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Year 4 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is the main cause of coronary artery disease

A

atherosclerosis

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2
Q

What are the types of coronary artery disease

A
  • stable angina

* acute coronary syndrome

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3
Q

What are the types of acute coronary syndrome

A

unstable angina
NSTEMI
STEMI

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4
Q

Describe acute coronary syndrome

A

sudden, new-onset angina or increase in severity of angina

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5
Q

what is the difference pathologically between a STEMI and an NSTEMI

A

In a STEMI, the ruptured plaque occludes 100% of the lumen and causes acute transmural infarction

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6
Q

What are the main arteries supplying the heart

A
  • Right coronary artery
  • LAD
  • Left coronary artery
  • Circumflex artery
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7
Q

which artery is occluded in an inferior wall MI, and where might the pain be felt in this MI

A

Occlusion of the right coronary artery

Epigastric abdominal pain

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8
Q

What will an ECG show in posterior MI

A

ST-depression and tall R waves in V1-V3

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9
Q

What life-threatening arrhythmias may occur after an MI

A

ventricular tachycardia and fibrillation

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10
Q

What is the treatment for unstable angina/NSTEMI

A 
GTN spray
Beta-blocker
ACE-inhibitor
Ticagrelor/clopidogrel
Aspirin
Statins
Fondaparinux

+ morphine +/- anti-emetic (eg ondansetron)

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11
Q

give an example of a beta-blocker used for acute coronary sydrome

A

metoprolol IV

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12
Q

What loading dose of aspirin should be given in ACS

A

300mg

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13
Q

What management option needs to be undertaken for a STEMI

A

PCI

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14
Q

What medication should be prescribed for a STEMI

A

Aspirin 300mg loading dose

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15
Q

What would an anterior MI show on ECG

A

ST-elevation in leads V1-V3

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16
Q

What would ST depression in leads V1-V3 raise the suspicion of?

A

posterior MI

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17
Q

What is a subendocardial infarct

A

when the blood supply returns to an ischaemic area so only the inner third of the myocardium has been damaged,
This is an NSTEMI

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18
Q

What will a transmural infarct show on ECG

A

ST-elevation

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19
Q

What is a normal troponin

A

<6

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20
Q

Which investigations should be ordered for a 49M presenting with 2hr hx of chest pain and arm pain

A
  • troponin
  • FBC, U&E, LFT, TFT
  • ECG
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21
Q

Give an example of an ACE-inhibitor you would prescribe for hypertension

A

ramipril, lisinopril, perindopril

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22
Q

What are the important side-effects of ACE-inhibitors

A

persistent cough, hypotension, hyperkalaemia

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23
Q

What type of medication would you give if lisinopril was not tolerated?

A

An angiotensin receptor blocker

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24
Q

Give examples of angiotensin receptor blockers

A

Losartan

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25
Q

What additional medication should be offered to patients over 55 with hypertension

A

calcium channel blockers

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26
Q

name some calcium channel blockers

A

Amlodipine, diltiazem, verapamil

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27
Q

Which calcium channel blocker can be prescribed with bisoprolol

A

amlodipine

diltiazem and verapamil are contraindicated

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28
Q

why might a calcium channel blocker like amlodipine not be tolerated?

A

oedema

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29
Q

which type of diuretic can be offered in hypertension

A

a thiazide-like diuretic

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30
Q

Give an example of a thiazide-like diuretic

A

bendroflumethiazide, indapamide

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31
Q

What are the two types of tachyarrhythmia

A

narrow QRS complex and broad QRS complex

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32
Q

what rate is considered tachycardia

A

> 100bpm

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33
Q

What QRS complex is considered narrow

A

<120ms

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34
Q

what are the 4 types of narrow complex tachyarrhythmia`

A
  • atrial fibrillation
  • atrial flutter
  • supraventricular tachy
  • Wolf-Parkinson-White syndrome
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35
Q

What are the two types of supraventricular tachycardia

A
  • atrioventricular re-entrant tachy (AVRT)

* AV nodal re-entrant tachy (AVNRT)

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36
Q

What causes AVRT

A

accessory pathway

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37
Q

Which types of SVT is Wolff-parkinson-white syndrome?

