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Phase 4 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Which artery is most likely to be affected if post M.I there is a brady arrhythmia? and what type of arrhythmia is most common?

A

Inferior M.I due to RCA blockage

1st degree AV block

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2
Q

What are some common causes of tachy arrhythmias that can be reversed without shock or anti-arrhythmia drugs?

A

high K+ / Low K+

Hypoxia

Hypercapnia

Acidosis

Hypercalcaemia

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3
Q

What scoring system is used for NSTEMIs to predict risk of another MI or stroke within 6 months of a NSTEMI?

A

GRACE score

> 10% = surgical intervention

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4
Q

What are the causes of Acute De Novo heart failure?

A 
ICHAMP
- iatrogenic fluid overload 
- Coronary syndrome 
- Hypertension 
- Arrhythmias 
- M.I 
- P.E
-
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5
Q

What are the key symptoms for heart failure?

A

Breathlessness
Fatigue
Oedema

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6
Q

What is the greatest risk factor for endocarditis?

A

Previous endocarditis

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7
Q

What important electrolyte abnormalities can cause VT>

A

Hypokalemia

Hypomagnesemia`

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8
Q

What is first line management for diabetic patients with hypertension? regardless if they are above or below 55?

A

ACE inhibitor

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9
Q

In patients with a provoked P.E (i.e. recent surgery) how long should they be warfarinised following the P.E?

for those who have an unprovoked P.E, how long should they be?

And how long for someone with active cancer?

A

provoked: 3 months

Unprovoked: >3 months

Cancer: 6 months

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10
Q

What is needed to have trifascicular block?

A 
Anterior or posterior fascicular block 
\+ 
RBBB
\+ 
1st degree heart block

(remember to have left anterior fascicular block you need left axis deviation + rS wave in leads II,III, aVF)

(to have left posterior fascicular block you need right axis deviation + rSV wave in leads II, III, aVF) *rare

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11
Q

After initial bloods and ECG what investigations should be done into palpitations?

A

Holter monitor

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12
Q

What may be seen with hypothermia on the ECG?

A

Prolonged QT interval

J waves

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13
Q

Which type of heart rhythm is always abnormal?

A

LBBB

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14
Q

In order for there to be a STEMI what must be present?

A

> 2mm change in two consecutive leads in V1 - V6
or
1mm change in two consecutive leads in limb leads
+/-
LBBB

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15
Q

What is a sign of constrictive pericarditis?

A

Raised JVP during inspiration

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16
Q

What defect is typically seen with Down’s syndrome babies?

A

Ventricular septal defect

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17
Q

What should be offered to all heart failure patients annually?

A

Influenza Vaccine

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18
Q

If someone has a stroke due to AF, following the initial aspirin for 2 weeks, what medication should they be started on afterwards?

A

Warfarin

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19
Q

What is the biggest risk factor towards aortic dissection?

A

hypertension

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20
Q

What disease is most likely if a young female present with episodes of dizziness and lethargy and has an absent pulse on one side - usually left.

A

Takayusa’s vasculitis

- causes inflammation of the large vessels which can cause occlusion on one side

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21
Q

What two rhythms cannot be shocked?

A

Pulseless electrical activity

asystole

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22
Q

If a patient has suspected P.E but has renal disease, what investigations should be done?

A

V/Q miss match
- not CTPE

because renal function cannot handle the contrast

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23
Q

In the setting of infective endocarditis that is causes heart failure, what is the definitive management?

A

Immediate surgical intervention for valvular replacement

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24
Q

Where is the QT interval measured from?

A

From the start of the Q wave to the end of the T wave

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25
Q

Where is the PR interval measured from?

A

Start of the P wave to the start of the Q wave

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26
Q

What is an abnormal QT interval?

A

It should be half the cardiac cycle.
at 60bpm it should be
<440m/s in males
<460m/s in females

QTc needs to be established though because as the HR increases the QT reduces.

