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Year 3 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is critical stenosis?

A

> 75% stenosis, leads to compensatory vasodilation but this is not enough

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2
Q

When can an MI be seen histologically and macroscopically?

A

Histologically- 4 hours

Macroscopically- 12 hours

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3
Q

What is a silent MI and who is likely to have one?

A

ACS without chest pain: Diabetics, Elderly

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4
Q

How may a silent MI present?

A 
Syncope
Pulmonary oedema
Epigastric pain
Vomiting
Acute confusion
Stroke
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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
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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

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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
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8
Q

What are the features of systolic heart failure?

A

Impaired contractility
Rjection fraction <40%
Enlarged ventricles with thin walls

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9
Q

What is systolic heart failure caused by?

A

IHD
MI
Cardiomyopathy

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10
Q

What is diastolic heart failure caused by?

A 
Ventricular hypertrophy
Aortic stenosis
Hypertension
Tamponade
Constrictive pericarditis
Restrictive cardiomyopathy
Obesity
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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
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12
Q

What pharmacological agents can be used for SYSTOLIC heart failure?

A
  1. ACEIs/ARBS
  2. B blockers
  3. Diuretics eg. Spironalactone if K+ low
  4. Other diuretics
  5. Digoxin- relieves symptoms, for patients with Left ventricular systolic dysfunction
  6. Vasodilators eg. Hydralyzine
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13
Q

What is a biomarker of heart failure?

A

BNP

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14
Q

What is primary/ essential hypertension?

A

Hypertension with unknown cause, 95%

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15
Q

What are the causes of secondary hypertension?

A

Renal disease
Endocrine disease
Pregnancy
Drugs

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16
Q

What does NICE set as the target blood pressure?

A

140/90
150/90 if >80
130/80 if diabetic

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17
Q

What are the causes of aortic stenosis?

A

Calcification
Congenital eg. bicuspid valve
Rheumatic fever

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18
Q

What are the causes of aortic regurgitation?

A

Infective endocarditits
Rheumatic rever
Congenital

Aortic disection
Hypertension
RA
Syphilis
Connective tissue disorders
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19
Q

What are the causes of mitral stenosis?

A
  1. Rheumatic fever

2. Congenital

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20
Q

What are the causes of mitral regurgitation?

A
  1. Mitral valve proplapse
  2. LV dilation
  3. Congenital
  4. Infective endocarditis
  5. Papilliary muscle dysfunction
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21
Q

What is the most common valvular abnormality?

A

Mitral valve prolapse -> mitral regurgitation

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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

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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

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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

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25
Q

What are the signs and symptoms of mitral regurgitation?

A

Symptoms: Dyspnoea, palpitations, fatigue

Signs: AF, displaced apex

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26
Q

What is functional regurgitation?

A

Where a valve becomes incompetent due to ventricular dilation

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27
Q

Which bacteria cause the pharyngeal infection that proceeds rheumatic fever?

A

B-haemolytic S.pyogenes; antibodies to the strep bacteria damage heart valves

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28
Q

What are the symptoms/ signs of rheumatic fever?

A 
Positive Strep pyogenes culture
Carditis: tachycardia, murmur, pericardial rub
Arthritis
Fever
Raised CRP/ ESR
Erythema marginatum
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29
Q

What are the 3 most common causes of ACUTE infective endocarditis?

A

Highly virulent organisms-

  1. S. aureus
  2. Pneumococcus
  3. S.pyogenes
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30
Q

What are the 2 most common causes of SUBACUTE bacterial endocarditis?

A

Low virulence organisms-

  1. Strep viridans
  2. Enterococci
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31
Q

What are the signs/ symptoms of endocarditis?

A

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

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32
Q

What are the causes of dilated cardiomyopathy?

A 
Chronic anaemia
Haemochromatosis
Alcohol
Genetic
Idiopathic
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33
Q

Dilated cardiomyopathy makes up 90% of myopathies, and has dilation of all chambers, leading to …………….

A

Reduced ejection fraction

Thromboemboli common

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34
Q

How can pericarditic pain be relieved?

A

Leaning forward

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35
Q

When is pericarditic pain worse?

A

Laying flat, inspiration

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36
Q

What are the 3 factors for Beck’s Triad of cardiac tamponade?

