Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

5 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is acute coronary syndrome (ACS)?

A
  • STEMI
  • NSTEMI
  • Unstable angina
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are non-modifiable RFs for ACS?

A
  • increasing age
  • male
  • FHx premature CHD
  • premature menopause
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are modifiable RFs for atherosclerosis causing ACS?

A
  • smoking
  • DM and impaired glucose tolerance
  • HTN
  • dyslipidaemia
  • obesity
  • physical inactivity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Causes of ACS?

A

Coronary occlusion due to:

  • atherosclerosis
  • vasculitis
  • CHD
  • cocaine use
  • coronary trauma
  • congenital cardiac problems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do unstable angina and NSTEMIs present?

A
  1. Prolonged chest pain at rest
  2. Sweating
  3. Nausea
  4. Vomiting
  5. Fatigue
  6. SoB
  7. Palpitations
  8. Little/no response to GTN spray
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which groups of patients may present atypically with ACS?

A
  1. Diabetics
  2. Women
    (they may complain of fatigue, nausea, jaw pain/numbness)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some differential diagnosis for acute chest pain?

A
  1. Angina, STEMI, NSTEMI
  2. Oesophagitis
  3. Pneumothorax, PE
  4. Dissecting thoracic aortic aneurysm
  5. Chest wall pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What might suggest chest pain is due to oesophagitis rather than a cardiac cause?

A
  1. Previous episodes of pain when supine, after food, alcohol and NSAIDS
  2. Relieved by antacids
  3. No increase in troponin after 12h
  4. No serial changes on ECG
  5. Oesophagitis on endoscopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What might suggest chest pain is due to pulmonary embolus rather than a cardiac cause?

A
  1. Sudden SoB, pleural rub, cyanosis/hypoxia, tachycardia, loud P2, signs of DVT
  2. Presence of RFs (recent surgery, immobility, prev emboli, malignancy)
  3. CTPA showing clot in pulmonary artery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Management of oesophagitis?

A
  1. PPI and lifestyle modification

2. Calcium antagonist (nifedipine) if spasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Management of PE?

A
  1. O2 to maintain sats 94%
  2. LMW heparin, then warfarin
  3. Thrombolysis if hypotension, or acutely dilated RV on echo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What might suggest chest pain is due to pneumothorax?

A
  1. Pain in centre/side chest with abrupt breathlessness
  2. Diminished breath sounds
  3. Hyper-resonance to percussion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Management of pneumothorax?

A
  1. If tension: Large Venflon inserted into 2nd IC space, mid-clavicular line
  2. O2 if hypoxic
  3. Analgesia
  4. Aspiration (if moderate) or IC drain (if severe)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What might suggest chest pain is due to aortic dissection?

A
  1. Tearing pain - often radiating to back
  2. Abnormal/absent peripheral pulses
  3. Early diastolic murmur
  4. Low BP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Management of aortic dissection?

A
  1. O2
  2. Analgesia
  3. Large-bore IV access
  4. Blood transfusion (crossmatching 6 units)
  5. Urgent surgical intervention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

MI. How long following an MI might myocardial rupture develop?

A

3-14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

MI. Which NSAID is useful in prophylaxis and management of MI?

A

Aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

MI. What is the post-MI complication that may occur when there is an autoimmune response to myocardial antigen which results in pericarditis?

A

Dressler syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

MI. What is Dressler syndrome?

How is it treated?

A

Autoimmune pericarditis that can arise several weeks after a MI; consists of fever, pleuritic pain, pericarditis and/or pericardial effusion

Treated with NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

MI. An MI has most likely occurred in the _____ wall of the heart if there are pathological Q-waves in electrocardiogram leads II, III, and aVF.

A

Inferior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

MI. An MI has most likely occurred in the _____ wall of the heart if there are pathological Q-waves in electrocardiogram leads V1-V2.

A

Septal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

MI. An MI has most likely occurred in the _____ wall of the heart if there are pathological Q-waves in electrocardiogram leads V4-V6.

A

Anterolateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

MI. Blockage of which coronary artery is the leading cause of a myocardial infarction?

A

LAD (Left anterior descending)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

MI. Which is the most specific cardiac protein marker for diagnosing an MI?

