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Phase 2A Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is an ECG?

A

An electrocardiogram is a representation of the electrical events of the cardiac cycle.

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2
Q

What is the standard ECG callibration?

A

25mm/s paper speed

0.1 mV/mm voltage

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3
Q

What factors modulate the rate of depolarisation of the SAN?

A 
autonomic tone (parasymp and symp input)
stretch
temperature
hypoxia
blood pH
hormonal influences (tri-iodothyronine and serotonin)
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4
Q

What is the significance of the refractory phase in myocyte action potential?

A

It prevents early reactivation of the myocytes and directly determines the strength of the contraction.

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5
Q

Where is the SAN located?

A

It lies in the lateral and epicardial aspects of the junction between the superior vena cava and right atrium.

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6
Q

Where is the AVN located?

A

It lies beneath the right endocardium within the lower interatrial septum.

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7
Q

What three factors describe the contractile function of cardiac tissue?

A
  1. the velocity of muscle contraction
  2. the load that is moved by the contracting muscle
  3. the extent to which the muscle is stretched before contracting
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8
Q

What does Starling’s law of the heart state?

A

The law states that the stroke volume of the heart increases in response to an increase in the volume of blood in the ventricles, before contraction, when all other factors remain constant.

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9
Q

Why has low molecular weight heparin replaced unfractionated heparin as anticoagulation treatment?

A

more effective
does not require monitoring
less risk of bleeding

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10
Q

What is the target INR?

A

2.5 (2-3)

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11
Q

Name some beta blockers.

A

propranolol, atenolol, bisoprolol

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12
Q

what conditions can hypertension lead to?

A 
stroke
mi
heart failure
chronic renal disease
cognitive decline
premature death
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13
Q

what does hypertension increase the risk of?

A

atrial fibrillation

increased independent stroke risk

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14
Q

What are the clinical parameters for suspected hypertension? What is the next step?

A

140/90 or higher

people with suspected hypertension are offered ambulatory blood pressure monitoring (ABPM) which monitors it over 24 hours.

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15
Q

Whatare the main clinical inications for ACEIS?

A

hypertension
heart failure
diabetic nephropahty

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16
Q

Give examples of ACEIs?

A

ramipril

etc

17
Q

What are the main adverse effects of ACEIs?

A

related to reduced angiotensin II formation:

hypotension
acute renal failure
hyperkalaemia
teratogenic effects in pregnancy

related to increased kinin production:

cough
rash
anaphylactoid formation

18
Q

What are the main clinical indications for ARB?

A

hypertension
diabetic nephropathy
heart failure (when ACEIs contraindicated)

19
Q

What are the main adverse effects of ARBs?

A 
symptomatic hypotension (hypovolaemic patients)
hyperkalaemia
potential for renal dysfunction
rash
angio-oedema

contraindicated in pregnancy

20
Q

What are the main clinical indications for calcium channel blockers?

A

hypertension
ischaemic heart disease - angina
arrhythmia (tachycardia)

21
Q

What type of channels do CCBs act on?

A

L-type (long-acting) CC

22
Q

What are the three types of CCBs?

A

dihydropyridines

phenyl….

23
Q

What are the adverse effects of CCBs?

A 
due to peripheral vasodilation (mainly dihydropyridines as heart increases rate and pressure to match dilation)
flushing 
headache 
oedema
palpitations

due to negatively ….

24
Q

What are the main clinical indications for beta-adrenoceptor blockers?

A

hypertension etc…

25
Q

What are the main adverse effects of beta-adrenoceptor blockers?

A

fatigue
headache
sleep disturbance/nightmares

bradycardia
hypotension
cold peripheries

erectile dysfunction

26
Q

What previous conditions can beta blocker use worsen?

A

asthma or COPD
PVD- claudication or Raynaud’s
heart failure - if given in standard dose or acutely

27
Q

What are the main clinical indications for diuretic use?

A

hypertension

heart failure

28
Q

What are the different classes of diuretics?

A

thiazides and related drugs (distal tubule)

29
Q

Give examples of thiazide diuretics.

A

bendroflumethiazide
hydrochlorothiazide
chlorthalidone

30
Q

give examples of loop diuretics.

A

furosemide

bumetanide

31
Q

Give examples of potassium-sparing diuretics.

A

spironolactone

32
Q

What are the main adverse effects of diuretics?

A

hypovolaemia
hypotension (boh mainly loop diuretics)

hypokalaemia
hyponatraemia

33
Q

How can you relieve symptoms in congestive heart failure?

A

loop diuretics

34
Q

What does the disease influencing therapy of CHF involve?

A

neurohumoral blockade-

inhibition of RAAS and SNS

35
Q

What are the main effects of cardiac natriuretic peptides?

A

….

36
Q

What are nitrates mainly used for?

A

ischaemic heart disease - angina

heart failure

37
Q

What are the adverse effects of amiodarone?

A 
QT prolongation 
polymorphic ventricular tachycardia 
interstitial pneumonitis 
abnormal liver function 
hyperthyroidism/hypothyroidism 
sun sensitivity 
slate grey skin discolouration 
corneal microdeposits 
optic neuropathy

multiple drug interactions - especially warfarin - amiodarone displaces warfarin from its binding site to blood proteins causing a lot of free warfarin which will cause over-anticoagulation and bleed to death

very large volume of distribution so it gets everywhere

38
Q

How would you medically manage a patient with atrial fibrillation?

A
  1. tx underlying cause: alcohol, thyroid disease, hypertension, valve disease, heart failure etc
  2. rate control: beta blockers, calcium channel blockers, digoxin
  3. return sinus rhythm: electrical or pharmacological (amiodarone) cardioversion
  4. Maintain sinus rhythm: sotalol, amiodarone

Phase 2A Medicine (16 decks)

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