOB at rest

39
Q

What investigations are done into heart failure? (6)

A 
Bedside: ECG
                               (if ECG/BNP abnorm → ECHO)
Bloods:
Baseline – FBC/UEs/LFTs/TFTs
Cardiac enzymes (acute HF) 
BNP (normal excludes)

Imaging:
CXR
ECHO (Dx – ejection fraction <45%)

40
Q

List some causes of hyperkalaemia (3+3)

A

K-sparings
ACEis/ARBs
Heparin

AKI
Metab acidosis
Addison’s

41
Q

List the 1st, 2nd + 3rd line treatments for heart failure (chronic not acute)

What are the non-pharmological options

A

1st: ACEi + B-blocker + Thiazide
2nd: Spiro (add on);
Hydralazine + Nitrate (replace ACEi/ARB if not tol)
3rd: Digoxin

Non-pharm:
Lifestyle – moderate exercise
Pacemaker (cardiac resynch therapy) or (implantable cardioverter defib)

42
Q

What are the indications for Implantable Cardioverter Defibrillator (4)

A

Prev ventricular arrthymia → adverse effects (e.g. arrest)
Prev ventricular arrhythmia PLUS LVEF <35%
Familial risk sudden death (HOCUM, Long QT)
Prev surgery on congenital heart disease

43
Q

What are the Immediate complications of ACS (3)

A

Arrhythmias:
VF/VT (reperfusion)
AF**
AV Block/Brady (is affects SAN/AVN)

44
Q

What are the short term complications of ACS (not immediate) (7)

A

Cardiogenic shock
Acute HF/Pulm Oedema

Ventricular rupture
Septal repture
Chordae tendinae rupture (acute mitral regurg)

Thromboembolism
Pericarditis

45
Q

What are the long-term complications of ACS (4)

A

Pericarditis
Dressler’s

Ventricular aneurysm

Heart failure

46
Q

Causes of consTRictive pericarditis (4)

A

Trauma
TB
RA
Radiotherpay

47
Q

What will be seen on ABG in pulm oedema?

What will be seen on CXR?

A

Initial T1RF (hypervent) → T2RF (impaired gas ex)

Alveolar shadowing (Bats wing)
B-lines
Cardiomeg
Diversion of blood to upper/ prominent vessels
Effusion (pleural)
48
Q

What are the indications for HTN drug Tx?

A 
Stage 1 + lifestyle measures failed
Stage 1 + end-organ damage (e.g. renal)
Stage 1 + CVD
Stage 1 + >80
Stage 2+ (>160/100)

CP3 Medicine (7 decks)

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