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Cardiology Flashcards

1
Q

fever, pleuritic pain that is relieved by sitting up and leaning forwards

A

pericarditis

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2
Q

non productive cough, dyspnoea, flu-like symptoms, tachy-pnoea/cardia, pericardial rub

A

pericarditis

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3
Q

what can cause pericariditis

A

viral (coxsackie), TB, uraemia (fibrinous percarditis), trauma post MI (dresslers), connective tissue disease, hypothyroidism

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4
Q

saddle-shaped ST elevation, PR depression

A

pericarditis

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5
Q

dresslers syndrome triad

A

fever, pleuritic pain, pericardial effusion

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6
Q

janeway lesions/ osler’s nodes

A

subacute bacterial endocarditis

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7
Q

which valve more commonly affected by endocarditis

A

mitral

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8
Q

when does tricuspid valve get endocarditis

A

IV drug users- staph aureus

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9
Q

what are the risks for endocarditis

A

IV drugs, cardiac lesions, rheumatoid arthritis, dental treatment

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10
Q

what are the hacek organisms

A

normal flora in oral pharyngeal region

haemophilus, actinobacillus, cardiobacterium, eikenella, kingella

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11
Q

what are the causative organisms of endocarditis

A

staph viridans, aureus, epidermis

diphtheroids microaerophilic strep

HACEK

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12
Q

how is endocarditis classifies

A

dukes criteria

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13
Q

what are the major criteria in dukes

A

2 separate blood cultures

endocardial involvement

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14
Q

what are the minor dukes criteria

A

fever >38 degrees
IV drug user
predisposing heart condition
immunological phenomena (olser’s nodes, roth spots)
vascular phenomena (mycolytic aneurysm/ janeway lesions)
echocardiograph findings

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15
Q

what are the symptoms of endocarditis

A 
fever 
roth spots 
osler's nodes 
new murmer 
janeway lesions 
anaemia 
splinter haemorrhages 
emboli
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16
Q

what investigations are done into endocarditis

A

blood cultures (3 SEPARATE CULTURES FROM 3 PERIPHERAL SITES)
blood for anaemia
urinalysis (microscopic haematuria)
CXR
echo (transoesophageal/ transthoracic) for vegetations

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17
Q

Tx for native (subacute) endocarditis

A

amoxicillin IV and gentamicin

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18
Q

Tx for native valve acute with severe sepsis endocarditis

A

flucloxacillin IV

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19
Q

TX for prosthetic valve/ suspected MRSA endocarditis

A

vacomycin IV and rifampicin PO and gentamicin IV

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20
Q

TX for native valve, severe sepsis and risk factors for resistant pathogens

A

vancomycin IV and meropenem IV

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21
Q

complications of endocarditis

A

heart failure, arrhythmia, abscess formation in cardiac muscle, embolic formation (stroke, vision loss, infection spread)

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22
Q

when do you treat bradycardia

A

when hr <40 bpm

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23
Q

tx for bradycardia

A

atropine, subcutaneous pacing

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24
Q

what is sick sinus syndrome

A

sinus node dysfunction causes bradycardia +/- arrest, sinoatrial block or SVT alternating with bradycardia/ systole