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27
Q

Breathing problems with dropping sats and a clear chest one should think?

A

P.E

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28
Q

What tests are important to do prior to starting amiodarone?

A

TFTs - thyrotoxicosis

LFTs - hepatitis

U&Es - detect hypokalamia which may cause the arrhythmias

CXR - underlying fibrosis or pneumonia

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29
Q

What type of breath sound may be heard with acute heart failure? outwith things such as crackles

A

Polyphonic wheeze

  • due to oedema build up
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30
Q

What are the reversible causes of a cardiac arrest?

A

Hypothermia
Hypoxia
Hypovolaemia
Hypokalaemia / hyperkalaemia / hypoglycaemia

Tension pneumothorax
Toxins
Tamponade
Thrombosis

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31
Q

If there is systolic murmur which radiates to the back with splitting of S2, what is likely defect?

A

Atrial septal defect

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32
Q

List some differentials for ST elevation:

A 
Myocardial infarction 
pericarditis 
Takotsubo cardiomyopathy 
Intracranial hemorrhage 
Left ventricular aneurysm
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33
Q

In a thoracic arotic disection, what ECG findings would you likely see?

A

ST elevation in inferior leads

  • aVF
  • II
  • III
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34
Q

What does T wave inversion suggest?

A

Ischemia

Left ventricular hypertrophy

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35
Q

If a patient requires emergency surgery and is on warfarin, what should be done?

A

Prothrombin complex concentrate

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36
Q

What is the most common ECG finding of a P.E?

A

Sinus Tachycardia

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37
Q

What is the drug of choice for chemical cardioversion if there is no structural heart disease?

A

Flecainide

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38
Q

What is the most common cause of sudden death syndrome in young people, how is it inherited and name some clinical findings:

A

Hereditary obstructive cardiomyopathy

Autosomal dominant

  • Exertional syncope
  • systolic ejection murmur
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39
Q

How is Torsades de Pointes treated?

A

IV magnesium sulphate

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40
Q

In cardiac asystole what is the management?

A

Chest compression. stop every 2 mins and reasss. Adrenaline given every 3-5mins

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41
Q

What are the indications for transcutaneous cardiac pacing?

A

Complete AV block
- and M.I with instability

Secondary degree heart block
- with M.I and instability

First degree
- with instability

Bradycardia with adverse signs when atropine has been ineffective

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42
Q

In orthostatic hypotension, what drop in blood pressure is needed?

A

> 20mmHg

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43
Q

What drug is contraindicated in aortic stenosis?

A

GTN

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44
Q

Which two beta blockers have been showing to reduce mortality in heart failure?

A

Carvedilol

Bisoprolol

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45
Q

Statins can induce an increase in liver enzymes, when should they be discontinued?

A

LFTs need to be >3x normal limit before being discontinued.

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46
Q

Following an M.I, how long until you can drive again?

A

4 weeks

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47
Q

Which commonly used anti- hypertensive is contraindicated in pregnancy?

A

ACE inhibitors

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48
Q

How long should a patient be observed for following an anaphlyatix reaction?

A

6-12 hours

- due to biphasic reaction

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49
Q

In bradycardia if there is a risk of asystole or the patient is unstable, what is the first line? and what is second line?

A

First line:
* Atropine 500mcg IV

No improvement:

  • Atropine 500mcg IV repeated to 3mg
  • Other inotropes
  • Transcutaneous cardiac pacing (using defibrillator)
50
Q

What is the immediate management for NSTEMI?

A 
Clopidogrel 
Aspirin 
Heparin 
\+/- 
Beta blockers 
\+/- 
Nitrates 
\+/- 
Oxygen
51
Q

Following an NSTEMI a grace score should be calculated, if >10% what should be done?