A

Troponin I

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
MI. An MI causes severe, crushing chest pain that typically lasts longer than how many minutes?
20
26
MI. What type of mitral valve pathology may develop approx. 3-14 days post-MI? Why?
Mitral regurgitation due to papillary muscle damage
27
What is the first line treatment for Prinzmetal angina?
Calcium channel blockers
28
MI. Which ventricle is likely to be involved in an inferior wall MI?
Right
29
MI. Why are nitrates contraindicated in inferior wall MI?
Likely to be RV involvement; as RV depends on preload to maintain CO, nitrates could cause hypotension and cardiogenic shock
30
MI. What type of murmur might be heard in mitral regurgitation?
High-pitched holosystolic murmur at the apex
31
MI. Other than a high-pitched holosystolic murmur heard at the apex, give 2 other features that may be auscultated in a patient with mitral regurgitation following an MI.
1. Basal lung crackles (due to pulmonary oedema from increased pressure in lung capillaries) 2. Murmur radiates to back or clavicular area
32
MI. What does ST-elevations in leads V1-V6 and reciprocal changes (ST-depressions) in lead III and aVF suggest?
Anterior MI
33
MI. What is the leading cause of acute death following MI?
Ventricular tachycardia, leading to VFib, pulleys electrical activity, and asystole
34
MI. What does ST-elevation in leads II, III and aVF, Q-wave formation in leads III and aVF, and reciprocal ST-depression and T-wave inversion in aVL suggest?
Inferior STEMI
35
MI. What does ST-elevation in leads I, aVL, V5-6 and reciprocal-ST depression in the inferior leads (III and aVF) suggest?
Lateral MI
36
MI. Give 2 key biomarkers of severe myocardial ischaemia
1. Troponin I 2. CK-MB (MB isoenzyme of creatinine kinase) 3. Also: Troponin T
37
MI. What does diaphoretic mean?
Sweaty
38
In what condition would you see diffuse ST-elevation on ECG?
Acute pericarditis
39
MI. What is Beck's triad?
1. Hypotension 2. Jugular venous distension 3. Distant/muffled heart sounds *Seen in cardiac tamponade*
40
MI. What triad is seen in cardiac tamponade?
Beck's triad (hypotension, jugular venous distension, distant/muffled heart sounds)
41
MI. What might occur in the days following an MI that could result in Beck's triad?
Myocardial wall rupture; causes acute cardiac tamponade
42
MI. How would you treat myocardial rupture?
Pericardiocentesis
43
MI. What are the characteristic signs of pericarditis?
1. Pain, worse when lying flat 2. Pericardial rub 3. Pericardial effusion
44
MI. Give 4 RFs for myocardial rupture following MI
1. Female 2. Advanced age 3. First MI 4. HTN
45
Why should nitrates be avoided in patients with aortic stenosis or a Hx of inferior MI?
Because they are preload dependent, so giving them nitrates could lead to decreased CO and severe hypotension
46
What type of calcium channel blocker is amlodipine?
Dihydropyridine CCB
47
MI. Is significant HTN (>180/100) a CI to fibrinolytic drugs?
Yes
48
What is tPA?
Tissue plasminogen activator (fibrinolytic drug)
49
MI. What is the gold standard treatment for acute MI?
PCI (percutaneous coronary intervention)
50
What causes Prinzmetal’s angina?
Coronary artery vasospasm
51
What is the first line treatment for Prinzmetal’s angina?
CCB
52
Management of VT/VF?
Defibrillate! If awake, anaesthetist GA/midazolam, then defib If can't have GA, amiodarone IV +/- BB
53
Symptoms of VF?
Syncope/LoC
54
Symptoms of VT?
Palpitations SoB Syncope/pre-syncope Chest pain
55
Causes of VT/VF?
``` MI Drugs LV impairment Electrolytes Channelopathies (long QT/Brugada) HCM ```
56
If the patient went into VT/VF due to MI, recurrence not very likely unless another MI. If cause is still there, e.g. HCM, how would you manage?
Amiodarone/BB ICD (internal cardiac defib) Maybe ablation
57
VT ECG findings?
Broad complex | Regular
58
VF ECG findings?
Broad complex | Irregular
59
Atrial flutter ECG findings?
Saw tooth | Regular
60
SVT ECG findings?
