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Phase 4 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What are the causes of bradycardia?

A 
DIVISION 
Drugs 
- beta blockers 
- Digoxin
- Ca2+ blockers

Iscehmia

Vagal tone

Infection
- Infective endocarditis

Sick Sinus Syndrome

Infiltrative

  • sarcoidosis
  • Amyloid

O

  • Hypothyroidism
  • Hypokalemia

Neuro
- ICP

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2
Q

If a person is only started on rate control for AF, what else must the be prescribed?

A

Anti-coagulation

DOAC
or
Warfarin for valvular disease

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3
Q

What is the target HR in AF?

A

<90bpm

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4
Q

What are the complications of hypertension?

A

CANER

  • Cardio
  • Aorta
  • Neuro
  • Eyes
  • Renal
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5
Q

What clinical signs may you find of hypertension?

A 
Ventricular heave 
4th heart sound 
Abdominal bruits 
enlarged kidneys 
Radiofemoral delay
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6
Q

What is the management for Mitral stenosis?

A

Balloon Valvotomy

Anticoagulation
Beta blockers
Diuretics - to reduce pressure on atrium

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7
Q

What are the major causes of Dyslipidemia?

A

Predominantly hypercholesterolaemia
- primary: - Familial - loss of ApoB100

  • Secondary: Nephrotic syndrome And Hypothyroidism

Predominantly Triglyceridemia/ mixed:
- primary: - Lipoprotein Deficiency

  • Secondary: - Diabetes, central obesity
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8
Q

In a lipid profile, what is investigated?

A

Total cholesterol
HDL
LDL
Fasting triglycerides

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9
Q

What is the treatment for hyperlipidaemia?

A

Remove underlying causes

  • hypothyroidism
  • Diabetes

Lifestyle changes

1st: Atorvastatin
2nd: Ezetimibe
3rd: alirocumab

Hypertriglyceridemia:
1st: Fibrates

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10
Q

Which Valvular abnormality gets a TAVI?

A

Aortic Stenosis

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11
Q

What additional tests should be done into HTN?

A

Bloods:
• U&Es
- Assess renal damage
- Low K+ would also suggest primary aldosteronism

* Serum total cholesterol and HDL cholesterol
* TFTs   
* Serum glucose 
Orifices: 
	• Urinalysis 
	- Proteins 
	- Blood 
	- Glucose

ECG:

Consider secondary causes:

  • Cortisol
  • metadrenalines
  • renal ultrasounds
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12
Q

Following a PCI, if a patient develops severe chest pain, what should be done?

A

There can be failure of the procedure.

CABG needs to be considered

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13
Q

What measuring device can be put in place to measure the filling pressures of the heart - which are useful for assessing the type of shock someone is in?

A

Pulmonary artery catheter

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14
Q

Name some differentials for a P.E:

A

Pneumothorax

Pneumonia

Unstable Angina

Asthma

Pericarditis

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15
Q

What are some potential findings of P.E on x-ray?

A

Wedge shaped opacity

Enlarged pulmonary artery

Pulmonary opacities

Pleural effusion

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16
Q

What is the ABG likely to show on a P.E?

A

Respiratory alkalosis

In massive P.Es you may get mixed metabolic acidosis due to hemodynamic collapse

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17
Q

What are the complications of mitral stenosis?

A

Pulmonary hypertension

AF

Dysphagia

laryngeal palsy

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18
Q

What are the symptoms of a mitral valve prolapse and what are some complications of it?

A

Sudden onset breathlessness
Atypical chest pain
Palpitation
Anxiety attack

Complications:

  • Mitral regurgitation
  • Arrhythmias
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19
Q

What are the causes to cardiogenic shock?

A

MI HEART

MI 
Hyperkalemia
Endocarditis 
Aortic dissection
Rhythm disturbance 
Tamponade
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20
Q

What are the signs of a cardiac tamponade?

A

Beck’s signs:

  • raised JVP - during inspiration
  • Muffled heart sounds
  • Low BP

Kussmaul’s breathing

Pulsus paradoxus

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21
Q

What additional investigation can be done in AF to rule out thrombosis formation?

A

Transesophageal echocardiogram

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22
Q

Why is spironolactone used in heart failure?

A

Has been showing to increase life expectancy

- 30% reduced mortality

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23
Q

What should be checked prior to starting someone on an ACE inhibitor?

A

Renal function

  • not recommended in AKI
  • Renal stenosis contraindicated
  • if serum creatinine rises should be withheld

Electrolytes
- increases K+

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24
Q

What are the cardinal changes on ECG that are seen for a full thickness MI?

A

ST elevation in two continuous leads

  • Chest leads > 2mm (2 small boxes)
  • Limb leads >1mm (1 small box)

Q - waves

T Waves
Reciprocal are not cardinal

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25
Q

In heart failure what are you looking for on ECHO?

