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Finals Revision > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Causes Acute Pericarditis

A

Idiopathic
Secondary to infection, autoimmune (SLE, RA, Takayasu, IBD), drugs (eg isoniazid, hydralazine), uraemia, anorexia nervosa, MI

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2
Q

Central chest pain worse on inspiration/lying flat, relieved by sitting forwards

A

Acute pericarditis

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3
Q

ECG Acute Pericarditis

A

concave/saddle shaped ST elevation and PR depression

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4
Q

Management Acute Pericarditis

A

NSAIDs/Aspirin 1-2wks

Colchicine reduces risk of recurrence

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5
Q

What is Pericardial Effusion

A

Accumulation of fluid in the pericardial sac

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6
Q

Causes of Pericardial effusion

A

pericarditis, myocardial rupture, aortic dissection, malignancy

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7
Q

ECG + CXR + Echo finding pericardial effusion

A

ECG: low-voltage QRS
CXR: enlarged globular heart
Echo: echo-free zone surrounding heart

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8
Q

Management pericardial effusion

A

Treat the cause

Pericardiocentesis (+culture, stain, cytology)

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9
Q

What is Cardiac Tamponade?

A

A pericardial effusion that increases intrapericardial pressure, reducing ventricular filling, dropping cardiac output, can cause cardiac arrest

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10
Q

Signs on examination of Cardiac tamponade

A

Tachycardia, Hypotension, Pulsus paradoxus, raised JVP

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11
Q

Diagnostic criteria of Cardiac Tamponade

A

Beck’s triad:

  1. Falling BP
  2. Rising JVP
  3. Muffled heart sounds
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12
Q

ECG + Echo finding of Cardiac Tamponade

A

ECG: low-voltage QRS
Echo: diagnostic, echo-free zone around heart +/- diastolic collapse of RA + RV

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13
Q

Management of Cardiac Tamponade

A

Urgent drainage- Pericardiocentesis

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14
Q

What size defines AAA?

A

> 3cm across

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15
Q

What is the aetiology of AAA?

A

Degeneration of elastic lamellae and smooth muscle loss

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16
Q

Screening for AAA?

A

All men aged 65+ offered screening with USS

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17
Q

Management of AAA?

A

Surgery for large/rapidly expanding/symptomatic >5.5cm
Endovascular stenting
Emergency if rupture

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18
Q

Presentation of ruptured AAA

A

Intermittent/continuous abdominal pain radiates to back/iliac fossa/groin
Expansile abdominal mass
Shock

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19
Q

Management ruptured AAA

A

Rapid surgery

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20
Q

Define critical ischaemia in PAD

A

Ulceration + Gangrene + Foot pain at rest

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21
Q

Fontaine classification of Peripheral arterial disease

A
  1. Asymptomatic
  2. Intermittent claudication
  3. Ischaemic rest pain
  4. Ulceration/Gangrene
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22
Q

Investigations of PAD

A

Ankle-brachial pressure index

Colour Doppler USS 1st line

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23
Q

Management PAD

A

RF modification (smoking, treat HTN + cholesterol, antiplatelet eg Clopidogrel)
Claudication: supervised exercise programme, Vasoactive drugs eg Naftidofuryl oxalate
Percutaneous transluminal angioplasty
Surgical reconstruction
Amputation

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24
Q

Mid-diastolic murmur, with AF and malar flush

A

Mitral Stenosis

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25
Q

Causes of Mitral Stenosis

A

Rheumatic heart disease, infective endocarditis

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26
Q

Pansystolic high-pitched murmur, radiates to left axilla, 3rd heart sound

A

Mitral regurgitation

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27
Q

Causes of Mitral regurgitation

A

Age, ischaemic heart disease, infective endocarditis, rheumatic heart disease, Ehler-Danlos, Marfan’s

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28
Q

Ejection-systolic murmur with crescendo-decrescendo character, radiates to carotids, slow rising pulse and narrow pulse pressure

A

Aortic Stenosis

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29
Q

How might Aortic Stenosis present?

A

Exertional Syncope

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30
Q

Causes of Aortic Stenosis?

A

Age, Rheumatic heart disease

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31
Q

Early diastolic soft murmur, collapsing pulse

A

Aortic Regurgitation

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32
Q

Causes of Aortic Regurgitation

A

Age, Ehler-Danlos, Marfan’s

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33
Q

What is Dilated Cardiomyopathy associated with?

