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Phase 2a > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is the normal axis of the QRS complex?

Which leads to these numbers represent?

A

-30 -> +90
-30 = aVL
+90 = aVF

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2
Q

What is the dominant pacemaker of the heart? Rate?

What other pacemaker cells exist? Rate?

A

SA Node: 60-100

AV Node: 40-60
Ventricular cells 40-60

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3
Q

ECG: ST elevation in leads I, aVL, V5, V6
Which view of the heart?
Which coronary artery?

A

Lateral view

Circumflex

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4
Q

ECG: ST elevation in leads II, III, aVF
Which view of the heart?
Which coronary artery?

A

Inferior

Right coronary artery

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5
Q

ECG: ST elevation in leads V1, V2
Which view of the heart?
Which coronary artery?

A

Septal

Left Anterior Descending

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6
Q

ECG: ST elevation in leads V3, V4
Which view of the heart?
Which coronary artery?

A

Anterior

Right Coronary Artery

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7
Q

5 modifiable risk factors for IHD?

A 
Smoking
Diabetes
High cholesterol (LDL)
Obesity/sedentary lifestyle
Hypertension
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8
Q

3 non-modifiable risk factors for IHD?

A

Increasing age
Biological sex
Family history/genetics

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9
Q

What are the classic signs + symptoms of IHD?
Pain - radiation
Others?

A

Crushing, crescendo central chest pain. “squeezing, tight” - may radiate to neck, jaw, left shoulder, arm

Pallor, dyspnea, diaphoresis, , nausea/vomiting, anxiety

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10
Q

ECG investigations & biochemical markers for the 4 main IHD
What are the main markers?

A

1: ECG
Normal in SA
ST depression, Inverted T-waves in UA & NSTEMI

ST elevation & pathological Q waves in STEMI

2: Biochemical markers
Normal in SA and UA
Raised in NSTEMI
Raised in STEMI

Troponin I, Troponin T, Creatine Kinase myocardial band (CK-MB)

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11
Q

What other investigations can you do for IHD? (other than ECG and markers) (4)

A

Echocardiography - can show damage

CT angiography - good NPV, exlcuding disease

Exercise tolerance test - use drugs now

Invasive angiogram - can tell you FFR (fractional flow reserve)

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12
Q

Two types of revascularisation.

Adv and Dis of each

A

Percutaneous Coronary Intervention (PCI/stents)
Less invasive, convenient
Risk of restenosis

Coronary Artery Bypass Graft (CABG)
Good prognosis
Very invasive, long recovery

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13
Q

What is prinzmetals angina?
ECG?
Can lead to….
2 important management points?

A

Coronary Artery Vasospasm

Will cause ST-segment elevation: full occlusion

Can lead to arrhythmias

Calcium-channel blockers + avoid smoking

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14
Q

Significant difference between ACS symptoms and SA?

A

Stable angina: relieved by GTN spray and rest

ACS: not relieved easily

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15
Q

Initial managment of unstable IHD?

A 
Call an ambulance
M: morphine
O: oxygen
A: aspirin
N: nitrates
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16
Q

What is a silent heart attack?

Who is it more common in?

A

An MI with little or minimal symptoms

Women and diabetics

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17
Q

5 potential complications of an MI?

A
  1. Heart failure
  2. Rupture of ventricle or septum
  3. Mitral regurgitation
  4. Arrhythmias - eg, heart blocks
  5. Pericarditis
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18
Q

GUIDELINE TREATMENT OF ANGINA:
3 immediate actions
Next steps
Still intolerant?

A

Platelet therapy: Aspirin, Clopidogrel, Ticagrelor
Statins: Atorva or Simva
GTN spray

First line: BB or CCB
Switch, Combine

Still intolerant?
Long-acting nitrate or revascularisation

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19
Q 
ACEi:
Stands for?
Used in?
2 examples?
Side effects?
Less effective in...
Not used in...  (2)
A

Angiotensin Converting Enzyme inhibitor

Hypertension, Heart Failure, Diabetic Nephropathy

Ramipril & Enalapril

Dry cough
Hypotension, rash, allergy, renal failure

Afro-Caribbean

AKI & pregnancy

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20
Q 
ARB:
Stands for?
Used in?
3 examples?
Contraindicated in...?
A

Angiotensin II receptor blocker

Hypertension, Heart failure, Diabetic Nephropathy

Candesartan, Valsartan, Losartan

Not used in pregnancy

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21
Q 
CCBs:
Used in?
Stands for?
Which type of channels?
Used in?
Examples: 2 categories
Side effects?
A

Calcium Channel Blockers - dilate arteries/arterioles

IHD, HTN, arrhythmias

L-type calcium channels

Hypertension, IHD, arrhythmias

Amlodipine, -pines
Diltiazem, Verapamil

Side effects: flushing, headache, oedema
Bradycardia, AV block, constipation in diltiazem & verapamil

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22
Q 
BBs:
Used in?
Stands for?
Examples
What does selectivity mean in this context?
Side effects?
Contraindication!
A

Beta-adrenoreceptor blockers

IHD, heart failure, HTN, arrhythmias

Atenolol, Bisoprolol, Metoprolol, Propanolol

Selective (only beta-1) (A-> N)
Non-selective (beta-1 & beta-2) (O -> Z)

Fatigue, headache, sleep disturbance, bradycardia

Asthma (maybe COPD)

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23
Q

DIURETICS:
Used in?
3 types w/ examples
Side effects?

