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YEAR 3: Conditions Knowledge > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Define the diagnostic criteria for abdominal aortic aneurysm

A

Diameter of >3cm or >50% larger than normal size

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2
Q

Recall 3 groups of risk factors for AAA and give examples of each

A

CV: hyperlipidaemia, atherosclerosis
Inflammatory: takasayu’s arteritis
Connective tissue: Marfan’s, Ehlers-Danlos

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3
Q

Where is pain felt in a ruptured AAA?

A

Abdomen, back or loin

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4
Q

Describe the nature of pain in a rutured AAA

A

sudden + severe

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5
Q

Recall the symptoms of a ruptured AAA

A

Pain
Syncope
Shock

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6
Q

Recall the signs of AAA

A

3Bs: bulging, bruits, bruising
Pulsatile and laterally expansile mass
Abdominal bruit
Grey Turner’s sign

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7
Q

What is Grey Turner’s sign?

A

Flank bruising

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8
Q

What causes Grey-Turner’s sign in AAA?

A

Retroperitoneal damage

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9
Q

What scans can be used to detect AAA?

A

US can see aneurysm but not rupture

CT contrast can see rupture

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10
Q

Define aortic dissection

A

Tear in aortic intima –> blood surge into aortic wall

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11
Q

What is the difference between types A and B aortic dissection?

A

Type A = in ascending aorta

Type B = in descending aorta

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12
Q

How can surrounding arteries be damaged in aortic dissection?

A

Expansion of the false lumen can obstruct the subclavian/ coeliac/ carotid or renal arteries

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13
Q

What is the main risk factor for aortic dissection?

A

HTN

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14
Q

Between which 2 layers of the aortic wall does a false lumen develop in aortic dissection?

A

Inner and outer tunica media

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15
Q

What is the main symptom of aortic dissection?

A

Tearing chest pain that may radiate to the back between the shoulder blades

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16
Q

If the carotid artery is obstructed by an aortic aneurysm, what would the symptoms be?

A

Hemiparesis
Dysphasia
Loss of consciousness

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17
Q

Why might an aortic dissection present with abdominal pain?

A

Obstruction of coeliac artery

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18
Q

Recall the signs of aortic dissection

A

Wide Pulse Pressure
Aortic Regurgitation
Back Murmur
Blood pressure difference between arms

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19
Q

What might hypotension with aortic dissection indicate?

A

Cardiac tamponade

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20
Q

What form of specialised imaging could be used in aortic dissection as well as CXR and CT?

A

Cardiac catheterisation and aortography

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21
Q

Define aortic regurgitation

A

Reflux from aorta into left ventricle during diastole

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22
Q

Recall the 2 groups of causes of aortic regurgitation and give examples of both

A
  1. Valve abnormality: infective endocarditis, trauma

2. Aortic root dilatation: HTN, aortitis, arthritides, aortic dissection

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23
Q

What arthritides are present in the case of aortic regurgitation?

A

Aortic valve incompetence due to reumatoid arthritis

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24
Q

Which 2 measures of cardiac output are changed by aortic regurgitation and why is this?

A

End Diastolic Volume (EDV) and Stroke Volume (SV) are elevated due to LV dilatation