A

inpatient coronary angiography

CABG

PCI
- if symptomatic

52
Q

2-3 weeks following an MI a patient develops pleuritic chest, pericardial rub and fever.
ECG shows global ST elevation and bloods increased CRP and ESR.
what does this patient have? and how is it managed?

A

Dressler’s syndrome
- post immune mediated

  • NSAIDs
  • Steroids
  • pericardiocentesis
53
Q

What are some aetiologies to AV block?

A

Congenital

Idiopathic fibrosis

MI/ Ischemia - Right coronary artery

Inflammation

  • infective endocarditis
  • Sarcoidosis (chronic), Chaga’s disease

Trauma

Drugs

  • Beta blockers
  • digoxin
54
Q

What are some aetiologies of RBBB?

A

Normal variant

Right Ventricular hypertrophy/ strain
- P.E

Coronary heart disease

Atrial septal defect

55
Q

What are some aetiologies of LBBB?

A

Coronary heart disease

Hypertension

Cardiomyopathy

Aortic Valve disease

56
Q

What are some of the conditions/ states that are associated with atrial flutter?

A

Cardiomyopathy
thyrotoxicosis
Hypertension
Ischemic heart disease

57
Q

What is the management for Atrial flutter?

A

Rhythm/ Rate control

Radiofrequency ablation

Anti-coagulation

58
Q

What does AVNRT stand for?

A

Atrial ventricular nodal reentry tachycardia

59
Q

What are the three main types of SVT?

A

AVNRT
AVRT
Atrial Tachycardia (tachy originates in atrium)

60
Q

What is the long term management for SVT?

A

Medication
- beta blockers, Ca2+ blockers, Amiodarone

Radiofrequency ablation

61
Q

What is the accessory pathway in wolf -parkinson white syndrome called? and what medications are contraindicated in this condition?

A

Bundle of Kent

Calcium channel blockers, Beta blockers and adenosine are contraindicated.

  • they significant increase the risk of slowing conduction through the AV node, encouraging the current through the bundle’s of kent.
  • this can put the patient in a polymorphic wide complex tachycardia
62
Q

Briefly outline the pathophysiology behind Torsade de Pointes:

A

Prolonged repolarization of the ventricles leads to some myocytes to undergo spontaneous depolarisation - called [afterdepolarisations].
These then trigger further depolarisations prior to ventricles fully repolarizing

63
Q

What is the management for torsades de pointes?

A

Remove causative medications

  • macrolides
  • citalopram
  • amiodarone

IV magnesium infusion

Defib if VT develops

64
Q

How big are the boxes in 1st degree heart block?

A

5 small or 1 big box

- 0.2m/s

65
Q

Which types of heart block increase the risk of asystole?

A

Mobitz type II

3rd degree heart block

66
Q

What are some side effects of atropine?

A

Pupil dilation/ mydriasis
Dry mouth
Dry eyes
Urinary retention

67
Q

What are some x-ray signs of heart failure?

A

Upper lobe venous diversion

Kerley B lines

Fluid within the intralobular fissures

Bat-wing sign

Bilateral pleural effusions

68
Q

What is the management of severe pulmonary oedema that is not responding to diuretics, sitting up and oxygen alone?

A 
CPAP 
Dilators - morphine 
ITU admission 
\+ 
Diuretics 
Sitting up
69
Q

How many small squares should the QRS be?

A

< 3 = <120m/s

70
Q

What is the criteria used for rheumatic fever?

A 
Jone criteria: 
Evidence of Strep infection + 
1 major + 1 Minor 
or 
2 Majors

Step infection:

  • Streptolysin O antigen
  • recent strep throat

Major:
Pericarditis
- murmur
- pericardial rub

Polyarthritis

Subcutaneous nodes

Erythema Marginatum

Chorea movements

Minor:

  • fever
  • arthralgia
  • Raised ESR
  • Previous Rheumatic fever
71
Q

How is rheumatic fever treated?