A

HTN + Heart Failure

Thiazides - bendroflumethiazide, hydrochlorothiazide

Loop diuretics - furosemide, bumetanide

Potassium-sparing diuretics - spironolactone, eplerenone (aldosterone antagonists), amloride

Hypovolaemia, Hypotension, Low K+/Na+/Mg2+/Ca2+, Gout

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24
Q 
NITRATES:
Used in?
Mechanism?
3 categories - w/ examples
Side effects?
A

IHD & Heart Failure

Arterial + Venous dilation (decrease preload + afterload)

Long-acting (isosorbide, nicorandil, ivabradine)
Short-acting (GTN spray)
GTN infusion

GTN syncope and headaches

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25
Q

4 types of cardiomyopathy

Which is most common? (number)

A 
Hypertrophic Cardiomyopathy (HCM) 
Affects 1 in 500
Dilated Cardiomyopathy (DCM) - heart failure
Affects 1 in 2500

Arrhythmogenic Cardiomyopathy (ACM)

Restrictive cardiomyopathy (RCM)

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26
Q

4 types of channelopathy? Which ones are more common?

Basic explanantion of each

A 
LONG QT SYNDROME (common) - 3 subtypes
BRUGADA SYNDROME (common) - sodium channel

SHORT QT SYNDROME (fast ventricular repolarisation)
CVPT - catecholaminergic polymorphic ventricular tachycardia

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27
Q

Aortavascular syndromes
Increased risk of..?
Main one:
2 others linked

A

Aortic dissection or anuerysm

MARFAN’S SYNDROME: tall, slender

Loey’s-Dietz syndrome
Ehlers-Danlos syndrome

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28
Q

What are the causes of pericarditis? Name 4 out of 6

Usually?

A

Usually idiopathic (80-90%)

Virus - Coxsackle B, echovirus, HIV

Dressler syndrome - couple weeks after an MI

Uremic pericarditis

Autoimmune, cancer, medications

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29
Q

Two negative outcomes from pericarditis? Which one depends on…

A 
TAMPONADE PHYSIOLOGY
(Pericardial effusion)
or
RESTRICTIVE PERICARDITIS
(fibrosis)

Depends on whether there is time to adapt, tamponade if yes, restrictive if no

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30
Q

4 diagnostic factors of pericarditis

A

Saddle shaped ST elevation & PR depression
Friction rub
Sharp/stabbing chest pain
Pericardial effusion: pulsos paradoxus

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31
Q

Treatment of pericarditis?
First line
Second line
Third line

A

First: bed rest, oral NSAIDS
Second: Colchicine (inhibits neutrophil migration)
Third: drained or removed

32
Q

Different stages of HTN?

At what stage is medication used?

A

Stage 1: 140-160
Stage 2: >160
Malignant: Over 180

Medication generally started at stage 2, unless risk factors present (eg, diabetes)

33
Q

Two aetiologies of HTN

Proportion

A

Primary (>95% of cases)
Secondary (<5% of case)
eg, Renal, Endocrine, Pre-eclampsia, Aortic coarctation

34
Q

Symptoms & signs of HTN?
Usually?
Always check…

A

Usually asymptomatic
Possibly headaches, cardiovascular disease
CHECK EYES AND KIDNEYS

35
Q

What drugs to prescribe for HTN? Two pathways?

A

Under 55:

1: ACEi or ARB
2: + CCB
3: + Thiazide
4: Consider adding anything else

Over 55 or Afro-Caribbean any age

1: CCB
2: + ACEi or ARB
3: + Thiazide
4: Consider adding anything else (alpha blockers, eg: doxazosin, centrally acting, eg: clonidine, methydopa)

36
Q

Symptoms of pericarditis?
2 big
3 smaller

A

Chest pain - severe, sharp, pleuritic, rapid onset
Dyspnoea

Cough
Hiccups - phrenic nerve irriated
Skin rash

37
Q

5 abnormal heart sounds?

When do they occur?