A

Alcohol, haemochromatosis, autoimmune thyrotoxicosis, congenital (X-linked)

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34
Q

What is the possible inheritance of congenital DCM?

A

X-linked

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35
Q

Presentation of DCM

A

Fatigue, dyspnoea, pulmonary oedema, RVF, emboli, AF, VT

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36
Q

Signs on examination of DCM

A

Tachycardia, Hypotension, raised JVP, displaced apex, ascites

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37
Q

Possible blood test in DCM

A

Raised BNP

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38
Q

CXR findings of DCM

A

Cardiomegaly, Pulmonary oedema

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39
Q

ECG findings of DCM

A

Tachycardia, T wave changes, poor R wave progression

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40
Q

Echo findings of DCM

A

Globally dilated hypokinetic heart

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41
Q

Management of DCM

A

Diuretics, Beta blockers, ACEi, anticoagulation, biventricular pacing, ICDs

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42
Q

What is Hypertrophic cardiomyopathy?

A

LV outflow obstruction from asymmetric septal hypertrophy

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43
Q

What is the leading cause of cardiac death in the young?

A

Hypertrophic cardiomyopathy

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44
Q

What is the inheritance pattern of Hypertrophic cardiomyopathy?

A

Autosomal Dominant

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45
Q

Presentation of Hypertrophic cardiomyopathy

A

Sudden death

Angina, dyspnoea, palpitations, syncope, CCF

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46
Q

Examination findings of Hypertrophic cardiomyopathy

A

Ejection systolic murmur, systolic thrill at left lower sternal edge

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47
Q

ECG findings of Hypertrophic cardiomyopathy

A

Progressive T wave inversion, deep Q waves, AF, WPW, VT

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48
Q

Echo findings of Hypertrophic cardiomyopathy

A

Asymmetrical septal hypertrophy

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49
Q

Management of Hypertrophic cardiomyopathy

A

Implantable defibrillator
Amiodarone for arrhythmias
BB/Verapamil for symptoms

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50
Q

Investigations in chest pain

A

ECG, Blood glucose, Lipid profile, U&E, FBC, TFT, LFT, ESR/CRP, CXR

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51
Q

Cardiac causes chest pain

A

ACS, stable angina, pericarditis, acute congestive cardiac failure, arrhythmias

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52
Q

Pulmonary causes of chest pain

A

PE, pneumothorax, CAP, Asthma, lung Ca, Pleural effusion

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53
Q

Complications of MI

A

Cardiac arrhythmias, LV failure, Heart block, VT/VF, RV failure, Pericarditis, mitral regurg, ventricular septal defect, Dressler’s syndrome

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54
Q

What is Dressler’s syndrome?

A

Late-onset post-myocardial infarction pericarditis, usually occurring one to six weeks after the initial event

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55
Q

How does Dressler’s syndrome present?

A

Pleuritic chest pain, low-grade fever and pericarditis

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56
Q

Presentation of Aortic Dissection

A

Sudden tearing chest pain radiating to back

Branches of aorta occlude –> hemiplegia, unequal arm pulses/BP, acute limb ischaemia

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57
Q

Types of Aortic Dissection and their management

A

Type A- ascending aorta- surgical Mx

Type B- not ascending aorta- medical/surgical Mx

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58
Q

Causes of Hypertension

A 
95% Essential Hypertension
ROPE
Renal disease- renal artery stenosis
Obesity
Pregnancy
Endocrine- Conn's (renin:aldosterone ratio)
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59
Q

Complications of Hypertension

A

Retinopathy, Nephropathy, HF, CVA

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60
Q

Stages of Hypertension

A

Stage 1: clinic > 140/90 or home > 135/85

Stage 2: clinic > 160/100 or home > 150/95

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61
Q

Steps of Hypertension management

A
  1. Age < 55 non-black- ACEi OR >55 black- CCB
  2. Non-black ACEi + CCB; Black ARB + CCB
  3. ACEi + CCB + Thiazide-like diuretic
  4. ACEi + CCB + 2 thiazide-like diuretics
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62
Q

Name ACE inhibitors

A

Ramipril, Lisinopril, Enalapril

63
Q

Name Calcium channel blockers

A

Amlodipine, Nifedipine, Verapamil

64
Q

Name ARBs

A

Candesartan, Losartan, Valsartan

65
Q

Main side effect of thiazide-like diuretic (blood result)