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25
Recall the consequence of chronic and acute aortic regurgitation
Chronic: leads to heart failure Acute: leads to a sudden CV collapse
26
Important: Recall the 4 key signs of aortic regurgitation
Early diastolic murmur Collapsing pulse Wide Pulse Pressure Displaced and heavy apex beat
27
Define aortic stenosis
Narrowing of left ventricular outflow at level of aortic valve
28
What is the most common cause of aortic stenosis?
Rheumatic heart disease
29
When symptomatic, what symptoms may aortic stenosis cause?
Angina Syncope on exercise Symptoms of left heart failure: dyspnoea and orthopnoea
30
Recall the signs of aortic stenosis
``` Narrow Pulse Pressure Ejection Systolic Murmur Thrusting Apex Beat Aortic Thrill Slow-rising Pulse ```
31
Think of 2 ECG signs that may be seen in aortic stenosis
Signs of LV hypertrophy | LBBB
32
Which patients are most at risk of arterial ulcer?
Those with severe atheroma
33
What is the hallmark symptom of arterial ulcers?
Night pain
34
Describe the appearance of an arterial ulcer
Punched-out | Hairless
35
What are the effects of an arterial ulcer downstream of the artery it affects?
Nail dystrophy | Absence of pulses
36
What is the key investigation for arterial ulcers?
Duplex ultrasonography of lower limbs
37
What are the 3 subdivisions of atrial fibrillation?
Permanent Persistent Paroxysmal
38
What symptoms are possible with atrial fibrillation?
Palpitations | Syncope
39
What is the main complication risk of atrial fibrillation?
Thromboembolism
40
Describe the pulse in atrial fibrillation
Irregularly irregular
41
What key examination finding is indicative of atrial fibrillation?
Difference between apical beat and radial pulse
42
Which electrolytes need to be measured in AF, and why?
K+, Mg2+, Ca2+ | There is a risk of digoxin toxicity if potassium or magnesium are low, or if calcium is high
43
What is the characteristic appearance of atrial flutter on ECG?
Saw tooth baseline
44
How is rhythm controlled in acute atrial fibrillation?
If <48 hours: DC cardioversion, chemical cardioversion (amiodarone/flecainide) If >48 hours since onset: anticoagulate, then do as above
45
Recall 3 drugs used to control rate in AF
Digoxin Verapamil Beta blockers
46
How is longterm medication for AF decided?
Depends on stroke risk Low risk patients = aspirin High risk patients = warfarin
47
How do you measure stroke risk?
CHADS-vasc score
48
Recall the reversible causes of cardiac arrest
``` 4 Hs and 4Ts Hypokalaemia Hypothermia Hypovolaemia Hypoxia Tamponade Tension pneumothorax Thromboembolic Toxins ```
49
What drug is given in cases of asystole?
Atropine
50
Which drugs are given between each round of CPR in VF cardiac arrest?
``` shock + no drug CPR shock + adrenaline CPR shock + amiodarone ```
51
What are the defining characteristics of heart failure?
Cardiac output does not equal demand | Venous pressure is NORMAL
52
Recall the mnemonic for and the causes of left heart failure
``` Heart failure leaves you sitting in a CHAIR Cardiomyopathy Hypertension Aortic valve disease Ischaemic heart disease Regurgitation (mitral) ```
53
Recall 5 causes of right heart failure
``` Cardiomyopathy Tricuspid regurgitation Respiratory causes Infarction As secondary to LHF ```
54
Recall 4 causes of biventricular heart failure
Cardiomyopathy Myocarditis Arrhythmia Drug toxicity (--> arrhythmia)
55
Recall 3 causes of HIGH output heart failure
Demand is increased so: Pregnancy Anaemia Hyperthyroidism
56
Recall the 3 key symptoms of left heart failure
Dyspnoea Paroxysmal nocturnal dyspnoea Orthopnoea
57
Recall one weird sign that is present in acute left ventricular failure
Pink frothy sputum
58
What are left heart failure symptoms a result of?
Pulmonary congestion
59
Recall the symptoms of right heart failure
Swollen ankles and oedema Reduced exercise tolerance Fatigue
60
In which type of heart failure is the apex beat displaced?
Left
61
In which type of heart failure is there tachycardia and tachypnoea?
