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Finals > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Extrinsic causes of bradycardia

A

B blockers, hypothyroid, hypothermia

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2
Q

Name an intrinsic cause of bradycardia

A

Ischaemia of SAN
Fibrosis of atrium
Sick sinus syndrome - failure of the SAN to depolarise.

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3
Q

Causes of heart block

A

CAD, cardiomyopathy, fibrosis within the conducting tissue.

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4
Q

What is first degree heart block? ECG sign?

A

delayed AV conduction, prolonged PR interval

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5
Q

What is Mobitz type 1 heart block?

A

Progressive PR prolongation until it doesn’t conduct and absent QRS

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6
Q

What is Mobitz type 2 heart block?

A

dropped QRS complex (no PR prolongation.)

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7
Q

What is third degree heart block?

A

All atrial activity fails to conduct to the ventricles.

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8
Q

Causes of wide QRS complex on ECG?

A

Bundle branch block

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9
Q

What is the definition of tachycardia?

A

HR >100bpm

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10
Q

Causes of BBB?

A

PE/IHD/ventricular hypertrophy/AV disease/fibrosis.

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11
Q

Name some pathological causes of tachycardia?

A

fever, anaemia, thyrotoxicosis, PE, hypovolaemia.

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12
Q

Name causes of narrow complex QRS complex?

A

AVRT/AVNRT/physiological tachycardia.

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13
Q

What is AVNRT?

A

commonest SVT. Ring of conducting pathway in AVN.

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14
Q

What is AVRT?

A

accessory pathway connecting atria and ventricles.

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15
Q

Example of AVRT and ECG findings?

A

Wolff-Parkinson-White, delta waves before the QRS complex.

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16
Q

Symptoms of an arrhythmia?

A

Palpitation, dizzy, SOB, central chest pain, syncope.

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17
Q

Management of supraventricular tachycardias? unstable/stable and prevention

A

Unstable - Emergency conversion
Stable - Vagal stimulation, IV Adenosine
Prevention - radiofrequablation, B blocker

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18
Q

What is the HR like in AF?

A

irregularly iregular

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19
Q

AF ECG signs?

A

absent P waves

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20
Q

How to manage an unstable AF patient?

A

heparinisation, DC shock, IV amiodarone

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21
Q

Rate control in a stable AF patient?

A

1st line = B blocker (C/I in asthma patients?

2nd line = CCB/digoxin

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22
Q

Rhythym control in stable AF patient?

A

B blocker e.g. Sotalol

others: amiodarone

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23
Q

How to assess anticoagulation in AF patient?

A

CHADVASC2 - CHF, HTN, >75, 65-74, DM, TIA or stroke, VD, Female

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24
Q

Anticoagulation choice in AF patient?

A

DOAC e.g Rivaroxaban/apixaban

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25
Q

What is ventricular fibrillation?

A

Rapid and irregular ventricular rhythm with no mechanical effect. No CO.

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26
Q

Name some causes of HF

A

IHD, arrhythmia, anaemia, hyperthyroid, obesity

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27
Q

What is the pathophysiology of HF?

A

read in notes

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28
Q

Symptoms of HF?

A

exertional SoB, orthopnia, paroxysmal nocturnal dyspnoea, fatigue

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29
Q

Ix for HF? what would they show?

A

CXR - enlarged heart
ECG - underlying cause
Bloods - FBC, LFT, BG, UE, TFT, BNP
ECHO

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30
Q

General HF management?

A

Educate, physical exercise, diet, pneumococcal and influenza vaccine

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31
Q

1st and 2nd line treatment for HF

A

1st line = ACEi + B blocker
2nd line = Aldosterone antagonist (Spironolactone)
3rd line = digoxin

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32
Q

Symptomatic Mx for HF?

A

pillows, furosemide

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33
Q

investigations for acute heart failure?

A

CXR, ECG, bloods, ECHO

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34
Q

signs of fluid overload?

A

hypertension, raised JVP, pulm oedema (breathless)

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35
Q

Management of acute heart failure?

A

High flow O2 and IV 50mg Furosemide

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36
Q

What causes myocardial ischaemia?

A

imbalance in supply/demand of myocardial muscle

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37
Q

Commonest cause of IHD? how does it cause it?

A

coronary artery disease - atheromatous plaques whcih narrow lumen of the artery.

