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Cardiology Flashcards

1
Q

CHA2DS2VASc components

A 
Congestive HF
HTN
A2 age 65-74 or 75+
Diabetes
S2 stroke, TIA or VTE before
Vascular disease (IHD, PAD)
Sex - female
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2
Q

anticoagulation based on CHADVASC score

A

0 - no treatment
1 - males - consider anticoag, females - no treatment
2 - offer anticoag

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3
Q

management of supraventricular tachycardia

A 
valsava manoeuvre (a vagal manoeuvre)
IV adenosine if doesn't work
electrical cardioversion if doesn't work
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4
Q

where is a mitral stenosis murmur heard and what position accentuates it?

A

apex

accentuated lying on left

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5
Q

what murmur can rheumatic heart disease cause?

A

it’s the commonest cause of mitral stenosis murmur

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6
Q

timing of mitral stenosis

A

mid diastolic

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7
Q

timing of aortic stenosis

A

ejection systolic

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8
Q

paediatric ejection systolic murmurs

A

ASD (HS I - AV valves closing)

fallot’s

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9
Q

holosystolic murmurs

A

mitral + tricuspid regurgitation - AV valves that make HS I

VSD

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10
Q

what timing is aortic regurgitation?

A

early diastolic - aortic valve is HS II

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11
Q

continuous machine-like murmur - what could it be?

A

patent ductus arteriosus

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12
Q

hypokalaemia on ECG

A

U waves
small/absent/inverted T waves
prolonged PR + QT
ST depression

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13
Q

name 1 drug that can cause hypokalaemia

A

furosemide

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14
Q

diagnosis of HF in someone who’s had a previous MI

A

echo in 2 weeks

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15
Q

diagnosis of HF in someone who’s not had a previous MI

A

measure BNP
if high - echo in 2 weeks
if raised - echo in 6 weeks

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16
Q

what should be used for anticoagulation in AF?

A

warfarin or NOAC

aspirin not recommended for reducing stroke risk

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17
Q

HASBLED - used to calculate risk/benefit of starting someone on warfarin

A 
HTN uncontrolled
Abnormal renal/liver function
Stroke
Bleeding history
Labile INRs
Elderly (>65)
Drugs predisposing to bleeding or alcohol (>8 drinks/week)

3+ - high risk of bleeding

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18
Q

how does warfarin work?

A

inhibits reduction of vitamin K

this helps carboxylate clotting factors 1972 + protein C

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19
Q

warfarin - target INR post VTE? (first time and recurrent time)

A

2.5

if recurrent - 3.5

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20
Q

warfarin - target INR of AF?

A

2.5

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21
Q

5 things that potentiate warfarin

A 
liver disease
P450 inhibitors:
amiodarone
ciprofloxacin
cranberry juice
NSAIDs
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22
Q

SEs of warfarin

A

teratogenic (but fine breastfeeding)
skin necrosis
purple toes

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23
Q

someone on warfarin after PE. INR drops to 1.3. what to do?

A

increase warfarin dose

start LMWH - rapid anticoag - until INR fine

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24
Q

what is the cutoff for investigating BP?

