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Cardiology Flashcards

1
Q

3 classical features of stbale angina

A

Chest pain - radiation to left arm/jaw/neck
Brought on by exertion
Relieved by rest / GTN spray

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2
Q

Causes of angina

A

IHD
Coronary artery vasospasm
Decubitus

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3
Q

Stable angina sx

A

Dyspnoea
Nausea
Sweatiness
Faintness

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4
Q

Precipitating factors for angina

A

Emotion
cold weather
heavy meals

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5
Q

Stable angina Investigations

A

Bloods
ECG
- ST depression
- T wave inversion

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6
Q

Stable angina diagnostic investigations

A

CT coronary angiogram
Stress echocardiography
Cardiac MR

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7
Q

Stable angina management

- Lifestyle

A

Smoking cessation
Excercise
Dietary advice
Weight loss

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8
Q

Stable angina management

- Pharmacological

A

RF modification

  • Asprin
  • Statin

Symptomatic releif
- GTN spray

Antianginal medications

  • Bisoprolol or Amlodopine
  • Switch
  • combine
  • 3rd drug - Isosorbide dinitrate
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9
Q

Stable angina management

- surgical

A

PCI

  • DAPT
  • Risk of thrombosis and restenosis

CABG

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10
Q

What is unstable angina

A

Sudden new onset angina
Significant deterioration in angina
Pain with increasing frequency
Occurs on minimal exertion or rest

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11
Q

Unstable angina investigations

A

ECG - ST depression
Cardiac enzymes
FBC
Coronary angiogram

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12
Q

Unstable angina management

A

RF modification

  • Statin
  • ACEi

Reduce CV events

  • Aspirin + Clopidogrel
  • Fondaparinux / LMWH

Symptomatic
- GTN spray

Anti-anginal medications

  • Bisorpolol
  • Amlodopine
  • Nitrates
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13
Q

Differences in Investigations

  • Unstable angina
  • NSTEMI
  • STEMI
A

Unstable -
Normal ECG / ST depression
Normal troponins

NSTEMI -
ST depression / T wave inversion
Raised troponins

STEMI
ST elevation
New onset LBBB
Raised troponins

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14
Q

Myocardial infarction presentation

A 
Chest pain - radiation 
Occurs at rest 
Nausea 
dyspnoea
palpitations 
sweatiness 
pallor
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15
Q

Silent MIs presentation

A

Pulmonary oedema
epigastric pain
vomitting
syncope

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16
Q

STEMI Investigations

A

ECG

  • Hyperacute t waves
  • ST elevation
  • New LBBB
  • T wave inversion - days
  • Pathological Q waves - days

Bloods

  • Troponin
  • creatnine kinase

CXR

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17
Q

MI Acute management

A

Pre hospital

  • Aspirin
  • GTN
Hospital 
M - Morphine 
O - O2
N - GTN 
A - Aspirin + clopidogrel
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18
Q

STEMI acute management

A

Reperfusion therapy
- Angiography + PCI
Within 12hrs of STEMI onset

  • Thrombolysis
    PCI unavailble within 2hrs
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19
Q

PCI

- Medications given prior

A

DAPT

  • Aspirin
  • Ticagrelor

Tirofiban - GPIIb/IIa

LMWH

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20
Q

MI Complications

A 
Death 
Arrhythmias
Tamponade 
HF 
Valve disease 
Dresslers syndrome 
Embolism
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21
Q

Chest pain differential dx

A 
MI
Angina 
Pericarditis 
Rib fracture 
Anxiety 
PE
Pneumonia 
GORD 
Cholecystisis
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22
Q

NSTEMI/UA risk stratification

A

GRACE - Global registry of acute coronary events
- 6m mortality risk

TIMI - Thrombolysis in MI
- 14 day all cause mortality risk

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23
Q

Other causes of increased troponins

A 
HF 
Tachyarrhytmias 
sepsis 
myocarditis 
PE
Aortic dissection 
Chronic renal failure
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24
Q

