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Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

The four things to bare in mind for chest pain

A

Myocardial infarction, Dissecting aortic aneurysm, Pulmonary embolism, Pericarditis

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2
Q

Constricting pain

A

Angina/ Anxiety/ Oesophageal spasm

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3
Q

Sharp chest pain

A

Pleura, pericardium, chest wall damage

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4
Q

Precipitating factors for angina/ anxiety

A

Cold, exercise, palpitations, emotion

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5
Q

Precipitating factors for oesophageal spasm

A

Hot drinks, alcohol, lying flat, food

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6
Q

Angina causes (brief list)

A

Coronary artery disease, hypertrophic cardiomyopathy, aortic stenosis, paroxysmal supraventricular tachycardia

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7
Q

Aortic dissection pain description

A

tearing, instantaneous, retrosternal, intrascapular+ NEUROLOGICAL SYMPTOMS and uneven pulse and ST ELEVATION in inferior leads

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8
Q

Dyspnoea causes (brief list)

A

Pulmonary embolism(+PLEURITIC CHEST PAIN), anaemia, respiratory causes, pain, anxiety, left ventricular failure

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9
Q

Palpitation causes (brief list)

A

supraventricular tachycardia, atrial fibrillation, ventricular tachycardia, ectopic beats, sinus tachycardia, anxiety, pheochromocytoma (rare)

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10
Q

Syncope causes (brief)

A

CNS- headache, aura, limb weakness, dysarthria, (PROLONGED RECOVERY= SEIZURE)/ CARDIAC- chest pain, palpitation, dyspnoea (QUICK RECOVERY= ARRHYTHMIA)

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11
Q

P wave in atrial hypertrophies

A

wide/ bifid= LAH, taller>2.5mm= RAH

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12
Q

Rate in ECG

A

300/ big squares in R-R interval

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13
Q

Left axis deviation causes

A

Left anterior hemiblock, Inferior MI, Venous tachycardia (from left ventricular focus), Wolff-parkinson White, Left ventricular hypertrophy

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14
Q

Right axis deviation causes

A

Left posterior hemiblock, Anterolateral MI, Pulmonary embolism, Wolff-parkinson White, Right ventricular hypertrophy

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15
Q

short vs long P-R interval meaning (+expected duration)

A

3-5 small square, short= fast AV conduction like WOLFF-PARKINSON WHITE. long= FIRST DEGREE HEART BLOCK

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16
Q

QRS expected duration

A

<3 small squares

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17
Q

QT expected duration and causes

A

9-10 small squares, CAUSES- low potassium, low calcium, low magnesium, low thyroid, low temperature, low treats (food), connective tissue disorders, antihistamines, antiarrhythmics, psychoactive drugs

Causes VENTRICULAR TACHYCARDIA

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18
Q

ST segment elevation/ depression

A

elevation= infarction, depression= ischaemia

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19
Q

J wave causes

A

High calcium, sub-arachnoid haemorrhage, low temperature

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20
Q

causes of Atrial Fibrillation

A

Hypertension, Ischaemic heart disease, Heart failure, Obesity, Thyrotoxicosis, Alcohol

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21
Q

causes of bradycardia

A

hypothyroidism, hypothermia, HIGH ICP, CHOLESTASIS, drugs

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22
Q

Causes of first and second degree heart blocks

A

Digoxin, beta blockers, acute myocarditis, IHD

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23
Q

Causes of complete heart block

A

Congenital, Idiopathic, IHD, Digoxin, Infiltration, Aortic valve CALCIFICATION, Cardiac surgery or trauma

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24
Q

ST elevation common causes

A

Printzmetal’s Angina, Acute pericarditis, Normal, Acute MI, Left ventricular aneurysm, AORTIC DISSECTION (in inferior leads)

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25
Q

ST depression common causes

A

downward sloping= DIGOXIN, horizontal= angina, NSTEMI, Acute POSTERIOR MI (in V1-3)

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26
Q

T inversion in V1-3/ V2-5/ V4-6 and avL/ 2,3 and avF

A

V1-3= RBBB, RV strain (like Pulmonary embolism)/ Anterior ischaemia
V2-5= Hypertrophic cardiomyopathy, Sub-arachnoid Haemorrhage
V4-6 and avL= LBBB, LVH, Lateral ischaemia, DIGOXIN
2,3 and avF= Inferior ischaemia