Left, acute LV
62
Which type of heart failure can produce hepatomegaly?
Right
63
Which type of heart failure presents with a murmur, and what is it?
Left | Mitral regurgitation
64
Which type of heart failure causes a raised JVP?
Right
65
Bilateral basal crackles are present in which type of heart failure?
Left
66
What is the key sign to look for in any LV systolic impairment?
Pulsus alternans
67
Which 2 specific markers do you need to remember to order in the blood tests during acute cardiac failure?
Troponin | BNP
68
What do inverted T waves show on an ECG?
Ischaemic changes
69
What do you use to measure valve wedge pressures?
Swan-Ganz catheter
70
How do you treat cardiogenic shock in acute cardiac failure?
Inotropes like dobutamine
71
Recall the types of cardiomyopathy
Dilated Restrictive Hypertrophic
72
Give 3 causes of dilated cardiomyopathy
Post-viral Thyrotoxicosis Drugs/alcohol
73
Recall 3 causes of restrictive cardiomyopathy
sarcoidosis amyloidosis haemachromatosis
74
Which type of cardiomyopathy is usually asymptomatic?
hypertrophic
75
Recall the general symptoms of heart failure
``` TOAD: Tired/ thromboembolism Arrhythmias Oedema Dyspnoea ```
76
In which types of cardiomyopathy would the JVP be raised?
dilated + restrictive
77
Recall 3 signs of dilated cardiomyopathy
JAM JVP raised Apex beat displaced Mitral AND tricuspic regurgitation
78
Which type of cardiomyopathy can result in hepatomegaly?
Restrictive
79
How will restrictive cardiomyopathy affect an ECG?
Low voltage complexes
80
Define constrictive pericarditis
Chronic pericardial inflammation leading to thickening and scarring of cardiac tissue
81
Recall the usual aetiology of constrictive pericarditis
Usually idiopathic but can be viral
82
What is the usual timeline of onset of constrictive pericarditis?
Gradual
83
In advanced cases of constrictive pericarditis, how does the patient appear?
Jaundiced and cachexic | May have signs of right heart failure
84
What is the diagnostic test for constrictive pericarditis?
Echocardiogram
85
What must you always examine for in cases of DVT?
PE
86
How does DVT feel for the patient?
May actually be painless, just a swollen limb
87
What special sign can be elicited in DVT?
Homan's sign | Force dorsiflexion of the ankle causes pain
88
What risk score is used to calculate DVT risk?
Well's score
89
What is the gold standard investigation for DVT?
Doppler ultrasound
90
Recall the steps of management of DVT
1. Anticoagulate with heparin and warfarin Wait till INR is in target range of 2-3 If it extends beyond the knee: observed anticoagulation for 6 months If it does not extend beyond the knee: observed anticoagulation for 3 months 2. IVC filter 3. Prophylactic stockings and heparin
91
Compare the epidemiology of gangrene and nectrotising fasciitis
Gangrene is common | Necrotising fasciitis is rare
92
Recall the different types of gangrene
1. Wet with superimposing infection 2. Gas 3. Dry
93
What is the cause of gas gangrene?
Clostridia perfringens
94
Compare the seriousness of gangrene and necrotising fasciitis
``` Gangrene = limb-threatening NF = life-threatening ```
95
Define necrotising fasciitis
Life-threatening polymicrobial infection causing tissue necrosis and rapidly spreading across fascial planes
96
Recall 4 risk factors for gangrene
Diabetes Peripheral vascular disease Malignancy Steroid/immunosuppressant drugs
97
Why does gangrene appear black?
Hb breakdown
98
Which type of gangrene is most odourous?
Wet
99
Which type of gangrene causes crepitus?
Gas
100
Recall 2 signs of necrotising fasciitis that differentiate it from gangrene
Haemorrhagic blistering | Signs of sepsis
101
How is 1st degree heart block seen on an ECG?
Prolonged conduction through AVN
102
Differentiate between mobitz type 1 and 2 heart block
Type 1 = progressive prolongation of AVN conduction until skipped beat Type 2 = intermittent/ regular conduction failure
103
Recall the 2 major causes of heart block
IHD | MI
104
What symptoms does heart block cause?
