Cardiology

Question 1

What is AF?

Answer 1

Irregular atrial rhythm at 300-600bpm

Question 2

Signs + symptoms of AF

Answer 2

Palpitations, dizziness, dyspnoea, fatigue
Irregular pulse
Loss of P waves + altered QRS

Question 3

Causes of AF

Answer 3

Age, HTN, IHD, HF, Post-MI, alcohol, caffeine, drugs, post-operatively

Question 4

Treatment of AF

Answer 4

Anticoagulation - warfarin or DOAC (weigh up score using CHA2DS2VAS and HAS-BLED)

Rate control - beta blocker or CCB. If doesn’t work, add digoxin then consider amiodarone. DO NOT give beta-blockers with verapamil

Rhythm control - ?cardioversion or fleicanide

Question 5

What is an abdominal anuerysm?

Answer 5

When artery >50% its normal size
True aneurysm involves all 3 layers of the artery wall
>3cm

Question 6

Screening + surveillance for AAA

Answer 6

All men aged 65 offered 1 time USS
Surveillance if:
- 3-4.4cm every 2yrs
- 4.5 - 5.4 cm every 3m

Question 7

When to operate on AAA?

Answer 7

• Symptomatic
• Asymptomatic but measures >5.5cm
• Asymptomatic but measures >4cm + grown >1cm in 1yr

Question 8

Symptoms of AAA

Answer 8

• Pain radiating to back

- Expansile mass in abdomen

Question 9

What is endocarditis?

Answer 9

Fever + new murmur = endocarditis until proven otherwise!

Infiltration of heart valves with pathogens

Question 10

Causes of endocarditis

Answer 10

Acute - tends to be on normal valves with staph aureus or strep viridans from skin breaches, renal failure, immunosuppression, DM

In IVDU - tends to be on tricuspid valve

Endocarditis on prosthetic valves tends to present <60d post surgery - staph epidermis (poor prognosis)

Question 11

Diagnosis of endocarditis

Answer 11

Duke Criteria
2 major: +ve blood culture, endocardium involved

Minor: predisposition e.g. IVDU, fever >38, vacular phenomena e.g. emboli/janeway lesions, immunological phenomena e.g. oslers noodes, +ve blood culture

2 major or 1 major + 3 minor or all 5 minor

Question 12

Treatment of endocarditis

Answer 12

50% require surgery

IV abx

Question 13

Immunological complex deposition in endocarditis

Answer 13

Oslers nodes, roth spots, splinter haemorrhages

Question 14

Embolic phenomena in endocarditis

Answer 14

emboli may causes abscesses e.g. in skin - janeway lesions

Question 15

Treatment of pericarditis

Answer 15

NSAIDs + aspirin + PPI protection
Colchicine can prevent recurrence
Treat cause

Question 16

Signs + symptoms of pericarditis

Answer 16

Central chest pain, worse on lying down, relieved by sitting forward +/- fever
Friction rub may be heard
Saddle-shaped ST elevation across all leads

Question 17

What is paroxysmal nocturnal dyspnoea?

Answer 17

Occurs 1-2hrs after going to sleep + forces pt awake

When lying down - blood redistributes and you get increased blood to the lungs which causes transudation of plasma into alveolar spaces

Question 18

Systolic v diastolic HF

Answer 18

Systolic = impaired V contraction –> EF >40%
Causes: IHD, MI, cardiomyopathy

Diastolic = V can’t relax + fill properly. EF >50%
Causes: restrictive cardiomyopathy, tamponade, ventricular hypertrophy

Question 19

NYHA classification

Answer 19

1 = no limitation
2 = slight limitation on moderate exercise, comfortable at rest
3 = considerable limitation, only comfortable at rest
4 = breathlessness + fatigue at rest

Question 20

ABPM

Answer 20

Use average of at least 14 measurements taken during person’s waking hours. Check that each BP is recorded twice, 1 min apart with person sitting down. Ideally have morning + evening BP. Discard 1st day

Question 21

Stages of hypertension

Answer 21

Stage 1: clinic of 140/90 or ABPM of 135/85
Stage 2: clinic of 160/100 or ABPM of 150/95
Severe: 180/110

Question 22

Who to treat with HTN?

Answer 22

Refer anyone <40yrs to look for secondary causes

If stage 1, under 80 + evidence of target organ damage, DM, established CVD, renal disease or 10 year risk of >20% then treat

Treat all stage 2

Aim for BP on tx of 140/90 or 150/90 if >80

Question 23

Conns disease

Answer 23

Primary aldosteronism - excess production of aldosterone independent of RAAS causing increased Na + H2o retention and reduced renin release

Question 24

Phaeochromocytoma

Answer 24

Catecholamine producing tumour
Chromaffin cells
Usually found in adrenal medulla

Fam hx crucial

Classic triad: episodic headache, sweating + tachycardia
BP may be hard to control

Question 25

What is shock?

Answer 25

Circulatory failure resulting in inadequate organ perfusion leading to hypoxia

Question 26

4 types of shock

Answer 26

Cardiogenic
Hypovalemic
Obstructive
Distributive

Question 27

Cardiogenic shock

Answer 27

Shock due to failure of pump e.g. MI, drugs

Question 28

Hypovolemic shock

Answer 28

Shock due to loss of volume e.g. burns, haemorrhage, dehydration, pancreatitis

Question 29

Obstructive shock

Answer 29

Shock due to reduction in BF e.g. tamponade, PE, tension pneumothorax

Question 30

Distributive shock

Answer 30

Shock due to movement of fluid from normal compartment caused by vasodilation e.g. anaphylaxis, septic shock, neurogenic shock, adrenal insuffiency, anaesthesia

Question 31

How many litres of blood in the human body?

Answer 31

Roughly 5litres

Question 32

GRACE score

Answer 32

Age, HR, SBP, creatinine, ?cardiac arrest at admission, ST deviation on ECG?, abnormal cardiac enzymes? Killip class for CHF

Question 33

3 features of angina

Answer 33

1. Constricting/heavy discomfort to chest, jaw, neck, shoulders or arms
2. Sx brought on by exertion
3. Sx relieved within 5min by rest/GTN

3 = typical
2 = atypical
1 = not angina?

Question 34

Critical limb ischaemia

Answer 34

Rest pain >2wks and presence of ischaemic lesions/gangrenes. ABPI <0.5