Cardiology Flashcards
1
Q
What is critical stenosis?
A
> 75% stenosis, leads to compensatory vasodilation but this is not enough
2
Q
When can an MI be seen histologically and macroscopically?
A
Histologically- 4 hours
Macroscopically- 12 hours
3
Q
What is a silent MI and who is likely to have one?
A
ACS without chest pain: Diabetics, Elderly
4
Q
How may a silent MI present?
A
Syncope Pulmonary oedema Epigastric pain Vomiting Acute confusion Stroke
5
Q
What are the potential complications of MI?
A
Cardiac arrest Heart failure Arrhythmias eg. Bradyarrhythmias, tachyarrhythmias Myocardial rupture -> tamponade, left to right shunt Systemic emboli Papillary muscle dysfunction Ventricular aneursym Pericarditis
6
Q
What ECG changes are seen following an MI?
A
Hours/ days- ST elevation, tall T waves, may have new LBBB
Days/weeks- T wave inversion
7
Q
What are the differential diagnoses for MI?
A
Stable angina Unstable angina Pericarditis Myocarditis Aortic dissection PE Oesophageal spasm/ reflux Pneumothorax Musculoskeletal pain Pancreatitis
8
Q
What are the features of systolic heart failure?
A
Impaired contractility
Rjection fraction <40%
Enlarged ventricles with thin walls
9
Q
What is systolic heart failure caused by?
A
IHD
MI
Cardiomyopathy
10
Q
What is diastolic heart failure caused by?
A
Ventricular hypertrophy Aortic stenosis Hypertension Tamponade Constrictive pericarditis Restrictive cardiomyopathy Obesity
11
Q
What are the chest Xray features of left ventricular failure?
A
A- Alveolar oedema (Bat's wing shadowing) B- Kerley B lines (interstitial oedema) C-Cardiomegaly D-Dilated upper lobe vessels E-Pleural effusions
12
Q
What pharmacological agents can be used for SYSTOLIC heart failure?
A
- ACEIs/ARBS
- B blockers
- Diuretics eg. Spironalactone if K+ low
- Other diuretics
- Digoxin- relieves symptoms, for patients with Left ventricular systolic dysfunction
- Vasodilators eg. Hydralyzine
13
Q
What is a biomarker of heart failure?
A
BNP
14
Q
What is primary/ essential hypertension?
A
Hypertension with unknown cause, 95%
15
Q
What are the causes of secondary hypertension?
A
Renal disease
Endocrine disease
Pregnancy
Drugs
16
Q
What does NICE set as the target blood pressure?
A
140/90
150/90 if >80
130/80 if diabetic
17
Q
What are the causes of aortic stenosis?
A
Calcification
Congenital eg. bicuspid valve
Rheumatic fever
18
Q
What are the causes of aortic regurgitation?
A
Infective endocarditits
Rheumatic rever
Congenital
Aortic disection Hypertension RA Syphilis Connective tissue disorders
19
Q
What are the causes of mitral stenosis?
A
- Rheumatic fever
2. Congenital
20
Q
What are the causes of mitral regurgitation?
A
- Mitral valve proplapse
- LV dilation
- Congenital
- Infective endocarditis
- Papilliary muscle dysfunction
21
Q
What is the most common valvular abnormality?
A
Mitral valve prolapse -> mitral regurgitation
22
Q
What are the signs and symptoms of aortic stenosis?
A
Symptoms: Syncope, angina, heart failure, dizzyness, dyspnoea, faints
Signs: Slow rising pulse, narrow pulse pressure, heaving non displaced apex, S2 may be absent if severe AS, Aortic thrill
23
Q
What are the signs and symptoms of aortic regurgitation?
A
Symptoms: Dyspnoea, Palpitations, PND
Signs: Collapsing pulse, bounding pulse, wide pulse pressure, Corrigan’s sign, DeMusset’s sign, Quincke’s sign
24
Q
What are the signs and symptoms of mitral stenosis?
A
Symptoms: only when orifice is <2cm; pulmonary hypertension signs: chronic bronchitis picture, haemoptysis, dyspnoea
Signs: Malar flush, low volume pulse, AF, right sternal heave, loud S1
25
What are the signs and symptoms of mitral regurgitation?
Symptoms: Dyspnoea, palpitations, fatigue
Signs: AF, displaced apex
26
What is functional regurgitation?
Where a valve becomes incompetent due to ventricular dilation
27
Which bacteria cause the pharyngeal infection that proceeds rheumatic fever?
B-haemolytic S.pyogenes; antibodies to the strep bacteria damage heart valves
28
What are the symptoms/ signs of rheumatic fever?
```
Positive Strep pyogenes culture
Carditis: tachycardia, murmur, pericardial rub
Arthritis
Fever
Raised CRP/ ESR
Erythema marginatum
```
29
What are the 3 most common causes of ACUTE infective endocarditis?