A

Ejection click: aortic stenosis (early sys)
Non ejection click: mitral valve prolapse (later sys)
Opening snap: mitral stenosis

S3: volume overload, ventricular gallop, CHF
S4: pressure overload, atrial gallop

38
Q

Aortic stenosis:

When do symptoms occur? (What proportion of normal size)

A

Symptoms occur at 1/4th of normal
Normal = 3-4cm2
So… about 1cm2

39
Q

How does aortic stenosis present?
3 physical signs
3 main investigations?

A

Syncope, Angina, HF, Dyspnoea

Weak, late pulse (tardus & parvus), S4 gallop
Ejection-systolic murmur - diamond shape

Echo, ECG, CXR

40
Q

Management of aortic stenosis? 2 points

A

Dental hygience/care - IE prophylaxis

Valve replacement - increasingly TAVI

41
Q 
Mitral Regurgitation:
2 major causes?
Big link with....
Presentation?
Murmur?
A

IE and RF

Mitral prolapse

Exertional dyspnoea, palpitations, fatigue
Holo/pansystolic flat murmur (NEC w/ prolapse)

42
Q

AORTIC REGURG:
Murmur?
Other signs:

A

Decrescendo early diastolic murmur
Collapsing pulse, wide pulse pressure
(Corrigan’s, De Musset’s, Duroziez’s, Austin flin, Traube’s)

43
Q

MITRAL STENOSIS:
Murmur?
Common with?

A

Rumbling mid-diastolic murmur

Common with AF

44
Q

What is Libman-Sacks Endocarditis?
Association with?
Key feature

A

Non-bacterial cause of endocarditis
Association with SLE
Vegetations on both sides of the mitral valve

45
Q 
Bacteria associated with IE:
Most common? Note?
IV drug abusers?
On prosthetic valves
Underlying colorectal carcinoma
Negative blood cultures?
A

Strep viridans - low virulence, damaged valves
Staph aureus - IV, infects normal tricuspid
Staph epidermidis - prosthetic valves
Strep bovis - colorectal carcinoma
HACEK: Haemophilus, Actinobacillius, Cardiobacterium, Eikenella, Kingella

46
Q

Clinical features of IE?

Diagnosis criteria? Name, points, system

A

Fever, Murmur
Janeway lesions, Osler nodes, Roth spots, Splinter haemorrhages

“modified Duke’s”
2 major: +ve BC, ECHO
5 minor: fever, presdisposing factors, vascular problem, immune problem, equivocal blood cultures
2ma, 1+3, 5mi

47
Q

Two types of Rheumatic Fever?
What valve does it affect?
Causitive organism

A

Acute or Chronic
Mitral valve
Strep. pyogenes - Group A beta-haemolytic streptococcus

48
Q 
Causes of AV heart blocks? (4)
Treatment: 2 other points
Bradycardia medications (3)
A

Ischaemic heart disease, cardiomyopathies, Lev’s disese (conduction fibrosis), Myocarditis, Medications

Treat underlying cause, consider pacemaker

Medications: Atropine, Adrenaline, Dopamine

49
Q 
Explanation of:
First degree HB:
Mobitz 1:
Mobitz 2:
Third degree:
A

Prolonged PR interval longer than 200ms

“going, going, gone” - PR interval gradually increases until no QRS is seen

Random loss of QRS with stable PR interval

Completely independent atria and ventricle contraction

50
Q

Causes of bundle branch blocks?
Significance of MaRRoW and WiLLiaM
Treatment? - congenital and acquired

A

Fibrosis due to acute causes (MI, myocarditis) or chronic causes (HTN, CAD, cardiomyopathies)

Shape of V1 and V6 in an ECG

Congenital: doesn’t require
Acquired: pacemaker

51
Q

Key finding of a PE ECG?

A

S1Q3T3
Large S waves in lead 1
Large Q waves in lead 3
Inverted T waves in lead 3

52
Q

What is WOLFF-PARKINSON-WHITE SYNDROME?
Name of tract?
Main ECG finding?

A

Congenital abnormality which can result in SVT due to an AV accessory tract

Bundle of Kent

Delta waves

53
Q 
Atrial fibrillation:
ECG finding - 2 points
What does CHA2DS2-VASc score test for?
Symptoms (4)
4 possible treatment points
A

Irregularly irregular, no p-wave

Stroke risk for patients with AF

Symptoms: palpitations, SOB, fatigue, chest pain

Treat underlying cause - alcohol, thyroid, HTN, valve disease
Rate control - BBs, CCBs, Digoxin
Restore normal rate - amiodarone
Anticoagulants - wafarin or DOACs

54
Q

Atrial flutter:
ECG finding - 2 points
Symptoms

A

Narrow QRS, sawtooth flutter waves

Syncope, SOB, chest pain, dizziness, nausea

55
Q

What is the ECG finding in focal atrial tachycardia?

