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Cardiology Flashcards

1
Q

Patients with heart failure are most at risk of which two types of infection?

A
  1. Chest infections

2. Ulcerated cellulitis of the lower limbs

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2
Q

What 4 drugs/ drug classes have an evidence base for improving mortality in patients with chronic heart failure?

A
  1. ACE inhibitors
  2. Spironolactone
  3. Beta-blockers
  4. Hydralazine with nitrates
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3
Q

What is the first line treatment for all patients with chronic heart failure?

A

ACE inhibitor + a Beta-blocker

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4
Q

When is sacubitril- valsartan indicated in the treatment of chronic heart failure?

A

In patients with a reduced ejection fraction who are symptomatic on an ACE inhibitor

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5
Q

Name 3 beta-blockers licensed in the UK for the treatment of heart failure

A
  1. Bisoprolol
  2. Carvedilol
  3. Nebivolol
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6
Q

Though most patients with heart failure only require a one off pneumococcal vaccination, give 3 concurrent conditions that would require the patient to receive booster vaccinations every 5 years

A
  1. Asplenia
  2. Splenic dysfunction
  3. Chronic kidney disease
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7
Q

Simply contrast the pathophysiology of systolic and diastolic heart failure respectively

A

Systolic - Impaired contraction of the LV

Diastolic - Impaired relaxation of the LV

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8
Q

A productive cough in heart failure is associated with what type of sputum?

A

Frothy white/pink sputum

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9
Q

What are the 5 classical presenting features of patients with chronic heart failure?

A
  1. SOB that is worse on exertion
  2. Cough
  3. Orthopnoea
  4. PND
  5. Peripheral oedema
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10
Q

What are the 4 main categories of pathology that can lead to heart failure?

A
  1. Ischaemic heart disease
  2. Valvular heart disease e.g. aortic stenosis
  3. Hypertension
  4. Arrhythmias
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11
Q

According to NICE guidelines what BNP level requires an urgent specialist referral for patients with heart failure?

A

BNP > 2000

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12
Q

Name a patient cohort for which ACE inhibitors should NOT be prescribed for the treatment of heart failure

A

Patients with established valvular heart disease

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13
Q

Pulmonary hypertension is most commonly associated with what abnormal heart sound?

A

Loud S2

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14
Q

What pathologies causes a soft S2 heart sound?

A

Aortic stenosis

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15
Q

Name 4 potential causes of a widely split S2 heart sound

A
  1. RBBB
  2. Deep inspiration
  3. Pulmonary stenosis
  4. Severe mitral regurgitation
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16
Q

What is the normal PR interval range?

A

0.12 -0.21 seconds

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17
Q

Suggest 4 potential causes of sinus bradycardia

A
  1. Athletic physiology
  2. Acute MI
  3. Sick sinus syndrome
  4. Beta - blockers
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18
Q

Name 3 non-cardiac disorders which can lead to sinus bradycardia

A
  1. Myxoedema
  2. Jaundice
  3. Raised ICP
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19
Q

What is the most common form of cardiomyopathy?

A

Dilated cardiomyopathy

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20
Q

Suggest 4 infections that can lead to myocarditis

A
  1. Coxsackie B
  2. HIV
  3. Diphtheria
  4. Chagas disease
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21
Q

Name 2 substances of abuse that can potentially cause dilated cardiomyopathy

A
  1. Alcohol

2. Cocaine

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22
Q

Name a genetic syndrome associated with increased incidence of dilated cardiomyopathy

A

Duchenne muscular dystrophy

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23
Q

Name 2 infiltrative diseases that can potentially cause dilated cardiomyopathy

A
  1. Haemochromatosis

2. Sarcoidosis

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24
Q

Why can a systolic murmur sometimes develop in cases of dilated cardiomyopathy?

