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Year 3 Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Which ECG leads correspond to the lateral surface of the heart?

A

I, aVL, V5, V6

Circumflex artery

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2
Q

Which ECG leads correspond to the inferior surface of the heart?

A

II, III & aVF

Right coronary artery

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3
Q

Which ECG leads correspond to the septal area of the heart?

A

V1, V2

Left anterior descending artery

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4
Q

Which ECG leads correspond to the anterior surface of the heart?

A

V3, V4

R coronary artery

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5
Q

What are some non-modifiable risk factors for ACS?

A

Increased age
Male
Family history

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6
Q

What are some modifiable risk factors for ACS?

A

Smoking
Diabetes mellitus
Hypertension
Physical inactivity

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7
Q

What is a STEMI?

A

Cardiac chest pain with persistent ST elevation

Hs-TnI >100ng/L

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8
Q

What is an NSTEMI?

A

Cardiac chest pain
Normal ECG, ST depression or T wave inversion
Raised his-TnI

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9
Q

What is unstable angina?

A

Cardiac chest pain
Normal ECG, ST depression or T wave inversion
Normal troponin

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10
Q

What symptoms would indicate ACS?

A

Pain in chest, may radiate to jaw, back etc. New onset, or occurring with little exertion in pts with angina
Nausea and vomiting
Sweating
Breathlessness

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11
Q

What investigations are required for suspected ACS?

A 
12 lead ECG 
Cardiac enzymes 
FBC - rule out anaemia 
U&Es - inc K+ can cause arrhythmias 
Lipid profile
Random blood glucose, HbA1c
Blood gases - monitor oxygen levels
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12
Q

What is the initial management for a STEMI?

A

IV morphine, with an anti-emetic
Oxygen if hypoxic - aim for >94%
300mg aspirin

60mg prasugrel or 600mg clopidogrel

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13
Q

What is the definitive treatment for a STEMI?

A

Primary PCI

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14
Q

What drugs should be started after a STEMI?

A

ACE inhibitor or ARB
Aspirin
Bisoprolol
Statin

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15
Q

What is initial management of an NSTEMI?

A

Pain relief
Oxygen if hypoxic
300mg aspirin, 180mg ticagrelor
Low molecular weight heparin

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16
Q

When should a pt with NSTE-ACS be offered angiography?

A

High risk from GRACE score

Low risk, but Sx are recurring

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17
Q

What are some ischaemic complications of an MI?

A

Reocclusion
Infarction in a separate territory
Post-infarction angina

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18
Q

What are some mechanical complications of an MI?

A 
Left ventricular dysfunction 
Left/right heart failure 
Ventricular septal rupture 
Free wall rupture 
Acute mitral regurgitation
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19
Q

What is the drug treatment for stable angina?

A 
75mg aspirin
Sublingual GTN 
β-blocker
Non-dihydropyridine CCB (diltiazem, verapamil) 
Statin
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20
Q

What are some non-cardiac causes of chest pain?

A 
Costochondritis
GORD
Cholecystitis 
Acute pancreatitis 
Pneumonia 
PE
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21
Q

What are some causes of secondary hypertension?

A

Renal disease
Cushing’s syndrome
Conn’s syndrome
Pregnancy

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22
Q

How is hypertension defined?

A

Stage 1 - clinic 140/90mmHg, home/ambulatory 135/85mmHg

Stage 2 - clinic 160/100mmHg, home/ambulatory 150/95mmHg

Severe - 180mmHg systolic, 110mmHg diastolic

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23
Q

How can HTN present?

A

Usually asymptomatic

Headache
Sweating, palpitations, anxiety => phaeochromocytoma
Muscle weakness, tetany => hyperaldosteronism

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24
Q

What investigations are done to assess for end organ damage in hypertension?

A 
Urine albumin:creatinine ratio 
Haematuria 
Bloods - HbA1c, electrolytes, creatinine, eGFR, total cholesterol, HDL 
Fundoscopy 
12 lead ECG
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25
Q

What is non-pharmacological treatment for hypertension?

A 
Weight reduction 
Reduce salt intake 
Reduce alcohol intake 
Aerobic exercise 
Stop smoking
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26
Q

What is step 1 of treatment for hypertension?

A

<55yrs - ACE inhibitor, ARB

> 55yrs, Afro-Caribbean - CCB

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27
Q

What is stage 2 of treatment for HTN?

A

ACE inhibitor/ARB + CCB

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28
Q

What is stage 3 of treatment for HTN?