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27
Q

Myocardial infarction ECG changes (few hours, 1 day, few days)

A

few hours= ST elevation and PEAKED T wave
1 day= INVERTED T wave and if ST is still high- CORONARY ARTERY SPASM
few days= pathological Q waves

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28
Q

ADP receptor antagonists

A

GREL- less gastric irritation

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29
Q

DOACs examples

A

Apixaban, rivaroxaban, dabigatran (GIVE FOR AF)

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30
Q

BETA BLOCKERS

A

can cause bradycardia, bad for heart failure/ breathing problems, can mask blood sugar (in diabetics)

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31
Q

ACE INHIBITORS contraindications

A

avoid in acute kidney disease, hyperkalemia, dehydration

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32
Q

LOOP DIURETICS (like FUROSEMIDE) side effects

A

side effects- ototoxic, LOW Na, Ca, K

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33
Q

THIAZIDE DIURETICS side effects

A

side effects- LOW Mg, K, HIGH Ca and URATE (gout), Erectile Dysfunction

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34
Q

VASODILATORS examples and side effects

A

Nitrates, hydralazine, prazosin

Nitrates side effects- headaches and LOW BP

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35
Q

CALCIUM ANTAGONISTS examples and side effects

A

-PINEs used w/ BETA BLOCKERS (to avoid reflux tacycardia
VERAPAMIL/ DILTAZEM- don’t use with BETA BLOCKERS

S/E- gum hypertrophy, ankle oedema, DECREASE in LV FUNCTION, FLUSHES

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36
Q

DIGOXIN (contraindications and side effects)

A

CI- WPW+ HCM, LOW Mg/K/ HIGH Ca (same as THIAZIDE side effects), elderly (use lower doses)

S/E- Gynaecomastia, Yellow eyes, Nausea, ARRHYTHMIA, CONFUSION

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37
Q

Na blockers examples and contraindications

A

1A (procainamide) and 1B (lidocaine) used to terminate VENTRICULAR TACHYCARDIA

1C (flecainide) used for ATRIAL FIBRILLATION and for ARRHYTHMIA PROPHYLAXIS in WPW

CI- Heart failure, Heart block, IHD, Valve disease

38
Q

AMIODARONE uses and side effects

A

Used in supraventricular and ventricular tachycardia

S/E- pulmonary fibrosis, peripheral neuropathy, thyroid disease, liver disease

39
Q

IVABRADINE facts and contraindications

A

DOESN’T AFFECT BP, blocks funny current

CI- bradycardia, long QT, acute MI, CCB used, Shock

40
Q

STATINS facts and side effects

A

inhibit HMG-COA REDUCTASE- de novo synthesis of cholesterol in liver- decreases LDL, more effective at night

S/E- increase in CK/ TRANSAMINASE, muscle aches, myocytosis

41
Q

Drugs to avoid in WPW

A

Digoxin, verapamil, adenosine

42
Q

Typical angina 3 features

A

constricting pain (<30s) radiating to chest, neck, arms, shoulders, jaw

relieved by GTN/ rest

made worse by exercise

43
Q

VASOSPASTIC/ PRINTZMETAL ANGINA

A

Don’t use ASPIRIN or BETA BLOCKERS

44
Q

Angina treatment

A

first line- BETA BLOCKER +/- CCBs

Long acting nitrates/ ivabradine

Ranolazine

Nicorandil

45
Q

Ranolazine contraindications

A

Heart failure
Elderly
Low weight
Prolonged QT

46
Q

Nicorandil contraindications

A

LV failure
Acute pulmonary oedema
Severe hypotension
Hypervolaemia

47
Q

VASOSPASTIC (PRINZTMETAL) ANGINA treatment

A

NOT CAUSED BY HIGH CHOLESTEROL OR BP, caused by CORONARY ARTERY SPASM

Treatment-
Correct low magnesium
PRN GTN
CCB

AVOID ASPIRIN, BETA BLOCKERS, TRIPTAN

48
Q

Cardiac tamponade signs

A

Low cardiac output
Pulsus paradoxus on inspiration
Kussmaul’s sign on inspiration
Muffled heart sounds

treat with pericardial aspiration

49
Q

Heart failure causes

A

Coronary artery disease
hypertrophic cardiomyopathy
atrial fibrillation
valve disease

infective endocarditis
cor pulmonale
endocrine disorders

ANAEMIA
CARDIOMYOPATHIES

50
Q

Heart failure signs

A 
Major-
Paroxysmal nocturnal OEDEMA
Acute pulmonary oedema
Increased heart size/ CVP
Neck vein dilatation
S3 gallop
Minor-
Pleural effusion
Ankle oedema
Increased heart rate
Nocturnal cough