A

Benzylpenicillin STAT
followed by:
- phenoxymethylpenicillin 10 days

NSAIDs
+/-
prednisolone

Haloperidol

72
Q

What are the blood pressure targets:

A

<80: <140/90

> 80: <150/90

Diabetics: <130/80

73
Q

What score is used to assess if a P.E patient should be managed in hospital?

A

PESI

74
Q

What are the clinical findings of infective endocarditis?

A 
Janeway lesions 
Osler's nodes 
Splinter Hemorrhages
Roth Spots 
Finger clubbing 
Anaemia 
Splenomegaly 
Haematuria 
Murmur
75
Q

What is the adrenaline dose given to patients:

A

0-6 years = 0.15ml in 1 in 1000 = 150 micrograms

6 - 12 years = 0.3ml in 1 in 1000 = 300 micrograms

> 12 years = 0.5ml in 1 in 1000 = 500 micrograms

76
Q

What are the two broad types of heart failure?

A

Reduced ejection fraction:

  • Coronary heart disease
  • Younger patients
  • Males

Preserved ejection fraction:

  • elderly
  • females
  • Hypertension
  • Ventricular hypertrophy

High Output failure:

  • Anaemia
  • pregnancy
  • Hyperthyroidism
77
Q

How is acute heart failure managed?

A

Sit patient up
100% oxygen

Slow titrated morphine
+/- antiemetic

Furosemide
x2
- if needing more referral to senior staff

GTN

Consider:

  • CPAP
  • referral to senior staff in ICU

PODMAN

  • Position up right
  • oxygen
  • Diuretics
  • Morphine
  • Anti emetics
  • NItrates
78
Q

What are some contraindications to CPAP?

A 
BP <90mmHg 
Facial trauma 
Pneumothorax 
Type II respiratory failure 
Reduced consciousness 
- not responding to pain
79
Q

What are some complications of CPAP?

A

Hypotension
Aspiration
Gastric distention
Anxiety

80
Q

What investigations should be done into angina?

A

CT angiography
ECG
Stress ECG

81
Q

What are the secondary prevention medications used for angina?

A

Aspirin
ACE
Statins
Atenolol (although will usually be on for symptom control)

82
Q

What are some causes of tachyarrhythmias?

A

Cardiac:

  • MI
  • Long QT syndrome
  • Cardiomyopathy

Non cardiac:

  • Hypoxia
  • Hypomagnesemia
  • Hypokalemia
  • Sepsis
  • Hypoglycaemia

Drugs:

  • Cocaine
  • TCAs
  • Amphetamines
83
Q

What investigations should be done into tachycardia?

A

Bloods:

  • FBC
  • U&Es - K? Mg?
  • Bone profile - Ca2?
  • TFTs
  • coagulation studies

Orifices:

X-ray:
- Chest x-ray

ECG - essential

84
Q

What are some causes to bradyarrhythmias?

A

Physiological normal in young and extremely fit

Cardiac:

  • post MI
  • Sinus Node disease
  • AV block

Non - cardiac

  • vasovagal
  • Hypothermia
  • hypothyroidism
  • raised ICP - cushing’s effect

Drug induced

  • Calcium channel
  • beta blockers
  • Digoxin
85
Q

What are the causes of cardiac shock?

A 
M.I 
Arrhythmias
P.E 
Tension pneumothorax 
Aortic dissection
86
Q

How is cardiogenic shock managed?

A

ABCDE approach
Investigate the cause and look to reverse
Management often requires ICU

  • Oxygen
  • Morphine for anxiety
  • Correction of cause (arrhythmias etc)
  • Optimize filling pressures - plasma expanders/ dobutamine if to low
87
Q

What must be present in order to diagnose an M.I?

A

ECG changes + troponins

Signs and symptoms + troponins

88
Q

What are the other causes which can cause troponins to rise?