A

Multiple different p wave forms

56
Q

SVT vs VT:
Where do beats originate from in each?
Which is broad vs narrow complexes?
SVT examples

A

SVT: from AV node
VT: from ventricles

SVT: narrow
VT: broad

SVT: A FIB, A FLUTTER, ACCESSORY PATHWAY, FOCAL ATRIAL TACHYCARDIA, AVNRT

57
Q

What is a healthy ejection fraction?

A

65%-75%

58
Q

2 different classifications of heart failure?

A

Acute HF vs Chronic HF

Systolic HF (failure of ventricle to eject blood - HFREF)
Diastolic HF (failure of the ventricle to relax and fill - HFNEF)
59
Q

What is main cause of heart failure? Percentage?

3 other big causes

A

IHD (70%)

Other: HTN, valvular heart disease, cardiomyopathy

60
Q

What are 4 main symptoms of HF?
What are 4 main signs of HF?
Name of classification system?

A

Dyspnoea on exertion or rest, paroxysmal nocturnal dysponea, peripheral oedema, chest pain

Tachycardia, displaced apex beat (LV hypertrophy), raised JVP, 3rd heart sound (ventricular gallop)

New York Heart Assoication: I to IV

61
Q 
Investigations in HF:
What is the key chemical to measure and range to refer?
Other:
ECG finding?
Echo finding?
CXR finding?
A

NT-proBNP (400-2000)

ECG: no specific, but rarely normal
Echo: will show systolic and diastolic function
CXR: cardiomegaly, pulmonary congestion

62
Q

What is intermittent claudication a form of?

Describe it

A

Form of peripheral arterial disease

Cramping in legs due poor circulation

63
Q

What are the symptoms and signs of acute limb ischaemia?

If it becomes critical/chronic what else can become present?

A

6Ps
Pain, pale, paralysis, paraesthesia, perishing, pulseness

Rest pain, ulceration, gangrene

64
Q

3 diagnostic points for peripheral arterial disease in legs

A

Auscultation of legs (bruit)
Doppler ultrasound
Ankle-brachial index: BP is compared

65
Q

What size does an AAA have to be?
Symptoms?
Risk factors?

A

> 3cm or more than 50%

Usually asymptomatic until rupture - severe pain when ruptured

Male, caucasian, advanced age, smoking, HTN, family history, connective tissue disorders

66
Q

Diagnosis of AAA? (2)

Management? (3)

A

Ultrasound, CT

Monitoring - Ultrasounds, BP management, surgery

67
Q

What is an aortic dissection?

Two types:

A

Tearing and widening of the tunica intima, blood flows in, layer seperation and false lumen

Type A: ascending aorta (+/- arch)
Type B: not ascending aorta (descending +/- arch)

68
Q

What are the causes (3) and risk factors (3) of an aortic dissection?

A

C: Chronic HTN, Blood vessel coarctation, connective tissue (Marfan’s, Ehlers-Danlos)

RF: Pregnancy, Vasculitis, Family history

69
Q

Signs + symptoms of an aortic dissection:
Acute?
Chronic?

A

Acute: sudden, intense, tearing pain radiating to the back
Chronic: decreased peripheral pulses, diastolic decrescendo murmur from aortic regurg

70
Q

Diagnosis of an AA?

Treatment of AA? Is it different in type A and type B?

A

ECG: rule out
CXR, Echo, CT

A: surgical repair
B: lower heart rate, lower BP, pain management, surgical repair

71
Q

What is shock?
5 main types - skin will be…
Distributive shock includes…

A 
"reduced blood perfusion from whole body circulatory failure"
HYPOVOLAEMIC - cold
CARDIOGENIC - cold
NEUROGENIC - warm, dry
SEPTIC - warm
ANAPHYLATIC - warm

Distributive:
neurogenic, septic, anaphylatic

72
Q

4 parts of ToF
2 big symptoms
2 big treatments

A

VSD, pulmonary stenosis, hypertrophy of RV, overriding aorta

Cyanosis, squatting

Blalock-Taussig shunt (aortic branch to pulmonary artery to increase pulmonary flow)
Complete repair

73
Q

VSD:
Two types? Murmur?

Normal shunt? What is Eisenmenger’s?

A

Small (restrictive) - incidental, normally close by age 10 (loud pan-systolic murmur)

Large (non-restrictive) - heart failure, ventricular dilation, pulmonary HTN (quieter murmur)

Normal L->R
Eisenmenger’s reversal of shunt due to pulmonary damage and HTN

74
Q

ASD:
2-3 times more common in…
Often not found until…
3 types?

A

Women
Adulthood

• Sinus venous defects: superior septum
• Ostium secundum: mid-septum
• Ostium primum: AV septal, lower part
(AVSD - associated with Down’s syndrome, malformed single AV valve)

75
Q

Other than ASD, VSD, ToF, name 4 more congenital structural heart defects

A

Coarctation of the aorta
Patent ductus arteriosus
Bicuspid aortic valve
Transposition of the great vessels

Phase 2a (9 decks)

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