Cardiology Flashcards
1
Q
Diagnostic Investigation for aortic stenosis
A
Echo
2
Q
Ejection systolic murmur best heard at the 2nd right intercostal space, at the right sternal border which radiates to the carotid arteries,
A
Aortic stenosis
3
Q
Aortic stenosis
A
Murmur is accentuated when sits upright
most common valvular heart disease in the UK
4
Q
Elderly patient with exercise intolerance
or maybe asymptomatic
A
Aortic stenosis
5
Q
respiratory alkalosis
A
Pulmonary embolism
6
Q
initial investigation for PE
A
CTPA (CT pulmonary angiogram)
7
Q
if CTPA cant be performed(renal impairment or allergy to contrast media)
A
V/Q scan
8
Q
PE
A
Immediate administration of DOAC once PE is suspected (even prior to CTPA)
9
Q
ECG changes in PE
A
S1Q3T3
SINUS TACHYCARDIA
10
Q
Gold standard investigation PE
A
Pulmonary angiography (but CTPA has replaced it now)
11
Q
First line treatment for most PE+ pts with active cancer
A
DOACS (apixaban or rivoraxaban)
3-6months
12
Q
Pt with PE + severe renal impairment{15/antiphospholipid syndrome
A
LMWH + warfarin
13
Q
first line treatment when there is massive PE when there is circulatory failure (hypotension)
A
Thrombolysis
14
Q
wells score >4 ➝
A
Immediate CTPA
15
Q
wells score ≤4 ➝
A
D-dimer test, if +ve ➝ Immediate CTPA
16
Q
absolute CI to thrombolysis
A
CNS neoplasm,aortic dissection,stroke less than 3 months,active internal bleeding
17
Q
Chest pain often relieved by sitting forwards
•Worsened by inspiration, lying flat, cough, swallowing, or movement of the trunk
A
Pericarditis
18
Q
ECG changes in pericarditis
A
Saddle shaped ST elevation(upward concavity)
PR segment depression-most specific ecg marker for pericarditis
19
Q
ECG J waves
A
hypothermia
20
Q
ECG U waves
A
hypokalemia
21
Q
Nicorandil
ivabradine ranolazine
A
Used for angina. its a potassium channel activator.
22
Q
First line treatment for angina
A
Calcium channel blocker or beta blocker
23
Q
Ivabradine
A
reduces heart rate(visual effects)
24
Q
Transient ischaemic attack(facial weakness 4days ago now fine)
A
Immediate treatment: aspirin + urgent referral to specialist (24hr) further management: Clopidogrel (first line) Carotid endarterectomy (}}70% stenosis)
25
```
Presents as palpitations(300-400)
ECG: An irregularly irregular pulse
• Absent P wave
irregular QRS complex
variable R-R intervals
```
Atrial fibrillation
26
A fib + Hemodynamically unstable
Immediate DC cardioversion
| or pharmacologic cardioversion
27
A fib Patient is hemodynamically stable
1st choice → beta-blockers or CCB (diltiazem or verapamil)
• Digoxin is used if there’s CHF
• Thromboprophylaxis is also used(warfarin plus NOACs)
28
Pansystolic murmur at apex 5th (intercostal space, left midclavicular line) which radiates to the axilla
Mitral Regurgitation
29
2-10 days post MI and the patient is
| presented with pulmonary edema or after rheumatic fever. struggles to lie flat at night
Mitral Regurgitation
Left ventricular failure: dyspnea, orthopnea and paroxysmal nocturnal dyspnea
severe MR → right sided heart failure → edema and ascites
30
Anticoagulation after A fib(lifelong) if chads score greater) age hypertension previous stroke etc
Warfarin or NOAC
| Aspirin is not recommended for reducing stroke risk in patients with A fib
31
Anaphylactic reaction
IM adrenaline O.i5 0.3 0.5 anterolateral aspect of middle third of thigh
give 2 inj 1:1000
32
no relationship b/w P waves and QRS complex
Third degree block. Cannon waves in neck. Rx pacemaker
33
Fondaparinux
activates antithrombin 3
34
Most suitable initial investigation for someone having syncopial attacks
ECG
35
ECG old MI
persistent Q waves
36
MI ECG
Hyperacute T waves:first change
ST elevation:minutes--hours
Q waves:hour---indefinitely
T wave inversion:first 24 hours to few days
37
RBBB
MarroW V1 and V6
38
LBBB
WilliaM V1 and V6
39
Wolf Parkinson white
Delta waves
40
warfarin
inhibits reduction of vit k (1972c)
CI in pregnancy but allowed while breastfeeding
target inr 2.5 (if recurrent 3.5)
SE: hemorrhage,purple toes,skin necrosis
41
Management when INR is high
Major bleeding stop warfarin give IV vit K PCC or FFP
42
Chest pain radiating to back
Hypertension
Mediastinal widening on CXR
Assymetry of pulses
Aortic Dissection
43
target BP for a well-controlled diabetic
140/90
44
First line management of heart failure