A

AVRT

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38
Q

What causes AVNRT

A

loop in AV node

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39
Q

What ECG signs are seen in SVT

A

absent P wave/P wave inverted after QRS

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40
Q

What ECG sign is distinctive in wolff-parkinson-white

A

delta wave (slurred upstroke in QRS)

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41
Q

What is the management of atrial fibrillation

A 
Rhythm control
- amiodarone/flecanide
Rate control
- CCB, Beta blocker, digoxin
Anticoagulant
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42
Q

When should flecanide be given? When should it NOT be given

A

good in structural heart disease, BAD in ischaemic heart disease

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43
Q

What investigation MUST you do before giving flecanide

A

Echo

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44
Q

What comorbidity is digoxin particularly good for in AF

A

heart failure

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45
Q

How is atrial flutter managed

A 
Rhythm control
- amiodarone/flecanide
Rate control
- CCB, beta blocker
Anti-coag
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46
Q

What is the main difference between AF management and atrial flutter management

A

digoxin has less of a role in atrial flutter

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47
Q

What management knocks out 1/4 of SVTs?

A

Valsalva manouevre or carotid massage

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48
Q

What drug management can be given for SVT

A

adenosine

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49
Q

what should be given if SVT is adenosine resistant

A

rate control

- CCB, beta blockers, digoxin

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50
Q

What surgical management option is required in SVT? Why?

A

ablation to control the accessory pathway

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51
Q

What management option must be given if severe acute tachycardia?

A

DC cardioversion

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52
Q

What must be given before patient with AF is brought back for cardioversion?

A

anti-coagulation

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53
Q

Why must patients with AF be given anticoagulation before cardioversion?

A

risk of thrombus

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54
Q

Which tachyarrhythmia presents with no pulse and complete loss of conscioussness?

A

ventricular fibrillation

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55
Q

What is ventricular fibrillation also known as?

A

pulseless VT

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56
Q

What happens if you do not cardiovert v-fib?

A

death

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57
Q

What is the long-term management of v-fib

A

implantable defibrillator-cardioverter

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58
Q

is ventricular tachycardia pulseless?

A

may be

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59
Q

Torsades de pointes looks like v-fib, but is actually ___ with ___

A

Torsades de pointes looks like v-fib, but is actually v-tac with varying axis

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60
Q

What are the types of broad complex tachyarrhythmias

A
  • v fib
  • v tac
  • torsades de pointes
  • bundle branch block
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61
Q

What is bundle branch block

A

delay or blockage somewhere along the heart’s conduction pathway

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62
Q

V1 up, V5 down pattern on ECG is ____

A

right bundle branch block

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63
Q

In ventricular tachycardia, if there is a pulse, what medication can you give IV?

A

IV amiodarone

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64
Q

What MUST you give in torsades de pointes?

A

IV magnesium

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65
Q

What might cause torsades de pointes?

A

medication, ie macrolides

electrolyte disturbances

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66
Q

Impulses travel from the __ node to the __ node

A

impulses travel from the SA node to the AV node

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67
Q

Bradyarrhythmia is bpm

A

Bradyarrhythmia is <60bpm

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68
Q

If bradycardia is asymptomatic and >40bpm, treatment is ___

A

nothing

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69
Q

What is the treatment for symptomatic brady or brady <40bpm?

A

IV atropine or insertion of temporary pacing wire

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70
Q

What are symptoms of bradycardia?

A
  • lightheadedness
  • syncope/presyncope
  • fatigue
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71
Q

What are the three types of AV block

A

First degree AV block
Second degreer (Mobitz) AV block
Complete (third degree) block

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72
Q

What are the ECG changes on first degree AV block

A

prolonged PR interval

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73
Q

What are the types of second degree AV block

A

Mobitz type I and type II

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74
Q

What are the ECG changes on Mobitz type I

A

Progressively prolonging PR interval culminating in non-conducted P wave (dropped QRS complex)

75
Q

What are the ECG changes on mobitz type II

A

Non-conducted P wave without progressively prolonging PR interval

76
Q

How is the relationship between the non-conducted P wave and the PR intervals described in Mobitz type II block

A

1:1, 2:1, 3:1 etc

77
Q

What is third degree AV block

A

Complete heart block

78
Q

What ECG changes are seen in complete heart block

A

no relationship between atrial and ventricular contraction

79
Q

What is a long-term management option for AV block?

A

permanent pacemaker

80
Q

What is systolic dysfunction

A

heart failure with reduced ejection fraction
enlarged ventricles fill adequately but do not empty into the vessels adequately, reducing the blood ejected from the ventricles

81
Q

What % is considered reduced ejection fraction?

A

<40%

82
Q

What is diastolic dysfunction?

A

HF with preserved ejection fraction

Blood fills into small ventricles, which then pump most of that blood back out into the vessels

83
Q

What are common causes of HF with reduced ejection fraction?

A
  • ischaemic heard disease
  • chronic HTN
  • dilated cardiomyopathy
84
Q

What are common causes of HF with preserved ejection fraction?

A
  • ventricular hypertrophy
  • sarcoidosis
  • HTN with left ventricular hypertrophy
85
Q

What cases right ventricular dysfunction

A
  • left ventricular dysfunction

* increased pulmonary artery pressure (pulmonary stenosis, COPD)

86
Q

What can cause increased pulmonary artery pressure

A

COPD, pulmonary artery stenosis

87
Q

What can cause left ventricular dysfunction?

A
  • coronary artery disease
  • HTN
  • MI
88
Q

What are symptoms of decompensated heart failure?

A
  • dyspnoea
  • orthopnoea
  • paroxysmal noctural dyspnoea
  • pulmonary oedema
89
Q

What signs of heart failure would you find on cardiovascular examination?

A
  • raised jugular venous pressure
  • Heart sound 3
  • peripheral oedema
90
Q

What signs of heart failure would you find on a respiratory + abdominal exam

A
  • signs of pulmonary oedema/pleural effusion
  • ascites
  • hepatojugular reflex
91
Q

What investigations would you order for suspected heart failure?

A
  • BNP
  • CXR
  • Echo
92
Q

What signs of heart failure could you see on CXR

A
  • cardiomegaly
  • pleural effusion
  • Kerley B lines
93
Q

What treatment could you give for heart failure?

A
  • diuretics
  • ace-inhibitors (or ARBs if not tolerated)
  • beta blocker
  • digoxin
  • possibly anticoagulation
94
Q

Why would you give anticoagulation in heart failure?

A

If the patient had AF or a history of thromboembolism

95
Q

What is infective endocarditis

A

an infection of the endocardium, usually caused by bacteria colonising a thrombus on an area of damage

96
Q

Where does infective endocarditis most commonly occur

A

tricuspid valve is affected in 50% of cases

97
Q

What are some predisposing factors for infective endocarditis?

A
  • IVDU
  • prosthetic valve
  • valvular disease
  • surgery
  • poor dental hygience
98
Q

What are the two types of endocarditis presentation

A

acute and subacute

99
Q

What kind of patient is predisposed to subacute endocarditis

A

patients with structurally abnormal valves: valvular disease or prosthetic valves

100
Q

Fever and new murmur should be treated as ___ until proven otherwise

A

fever and new murmur should be treated as infective endocarditis until proven otherwise

101
Q

What are the potential complications of infective endocarditis?

A
  • local destruction (may cause valve regurgitation or stenosis in particularly large vegetations)
  • septic emboli - may cause infections or thromboemboli
  • type III autoimmune reactions - may cause glomerulonephritis
102
Q

What investigations should be conducted in suspected infective endocarditis

A
  • blood cultures - 3 sets from different sites at different times
  • FBC - shows raised inflammatory markers
  • urinalysis - shows microhaematuria
  • CXR - may show cardiomegaly
  • ECG - may show PR lengthening
  • Echo - vegetations
103
Q

What are the two types of echocardiogram? Which is most sensitive for vegetations?

A

TTE - thransthoracic echo

TOE - transoesophageal echo - this is more sensitive

104
Q

What antibiotics should be prescribed for infective endocarditis?

A

Whatever the sensitivies are

  • blind treatment for native valve is amox + gent
  • blind treatment for prosthetic valve is vanc + gent + rifampicin
105
Q

What is the most common bacteria found in infective endocarditis?

A
  • strep viridans

* then staph aureus

106
Q

What are Dukes major criteria for infective endocarditis

A
  • 2 positive cultures for a typical bacteria
  • consistent (>3) positive cultures
  • evidence of endocarditis on echo
107
Q

What are Dukes minor criteria for infective endocarditis

A
  • fever
  • immunological signs (eg glomerulonephritis)
  • vascular phenomena (eg janeway lesions)
  • positive cultures that don’t fit the major criteria
  • predisposing heart condition/IVDU
108
Q

What combination is needed for a positive dukes criteria

A

2 major
1 major + 3 minor
5 minor

109
Q

Clubbing is seen in ____ infective endocarditis

A

finger clubbing is seen in subacute infective endocarditis

110
Q

What hand signs might be seen in infective endocarditis?

A
  • finger clubbing (subacute)
  • splinter haemorrhages
  • Osler’s nodes/janeway lesions
111
Q

What is the difference between osler’s nodes and janeway lesions?

