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Finals > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Which conditions does ACS refer to

A

Unstable angina
NSTEMI
STEMI

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2
Q

What is the gold standard investigation of ACS

A

CT coronary angiogram

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3
Q

A STEMI can be defined as

A

ACS with ST elevation or new LBBB on ECG

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4
Q

How could you describe the difference between STEMI and NSTEMI to patients

A

STEMI is full vessel occlusion and ischaemia/infarction of the entire myocardial thickness
NSTEMI is partial vessel occlusion that caused ischaemia/infarction part of the myocardium wall (not the full thickness)

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5
Q

How can you differentiate unstable angina from MI

A

Trop rise - present in MI, absent in unstable angina

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6
Q

Which are the most cardiospecific troponins?

A

I and T

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7
Q

How long should you wait between repeating troponin levels?

A

4-6 hours

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8
Q

Causes of raised troponin levels

A 
MI
HF
Renal failure/CKD
PE
Arrhythmias
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9
Q

How long after an MI do troponins stay raised

A

7-10 days

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10
Q

Describe the sequence of ECG changes during a STEMI

A 
Hyperacute T waves
ST elevation/new LBBB
Pathological Q waves
T wave inversion
ST normalisation
T wave normalisation
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11
Q

Possible ECG changes in NSTEMI/unstable angina

A

ST depression
T wave inversion
Loss of R wave
Normal

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12
Q

Which are the inferior leads on ECG

A

II + III + aVF

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13
Q

Which are the lateral leads on ECG

A

I + aVL + V5 + V6

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14
Q

Which are the septal leads on ECG

A

V1 + V2

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15
Q

Which are the anterior leads on ECG

A

V3 + V4

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16
Q

Which vessel supplies the inferior territory on ECG

A

Right coronary artery

Posterior descending branch

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17
Q

Which vessel supplies the lateral territory on ECG

A

Left coronary artery

Circumflex branch

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18
Q

Which vessel supplies the septal and anterior territories on ECG

A

Left anterior descending artery
Septal branch = septal
Diagonal branch = anterior

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19
Q

How soon after an MI do troponins rise

A

6-8 hours

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20
Q

Differentials for ST elevation on ECG

A 
STEMI
LBBB
Pericarditis
Hyperkalaemia
PE
Tricyclic antidepressants
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21
Q

General management for all ACS

A

Morphine + metoclopramide
Nitrates (GTN, not if inferior)
Oxygen (if sats <94%)
Aspirin 300mg

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22
Q

Describe the specific management of STEMI

A

If symptoms started >12 hours ago then give fondaparinux
If symptoms started <12 hours ago then for reperfusion therapy: if can get to PCI within 120 mins the PCI. If cant get to PCI within 120 mins then thrombolyse

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23
Q

What is the time window from symptom onset for a STEMI to qualify for reperfusion therapy

A

<12 hours

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24
Q

If a STEMI had symptom onset <12 hours ago, how long do you have to get them to the cath lab to be able to perform PCI?

A

120 minutes

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25
Q

Contraindications to thrombolysis

A 
Previous intracranial bleed
Ischaemic stroke <6 months ago
Cerebral malignancy or AVM
Major trauma or surgery <3 weeks ago
GI bleed <1 months ago
Known bleeding disorder
Aortic dissection
Recent biopsy/lumbar puncture (<24hrs ago)
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26
Q

What cardioprotective medication do you initiate after ACS

A

Aspirin for life + Ticagrelor/Clopidogrel for 12 months
Beta blocker
ACEi
High dose statin

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27
Q

MI complications most common in the first 0-24hrs

A

Ventricular arrhythmia - VT, AV block - causes sudden cardiac death
Acute left heart failure
Cardiogenic shock

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28
Q

MI complications most common 1-3 days after

A

Early infarct associated pericarditis - can cause haemopericardium/pericardial tamponade

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29
Q

MI complications most common 3-14 days after

A

Papillary muscle rupture - acute mitral regurgitation
Ventricular septal rupture
Left ventricular free wall rupture

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30
Q

MI complications most common two week-months after

A 
Atrial/ventricular aneurysms
Dressler syndrome
Arrhythmia/AV block
Congestive heart failure
Reinfarction
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31
Q

What is the GRACE score used for

A

Inpatient and 6 month mortality risk following ACS

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32
Q

What is the CRUSADE score used for

A

Predicts risk of major bleeding in patients diagnosed with ACS, especially NSTEMI - used to help inform about risk of thrombolysis

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33
Q

What is the HAS-BLED score used for

A

To assess 1-year risk of major bleeding in patients taking anticoagulants with atrial fibrillation

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34
Q

What is the QRISK2 score used for

A

Risk of MI or stroke over the next 10 years

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35
Q

What is the CHADSVASC score used for

A

Assesses embolic risk in patient with AF

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36
Q

Causes of angina

A

Atheroma
Anaemia
Aortic stenosis
Tachyarrhythmias

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37
Q

Describe stable angina

A

Induced by effort, relieved by rest

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38
Q

Describe unstable angina

A

Angina of increasing frequency/severity/occuring on minimal exertion/at rest

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39
Q

What 3 features need to be present for angina to be classed as typical?

