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Phase 2A Med Concise > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is bicuspid aortic valve?

A

Congenital heart condition where aortic valve has 2 instead of 3 leaflets

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2
Q

Bicuspid aortic valve - 2 Complications

A 
Aortic stenosis (Narrowing aorta)
Aortic regurgitation (Backflow blood from aorta to ventricle)
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3
Q

What activity would make the complications of bicuspid aortic valve appear faster?

A

Exercise

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4
Q

Bicuspid aortic valve - Treatment

A

Valve replacement

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5
Q

What is an ASD (Atrial septal defect) ?

A

Congenital heart condition which causes a left to right shunt (hole in heart)
Primum - presents earlier
Secundum - asymptomatic until adulthood

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6
Q

By age 40 what 2 issues can ASD lead to?

A

Heart failure

SOB

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7
Q

What can reverse shunt lead to in ASD?

A

Pulmonary hypertension - Cyanosis and organ damage

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8
Q

What is VSD (Ventricular septal defect) ?

A

Congenital heart defect which causes a left to right shunt (hole in heart)
No cyanosis

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9
Q

Size of holes in heart and their symptoms

A

Large holes - symptoms during infancy

Small holes - asymptomatic but increased risk of infective endocarditis

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10
Q

ASD//VSD - Treatment

A

Medically treated at first as may close naturally

Otherwise, surgery required

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11
Q

What is coarctation of the aorta?

A

Aorta is narrowed at the site of the ductus arteriosus

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12
Q

Coarctation of aorta - Complications (mild and severe)

A

Mild - Raised BP

Severe - Blocked aorta, heart failure, IE

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13
Q

Coarctation of aorta - Treatment

A

Surgery

Stent

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14
Q

What is cyanosis?

A

Blue-ish discolouration of skin etc, due to excessive concentration

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15
Q

What is the most common cyanotic cardiac disorder?

A

Tetralogy of fallot (TOF)

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16
Q

Tetralogy of fallot (TOF) - 4 features

A

VSD
Pulmonary stenosis
RV hypertrophy
Overriding aorta

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17
Q

Tetralogy of fallot (TOF) - Treatment

A

Surgery

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18
Q

ECG - PQRST

A

P wave - Atria depolarise
PR interval - Delay of AV node to allow ventricle filling
QRS complex - Ventricles depolarise
ST segment - Beginning of ventricle repolarisation
T wave - Ventricles repolarise

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19
Q

Myocardial ischaemia - 2 Causes

A

Reduced blood flow to heart muscle due to clot/atheroma

Reduced O2 carrying capacity (Anaemia) or availability (Hypoxia)

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20
Q

Ischemic heart disease - Risk factors

A

Modifiable - Smoking, obesity, exercise, diet
Clinical - Hypertension, diabetes
Non-modifiable - Age, genetics, gender (m>f)
Psychosocial - High stress jobs, low social interaction and support

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21
Q

Which tool predicts risk of cardiovascular disease in next 10 years?

A

QRISK2 score

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22
Q

Angina pectoris - Presentation

A 
Chest pain on exertion but rapidly resolves with rest
May radiate to arms, jaw and neck
Dyspnoea 
Palpitations
Syncope (fainting)
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23
Q

Angina pectoris - 4 Investigations (BECA)

A

ECG - ST depression, T wave inversion
Bloods - Anaemia
CXR - Heart size and pulmonary vessels
Angiogram - Luminal narrowing

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24
Q

Angina pectoris - Treatment

A

Lifestyle - Diet, exercise, stop smoking
Medical - Control hypertension and diabetes
Drugs - GTN spray (chest pain), B-blocker, aspirin, ACE-inhibitor, ivabradine (HR lowering)
PCTA - Stenting (ballooning) the narrowing
CABG is another option

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25
Q

Acute coronary syndrome (ACS) - Pathology

A

Plaque rupture leads to thrombosis and inflammation

Necrosis and myocyte death

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26
Q

Acute coronary syndrome (ACS) - ECG changes

A

STEMI (ST elevation MI) - ST elevation
NSTEMI (Non STEMI) - ST depression, T inversion
Ischaemia - ST depression, T wave flat
Q waves - indicate previous infarctions

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27
Q

Acute coronary syndrome (ACS) myocardial infarction (MI) localisation and affected artery

A 
Anterior/septal MI - LAD
Lateral - LCX
Inferior - RCA/RCX
Posterior - RCX
Right ventricle/atrial - RCA
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28
Q

Acute coronary syndrome (ACS) - Investigations (EBC)

A

ECG (acute) - ST elevation
ECG (days) - T wave inversion, Q waves
Bloods - FBC, U&E
Cardiac enzymes - Raised troponin, CK (Creatine kinase), myoglobin

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29
Q

Which angina is stable?