A

osler’s nodes are painful, janeway lesions are not

112
Q

What might be heard on listening to the heart in infective endocarditis?

A

new murmur - typically a new regurgitative murmur although stenosis can occur in very large vegetations

113
Q

What is heart sound S3 indicative of?

A

heart failure

114
Q

What is postural hypotension

A

transient fall in BP when a patient moves from sitting/lying to standing

115
Q

how is postural hypotension diagnosed

A

by doing a lying and standing blood pressure

A drop of >20mmHg along with symptoms when a patient stands is diagnosed as postural hypotension

116
Q

High levels of the lipid ____ in the blood are strongly correlated with coronary artery disease

A

High levels of LDLs in the blood are stongly correlated with coronary artery disease

117
Q

Which type of lipoprotein is protective against coronary artery disease?

A

HDLs (high density lipoproteins)

118
Q

What is the main medical treatment for hyperlipidaemia

A

statins

119
Q

What is the most common cause of mitral valve regurgitation

A

mitral valve prolapse

120
Q

What kind of murmur would mitral regurgitation cause

A

a systolic murmur

121
Q

What is mitral regurgitation

A

incomplete closure of the mitral valve allowing blood to flow back from the left ventricle to the left atrium during systole

122
Q

What can be some causes of mitral regurgitation

A
  • connective tissue disorders (eg marfan’s)
  • cardiomyopathy
  • left-sided heart failure
  • post MI changes
123
Q

What are some symptoms of mitral regurgitation

A
  • dyspnoea
  • fatigue
  • palpitations
  • infective endocarditis
124
Q

what signs of mitral regurgitation might you find on examination

A
  • displaced, hyperdynamic apex

- systolic murmur

125
Q

The more severe the mitral regurgitation, the ____ the left ventricle

A

the more severe the mitral regurgitation, the larger the left ventricle

126
Q

what test is diagnostic of mitral regurgitation?

A

echo

127
Q

What is the most common cause of mitral valve stenosis

A

rheumatic fever

128
Q

Describe the pathogenesis of mitral valve stenosis leading to right-sided heart failure

A

Stenosis of the mitral valve causes congestion in the left atrium which causes increased pressure in the pulmonary circulation, which backs up into the right ventricle, causing right sided heart failure

129
Q

How might mitral stenosis cause atrial fibrillation

A

stretching of the cells in the enlarged left atrium can cause atrial fibrillation

130
Q

What are some symptoms of mitral stenosis

A
  • dyspnoea
  • orthopnoea
  • dysphagia
  • haemoptysis
131
Q

What signs might you find in mitral stenosis

A
  • malar flush
  • ‘snap’ sound at S2 and diastolic rumble before S1
  • signs of pulmonary congestion
132
Q

Why might mitral stenosis cause malar flush

A

due to decreased cardiac output

133
Q

What is aortic stenosis?

A

incomplete opening of the aortic valve

134
Q

What is the most common cause of aortic stenosis?

A

senile calcification

135
Q

What is the classic triad of symptoms in aortic stenosis?

A
  • syncope
  • angina
  • signs of heart failure
136
Q

Explain the pathophysiology of the classic triad of symptoms in aortic stenosis

A

not enough blood is pumped out of the left ventricle so the organs are hypoperfused, causing syncope and angina, and eventually signs fo heart failure

137
Q

What changes happen to the left ventricle in aortic stenosis? why?

A

more pressure is required to expell blood from the left ventricle through the stenosed valve, so the left ventricle undergoes hypertrophy

138
Q

What is the murmur heard in aortic stenosis?

A

ejection systolic murmur (a classic snap noise) radiating to the carotids

139
Q

What is aortic regurgitation?

A

aortic insufficiency. The aortic valve closes incompletely, allowing blood to flow backwards into the left ventricle

140
Q

What happens to the left ventricle in aortic regurgitation?

A

It becomes enlarged

141
Q

give a cause of aortic regurgitation?

A

infective endocarditis

142
Q

What kind of murmur is heard in aortic regurgitation?

A

an early diastolic murmur

143
Q

What happens to the blood pressure in aortic regurgitation?

A

The systolic blood pressure increases and diastolic decreases, causing a wide pulse pressure

144
Q

What causes the ‘water hammer’ pulse in aortic regurgitation?

A

The wide pulse pressure

145
Q

What other signs would you see in aortic regurg?

A
  • water-hammer pulse
  • Quincke’s sign
  • Carotid pulsation
  • head bobbing with pulse
146
Q

What is Quincke’s sign?