A
  1. Constricting discomfort in the front of the chest, or in the neck/shoulders/jaw/arms
  2. Precipitated by physical exertion
  3. Relieved by rest or GTN in 5 mins
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40
Q

What advice do you give to patients on what to do when they have an angina attack?

A

Stop and rest
Use GTN and wait 5 mins
Second dose of GTN and wait 5 min
Call 999 (or earlier if pain is intensifying/feel unwell)

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41
Q

How do you manage angina

A

Address causative/exacerbating factors (anaemia, thyroid)
Secondary prevention of CVD - lifestyle modification, control of HTN and DM
GTN for symptom relief
Beta blocker +/ calcium channel blocker

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42
Q

Name some narrow complex tachycardias

A

Sinus tachycardia
Atrial flutter
Atrial fibrillation

43
Q

Narrow complex tachycardias represent the electrical signal being initiated where?

A

Supraventricular

44
Q

Broad complex tachycardias represent the electrical sign being initiated where?

A

Ventricular

45
Q

Name some broad complex tachycardias

A

Premature/ectopic ventricular beats
VT
Torsade de pointes
VF

46
Q

Name some bradycardias

A

Sinus bradycardia
First degree heart block
Second degree heart block
Third degree heart block

47
Q

Endocrine causes of secondary HTN

A 
Primary hyperaldosteronism (Conn syndrome)
Primary hyperparathyroidism
Pheochromocytoma
Cushings syndrome
Hyperthyroidism
Acromegaly
Congenital adrenal hyperplasia
48
Q

Renal causes of secondary HTN

A

Renal artery stenosis
ADPKD
Renal failure/decreased GFR
Glomerulonephritis

49
Q

Fundoscopic features of hypertensive retinopathy

A 
Cotton wool spots
Flame haemorrhages
Hard exudates
AV nicking
Papilloedema
50
Q

How do you assess for hypertensive end-organ damage?

A

ECG/echo
Fundoscopy
Renal function + Urinalysis

51
Q

What is the difference between hypertensive urgency and hypertensive emergency

A

Hypertensive urgency does have signs of end-organ damage

Hypertensive urgency has signs of end-organ damage

52
Q

How do you manage hypertensive urgency?

A

Oral antihypertensives

53
Q

How do you manage hypertensive emergency?

A

IV antihypertensives

54
Q

How do you go about diagnosing hypertension

A

2 readings in clinic 140/90 or above then ABPM or HBPM average reading of 135/85 or more

55
Q

How often does ABPM take readings

A

2 measurements every hour

56
Q

How often does HBPM take readings

A

2 measurement twice a day

57
Q

Describe the pathway for treating with antihypertensives

A

Step 1: ACEi/ARB if <55, CCB if >55 or Afro-Caribbean
Step 2: ACEi/ARB + CCB
Step 3: ACEi/ARB + CCB + Thiazide diuretic
Step 4: A + C + D + alpha/beta blocker

58
Q

Side effects of calcium channel blockers

A

Flushes/headache
Ankle oedema
Fatigue

59
Q

Side effects of ACE inhibitors

A

Dry cough
High K
Angioedema/rash
Dizziness/headache

60
Q

Side effects of ARBs

A

Dizziness/headache
Urticaria/pruritus
High K
Cough

61
Q

Side effects of beta blockers

A

Dry mouth/skin/eyes
Cold peripheries
Dizziness
GI upset

62
Q

Causes of left heart failure

A 
Hyperdynamic circulation - anaemia, thyrotoxicosis
Arrhythmia - AF
Valvular disease - MR, AR, AS
HTN
MI
Congenital defects - ASD, VSD
63
Q

Signs/symptoms of left heart failure

A 
Dyspnea
Orthopnea
Pulmonary oedema
Bilateral basal crackles
Paroxysmal nocturnal dyspnea
Cool peripheries
Sweating
Cerebral/renal dysfunction
64
Q

Causes of right heart failure

A 
Left heart failure
COPD
Pulmonary hypertension
Tricuspid regurgitation
Atrial septal defect
65
Q

Signs/symptoms of right heart failure

A

Peripheral pitting oedema
Raised JVP with hepatojugular reflex
Hepatosplenomegaly
Ascites

66
Q

NYHA classification of heart failure

A

I. no limitation/sx with normal physical activity
II. slight limitation/sx of normal physical activity
III. marked sx with less than normal physical activity e.g. getting dressed
IV. sx at rest, can’t really do any physical activity

67
Q

Which blood test can assess for heart failure?