A

Stretching of the valves may lead to mitral and tricuspid regurgitation

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25
What is the most common cause of sudden cardiac death in the young?
HOCM - Hypertrophic obstructive cardiomyopathy
26
What is the most common murmur associated with HOCM?
Ejection systolic murmur
27
Name 2 other conditions that HOCM is commonly associated with
1. Friederich's ataxia | 2. Wolff-Parkinson White syndrome
28
Using the mnemonic 'MR SAM ASH' , what are the echo findings associated with HOCM?
- Mitral regurgitation (MR) - Systolic anterior motion (SAM) - Asymmetric hypertrophy (ASH)
29
What is the triad of clinical pathologies seen in Naxos disease?
1. ARVC - Arythmogenic right ventricular cardiomyopathy 2. Palmoplantar keritosis 3. Woolly hair
30
Define syncope
Transient loss of consciousness due to global cerebral hypo perfusion
31
What are the 3 broad categories of syncope to consider on presentation?
1. Reflex 2. Orthostatic 3. Cardiac
32
Give 2 potential causes of primary autonomic failure which may lead to orthostatic syncope
1. Parkinson's disease | 2. Lewy body dementia
33
Give 3 potential causes of secondary autonomic failure which may lead to orthostatic syncope
1. Diabetic neuropathy 2. Amyloidosis 3. Uremia
34
Name 3 drug-induced causes of orthostatic syncope
1. Diuretics 2. Alcohol 3. Vasodilators
35
Name the potential non cardiac cause of cardiac syncope
PE
36
Suggest 3 structural causes of cardiac syncope
1. Valvular abnormalities 2. MI 3. Hypertrophic obstructive cardiomyopathy (HOCM)
37
Give 8 potential causes of a RBBB
1. Normal variant (becomes more common with increasing age) 2. Right ventricular hypertrophy 3. Cor pulmonale (or other causes of chronically increased high ventricular pressure) 4. PE 5. MI 6. Atrial septal defect 7. Cardiomyopathy 8. Myocarditis
38
What are the two main cardiac complications of myotonic dystrophy?
1. Heart block | 2. Cardiomyopathy
39
What 3 pathologies can lead to an S3 heart sound?
1. Left ventricular failure e.g. due to dilated cardiomyopathy 2. Constrictive pericarditis 3. Mitral regurgitation
40
Name 3 conditions in which an S4 heart sound may be heard
1. Aortic stenosis 2. HOCM 3. Hypertension
41
What causes the S4 added heart sound?
Atrial contraction against a stiffened ventricle
42
What are the 4 most common causes of decompensated acute heart failure
1. Acute coronary syndrome 2. Hypertensive crisis 3. Acute arrhythmia 4. Valvular disease
43
Define de-novo acute heart failure
Acute heart failure occurring without any prior history of heart failure
44
Suggest 4 causes of de-novo acute heart failure
1. Ischaemia 2. Viral myopathy 3. Toxins 4. Valve dysfunction
45
List the 5 potential causes of an ejection systolic murmur
1. Aortic stenosis 2. Pulmonary stenosis 3. Hypertrophic obstructive cardiomyopathy 4. Atrial septal defect 5. Tetralogy of Fallot
46
List the 3 potential causes of a pan systolic murmur
1. Mitral regurgitation 2. Tricuspide regurgitation 3. Ventricular septal defect
47
Give 2 causes of a late systolic murmur
1. Mitral valve prolapse | 2. Coarctation of the aorta
48
Give 2 causes of an early diastolic murmur
1. Aortic regurgitation | 2. Pulmonary regurgitation
49
Give 2 causes of a mid-late diastolic murmur
1. Mitral stenosis | 2. Austin-Flint murmur (severe aortic regurgitation)
50
What is the cause of a 'continuous machine like murmur'?
Patent ductus arteriosus
51
What are the 3 main consequences of plaque formation in atherosclerosis?
1. Stiffening of the arterial walls - leading to hypertension 2. Stenosis - leading to reduced blood flow (angina) 3. Plaque rupture giving off a thrombus
52
Give 3 non modifiable risk factors associated with atherosclerotic disease
1. Old age 2. Male 3. Family history
53
Name 5 medical co-morbidities that can increase the risk of atherosclerotic disease
1. Diabetes 2. Hypertension 3. Chronic kidney disease 4. Inflammatory conditions such as rheumatoid arthritis 5. Atypical antipsychotic medications
54
List 6 medical consequences of atherosclerosis
1. Angina 2. MI 3. TIA 4. Stroke 5. Peripheral vascular disease 6. Chronic mesenteric ischaemia
55
In managing a patient with a cardiovascular disease risk. in what 3 situations would the prescription of a statin be indicated?
1. QRISK 3 score >10% 2. Chronic kidney disease 3. Diabetes
56