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25
Q

what can be a complication of sick sinus syndrome

A

AF and thromboembolism

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26
Q

when and how do you treat sick sinus syndrome

A

if symptomatic- pace

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27
Q

narrow complex tachycardia

A

SVT- QRS < 0.12seconds

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28
Q

tx foe SVT

A

vagal manoeuvres, IV adenosine or verapamil

DC shock if compromised

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29
Q

what is the maintenance therapy for SVT

A

BBs or verapamil

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30
Q

irregularly irregular pulse, absent P waves

A

AF

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31
Q

saw tooth baseline + 150 bpm

A

atrial flutter

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32
Q

how do you treat pre-excited AF

A

flecainide

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33
Q

broad complex tachycardia

A

VT

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34
Q

acute treatment for VT

A

IV amiodarone or IV lidocaine

if no response/ compromised DC shock

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35
Q

congenital accessory conduction pathway between atria and ventricles

A

WPW

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36
Q

short PR interval, wide QRS, delta wave, ST-T changes

A

WPW

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37
Q

how does WPW present

A

SVT, pre excited AF or pre excited atrial flutter

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38
Q

what is a pre excited beat

A

impulse conducted through the accessory pathway

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39
Q

tx for WPW

A

ablation

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40
Q

what is holiday heart syndrome

A

seen in binge drinking with no other heart disease, can result in SVT or AF, tx is to stop drinking

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41
Q

irregularly irregular

A

AF

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42
Q

slow rising pulse

A

aortic stenosis

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43
Q

collapsing pulse

A

aortic regurgitation

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44
Q

bounding pulse

A

acute CO2 retention, hepatic failure, sepsis

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45
Q

radiofemoral delay

A

coarctation of aorta

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46
Q

jerky pusle

A

HOCM, mitral regurg

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47
Q

pulsus bisferiens

A

mixed aortic valve disease, HOCM

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48
Q

pulsus paradoxus

A

constrictive pericarditis, cardiac tamponade

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49
Q

describe a slow rising pulse

A

time to peak increase, whole pulse flattened and small

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50
Q

describe a pulsus bisferiens

A

2 peaks in pulse (brachial/ femoral)

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51
Q

describe a pulsus paradoxus

A

systolic pressure drop >10mm Hg with inspiration

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52
Q

what is hypertension

A

> 140/90

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53
Q

young patients with acute onset hypertension with a history of renal or endocrine disorders

A

secondary hypertension

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54
Q

what can cause secondary hypertension

A

diabetes complications (diabetic nephropathy), polycystic kidney disease, glomerular disease, renovascular hypertension, cushing syndrome, aldosteronism, pheochromocytoma, thyroid problems

lifestyle factors contribute: stress, smoking and obesity

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55
Q

what is pre hypertension

A

120-130/ 80-89

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56
Q

what is stage one hypertension

A

140-159/90-99

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57
Q

stage 2 hypertension

A

160-179/100-109

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58
Q

what is severe hypertension

A

> /= 180/ >/= 110

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59
Q

what bloods should be done for hypertension

A

FBC, LFTs, U/Es, creatinine, serum urea, cGRR, lipid levels, glucose, serum Ca2+

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60
Q

what might be seen on an ECH in hypertension

A

LV hypertropy

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61
Q

what might be seen in hypertension in a urine dipstick

A

haematuria and proteinuria

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62
Q

what are the complications of hypertension

A

MI, heart failurem renal impairment, stroke, hypertensive retinopathy

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63
Q

how is resistant hypertension treated

A

higher doses of thiazide or spironolactone. add alpha or beta blocker if Diuretic insufficient

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64
Q

rib notching on CXR

A

coarctation of the aorta- due to dilatation of the intercostal arteries

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65
Q

cyanosis first day of birth, boot shaped heart

A

tetralogy of fallot

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66
Q

components of tetralogy of fallot

A

overriding aorta, pulmonary stenosis, ventricular septal defect, RV hypertrophy

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67
Q

wide, fixed split S2, ejection systolic murmur 2nd/3rd intercostal space

A

atrial septal defect

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68
Q

radiofemoral delay, hypertension

A

coarctation of the aorta

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69
Q

harsh pansystolic murmur at the left sternal edge

A

ventricular septal defect

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70
Q

continuous machinery murmur below left clavicle

A

persistent ductus arteriosus

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71
Q

cyanosis first day of birth, egg shaped ventricles

A

transposition of great vessels

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72
Q

what congenital heart problems making you cyanotic

A

tetraology of fallot
transposition of great arteries
tricus. artresia
pulmonary stenosis