A

140/90 +

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25
stages of HTN
1 - clinic 140/90+ - abpm/hbpm 135/85+ 2 - clinic 160/100+ - abpm/hbpm 150/95+ severe - clinic 180/or/110+
26
what are the criteria for treating HTN?
stage 2, or stage 1 (135/85)+, <80y and target organ/CV/renal disease/diabetes/10y CV risk 20%+
27
if an ACEi + CCB combo isn't working, what's the next thing to add for HTN? examples?
thiaziude-like diuretic eg chlorthalidone or indapamide
28
if ACEi, CCB + thiazide diuretic aren't working, what's next mgmt for HTN? what BP defines not working?
140/90+ - resistant HTN if K 4.5 or less - spironolactone if K > 4.5 - higher-dose thiazide-like treatment if this doesn't work consider alpha or beta blocker
29
what are the BP targets?
<80y - clinic 140/90; amb/home 135/85 >80y - clinic 150/90; amb/home 145/85
30
management of VT
immediate cardioversion if adverse signs - BP < 90, CP, HF, LOC if not, antiarrhythmics eg amiodarone if fails, electrical cardioversion - DC shocks
31
what could a broad complex tachycardia with low BP indicate?
ventricular tachycardia
32
management of aortic stenosis
aortic valve replacement if symptomatic or gradient > 40
33
4 signs of aortic stenosis
narrow pulse pressure slow rising pulse LVH/failure
34
1 thing that decreases effects of warfarin? why does this happen? how does this affect INR?
st johns wort induces P450 enzyme system (which metabolises warfarin?) shortens INR
35
what is bumetanide?
loop diuretic
36
what are the indications of loop diuretics?
heart failure - acute (IV) or chronic (oral) | resistant HTN
37
adverse effects of loop diuretics
``` gout otoxicity + nephrotoxicity hypotension low Na / K / Ca hyperglycaemia alklalosis ```
38
what kind of acute cardiac problem does alcoholism + severe hypokalaemia point to? mgmt?
polymorphic VT (torsade de pointes) - give 2g Mg
39
risk of combining statins and erythro/clarithromycin? | features of this?
statin-induced myopathy | myalgia + increased creatine kinase
40
what are the 2 main adverse effects of statins?
myopathy | liver impairment - monitor LFTs
41
what do you give in primary prevention of stroke?
atorvastatin 20mg on
42
what do you give in secondary prevention of stroke?
atorvastatin 80mg on
43
features of heart failure on CXR?
``` Alveolar oedema (bat's wings) B - Kerley B lines (interstitial oedema) Cardiomegaly Dilated prominent upper lobe vessels Effusion - pleural ```
44
what does a boot-shaped heart indicate?
tetralogy of fallot
45
what does a widened mediastinum on CXR indicate?
aortic dissection or aneursym
46
when should oxygen therapy be avoided if there's no hypoxia?
ACS/MI stroke obstetric emergencies anxiety
47
Breathlessness, raised JVP, fine basal crackles, 3rd heart sound - what is it?
Pulmonary oedema | As fine bibasal crackles are a feature, + other signs of HF
48
Raised JVP Muffled heart sounds Hypotension What is it?
Pericardial effusion
49
Ascites, pulsatile liver, peripheral oedema + pansystolic murmur?
Tricuspid regurgitation
50
Drug induced facial swelling, breathing difficulty + stridor - what could have caused this? (Not anaphylaxis)
ACEi-induced angioedema
51
what electrolyte abnormalities can cause long QT?
low K / Mg / Ca - ie the 3 involved in muscle contraction
52
what can long QT predispose to?
torsades de pointes
53
what is torsades de pointes? how dangerous is it? what can it cause?
polymorphic VT - multiple ventricular foci so QRS vary in amplitude, axis + duration life threatening - can cause VF
54
what is HS I?
closing of atrioventricular valves - ie mitral (left atrium to ventricle) + tricuspid (right atrium to ventricle)
55
what is HS II?
closing of aortic (left ventricle to aorta) + pulmonary (right ventricle to pulmonary artery) valves
56
what are the 4 main types of SVT?
AF Aflutter WPW paroxysmal SVT
57
what is a U wave?
wave that follows the T wave
58
what is doxazosin? what used for?
a1 blocker | HTN + BPH-associated urinary retention
59
management of torsade de pointes
IV magnesium sulphate
60
what metabolic abnormality can ACEis cause?
hyperkalaemia
61
what can cause torsade de pointes?
low Ca, K, Mg | hypothermia
62
causes of HS4
HF MI HTN
63
how does HTN affect heart? how is this identified OE?
pressure overload - ventricle thickens inwards | apex beat is powerful but not displaced
64
HS3 - causes
normal up to age 30 HF MI HTN
65
what is a big indication for warfarin and not a NOAC? what INR would you aim for?
metallic valve | 3-4
66
how do ACEis help in MR?
reduce afterload so more blood goes out of heart rather than back into atria
67
3 signs of RHF
raised JVP oedema ascites
68
what does a Q wave indicate?
full thickness transmural infarct
69
complications of MI
``` sudden death on PRAED street Pump failure Ruptured papillary or septum Aneurysm + arrhythmias Embolism Dressler's + pericarditis ```
70
symptom of dressler's/pericarditis post MI | management
"pain has changed" + doesn't respond to opiates | give ibuprofen
71
acute bioprosthetic valve failure - presentation
sudden failure | acute severe pulmonary oedema + cardiogenic shock
72
WPW - presentation
palpitations dizziness tachycardia on exertion?
73
what are the CIs to nitrates in ACS?
hypotension (sBP <90) bradycardia (<50) recent sildenafil use
74
pericarditis - presentation
pleuritic chest pain | may have a few days hx
75
what is sick sinus syndrome + how does it present? causes?
SAN dysfunction - causes tachy or brady fatigue, dizziness, LOC, chest pain, palpitations (irregular beats) causes: usually age-related scarring + hardening of SAN sometimes beta blockers, ccbs
76
which disorders is MR assoc with?
ehlers dahnlos marfan's both collagen disorders
77
widespread joint hypermobility + striae on skin - dx?
ehlers dahnlos
78
what is a CI to adenosine?
asthma

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