A

Angina pectoris

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30
Q

Unstable angina - Investigations

A

FBC - Anaemia
Cardiac enzymes
ECG - ST depression
Coronary angiography

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31
Q

Myocardial infarction (MI) - Pathology

A

Plaque rupture leads to a clot which occludes a coronary artery causing myocardial cell death and inflammation

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32
Q

Myocardial infarction - Signs and symptoms

A

Signs - Pale, pansystolic murmur, peripheral oedema

Symptoms - Acute central chest pain radiating to jaw/shoulder, lasting over 20 mins, SOB, palpitations

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33
Q

Which tends to be more dangerous STEMI or NSTEMI?

A

STEMI>NSTEMI

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34
Q

STEMI - Acute management

A

1) 12-lead ECG
2) Oxygen
3) Establish IV access
4) Aspirin
5) Morphine and anti-emetic
6) B-blocker and ACE-inhibitor
7) Refer for PCI (Stent) or thrombolysis ASAP

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35
Q

STEMI - Chronic management (ABAS)

A 
Aspirin
B-blocker (Verapamil)
ACE-inhibitor 
Statin (lower cholesterol)
Address modifiable risk factors (exercise)
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36
Q

Name 2 life-threatening ventricular arrhythmias

A

Ventricular tachycardia

Ventricular fibrillation

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37
Q

Differential diagnosis of chest pain

A

Cardiac - ACS
Resp - PE, pneumonia
MSK - Rib fracture/chest trauma
GI - GORD

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38
Q

Peripheral arterial disease - Signs and symptoms

A

Signs - Absent pulses, ulcers

Symptoms - Cramping pain in calves, thighs and buttocks relieved by rest

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39
Q

Peripheral arterial disease - 6 Ps of limb ischaemia

A 
Pain
Pallor (pale)
Pulselessness 
Paraesthesis (pins and needles sensation)
Paralysis 
Perishing cold
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40
Q

Peripheral arterial disease - Investigations

A

Colour duplex US (ultrasound) - Blood vessels flow
CT angiography - Stenoses/vessel quality
Blood tests - Raised CK due to muscle damage

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41
Q

Peripheral arterial disease - Management

A

Risk factor modification - stop smoking, diet (lower fat/chol), exercise
Medication - Anti-platelet (Clopidogrel)
PTA (stent) /surgery - correct stenosis

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42
Q

Critical limb ischemia - Symptoms (6Ps)

A 
Pain
Pallor (pale)
Pulselessness 
Paraesthesis (pins and needles sensation)
Paralysis 
Perishing cold
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43
Q

Critical limb ischemia - Causes

A

Thrombosis
Emboli
Trauma
Graft occlusion

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44
Q

Critical limb ischemia - Management

A

Surgical embolectomy
Local thrombolysis with t-PA
If not revascularised within 6 hrs then amputation last resort

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45
Q

What is heart failure?

A

Symptomatic condition where breathlessness, fluid retention and fatigue are associated with a cardiac abnormality that reduces cardiac output

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46
Q

Heart failure - 2 Types

A

Systolic - Failure to contract (IHD, MI)

Diastolic - Inability to relax (Hypertension, cardiac tamponade, constrictive pericarditis)

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47
Q

Heart failure - 2 Types of output

A

Low output HF - Decreased cardiac output which fails to increase with exertion (due to pump failure)
High output HF - Anaemia, pregnancy, hyperthyroidism

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48
Q

Heart failure - 3 Compensatory changes to increase preload/afterload

A 
Sympathetic stimulation (peripheral vasoconstriction)
RAAS (salt/water retention, vasoconstriction)
Cardiac changes (Myocyte hypertrophy)
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49
Q

Heart failure - 4 Mechanisms

A

1) Increased preload
2) Increased afterload
3) Salt and water retention
4) Myocardial remodelling