What is the statin prescription of choice for the management of cardiovascular disease risk?
Atorvastatin 20mg at night
57
What transient changes can occur on an LFT panel in patients that have just started taking a statin?
Mild increase in ALT and AST within the first few weeks of treatment initiation
58
Recall the 4 A's for secondary prevention of cardiovascular disease
1. Aspirin 2. Atorvostatin (80mg) 3. Atenolol (or another beta blocker) 4. ACE inhibitor
59
Name 3 notable side effects that can be associated with statin use
1. Myopathy 2. T2DM 3. Haemorrhagic stroke (although v.rare)
60
Define 'stable' angina
Symptoms are always relieved by rest or GTN
61
Why are ACE inhibitors given as pro-drugs?
The active drugs are water soluble and hence poorly absorbed by the intestinal tract
62
Name a medical condition that is a significant contraindication for the use of ACE inhibitors
Severe renal artery stenosis
63
Give 6 contraindications to the use of amiodarone
1. Severe conduction disturbances 2. Sinus node disease 3. Iodine sensitivity 4. Sino atrial heart block 5. Sinus bradycardia 6. Thyroid dysfunction
64
What are the 2 congenital causes of aortic stenosis?
1. Bicuspid valve | 2. Williams syndrome
65
What 3 signs are associated with aortic stenosis on clinical examination?
1. Ejection systolic murmur best heard in the aortic area that radiates to the carotids 2. A slow rising pulse with a narrow pulse pressure 3. Heave, although the apex beat is not usually displaced
66
Recall the 4 ECG changes that can be associated with severe aortic stenosis
1. LBBB (due to calcification) 2. Left axis deviation 3. LVH 4. Poor R wave progression (i.e. depolarisation of the ventricles is slow)
67
Name the 2 subtypes of atrial septal defect
1. Secundum ASD (patent foramen ovale) | 2. Partial AVSD
68
Though often asymptomatic, suggest 3 clinical symptoms that can be associated with an atrial septal defect
1. Heart failure 2. Arrhythmia ( not until > 4th decade of life) 3. Recurrent chest infections and wheeze
69
What 2 clinical findings on examination can be associated with an atrial septal defect?
1. A split S2 heart sound 2. Ejection systolic murmur, best heard at the left sternal edge (due to increased bloodflow in the right ventricular outflow tract)
70
What is the most common cause of cyanotic heart disease?
Tetralogy of Fallot
71
Outline the 4 components of tetralogy of Fallot
1. Large VSD 2. Right ventricular outflow obstruction (often pulmonary valve stenosis) 3. Overriding of the aorta 4. Right ventricular hypertrophy
72
What is the most common cause of blue baby syndrome?
Tetralogy of Fallot
73
Roughly what % of stroke patients are thought to have AF?
15%
74
Give 5 cardiac causes of AF
1. Heart failure 2. MI 3. Hypertension 4. Mitral valve disease 5. Congenital heart disease
75
Give 3 pulmonary causes of AF
1. PE 2. Pneumonia 3. Bronchocarcinoma
76
Suggest 2 electrolyte abnormalities that could induce AF
1. Hypokalaemia | 2. Hypermagnesemia
77
Recall the 4 main components of clinical symptoms seen in a patient presenting with acute AF
1. Palpitations 2. Chest pain 3. Dysponea 4. Dizziness/ syncope
78
Suggest 6 causes of LVH
1. Hypertension 2. Aortic stenosis 3. Aortic regurgitation 4. Mitral regurgitation 5. Coarctation of the aorta 6. Hypertrophic cardiomyopathy
79
In an investigative echo for AF, what 3 pathological changes might you be looking for?
1. Mitral valve disease 2. Left ventricular dysfunction 3. Left atrial enlargement
80
Name 2 as required medication that can be used in the treatment of paroxysmal AF
1. Flecainide | 2. Sotalol
81
What are the 4 principle causes of cardiac tamponade?
1. Traumatic injury 2. Pericarditis 3. Cancer 4. Iatrogenic - can occur after cardiothoracic surgery
82
Outline the components of Beck's triad (occurs in ~ 1/3 of patients with cardiac tamponade)
1. Hypotension 2. Distended neck veins 3. Muffled heart sounds
83
Define cardiomyopathy
Myocardial disorder in which heart muscle is structurally and functionally abnormal without coronary artery disease, hypertension, valvular or congenital heart diseases.
84
What is the most common cause of unexpected death in childhood?
Hypertrophic cardiomyopathy
85
Name 3 nutritional deficiencies which can predispose a patient to cardiomyopathy
1. Vitamin B1 2. Calcium 3. Magnesium
86
Name 2 connective tissue disorders which can be associated with cardiomyopathy
1. Sarcoidosis | 2. SLE
