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MOSLER > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Atherosclerosis.

  1. Risk factors
  2. Medical comorbidities that increase the risk
  3. Primary prevention of cardiovascular disease
  4. Monitoring of statins
  5. When should you stop statins?
  6. Secondary prevention of cardiovascular disease
A
  1. Age, family history, smoking, diet, obesity, male, alcohol, low exercise, stress
  2. Diabetes, CKD, HTN, inflammatory conditions
  3. QRISK3. If over 10% - start atorvastatin 20mg OD
  4. Check LFTs within 3 months and at 12 months
  5. If rise in ALT/AST is more than 3 times the upper limit
  6. 4 As - aspirin, atorvastatin 80mg, atenolol, ACEi
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2
Q

Stable Angina

  1. Investigations
  2. Medical management
  3. Secondary prevention
  4. Procedural/Surgical interventions
  5. Scar seen in patients who have had CABG
  6. Scar seen in patients who have had PCI
A
  1. CT coronary angiography - gold standard.
    Physical exam, ECG, FBC, U+E, LFTs, lipid profile, TFTs,
    HbA1c and glucose
  2. GTN spray - immediate. Beta blocker, CCB -long term
  3. 4As- aspirin, atorvastatin, atenolol, ACEi
  4. PCI with coronary angioplasty, CABG
  5. Midline sternotomy
  6. Scars around brachial/femoral arteries, an along inner calves
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3
Q

ACS

  1. Symptoms
  2. ECG changes in STEMI
  3. ECG changes in NSTEMI
  4. Anterolateral area- coronary territory and leads
  5. Anterior area - coronary territory and leads
  6. Lateral area- coronary territory and leads
  7. Inferior area - coronary territory and leads
  8. Causes of raised troponins
  9. Investigations
  10. Acute STEMI treatment (definitive)
  11. Acute NSTEMI treatment
  12. Score used to assess for PCI in NSTEMI
  13. Complications of MI
  14. Secondary Prevention
  15. Type 1 MI
  16. Type 2 MI
  17. Type 3 MI
  18. Type 4 MI
A
  1. Central, crushing chest pain, N+V, sweating, feeling of impending doom, SOB, palpitations, pain radiating to jaws or arms. >20 minutes
  2. ST elevation, new LBBB
  3. T wave inversion, ST depression, pathological Q waves
  4. Left coronary artery, I, avL, V3-V6
  5. LAD, V1-4
  6. left cirumflex, avL, I, V5-6
  7. right coronary artery, II, III, aVF
  8. MI, chronic renal failure, sepsis, myocarditis, PE
  9. As for stable angina + troponins, ECG, CXR, echo, CT angiogram
  10. PCI (if available within 2 hours), thrombolysis if not
  11. Beta blockers, Aspirin 300mg, Ticagrelor 180mg, Morphine, Anticoagulant (LMWH), Nitrates, Oxygen if dropping sats
  12. GRACE score
  13. Dressler’s syndrome, Rupture of septum or papillary muscles, Edema, Arrhythmia and Aneurysm, Death
  14. 6As - aspirin, another antiplatelet, atenolol, atorvastatin, ACEi, aldosterone antagonist
  15. traditional, due to acute coronary event
  16. ischaemia secondary to increased demand or reduced supply of O2
  17. Sudden cardiac death or cardiac arrest
  18. Associated with PCI, stenting, CABG
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4
Q

Acute LVF + Pulmonary Oedema

  1. Presentation
  2. Triggers
  3. Investigations
  4. CXR Findings
  5. Management
A
  1. SOB, Type 1 respiratory failure, cough with frothy white/pink sputum, raised RR, tachycardia, reduced O2, 3rd HS, bilateral basal crackles, hypotension
  2. Sepsis, MI, Arrhythmias, iatrogenic (eg giving too much fluids)
  3. ECG, ABG, CXR, FBC, U+Es, BNP, troponin, echo
  4. Alveolar shadowing, kerley B lines, Cardiomegaly, Diversion of upper lobes, Effusion
  5. Pour SOD - stop IV fluids, Sit up, Oxygen, Diuretics
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5
Q

Chronic HF

  1. Presentation
  2. Investigations
  3. Causes
  4. Management
  5. Medical management
A
  1. SOB, cough, orthopnoea, PND, oedema
  2. BNP (NT-proBNP), echo, ECG
  3. IHD, valvular heart disease, HTN, arrhythmias
  4. Referral! Medical management, surgical, HF specialist nurse. Yearly flu and pneumococcal vaccine, lifestyle
  5. ACEi, Beta blocker, aldosterone antagonist, loop diuretics
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6
Q