Secondary prevention following MI

A 
Beta blocker
ACEi
Clopidogrel 
Aspirin 
Statin
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25
Q

AAA Presentation

A

Asymptomatic

Pain - lower back

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26
Q

AAA Examination findings

A

Pulsatile abdominal mass
Auscultation - Bruit
Tachycardia

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27
Q

AAA Investigations

A

Abdominal IS
CT scan - IV Contrast
X - Ray

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28
Q

AAA complications

A

Aortic dissection

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29
Q

TAA Risk factors

A 
Arterial HTN 
CTD 
- Ehlers danlos 
- Marfans 
Bicuspid aortic valve 
Trauma 
Smoking
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30
Q

TAA presentation

A 
Thoracic back pain 
chest pressure 
Dysphagia 
cough 
Upper venous congestion - Mediastinal compression
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31
Q

TAA Investigations

A

CXR
TOE echo
CT angiogram chest

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32
Q

TAA Complications

A

Embolism
Aortic valve regurgitation
TAA rupture
Aortic dissection

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33
Q

What classification is used for heart failure

A

NYHA

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34
Q

Causes of systolic HF

A

HTN
MI
IHD
Cardiomyopathy

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35
Q

Causes of diastolic HF

A

Constrictive pericarditis
Obesity
Restrictive cardiomyopathy

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36
Q

HF Compensatory mechanisms

A

Increase HR

RAAS Activation
- Increases afterload + preload

SNS Activation

  • Afterload - Vasoconstriction
  • Increased HR
  • Increased preload
  • Increase contractability
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37
Q

HF cardiac changes

A

Ventriuclar dilatation

Myocyte hypertrophy

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38
Q

HF presentation - Sx

A 
SOB
Fatigue 
Ankle swelling 
Orthopnea - PND 
Cough 
- Sputum - Pink/frothy (PO)
Weight loss
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39
Q

HF Examiantion findings

A

Palpation

  • Displaced apex beat
  • Raised JVP
  • Oedema
  • Tachycardia

Auscultation

  • 3rd + 4th heart sounds
  • Narrow pulse pressure
  • Bibasal lung crackles
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40
Q

HF investigations

A

Bloods

  • BNP
  • Cardiac enzymes
  • FBC
  • LFTs (Heaptomegaly)

CXR

ECG

  • L.V hypetrophy
  • Ischaemia

Echo - Gold standard
- Conducted if BNP too high

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41
Q

HF CXR findings

A 
A - Alveolar oedema 
B - Kerely B lines 
C - Cardiomegaly 
D - Dilated prominent lobe vessels 
E - Pleural effusion
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42
Q

HF Management - Pharmacolgical

A

Symptomatic relief
- Furosemide

Disease - altering
1st = Ramipril + Bisoprolol
2nd= Spirinolactone
3rd = Digoxin

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43
Q

Causes of increased BNP

A 
DM
Sepsis 
Old age 
HF 
PE
COPD
Kidney disease
Liver cirrhosis
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44
Q

Acute HF management

A

100% O2
Diamorphine
Furosemide
Nitrates

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45
Q

Causes of Cor pulmonale

A

COPD
Bronchiectasis
Pulmonary fibrosis
Sever chronic asthma

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46
Q

HTN presentation - Sx

A

Asymptomatic
Headache
visual disturbance
Chest pain

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47
Q

HTN presentation - signs

A

Bilateral retinal haemorrhages

Papilloedema

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48
Q

HTN complications

  • eyes
  • cardiac
  • renal
  • neurological
  • Gu
A

Retinopathy

LVH
HF
IHD
PVD

Renal failure
Proteinuria

Headache
nausea
vomitting
stroke/TIA

Impotnece

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49
Q

Malignant HTN - Retinal changes

A

Flame shaped haemorrhages
Cotton wool spots
Hard exudates
Papilloedema

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50
Q

HTN investigations

A

Clinical spygmammoter

24hrs ABPM

Test for end organ damage:

  • ECG/Echo
  • Urinalysis
  • Fundoscopy
  • Retinopathy
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51
Q