A

ACE inhibitor/ARB
CCB
Diuretic (thiazide-like)

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29
Q

What is step 4 of treatment for HTN?

A

ACE inhibitor/ARB
CCB
Thiazide like diuretic
α/β blocker or low dose spironolactone

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30
Q

What is accelerated hypertension?

A

Severe hypertension (systolic >200mmHg, diastolic >130mmHg)

Accompanied by end organ damage - encephalopathy, aortic dissection, papilloedema, AKI, MI

Hypertensive emergency

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31
Q

What is hypertensive urgency?

A

Systolic >180mmHg
Diastolic >120mmHg

No end organ damage
Grade 3/4 hypertensive retinopathy

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32
Q

How would someone with accelerated HTN present?

A 
Headache 
Nausea &amp; vomiting
Visual disturbance 
Chest pain 
Fits
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33
Q

What is the treatment for a hypertensive emergency?

A

Sodium nitroprusside
Labetalol
GTN
Esmolol

All IV

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34
Q

What are some causes of heart failure?

A

Ischaemic heart disease
Hypertension
Valvular heart disease
Chronic lung disease

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35
Q

What are some symptoms of heart failure?

A 
Exertional dyspnoea 
Orthopnea 
Paroxysmal nocturnal dyspnoea
Fluid retention 
Nocturnal cough
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36
Q

What are some signs of heart failure?

A 
Tachycardia 
Low systolic blood pressure 
Raised JVP 
Peripheral oedema 
Displaced apex beat 
Pulse alterans
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37
Q

What blood tests are required to investigate heart failure?

A 
Renal function 
FBC
LFT
TFT
Ferritin &amp; transferring - haemochromatosis 
BNP
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38
Q

What imaging is required to investigate heart failure?

A

Echocardiogram

Chest x-ray

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39
Q

How does echocardiography help diagnose heart failure?

A

Measures the end diastolic volume
Large => systolic dysfunction
Small => diastolic dysfunction

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40
Q

What is systolic heart failure?

A

Ventricles are unable to contract normally => reduced cardiac output

Heart failure with reduced ejection fraction <40%

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41
Q

What is diastolic heart failure?

A

Inability for ventricles to relax and fill normally => inc filling pressures

Heart failure with preserved ejection fraction

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42
Q

What changes can be seen on a CXR in heart failure?

A 
Alveolar oedema 
Kerley B lines 
Cardiomegaly 
Dilated upper lobe vessels 
Pleural effusion
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43
Q

What is the New York classification of heart failure?

A

I - no excessive dyspnoea on normal activity
II - comfortable at rest, dyspnoea on normal activity
III - less than ordinary activity causes dyspnoea
IV - dyspnoea at rest, all activity causes discomfort

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44
Q

What lifestyle modifications should be advised in heart failure?

A

Smoking cessation
Restrict alcohol consumption
Salt restriction
Fluid restriction if hyponatraemic

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45
Q

What are some commonly used drugs in heart failure?

A

Diuretics
ACE inhibitor, ARB
Beta blocker
Mineralocorticoid receptor antagonist

46
Q

How are ACE inhibitors beneficial in heart failure?

A

Improves ventricular function and reduces mortality

Can inc K+ therefore monitor U&Es

47
Q

What diuretics are used for symptomatic relief in heart failure?

A

Loop diuretics - furosemide, bumetanide

Add K+ sparing diuretic (spironolactone) if hypokalaemia 
Add thiazide (metalozone) if refractory oedema
48
Q

How are beta blockers beneficial in heart failure?

A

Increase ejection fraction & exercise tolerance

Decreases mortality

49
Q

What is the treatment for acute pulmonary oedema?

A

Sit pt upright
High flow oxygen if hypoxic
Sublingual GTN - vasodilator, only give if systolic BP is >90mmHg & no serious valvular disease
IV furosemide
IV diamorphine - analgesia & sedation

50
Q

How does CPAP help in acute pulmonary oedema?

A

Drives fluid out of alveolar spaces into vasculature therefore improving ventilation

51
Q

What are some symptoms of aortic stenosis?

A

Angina
Syncope
Heart failure

Exertional dyspnoea, decrease in exercise tolerance

52
Q

What are some causes of aortic stenosis?

A

Senile calcification
Congenital biscuspid valve
Previous rheumatic fever

53
Q

What are some signs of aortic stenosis?