Narrow complex
61
SVT symptoms?
Palpitations
62
Management of SVT?
Vagal manouevres (syringe + carotid massage) Adenosine 6mg, then try 12mg Verapamil If compromised, DC cardioversion Long term: BB, flecainide, CCB, ?ablation
63
Causes of AF?
``` PIRATE Pulmonary embolism Ischaemia Respiratory disease Atrial enlargement/myxoma Thyroid disease Ethanol Sepsis/sleep apnoea ```
64
What is the tool to decide whether to anticoagulate a patient with AF? What score would indicate anticoagulation
CHA2DS2-VaSc Males: 1+ Females: 2+
65
What are the components of the CHA2DS2-VaSc score?
``` Congestive heart failure Hypertension Age (75+ = 2 points; 65-74 = 1 point) Diabetes Previous Stroke or TIA Vascular disease (IHD, PAD) Sex (female) ```
66
What is the management of chronic AF?
Warfarin/NOAC Metoprolol (/diltiazem/verepamil/amiodarone) Digoxin in sedentary Cardioversion +/- amiodarone, or fleicanide
67
Should the AVR lead on an ECG have a +ve or -ve tracing?
-ve
68
How can you identify a patient is in sinus rhythm from an ECG?
P wave before every QRS Regular Rate 60-100
69
How do you work out the axis from an ECG?
Lead 1 and AVF should both be positive
70
What is sinus arrhythmia?
Slight shortening and lengthening with respiration, common in young
71
What causes a prolonged PR interval?
Heart block
72
What causes a short PR interval?
Accessory pathway, e.g. WPW
73
How long should the PR interval be?
3-5 small squares
74
Describe the degrees of heart block
1st: constant prolonged PR 2nd: Mobitz 1 = lengthening then drops 1 2nd: Mobitz 2 = constant prolonged then drops 1 3rd: no relationship between P and QRS
75
Management of heart block?
Pacemaker
76
Define heart block
Disrupted passage of impulse through the atrioventricular node (AVN)
77
What might cause 1st and 2nd degree heart block?
``` IHD/MI Myoacrditis Athletes Sick sinus syndrome Drugs: digoxin, BB ```
78
What is sick sinus syndrome?
Dysfunctional sinus node (fibrosis) Can cause brady/tachycardia, AF, sinus pause Usually in the elderly
79
What causes a deep/pathological Q wave on ECG?
Previous MI
80
What causes a tall/big QRS on ECG?
LV hypertrophy
81
What causes a long/wide QRS on ECG?
BBB (ventricle conduction problem)
82
Signs of hyperkalaemia on ECG?
Tall tented T waves
83
What does T wave inversion on ECG indicate?
Infarct/ischaemia
84
Leads II, III and AVF affected. Likely site of infarct and vessel?
Inferior | Right coronary artery
85
Leads I, aVL, V5-6 affected. Likely site of infarct + vessel?
Lateral | Circumflex
86
Leads V1-4 affected. Likely site of infarct + vessel?
Anterioseptal | LAD
87
Causes of long QT on ECG?
Genetic predisposition (long-QT syndrome) Drugs: antipsychotics, macrolides Hypocalc/hypokal
88
What hormone abnormality might cause someone to go in and out of AF?
Hyperthyroidism
89
If the SAN gives HR of 100bpm, what slows the heart rate?
Vagal tone (activity of the vagus nerve)
90
Signs of ischaemia/infarct on ECG?
ST elevation/depression T wave inversion Q waves
91
What blood results/ biomarkers may be seen in alcoholism?
^GGT Low urea ^MCV ^AST/ALT
92
What is the most common ECG finding in PE?
Sinus tachy | other less common: RBBB, T-wave inversion/ST depression in V1 and V2, S1Q3T3
93
Name of the condition where narrowing of the aorta leading to hypoperfusion of the lower body? What murmur is heard?
Coarctation of the aorta Systolic murmur best heard in left sternal edge
94
Hypertension. Give 3 lifestyle modifications a patient with HTN could make
Low salt diet (<6g/day) Reduce caffeine intake Stop smoking, less alcohol, balanced diet, more exercise, lose weight
95
HTN Step 1. What would you prescribe for a patient: a) <55 or with DM? b) 55+ or Afro-Carib?
a) ACEi or ARB | b) CCB
96
HTN Step 2. What would you prescribe for a patient: a) already taking ACEi/ARB? b) already taking CCB?
a) CCB or thiazide-like diuretic | b) ACEi or ARB ARB > ACEi for Afro-Carib
97