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73
Q

when does fallots usually present

A

1-2 months

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74
Q

louder in left lateral position on expiration

A

mitral stenosis

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75
Q

tappping apex, loud S1, rumbling mid-diastolic

A

mitral stenosis

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76
Q

soft S2, ejection systolic, radiates to carotids, crescendo decrescendo, slow rising pulse, heaving

A

aortic stenosis

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77
Q

soft S2

A

aortic stenosis

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78
Q

loud s1

A

mitral stenosis

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79
Q

bets heard on expiration leaning forwards

A

mitral regurg

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80
Q

large systolic JVP ‘v’ waves, pansystolic at lower left sternal edge

A

tricuspid regurgitation

81
Q

what murmurs can rheumatic heart disease cause

A

MR, MS, AS

82
Q

causes of mitral stenosis

A

calcification, RA, AS, malignant carcinoid, SLE

83
Q

what can cause mitral regurgitation

A

papillary muscle rupture muscle rupture, infective endocarditis, prolapse

84
Q

raised fixed JVP

A

superior vena cava obstruction

85
Q

JVP rising on inspiration

A

cardiac tamponade, constrictive pericarditis- look for pulsus paradoxicus

86
Q

large v waves

A

tricuspid regurgitation

87
Q

absent a waves

A

atrial fibrillation

88
Q

cannon a waves

A

complete heart block, AV dissociation, ventricular arrhythmias

89
Q

what is jvp an indicator of

A

central venous pressure

90
Q

a wave

A

atrial contraction

91
Q

c wave

A

tricuspid valve bulging into atrium

92
Q

v wave

A

rise in atrial pressure during filling

93
Q

blurred yellowing vision headache

A

digoxin toxicity

94
Q

s2 split during inspiration

A

normal

95
Q

s3

A

normal if <30 (in women up to 50)

may be heard in LVF and constrictive pericarditis

96
Q

s4

A

HOCM, hypertension

97
Q

fever, conjunctivitis, bright red cracked lips, strawberry tongue, cervical lymphadenopathy, red palms of hands/ soles of feet

A

kawasaki disease

98
Q

how is kawasaki treated

A

aspirin (high dose), IV immunoglobulins, ECHO

99
Q

complications of kawasaki

A

coronary artery syndrome

100
Q

why is aspirin not usually indicates in children

A

reye’s- swelling in liver and brain while recovering from viral infection

101
Q

SV x TPR =

A

CO

102
Q

MAP formulas

A

((2 x diastolic) + systolic) / 3

diastolic + 1/3 (systolic -diastolic)

103
Q

where to place the chest leads:

V1

A

right sternal edge, 4th intercostal space

104
Q

where to place the chest leads:

V2

A

left sternal edge, 4th intercostal space

105
Q

where to place the chest leads:

V3

A

halfway between V2 and V4

106
Q

where to place the chest leads:

V4

A

5th intercostal space, mid clavicular line

107
Q

where to place the chest leads:

V5

A

anterior axillary line

108
Q

where to place the chest leads:

V6

A

mid axilliary line

109
Q

tall tented P waves, prominent U waves (and wide QRSs)

A

hyperkalaemia- muscle weakness, cramps, tetany

110
Q

flattened T waves, prominent U waves (and wide QRS’s)

A

hypokalaemia- muscle weakness, cramps

111
Q

long q t interval

A

hypocalcaemia

112
Q

absent p wave

A

sinoatrial block

113
Q

bifid p wave

A

LA hypertrophy (e.g mitral stenosis)

114
Q

peaked P waves

A

right atrial hypertrophy (e.g. pulmonary hypertension, tricuspid stenosis)

115
Q

ST depression

A

myocardial ischaemia

116
Q

ST elevation

A

acute MI, LV aneursym

117
Q

LBBB

A

W seen in V1, V2

M seen in V4-V6

118
Q

RBBB

A

M seen in V1

W seen in V5-V6

119
Q

what can cause RBBB

A

age, RV hypertrophy, cor pulmonale (raised RV pressure), MI, atrial septal defect, cardiomyopathies, myocarditis