A 
Congestive heart failure 
Sepsis 
Chronic renal failure 
Tachyarrhythmias 
P.E 
Infiltrative cardiomyopathies 
- Sarcoidosis
- Amyloidosis
89
Q

If there is a posterior wall infarction which vessel has been occluded?

A

Left circumflex

90
Q

What are the stages of hypertension?

A

Stage 1: >140-160 or >135

Stage 2: >160 - 180 or 155

Stage 3: >180/110

91
Q

What are the causes to hypertension?

A

Primary

  • idiopathic
  • low birth weight
  • Environmental factors

Secondary

  • Primary aldosteronism
  • Pheochromocytoma
  • Cushing’s disease
  • Hyperthyroidism
  • Renal stenosis
  • Drugs - oral contraception
92
Q

How is the diagnosis of hypertension made?

A

Clinic - 2 reading, 5 mins apart over 2 appointments
- >140/90

Home Ambulatory: >135/85

Night time measuring: >120/80

93
Q

Who always gets treated for hypertension?

A

> 160/100 - stage 2
or
150/90 Home ambulatory

94
Q

What tests should be conducted in hypertension to exclude secondary causes?

A

Bloods:

  • U&Es
  • TFTs
  • Lipid profile
  • Fasting glucose

Orifices:

  • Urine analysis - kidney damage
  • Urine metadrenaline - Chromocytoma
  • Urinary free cortisol

X-ray

  • Echocardiogram
  • Renal ultrasound - renal stenosis

ECG
- LVH?

95
Q

If a patient is being thrombolysed following an MI and are on diabetic medication, what should happen with regard to their medication?

A

Stopped and placed on a insulin infusion

96
Q

What electrical activity can be seen on ECG with a cardiac tamponade?

A

Electrical alternans

- QRS fluctuates in size

97
Q

What other symptoms outwith chest pain are associated with angina?

A

Sweatiness
Dyspnea
Faintness
Nausea

98
Q

What is the management for Angina?

A

Lifestyle advice

Referral to cardiology

Symptom relieve:
- GTN spray

Symptom control:

  • Beta blocker
  • Ca2+
  • Combined
  • Nicorandil

Secondary prevention:

  • Aspirin
  • ACE
  • Atorvastatin

Surgical input

  • CABG
  • PCI
99
Q

What investigations should you do into postural hypotension?

A

Sit to rising - Taking times at 2,3,7 mins

Table tilt test

Valsalva maneuver

24 hour blood pressure monitoring

100
Q

Name non- pharmacological ways of reducing falls in orthostatic hypotension:

A

Stand slowly

Sit cross legged

Increase Salt intake

Referral to falls clinic

101
Q

What is the medication that be used in orthostatic hypotension?

A

Fludrocortisone

102
Q

What are the complications of untreated hypertension?

A 
Stroke 
Heart failure 
M.I 
PVD 
Renal stenosis 
Aortic dissection
Retinopathy
103
Q

In coronary heart disease, what score can be done to assess the risk of an adverse advent?

A

QRISK 3

104
Q

What symptoms may someone with coronary heart disease have and how is it managed?

A 
Angina 
Strokes 
MI 
PVD 
Mesenteric ischemia

Primary:
- QRISK 10% > aspirin and atorvastatin

Secondary 
- previous adverse event 
Aspirin 
80mg Atorvastatin 
ACE 
Beta blocker
105
Q

What are some causes to pericarditis?

A

Recent viral infection

Dressler’s syndrome

Uraemia

Autoimmune

  • RA
  • SLE

Radiotherapy

106
Q

How is pericarditis managed?

A

NSAIDs
Steroids
Colchicine

severe:
- pericardial paracentesis

Life threatening:
- Pericardiectomy

107
Q

What does a lipid profile include?

A

Total levels of cholesterol
Triglycerides
HDL

108
Q

What is the management of hyperlipidaemia?

