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Cardiology Flashcards

1
Q

What is the dose of aspirin and ticagrelor given during an M.I?

A

Aspirin 300mg
Ticagrelor 180mg
STAT

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2
Q

What are the cautions for ticagrelor?

A

Asthma
COPD
Bradycardia

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3
Q

What are some cardiac and non cardiac causes of elevated BNPs?

A

Cardiac:

  • Heart failure
  • ACS
  • Myocarditis

Non- cardiac:

  • advance age
  • ischemic stroke
  • SAH
  • COPD
  • Burns
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4
Q

In an echocardiogram for heart failure, what are you looking for?

A

LV systolic function - ejection fracture

LV dimision

Valvular abnormalities

Diastolic function

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5
Q

What are the levels of ejection fracture?

A

Normal >55%
Mild 45-55%
Moderate 36-44%
Severe <35%

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6
Q

What signs may be seen on ultrasound of a P.E?

A

RV dilation
RV hypokinesis
Pulmonary hypertension

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7
Q

What murmur may be heard with aortic dissection?

A

Aortic regurgitation
- due to widen of the aortic outlet causing back flow.

intussusception may occur

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8
Q

What are the indications for CABG?

A

> 50% stenosis of the main left artery “critical main left stem disease”

2-3 Artery involvement “triple disease”

Poor ventricular function associated with multi-vessel disease

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9
Q

When a patient is put on cardiopulmonary bypass - what must they be given and then what follows this?

A

Heparin to avoid clots within the machine.

this is revered with protamine once the blood returns to the patient.

*blood is drained via the great veins, either IVC or SVC and returned directly into the aorta

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10
Q

What drug is given to stop the heart during a cardiopulmonary bypass?

A

Cardioplegia
- high K+ load.

doesn’t cause ischemia

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11
Q

What is the procedure of choice for aortic stenosis, and what is the alternative for those who are not fit for surgery?

A

Aortic valve replacement is treatment of choice.

TAVI is the option for those who are unfit for surgery.

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12
Q

Contrast the differences between mechanical and tissue AVRs

A

mAVR:

  • lifelong
  • Durable
  • requires anticoagulation
  • clicks
  • haemolysis

tAVR:

  • 10-15years
  • non-durable
  • doesn’t require anticoagulation
  • non-audible
  • vegetations grow
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13
Q

What are the indications for a mitral valve replacement?

A

Severe MR

Severe symptoms

Papillary muscle rupture - usually post M.I

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14
Q

When would you only control the rate in someone with AF?

A

Structurally abnormal heart

> 65 years old

Persistent AF

Hypertension

Previously failed treatment

Less symptomatic

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15
Q

What type of aortic dissection will have a weak/ absent radial pulse? and what is the management?

A

Stanford type B
- it is distal to subclavian

  • Medical management
  • to control BP
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16
Q

What are the indications for surgery in aortic dissection?

A

Type A

Persistent pain

Failure of medical management

Aortic rupture

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17
Q

What conditions are associatted with VSD?

A

Down’s syndrome

Edwards syndrome

Patau’s syndrome

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18
Q

What is the most common congenital heart disease, and what syndrome is it highly associated with?

A

Bicuspid Aortic valve

Turner’s syndrome

19
Q

What heart murmur would you expect to hear with coarctation of the aorta?

A

Systolic murmur in between the shoulder blades, usually nearer the left

Harsh systolic ejection over the left side

20
Q

What are some of the systemic outcomes of Eisenmenger’s syndrome?

A

Increased erythrocytes
- increased blood viscosity and clots

Damaged endothelium due to high pressure
- increased bleeding and poor platelet activation

Gout

Acne

21
Q

What are some of the systemic signs of Eisenmenger’s syndrome?

A

Dyspnea

Syncope

Cyanosis

Finger clubbing

Right ventricular heave

22
Q

List some conditions where pregnancy is contraindicated:

A

Primary pulmonary hypertension
- carries a mortality of 30-50%

Marfan’s syndrome with dilated aortic root

Severe aortic stenosis

Severe mitral stenosis

Severe LVSD

23
Q

What congenital heart disease is associated with berry aneurysms?

A

coarctation of the aorta

24
Q

What vessels maybe used in bypass graft?

A

venous
- great saphenous vein

Arterial
-left internal mammary artery

25
Q

If a patient continually suffers from collapse, outwith the direct disease/ condition, what other factors should one consider?

A

Hydration status

Excessive diuresis

Medications - polypharmacy

Age

26
Q

Why does Aortic stenosis cause chest pain?

A

Two fold:
- Left ventricular hypertrophy, demands more blood but does not receive it as well

  • Reduced blood following into the coronary sinuses due to hypokinetic valves blocking entrance
27
Q

What are the characteristics of pericarditis pain?