A

Ejection systolic murmur - radiates to carotids
Slow rising pulse with narrow pulse pressure
LV heave
Aortic thrill

54
Q

What will an ECG show in aortic stenosis?

A

LVH or left ventricular strain

LBBB or complete heart block - calcified ring

55
Q

What can a CXR show in aortic stenosis?

A

Cardiomegaly

Calcification of aortic valve

56
Q

What test is diagnostic of aortic stenosis?

A

Doppler echo

Estimates gradient across valves

57
Q

What are the indications for surgery in aortic stenosis?

A

Symptomatic
Asymptomatic with left ventricular systolic dysfunction
Asymptomatic with abnormal exercise test

58
Q

What are some causes of aortic regurgitation?

A

Bicuspid aortic valve
Infective endocarditis
Connective tissue disorders

59
Q

How does aortic regurgitation present?

A

Exertional dyspnoea, reduction in exercise tolerance

Palpitations, angina, syncope

60
Q

What are some signs of aortic regurgitation?

A

Early diastolic murmur at left eternal edge

Collapsing pulse, wide pulse pressure, displaced apex beat

61
Q

What investigations is diagnostic of aortic regurgitation?

A

Echo - quantification of severity and assessment of the rest of the heart

62
Q

When is surgery indicated in aortic regurgitation?

A

Symptomatic
Asymptomatic with evidence of early LV systolic dysfunction
Asymptomatic with aortic root dilatation

63
Q

What are some causes of mitral regurgitation?

A

IHD => papillary muscle/chordae tendinae dysfunction
Marfan’s
Infective endocarditis

64
Q

How does mitral regurgitation present?

A

Acute => pulmonary oedema, requires emergency valve repair

Chronic => heart failure, breathlessness

65
Q

What are some signs of mitral regurgitation?

A

Pansystolic murmur over mitral area, radiates to axilla

Displaced apex beat

66
Q

What can an ECG show in mitral regurgitation?

A

AF

LVH

67
Q

How is echocardiography used in mitral regurgitation?

A

Assesses LV function, mitral regurgitation severity and aetiology

68
Q

What is medical management of mitral regurgitation?

A

Control rate if fast AF
Anti-coagulation for: AF, prosthetic valve

Diuretics

69
Q

When is surgery indicated in mitral regurgitation?

A

Symptomatic

Asymptomatic with mild-moderate LV dysfunction

70
Q

What are some risk factors for infective endocarditis?

A

Valvular heart disease
Valve replacement
IVDU

71
Q

Which valves are most commonly affected in infective endocarditis?

A

Mitral

Aortic

72
Q

What organisms are commonly responsible for infective endocarditis?

A

Strep viridans
Staph aureus - most common in IVDU
Strep bovis - needs colonoscopy => tumour

Candida/aspergillus
Enterococci
HACEK organisms

73
Q

How does infective endocarditis present?

A

Fever and a new murmur

Fatigue, flu like symptoms, weight loss

74
Q

What are some signs of infective endocarditis?

A

Murmur
Splinter haemorrhages
Osler’s nodes
Janeway lesions

75
Q

What investigations are required for infective endocarditis?

A

Echo - transoesophageal more sensitive

FBC, ESR & CRP, U&Es, LFT
At least 3 sets of blood cultures

Urine dip => microscopic haematuria

CXR
ECG - prolonged PR interval => AV block

76
Q

What is major diagnostic criteria for infective endocarditis?

A

Positive blood cultures: 2 typical, persistently +ve cultures >12 hours apart
Endocardial involvement - vegetation, abscess
Valvular regurgitation

77
Q

What is the minor diagnostic criteria for infective endocarditis?

A 
Predisposition 
IVDU
Pyrexia >38
Embolic phenomena 
Vasculitis phenomena 
\+ve blood cultures which don’t meet major criteria
78
Q

How is response to therapy monitored in infective endocarditis?

A

Echocardiogram once a week
ECG at least twice a week
Blood tests - ESR, CRP, FBC, U&Es

79
Q

When is surgery needed in infective endocarditis?

A

Moderate to severe cardiac failure due to valve compromise
Valve dehiscence
Uncontrolled infection despite treatment
Coxiella burnetii and fungal infections

80
Q

What are some cardiac causes of arrhythmias?

A

IHD
Structural changes
Cardiomyopathy

81
Q

What are some non-cardiac causes of arrhythmias?

A

Alcohol
Drugs
Thyroid dysfunction

82
Q

How can arrhythmias present?