A

Ejection fracture and peak velocity
Valvular abnormalities
Wall thickness
Heart size

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26
Q

Other than medications, what treatments should be implemented into heart failure?

A 
Low Salt intake 
Low restriction 
Rehabilitation exercise programs 
Low fat diet 
Weight loss 
Education
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27
Q

Why should IV drugs be used in severe hypotension?

A

Reduced absorption from SC or G.I or Rectal if low perfusion

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28
Q

What are the features of pericarditis?

A

Sharp
Central
Worse when leaning back

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29
Q

What are some causes of pericarditis?

A

Autoimmune
Dressler’s
Infection
Uraemia

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30
Q

With acute onset breathlessness in LV failure, what questions do you want to ask?

A 
Is it made worse lying down? 
Normal level of exercise? 
Sputum? 
Syncope? 
Chest pain?
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31
Q

What will an ECG of aortic stenosis show on ECG?

A

Left ventricular hypertrophy

Left axis deviation

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32
Q

What are the two types of electric shock delivered, and when is what given?

A

DC synchronised cardioversion
- timed with QRS - for downslope of Q wave

Defibrillation
- given at any point through cardiac cycle.

Cardioversion used when:

  • AF
  • Atrial flutter
  • VT WITH pulse but unstable

Defibrillation

  • VF
  • VT WITHOUT a pulse
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33
Q

How long does Dressler’s take to present?

A

Few weeks.
- there will be fever as well

If there is symptoms consistent with pericarditis following M.I within a few days it is simply pericarditis

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34
Q

How can you differentiate between JVP and carotid and what things will cause it to rise?

A

2 waves form
Hepatojugular reflux
Non- palpable pulse

Heart failure
Fluid overload
Constrictive pericarditis
Tamponade

35
Q

What are the signs of Pericarditis?

A

Pleuritic central pain
Worse on:
- inspiration
- Lying back - lean forward for relieve

Pericardial friction rub

Fever

ECGs:

  • ST saddle shape
  • PR depression
36
Q

Why do heart failure patients get worse symptoms at night?

A
  1. Lying flat allows fluid to build up
    1. Reduced respiratory effort due to sleep - allows saturations to change more drastically and more shallow breathes
    2. Less adrenaline levels - less cardiac output - worse heart failure
37
Q

Specifically what BNP is monitored for in heart failure? and what additional tests should be done?

A

N terminal Pro-B type natriuretic / NT proBNP

ECG
Echocardiogram

38
Q

In heart failure, who should not get ACE inhibitors?

A

Valvular disease patients

39
Q

What are the grades of a murmur?

A

Grade 1: Difficult to hear
Grade 2: Quiet
Grade 3: Easy to hear
Grade 4: Easy to hear with palpable thrill
Grade 5: Can hear it with stethoscope just touching
Grade 6: Without stethoscope

40
Q

Outwith CT angiogram what other investigations can be done into angina?

A

Stress echo
Stress ECG
Myocardial perfusion scans
CT calcification

41
Q

List some causes of non cardiac progressive breathlessness

A 
Anemia
COPD  
Lung cancer 
Interstitial lung disease 
Pleural effusion 
Sarcoidosis
42
Q

In HTN, what does Left ventricular hypertrophy demonstrate?

A

End organ failure

- heart is struggling

43
Q

What is the INR target for AF when anticoagulation with warfarin?

A

2-3

44
Q

What can falsely lower BNPs?

A

Beta blockers
ACE
Aldosteronism antagonists
Obesity

45
Q

What are the shockable rhythms?

A

VT - which will be pulseless

VF - which will also be pulseless

46
Q

What are some causes of RBBB?

A

Can Be normal

Pulmonary hypertension
P.E

M.I
Cardiomyopathy
Fibrosis
Chagas disease

47
Q

What are some causes of LBBB?

A

Aortic stenosis
Hypertension

M.I
Severe coronary artery disease

48
Q

When shocking someone, why is the shock delivered on the QRS?

A

It is an easily definable mark to be shocked on and ensure not shocking on T wave - which would cause VF

49
Q

What is the management for long term VT?

A

Implantable cardiac defibrillator

50
Q

What drugs can be used for rhythm control of AF?

A

Beta blockers
Flecainide
Sotalol - actually works by class III action - K+
Amiodarone

51
Q

What are the different classifications of AF?

A

Acute - first presentation

Paroxysmal - terminates within 7 days

Persistent - requires cardioversion to stop

Permanent - does not terminate. Requires rate control

52
Q

What factors should be considered when thinking about cardioverting someone from AF?

A

How well the arrhythmia is tolerated

Whether anticoagulation is required

Whether spontaneous cardioversion is likely

Whether cardioversion is likely to work

53
Q

If AF >48 hours what is the anticoagulation times?

A

3 weeks before

4 weeks afterwards

54
Q

Who is typically considered for rhythm control in AF?