HTN Step 3. What would you prescribe for a patient: a) on an ACEi/ARB + thiazide-like diuretic? b) on a CCB + ACEi/ARB?
a) CCB | b) thiazide-like diuretic
98
HTN Step 4 (resistant hypertension). What 3 things do you need to check before adding further anti-HTN medication?
Confirm elevated BP with ABPM or HBPM Assess for postural hypotension Discuss adherence
99
HTN Step 4 (resistant hypertension). What medication medication would you add for a patient with: a) K+ <4.5 mmol/L b) K+ >4.5 mmol/L
a) low-dose spironolactone | b) alpha/ beta-blocker
100
Heart failure. Give 4 symptoms
Breathlessness Reduced exercise tolerance Oedema Fatigue
101
Heart failure. Give 4 signs
``` Cyanosis Tachycardia Elevated JVP Displaced apex beat Chest Sx: bibasal crackles, wheeze S3-heart sound ```
102
Heart failure. 4 investigations?
Blood tests (anaemia, electrolytes, infection) CXR (pulmonary venous congestion, interstitial oedema, cardiomegaly) Echo (pericardial effusion and cardiac tamponade) BNP (^levels indicate myocardial damage)
103
How do statins work?
Inhibit action of HMG-CoA reductase (rate-limiting enzyme in hepatic cholesterol synthesis)
104
3 key adverse effects of statins?
Myopathy Liver impairment (check LFTs at baseline, 3 mo, 12 mo) Intracerebral haemorrhage in prev. stroke patients
105
Give 2 contraindications to statins?
Macrolides (e.g. erythromycin) | Preganancy
106
What dose of atorvastatin should be given in: a) primary prevention b) secondary prevention
a) 20mg OD | b) 80mg OD
107
What are the components of CHA2S2VASc score?
``` CHF - 1 HTN - 1 Age (75+ or 65-74) - 1 or 2 DM - 1 Stroke/TIA - 2 Vascular (IHD, etc) - 1 Sex category - 1 if female ```
108
A 74-year-old man presents to his GP for a medication review. Blood pressure is recorded as 184/72. This is confirmed on two further occasions. What is the most appropriate first line therapy?
CCB e.g. amlodipine
109
Heart failure. Give an example of a thiazide-like diuretic
Indapamide | Chlortalidone
110
What type of diuretic is bendroflumethiazide?
Thiazide diuretic
111
What type of diuretic is indapamide?
Thiazide-like
112
A 53-year-old man is reviewed in clinic. Two months ago he was started on ramipril after being diagnosed with stage 2 hypertension following ambulatory blood pressure monitoring. His clinic readings had decreased from 164/96 mmHg to 142/84 mmHg. Unfortunately he has developed a troublesome, dry cough over the past 4 weeks. What is the most appropriate course of action?
Stop ACEi (eg ramipril) and start ARB (eg losartan)
113
Give an example of an ARB
Losartan
114
8 reversible causes of cardiac arrest?
``` 4Hs and 4Ts Hypo: - thermia - xia - volaemia - kalaemia/glycaemia (and hyperkalaemia) ``` Tension pneumothorax Toxins Tamponade Thrombosis
115
Why should beta blockers not be prescribed with verapamil?
Risk of complete heart block
116
Management of angina pectoris?
1) aspirin and statin 2) + GTN spray 3) + BB OR CCB (e.g. verapamil, diltiazem) 4) + long-acting dihydropyridine CCB, e.g. nifedipine 5) ^to max tolerated dose 6) If still symptomatic after mono therapy, add either CCB or BB (nb NOT BB + verapamil) 7) If on mono therapy and cannot tolerate CCB/BB, + long-acting nitrate, e.g. ivabradine, nicorandil, ranozaline
117
Heart failure. How does furosemide work?
Inhibits Na-K-Cl cotransporter in asc. LoH | Reduced absorption of NaCl
118
What type of diuretic causes hypocalcaemia?
Loop diuretic, e.g. furosemide
119
Ejection systolic murmur loudest in the aortic region. | 2 possible causes? How would you differentiate?
Aortic stenosis Aortic sclerosis No radiation to carotids in aortic sclerosis, and no ECG changes
120
A 23-year-old man is given intravenous adenosine to treat a supraventricular tachycardia. What is the approximate half-life of adenosine?
8-10 seconds
121
Which group of patients should adenosine be avoided in?
Asthmatics
122
How does adenosine work?
Causes transient heart block in AV node | Used to stop SVTs
123
Give 3 examples of thrombolytic drugs