ACE I and beta blockers(decrease mortality)
45
Rx of CCF
Please note acute management is different
ACE I and beta blockers(decrease mortality)
1st line → ACE-inhibitor and beta-blocker (e.g. Carvedilol)
- DM or signs of fluid overload → start with ACE-inhibitor
- Ejection fraction ≤40% → start with ACE-inhibitor
- Angina → start with beta-blocker
• 2nd line → Spironolactone )
• manegement of symptoms : furosemide
Digoxin → Heart failure + Atrial Fibrillation
alternative agent: ivabradine
46
1st line blood test for heart failure
NT-proBNP
| high above 2000 specialist review and echo within two weeks
47
PLAB tip
Do NOT combine ARB and ACE I
48
DVLA
post MI can not drive for 4 weeks
htn continue driving
angioplasty 1 week
CABG 4 wks
post ACS 4 wks 1 wk if sucsfl angioplasty
angina- driving must cease if symptoms occur at rest
pacemaker insertion 1 wk
defibrillator 1 month to 6 months
catheter ablation post arrythmia 2 days off
aortic aneurysm more than 6.5 cm cease driving
49
ACE I SE
cough
hypotension(diuretics,aortic stenosis)
angioedema
hyperkalemia
50
hypertrophic cardiomyopathy
autosomal dominant disorder
51
hypertrophic cardiomyopathy
ejection systolic murmur increases on valsalva maneuver
52
hypertrophic cardiomyopathy ECHO
MR SAM ASH
53
Antibiotic prophylaxis for IE
not routinely recommended in the UK
54
Fever + new murmur
Endocarditis until proven otherwise
55
IE MC Causative organisms:
```
Staph aureus(IVDU)
Strept viridians(developing countries)(dental hygiene)
Staph epidermidis- prosthetic heart valves
```
56
IE DX
BE FIVE PM
57
IE RX
amoxicillin + gentamicin
MRSA or penicillin allergy: vancomycin + gentamicin
Prosthetic valves; vancomycin + gentamicin + rifampicin
58
bendroflumethiazide
no longer used diuretic for HTN
59
a girl on microgynon30,chest pain, SOB,cough,tachcardia ecg s1q3t3
(alternatively a history of long travel or immobilisation can be given)
Pulmonary Embolism
60
absent left radial pulse
Takayasu Arteritis
61
scenario post MI ejection fraction less than 40.
heart failure so give ACE I AND beta blocker
62
Pulsus Paradoxus
Cardiac tamponade
| Asthma
63
Slow rising pulse
Aortic stenosis
64
Collapsing pulse
aortic regurgitation
| PDA
65
jerky pulse
hypertrophic cardiomyopathy
66
Atypical MI
Abdominal pain plus jaw pain
67
MI diagnosis
NSTEMI we need cardiac enzymes to make the diagnosis
| STEMI ECG is essential and cardiac enzymes are not needed to make the diagnosis
68
MCC of death post MI
cardiac arrest due to ventricular fibrillation
69
VSD and MR post MI
an ECHO to differentiate because both presesnt with pan systolic murmur
70
Post MI management
CABAS
| sexual activity after 4 weeks
71
MCC valvular cause of syncopial attack
Aortic stenosis
| Dx Echo
72
Post MI stroke and persistent ST elevation
ventricular thromboembolism (aneurysm)\
73
Pt with heart failure symptoms and bradycardia:
Give atropine as SINUS BRADYCARDIA
do transvenous pacing if risk of asystole
(mobitz type 2 or complete heart block)
74
Torsades de points
Erythromycin clarithromycin ciprofloxacin amiodarone sotalol SSRIs TCA chloroquine
Rx IV MgSO4
75
Statin + erythromycin/clarythromycin
myopathy
76
First line for treatment of angina
Beta blocker and calcium channel blocker-first line
aspirin + statin should be prescribed
glyceryl trinitrate to abort
77
post PE INR 1.8
needs immediate anti coagulation with fast acting LMWH. warfarin dose also increased to 6 mg. INR should be closely monitered and LMWH discontinued when INR is normal
78
DVLA (group 2 bus or lorry) post MI
Notify DVLA stop driving for 6 weeks then DVLA will assess and decide
79
recent sore throat infection,fever,arthralgi, jerky movements, erythema marginatum
Rheumatic fever
| Dx ASO titres
80
Rheumatic fever
Pancarditis(that means including endocarditis)mitral regurgitation or mitral stenosis
81
cardiac arrest
1 mg adrenaline
82
factors which reduce BNP
ACE I, ARB diuretics
| raised levels in ckd
83
choking-
if person responds and answers encourage him to cough
if severe- 5 back blows
5 abdominal thrusts and repeat
if unconscious call ambulance and start cpr
84
starting an anti psychotic
ECG should be done to see for long QT
85
WPW syndrome
short PR interval
wide QRS complex with delta waves
axis deviations
86
does not improve mortality in CHF
digoxin diuretic