A

BNP

68
Q

Which medications improve mortality in heart failure

A

ACEi/ARBs
Beta blockers
Spironolactone (aldosterone antagonist)

69
Q

Which medications just give symptom relief in heart failure

A

Furosemide

Digoxin

70
Q

Describe ECG findings of AF

A

Irregularly irregular rhythm
Narrow QRS
Absent/indiscernible P waves
Increased rate

71
Q

If AF has been present for >48 hours or an unknown duration, how long would you ideally anticoagulate before cardioversion?

A

3 weeks

72
Q

Which medications are used for rhythm control in AF

A

Amiodarone

Flecainide

73
Q

Which medications are used for rate control in AF

A

Beta blocker
Non-dihydopyridine calcium channel blockers - Diltiazem, Verapamil
Digoxin

74
Q

Which two scores can you use to assess risk/benefit of starting anticoagulation in AF

A

CHADSVASC and HAS-BLED

75
Q

Causes of pericarditis

A 
Viral infection
Bacterial infection
MI
Trauma/surgery
SLE/RA
Uraemia
Radiation
76
Q

Symptoms of pericarditis

A

Pleuritic chest pain, improved by sitting forwards
Tachypnoea
Dyspnea
Flu like symptoms/low grade fever

77
Q

ECG changes in pericarditis

A

Diffuse ST elevation - with ST depression in aVR and V1

Inverted T waves

78
Q

Management of acute pericarditis

A

Usually self limiting and resolves in 2-6 weeks
NSAIDs/Aspirin
Restrict physical activity
Colchicine to reduce risk of recurrent

79
Q

Which valve is most commonly affected by infective endocarditis in IVDU’s

A

Tricuspid valves

80
Q

Signs/symptoms of infective endocarditis

A 
Fever/chills, malaise, B sx
New murmur, arrhythmias, HF
Oslers nodes
Splinter haemorrhages
Janeway lesions
Clubbing
Signs/sx of emboli - kidney, lungs, brain
81
Q

What is the name of the criteria used to diagnose infective endocarditis?

A

Modified Duke’s criteria

82
Q

Rheumatic fever occurs after infection with what?

A

Group A beta-haemolytic streptococcal pharyngitis

83
Q

Clinical features of rheumatic fever

A 
Fever, malaise, fatigue
Large joint polyarthritis
Pancarditis
Valvular disease
Sydenham chorea
Subcutaneous nodules
Erythema marginatum
84
Q

What is the name of the criteria used to diagnose rheumatic fever

A

Jones criteria

85
Q

Systolic murmurs

A 
AS
PS
MR
TR
MVP
86
Q

Diastolic murmurs

A

AR
PR
MS
TS

87
Q

Describe how you grade a murmur

A

1 - heard only if you listen hard for ages
2 - faint but heard easily
3 - loud no thrill
4 - loud with thrill

88
Q

Describe the murmur of aortic stenosis

A

Opening click + ejection harsh systolic murmur

89
Q

Describe the murmur of pulmonary stenosis

A

Ejection systolic

90
Q

Describe the murmur of mitral regurgitation

A

Pansystolic

91
Q

Describe the murmur of tricuspid regurgitation

A

Pansystolic

92
Q

Describe the murmur of mitral valve prolapse

A

Mid systolic click + mid/late systolic murmur

93
Q

Aortic stenosis findings

A

Opening click + harsh ejection systolic murmur
Slow-rising small volume pulse, narrow pulse pressure
Displaced heaving apex beat if LVH
Systolic thrill in aortic area
Reduced/absent S2
Radiates to carotids

94
Q

Pulmonary stenosis findings

A

Ejection systolic murmur
Right-sided heart failure (RV heave, tricuspid regurgitation, raised JVP)
Widely split S2
Right ventricular dilation (right ventricular heave, peripheral signs of right heart failure)
Radiates to left shoulder/infraclavicular

95
Q

Aortic regurgitation findings

A

Decrescendo early diastolic murmur
Collapsing pulse, wide pulse pressure. Corrigan’s, Quincke’s, de-Musset’s
Displaced hyperdynamic apex beat
Radiates to left sternal edge

96
Q

Mitral stenosis findings

A

Opening snap + low pitched rumbling mid-diastolic murmur
Loud S1
Tapping apex beat
Low volume pulse
AF
Signs of pulmonary HTN (malar flush, right sternal heave, engorged neck veins)

97
Q

Describe the murmur of aortic regurgitation

A

Decrescendo early diastolic murmur

98
Q

Describe the murmur of pulmonary regurgitation

A

Early decrescendo diastolic murmur

99
Q

Describe the murmur of mitral stenosis

A

Opening snap + low pitch rumbling mid-diastolic murmur

100
Q

Describe the murmur of tricuspid stenosis

A

Mid-diastolic

101
Q

Getting a patient to sit forward and hold expiration exaggerates which murmur?

A

Aortic stenosis

102
Q

Getting a patient to lie on their left and hold expiration exaggerates which murmur?

A

Mitral regurgitation

103
Q

Causes of a third heart sound

A

Left ventricular failure - dilated cardiomyopathy
Constrictive pericarditis
Mitral regurgitation

Finals (32 decks)

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