A

Hyperkalaemia

66
Q

Name thiazide-like diuretics

A

Indipamide, Bendroflumethiazide

67
Q

Blood pressure targets for managing hypertension

A

<80yrs: < 140/90
>80yrs: < 150/90
Diabetic: < 130/80

68
Q

Presentation of angina

A

Contricting chest pain +/- radiation to arms or jaw

69
Q

Difference between stable and unstable angina

A

Stable always relieved by GTN or rest

Unstable come on randomly at rest - ACS

70
Q

4 Types of Angina

A

Stable- on exertion, relieved by rest/GTN
Unstable- at rest
Prinzmetal- coronary artery vasospasm
Decubitus- lying flat

71
Q

Diagnosis of Angina

A

CT Coronary angiogram

72
Q

Medical management of Angina

A

Acute: GTN spray- vasodilates
Long-term: Beta blocker or CCB
Secondary prevention: 3As: Aspirin 75mg, Atorvastatin, ACEi

73
Q

Surgical management of Angina

A

Percutaneous coronary intervention with coronary angioplasty

Coronary artery bypass graft (CABG) if severe stenosis

74
Q

What is Cor Pulmonale?

A

Right heart failure caused by respiratory disease- causes increased pressure and resistance in pulmonary arteries

75
Q

Causes of Cor Pulmonale

A

COPD, PE, interstitial lung disease, CF

76
Q

Presentation of Cor Pulmonale

A

SOB, peripheral oedema, syncope, chest pain

77
Q

Examination findings of Cor Pulmonale

A

Hypoxia, cyanosis, raised JVP, 3rd heart sound, hepatomegaly

78
Q

Blood supply heart

A

LCA splits into circumflex + LAD
- Circumflex supplies LA and posterior LV
- LAD supplies anterior LV and anterior septum
RCA supplies RA+RV, inferior LV + posterior septum

79
Q

3 Types of ACS

A
  1. Unstable angina
  2. NSTEMI
  3. STEMI
80
Q

Presentation of ACS

A

Central crushing chest pain radiating to jaw/arm, N&V, sweating, clammy, SOB, impending doom, palpitations

81
Q

Which group of people are more likely to have a ‘silent MI’?

A

Diabetics

82
Q

ECG changes in STEMI

A

ST elevation or new LBBB

83
Q

ECG changes in NSTEMI

A

ST depression, T wave inversion, Pathological Q waves

84
Q

What are pathological Q waves?

A

> 40ms wide
2mm deep
25% depth of QRS
Seen in leads V1-3

85
Q

ECG territories in MI and blocked artery

A

I, aVL, V3-V6: Anterolateral: LCA
V1-4: Anterior: LAD
I, aVL, V5-V6: Lateral: Circumflex
II, III, aVF: Inferior: RCA

86
Q

When is troponin testing in ACS?

A

Baseline + 6-12hrs after

87
Q

Causes of raised troponin?

A

ACS, chronic renal failure, sepsis, myocarditis, aortic dissection, PE

88
Q

Management of acute STEMI

A

If present within 12hrs:

  • Primary PCI (within 2hrs)
  • Thrombolysis if not- Streptokinase/Alteplase
89
Q

Management of acute NSTEMI

A

BATMAN

  • Beta blockers unless CI
  • Aspirin 300mg stat
  • Ticagrelor/Clopidogrel
  • Morphine
  • Anticoagulant- LMWH Tx dose
  • Nitrates
90
Q

Secondary Prevention after ACS

A 
6As:
Aspirin 75mg
Another antiplatelet- Ticagrelor
Atorvastatin
ACEi- Ramipril
Atenolol
Aldosterone antagonist eg Eplerenone (if HF)
91
Q

Presentation of AF

A

Palpitations, SOB, syncope, symptoms of VTE

92
Q

Examination findings of AF

A

Irregularly irregular pulse

93
Q

What are the 2 causes of an irregularly irregular pulse?

A

AF

Ventricular ectopics

94
Q

ECG findings of AF

A

absent p waves
irregularly irregular
narrow QRS tachycardia

95
Q

What is valvular AF?

A

AD + severe mitral stenosis or mechanical heart valve

96
Q

Causes of AF

A 
(Mrs) SMITH:
Sepsis
Mitral stenosis/regurgitation
Ischaemic heart disease (MI)
Thyrotoxicosis
Hypertension
97
Q

Management of AF

A

Rate control: aim <100
- 1st line
- Beta blocker/CCB/Digoxin (only sedentary people)
Rhythm control:
- Cardioversion: Pharmacological (flecanide/amiodarone) or Electrical with sedation
- Long term- Beta blockers or Dronedarone
Anticoagulation:
- Warfarin/NOAC
- HASBLED + CHADSVASC Score

98
Q

What is target INR for Warfarin used in AF?

