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Revision lectures > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is hypertension

A

BP over 140/90

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2
Q

Primary hypertension

A

No obvious cause

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3
Q

Secondary hypertension

A
  • renal disease eg renal artery stenosis
  • endocrine eg Conn’s, Cushing’s, phaeochromocytoma
  • aortic eg coarctation
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4
Q

If BP in clinic is over 140/90

A

Then do ABPM - ambulatory BP monitoring

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5
Q

Stage 1 hypertension

A

Over 140/99

Or

ABPM over 135/85

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6
Q

Stage 1 HTN - first step

A

Lifestyle interventions

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7
Q

Stage 1 HTN should be treated if…

A
  • end organ damage
    (fundoscopy - for hypertensive retinopathy, urine dipstick - for proteinuria, ECG - for LVF or IHD)
  • established CVS disease, renal disease, diabetes
  • 10 year CVS risk above 20%
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8
Q

Stage 2 HTN

A

BP over 160/100

Or

Over 150/95

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9
Q

Stage 3 HTN

A

Systolic over 180

Or

Diastolic over 110

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10
Q

Treatment of HTN - First line - Aged under 55

A

ACE Inhibitor

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11
Q

Treatment of HTN - First line - Aged over 55 or black person of African or Carribbean family origin of any age

A

Calcium Channel Blocker

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12
Q

Treatment of HTN - First line - Diabetics

A

ACEI

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13
Q

Treatment of HTN - First line - Pregnant

A

B-Blocker

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14
Q

Second line HTN treatment

A

ACEI + Calcium Channel Blocker

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15
Q

Third line HTN treatment

A

ACEI + Calcium Channel Blocker + Diuretic

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16
Q

Treatment for resistant HTN

A

ACEI + Calcium Channel Blocker + Diuretic + consider further diuretic or alpha or beta blocker

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17
Q

Diuretic of choice for HTN

A

Indapamide

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18
Q

Resistant HTN treatment…

A

K under 4.5 use spironolactone

K over 4.5 use higher dose thiazide diuretic

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19
Q

Malignant HTN definition

A

BP over 200/130

Causes fibrinoid necrosis

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20
Q

Features of malignant HTN

A

Headache, nausea, vomiting, visual disturbance

Papilloedema

Encephalopathy eg seizures

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21
Q

Management of malignant HTN

A

Oral theray eg atenolol

If severe or encephalopathic use IV therapy eg IV labetalol or IV nitroprusside

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22
Q

Definition of Unstable Angina

A

ST depression or T wave inversion

No troponin rise

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23
Q

Definition of NSTEMI

A

ST depression or T wave inversion

Troponin rise

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24
Q

Definition of STEMI

A

ST elevation

Troponin rise

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25
Q

STEMI Criteria

A
  • Over 1mm ST elevation in 2 adjacent limb leads
  • Over 2mm ST elevation in at least 2 contiguous precordial leads
  • New onset Left Bundle Branch Block
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26
Q

Site of MI

Anterior

A

V1-V6

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27
Q

Site of MI

Anteroseptal

A

V1 - V4 (LAD)

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28
Q

Site of MI

Anterolateral

A

1, aVL, V5, V6 (circumflex)

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29
Q

Site of MI

Inferior

A

II, III and aVF (right coronary artery)

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30
Q

Site of MI

Posterior

A

ST depression and upright T waves in V1-V3 (right coronary artery)

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31
Q

Medical management of STEMI

A 
Morphine and Metoclopramide (IV)
Oxygen
Nitrates (GT spray)
Aspirin 300mg
PLUS
Second antiplatelet usually given
Clopidogrel or ticagrelor
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32
Q

Medical intervention in STEMI

A

Primary PCI within 120 mins

If not use fibrinolysis

After fibrinolysis wait 90 mins and do ECG - if not greater than 50% resolution of ST elevation then transfer for PCI

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33
Q

Medical Management of NSTEMI

A 
Morphine and metaclopramide (IV)
Oxygen
Nitrates (GTN spray)
Aspirin 300mg
Clopidogrel (and continue for 12 months)

Offer fondaparinux
Coronary angiography

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34
Q

Complications of MI

A 
Arrhythmias
Ventricular fibrillation = most common cause of death post MI
Bradyarrhythmia (AV block) 
Left ventricular aneurysm 
Persistent ST elevation and LVF
Pericarditis/Dressler’s syndrome
Heart failure
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35
Q

All patients with angina should receive..