Alteplase Tenecteplase Streptokinase
124
How do thrombolytic drugs, e.g. alteplase, work?
Activate plasminogen to form plasmin | This degrades fibrin and helps break up emboli
125
Give 3 contraindications to thrombolysis
``` Active internal bleeding Recent haemorrhage, trauma, or surgery Coagulation/bleeding disorders Intracranial neoplasm Stroke <3 months Aortic dissection Recent head injury Pregnancy Severe HTN ```
126
Most common cause of death in patients following a myocardial infarction?
Ventricular fibrillation
127
Peri-arrest bradycardia. What is the first line treatment if the patient is showing signs of haemodynamic compromise/risk of asytole? What could be done after this?
Atropine 500mcg IV Atropine (up to max 3mg) Transcutaneous pacing Isoprenaline/adrenaline infusion
128
What is torsades de pointes? How is it treated?
Form of polymorphic ventricular tachycardia (occurs due to prolonged QT) IV MgSO4 and Stop offending agent (e.g. haloperidol)
129
Give 4 causes of dilated cardiomyopathy
``` Alcohol Coxsackie B virus Wet beri beri Doxorubicin Postpartum Hypertension ```
130
Conduction blocks. What ECG changes are seen in First-Degree Heart Block?
PR interval >200ms (1 large square)
131
Conduction blocks. What ECG changes are seen in Mobitz Type I Second-Degree Heart Block?
Progressive prolongation of the PR interval before the missed QRS complex
132
Conduction blocks. What ECG changes are seen in Mobitz Type II Second-Degree Heart Block?
Absence of progressive prolongation of the PR interval before the missed QRS complex.
133
Conduction blocks. What ECG changes are seen in Third-Degree Heart Block?
Absence of relationship between P waves and QRS complexes
134
Conduction blocks. What is a bifascicular block?
RBBB + LAFB/LPFB ``` LAFB = left anterior fascicular block LPFB = left posterior fascicular block ```
135
Conduction blocks. What is left anterior fascicular block?
L-axis deviation Q waves in leads I and aVL Small R in lead III (in absence of LVH)
136
Conduction blocks. What is left posterior fascicular block?
R-axis deviation Small R in lead I Small Q in lead III (in absence of RVH)
137
Conduction blocks. What is RBBB?
QRS > 120ms Dominant R wave in V1 RSR' pattern (M) in V1, wide S wave (W) in V6 (MaRRoW)
138
Conduction blocks. What is LBBB?
QRS > 120ms Dominant S wave in V1 Deep S wave (W) in V1 with slurred R wave (M) in V6 (WiLLiaM)
139
Conduction blocks. What is trifascicular block?
Bifascicular block + evidence of 1st/2nd degree AV block | bifascicular block = RBBB + LAFB/LPFB
140
How can you calculate the rate from an ECG?
Slow/irreg: [no. R-waves] x 6 Fast: 1500/[no. small squares R-R] Normal: 300/[no. large squares R-R]
141
ECG. How many ms in: a) small square b) big square
a) 40ms (0.04s) | b) 200ms (0.2s)
142
74F presents with falls. O/E: HR 64bpm. Known 1st degree heart block. L-axis deviation + RBBB seen on ECG. Most likely diagnosis?
Trifascicular block
143
HTN. Why are ACE inhibitors recommended first-line in patients with DM?
ACEi = renoprotective as they inhibit the action of AngII. This reduces action of prostaglandin E2 This causes constriction of the efferent arteriole Therefore reducing kidney workload
144
Scoring systems. What is used to determine the need to anticoagulate a patient in atrial fibrillation
CHA2DS2-VASc
145
Scoring systems. Prognostic score for risk stratifying patients who've had a suspected TIA?
ABCD2
146
Scoring systems. Heart failure severity scale?
NYHA
147
Scoring systems. Disease activity in RA?
DAS28
148
Scoring systems. Severity of liver cirrhosis?
Child-Pugh classification
149
Scoring systems. Risk of DVT?
Wells score
150
Scoring systems. Assess cognitive impairment?
MMSE (several others too)
151
Scoring systems. Assess severity of anxiety + depression symptoms?
HAD (hospital anxiety and depression) scale
152
Scoring systems. Assess severity of depression symptoms?
PHQ-9
153
Scoring systems. Severity of generalised anxiety disorder?