Highly virulent organisms-
1. S. aureus
2. Pneumococcus
3. S.pyogenes
30
What are the 2 most common causes of SUBACUTE bacterial endocarditis?
Low virulence organisms-
1. Strep viridans
2. Enterococci
31
What are the signs/ symptoms of endocarditis?
Septic symptoms: Fever, night sweats, weight loss, rigors, malaise, anaemia, splenomegaly, clubbing
Embolic features: Janeway lesions, abscesses in relevant organs
Immunoligical deposition: Osler's nodes, microscopic haematuria
New murmur
32
What are the causes of dilated cardiomyopathy?
```
Chronic anaemia
Haemochromatosis
Alcohol
Genetic
Idiopathic
```
33
Dilated cardiomyopathy makes up 90% of myopathies, and has dilation of all chambers, leading to ................
Reduced ejection fraction
| Thromboemboli common
34
How can pericarditic pain be relieved?
Leaning forward
35
When is pericarditic pain worse?
Laying flat, inspiration
36
What are the 3 factors for Beck's Triad of cardiac tamponade?
Diagnostic of Cardiac Tamponade:
1. Rising JVP
2. Falling BP
3. Muffled heart sounds
37
What are the features of pericarditis on ECG?
Saddle shaped ST elevation
| PR Depression
38
What are the features of myocarditis on ECG?
ST changes
| T wave inversion
39
What is the leading cause of cardiac sudden death in young people?
Hypertrophic cardiomyopathy
40
Orthostatic hypotension is defined as a ____mmHg drop in systolic or a ______mmHg drop in diastolic BP on standing.
20 systolic
10 diastolic
41
What are the potential causes of orthostatic hypotension?
```
Adrenal insufficiency (Addison's)
Autonomic failure eg. in diabetes, Parkinsons, alcohol
```
42
The treatment for dilated cardiomyopathy is ...........
Heart transplant
43
Which type of heart murmur is associated with nocturnal angina?
Aortic Regurgitation
44
What is sinus arrhythmia?
Slight lengthening and shortening between each complex
Regular
Changes with respiration, common in young
45
What are the causes of atrial fibrillation?
1. Hypertension
2. Heart failure
3. Ischemic heart disease
4. Mitral valve disease
5. Hyperthyroidism
6. Caffeine, alcohol
7. Post operative
8. PE
9. Pneumonia
10. Cardiomyopathy
46
What tests should be done on a patient with suspected AF?
1. ECG- look for absent P wave, irregular WRS
2. Bloods- U&Es, cardiac enzymes, TFTs
3. Echo- look for mitral valve disease, enlarged left atria
47
What are the main aims in treating chronic AF?
1. Anticoagulation to reduce stroke risk
| 2. Rate control
48
Which drugs should be used for rate control in AF?
1st line: B blockers or Rate limiting CCBs (Diltiazem)
If these don't work: Add Digoxin, or consider Amiodarone
49
How should rhythm control be achieved in AF?
1. DC cardioversion
2. Flecainide
3. Amiodarone
50
When is rhythm control used in AF?
Young patients
1st presentation of lone AF
Symptomatic
CCF
51
How should atrial flutter be treated?
1. DC Cardioversion
2. IV Amiodarone
3. Anticoagulate, rate and rhythm control
52
What are the 4 classes of anti arrhythmic drugs?
1. Drugs which block Vol Na channels
2. B blockers
3; Drugs which prolong action potential
4. CCBs
53
Give examples of drugs in each of the 4 classes of anti-arrhythmic drugs?
1. Phenytoin, Flecainide
2. Bisoprolol
3. Amiodarone
4. Diltiazem
54
How should SVT be treated?
EMERGENCY
1. Defibrillator pads
2. Vagal manouvre/ carotid sinus massage
3. IV Adenosine to cause transient AV block and uncover rhythm
55
How does adenosine work?
A1 adenosine receptor AGONIST
Causes hyperpolarisation, transient AV block
Opposite of caffeine
56
Which CCBs are used in atrial fibrillation?
Non dihydropyridines:
1. Diltiazem
2. Verapamil
57
What are the 2 main types of CCBs?
1. Dihydropyridines eg. Amlodipine, used for hypertension and angina as cause vasodilation
2. Non Dihydropyridines eg. Diltiazem , Verapamil, used for AF rate control as act on the heart and reduce heart rate
58
How does aspirin work?
Irreversibly inhibits COX enzymes, preventing production of Thromboxane A2, so inhibiting platelet aggregation.
59
How does Clopidogrel work?
Blocks platelet aggregation
Less gastric irritation than aspirin
60
What is aspirin used for?
1. Secondary prevention of MI, stroke, TIA
| 2. Angina
61
How do B1 receptor blockers work?