A

capillary pulsation in nail beds in aortic regurgitation

147
Q

what are the three main types of cardiomyopathy?

A
  • dilated cardiomyopathy
  • hypertrophic cardiomyopathy
  • restrictive cardiomyopathy
148
Q

what is the most common type of cardiomyopathy?

A

dilated cardiomyopathy?

149
Q

What happens in dilated cardiomyopathy?

A

enlarged ventricles result in poor systolic function

150
Q

What is the presentation of dilated cardiomyopathy?

A
  • dyspnoea
  • fatigue
  • pulmonary oedema
  • right ventricular failure
  • ventricular tachy
  • atrial fibrillation
151
Q

What usually causes hypertrophic cardiomyopathy?

A

genetic causes

152
Q

____ cardiomyopathy is a leading cause of sudden death in the young

A

hypertrophic cardiomyopathy is a leading cause of sudden death in the young

153
Q

how does hypertrophic cardiomyopathy cause sudden death?

A

hypertrophic ventricles cause left ventricular outflow tract obstruction (LVOTO) which causes blood not to get into the aorta

154
Q

Why might hypertrophic cardiomyopathy cause angina?

A

increased oxygen demand of hypertrophic cardiac muscles

155
Q

What are some symptoms of hypertrophic cardiomyopathy

A
  • angina
  • palpitations
  • syncope
  • sudden death
156
Q

What happens in restrictive cardiomyopathy

A

ventricle walls become stiffened, so they do not fill properly in diastole

157
Q

(diastolic/systolic) function can be normal in restrictive cardiomyopathy

A

systolic function can be normal in restrictive cardiomyopathy

158
Q

Describe ventricular septal defect

A

an abnormal opening in the heart between the two ventricles

159
Q

is ventricular septal defect a cyanotic congenital heart condition? why?

A

No

The blood shunts from left-to-right, so deoxygenated blood will not flow into the left ventricle and through the aorta

160
Q

What are the complications of ventricular septal defect?

A
  • right ventricular hypertrophy

* pulmonary HTN

161
Q

What is atrial septal defect?

A

Where a hole exists between the artium, causing shunting of blood from the left atrium to the right

162
Q

When is atrial septal defect commonly discovered?

A
  • coincidentally

* in late adulthood with dyspnoea/heart failure

163
Q

What symptoms might an adult with atrial septal defect have?

A

dyspnoea or heart failure

164
Q

What genetic condition predisposes to atrial septal defect?

A

down’s syndrome

165
Q

How might atrial septal defect lead to cyanosis?

A

left-to-right shunt might cause pulmonary hypertension which then causes increased right heart pressure which would cause the shunt to reverse, causing cyanosis

166
Q

what is a common complication of bicuspid aortic valve?

A

aortic stenosis

167
Q

What murmur might be heard in atrial septal defect?

A

split S2

168
Q

What is coarctation of the aorta?

A

a congenital narrowing of the aorta typically distal to the left subclavian artery

169
Q

what does coarctation of the aorta cause?

A

raised blood pressure in the upper extremities and low BP in the lower extremities

170
Q

What is the pericardium

A

the protective sac around the heart

composed of an outer fibrous and inner serosal layer

171
Q

Give some causes of secondary pericarditis

A

EBV, HIV, staphylococcus, TB, fungal infection, neoplasm, rheumatoid arthritis

172
Q

What are the symptoms of pericarditis

A
  • dyspnoea (worse on lying flat or inspiration)

* may have fever

173
Q

What might you hear on auscultation with pericarditis

A

pericardial friction rub

174
Q

What will an ECG in pericarditis look like

A

NSR or saddle-shaped ST elevation

175
Q

What is treatment for pericarditis

A

treat underlying cause

176
Q

what is a pericardial effusion?

A

fluid accumulation in the pericardial sac

177
Q

what causes pericardial effusion

A

any cause of pericarditis

178
Q

what signs are seen in pericardial effusion

A
  • dyspnoea

* raised JVP

179
Q

What is a haemopericardium

A

blood in the pericardial sac

180
Q

What is cardiac tamponade

A

fluid in the pericardial sac causes the ventricles to fill insufficiently, causing poor cardiac output
It is a medical emergency

181
Q

What is aortic dissection

A

tearing of the inner layer of the aorta, allowing blood to pool there causing haemorrhage and occlusion of the vessels distally

182
Q

What might someone present with aortic dissection

A

a sudden sharp pain radiating to their back

183
Q

What would uneven pulses indicate

A

aortic dissection

Year 4 (13 decks)

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