A

Palpitations
Shortness of breath
Chest pain
Syncope

83
Q

What is first degree heart block?

A

PR interval >0.2 seconds

84
Q

What is heart block?

A

Disruption of the conduction between the sinus and AV node

85
Q

What is second degree heart block, Mobitz 1?

A

Progressive lengthening of the PR interval, followed by a missed QRS

86
Q

What is second degree heart block, Mobitz 2?

A

Constant PR interval with sudden missed QRS

May progress to complete heart block

87
Q

What are some causes of first and second degree heart block?

A

Sick sinus syndrome
IHD - inferior MI
Drugs - beta blocker, digoxin
Athlete

88
Q

What is third degree heart block?

A

No conduction between atria and ventricles

Pt becomes v bradycardic due to pacing of tissue distal to AVN => haemodynamic compromise

89
Q

What are some causes of third degree heart block?

A

IHD - inferior MI, will probs resolve
Digoxin toxicity
Hyperkalaemia

90
Q

What is the immediate management of a pt with third degree heart block who is haemodynamically unstable?

A

IV atropine 600mcg up to 3mg

91
Q

What is the definitive management of third degree heart block?

A

Permanent pacing

Not required in pts with recent coronary event - high likelihood of recovery

92
Q

What are some causes of AF?

A 
Heart failure 
IHD 
HTN
Mitral valve disease
Hyperthyroidism 
Alcohol, caffeine
93
Q

What are symptoms of AF?

A

Asymptomatic

Chest pain, syncope, palpitations

94
Q

What are signs of AF?

A

Irregularly irregular pulse

Signs of LVF - dyspnoea, raised JVP, fine lung crackles

95
Q

What investigations are required for AF?

A

12 lead ECG
Bloods - U&E, cardiac enzymes, TFTs
Echo

96
Q

What would an ECG show in AF?

A

Absent P waves

Irregular QRS complexes

97
Q

What is involved in the management of AF?

A

Anticoagulation
Rate control
Rhythm control

98
Q

What is the management of acute AF (unstable pt)?

A

DC cardioversion
Amiodarone if this doesn’t work
Correct electrolyte abnormalities
Anticoagulate with heparin

99
Q

What is the management of acute AF, stable pt, onset >48hrs ago?

A

Rate control - bisoprolol, metoprolol

Rhythm control only if properly anti-coagulated for 3 wks

100
Q

What is the management of acute AF, stable pt, onset <48hrs ago?

A

Rhythm control - DC cardioversion, flecainide, amiodarone
Rate control - beta blocker
Anti-coagulate with heparin

101
Q

What rate control should be offered in the long term management of AF?

A

Beta blocker, rate limiting CCB

102
Q

When should rhythm control be offered for long term management of AF?

A

Symptomatic, younger pts or presenting for the first time

103
Q

What rhythm control can be offered for long term management of AF?

A

Elective cardioversion
Amiodarone - for HF/left ventricular dysfunction
Flecainide - not for IHD

104
Q

What is included in chadsvasc?

A 
CCF
Hypertension 
Age >75yrs (2 points)
Diabetes 
Stroke/TIA/VTE (2 points)
Vascular disease
Age 65-74
Sex - female
105
Q

What is included in HASBLED?

A 
Hypertension
Abnormal liver/renal function
Stroke
Bleeding 
Labile INR
Elderly >75 yrs
Drugs/alcohol
106
Q

How is chadsvasc used?

A

Assess risk of stroke

>2 - high risk, needs anticoagulation

107
Q

What anti-coagulation is offered for AF?

A

DOAC - rivaroxaban

Warfarin

108
Q

What are some causes of narrow complex tachycardia?

A

Sinus tachycardia
Atrial flutter
Atrial fibrillation
AVRT/AVNRT

109
Q

What is the management of narrow complex tachycardia, no adverse signs?

A 
Vagal manoeuvres - valsalva manoeuvre or carotid sinus massage
IV adenosine (verapamil if contra-indicated)
110
Q

What ECG changes would indicate AVRT/AVNRT?

A

Narrow QRS
Regular
No p waves

111
Q

What are causes of broad complex tachycardia?

A

SVT with BBB
Ventricular tachycardia
Torsades de Pointes
Ventricular fibrillation

112
Q

How is regular broad complex tachycardia managed?

A

Treat as VT if uncertain

IV amiodarone

DC cardio version if unstable

Year 3 Medicine (11 decks)

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