HTN

  1. Causes
  2. Stage 1
  3. Stage 2
  4. Step 1 management
  5. Step 2 management
  6. Step 3 management
  7. Step 4 management
  8. Treatment target if >80
  9. Treatment target if <80
  10. Treatment target if diabetic
A
  1. Essential HTN. Renal disease. Obesity. Pregnancy-induced. Endocrine
  2. Clinic BP >140/90, ABP/HBP >135/85
  3. Clinic BP >160/100, ABP/HBP >150/95
  4. If <55 and/or diabetes = ACEi, if >55 or Afro-Carribean = CCB
    • CCB or ACEi/ARB
  6. +TLD
  7. K+ >4.5 = higher dose TLD, if <4.5 = spironolactone
  8. <150/90
  9. <140/90
  10. <130/80
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7
Q

Murmur Grades

A
  1. Difficult to hear
  2. Quiet
  3. Easy to hear
  4. Easy to hear with palpable thrill
  5. Can hear with stethoscope barely touching chest
  6. Can hear with stethoscope off the chest
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8
Q

Assessing a Murmur - SCRIPT

A
  1. Site
  2. Character
  3. Radiation
  4. Intensity
  5. Pitch
  6. Timing
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9
Q

Mitral Stenosis

  1. Causes
  2. Murmur produced
  3. Associations
A
  1. rheumatic heart disease. Infective endocarditis
  2. Diastolic, low-pitched, rumbling murmur. Tapping apex beat
  3. Malar flush. AF
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10
Q

Mitral Regurgitation

  1. Causes
  2. Murmur produced
A
  1. idiopathic. IHD, infective endocarditis, rheumatic heart disease, connective tissue disorders
  2. Pansystolic, high pitched murmur. radiates to left axilla.
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11
Q

Aortic Stenosis

  1. Causes
  2. Murmur produced
  3. Other signs
A
  1. Idiopathic age related calification, rheumatic heart disease, bicuspid valve
  2. Ejection systolic, crescendo-decrescendo
  3. radiates to carotids, slow rising pulse, narrow pulse pressure, exertional syncope
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12
Q

Aortic Regurgitation

  1. Causes
  2. Murmur produced
  3. Other signs
A
  1. Idiopathic weakness of the valve. CTDs
  2. early diastolic, soft murmur.
  3. Corrigan’s pulse
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13
Q

AF

  1. Presentation
  2. ECG findings
  3. Causes
  4. Rate control in AF
  5. Rhythm control in AF - acutely
  6. Long term rhythm control
  7. Other management
A
  1. Palpitations, SOB, syncope
  2. absent P waves, irregularly irregular, narrow QRS complex tachycardia
  3. Sepsis, Mitral valve pathology, Ischaemic heart disease, Thyrotoxicosis, Hypertension
  4. Beta blocker (1st line) CCB, digoxin
  5. Immediate or delayed cardioversion (if >48 hours, need to be anticoagulated for minimum of 3 weeks). Pharmacological - flecanide, amiodarone (if structural heart disease), electrical cardioversion
  6. beta blockers, dronedarone, amiodarone
  7. Anticoagulation
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14
Q

Arrhythmias

  1. 2 shockable rhythms
  2. 2 non-shockable rhythms
  3. Management of AF
  4. Management of atrial flutter
  5. Management of SVT
  6. Management of VT
A
  1. VT, VF
  2. pulseless electrical activity, asystole
  3. Rate control with beta blcoker or diltiazem
  4. Rate control with beta blocker
  5. vagal manouevres and adenosine
  6. Amiodarone infusion
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15
Q

Wolff-Parkinson-White Syndrome

  1. Definitive treatment
  2. ECG changes
A
  1. Radiofrequency ablation of the accessory pathway

2. Short PR interval, broad QRS, delta wave

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16
Q

Prolonged QT

  1. Causes of prolonged QT
  2. Acute management of torsades de pointes
  3. Long term management of prolonged QT syndrome
A
  1. long QT syndrome, antipsychotics, citalopram, flecainide, sotalol, amiodarone, macrolides, hypocalcaemia, hypokalaemia, hypomagnesaemia
  2. Correct cause. Magnesium infusion. Defibrillation if VT occurs
  3. Avoid meds that prolong QT. correct electrolyte disturbances, beta blockers, pacemaker or ICD
17
Q

Heart Block

  1. First degree
  2. Second Degree Type I
  3. Second degree type II
  4. Third degree
  5. Treatment of unstable bradycardia/AV block
  6. Treatment in patients with high risk of asystole
A
  1. Prolonged PR interval
  2. Prolonged PR interval, gets longer then QRS drops
  3. PR interval normal, QRS drops
  4. No relationship between P waves and QRS complexes
  5. Atropine 1st line
  6. Temporary transvenous cardiac pacing. Permanent implantable pacemaker

MOSLER (6 decks)

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