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50
Q

Left-sided HF - Signs and symptoms

A

Signs - Cardiomegaly, reduced BP, tachycardia, heart murmur, 3rd/4th heart sounds
Symptoms - Dyspnoea, fatigue, nocturnal cough (pink, frothy sputum)

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51
Q

Right-sided HF - Causes

A

Left ventricular failure (LVF)
Pulmonary stenosis
Lung disease

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52
Q

Right-sided HF - Signs and symptoms

A

Signs - Raised JVP (jugular venous pressure), hepatomegaly, pitting oedema, weight gain (fluid), ascites (fluid in abdomen)
Symptoms - Peripheral oedema, ascites, nausea, anorexia

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53
Q

Heart failure - Investigations

A 
Bloods - FBC, U&E, LFT
Cardiac enzymes - Creatinine kinase (CK), troponin
CXR
ECG
Echo (TTE)
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54
Q

Heart failure - Management

A 
Lifestyle - SED (Quit smoking, exercise, diet)
Loop diuretics
ACEi
B-blockers
Aldosterone antagonists
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55
Q

Heart failure - Treatment

A

Acute - Oxygen, GTN, diamorphine, furosemide (IV where poss)

Chronic - Ramipril (ACEi), atenolol (B-blocker), amlodipine (vasodilator), furosemide (loop diuretic)

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56
Q

Cardiac dysrhythmias - 2 Types

A

Bradycardia - <60bpm

Tachycardia - >100bpm

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57
Q

What is sinus tachycardia?

A

> 100bpm

Physiological response to exercise/excitement

58
Q

Causes of sinus tachycardia?

A

Heart failure
Anaemia
Acute PE
Hypovolaemia (decreased blood/fluid in body)

59
Q

Sinus tachycardia - Management

A

Beta-blocker (Atenolol)

60
Q

What is a supraventricular tachycardia?

A

Tachycardia which arises from the atrium or atrioventricular junction

61
Q

Supraventricular tachycardia - 4 Types

A

Atrial fibrillation
Atrial flutter
AV nodal re-entry tachycardia (AVNRT
AV reciprocating tachycardia (AVRT)

62
Q

Which is the most common arrhythmia?

A

Atrial fibrillation

63
Q

Atrial fibrillation - 2 Causes

A

Any condition causing raised atrial pressure (Heart failure, hypertension)

64
Q

Atrial fibrillation - Pathophysiology

A

1) Atrial over-activation
2) Only a proportion of these impulses are conducted to ventricles due to refractory period of AVN
3) HR increased - Tachycardia

65
Q

Atrial fibrillation - Symptoms

A

Palpitations
Fatigue
Heart failure

66
Q

Atrial fibrillation - Management

A

B-blocker - Atenolol (rate control)
Electrical DC cardioversion (rhythm control)
Warfarin (anti-coag)

67
Q

Atrial fibrillation - ECG pattern

A

Irregular
F waves (sawtooth flutter waves)
No clear P waves
QRS is rapid and irregular

68
Q

Which tool is used to calculate stroke risk in atrial fibrillation (AF) ?

A

CHADS2VASc score

69
Q

What is atrial flutter often associated with?

A

Atrial fibrillation

70
Q

Atrial flutter - ECG pattern

A

F waves (sawtooth flutter waves)

71
Q

What is the HR in sinus bradycardia?

A

HR - <60bpm

72
Q

Bradycardia - Causes

A

Extrinsic - B-blocker, digoxin, hypothyroidism, hypothermia, raised intracranial pressure
Intrinsic - Acute ischaemia, SAN infarction

73
Q

Bradycardia - Treatment

A

Atropine (increase HR)

Temporary pacing

74
Q

Heart block - 2 Types

A 
AV block (AVN/bundle of his blocked)
Lower conduction system block (RBBB/LBBB - Right/Left bundle branch block)
75
Q

Heart block - Causes

A

Cardiomyopathy
Fibrosis of conducting tissues
Coronary artery disease

76
Q

What is 1st degree heart block?