A

2-3

99
Q

Name some NOACs

A

Apixaban, Dabigatran, Rivaroxaban

100
Q

Complications of AF

A

Heart failure, VTE, Stroke

101
Q

HASBLED Score

A 
Major bleeding risk for anticoagulation of patients with AF:
Hypertension
Abnormal renal/liver function
Stroke
Bleeding
Labile INRs
Elderly
Drugs/Alcohol
102
Q

CHA2DS2VASc Score

A 
Stroke risk for patients with AF:
Congestive heart failure
Hypertension
Age > 75 (2) 
Diabetes
Stroke/TIA previously (2)
Vascular disease
Age 65-74
Sex (female)
103
Q

Name the 4 cardiac arrest rhythms and split them into shockable and non-shockable

A 
Shockable:
1. Ventricular tachycardia
2. Ventricular fibrillation
Non-shockable:
3. Pulseless electrical activity
4. Asystole
104
Q

What is the aetiology of atrial flutter?

A

Re-entrant rhythm –> atrial contraction at 300 bpm and ventricular contraction at 150 bpm

105
Q

Characteristic appearance of atrial flutter on ECG?

A

Saw-tooth

106
Q

What is atrial flutter associated with?

A

Hypertension, Ischaemic heart disease, cardiomyopathy, thyrotoxicosis

107
Q

Management of atrial flutter?

A

Rate/Rhythm control: BB or Cardioversion
Radiofrequency ablation of re-entrant pathway
Anticoagulation

108
Q

Aetiology of SVT

A

Electrical activity in ventricles re-enters the atria

109
Q

3 types of SVT

A
  1. AV node re-entrant tachycardia
  2. AV re-entrant tachycardia- accessory pathyway (WPW)
  3. Atrial tachycardia- electrical signal comes from somewhere other than SA node
110
Q

Acute Management of SVT

A
  • Valsalva maneouvre
  • Carotid sinus massage
  • Adenosine fast bolus –> momentary asystole
  • Verapamil
  • DC cardioversion
111
Q

Long-term prevention of SVT

A

BB, CCB, Amiodarone

Radiofrequency ablation

112
Q

What is Wolff-Parkinson-White Syndrome?

A

Extra electrical pathway connecting atria and ventricles

113
Q

ECG findings in WPW syndrome?

A

Short PR interval, wide QRS, delta wave- slurred upstroke of QRS

114
Q

Treatment of WPW syndrome

A

Radiofrequency ablation

115
Q

ECG findings in PE

A

S1Q3T3
Deep S wave in I
Pathological Q waves in III
Inverted T waves in III

116
Q

What is Torsades de Pointes?

A

Polymorphic ventricular tachycardia which occurs in patients with a prolonged QT

117
Q

Causes of Torsades de Pointes?

A

Inherited long-QT syndrome
Meds- anti-psychotics, citalopram, flecanide, amiodarone, macrolide Abx
Electrolyte disturbances- hypokalaemia, hypomagnesaemia, hypocalcaemia

118
Q

Causes of long-QT

A

Inherited long-QT syndrome
Meds- anti-psychotics, citalopram, flecanide, amiodarone, macrolide Abx
Electrolyte disturbances- hypokalaemia, hypomagnesaemia, hypocalcaemia

119
Q

Acute management of Torsades de Pointes

A

Correct cause
Magnesium infusion
Defib if VT

120
Q

Long-term management of Torsades de Pointes

A

Correct electrolytes
Beta Blockers
Pacemaker/implantable defib

121
Q

Prognosis of Torsades de Pointes

A

Will either spontaneously resolve or progress to VT

122
Q

Describe the 3 levels of heart block

A

1st degree: delayed AV conduction through AV node- PR > 0.2s
2nd degree: some impulses do not make it through AV node
- Mobitz type 1: Wenkebach’s, increasing PR until 1 QRS missed then starts again
- Mobitz type 2: set ratio of P to QRS eg 2:1 or 3:1
3rd degree/complete: no relation of P to QRS

123
Q

Presentation of acute LV failure

A

Rapid onset breathlessness, exacerbated by lying flat - Pulmonary oedema
Cough of frothy white/pink sputum

124
Q

Triggers for acute LV failure

A

iatrogenic (fluids), sepsis, MI, arrhythmias

125
Q

What type of respiratory failure is seen in acute LV failure?