A

Younger patients
Symptomatic patients
Active patients
Recurrent paroxysmal

55
Q

How can the rate limiting effect in AF be assessed?

A

ECG holder

Exercise stress test

56
Q

What maneuver can be done to expose F waves seen in atrial flutter?

A

Carotid massage
or
Adenosine

57
Q

If a young person has RBBB and stroke what is the likely defect?

A

Patient Foramen ovale

58
Q

A raised JVP during inspiration is called? and is associated with what?

A

Kussmaul sign

Cardiac tamponade

59
Q

What are the first signs on ECG of M.I?

A

Hyperacute T waves
- the T waves will then flip afterwards - usually within 24 hours.

Q waves begin usually after 24 hours and last for a long time

60
Q

Why should statins be stopped during pregnancy?

A

Cholesterol is essential for the fetus

61
Q

Whats the most common cause of death in M.I?

A

VF

62
Q

What are some causes of Prolonged QT?

A 
Hypokalaemia 
Hypomagnesaemia 
Hypocalaemia 
Macrolides 
Quinolones 
Amiroadone 
M.I
63
Q

What is the presentation of mitral stenosis? and how should it be investigated?

A 
AF 
Pulmonary hypertension 
- dyspnea 
- frothy bloody sputum 
Right heart failure

Investigations:

  • CXR
  • ECG
  • Echocardiogram
64
Q

How can the murmur of mitral stenosis be described?

A

Splitting of the S2 with diastolic low rumble

The 2nd S2 sound is actually the snapping opening of the mitral valve.

65
Q

What is the most common cause of aortic stenosis?

A

Calcific Aortic Valvular Disease

Bicuspid Aortic Valve

Rheumatic fever

66
Q

When analysing an echocardiogram for aortic stenosis, what things are you looking for?

A

Valvular calcification
Left ventricular hypertrophy
Peak velocity of outflow

67
Q

What is pulsus alternans? and what does it signify?

A

It is where there is a strong contraction and then a weak contraction.
- associated with severe myocardial failure.

May seen on blood pressure monitoring changes as much as 50mmHg

68
Q

What things may cause a soft S1 sound?

A 
Mitral regurgitation 
Shock 
Heart Failure 
Obesity 
Emphysema
69
Q

What murmur may be associated with aortic stenosis and what is it? and what can it be mistaken for and how is that resolved?

A

Gallavardin phenomenon
- where there is a musical like radiation to the apex

Often mistaken for Mitral regurgitation
Can be differentiated because mitral regurgitation radiates to the axilla

70
Q

What are the signs of aortic regurgitation?

A 
Collapsing pulse 
Wide pulse pressure 
Capillary Pulsation 
Head nodding with each heart beat 
Pistol shot femoral

**high pitched over the left sternal edge 4th intercostal space

71
Q

What murmur is associated with Aortic regurgitation?

A

Austin Flint murmur

72
Q

How does aortic dissection present?

A 
Sever pain radiating to the back 
Hypertension **differentiates from AAA
Reduced pulses peripherally 
Different pulses on limbs
Aortic regurgitation (present with type A)
73
Q

What is the diagnostic investigation and what medical management for an aortic dissection?

A

CT angiogram of thorax and abdomen

Maintain a low blood pressure

  • beta blocker - labetalol IV
  • GTN IV
  • Contact cardio-thoracic surgeons
74
Q

What blood tests do you want for a suspected P.E?

A 
FBC - infection?
ABG 
D-dimers
U&amp;Es - for contrast use 
Coagulation screen 
ESR
75
Q

Prevention of a P.E can be achieved via:

A

LMWH
Enoxaparin

Stockings

Early mobilisation

ERAS

IVC filters

76
Q

When should diabetics be started on hypertensive medication?

A

Home ambulatory >135/85

77
Q

What are some of the complications of infective endocarditis?

A

Stroke

Congestive heart failure

P.E

AKI
- with nephritic syndrome

Splenic infarction

Septic arthritis

78
Q

When is surgery indicated for Infective endocarditis?

A

Signs of heart failure

Multiple septic emboli

Abscess formation

Obstruction of the valve

Persistent positive cultures

79
Q

What is the wanted antibiotics for prosthetic valve endocarditis?

A 
Vancomycin 
\+ 
Gentamicin 
\+ 
Rifampin
80
Q

How can you distinguish a pericardial rub from a pleuritic rub?

A

Ask the patient to hold their breath

81
Q

When is a cardiac rupture most likely to occur following an M.I?

A

3-7 days
- due to macrophage involvement of the removal of necrotic tissues

**most common an anterior rupture due to LAD involvement

82
Q

Why is there pain to the left arm during an MI?

A

T1 dermatomal distribution

83
Q

Who receives eplerenone following an M.I?

A

Diabetic patients

Ejection fraction <40%

Phase 4 (49 decks)

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