A

Delayed AV conduction (PR interval prolonged)

77
Q

1st Degree heart block - Causes

A

Myocarditis

Hypokalaemia

78
Q

1st Degree heart block - Treatment

A

Asymptomatic so no treatment

79
Q

2nd Degree heart block - 2 Types

A

Mobitz type 1

Mobitz type 2

80
Q

2nd Degree heart block mobitz type 1 - ECG pattern

A

Progressive PR interval prolongation until P wave fails to conduct and QRS drops
Cycle repeats

81
Q

2nd Degree heart block mobitz type 1 - Symptoms

A

Light headedness
Dizziness
Syncope (temporary drop in BP leading to fainting)

82
Q

2nd Degree heart block mobitz type 2 - ECG pattern

A

PR interval same

QRS drops

83
Q

2nd Degree heart block mobitz type 2 - Symptoms

A

Chest pain
SOB
Postural hypotension

84
Q

What is 3rd degree heart block?

A

Complete heart block

All atrial activity fails to conduct to ventricles (no association between atrial and ventricular activity)

85
Q

3rd Degree heart block - ECG pattern

A

P waves and QRS complex are independent

86
Q

3rd Degree heart block - Causes

A

Coronary heart disease
Infection
Hypertension

87
Q

3rd Degree heart block - Management

A 
IV atropine (acute)
Pacemaker insertion
88
Q

Bundle branch block - 2 Types

A

RBBB (Right bundle branch block)

LBBB (Left bundle branch block)

89
Q

Bundle branch block - Causes

A

RBBB - PE, IHD

LBBB - IHD, aortic valve disease

90
Q

Valvular disease - 4 Types

A

Aortic stenosis
Aortic regurgitation
Mitral stenosis
Mitral regurgitation

91
Q

Aortic stenosis - 3 Types

A

Supravalvular
Subvalvular
Valvular

92
Q

Aortic stenosis - Causes

A

Congenital bicuspid valve
Degenerative calcification
Rheumatic heart disease

93
Q

Aortic stenosis - Symptoms (SAHD)

A

Syncope (exertional)
Angina
Heart failure
Dyspnoea

94
Q

Aortic stenosis - Investigations

A

ECG
Echocardiography (diagnostic)
CXR - LVH (left ventricular hypertrophy), calcified aortic valve

95
Q

Aortic stenosis - Management

A

General - Dental hygiene/care

Surgical - Valve replacement

96
Q

What is mitral regurgitation?

A

Backflow of blood from LV>LA during systole

97
Q

Mitral regurgitation - Causes

A

IE

Mitral valve prolapse

98
Q

Mitral regurgitation - Pathophysiology

A 
Volume overload leads to dilation
Compensatory mechanisms (left atrial enlargement, LVH and increased contractility)
99
Q

Mitral regurgitation - Symptoms

A

Dyspnoea (exertive)
Palpitations
Fatigue

100
Q

Mitral regurgitation - Investigations

A

Echocardiogram
CXR - Enlarged LA/LV
ECG

101
Q

Mitral regurgitation - Treatment

A 
ACEi (vasodilator)
B-blocker (AF rate control)
Anti-coag - AF/flutter
Diuretics
Valve replacement
102
Q

What is aortic regurgitation?

A

Blood leakage into LV during diastole due to ineffective coaptation of aortic cusps

103
Q

Aortic regurgitation - Causes

A

IE

Bicuspid aortic valve

104
Q

Aortic regurgitation - Pathophysiology

A

Combined pressure and volume overload leads to LV dilation, and so LVH too

105
Q

Aortic regurgitation -Symptoms

A

Dyspnoea (exertional)

106
Q

Aortic regurgitation - Investigation

A

Echocardiogram
ECG
CXR - Cardiomegaly

107
Q

Aortic regurgitation - Management

A

ACEi

Valve replacement

108
Q

What is mitral stenosis?

A

Obstruction of LV inflow that prevents sufficient filling during diastole

109
Q

Mitral stenosis - Causes

A

IE
Rheumatic heart disease
Mitral calcification
Congenital

110
Q

Mitral stenosis - Signs and symptoms

A

Signs - Malar flush (cheeks), Shallow pulse

Symptoms - Dyspnoea, fatigue, palpitations, chest pain

111
Q

Mitral stenosis - Investigations

A

Echocardiogram
CXR - LA enlargement
ECG - AF

112
Q

Mitral stenosis - Management

A

Rate control for AF (B-blocker)
Anti-coag (Warfarin)
Diuretics
Valvotomy

113
Q

What is shock?