A

Type 1

126
Q

Signs on examination of acute LV failure

A

Tachypnoea, Hypoxia, Tachycardia, 3rd heart sound

Bilateral basal crackles

127
Q

Specific blood result in acute LV failure

A

Raised BNP

128
Q

Investigations in acute LV failure

A

Raised BNP
Echo for ejection fraction
CXR

129
Q

CXR findings in acute LV failure

A 
Cardiomegaly
Upper lobe venous diversion
Pleural effusions
Interlobar fissures
Kerley B lines
130
Q

Management of acute LV failure

A 
Pour SOD
Pour away (stop) fluids
Sit up
Oxygen
Diuretics- IV Furosemide
131
Q

Presentation of chronic heart failure

A

SOB worse on exertion, cough with frothy white/pink sputum, orthopnoea, paroxysmal nocturnal dyspnoea, peripheral oedema

132
Q

Investigations in chronic heart failure

A

BNP
Echo
ECG

133
Q

Causes of chronic heart failure

A

Ischaemic heart disease, AS, hypertension, AF or other arrhythmias

134
Q

Management of chronic heart failure

A 
Conservative: stop smoking
Medical: ABAL:
- ACE inhibitor: Rampipril
- Beta Blocker: Bisoprolol
- Aldosterone antagonist: Spironolactone
- Loop diuretic: Furosemide
Surgical: for AS or MR
Flu + Pneumococcal vaccines
135
Q

Classification of chronic heart failutr

A

New York Heart Association (NYHA) Classification:

  • Stage 1: no limitation on ordinary activity
  • Stage 2: normal at rest, ordinary activity causes breathlessness
  • Stage 3: normal at rest, less than normal activity causes breathlessness
  • Stage 4: symptoms at rest
136
Q

2 features to suspect Infective endocarditis

A

Fever + New Murmur

137
Q

Patient presents with fever and new murmur. Think…

A

Infective Endocarditis

138
Q

What are the most common organisms in Infective Endocarditis

A

Streptococcus viridans most common
Then Staph aureus
Prosthetic valves: Staph epidermidis

139
Q

RFs for Infective Endocarditis

A

Skin breaches, immunosuppression, prosthetic valves, renal failure, DM, IVDU

140
Q

Presentation of Infective Endocarditis

A

Fever, rigors, night sweats, malaise, weight loss, new murmur

141
Q

Signs on examination of Infective Endocarditis

A 
Vasculitis
Microscopic haematuria
Roth spots
Splinter haemorrhages
Osler's nodes
Janeway lesions
142
Q

What are Roth Spots?

A

Boat shaped retinal haemorrhages with pale centre

143
Q

What diagnostic criteria is used for Infective Endocarditis?

A

Modified Duke Criteria

144
Q

What investigations in Infective Endocarditis?

A

3 x blood cultures
Urinalysis for microscopic haematuria
TOE/TTE

145
Q

What antibiotics for Infective Endocarditis?

A

Local trust guidelines
Native valve: Ampicillin + Flucloxacillin + Gentamicin
Prosthetic valve: Vancomycin + Gentamicin + Rifampicin

146
Q

Management of Infective Endocarditis

A

Antibiotics

Surgery

147
Q

What is Brugada Syndrome?

A

A cause of sudden cardiac death in the young

Faulty sodium channels which predispose to fatal arrhythmias eg VF

148
Q

What is the inheritance pattern of Brugada Syndrome?

A

Autosomal dominant

149
Q

Management of Brugada syndrome

A

Implantable defibrillator

150
Q

Signs of an ischaemic limb

A 
Pain
Pale
Pulseless
Perishingly cold
Paraesthesia
Paralysis
151
Q

What score is used for classification of acute limb ischaemia?

A

Rutherford score- 1, 2a, 2b, 3

152
Q

What are the 7 parameters to check for an acutely ischaemic limb?

A
  1. Pain
  2. Pedal pulse palpation
  3. Pedal pulse doppler
  4. Skin- colour, temp, CRT
  5. Nerves- sensory deficit
  6. Nerves- motor deficit
  7. Muscle tenderness
153
Q

Management of an acutely ischaemic limb

A

IV Heparin

Finals Revision (13 decks)

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