120
Q

how long is a P wave and what is it

A

atrial depolarisation

0.08-0.1s

121
Q

how long is the QRS complex and what is it

A

ventricular depolarisation <0.12s

122
Q

what is the T wave

A

ventricular repolarisation

123
Q

how long should the PR interval be

A

0.12-0.2s

124
Q

how to calculate heart rate from an ECG

A

if regular 300/ large boxes between beats

if irregular no of QRS in 30 large squares and multiply by ten

125
Q

how long is a large box

A

0.2 secs

126
Q

how long is a small box

A

0.04 secs

127
Q

normal ecg axis

A

complexes in I and II and predominantly positive

128
Q

lead 1 pos lead aVF +

A

normal axis

129
Q

lead 1 + leade aVF -

A

left axis deviation

130
Q

lead 1 - lead aVF +

A

RAD

131
Q

lead 1 - lead a VF -

A

extreme axis deviation

132
Q

what can cause LAD

A

left anterior hemiblock, inferior MI, VT from LV focus, WPW syndrome, LVH

133
Q

what can cause RAD

A

RVH, PE, anterolateral MI, WPW syndrome, left posterior hemiblock

134
Q

hyperacute T waves (inverts later), ST elevation, Q wave fromation

A

localising infarct

135
Q

II, III, aVF

A

inferior MI

136
Q

right coronary leads

A

II, III, aVF (inferior)

137
Q

I, aVL, V2-6

A

anterolateral

138
Q

LAD/ left cicumflex leads

A

(anterolateral) I, aVL, V2-6

139
Q

V2-5

A

anterior

140
Q

LAD leads

A

V2-5 (anterior)

141
Q

V1-4

A

anteroseptal (LAD)

142
Q

subendocardial infarct

A

ST and T changes with no Q waves

143
Q

posterior MI

A

V1,2 (tall R waves, ST depression, tall upright T waves)

144
Q

what artery is posterior

A

left circumflex, right coronary

145
Q

where do atrial ectopic beats originate from

A

pulmonary veins

146
Q

pathophysology of A fib

A

atrial ectopic beats cause dysfunction of electric signalling

147
Q

what are the causes of A fib

A

idiopathic, ischaemic heart disease, heart failure, valve disease, hypertension, hyperthyroidism, alcohol induced, familial

148
Q

abscent P waves, irreg R-R intervals, undulating baseline

A

A Fib

149
Q

investigations into A fib

A

ECG, holter monitoring (ambulatory ECG), ECHO, Thyroid function tests, CXR

150
Q

what are the complications of A fib

A

stroke heart failure, sudden death

151
Q

what is the treatment for A fib

A 
restore rate 
BB
CCB
Digoxin 
amiodarone

restore rhythm
BB
DC cardioversion
amiodarone

anticoagulant- warfarin, apixaban, dabigatran , rivaroxaban

152
Q

sense of impeding doom

A

MI

153
Q

what are the acute coronary syndromes

A

STEMI, NSTEMI, unstable angina

154
Q

how long do MI symptoms have to last to become worrying

A

> 20 mins

155
Q

who gets a silent MI

A

diabetics

156
Q

what are the signs (not symptoms) of an MI

A

raised JVP, increased pulse + BP changes, pallor and anxiety

157
Q

transmural infarct

A

all of myocardial wall, ST depression

158
Q

what is seen on an ECG of an MI

A

ST elevation/depression, inverted T waves, LBBB, pathological Q waves

159
Q

what is seen on an MI CXR

A

cardiomegaly, pulmonary oedema, widening of mediastinum

160
Q

what bloods for MI

A

troponin I and T

161
Q

what is PCI

A

angiography-images coronary vessels can be used for MI surgical intervention

162
Q

what is the acute treatment for an MI

A 
MONA T
morphine + anti emetic 
oxygen 
nitrates 
anticoagulants

ticagrelor

163
Q

drugs for discharged MI

A

aspirin, ACEi, BB (2nd CCB), statin

164
Q

what are the complications of MI

A 
cardiogenic shock arrhythmia 
pericarditis
emboli
aneurysm 
rupture of ventricle 
dresslers syndrome 
rupture of free wall 
papillary muscle rupture
165
Q