Stokes-adams attacks
105
What is a stokes-adams attack?
syncope caused by ventricular asystole
106
In which grades of heart block are stokes-adams attacks seen?
MNII/ 3rd
107
Recall a specific sign of 3rd degree heart block
Cannon A waves in JVP
108
Recall 3 blood tests to order in heart block
Troponin Cardiac enzymes DIGOXIN
109
What is the first step in management of acute heart block?
IV atropine
110
What are the diagnostic criteria for hypertension?
BP >140/90 on 3 separate occasions
111
What are the diagnostic criteria for malignant hypertension?
>180/120
112
What % of hypertension cases are essential?
90%
113
Recall 4 possible causes of secondary HTN
Pregnancy Renal Endocrine Drugs
114
What might be seen on fundoscopy in hypertension?
Silver wiring
115
Recall the management of malignant hypertension
IV beta blocker Labetolol Hydralesine Sodium nitroprusside
116
What is the main risk to be aware of when treating malignant hypertension?
If you drop the BP too rapidly it may cause a cerebral infarction due to autoregulatory vasoconstricting response
117
What is the target BP for type 2 diabetics?
Without CKD - Clinic BP <140/90 (higher if older) With significant CKD (stage 3, high albumin creatinine ratio) - Clinic BP <130/80 ABPM should be 5 lower
118
Recall the 3 most commonly implicated pathogens in infective endocarditis
Streptococcus Staphylococcus Enterococcus
119
Recall the mnemonic for and the symptoms of infective endocarditis
``` Severe Cardiac Affliction Makes Many Feverish Skin lesions Confusion Arthralgia Myalgia Malaise Fever ```
120
Recall the mnemonic for and signs of infective endocarditis
``` Numerous Signs Can Point To Valve Sickness New regurgitant murmur Splenomegaly Clubbing Pyrexia Tachycardia Vascular lesions (Osler's nodes. Janeway lesions, roth spots, splinter haemorrhages) Signs of arrhythmia ```
121
What will the FBC show in infective endocarditis?
Anaemia of chronic disease | Neutrophilia
122
Recall 2 findings on urine dipstick in infective endocarditis
Microscopic haematuria | Proteinurua
123
How are investigation results compiled to make a diagnosis of infective endocarditis?
Duke's classification
124
What is the treatment for infective endocarditis?
Antibiotics for 4-6 weeks
125
Which antibiotics are first line in a streptococcal infective endocarditis?
Benzylpenicillin and gentamycin
126
Which 4 conditions come under the umbrella term of "ischaemic heart disease"?
Stable angina Unstable angina STEMI NSTEMI
127
Summarise the pathophysiology of atherosclerotic plaque production
Macrophages engulf LDL --> foam cells GF released by foam cells Collagen produced by SMCs
128
Recall the signs of MI (non-silent)
Pale Sweaty Slightly pyrexial
129
Which markers should be checked in the blood in suspected cases of the acute coronary syndrome?
AST (raised 24 hours post-MI) | LDH (raised 48 hours post-MI)
130
Recall 2 signs that may be seen on an ECG of unstable angina or NSTEMI
Inverted T waves or ST depression
131
What sort of branch block is often seen in STEMIs?
LBBB
132
What constitutes a "fail" on an exercise ECG?
failure to produce 85% of max predicted HR
133
Which 4 investigations should be done in patients presenting with likely ischaemic heart disease?
Bloods ECG Exercise ECG Echo
134
If stable angina patients are on max doses of GTN spray and prophylactic medication but pain persists, what can be done?
PCI or CABG
135
Recall the mnemomic for and the management of unstable angina/NSTEMI
``` MONABASH Morphine Oxygen Nitrates Anticoagulants Beta-blockers ACE-inhibitors Statins Heparin ```
136
How does STEMI management differ from NSTEMI?
Same but in addition: Clopidogrel PCI asap Thrombolysis if within 12 hours and there are ECG changes
137
Define mitral regurgitation
Flow of blood from the left ventricle to the left atrium during systole
138
In which demographic is mitral valve prolapse common?
Young females
139
What is the most common cause of mitral valve damage?
Rheumatic heart disease
140