A

Pain located retrosternally

Pain not associated with exertion

Sharp/ shooting pain. Not constrictive

Radiates to left shoulder

Relieved by sitting forward

28
Q

Outline the management of cardioversion of AF:

A

<48 hours

  • herparinse
  • Electro- Cardioversion
  • Pharmacological (amiodarone if structural heart disease)

> 48 hours
- 4 week anti-coagulation
or
- confirm with transesophageal US

29
Q

What investigation can be done to establish if there is a thrombus present prior to cardioverting in a patient with AF?

A

Transoepahgeal US

30
Q

Outline the management of heart failure:

A
  1. ACE + Beta blocker
  2. Mineral receptor blocker
    • this is specialist input
      - Ivabrindine (<35% EF and >75bpm sinus)
      - Dixogin (AF present)
      - Sacubitril/ valsartan (<35%)
    • LVAD
    • CRD
  • flu vaccine yearly
  • one off pneumococcal vaccine
31
Q

What signs may you see regarding the liver in heart failure?

A

Enlarged smooth liver which is pulsatile

32
Q

How can the pulmonary arterial pressure be measured, how can the pulmonary venous and left atrium pressures be measured?

A

Cardiac catheterisation passed into a vein and through right side of heart and into the pulmonary vessels.
- direct measuring can then occur

To measure the Pulmonary venous pressure or left atrium the catheter whilst in the pulmonary circulation can wedge off the arterial flow

  • thus only measuring the venous and atrial pressures
  • pulmonary capillary wedge pressure
33
Q

What type of cardiac catherization is used to assess left ventricular function including aortic regurgitation?

A

Arterial catherization

Accessed via the:
- Right femoral
or
- Radial

34
Q

What are some of the indications for cardiac catherization?

A

Diagnosis and assessment of coronary arterial disease
+
Therapeutic intervention (angioplasty, Stenting)

Valvular disease - diagnosis and assessment
+
Therapeutic intervention

Congenital heart disease - diagnosis and assessment
+
Therapeutic intervention

Electrophysiology for diagnosis and therapeutic intervention

Measuring pressures

35
Q

Outline some of the pre-procedural management for cardiac catheterisation and list some complications:

A

Bloods:

  • FBC
  • U&Es
  • Coagulation studies
  • LFTs

CXR

ECG

IV access (on the left)

Complications:

  • Haemorrhage from enter site
  • Angina
  • Arrhythmias
  • Vessel spasm (causing loss of distal pulses)
  • Aortic dissection
  • Infection at sight
36
Q

What is the most common type of primary cardiac tumour?

A

Atrial Myxoma

37
Q

What are the symptoms of obstructive cardiomyopathy?

A

*obstruction due to spetal hypertrophy.
most common cause of sudden death in young person.
- AD pattern
- sporadic mutation

Symptoms:

  • syncope/ presyncope on effort
  • dyspnoea
  • Chest pain
  • asymptomatic

Signs:

  • Double apical pulsation
  • Jerky carotid pulse (rapid ejection followed by obstruction)
  • ejection systolic murmur
38
Q

What ECG findings might you see with obstructive cardiomyopathy?

A

Left ventricular hypertrophy

Twave inversion

Non-specific ST changes

39
Q

What investigations and treatments are there for obstructive cardiomyopathy?

A

Investigations:

  • ECG
  • Echo
  • MRI of heart

Management:

  • Beta blocker +/- calcium channel blockers
  • ICD

*ACE inhibitors are contraindicated due to reduced expansion of pre-load = reduced cardiac output

40
Q

What are the causes of dilated cardiomyopathy?

A 
Familial 
Alcohol 
Myocarditis 
Thyroidtoxicosis 
Neuromuscular - Duchene
41
Q

What are the signs and symptoms of dilated cardiomyopathy?

A

Symptoms:

  • Heart failure symptoms
  • AF
  • VTEs

Signs:

  • dynamic Apex beat
  • High HR
  • Low BP
  • Hepatosplenomegaly
  • Raised JVP
42
Q

How is dialted cardiomyopathy investigated and treated?

A

Investigations:

  • Bloods - BNP and U&Es
  • ECG (Non-specific findings)
  • Echocardiogram
  • Heart MRI

Management:

  • Heart failure management
  • VTE prophylaxis
  • Heart transplant (if indicated)
43
Q

What are the causes of mitral stenosis and when is it considered severe?

A

Rheumatic fever
- most common valve

Congenital

Lutembacher’s syndrome
- ASD + mitral stenosis

Severe is when the annulus is <1cm in diameter
Symptoms appear after <2cm

44
Q

What are some of the signs of mitral stenosis and what does the murmur sound like?

A

Face:
- Malar flush

Pulse:
- AF

Jugular:
- distended - right sided heart failure

Palpation
- palpable first heart sound

Right ventricular heave
- when the right side is affected.

Murmur:
Mid diastolic murmur with opening snap- rumble sound
- apex
*heard best with patient in the left lying position

Loud S1 sound

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