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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
Q

stages of HTN

A

1 - clinic 140/90+ - abpm/hbpm 135/85+
2 - clinic 160/100+ - abpm/hbpm 150/95+
severe - clinic 180/or/110+

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26
Q

what are the criteria for treating HTN?

A

stage 2, or stage 1 (135/85)+, <80y and target organ/CV/renal disease/diabetes/10y CV risk 20%+

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27
Q

if an ACEi + CCB combo isn’t working, what’s the next thing to add for HTN? examples?

A

thiaziude-like diuretic eg chlorthalidone or indapamide

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28
Q

if ACEi, CCB + thiazide diuretic aren’t working, what’s next mgmt for HTN? what BP defines not working?

A

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

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29
Q

what are the BP targets?

A

<80y - clinic 140/90; amb/home 135/85

> 80y - clinic 150/90; amb/home 145/85

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30
Q

management of VT

A

immediate cardioversion if adverse signs - BP < 90, CP, HF, LOC

if not, antiarrhythmics eg amiodarone
if fails, electrical cardioversion - DC shocks

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31
Q

what could a broad complex tachycardia with low BP indicate?

A

ventricular tachycardia

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32
Q

management of aortic stenosis

A

aortic valve replacement if symptomatic or gradient > 40

33
Q

4 signs of aortic stenosis

A

narrow pulse pressure
slow rising pulse
LVH/failure

34
Q

1 thing that decreases effects of warfarin? why does this happen? how does this affect INR?

A

st johns wort
induces P450 enzyme system (which metabolises warfarin?)
shortens INR

35
Q

what is bumetanide?

A

loop diuretic

36
Q

what are the indications of loop diuretics?

A

heart failure - acute (IV) or chronic (oral)

resistant HTN

37
Q

adverse effects of loop diuretics

A 
gout
otoxicity + nephrotoxicity
hypotension
low Na / K / Ca
hyperglycaemia
alklalosis
38
Q

what kind of acute cardiac problem does alcoholism + severe hypokalaemia point to? mgmt?

A

polymorphic VT (torsade de pointes) - give 2g Mg

39
Q

risk of combining statins and erythro/clarithromycin?

features of this?

A

statin-induced myopathy

myalgia + increased creatine kinase

40
Q

what are the 2 main adverse effects of statins?

A

myopathy

liver impairment - monitor LFTs

41
Q

what do you give in primary prevention of stroke?

A

atorvastatin 20mg on

42
Q

what do you give in secondary prevention of stroke?

A

atorvastatin 80mg on

43
Q

features of heart failure on CXR?

A 
Alveolar oedema (bat's wings)
B - Kerley B lines (interstitial oedema)
Cardiomegaly
Dilated prominent upper lobe vessels
Effusion - pleural
44
Q

what does a boot-shaped heart indicate?

A

tetralogy of fallot

45
Q

what does a widened mediastinum on CXR indicate?

A

aortic dissection or aneursym

46
Q

when should oxygen therapy be avoided if there’s no hypoxia?

A

ACS/MI
stroke
obstetric emergencies
anxiety

47
Q

Breathlessness, raised JVP, fine basal crackles, 3rd heart sound - what is it?

A

Pulmonary oedema

As fine bibasal crackles are a feature, + other signs of HF

48
Q

Raised JVP
Muffled heart sounds
Hypotension
What is it?

A

Pericardial effusion

49
Q

Ascites, pulsatile liver, peripheral oedema + pansystolic murmur?

A

Tricuspid regurgitation

50
Q

Drug induced facial swelling, breathing difficulty + stridor - what could have caused this? (Not anaphylaxis)

A

ACEi-induced angioedema

51
Q

what electrolyte abnormalities can cause long QT?

A

low K / Mg / Ca - ie the 3 involved in muscle contraction

52
Q

what can long QT predispose to?

A

torsades de pointes

53
Q

what is torsades de pointes? how dangerous is it? what can it cause?

A

polymorphic VT - multiple ventricular foci so QRS vary in amplitude, axis + duration
life threatening - can cause VF

54
Q

what is HS I?

A

closing of atrioventricular valves - ie mitral (left atrium to ventricle) + tricuspid (right atrium to ventricle)

55
Q

what is HS II?

A

closing of aortic (left ventricle to aorta) + pulmonary (right ventricle to pulmonary artery) valves

56
Q

what are the 4 main types of SVT?

A

AF
Aflutter
WPW
paroxysmal SVT

57
Q

what is a U wave?

A

wave that follows the T wave

58
Q

what is doxazosin? what used for?

A

a1 blocker

HTN + BPH-associated urinary retention

59
Q

management of torsade de pointes

A

IV magnesium sulphate

60
Q

what metabolic abnormality can ACEis cause?

A

hyperkalaemia

61
Q

what can cause torsade de pointes?

A

low Ca, K, Mg

hypothermia

62
Q

causes of HS4

A

HF
MI
HTN

63
Q

how does HTN affect heart? how is this identified OE?

A

pressure overload - ventricle thickens inwards

apex beat is powerful but not displaced

64
Q

HS3 - causes

A

normal up to age 30
HF
MI
HTN

65
Q

what is a big indication for warfarin and not a NOAC? what INR would you aim for?

A

metallic valve

3-4

66
Q

how do ACEis help in MR?

A

reduce afterload so more blood goes out of heart rather than back into atria

67
Q

3 signs of RHF

A

raised JVP
oedema
ascites

68
Q

what does a Q wave indicate?

A

full thickness transmural infarct

69
Q

complications of MI

A 
sudden death on PRAED street
Pump failure
Ruptured papillary or septum
Aneurysm + arrhythmias
Embolism
Dressler's + pericarditis
70
Q

symptom of dressler’s/pericarditis post MI

management

A

“pain has changed” + doesn’t respond to opiates

give ibuprofen

71
Q

acute bioprosthetic valve failure - presentation

A

sudden failure

acute severe pulmonary oedema + cardiogenic shock

72
Q

WPW - presentation

A

palpitations
dizziness
tachycardia

on exertion?

73
Q

what are the CIs to nitrates in ACS?

A

hypotension (sBP <90)
bradycardia (<50)
recent sildenafil use

74
Q

pericarditis - presentation

A

pleuritic chest pain

may have a few days hx

75
Q

what is sick sinus syndrome + how does it present? causes?

A

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
Q

which disorders is MR assoc with?

A

ehlers dahnlos
marfan’s

both collagen disorders

77
Q

widespread joint hypermobility + striae on skin - dx?

A

ehlers dahnlos

78
Q

what is a CI to adenosine?

A

asthma

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