What are the symptoms of acute and chronic mitral regurgitation? (mnemonic for chronic symptoms)
Acute: LV failure Chronic: APEX (Atrial fibrillation, Palpitations, Exertional dyspnoea, eXtreme tiredness)
141
Describe the pulse in mitral regurgitation
Irregularly irregular (as AF is present)
142
Describe the ECG in mitral regurgitation
May be normal | May have *p mitrale* = broad, notched p waves
143
Which heart murmur causes left atrial dilation on echo?
Mitral regurgitation
144
Describe the LVEF in mitral regurgitation
Reduced
145
What is the most common cause of mitral stenosis?
Rheumatic fever
146
What are the symptoms of mitral stenosis?
``` APEX AF Palpitations Exertional dyspnoea eXtreme tiredness ALSO ORTHOPNOEA ```
147
Recall the mnemonic for and the signs of mitral stenosis
If inspection Points to Mitral Pathology so Commence Heart Protection Irregularly Irregular Pulse Malar flush Peripheral Cyanosis Heaves (Parasternal)
148
In which conditions might p mitrale be seen on ECG?
mitral regurgitation and mitral stenosis
149
What would a CXR show in mitral valve disease
Left atrial enlargement
150
What is the most common cause of myocarditis and pericarditis in Europe?
Coxsackie B virus
151
Recall the different types of pericarditis
Acute Subacute Chronic
152
Which disease increases risk of myocarditis and pericarditis?
SLE
153
Describe the symptoms of myocarditis
"flu like" prodromal fever Breathlessness Palpitations
154
Describe the symptoms of pericarditis
Chest pain that extends to the pleura, relieved by sitting forwards
155
Recall 2 signs of pericarditis
Friction rub | Tamponade
156
What ECG changes are seen in myocarditis?
Non-specific T and ST changes
157
What ECG changes are seen in pericarditis?
Widespread saddle-shaped ST elevation
158
What is the treatment for cardiac tamponade?
Pericardiocentesis (emergency)
159
What is the treatment for constrictive pericarditis?
Pericardectomy
160
Recall 3 possible complications of pericarditis
Pericardial effusion Tamponade Arrhythmias
161
What are the different types of peripheral vascular disease?
``` Intermittent claudication Critical limb ischaemia Acute limb ischaemia Arterial ulcers Gangrene ```
162
In which artery is the pathology when there is intermitent claudication of the thigh or leg?
Femoral
163
In which artery is the pathology when there is intermitent claudication of the buttock?
Iliac
164
What classification is used for critical limb ischaemia?
Fontaine
165
Recall the mnemonic for and the signs of peripheral vascular disease
``` 6Ps Pulseless Pain Pale Paralysis Perishingly cold Paraesthesia ```
166
What is the first-line investigation in peripheral vascular disease?
colour duplex ultrasound
167
Recall 2 major risk factors for pulmonary hypertension
Left ventricular failure | Pulmonary emboli
168
Recall the mnemonic for and symptoms of pulmonary hypertension
``` AT BEST Angina Tachycardia Breathlessness Exertional dyspnoea Syncope Tiredness ```
169
Which heart murmurs result when there is pulmonary hypertension?
Pulmonary and tricuspid regurgitation
170
Recall 3 signs of pulmonary HTN
Tricuspid and pulmonary regurgitation Raised JVP Peripheral oedema
171
What can confirm a diagnosis of pulmonary hypertension
Right heart catheterisation
172
Define supraventricular tachycardia
Regular, narrow-complex tachycardia: no p waves, supraventricular origin
173
Recall the 2 possible pathologies underlying a supraventricular tachycaradia
AVRT | AVNRT
174
Which drug carries risk of causing supraventricular tachycardia?
Digoxin
175
What are the signs of Wolff-Parkinson White?
Tachycardia | Secondary cardioyopathy
176
How can you differentiate between AVRT and AVNRT on ECG?
AVRT --> delta waves (slurred QRS upstroke + short PR) | AVNRT - relatively normal, just a narrow QRS and tachycardia
177
What are delta waves?
Slurred QRS upstrokes on ECG
178
Recall the steps of medical management of supraventricular tachycardia
1. IV adenosine 2. If haemodynamically stable: IV beta blocker, dilitiazem and verapamil 3. If haemodynamically unstable: DC cardioversion