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38
Q

Irreversible RF for IHD

A

age, gender, family Hx

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39
Q

Reversible RF for IHD

A

hyperlipidaemia, smoking, HTx, DM, low veg diet, stress

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40
Q

Symptoms of stable angina?

A

central crushing chest pain (retrosternal) worse with exertion and relieved by rest.

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41
Q

Ix of angina?

A

ECG, stress ECG, ECHO, coronary antiography, clinical Hx

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42
Q

General risk Mx in angina patients?

A

lifestyle advice, aspirin 75mg OD, statin

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43
Q

Symptomatic Mx of angina?

A

sublingual GTN with symptoms, B blocker e.g. atenolol

44
Q

2 surgeries for Angina

A

PCI, CABG

45
Q

What causes ACS?

A

rupture of atheromatous fibrous plaque which causes formation of platelet rich clot within a coronary artery

46
Q

Features of unstable angina?

A

worsening angina on minimal exertion, pain at rest - not relieved by nitrates. New onset HF/collapse.

47
Q

DD of ACS?

A

aortic dissection/MSK pain/GORD

48
Q

Ix of ACS?

A

FBC, creatinine, electrolytes, glucose, lipids, ECG (STEMI or NSTEMI), toponin and CK, cardiac monitor.

49
Q

Management of acute ACS?

A

Morphine sulfate (for pain.)
Oxygen if <88%???
Nitrates
Aspirin (300mg then 75mg daily) +/- Clopidogrel

Metoclopromide for nausea?

50
Q

What scoring systems for risk of ACS?

A

Grace

TIMI

51
Q

Featues of STEMI?

A

central chest pain occuring at rest. Sweating, breathless, N&V, pale/grey/sweaty

52
Q

ECG signs of a STEMI?

A

ST segment elevation

T wave flatteningt/inversion

53
Q

Mx of a stemi?

A

MONA + Metoclopromide + immediate primary angioplasty

Fibrinolytic agents - bolus IV streptokinase/alteplase

54
Q

Complications of a stemi?

A

Arrhythmia, heart block, heart failure

55
Q

What causes rheumatic fever?

A

Group A strep

56
Q

Features of rheumatic fever?

A

fever, joint pain, heart murmer

57
Q

Ix of rheumatic fever?

A

FBC, ESR, Ducket jones criteria, throat swab for strep

58
Q

Mx of rheumatic fever?

A

high dose aspirin, penicillin

59
Q

Causes of Mitral stenosis?

A

Rheumatic fever

60
Q

what would you hear on auscultation of a pt with mitral stenosis?

A

mid diastolic rumbling murmer with loud first heart sound?

61
Q

Ix for any valve pathology?

A

CXR, ECHO, ECG

62
Q

How does mitral regurgitation cause pulm oedema?

A

back log into the LA and back into the lungs.

63
Q

auscultation of mitral regurgitation?

A

pansystolic murmer + thrill

64
Q

Cause of prolapsing valves?

A

Marfan syndrome.

65
Q

Causes of aortic stenosis?

A

degeneration, calcification, rheumatic HD

66
Q

Symptoms of Aortic stenosis? Why do you get these?

A

Obstructed LV exit - causes angina, exertional syncope, congestive HF

67
Q

Auscultation of aortic stenosis?

A

harsh ejection systolic murmer

68
Q

Signs of aortic regurgitation?

A

collapsing water hammer pulse

69
Q

Symptoms of aortic regurgitation?

A

dyspnoea, orthopnea, LV failure (fatigue)

70
Q

What criteria is used for infective endocarditis?

A

Dukes criteria

71
Q

Causative organisms of infective endocarditis?

A

Strep.Pneumoniae, Staph.Aureus

72
Q

Features of infective endocarditis?

A

fever, malaise, weight loss, anaemia, new onset HF, murmers, emboli

73
Q

Ix of IE?

A

blood cultures, ECHO, CXR. ECG, FBC, ESR, Serum IGs

74
Q

What is the definition of pulmonary HTN?

A

pressure in pulm arteries >25mmHG at rest (normally 10-14mmHG)

75
Q

Causes of pulm HTN?

A

idiopathic, hereditary, inflammatory (SLE/RA)

76
Q

Ix of pulm HTN? what would these show?

A

CXR - enlarged pulmonary arteries
ECG - RV hypertrophy
ECHO

77
Q

Mx of pulm HTN?

A

O2, warfarin, diuretic, CCB (pulm vasodilators.)

78
Q

Features of a PE?

A

breathless, pleuritic chest pain, haemoptysis, tachypnoec, shocked, pale, sweaty, tachycardic, death

79
Q

Risk score for a PE? what does it look at?

A

WELLS Score - clinical signs of DVT, alternative diagnosis is less likely, HR > 100, recent immobilisation, previous DVT/PE, haemoptysis, malignancy (>4 = high suspicion of a PE.)

80
Q

Management of a PE in a high risk patient?

A

High risk –> start DOAC/LMWH –> CTPA –> diagnosis

81
Q

management of PE in a low risk patient?

A

low risk –> D Dimer / other IX –> positive –> CTPA

82
Q

General Mx of a PE patient?

A

Give O2, thrombolysis if massive, morphine, IV fluids

83
Q

What does a D dimer show? When is it not useful?

A

fibrinogen degradation products when the clot is dissolved - false positives in pregnancy/malignancy.

84
Q

Name 2 cardiomyopathies

A

hypertrophic, dilated

85
Q

Causes of acute pericarditis?

A

Viral (Coxasackie), MI, uraemia, malignancy

86
Q

Features of acute pericarditis?

A

sharp retrosternal chest pain (relieved by leaning forwards), pain worse on inspriation and pericardial friction rub.

87
Q

what does an ECG show in acute pericarditis?

A

Saddle shaped ST segment

88
Q

mx of acute pericarditis

A

1st line = NSAIDS
2nd line = corticosteroids
pain relief, look at underlying cause

89
Q

what is cardiac tamponade?

A

medical emergency. rapid accumulation of fluid restricting diastolic filling of the ventricles which reduces CO.

90
Q

Features of pericardial effusion?

A

soft heart sounds, low BP, increased HR, raised JVP, kussmauls resp

91
Q

Mx of cardiac tamponade?

A

pericardiocentesis

92
Q

Causes of essential HTN?

A

genetics, low birth weight, obesity, increased alcohol and salt intake

93
Q

secondary causes of hypertension?

A

pre-eclampsia, renal stenosis, Conns, phaemochromcytoma, coarction of aorta, COCP, NSAIDS

94
Q

What histology is shown with hypertension?

A

fibrinoid necrosis of the vessel walls

95
Q

name end organ damage that occurs due to hypertension?

A

Kidneys - haematuria, proteinuria, progressive CKD
Brain - oedema, haemorrhage
Retina - flame haemorrage, cotton wool spots, pappilodoema
CVS - acute HF, aortic dissection

96
Q

What Ix do you do for HTN?

A

serum UE, urine stix, BG, lipids, ECG

97
Q

non pharm Mx measures for HTN?

A

weight loss, low fat and salt diet, reduce alcohol, exercise, increase fruit and veg, stop smoking

98
Q

pharm management of HTN patheway?

A

1st line = <55/T2DM - ACEi, Afro-Carib,>55 - CCB
2nd line (A+C) or (A+D)
3rd line = (A + C + D)

99
Q

Examples of ACEi/their action/side effects

A

lisinopril/ramipril
they block the conversion of angiotensin 1 –> angiotensin 2 (vasoconstrictor.)
SE = cough/rash/hypotension

100
Q

Example of ARB and how they work?

A

Losartan - blocks angiotensin 2 receptor - good in ACEi patients who cannot tolerate cough.

101
Q

Example of CCB/how they work/side effects

A

Amlodipine/nifedipine
cause dilation of peripheral arterioles
SE = headache/flushing/periphera oedema

102
Q

name the 2 different types of diuretic and an example

A

loop diuretic - furosemide

thiazide - bendroflumethiazide

103
Q

Definition of an aortic aneurysm?

A

vessel Diameter >3cm. Permanent localised dilation of an artery.

104
Q

Features of abdo/thoracic aneurysms

A

ABDO - pulsating mass, epigastric or back pain

THORACIC - back pain, dysphagia, cough

105
Q

What occurs during dissection? Features?

A

tear in the intima, false lumen created. Abrupt onset severe tearing central chest pain which radiates to the back.
Neuro signs, absent pulses, unequal BP in arms!!

106
Q

Ix of dissected anuerysm?

A

CXR - widened mediastinum.

CT/ECHO/MRI

Finals (21 decks)

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