HIGH BNP in BLOOD

51
Q

Heart failure treatment

A 
ACE
Beta blockers
CANDOSARTAN (if not ACE)
Digoxin
Diuretics- FUROSEMIDE
Spironolactone
52
Q

Heart failure CXR signs

A 
ALVEOLAR OEDEMA
Kerley B lines
Cardiomegaly
Dilated upper lobe vessels
Pleural effusion
53
Q

5 signs of RIGHT SIDED HEART FAILURE

A 
Ascites
Distended JVP
Raised peripheral venous pressure
Weight gain
HEPATOMEGALY/ SPLENOMEGALY
54
Q

6 signs of LEFT SIDED HEART FAILURE

A 
Paroxysmal nocturnal dyspnoea
Cyanosis
Tachycardia
Pulmonary congestion
Fatigue
Orthopneoa
55
Q

2 things that increase pulse pressure

A

Less compliant aorta

Increased stroke volume

56
Q

AORTIC STENOSIS sound and pulse

A

NARROW pulse pressure
Soft S2
SLOW RISING pulse

Crescendo-decrescendo- EJECTION SYSTOLIC murmur- radiates to CAROTIDS

57
Q

AORTIC REGURGITATION sound and pulse

A

WIDE pulse pressure
COLLAPSING pulse

WATERHAMMER pulse

Traube’s sign- pistol shot over femoral artery
De Musset’s sign- head nodding in time with heart beat
Quincke’s sign- pulse felt in nail

Decrescendo- EARLY DIASTOLIC murmur

58
Q

MITRAL STENOSIS sound and pulse

A

LOW VOLUME pulse
Loud S1
Opening snap

Tapping apex beat

Low pitch MID DIASTOLIC murmur

59
Q

MITRAL REGURGITATION sound and pulse

A

harsh PAN SYSTOLIC murmur radiating to AXILLA

Displaced apex beat

60
Q

RAAS AFFECTS ___LOAD

A

RAAS affects PRELOAD

61
Q

Sympathetic nervous system affects ____LOAD

A

Sympathetic nervous system affects AFTERLOAD

62
Q

Visible signs of MI

A

Raised JVP, Increased pulse, Pallor

63
Q

CXR of MI

A

cardiomegaly, widening of mediastinum, pulmonary oedema

64
Q

Immediate management of MI

A

Morphine, Oxygen, Nitrates (GTN), Anticoagulants (ASPIRIN and ANTIEMETIC), Beta blockers

65
Q

Management on discharge for MI

A

ACE
Aspirin
Beta blocker (or CCB if CI)

66
Q

Surgical treatment of MI

A

PCI

Fondaparinux or LMWH can be given if NSTEMI patients aren’t having immediate PCI

67
Q

Complications of MI

A

Cardiogenic shock/ cardiac arrhythmia (AF INCREASES RISK OF STROKE SO START ANTICOAGULANTS)