Stage 1 HTN

A

Clinical BP = 140/90

ABPM = 135/85

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52
Q

Stage 2 HTN

A

Clinical BP = 160/100

ABPM = 150/95

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53
Q

Stage 3 HTN

A

Clinical BP = 180/120

IMMEDIATE TX

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54
Q

When is treatment given in HTN

A

ABPM < 135/85 - No tx

ABPM > 135/85
Tx - If QRisk2 is >20%

ABPM >150/95 - Tx

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55
Q

HTN Management - lifestyle

A

Weigh tloss
reduce alcohol intake
reduce salt intake
smoking cessation

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56
Q

Causes of a systolic murmur

A

Aortic stenosis
- Ejection systolic

Mitral regurgitation
- Pansystolic

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57
Q

Causes of diastolic murmur

A

Aortic regurgitation
- Early diastolic murmur

Mitral stenosis
- Mid diastolic murmur

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58
Q

What does S1 represent

A

Mitral and tricuspid valve closure

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59
Q

What does S2 represent

A

Aortic and pulmonary valve closure

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60
Q

What is S3 common in

A

MR

HF

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61
Q

Causes of aortic stenosis

A

Calcification
RHD
Bicuspid valve

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62
Q

Aortic stenosis presentation

A 
DASH 
D - Dyspnoea
A - Angina 
S - Syncope 
H - HF (LVH)
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63
Q

Aortic stenosis signs

A

Slow rising carotid pulse
Narrow pulse pressure
Carotid radiation

Ejection systolic murmur

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64
Q

Aortic stenosis investigations

A

Echo

ECG

  • LVH with strain
  • P mitrale
  • LAD

CXR

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65
Q

What is aortic sclerosis

A

Senile degeneration of valve - Ejection systolic murmur but no carotid radiation

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66
Q

Causes of mitral regurgitation

A 
IHD 
Annular calcification 
RHD 
Pappilary muscle failure - MI 
Mitral valve prolapse - Ehlers danlos + Marfans
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67
Q

Mitral regurgitation presentation

A

Exertional dyspnoea
fatigue
palpitations

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68
Q

Mitral regurugitation signs

A

Auscultation -
Pansystolic murmur - Apex radiates to axilla
Soft S1

Palpation
Displaced apex beat

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69
Q

What causes tall peaked P waves in lead II

A

Right atrial enlargement

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70
Q

What causes bifid P waves

A

Left atrial enlargement

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71
Q

Mitral regurgitation investigations

A

Echo
ECG - AF / LVH
CXR - Larger L.A

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72
Q

Causes of aortic regurgitation

A

IE
Ascending aortic dissection
Trauma

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73
Q

Aortic regurgitation presentation

A

PAD
P - Palpitations
A - Angina
D - Dyspnoea

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74
Q

Aortic regurgitation signs

A

Auscultation

  • wide pulse pressure
  • early diastolic murmur

Palpation

  • Collapsing pulse
  • Displaced apex beat
75
Q

Causes of mitral stenosis

A

RF
IE
Mitral annular calcification

76
Q

Mitral stenosis presentation

A 
Dyspnoea 
fatigue 
palpitations 
chest pain 
haemoptysis 
R. Heart failure sx
77
Q

Mitral stenosis signs

A

Malar flush

Palaption -
Raised JVP
Low volume pulse

Auscultation
Mid - diastolic murmur

78
Q

When can a Mitral stenosis mumrur be heard the best

A

Patient laid in L- side + Expiration

79
Q

Charecteristics of Mitral regurgitation murmur

A

At apex and spreads to axilla

80
Q

When can a Aortic regurgitation mumrur be heard the best

A

Sitting foward

81
Q

What classifies a narrow complex tachycardia

A

QRS < 120ms

82
Q

Causes of sinus tachycardia

A 
Anaemia 
infection 
fever
Thyrotoxicosis 
Acute PE 
Hypovolaemia 
Atropine
83
Q

What si the 1st line management of SVT

84
Q

Causes of AF

A 
SMITH 
S- Sepsis 
M - Mitral pathology 
I - IHD 
T - Thyrotoxicosis 
H - HTN
85
Q