A

Diagnostic of Cardiac Tamponade:

  1. Rising JVP
  2. Falling BP
  3. Muffled heart sounds
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37
Q

What are the features of pericarditis on ECG?

A

Saddle shaped ST elevation

PR Depression

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38
Q

What are the features of myocarditis on ECG?

A

ST changes

T wave inversion

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39
Q

What is the leading cause of cardiac sudden death in young people?

A

Hypertrophic cardiomyopathy

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40
Q

Orthostatic hypotension is defined as a ____mmHg drop in systolic or a ______mmHg drop in diastolic BP on standing.

A

20 systolic

10 diastolic

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41
Q

What are the potential causes of orthostatic hypotension?

A 
Adrenal insufficiency (Addison's)
Autonomic failure eg. in diabetes, Parkinsons, alcohol
42
Q

The treatment for dilated cardiomyopathy is ………..

A

Heart transplant

43
Q

Which type of heart murmur is associated with nocturnal angina?

A

Aortic Regurgitation

44
Q

What is sinus arrhythmia?

A

Slight lengthening and shortening between each complex

Regular
Changes with respiration, common in young

45
Q

What are the causes of atrial fibrillation?

A
  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
Q

What tests should be done on a patient with suspected AF?

A
  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
Q

What are the main aims in treating chronic AF?

A
  1. Anticoagulation to reduce stroke risk

2. Rate control

48
Q

Which drugs should be used for rate control in AF?

A

1st line: B blockers or Rate limiting CCBs (Diltiazem)

If these don’t work: Add Digoxin, or consider Amiodarone

49
Q

How should rhythm control be achieved in AF?

A
  1. DC cardioversion
  2. Flecainide
  3. Amiodarone
50
Q

When is rhythm control used in AF?

A

Young patients
1st presentation of lone AF
Symptomatic
CCF

51
Q

How should atrial flutter be treated?

A
  1. DC Cardioversion
  2. IV Amiodarone
  3. Anticoagulate, rate and rhythm control
52
Q

What are the 4 classes of anti arrhythmic drugs?

A
  1. Drugs which block Vol Na channels
  2. B blockers
    3; Drugs which prolong action potential
  3. CCBs
53
Q

Give examples of drugs in each of the 4 classes of anti-arrhythmic drugs?

A
  1. Phenytoin, Flecainide
  2. Bisoprolol
  3. Amiodarone
  4. Diltiazem
54
Q

How should SVT be treated?

A

EMERGENCY

  1. Defibrillator pads
  2. Vagal manouvre/ carotid sinus massage
  3. IV Adenosine to cause transient AV block and uncover rhythm
55
Q

How does adenosine work?

A

A1 adenosine receptor AGONIST
Causes hyperpolarisation, transient AV block
Opposite of caffeine

56
Q

Which CCBs are used in atrial fibrillation?

A

Non dihydropyridines:

  1. Diltiazem
  2. Verapamil
57
Q

What are the 2 main types of CCBs?

A
  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
Q

How does aspirin work?

A

Irreversibly inhibits COX enzymes, preventing production of Thromboxane A2, so inhibiting platelet aggregation.

59
Q

How does Clopidogrel work?

A

Blocks platelet aggregation

Less gastric irritation than aspirin

60
Q

What is aspirin used for?

A
  1. Secondary prevention of MI, stroke, TIA

2. Angina

61
Q

How do B1 receptor blockers work?

A

Decrease HR

Decrease force of contraction

62
Q

How do B2 receptor blockers work?

A

Bronchoconstriction

Peripheral vasoconstriction

63
Q

Which beta blockers are cardioselective (act on B1 receptors)?

A

Bisoprolol

Atenolol

64
Q

Which beta blockers are non cardioselective (act on B1 and B2 receptors)?

A

Propanolol

Timolol

65
Q

What are beta blockers used for?

A
  1. Hypertension
  2. Angina
  3. Post MI
  4. AF
  5. Heart failure
66
Q

When are beta blockers contraindicated?

A

Asthma
COPD
Heart block

67
Q

What are the side effects of beta blockers?

A

Cold extremities
Erectile dysfunction
Bradycardia
Hypoglycaemia

68
Q

What are ACEIs used for?

A
  1. Hypertension
  2. Heart failure
  3. Post MI
69
Q

Why should bloods be monitored when starting or increasing ACEI dose?