GAD-7
154
Scoring systems. Postnatal depression?
Edinburgh Postnatal Depression Score
155
Scoring systems. Eating disorders?
SCOFF
156
Scoring systems. Alcohol screening?
AUDIT CAGE FAST
157
Scoring systems. Pneumonia prognosis?
CURB-65
158
Scoring systems. Assessment of suspected obstructive sleep apnoea?
Epworth sleepiness scale
159
Scoring systems. Prostate symptoms?
IPSS (international prostate symptom score)
160
Scoring systems. Prognosis in prostate cancer?
Gleason score
161
Scoring systems. Health of newborn immediately after birth?
APGAR
162
Scoring systems. Assess whether induction of labour required
Bishop
163
Scoring systems. Risk of developing pressure sore
Waterlow
164
DVLA. How long does a patient have to wait before driving after an ACS? How is this different if they are successfully treated by angioplasty?
4 weeks only 1 week
165
DVLA. How long does a patient have to take off driving after insertion of a pacemaker?
1 week
166
DVLA. How long does a patient have to take off driving after a CABG?
4 weeks
167
MI. An MI has most likely occurred in the ___ wall of the heart if there is reciprocal ST segment depression in leads V1-V3?
Posterior
168
What is the classical triad of symptoms seen in aortic stenosis? What murmur is heard?
SAD- Syncope, Angina, Dyspnoea Ejection systolic
169
What valve pathology would you suspect with systolic murmur with an opening click?
Mitral valve prolapse
170
Which valves are affected if an early diastolic murmur is heard?
Aortic/Pulmonary (regurgitation)
171
Which valves are affected if a mid-late diastolic murmur is heard?
Mitral/Tricuspid (stenosis)
172
Give 3 causes of ejection systolic murmurs, and describe the murmur for each
Aortic/Pulmonary stenosis (crescendo-decrescendo) Mitral/Tricuspid regurgitation (pan systolic) Aortic stenosis and HOCM (loudest in aortic valve area during expiration) and AS radiates to carotids (HOCM does not)
173
Most common cause of aortic stenosis?
Degenerative age-related calcification
174
Condition with congenital narrowing of the descending aorta?
Coarctation of the aorta
175
Signs of coarctation of the aorta?
Hypertension Radio-femoral delay Mid-systolic murmur, maximal over the back Apical click from aortic valve Notching of inferior border of ribs (due to collateral vessels)
176
What is the mode of inheritance of Hypertrophic Obstructive Cardiomyopathy (HOCM)? What is the basic pathology?
Autosomal dominant Defect in genes encoding contractile proteins Common cause of sudden cardiac death in the young
177
List 4 signs you would seen on examination of a patient with aortic stenosis
``` SAD (syncope, angina, dyspnoea) Ejection systolic murmur radiating to carotids Narrow pulse pressure Slow rising pulse Thrill over apex S4 (LVH) Soft/absent S2 ```
178
What is a fourth heart sound (S4) indicative of?
Left ventricular hypertrophy
179
What investigations must be carried out before starting a patient on amiodarone?
TFT LFT U+E CXR Baseline CXR required due to risk of pulmonary fibrosis/pneumonitis in patients treated with amiodarone
180
Give 3 SE of amiodarone
``` Thyroid dysfunction Corneal deposits Pulmonary fibrosis/pneumonitis Liver fibrosis/hepatitis Peripheral neuropathy, myopathy Photosensitivity Slate-grey appearance Thrombophlebitis and injection site reactions Bradycardia Longer QT interval ```
181
AF. Name a fast-acting beta blocker
Metoprolol
182
MI. What are the criteria for diagnosing MI?
Rise +/- fall in cardiac biomarkers (cTn) Plus at least one of: - Symptoms of ischaemia - New ST changes or LBBB - Q waves - Imaging evidence - Intracoronary thrombus on angiography
183
What might cause raised troponin?
Myocarditis Aortic dissection Pulmonary embolism
184
Hypertension. What is the target BP for patients with: a) diabetes b) diabetes with end-organ damage (e.g. retinopathy)?
a) <140/80 | b) <130/80
185
What is the Levine scale? Briefly describe the grades