Pericarditis

Emboli

Aneurysm

Rupture of Ventricle

Dressler’s Syndrome

Rupture of free wall

Papillary muscle rupture

68
Q

Risk factors for Infective Endocarditis

A

RHD
Cardiac lesions
IV drug user
DENTAL TREATMENT

69
Q

Causative agents for Infective Endocarditis

A

Strep viridans
Staph aur
Staph Epid

Diptheroids
Microaerophilic strep

HACEK- Haemophilia, Actinobacillus, Cardiobacterium, Eikenella, Kingella

70
Q

Investigations for Infective Endocarditis

A

Bloods for ANAEMIA

Urinalysis- MICROSCOPIC HAEMATURIA

CXR

Transoesophageal/ Transthoracic ECHO for vegetations

71
Q

Signs and Symptoms for Infective Endocarditis

A

Fever
Roth’s spots
Osler’s nodes
New Murmur

Janeway lesions
Anaemia
Nails- splinter haemorrhages
Emboli

72
Q

Treatment for Infective Endocarditis

A

generally- BENZYLPENICILLIN and GENTAMYCIN

Strep- BENZYLPENICILLIN and AMOXICILLIN

Staph- FLUCLOXALLIN and GENTAMYCIN

Aspergillus- MICONAZOLE

73
Q

Aortic Stenosis Causes and Symptoms

A

Causes-

RHD
Congenital bicuspid valve
Atherosclerosis

Symptoms-

Syncope
Angina
Dyspnoea

74
Q

Investigations for Aortic Stenosis

A

ECG- LVH and AV block

CXR- post-stenotic dilatation of ASCENDING AORTA/ calcification of valve

75
Q

Complications of Valve Diseases

A

Heart failure
Infective endocarditis
Arrhythmia

76
Q

Causes of Aortic Regurgitation (Acute and Chronic)

A

ACUTE-

Cusp rupture
Perforation (secondary to infection)
Aortic DISSECTION
Connective tissue disorder

CHRONIC-

RA
Ankylosing Spondylitis
Syphilis

77
Q

Investigations for Aortic Regurgitation

A

ECG- LVH

CXR- cardiomegaly/ pulmonary oedema

78
Q

Symptoms of Aortic Regurgitation

A

Heart Failure
Angina
Dyspnoea

79
Q

Causes of Mitral Stenosis

A

RA
Ankylosing Spondylitis
SLE

RHD
Valve calcification
Malignant carcinoid

80
Q

Symptoms of Mitral Stenosis

A

Heart Failure
Palpitations (if AF)
Haemoptysis
Dyspnoea

81
Q

Signs of Mitral Stenosis

A

MALAR FLUSH
Tapping Apex Beat
HOARSE VOICE

82
Q

Investigations for Mitral Stenosis

A

ECG- AF/ Bifid P waves

CXR- enlarged left atrium/ pulmonary oedema

83
Q

Causes of Mitral Regurgitation

A

Papillary muscle rupture
INFECTIVE ENDOCARDITIS
RHD
Prolapse

84
Q

Symptoms of Mitral Regurgitation

A

Heart Failure
Palpitations (if AF)
Symptoms of INFECTIVE ENDOCARDITIS
Dyspnoea

85
Q

Investigations of Mitral Regurgitation

A

ECG- AF/ Bifid P waves

CXR- pulmonary oedema/ cardiomegaly

ECG of MS/ CXR of AR

86
Q

Hypertension treatment (<55yo)

A

ACE (or ARB if CI) or CCB

Then ACE and CCB

Then ACE and CCB and Diuretic

(ARB can also be used instead of ACE if CI)

87
Q

Hypertension treatment (>55yo or black)

A

Diuretic (Thiazide)

Then ACE (or ARB) and Diuretic

Then ACE (or ARB) and CCB and Diuretic

88
Q

What does Angiotensin 2 stimulate? (4 things)

A

Aldosterone secretion from Zona Glomerulosa
Vasoconstriction
Sympathetic NS
ADH release from posterior pituitary

89
Q

Signs and Symptoms of Atrial Fibrillation

A

Palpitation
EXERCISE INTOLERANCE
Normal
Dyspnoea

Fatigue
Irregularly irregular pulse
Syncope
HEART FAILURE

90
Q

PATHOPHYSIOLOGY of Atrial Fibrillation

A

Atrial ectopic beats thought to originate in PULMONARY VEINS

Atria no longer contract in coordinated manner

Atria fail to empty adequately

Blood accumulates- high risk of clotting/ embolic strokes

91
Q

Treatment for Atrial Fibrillation

A

Treat UNDERLYING CAUSE

Rate-

  • Beta blocker
  • CCB
  • Amiodarone
  • Digoxin

Rhythm-

  • Beta blocker
  • Cardioversion
  • Amiodarone

Anticoagulant-

  • WARFARIN
  • Apixaban
  • Dabigatran
  • Rivaroxaban

Medicine (15 decks)

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