A

Aspirin
Statin
GTN Spray

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36
Q

First line treatment of angina

A

Beta blocker (eg atenolol) or Calcium Channel Blocker

If just CCB - verapamil or diltiazem

If CCB + BB = nifedipine

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37
Q

Symptoms of acute left ventricular failure - pulmonary oedema

A

Dyspnoea
Orthopnoea
Pink frothy sputum

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38
Q

Management of acute left ventricular failure - pulmonary oedema - LMNOP

A 
Loop diuretic eg IV furosemide
Morphine
Nitrates
Oxygen
Postural - sit up
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39
Q

Chronic Left Sided Heart Failure overview

A

Causes include ischaemic heart disease, valvular disease, cardiomyopathy
Symptoms include dyspnea, orthopnoea, pink frothy sputum
Examination – fine crackles, pleural effusion, 3rd heart sound

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40
Q

Chronic Right Sided Heart Failure Overview

A

Causes include congenital heart disease, cor pulmonale, secondary to LVF
Symptoms/signs peripheral oedema, raised JVP, hepatomegaly, ascites

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41
Q

Investigation HF

A 
Signs of symptoms
THEN
Examination (FBC, TFTs, Fasting glucose, U&Es, urinalysis, CXR)
THEN
BNP or ECG
THEN if still possibility 
ECHO
42
Q

What is BNP in relation to heart failure?

A

BNP = B natriuretic peptide (secreted by ventricles).
If < 100, heart failure is unlikely
If BNP raised or abnormal ECG → ECHO

43
Q

1st Line Tx for HF

A

ACEI and beta blocker (eg bisoprolol)

Offer annual flu vaccine
Offer one off pneumococcal vaccine (CKD need booster every 5 years)

44
Q

2nd line Tx for HF

A

Spironolactone, ARB (eg candesartan) or hydralazine with a nitrate

45
Q

3rd line Tx for HF

A

Digoxin or Cardiac Resynchronisation Therapy

Ivabradine alternative - must be on suitable therapy, have HR over 75 and LVF under 35%

46
Q

Diuretic of choice if fluid overload in HF

A

Furosemide

47
Q

In Tachycardia - with a pulse - look for adverse features

A 
Shock
Syncope
Heart failure
Myocardial ischaemia
If there are adverse features → DC cardioversion
48
Q

In Tachycardia - with a pulse and no adverse features

Broad QRS Complex

A

If regular:
Ventricular tachycardia (treat with amiodarone)
If known to be SVT with bundle branch block then follow narrow complex tachycardia

If irregular – seek expert help

49
Q

In Tachycardia - with a pulse and no adverse features

Narrow QRS Complex

A

If regular:
Vagal maneouvres
Adenosine (6mg, 12mg, 12mg)

If irregular – probable AF
Control rate with beta-blocker or diltiazem

50
Q

In Bradycardia with a pulse look for…

A 
Look for adverse features:
Shock
Syncope
Heart failure
Myocardial ischaemia
AND
Look for risk of asystole:
Recent asystole
Mobitz II AV block
Complete heart block with broad QRS
Ventricular pause > 3 s
51
Q

In Bradycardia with a pulse and adverse features or risk of asystole…

A

Give 500micrograms of atropine to a maximum of 3mg

52
Q

Atrial Fibrillation Management

A

Rate vs Rhythm control

53
Q

AF Rate Control

A

Bisoprolol or Diltiazem

If one does not control rate then combination. With two of

  • Beta blocker
  • diltiazem
  • digoxin
54
Q

AF Rhythm Control used when..