AF - sx and sign

A

sx -

  • chest pain
  • palpitations
  • dyspnoea

signs -
- Irregularly irregular pulse

86
Q

AF Investigations

A

ECG

  • Rapid and irregualr QRS complexes
  • no p waves
  • Irregualrly irregualr pulse
87
Q

Acute AF management

A

Rate control
Beta blockers - Atenolol
CCB - Diltiazem

Rhythm control -
Time of onset established

<48hrs - Cardioversion

> 48hrs - Anticoagualtion

  • Warfarin
  • Rivaroxiban
88
Q

CHA2-DS2-VASc score

A 
C - CCF
H - HTN 
A - Age > 75
D - DM 
S - Stroke 
V - Vascualr disease 
A - Age (65-74)
S - Sex - female
89
Q

What is used to assess bleeding score when considering anticoagualtion

A 
HASBLED 
H - HTN 
A - Abnormal liver/renal fucntion 
B - Bleeding 
L - Liable INRs
E - Elderly 
D - Drugs / alcohol
90
Q

Atrial flutter management

A

Beta blockers
DC cardioversion
Anti-coagualtion - warfarin

Radiofrequency catheter ablation

91
Q

Cause of AV re entrant tachycardia

A

Incomplete seperation atria and ventricles leads to accessory pathyway
- Prone to AF

92
Q

Accessory pathway in Wolff parkinson white syndrome

A

Bundle of kent

93
Q

WPWS investigations

A

Short PR Interval
Wide QRS complex
Delta wave

94
Q

WPWS Tx

A

Haemodynamic instability –> Cardioversion

Haemodynamically stable –>
1 - Carotid massage
2- Valsalva manoevere
3- Adenosine

Surgical
Catheter ablation - AVRT

95
Q

Most common post - MI arrhythmia

A

Ventricualr ectopics

96
Q

Causes of ventricular tachycardia

A

Long QT
Digoxin toxicity
Ischaemia
Scarring

97
Q

VT treatment

A

Unstbale -
Electrical cardioversion + Amiodarone

Stable -
Beta blockers + Amiodarone

98
Q

Ventricualr fibrillation Investigations

A

ECG

  • Shapeless rapid oscillations
  • No organised complexes
99
Q

VF causes

A

Ventricualr ectopic beats

100
Q

Shockable hearth rhythms

101
Q

Causes of long QT syndrome

A 
Hyponatraemia 
Hypocalcaemia 
Hypomagneasemia 
Amiodarone 
Tricyclics
102
Q

Tx of sinus bradycardia

103
Q

Causes of 1st and 2nd degree HB

A 
Athletes 
Inferior MI
AVN vlocking drugs 
Myocarditis
Hypokalemia
104
Q

Cause of 3rd degree HB

A 
Congenital heart disease 
IHD 
Infection 
HTN 
Drug - induced
105
Q

Causes of LBBB

A

IHD
Aortic valve disease
HTN
Cardiomyopathy

106
Q

Causes of RBBB

A 
PE 
IHD 
ASD
VSD
Cor pulmonale
107
Q

Acute limb ischaemia defenition

A

End stage of PAD

Inadequate blood supply to the limg to allow it to fucntion normally at rest

108
Q

What is intermittent claudication

A

Ischaemia in a limb during exertion

- Relieved by rest

109
Q

Examiantion signs of PVD

A
  • Buergers angle < 20 degrees
  • Absent femoral/popliteal/foot pulses
  • Punched out ulcers
  • CRT > 15s
110
Q

Chronic limb ischaemia stages

A

Asymptomatic
IC
Ischaemic rest pain
Ulceration / gangrene

111
Q

IC presentation

A

Cramping pain
Induced by excercise
Relieved by rest

112
Q

Critial ischaemia presentation

A

Ulceration
gangrene
foot pain - NOCTURAL + at rest

Relieved by hanging foot over bed

113
Q

Critical limb ischaemia investigations

A

1st - Colour duplex US

2nd - ABPI

  • PAD (0.5-0.9)
  • Critical limb (<0.5)

Bloods
CT angiography

114
Q

Critical limb ischaemia management

A

Treat HTN
Atorvastatin
Quit smoking
Clopidogrel

115
Q

Acute limb ischaemia presentation

A 
6P's 
Pain 
pulseless
parasthesia 
perishigly cold 
paralysis 
pale
116
Q

Acute limb ischaemia management

A

Emboli - Surgical embelectomy

Heparin

117
Q

Sepsis 6?