A

To check for creatinine rise in UandEs, rise >20% is concerning

70
Q

What are the side effects of thiazide diuretics?

A

Gout
Erectile dysfunction
Hypercalcaemia
Hyperglycaemia

71
Q

What are the side effects of loop diuretics?

A 
Hypovolaemia
Polyuria
Hypokalaemia
Hyponatraemia
Ototoxicity
72
Q

What are the side effects of potassium sparing diuretics?

A

Hyperkalaemia
Gynaecomastia
Erectile dysfunction

73
Q

What are thiazide diuretics used for?

A

Hypertension

Heart failure

74
Q

What are loop diuretics used for?

A

Heart failure
Pulmonary oedema
Nephrotic syndrome
Ascites

75
Q

What are potassium sparing diuretics used for?

A

Hyperaldosteronism (Conn’s)

76
Q

What are vasodilators used for?

A

Heart failure
Hypertension
Ischemic heart disease

77
Q

How do dihydropyridines (CCBs) work?

A

Cause vasodilation
Used for hypertension and angina

Eg. Amlodipine

78
Q

How do non-dihydropyridines (CCBs) work?

A

Cause decreased heart rate
Used for hypertension, angina and AF

Eg. Diltiazem, Verapamil

79
Q

What is Digoxin used for?

A 
Heart failure (after using ACEis)
AF
80
Q

How does Digoxin work?

A

Blocks Na/K pump in myocytes, causes intracellular rise in Na, and rise in Ca, leading to positive inotrophy

81
Q

How does Amiodarone work?

A

Class III Anti Arrythmic drug

Prolongs cardiac action potential and the effective refractory period

82
Q

What is Amiodarone used for?

A

AF

Both SVTs and VT

83
Q

What are the side effects of Amiodarone?

A

Thyroid disease
Tremors
Liver disease
Pulmonary fibrosis

84
Q

How do statins work?

A

Inhibit HMG COA reductase

Preventing synthesis of cholesterol in the liver

85
Q

What are the side effects of statins?

A

Muscle aches

Abdominal discomfort

86
Q

Hypertension can lead to…….

A

Aortic stenosis
LV hypertrophy
Left atrial enlargement
Impaired filling

87
Q

At what blood pressure should hypertension be treated?

A

160/100

or 140/100 if end organ damage

88
Q

What is defined as Stage 1 Hypertension?

A
  1. Clinic BP >140/90

2. Home/ambulatory BP average 135/85

89
Q

What is defined as Stage 2 Hypertension?

A
  1. Clinic BP >160/100

2. Home/ ambulatory BP average 150/95

90
Q

What is defined as Stage 3 (severe) Hypertension?

A
  1. Systolic BP 180

2. Diastolic BP 110

91
Q

What drug is used for orthostatic hypotension?

A

Fludrocortisone

92
Q

How does doxazosin work?

A

Blocks alpha related vasoconstriction

93
Q

Which drugs are used for diastolic heart failure?

A

Very little evidence for use of drugs

Control BP
Control symptoms eg. Furosemide

94
Q

Which drugs INHIBIT warfarin breakdown (so increase INR)?

A
  1. Cranberry juice
  2. Metronidazole
  3. Ciprofloxacin
  4. Clarithromycin
95
Q

Which drugs ENHANCE warfarin breakdown (so decrease INR)?

A
  1. St Johns Wort
  2. Vitamin K
  3. Carbamazepine
  4. Rifampicin
96
Q

Which Troponins are cardio specific?

97
Q

When do serum troponins increase following chest pain?

A

3-12 hours after onset

Peak levels 24-48 hours

98
Q

How long does it take troponins to return to normal following an MI?

99
Q

Which biomarker is the best EARLY marker of cardiac damage, but has poor specificity?

100
Q

What can cause raised Troponins other than ACS?

A
  1. Sepsis
  2. Acute PE
  3. CKD
  4. Congestive cardiac failure
  5. Myocarditis
  6. Aortic dissection
101
Q

What is an Echo used for looking for?

A
  1. Left ventricular ejection fraction
  2. Valvular disease
  3. Thrombus in endocarditis
  4. Congenital abnormalities
  5. Cardiomyopathy
  6. Stress echo
102
Q

Which chemical is given in a stress Echo?

A

Dabutamine

Increases HR

Year 3 (22 decks)

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