can you give PCI in NSTEMI

A

yes

166
Q

what do you give if you cant do PCI immediately

A

fondaparinux or LMWH (subcutaneously)

167
Q

malar (cheek) flush

A

mitral stenosis

168
Q

pulsatile hepatomegaly

A

tricuspid regurgitation

169
Q

carotid pulsation (corrigans)

A

aortic regurg

170
Q

head nodding (de musset’s sign)

A

aortic regurg

171
Q

capillary pulsations in nail bed

A

aortic regurgitation

172
Q

pisto shot heart over femorals

A

aortic regurgitation

173
Q

roth spots (boat shaped retinal haemorrhages)

A

infective endocarditis

174
Q

olsers nodes (painful, hard swellings on fingers/toes)

A

infective endocarditis

175
Q

janeway lesions (painless erythematous blanching macules seen on palmar surface)

A

infective endocarditis

176
Q

what criteria asses severity of heart failure

A

framingham (2 major/ 1 major + 2 minor)

177
Q

what are the major criteria for heart failure

A 
paroxysmal nocturnal dyspnoea 
acute pulmonary oedema 
increased heart size/ CVP
neck vein dilatation 
S3 gallop
178
Q

what are the minor criteria for heart failure

A

pleural effusion, ankle oedema, increased HR, nocturnal cough

179
Q

new york heart assoc classification of CCF

A

I- no limitation
II-slight
III-marked
IV- inability to carry out physical activity

180
Q

what are the signs of RVF

A

peripheral oedema and ascites

181
Q

what can cause RVF

A

LVF, tricus/pulm valve disease, pulmonary vascular disease

182
Q

what are the signs of LVF

A

PND, wheeze, nocturnal cough with pink sputum (pulmonary oedema)

183
Q

what can cause LVF

A

coronary artery disease, hypertension, aortic/ mitral disease, myocardial disease

184
Q

LVF and RVF both cause

A

ischameic injury and reduction in myocardial efficiency

-causes increased work load, decreased CO and contractility

185
Q

what are the compensatory mechanisms of heart failure

A

RAAS, SNS activation, increase in myocyte size

186
Q

what does activation of RAAS cause

A

Na+ ion and H2O retention and peripheral vasoconstriction= increased preload and venous return

187
Q

what does SNS activation cause

A

increased HR, peripheral vasoconstriction, increasing afterload

188
Q

what does chronic activation of heart failure compensatory mechanisms cause

A

makes heart failure worse

189
Q

how does heart failure cause hepatomegaly

A

congestion of the hepatic portal system

190
Q

causes of angina pectoris

A

atherosclerosis, anaemia, tachyarrhythmia

191
Q

what can precipitate angina

A

exercise, cold weather, heavy metals

192
Q

decubitus angina

A

triggered y lying flat

193
Q

prinzmetal angina

A

coronary artery spasm

194
Q

which type of angina causes ST elevation

A

prinzmetal

195
Q

what investigations for angina

A

ECG, CT scan, Caclium score (measured on CT), coronary angiography (gold standard), thallium scan

196
Q

complications of angina

A

MI and stroke

197
Q

process of atheroma formation

A

fatty streak, fibrolipid plaque formation, complicated atheroma (prone to rupture)

198
Q

drugs for angina

A

GTN, aspirin, BB, CCB, K+ channel acitvator (nicorandil)

199
Q

surgery for angina

A

PCTA, or CABG

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