A 
BUFALO 
Blood cultures
Urine output 
Fluids 
Abx 
Lactate
O2
118
Q

Teratology of fallot charecteristic features

A

Over riding aorta
VSD
Patent ductus arteriosis
Pulmonary stenosis

119
Q

Teratology of fallot presentation - sx + signs

A

Cyanotic (R–>L shunt)
Squatting

Pulmonary stenosis murmur

120
Q

Teratology of fallot investigations

A

CXR - Boot shaped heart

Echo

121
Q

VSD

  • Presentation
  • Signs
A

SOB
Poor feeding
failure to thrive

Pan-systolic murmur

122
Q

Signs of co-arctation of aorta on exmaination

A

Radiofemoral delay
R.arm HTN
Scapular bruit

123
Q

Causes of pericarditis

A 
Coxsackie B 
EBV 
TB 
Rheumatoid arhtiritis 
Kidney failure - uraemia 
Post - MI
124
Q

Pericarditis presentation

A

Chest pain

  • Pleuritic
  • Worse on lying down
  • Relieved by sitting foward

Fever

Dyspnoea

125
Q

Pericarditis investigations

A

Auscultation
- Pericardial friction rub

Bloods

ECG

  • Saddle shaped ST elevation
  • PR depression
  • Flattened t waves
  • T wave depression

ECG - Pericardial effusion

126
Q

Pericarditis management

A

NSAIDs
Aspirin
Colichine

127
Q

What decreases the recurrence of pericarditis

A

Colchicine

128
Q

What is given for recurrent pericarditis

A

Prednisolone

129
Q

complications of pericarditis

A

Pericardial effusion –> Cardiac tamponade

Constrictive pericarditis

130
Q

What is beck’s triad

A

Muffled heart sounds
increased JVP
Falling BP

131
Q

Most affected valves in IE

132
Q

IE most common cause

A

Streptococcus viridans - new cardiac murmur

133
Q

Cause of IE in:

  • IVDU
  • Dermatitis
  • DM
A

Staphylococcus aureus

134
Q

Cause of IE in:

Metallic valve replacement

A

Staphylococcus epidermitis

135
Q

Describe staph.Aueus

A

Gram +ve staphylococcus
coagulase +ve
Gold clumping

136
Q

Describe staph.Epidermididtis

A

Gram +ve Staphlococcus

coagulase -ve

137
Q

Describe Viridans streptococci

A

Gram +ve streptococci
Alpha - haemolytic
Optocjin resistnat

138
Q

IE presentation

A

Fever + new murmur

FROM JANE 
F - Fever
R - Roth spots
O - Osler nodes 
M - Murmur

J - Janeway lesions
A - Anaemia
N - Nails SH
E - Emboli

Clubbing

139
Q

IE investigations

A

Blood cultures

Echo - vegitations

Bloods

Urinalysis

ECG

  • HB
  • Long PR interval
140
Q

IE diagnostic criteria

A

Duke modified criteria

141
Q

IE management - Emperical tx

A

Ampicillin + flucloxacillin + gentamicin

142
Q

IE Management - Step

A

Benzylpenicillin + gentamicin

143
Q

IE Management - Staph

A

Vancomycin + Rifampicin

144
Q

IE Prophylactic therpay

A

Amoxicillin

Clindamycin

145
Q

How long should the PR interval last

A

120 - 200ms

146
Q

Which is the most effect Beta-blocker post MI

A

Propanolol

Blocks Na+ channels

147
Q

Why is Verapamil more effective than amlodopine

A

No effect on Ca2+ at rest

148
Q

Indication of adenosine

A

1st line - SVT

149
Q

Adenosine S/E

A

Bradycardia

Impending doom

150
Q

Indication od amioderone

A

Last line Tachyarrhythmias

151
Q

Amiodarone S/E

A 
QT prolongation 
Grey skin 
Hypo/hyper thyroidism 
Hepatitis 
Sun sensitivity
152
Q