A

Lifestyle changes
Lowering of BMI

1st line: Atorvastatin

2nd line: Ezetimibe (cholesterol absorption inhibitor)

3rd line: Alirocumab (PCSK9 inhibitor - blocks LDL)

109
Q

What are the main categories of dyslipidemia?`

A

Hypercholesterolaemia

Hypertriglyceridemia

Mixed hyperlipidaemia

110
Q

What are some secondary causes to hypercholesterolaemia and hypertriglyceridemia?

A

Hypercholesterolemia:

  • hypothyroidism
  • pregnancy
  • cholestatic liver disease

Hypertriglyceridemia:

  • DM type 2
  • Chronic renal disease
  • abdominal obesity
  • Excess alcohol
111
Q

What are some clinical manifestations of hypercholesterolaemia?

A

Xanthelasma - around the eyes

Corneal arcus

Xanthomas

  • achilles
  • Knee
  • Extensors
112
Q

What are the clinical signs of hypertriglyceridemia?

A

Lipaemia retinalis

Lipaemic and blood

Eruptive Xanthomas

113
Q

Signs and symptoms of AF?

A

Palpitations

Hypotension

Chest pain

Dizziness

Breathless

Evidence of a stroke

114
Q

What are some symptoms of heart failure?

A

Breathless

fatigue

Paroxysmal nocturnal dyspnoea

Nocturnal cough

Wheeze

Cold peripheries

Congestion - if right sided

Poor exercise in tolerance

115
Q

What investigations should be done into angina?

A

ECG

Exercise ECG

Angiography - CT Angiography or Transcatherter angiography - which allows for therapeutic intervention as well

116
Q

What are the signs of Mitral regurgitation? and what is the definitive diagnosis?

A

Displaced - hyperdynamic apex beat

Pansystolic murmur heard at apex - radiates to axilla

Splitting of S2 due to pulmonary oedema

Tests:

  • initially Transesophageal echo
  • cardiac catheterisation to confirm diagnosis - measure pressures
117
Q

What are the complications of mitral regurgitation?

A

Arrhythmias

Stroke

Sudden death syndrome

118
Q

What are the signs of Mitral stenosis? and how is it diagnosed? and treated?

A

Usually presents with signs of pulmonary oedema

Mid-diastolic snap
Heard on apex  - best in expiration 
Malar flush on cheeks - low cardiac output 
Low volume pulse 
RV heave

Diagnosis:
- echocardiogram

Management:

  • control AF - rate limiting
  • Anticoagulation
  • Balloon dilation
  • valvular replacement
119
Q

What are the classical presentational symptoms of aortic stenosis?

A 
Chest pain 
Exertional syncope 
Heart failure 
Dyspnoea 
Dizziness

Signs:

  • Ejection systolic murmur - crescendo decrescendo
  • slow rising pulse
  • narrow pulse pressure
  • Heaving
  • LBBB
  • Complete AV block
  • LVH strain

Management:

  • valvular replacement
  • TAVI
120
Q

Name some signs seen with aortic regurgitation:

A

Externational dyspnoea
palpitation
Syncope

High pitched early diastolic murmur 
Collapsing pulse 
Wide pulse pressure 
Hyperdynamic apex beat 
Head nodding - Musset's sign 
Pistol shot over the femorals

Cardiomegaly
pulmonary oedema

121
Q

How is aortic regurgitation assessed?

How is it managed?

A

Diagnosed via echocardiogram with doppler

Assessed for severity using cardiac catheterization

Control hypertension - ACE 
Echo every 6-12 months 
Valvular replacement 
- if severe 
- enlarging 
- Deterioration in LV functioning
122
Q

What are features of pericarditis pain?

What are some clinical findings of pericarditis?

A 
Direct retrosternal pain 
Pain relieved by sitting forward 
No Pain related to activity 
Pain is worse on deep inspiration 
Fever may also accompany

Pericardial Rub
ECG - ST elevation across all leads
QRS Alterna

Phase 4 (49 decks)

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