A

Used if patient has heart failure, first onset of AF or a reversible cause of AF

55
Q

Rhythm Control in unstable patient with AF

A

Electrical cardioversion

Patient should be anticoagulated for at least 4 weeks after

56
Q

Rhythm Control Pharmacology in AF

Amiodarone

A

If structural heart disease

57
Q

Rhythm Control Pharmacology in AF

Flecainide

A

Without structural disease

58
Q

Rhythm Control Pharmacology in AF

Cardioversion

A

Patients should have under 48 hours of symptoms or be anticoagulated for 3 weeks before attempting cardioversion

59
Q

CHA2DS2VS

A 
Congestive Heart Failure = 1
HTN = 1
Age over 75 = 2
Age 65-74 = 1
Diabetes = 1
Stroke/TIA/thromboembolism = 2
Vascular disease = 1
Sex (female) = 1
60
Q

Chadvasc score and offering anticoagulation

A

0 = no treatment

1 = males = consider anticoagulation
1 = females = no treatment

2 = females = offer anticoagulation

61
Q

If after an ACEI a patient develops a dry cough..

A

Change to low cost ARB

62
Q

If after an ACEI a patient develops a dry cough..

Or angioedema, hyperkalaemia

A

Change to low cost ARB

63
Q

Indications for warfarin and target INR

Venous thromboembolism

A

2.5

If recurrent 3.5

64
Q

Indications for warfarin and target INR

AF

A

2.5

65
Q

Factors that may potentiate warfarin

A

Liver disease
P450 enzyme inhibitors eg. Amiodarone and ciprofloxacin
Cranberry juice
NSAIDs

66
Q

Stopping warfarin before surgery

A

Usually 5 days before

INR 1.5 or less

67
Q

Primary prevention statins given if…

A 
10 year CVS risk over 10%
OR
T1DM (over 40, over 10 years diabetic or established nephropathy)
OR
CKD if eGFR under 60

Atorvastatin 20mg OD

Titrate up to 80mg max if non-HDL hasn’t fallen by 40%

68
Q

Secondary prevention statins given…

A 
If known ischaemic heart disease 
OR
Cerebrovascular disease
OR
Peripheral arterial disease

Atorvastatin 80mg OD

69
Q

Contraindications to thrombolysis

A 
Active internal bleeding
Recent Haemorrhage, trauma or surgery
Coagulation and bleeding disorders
Intracranial neoplasm
Stroke under 3months
Aortic dissection
Recent head injury
Pregnancy
Severe HTN
70
Q

Examples of thrombolysis

A

Alteplase
Tenecteplase
Streptokinase

71
Q

Side effects of loop diuretics

A 
Hypotension
Hyponatraemia
Hypokalaemia
Ototoxicity
Hypocalcaemia
Renal impairment 
Hyperglycaemia (but less common that thiazides)
Gout
72
Q

Management of Torsades de Pointes

A

IV MgSO4

73
Q

Statin + Erythromycin/Clarithromycin =

A

Statin induced myopathy

74
Q

Cautions and contraindications of ACEI

A

Pregnancy and breast feeding - avoid
Renovascular disease - significant renal impairment may occur in patients with undiagnosed bilateral renal artery stenosis
Aortic stenosis - may result in hypotension
High dose diuretic therapy - increases chance of hypotension
Hereditary idiopathic angioedema

75
Q

Rheumatic fever diagnosis based on…

A

Recent streptococcal infection
(History of scarlet fever, positive threat swab, increase in DNase B titre)

And 2 major criteria

Or 1 major and 2 minor criteria

Major = erythema marginatum, Sydenham's chorea, polyarthritis, endo/myo/peri-carditis, subcutaneous nodules)
Minor = raised ESR or CRP, pyrexia, arthralgia, prolonged PR interval
76
Q

Drugs shown to reduce mortality in patients with left ventricular failure

A 
ACEI
Beta Blockers
ARBs
Aldosterone antagonists eg spironolactone
Hydralazine and nitrates
77
Q

Side effects of Beta Blockers

A

Bronchospasm
Cold peripheries
Fatigue
Sleep disturbances

78
Q

Contraindication of beta Blockers

A

Uncontrolled heart failure
Asthma
Sick sinus syndrome
Concurrent verapamil

79
Q

Mack let Triad for Boerhaave syndrome

A

Vomiting
Thoracic pain
Subcutaneous emphysema

Commonly middle aged men with background of alcohol abuse

80
Q

Coarctation of the aorta

Features and associations

A

Congenital narrowing of descending aorta
More common in males despite association with Turners