Grading scale for murmurs Grade 1 = v faint murmur Grade 2 = slight murmur Grade 3 = moderate murmur w/o palpable thrill Grade 4 = loud murmur w/ palpable thrill Grade 5 = v loud murmur w/ v palpable thrill Grade 6 = v loud murmur (heard w/o stethoscope)
186
What are the NHYA stages of Heart Failure?
I - no limitation on ordinary physical activity II - normal at rest, breathless w/ ordinary activity III - normal at rest, breathless w/ less-than-ordinary activity IV - Sx at rest
187
Management of heart failure?
1. ACEi and BB 2. Aldosterone antagonist, AngIIRB or Hydralazine + Nitrate 3. Cardiac resynchronisation therapy or digoxin or ivabradine Diuretics for fluid overload Annual flu vaccine One-off pneumococcal vaccine
188
Ventricular Tachycardia. Initial assessment/management?
``` ABCDE SpO2 BP ECG IV Access Rx reversible causes ```
189
Ventricular Tachycardia. What are some signs the patient is unstable?
Shock Syncope MI Heart Failure
190
Ventricular Tachycardia. What are the management steps for a patient with unstable VT?
1. Synchronised DC shock (up to 3 attempts) 2. Seek expert help 3. Amiodarone 300mg IV over 10-20 mins 4. Repeat shock then give amiodarone 900mg over 24h
191
Ventricular Tachycardia. What are the management steps for a patient with stable VT and a narrow QRS? (regular and irregular)
Regular: 1. Vagal manoeuvres 2. Adenosine 6-12-12 Irregular 1. Rate control: BB or Diltiazem 2. Consider digoxin in HF 3. Consider anticoagulation
192
Ventricular Tachycardia. What are the management steps for a patient with stable VT and a broad QRS? (irregular and regular)
Irregular: Seek expert help (consider AF w/ BBB - treat like narrow complex) Regular: Amiodarone 300mg IV over 20-60min then 900mg over 24h
193
Give 2 agents used to rate-control in patients with atrial fibrillation
BB CCB (e.g. Diltiazem) If co-existent heart failure: Digoxin or Amiodarone
194
ECG. What is the J point?
End of QRS and onset of ST segment
195
ECG. J waves can be confused for ST-elevation. Give some cause of J waves?
Hypothermia Hypercalcaemia Neuro (SAH, intracranial HTN, etc) Brugada syndrome
196
What is the mechanism of action of dipyridamole?
Antiplatelet used w/ aspirin after ischaemic stroke/TIA Phosphodiesterase inhibitor
197
What is Cor Pulmonale?
Hypertrophy of RV and RHF Caused by pulmonary arterial HTN
198
How does COPD cause Cor Pulmonale?
Hypoxia causes pulmonary vasoconstriction, which causes pulmonary HTN This leads to RVH and R-sided HF
199
Give 3 signs of R-sided heart failure
Hepatomegaly Raised JVP Bilateral ankle oedema
200
Give 3 signs of L-sided heart failure
SoB on exertion Orthopnoea Paroxysmal nocturnal dyspnoea Wheeze and cough
201
What is the first line treatment for supra ventricular tachycardia in a stable patient?
Valsalva manouevres
202
Give 4 medications a patient should receive following an MI?
Dual anti platelet therapy (aspirin + ticagrelor or prasugrel) ACEi BB Statin
203
What is Nicorandil? What is it used to manage? 3 side effects?
Potassium channel activator Angina S/E: headache, flushing, anal ulceration
204
What are some environmental factors which may exacerbate angina?
Cold weather Heavy meals Emotional stress
205
Which other medical conditions/states can exacerbate angina due to a decreased supply of blood?
``` Anaemia Hypoxaemia Polycythaemia Hypothermia Hypovolaemia ```
206
Which other medical conditions/states can exacerbate angina due to an increased need for blood in the heart?
``` Hypertension Tachyarrhythmia Valvular heart disease Hyperthyroidism Hypertrophic cardiomyopathy ```
207
Give 3 RFs for angina
``` Increasing age Smoking FHx Diabetes Hyperlipidaemia Hypertension Kidney disease Obesity Physical inactivity Stress ```
208
Give 4 key clinical features of angina
Crushing central chest pain May be short of breath Provoked by physical exertion, esp after large meal, cold weather, or strong emotion Relieved with rest/GTN spray

5 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions