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Year 5 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is the mechanism of action of Dabigatran?

A

Direct thrombin inhibitor

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2
Q

What drug is used to reverse the effects of Dabigatran?

A

Idarucizumab

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3
Q

Name the 4 different types of heart (AV) block and what is shown on ECG

A

1st degree - increased PR interval >0.2 seconds
2nd degree mobitz 1 (wenckebach) - increasing PR until QRS drop
2nd degree mobitz 2 - constant PR interval but random QRS drops
3rd degree - no association between p waves and QRS

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4
Q

Symptoms of severe hypertension

A

Headaches
Visual disturbances
Seizures

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5
Q

Classifications of hypertension

A

Stage 1 - >140/90
Stage 2 >160/100
Stage 3 > 180/110

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6
Q

Causes of secondary hypertension

A 
Renal artery stenosis 
Glomerulonephritis 
PCKD
Primary hyperaldosteronism (conns)
Congenital adrenal hyperplasia 
Phaeochromocytoma
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7
Q

What investigations should you do when diagnosing hypertension?

A 
U&Es - check for renal disease
HbA1c - check for diabetes, important CVD risk factor
Lipids
TFT - can contribute to cause
ECG
Urine dip
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8
Q

Medical management of hypertension

A

1) A or C
2) A+C or A+D
3) A+C+D
4) If K+ <4.5 - add spironolactone, if K+ >4.5 add alpha or beta blocker

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9
Q

What are the 3 features of angina?

A

Central constricting chest pain
Precipitated by physical exertion
Relieved by rest or GTN spray

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10
Q

How is Angina Managed?

A

Aspirin and Statin (If non contraindications)
Sublingual GTN
Beta blocker
Calcium channel blocker - if used in combination with beta blocker then long acting one e.g, modified release nifedipine
Long acting nitrate - if symptoms still aren’t controlled

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11
Q

Which calcium channel blocker should never be co prescribed with a beta blocker and why?

A

Verapamil

Risk of complete heart block

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12
Q

How can you tell what type of MI has occurred from ECG?

Which artery has been affected?

A

Anterior MI: V1-V4 (Left anterior descending)
Inferior MI: II, III, aVF (right coronary artery)
Lateral MI: V5-V6 (left circumflex)

Posterior MI: Tall R waves in V1-V3 (left circumflex/right coronary)

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13
Q

What is the management of STEMI?

A

MONA - emphasis on aspirin 300mg, others can be considered
Refer for PCI if symptoms started within 12 hours and can be performed within 120 minutes
Thrombolysis if PCI not available and can be performed within 12 hours of onset of symptoms

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14
Q

What medication should be given prior to PCI?

A

Duel anti placement therapy (aspirin + prasugrel/clopidogrel) and unfractionated heparin

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15
Q

How is NSTEMI Managed?

A 
GRACE risk - determines 6 month mortality 
Coronary angiography (with follow on PCI if necessary) within 72 hours if GRACE >3%
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16
Q

Complications following MI

A

Cardiac arrest - due to VF development
Cardiogenic shock
Pericarditis (within 48 hours), Dressler’s syndrome (2-6 weeks)
Left ventricular aneurysm - persistent ST elevation
Left ventricular wall rupture (occurs 1-2 weeks after)
Ventricular septal defect - pan systolic murmur, occurs in 1st week

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17
Q

What are the options for rate control within AF

A

Atenolol
Diltiazem
Digoxin - if patient has coexisting heart failure

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18
Q

What are the options for rhythm control within AF?

A

Flecanide - no structural heart disease
Amiodarone- evidence of structural heart disease
Digoxin - patients with heart failure

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19
Q

When would you consider anticoagulation in AF?

A

CHADS2VAS score:
1 for males
2 for females

If 0, then do TTE to look for evidence of structural heart disease - this is also an indication

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20
Q

What is the genetic inheritance of HOCM?

A

Autosomal dominant

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21
Q

What is the pathophysiology of HOCM?

A

Mutation in myosin chain protein
Leads to ventricular hypertophy - this leads to decreased cardiac output and increased thickness of intraventricular septum

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22
Q

What is the pulse in HOCM?

A

Bisferiens - double pulse felt due to missed aortic valve disease
Jerky pulse

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23
Q

Management of HOCM?

A 
ABCDE
A - amiodarone 
B - beta blockers
C - cardioverter defibrillator 
D - duel chamber pacemaker 
E - endocarditis prophylaxis
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24
Q

What is the heart conduction issue associated with HOCM?

A

Wolff-Parkinson white

25
Q

What is Wolff Parkinson White

A

Congenital accessory conducting pathway between atria and ventricles which leads to AV re renters tachycardia

26
Q

ECG Features of Wolff Parkinson white

A

Short PR interval
QRS slurred upstroke (delta waves)
Left axis deviation

27
Q

Management of Wolff parkinson white

A

Radiofrequency ablation of accessory pathway

28
Q

Arrthymia risk assocaited with WPW?

A

Ventricular Fibrillation

29
Q

What is Eisenmenger’s Syndrome?

A

Reversal of a left to right shunt in congenital heart defect due to pulmonary hypertension

30
Q

What is bifascicular block

A

RBBB with left anterior or posterior hemiblock

31
Q

What is trifasicular block?

A

Bifasicular block (RBBB with left anterior or posterior hemiblock) + 1st degree heart block

32
Q

How is BNP interpreted?

A

<100 - normal
>400 - high (arrange ECHO within 2 weeks)
100-400 - raised (arrange ECHO within 6 weeks)

33
Q

Drug management in heart failure

A

1st line - ACEi + beta blocker
2nd line - add spironolactone, or hydralazine with nitrate

Consider furosemide for symptomatic relief
Consider digoxin if coexistent AF

34
Q

Clinical features of pericarditis

A 
Chest pain - often relieved by sitting forwards
Non productive cough 
Dyspneoa 
Pericardial rub 
Tachycardia and tachypnoea
35
Q

ECG Features of pericarditis

A

Saddle shaped widespread ST elevation

PR depression

36
Q

Most common viral cause of pericarditis

A

Coxsackie

37
Q

Management of pericarditis

A

Treat underlying cause

NSAID and colchicine - for idiopathic or viral pericarditis

38
Q

Which valve is most commonly affected in endocarditis

A

Mitral valve

39
Q

What criteria is used for infective endocarditis

A

Dukes

40
Q

Risk factors for endocarditis

A

Rheumatic valve disease
Prosthetic valves
IVDUs
Congenital heart defects

41
Q

Management of endocarditis

A

IV abx
Staphylococcus cause - flucloxacillin
Streptococcus cause - benzylpenicillin

42
Q

Indications for valve replacement surgery in endocarditis

A

Severe heart failure
Overwhelming sepsis despite abx therapy
Recurrent embolic episodes despite abx therapy
Pregnancy

43
Q

Triad for PE

A

Pleuritic chest pain
Dyspneoa
Haemoptysis

44
Q

CXR findings in PE

A

Usually normal

Possible wedge shaped opacification

45
Q

ECG findings in PE

A

Sinus tachycardia

S1Q3T3 - large S lead I, large Q lead III, inverted T lead III (only seen in 20% of patients)

46
Q

How do you interpret the wells score?

A

> 4 points - arrange CTPA
<4 points - D dimer (if positive arrange CTPA)

If CPTA is negative then consider proximal leg vein USS

47
Q

Acute Medical management of PE?

A

1st line - apixiban or rivaroxaban

Thrombolysis - for patients with suspected massive PE (signs of circulatory failure e.g, hypotension)

48
Q

Long term management of PE

A

Provoked - continue anticoagulant for 3 months (3-6 months for active cancer)
Unprovoked - continue for 6 months

49
Q

Features of aortic dissection

A 
Central chest pain radiating to the back
Hypertension
Aortic regurgitation murmur
Weak or absent carotid, brachial or femoral pulse
Variation of >20mmHg BP between arms
50
Q

Standford Types of aortic dissection

A

Standford A - ascending aorta

Standford B - descending aorta (distal to subclavian origin)

51
Q

Management of aortic dissection

A

Type A - surgical management (control BP with labetalol while awaiting surgery)
Type B - conservative management, best rest (control BP with labetalol to prevent progression)

52
Q

Triad for cardiac tamponade

A

Becks triad:
Raised JVP
Hypotension
Muffled heart sounds

53
Q

How would a left ventricular free wall rupture present?

A 
Usually occurs 1 week post MI as complication
Cardiac tamponade 
Reduced BP
Raised JVP 
Pulsus paradoxus
54
Q

How would a ventricular septal defect present post MI

A

Occurs within first week post MI
Acute heart failure symptoms - SoB, worse when lying flat, wheezy cough
Pan systolic murmur

55
Q

Side effects of ACEis

A

Dry cough
Angiodema - may occur up to a year after starting treatment
Hyperkalaemia

56
Q

How would a ruptured papillary muscle present as a complication following MI?

A

Occurs in 1st week after
Acute mitral regurgitation - pan systolic murmur
Low BP
Acutely SoB

57
Q

What are the ECG changes associated with hypothermia?

A 
Bradycardia 
J waves - small hump at the end of QRS complex
First degree heart block 
Long QT interval 
Atrial and ventricular arrhythmias
58
Q

When should anticoagulation therapy be started in a patient with AF + acute stroke and why

A

2 weeks after the event

Any earlier and there is a risk of haemorrhagic transformation of stroke

Year 5 (17 decks)

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