Decrease HR
| Decrease force of contraction
62
How do B2 receptor blockers work?
Bronchoconstriction
| Peripheral vasoconstriction
63
Which beta blockers are cardioselective (act on B1 receptors)?
Bisoprolol
| Atenolol
64
Which beta blockers are non cardioselective (act on B1 and B2 receptors)?
Propanolol
| Timolol
65
What are beta blockers used for?
1. Hypertension
2. Angina
3. Post MI
4. AF
5. Heart failure
66
When are beta blockers contraindicated?
Asthma
COPD
Heart block
67
What are the side effects of beta blockers?
Cold extremities
Erectile dysfunction
Bradycardia
Hypoglycaemia
68
What are ACEIs used for?
1. Hypertension
2. Heart failure
3. Post MI
69
Why should bloods be monitored when starting or increasing ACEI dose?
To check for creatinine rise in UandEs, rise >20% is concerning
70
What are the side effects of thiazide diuretics?
Gout
Erectile dysfunction
Hypercalcaemia
Hyperglycaemia
71
What are the side effects of loop diuretics?
```
Hypovolaemia
Polyuria
Hypokalaemia
Hyponatraemia
Ototoxicity
```
72
What are the side effects of potassium sparing diuretics?
Hyperkalaemia
Gynaecomastia
Erectile dysfunction
73
What are thiazide diuretics used for?
Hypertension
| Heart failure
74
What are loop diuretics used for?
Heart failure
Pulmonary oedema
Nephrotic syndrome
Ascites
75
What are potassium sparing diuretics used for?
Hyperaldosteronism (Conn's)
76
What are vasodilators used for?
Heart failure
Hypertension
Ischemic heart disease
77
How do dihydropyridines (CCBs) work?
Cause vasodilation
Used for hypertension and angina
Eg. Amlodipine
78
How do non-dihydropyridines (CCBs) work?
Cause decreased heart rate
Used for hypertension, angina and AF
Eg. Diltiazem, Verapamil
79
What is Digoxin used for?
```
Heart failure (after using ACEis)
AF
```
80
How does Digoxin work?
Blocks Na/K pump in myocytes, causes intracellular rise in Na, and rise in Ca, leading to positive inotrophy
81
How does Amiodarone work?
Class III Anti Arrythmic drug
| Prolongs cardiac action potential and the effective refractory period
82
What is Amiodarone used for?
AF
| Both SVTs and VT
83
What are the side effects of Amiodarone?
Thyroid disease
Tremors
Liver disease
Pulmonary fibrosis
84
How do statins work?
Inhibit HMG COA reductase
| Preventing synthesis of cholesterol in the liver
85
What are the side effects of statins?
Muscle aches
| Abdominal discomfort
86
Hypertension can lead to.......
Aortic stenosis
LV hypertrophy
Left atrial enlargement
Impaired filling
87
At what blood pressure should hypertension be treated?
160/100
| or 140/100 if end organ damage
88
What is defined as Stage 1 Hypertension?
1. Clinic BP >140/90
| 2. Home/ambulatory BP average 135/85
89
What is defined as Stage 2 Hypertension?
1. Clinic BP >160/100
| 2. Home/ ambulatory BP average 150/95
90
What is defined as Stage 3 (severe) Hypertension?
1. Systolic BP 180
| 2. Diastolic BP 110
91
What drug is used for orthostatic hypotension?
Fludrocortisone
92
How does doxazosin work?
Blocks alpha related vasoconstriction
93
Which drugs are used for diastolic heart failure?
Very little evidence for use of drugs
Control BP
Control symptoms eg. Furosemide
94
Which drugs INHIBIT warfarin breakdown (so increase INR)?
1. Cranberry juice
2. Metronidazole
3. Ciprofloxacin
4. Clarithromycin
95
Which drugs ENHANCE warfarin breakdown (so decrease INR)?
1. St Johns Wort
2. Vitamin K
3. Carbamazepine
4. Rifampicin
96
Which Troponins are cardio specific?
T and I
97
When do serum troponins increase following chest pain?
3-12 hours after onset
Peak levels 24-48 hours
98
How long does it take troponins to return to normal following an MI?
5-14 days
99
Which biomarker is the best EARLY marker of cardiac damage, but has poor specificity?
Myoglobin
100
What can cause raised Troponins other than ACS?
1. Sepsis
2. Acute PE
3. CKD
4. Congestive cardiac failure
5. Myocarditis
6. Aortic dissection
101
What is an Echo used for looking for?
1. Left ventricular ejection fraction
2. Valvular disease
3. Thrombus in endocarditis
4. Congenital abnormalities
5. Cardiomyopathy
6. Stress echo
102
Which chemical is given in a stress Echo?
Dabutamine
Increases HR