87
pt comes with chest pain first step
ECG
88
PT WITH PALPITATIONS AND MISSED BEAT
VENTRICULAR ECTOPICS
89
Pts with MI and diabetes
stop anti diabetic drugs andstart continuous infusion
90
Drugs to avoid in WPW syndrome
Ca channel blockers and digoxin
91
Rx WPW syndrome
radiofrequency ablation- first line
sotalol avoid in A fib
amiodarone
flecainide
92
NYHA class IV CCF
```
symptoms even at rest
class III comfortable at rest but less than ordinary activity results in symptoms
```
93
following a stroke
aspirin 300 mg 2 weeks
| clopidogrel 75 mg lifelong
94
Following ST elevation MI
Dual antiplatelet therapy
Beta blocker
ACE I
Statin
95
proximal aortic dissection
aortic root replacement
96
PEA and asystole are nonshockable rhythms
unresponsive to defibrillation
97
Cardiac arrest
IV adrenaline 1:10000 IV
98
beta blockers in CHF
carvedilol and bisoprolol
99
Atrial myxoma
mid diastolic murmur dyspnea syncope
100
narrow complex tachycardia
SVT
101
SVT Rx
acute management
vagal maneuvers-first line
adenosine 6,12,12 CI in asthma
cardioversion
to control future:
beta blockers
ablation
102
Pt reports 3 episodes of collapse
ECG then holter ECG
103
atenolol and verapamil
should not be prescribed together
104
A fib plus 'structural abnormality'
amiodarone(not flecanide)
105
pansystolic murmue
IE
106
muffled heart sounds,distended neck veins,hypotension
```
Becks triad(cardiac tamponade)
(chest was clear)
```
107
Indication of valve replacement in aortic stenosis
Symptomatic patients
108
SE of beta blockers
Sleep disturbances
Cold peripheries
Bronchospasm
109
pulmonary edema due to CHF
CPAP if medical intervention fails
110
Dizziness plus vertigo plus right arm pain
subclavian steal
111
VF
1 shock followed by two minutes of CPR
112
Post A fib give warfarin or NOACs
WARFARIN
113
Diuretics
Hearing loss,hypotension,hyponatremia,hypokalemia gout
114
Dx when the pt is blacking out/syncope
ECG and BP reading when pt is standing or lying down
115
statin after MI
atorvastatin 80 mg
116
straight left heart border
mitral stenosis
117
NSTEMI
anti thrombotic plus fondaparinux
118
Statins
Myopathy and liver disease (LFTS at baseline 3 months and 12months
119
Mobitz type 2 block
initial: atropine
Definitive: pacing
120
Becks triad muffled heart sounds,distended neck veins,hypotension trachea was central
cardiac tamponade most appropriate management pericardiocentesis
initial:IV fluids
121
Pulsus paradoxus
cardiac tamponade
122
QRISK greater than 10 and age less than 64
Statin
123
Family hypercholesterolemia
cholesterol greater than 7.5 and family history
124
Family hypercholesterolemia
Statin or ezetimibe
125
Papillary muscle rupture post MI
results in mitral regurgitation pansystolic murmur apex
126
3rd degree heart block atropine given whats the next step
temporary pacing(not permnanent)
127
ejection systolic murmur louder when patient sits upright
aortic stenosis
128
V fib
Pulse can not be felt
129
atrial fibrillation
atenolol
130
normal alcohol intake in the uk
less than 14 units
131
Investigation of choice for cardiac tamponade
echo
132
artey dominance in 85% of the population
RCa
133
ccb s/e
pitting edema
| gingival hyperplasia
134
atrial flutter
saw-tooth waves on V1
| can be irregular too
135
hyperkalemia greater than 6.5
Start calcium gluconate (even if no ECG changes)
| 6 to 6.4 only if ecg changes
136
hyperkalemia greater than 6.5
Start calcium gluconate (even if no ECG changes)
| 6 to 6.4 only if ecg changes
137
crepitations in both lung fields plus chf features
pulmonary edema to confirm the Dx chest x ray
| and to find the underlying cause: echo
138
unstable centre pulsatile mass plus absent femoral pulse
ruptured aortic aneurysm
139
ruptured aortic aneurysm investigation
U/S or CT
140
Medication to avoid in CKD IHD HF
NSAIDs
141
Postural hypertension diagnosis
BP monitoring(not ambulatory)
142
ventricular aneurysm
persistently raised ST
143
a new onset LBBB
MI
144
yellow haloes plus arrythmias
DIGOXIN toxicity
145
pain worse on inspiration
Pericarditis
146
young pts plus recurrent palpitations and regular pulse
SVT
147
old pts plus some heart dysfunction plusrecurrent palpitations and regular pulse
VT
148
Broad complex
VT
149
Narrow complex
SVT A fib
150
straight left heart border on CXR
Mitral stenosis(associated with A fib)