179
How can an AVRT or AVNRT be cured?
Radiofrequency ablation
180
Define tricuspid regurgitation
Backflow of blood from right ventricle to right atrium during systole
181
What is the most common cause of tricuspid regurgitation?
Infective endocarditis
182
Recall the mnemonic for and symptoms of tricuspid regurgitation
Learn Symptoms By Just Nailing Acronyms: Tricuspid Errors Produce Heart Palpitations Leg Swelling Breathlessness Jaundice Nausea Anorexia Tiredness Epigastric Pain Headache Palpitations
183
How does the JVP appear in tricuspid regurgitation?
Raised with giant V waves due to high right ventricular pressure
184
What sort of murmur is tricuspid regurgitation?
Pansystolic
185
What is another name for cor pulmonale?
Right sided heart failure
186
What would be seen on a CXR in tricuspid regurgitation?
Right atrial hypertrophy
187
Recall 4 causes of secondary varicose veins
``` Valve damage following DVT Outflow obstruction: - pregnancy - ascites - pelvic malignancy ```
188
Recall 3 symptoms of varicose veins
Itching Swelling Bleeding
189
How should you examine varicose veins?
With pt standing up: TAP TEST
190
How do you perform a tap test?
Feel distally whilst tapping saphenofemoral junction - if you feel something the valves are incompetent
191
Other than the tap test, what test can show valve incompetency?
Trendelenberg
192
What investigation may be done for varicose veins?
Duplex ultrasound
193
What are two possible complications of varicose veins and how do you treat these?
Venous telangiectasia and reticular veins | Scleropatherapy
194
Which vein is usually implicated in varicose veins?
Long saphenous
195
What is the cause of vasovagal syncope?
Excessive vasovagal discharge
196
What are 2 common triggers of a vasovagal syncope episode?
Emotion | Orthostatic stress
197
Alongside a faint, what symptoms may be experienced in vasovagal syncope?
Sweating | Dizziness
198
Where is the most common site of venous ulcers?
Just superior to medial malleolus
199
What is the pathophysiology of venous ulcers?
Valve incompetency --> venous stasis --> increased venous pressure -> ulceration
200
Describe the appearance of a venous ulcer
Irregular margin
201
In addition to a venous ulcer, what skin changes may be seen in the area?
Stasis eczema | Dark colour from haemosiderin deposition
202
What is the main investigation to do in venous ulcers?
ABPI (ankle brachial pressure index)
203
What is the treatment for venous ulcers?
Graduated compression
204
Define ventricular fibrillation
Irregular broad complex tachycardia
205
What will VF survivors need as part of their long-term management?
ICD (defibrillator implant)
206
What is the main complication seen in survivors of VF?
Anoxic encephalopathy
207
Define ventricular tachycardia
Regular broad-complex tachycardia with AV dissociation
208
Describe the aetiology of ventricular tachycardia
Electrical impulses arise from ventricular ectopic focus
209
Recall some signs indicative of ventricular tachycardia
Raised JVP with hypotension due to inefficient pumping | Respiratory distress with bibasal crackles
210
Which is more common out of SVT and VT?
VT
211
If somebody has VF but is not in cardiac arrest, how should you manage them?
Unstable: DC cardioversion Stable: Amiodarone
212
Define Wolff-Parkinson-White syndrome
Congenital supraventricular tachycardia | Pre-excitation syndrome
213
Recall the aetiology of Wolff-Parkinson-White
Bundle of Kent accessory pathway
214
What are the symptoms of WPW?
Dizziness Syncope Palpitations
215
What unusual sign may be observed in paroxysmal WPW?
May be followed by polyuria: atrial dilatation --> ANP production --> polyuria
216
In what case would a WPW patient have a normal ECG?
If Bundle of His and Bundle of Kent have same conduction speed
217
What is the main possible abnormality on ECG in WPW?
Shortened PR interval

YEAR 3: Conditions Knowledge (17 decks)

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