87
What is the most common reason for a heart transplantation?
Dilated cardiomyopathy
88
Suggest 5 differential diagnoses for cardiomyopathy
1. Ischaemic heart disease 2. Valvular heart disease 3. Pericarditis 4. Valvular stenosis 5. VSD
89
Suggest 4 arteries that can be used during a CABG procedure
1. Internal thoracic arteries (internal mammary) 2. Gastro-epiploic 3. Inferior epigastric 4. Radial artery
90
Define surgical cardioplegia
Where the heart is manually stopped during a procedure. Achieved by cooling the heart to 34 degrees before injecting cold cardioplegic crystalloid solution into the coronary circulation. This induces asystole but also protects the myocardium from damage.
91
What are the 3 main clinical features of symptomatic aortic stenosis
1. Chest pain 2. Dyspnoea 3. Syncope
92
What type if murmur is classically seen in aortic stenosis?
An ejection systolic murmur
93
Give 6 features associated with aortic stenosis
1. Narrow pulse pressure 2. Slow rising pulse 3. Delayed ejection systolic murmur 4. Soft/absent S2 heart sound 5. S4 heart sound 6. Thrill
94
Suggest 5 potential causes of aortic stenosis
1. Degenerative calcification 2. Bicuspid aortic valve 3. William's syndrome (supravalvular aortic stenosis) 4. Post rheumatic disease 5. Subvalvular: HOCM
95
S4 heart sounds are associated with which valvular abnormality?
Aortic stenosis
96
Give 4 side effects associated with ACE inhibitors
1. Cough 2. Angioedema 3. Hyperkalemia 4. First dose hypotension
97
ECG changes in V1-V4 are associated with which area of the heart?
Anteroseptal
98
ECG changes in V1-V4 are associated with a lesion in which coronary artery?
Left anterior descending
99
ECG changes in II, III and aVF are associated with which area of the heart?
Inferior
100
ECG changes in II, III and AVF are associated with a lesion in which coronary artery?
Right coronary artery
101
ECG changes in V4-V6, I and aVL are associated with which area of the heart?
Anterolateral
102
ECG changes in V4-V6, I and aVL are associated with a lesion in which coronary artery?
Left anterior descending or left circumflex artery
103
ECG changes in I, aVL +/- V5-V6 are associated with which area of the heart?
Lateral
104
ECG changes in I, AVL +/- V5-V6 are associated with a lesion in which coronary artery?
Left circumflex artery
105
Tall R waves in V1-V2 can be associated with a lesion in which coronary arteries?
Usually the left circumflex but also the right coronary artery
106
Give 5 components of a history that are important when assessing a patient with valvular heart disease
1. IV drug use 2. History of untreated streptococcal pharyngitis or scarlet fever 3. History of valve replacement 4. Family history of CV disease 5. Genetic disease
107
Suggest 3 types of murmurs that can be accentuated by hand clenching
1. Aortic regurgitation 2. Mitral regurgitation 3. Ventricular septal defect
108
Suggest 2 types of heart murmurs that can be accentuated through a valsalva manoeuvre
1. Mitral valve prolapse | 2. HOCM
109
Give 5 potential causes of pulmonary stenosis
1. Tetralogy of Fallot 2. Carcinoid syndrome 3. Congenital rubella syndrome 4. Multi organ congenital syndromes 5. Noonan syndrome
110
Suggest 2 long term risks associated with tricuspid stenosis
1. Right atrial dilatation | 2. Arrhythmia
111
Recall 2 patient subgroups that are at an increased risk of developing tricuspid stenosis
1. IVDU | 2. Carciniod syndrome patients
112
Give 6 causes of mitral regurgitation
1. Infective endocarditis 2. Chronic rheumatic heart disease 3. Degenerative valvular heart disease 4. Ehlers- Danlos syndrome 5. Marfan syndrome 6. SLE
113
What type of MI can precipitate acute, severe mitral regurgitation?
Inferior wall MI
114
What is the most common cause of mitral valve prolapse?
Idiopathic myxomatous valve degeneration
115
What is Ebstein's anomaly?
A congenital heart defect causing malformation of the tricuspid valve and right ventricle
116
Outline the 5 characteristic features of Ebstein's anomaly
1. Adherence of the posterior and septal leaflets to the underlying myocardium 2. Apical displacement of the functional annulus 3. Dilatation of the atrialised portion of the right ventricle 4. Redundancy, fenestration and tethering of the anterior leaflet 5. Dilatation of the right atrioventricular junction

Clinical Medicine (8 decks)

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