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Medicine > Cardiology 🫀 > Flashcards

Cardiology 🫀 Flashcards

1
Q

What are 1st line anti-hypertensives?

A

ACE-i (Eg Ramipril) if under 55 or diabetic. Calcium channel blockers (Eg Amlodipine) if over 55 and not diabetic or black/Afro-Caribbean

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2
Q

Chest XR findings in Heart Failure

A

A - Alveolar oedema (bat’s wings)
B - kerley’s B lines (interstitial oedema)
C - Cardiomegaly
D - Dilated prominent upper lobe vessels
E - Effusion (pleural)

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3
Q

Causes of Pericardial Effusion

A

Right-sided heart failure
Bacterial/fungal infection
Mesothelioma
Pericardial cyst
Adenocarcinoma (MOC-31 +ve)

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4
Q

How do you treat ventricular septal defects (VSDs)?

A

Diuretics
If associated with aortic regurgitation then a high caloric diet

Follow this with closure of the defect

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5
Q

Why does valve replacement worsen symptoms of dementia?

A

Use of cardio-pulmonary bypass

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6
Q

What would you see on examination of atrial septal defects?

A

Right ventricular impulse (heave)
Wide split fixed 2nd heart sound
Soft systolic ejection murmur

ECG may show right axis deviation

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7
Q

In heart block, will the heart rate be fast or slow?

A

Slow

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8
Q

How do you manage VT?

A

Electrocardioversion

Bolus of amiodarone or lidocaine if stable and unsure of cause

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9
Q

How do you test for and treat postural hypotension?

A

Tilt test -> Attempt to provoke episode of postural hypotension (usually fainting)

Treat with high salt diet
Can give salt in tablets but don’t usually work

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10
Q

What are the ECG findings in PE?

A

S1Q3T3 or Sinus Tachycardia

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11
Q

What are the causes of high-output heart failure?

A

AAPPTT
Anaemia
Arteriovenous malformation
Paget’s dx
Pregnancy
Thyrotoxicosis
Thiamine deficiency (wet beri beri)

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12
Q

What medications cause hypertension as a SE?

A

NSAIDs, COCP, ciclosporin, carbenoloxone

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13
Q

What are the endocrine causes of secondary HTN?

A

Conn’s syndrome
Pheochromocytoma
Cushing’s
Acromegaly (too much growth hormone)
Hyperthyroidism

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14
Q

If a pt has resistant HTN, what is the management?

A

ACE-i, Ca-channel blocker + a diuretic.

If K+ >4.5 then Thiazide diuretic.
If K+ <4.5 then spironolactone.

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15
Q

What is classed as severe HTN?

A

180/120mmHg

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16
Q

What is the 1st line anyi-hypertensive in pregnancy?

A

Labetolol

Can also use Methyldopa and MR nifedipine

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17
Q

Target BP in pregnancy?

A

<140/90

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18
Q

The BP in a pregnant lady is over 160/110, how do we treat this medical emergency?

A

IV labetolol or hydralazine or MR nifedipine

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19
Q

What % of clotting factors is sufficient for clotting and what % is insufficient?

A

Sufficient = >30% (Borderline haemostasis)
Insufficient = <20% (Established haemostatic failure)

20
Q

What is the most common cardiomyopathy seen in heart transplant?

A

Dilated cardiomyopathy

21
Q

Cardiomyopathy Px?

A

Heart failure symptoms (high JVP, pulmonary oedema, dyspnoea)
Palpitations
Syncope and pre-syncope
Chest pain

HCM: can show signs of hypertrophy or Q waves (replacement fibrosis)

22
Q

Diagnosis of cardiomyopathy?

A

MRI or echo to assess myocardial structure
Heart failure diagnostic factors (Eg NT pro-BNP)
Exclude other causes (CAD, HTN, valvular dx or congenital heart dx)

HCM: wall thickness >15mm

23
Q

Management of cardiomyopathies?

A

Symptoms relief (HF or arrhythmia therapy —> ACE-i, b-blockers and diuretics)
Can do ICD implantation (to reduce the chance of sudden cardiac death)
Lifestyle modifications

In some cases, can treat the underlying cause Eg iron overload

24
Q

What are the complications of cardiomyopathies?

A

Heart failure
Stroke
Sudden cardiac death (due to arrhythmias) - most common in ACM and HCM

25
Q

What is Hypertrophic Cardiomyopathy?

A

Increased ventricular wall thickness or mass without loading conditions sufficient to cause the observed abnormality (Eg CAD, valvular dx, congenital heart dx or HTN)

Mainly genetic cause

26
Q

What is Dilated Cardiomyopathy?