A

Circulatory failure resulting in inadequate organ perfusion

Low BP - Systolic <90mmHg

114
Q

Shock - 4 Types (SHAN)

A

Septic - Infection (acute vasodilation from inflammatory cytokines)
Anaphylactic - Type-1 IgE-mediated hypersensitivity (histamine released)
Neurogenic - Spinal cord injury/anaesthesia, epidural
Hypovolaemic - Bleeding, trauma, ruptured aortic aneurysm, GI bleed

115
Q

Septic shock/Systemic inflammatory response syndrome (SIRS) - 4 Features

A

Extremes of body temp (hot/cold) - Over 38/under 36 degrees
Tachycardia
Increased resp rate
Increased WBC

116
Q

Septic shock - Management

A

ABC - Airways, breathing, circulation

Blood cultures then antibiotics

117
Q

Hypertension - Risk factors

A 
Obesity/unhealthy diet
Lack of physical activity
Afro-carib
Male>female
Old age
Family history
118
Q

Hypertension - Investigation

A

Check BP
If over 140/90 start BP monitoring
If over 180/110 start anti-hypertensive drugs

119
Q

End-organ damage - Test

A

Urine analysis (kidney)
ECG/echo - LVH
History - MI/stroke
Fundoscopy - Hypertensive retinopathy

120
Q

Hypertension - Causes

A

Renal (CKD), endocrine disease, aortic coarctation, pregnancy

121
Q

Hypertension - Lifestyle changes

A 
Stop smoking
Low-fat/salt diet
Reduce alcohol
Increase exercise
Reduce weight if obese
122
Q

Hypertension - Treatment

A

ACEi
B-blocker
Diuretics
Sodium nitroprusside (SNP) - BP lowering

123
Q

Hypertension - Signs and symptoms

A

Signs - Severe HTN - 200/130mmHg, bilateral retinal haemorrhages, papillooedema
Symptoms - Headache, visual disturbance

124
Q

Hypertension - Complications

A

Acute kidney injury
Heart failure
Encephalopathy (brain damage)

125
Q

What is pericarditis?

A

Inflammation of the pericardium

126
Q

Pericarditis - Causes

A

Idiopathic (any condition which arises spontaneously with unknown cause)
Viral infection
Autoimmune
Dressler syndrome (inflammation of pericardium after MI)

127
Q

Acute pericarditis - Symptoms

A

Central pain, worse on inspiration/lying flat, relieved by sitting forward

128
Q

Acute pericarditis - Investigations

A

Stethescope auscultation (scratching sound - pericardial friction rub)
ECG - ST elevation, PR depression
Cardiac enzymes - Increased troponin

129
Q

Acute pericarditis - Treatment

A

Aspirin (NSAID)

PPI (gastric protection)

130
Q

Acute pericarditis - Complications

A 
Chronic constrictive pericarditis (fibrosis) - Remove by surgical excision 
Pericardial effusion (fluid accumulation) - Pericardiocentesis (drainage of pericardial fluid)
131
Q

Beck’s triad - 3 Features

A

Falling BP
Rising JVP
Muffled heart sounds

132
Q

Aneurysm - 2 Types

A

True aneurysm - Affects all 3 layers of vessel (intima, media, adventitia)
False aneurysm - Collection of blood under adventitia only

133
Q

Aneurysm - Causes (CAT)

A

Connective tissue disorders (Mafan’s)
Atheroma
Trauma

134
Q

Abdominal aortic aneurysm (AAA) - Investigation

A 
Aortic ultrasound (screening)
CT angiography (suspected rupture - assessing for surgery)
135
Q

Abdominal aortic aneurysm (AAA) - Signs and symptoms

A

Signs - Expansile abdo mass/pulsatile

Symptoms - Abdo/back pain

136
Q

Abdominal aortic aneurysm (AAA) - Treatment

A

Surgery

137
Q

What is aortic dissection?

A

Tear of intima
Blood then flows into aortic media and splits it
Leads to occlusion of aortic branches

138
Q

Aortic dissection - Symptoms

A

Sudden tearing chest pain, radiating to back

139
Q

Aortic dissection - 2 Types

A

Type A - Involves ascending aorta

Type B - Doesn’t involve ascending aorta

140
Q

Aortic dissection - Treatment

A

Surgery for both types

Antihypertensive drugs for type B also

141
Q

Aortic dissection - Investigation

A

CT

MRI

Phase 2A Med Concise (18 decks)

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