Tx for Bradyarhytmias

153
Q

Atropine S/E

A

Tachycardia
dry mouth
constipation

154
Q

MOA -

  • Thiazides
  • Loop
  • Aldosterone antagonist
A

DCT - Na+/Cl-

Asceding loop - Na+/k+/Cl

DCT

155
Q

Loop diuretics S/E

A

Hypotension
Low electrolyte state
Hearing loss
tinitus

156
Q

Thiazide diuretics S/E

A

Hyponatraemia
Hypokalaemia
Impotence
IGT

157
Q

CYP450 inhibitors

A

Macrolides - erythromycin
Diltiazem
Amiodarone

158
Q

CYP450 Inducers

A

Carbamezepine
Phenytoin
Rifampicin

159
Q

Causes of radio-radial delay

A

Sublavian artery stenosis
Aortic dissection
Aortic co-arctation

160
Q

Slow rising pulse

A

Aortic stenosis

161
Q

Thready pulse

A

Intravascualr hypovolaemia - Sepsis

162
Q

Collapsing pusle

A 
Fever
Pregnancy 
Aortic regurgitation 
Patent ductus arteriosus 
Anaemia 
Thyrotoxicosis
163
Q

What is a corneal arcus

A

Yellow/grey ring around iris - Hypercholesterolaemia

164
Q

What is Buerger’s test

A

Ischaemia severity indicator

- Positive = Legs turn Red/Purple

165
Q

What is lipodermatosclerosis

A

Hardening of the skin distally and swelling of the calf

166
Q

Where is the SFJ located

A

4cm lateral and 4cm inferior to the pubic tubercle

167
Q

What does the tap test indicate

A

Thrill felt by finger at SFJ

Continuity of the vein secondary to valve incompetancy

168
Q

What does the Trendelenburg test Indicate

A

Tourniquet at SFJ
Veins refill - Problem below torniquet level

Veins don’t fill back up - Problem above torniquet level

169
Q

Bounding pulse

A

Aortic regurgitation

CO2 retention

170
Q

Narow BP

A

Aortic stenosis
CCF
Cardiac tamponade

171
Q

Wide BP

A

Aortic reguritation

Aortic dissection

172
Q

Positive hepatojugular reflux test

A

Constricitve pericarditis
RVF
LVF
Restrictive cardiomyopathy

173
Q

Parasternal heave

174
Q

Pulsating hepatomegaly

A

Tricuspid regurgitation

175
Q

Function of calcium gluconate in hyperkalaemia

A

stabalises cardiac membrane

176
Q

Function of insulin in hyperkalaemia

A

Drives extracellular K+ into the cell

177
Q

Mobitz type 1 presentation

A

Lightheaded
dizzy
syncope

178
Q

Mobitz type 2 presentation

A

SOB
Chest pain
Postural HTN

179
Q

Post MI medications

A 
DABS 
DAPT - Asprin + Ticagleror
A - Ramipril
B - Bisoprolol
S - Atorvastatin
180
Q

Acute NSTEMI Management

181
Q

Tachyarrhythmias management

A

Unstable

  • 3 shocks
  • Amiodarone

Narrow complex

  • AF
  • Flutter –> Rate control
  • SVT –> Vasovasal / Adenosine

Broad
- VT –> Amiodarone

182
Q

Drawbacks of mechanical heart valves

A

Thrombus formation
IE
Haemolysis
Lifelong anticoagulation - warfarin

183
Q

Causes of an irregualrly irregualr pulse

A

AF

Ventricualr ectopics

Disease summaries (9 decks)

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