A

Most commonly seen cardiomyopathy in transplant

Progressive left ventricular wall thinning and dilating accompanied by gradual functional impairment (Eg functional mitral/tricuspid regurgitation)
Can be post-myocarditis or due to alcohol

27
Q

What is ARVC (Arrhythmogenic Right Ventricular Cardiomyopathy)?

A

A genetic dx characterised my fibrofatty infiltration of the myocardium as a mechanism of repair.
Unlike DCM, there is a RV predominance due to thinner RV walls (+ :. Higher susceptibility to stresses)

28
Q

Which cardiomyopathy is most likely to arise from chronic alcohol-use disorder?

A

Dilated cardiomyopathy

29
Q

What is the initial/most common direction of shunt blood flow in a septal defect and why?

A

Left –> Right.
This is because there is a higher pressure in the left side of the heart due to it having to pump blood around the whole body, whereas right only has to fill the lungs.

A left to right shunt means blood still travels to the lungs and gets oxygenated, so the patient does not become cyanotic.

30
Q

How does a right –> left shunt come about?

A

Initially there is a left –> right shunt due to left having higher pressure, but when the extra blood increases pulmonary pressure so much it exceeds systemic pressure the direction of shunt blood flow reverses and a right –> left shunt is formed.

This causes deoxygenated blood to bypass the lungs and enter the body. This causes cyanosis.

31
Q

What is the drug Sildenafil used for?

A

Pulmonary arterial HTN +/or Erectile dysfunction

32
Q

What is the treatment for regular narrow complex tachycardias e.g. supraentricular tachycardia (SVT) if vagal manoeuvres fail?

A

IV adenosine

33
Q

What is the Rx for a polymorphic VT such as Torsade de Pointes?

A

IV Magnesium

34
Q

What is the treatment for regular broad complex tachycardias such as VT if adverse features are not present?

A

IV Amiodarone

Loading dose of 300mg over 10-12 mins, followed by an infusion of 900mg her 24hrs

35
Q

What is the initial management for narrow complex tachycardias like SVT?

A

Vagal manoeuvres

36
Q

When does a pt require DC Cardioversion?

A

If a patient with a tachyarrhythmia has adverse features (shock, syncope, myocardial ischaemia or heart failure)

37
Q

What are the most common causative organisms bacterial endocarditis?

A

Gram +ve cocci
Eg streptococcus viridans, Staphylococcus aureus (IVDU or prosthetic valves), and staphylococcus epidermis (prosthetic valves).

38
Q

In what cardiological condition do you see notching of the inferior border of the ribs on CXR?

A

Coarctation of the aorta

Due to increased pressure + :. dilated intercostal vessels and the vessels erode the inferior ribs.

39
Q

What conditions are associated with coarctation of the aorta?

A
  • Turners syndrome
  • Bicuspid aortic alvve
  • Berry aneurysms
  • Neurofibromatosis
40
Q

What are the features of coarctation of the aorta?

A
  • Infancy: Heart failure
  • Adult: HTN
    -Radio-femoral delay
    -Mid systolic murmur, loudest over back
  • Apical click
  • Notching of the inferior border of the ribs (not seeing young people)
41
Q

What drugs used in heart failure are known to worsen glucose tolerance?

A

Thiazide diuretics Eg Indapamide

NB: They also cause erectile dysfunction, gout and postural hypotension

42
Q

What is the classic Px of aortic dissection?

A
  • Tearing chest pain
  • Diastolic murmur heard loudest over 2nd intercostal space, right sternal border (suggesting aortic regurg)
  • A widened mediastinum on CXR
  • Male over 50yrs
43
Q

What is the treatment for an acute NSTEMI?

A

BATMAN!
B -Beta blockers (unless contraindicated)
A - Aspirin 300mg stat dose
T -Ticagrelor 180mg stat dose (clopidogrel 300mg is alternative if higher bleeding risk)
M -Morphine
A - Anticoagulant:Fondaparinex (unless high bleed risk)
N - Nitrates e.g. GTN to relieve coronary artery spasm

44
Q

What are the complications of MI?

A

DREAD

D-Death
R - Rupture of the heart septum or papillary muscles
E - Edema (Heart failure)
A - Arrhythmia and Aneurysm
D - Dressler’s syndrome

45
Q

What are the causes of AF?

A

SMITH
Sepsis
Mitral valve pathologies
Ischaemic heart disease
Thyrotoxicosis
Hypertension

46
Q

How can you tell if a patient is de compensating? (HISS)

A

HISS
H- heart failure
I - ischaemia
S - systolic less than 90
S - systole

Medicine (16 decks)

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