Features - infancy:heart failure, adult:hypertension, radiofemoral delay, mid systolic murmur maximal over back, apical click from aortic valve, notching of inferior border of ribs
Associations - Turners, bicuspid aortic valve, berry anuerysms, neurofibromatosis

81
Q

Features of complete heart block (3rd degree)

A 
Syncope
Heart failure
Regular bradycardia 30-50bpm
Wide pulse pressure
JVP: cannon waves in neck
Variable intensity of S1
82
Q

First degree heart block

A

PR interval >0.2s

83
Q

Second degree heart block

A

Mobitz 1 - progressive prolongation of PR until drop

Mobitz 2 - PR interval constant but P wave is often not followed by QRS

84
Q

Third degree heart block

A

No association between P waves and QRS complexes

85
Q

Warfarin Management

Major bleeding

A

Stop warfarin
Give IV Vit K 5mg
Prothrombin complex concentrate - if not available then FFP

86
Q

Warfarin Management

INR >8
Minor bleeding

A

Stop warfarin
Give IV Vit K 1-3mg
Repeat dose of Vit K if INR still too high after 24hours
Restart warfarin when INR under 5

87
Q

Warfarin Management

INR>8
No bleeding

A

Stop warfarin
Give IV Vit K 1-5mg by mouth using IV preparation orally
Repeat dose of Vit K if INR still too high after 24hours
Restart warfarin when INR under 5

88
Q

Warfarin Management

INR 5-8
Minor bleeding

A

Stop warfarin
Give IV Vit K 1-3mg
Restart when INR under 5

89
Q

Warfarin Management

INR 5-8
No bleeding

A

Withhold 1 or 2 doses of warfarin

Reduce subsequent maintenance dose

90
Q

Becks Triad for cardiac tamponade

A

Falling BP
Rising JVP
Muffled heart sounds

91
Q

Diagnostic test for cardiac tamponade

A

Echocardiogram

Can show enlarged pericardium or collapsed ventricles

92
Q

Tetralogy of Fallot

A

Pulmonary stenosis

Right ventricular outflow obstruction

Right ventricular hypertrophy

VSD (right to left shunt caused by pulmonary stenosis)

Overriding of the VSD by the aorta

Most common form of cyanosis heart disease. Presents with cyanotic episodes usually at 1-2months of age

93
Q

Amiodarone

6 Ps

A 
Prolongs action potential duration
Photosensitivity
Pigmentation of skin
Peripheral neuropathy
Pulmonary alveolitis and fibrosis
Peripheral conversion of T4 to T3 is inhibited leading to hypothyroidism
94
Q

Signs of mitral valve stenosis

A

Malar flush (mitral facies)
Atrial fibrillation (anything that causes left atrial enlargement can increase risk of AF)
Palpable S1 (tapping apex beat)
Loud S1 with opening snap (if pliable valve)
Rumbling low pitched mild diastolic murmur

95
Q

Causes of AF

A 
Soaring BP
Heart failure
IHD
MI
Mitral valve disease
Ethanol/endocrine (thyrotoxicosis)
Respiratory (pneumonia,PE,bronchial ca)
Sick sinus syndrome/Sepsis
96
Q

AF Prophylaxis

A

Amiodarone

Flecainide

Chemical cardioversion

97
Q

Systolic Murmurs

Occur on the pulse

A

Aortic Stenosis
Pulmonary Stenosis

Mitral Regurgitation (can be caused by mitral valve prolapse)
Tricuspid Regurgitation
98
Q

Diastolic Murmurs

A

Aortic Regurgitation
Pulmonary Regurgitation

Mitral Stenosis
Tricuspid Stenosis

99
Q

Aortic Stenosis

A

Ejection click
Crescendo Decrescendo - diamond shaped

Systolic ejection murmur

Heard most loudly at aortic area with radiation to carotids

100
Q

Mitral Regurgitation

A

Best heard in apex

Pan systolic

No change in intensity

Radiates to axilla

Associated condition - mitral valve prolapse - mid systolic click sometimes with following murmur of MR

101
Q

Aortic Regurgitation

A

Best heard in left sternal border

Decrescendo

Early diastolic murmur

102
Q

Mitral Stenosis

A

Opening snap

Mid diastolic rumble

Decrescendo

Pre systolic accentuation

Heard in mitral area

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