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4th Year Exam > Cardiology ILOs > Flashcards

Cardiology ILOs Flashcards

1
Q

Define coronary artery disease

A

Inability to adequate blood supply to myocardium caused by atherosclerosis of the epicardial coronary arteries

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2
Q

Give 3 symptoms of coronary artery disease

A

Chest pain
Sweating
Jaw pain

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3
Q

Give 3 risk factors for coronary artery disease

A

Age
Smoking
HTN

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4
Q

Outline the pathophysiology of coronary artery disease

A
  1. Vascular endothelium insult
  2. Fatty streak forms
  3. Fibrous cap forms and foam cells die
  4. Thrombus forms and occludes arteries
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5
Q

Give 3 investigations of coronary artery disease

A

Resting ECG (ST changes or Q waves)

FBC for anaemia

Lipid profile for elevated LDH

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6
Q

Give 3 treatment options for coronary artery disease

A

Lifestyle modification
Antiplatelet e.g. aspirin
Statin

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7
Q

Give 3 complications of coronary artery disease

A

MI
Heart failure
Sudden death

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8
Q

Define an MI

A

Myocardial cell death occurring due to prolonged mismatch between perfusion and demand

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9
Q

What is the pathophysiology of a STEMI?

A

Complete atherothrombotic occlusion of coronary artery

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10
Q

Give 3 risk factors for an MI

A

Smoking
HTN
Diabetes

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11
Q

Name 3 investigations that can be used in a STEMI

A

ECG (new or increased persistent ST elevation in at least 2 contiguous leads)

Troponin (raised)

Lipid profile

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12
Q

What is the immediate management of a STEMI?

A

Morphine and anti-emetic
Oxygen
Nitrate (GTN)
Aspirin 300mg

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13
Q

Describe PCI in the management of a STEMI

A

Reperfusion for pt. with symptom onset <12 hours ago

Balloon catheter into groin inserts stent into coronary artery within 120 mins of STEMI diagnosis

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14
Q

Describe fibrinolysis in the management of a STEMI

A

When PCI cannot be given within 120 mins of Dx and within 2-3 hours of symptoms

e.g. Tenecteplase

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15
Q

Give 3 complications of a STEMI

A

Cardiogenic shock
Arrhythmia
Heart block

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16
Q

Give 3 secondary prevention measures for STEMI

A

Dual anti platelet
Beta blocker
Statin

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17
Q

What should new LBBB on an ECG be treated as?

A

STEMI

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18
Q

Define NSTEMI

A

Partial occlusion of coronary artery resulting in compromised blood flow to myocardium

Differentiated from unstable angina by rise in troponin

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19
Q

What does an ECG show in an NSTEMI?

A

ST depression >1mm and/or inverted T waves

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20
Q

Name 3 treatment options for an NSTEMI

A

Antiplatelet
Monitor in coronary care
Secondary prevention

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21
Q

Outline the 2 classes of hypertension

A

Stage 1: systolic 130-139 and/or diastolic 80-89

Stage 2: systolic >140 and/or diastolic >90

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22
Q

List one cause of essential hypertension and secondary hypertension

A

Essential: idiopathic

Secondary: CKD

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23
Q

Although HTN is usually asymptomatic, give 3 symptoms which may occur

A

Headache
Dizziness
Epistaxis

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24
Q

What is first and second line treatment for HTN in under 55s who are not African-Caribbean?

A

1st: ACEI or ARB
2nd: Ca channel blocker

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25
Q

What is first and second line treatment for HTN in over 55s and those who are African-Caribbean?

A

1st: Ca channel blocker
2nd: ACEI or ARB

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26
Q

Give 3 possible complications of HTN

A

CVD
Cerebrovascular event
Nephropathy

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27
Q

What are the 4 adverse features of tachyarrhythmia’s?

A

Shock
Syncope
HF
Myocardial ischaemia

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28
Q

Define atrial fibrillation

A

Supraventricular tachycardia with uncoordinated atrial electrical activation

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29
Q

Give 3 symptoms of AF

A

Palpitations
SOB
Chest pain

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30
Q

Give 3 risks of AF

A

Age
HTN
Diabetes

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31
Q

Outline the pathophysiology of AF

A

Atria dilate due to fibrosis and inflammation

Causes difference in refractory periods within atria and promotes electrical re-entry

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32
Q

What does an ECG of AF show?

A

Absent P waves, irregularly irregular

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33
Q

Give 3 treatment options for AF

A

Rate control (e.g. beta blocker or rate limiting Ca channel blocker)

Anticoagulation

Electrical cardio version

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34
Q

Give 2 complications of AF

A

MI

Stroke

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35
Q

Define Wolff-Parkinson-White syndrome (a SVT)

A

One or more accessory pathways connects the atrium to ipsilateral ventricle and conduction reaches earlier causing pre-excitement of ventricle

36
Q

What can be seen on an ECG in Wolff-Parkinson-White syndrome and what treatment can be used?

A

Delta waves

Catheter ablation

37
Q

Define ventricular tachycardia

A

Ventricular rhythm faster than 100bpm lasting >30 seconds or requiring termination due to haemodynamic instability

38
Q

Give 2 causes of VT

A

Ischaemic heart disease

Coronary artery disease

39
Q

What is seen on an ECG of VT?

A

Wide complex tachycardia (QRS>120ms)

40
Q

What can be seen on an ECG of Torsades de Pointes?

A

Twisting morphology in QT prolongation and pathological U wave, commonly drug induced or due to hypokalaemia or low magnesium

41
Q

Define Ventricular Fibrillation

A

Life threatening, high-frequency, irregular waves, pt. is unconscious and unresponsive to stimuli

42
Q

Give 3 causes of ventricular fibrillation

A

Chronic cardiac disease
MI
Hypo/hyperkalaemia

43
Q

Define sinus bradycardia and give 3 symptoms

A

HR<60 BPM

Dizziness
Syncope
SOB

44
Q

Outline the pathophysiology of sinus bradycardia

A

Anything causing sinus node automaticity or conduction through AV node and/or His Purkinje system can cause bradycardia

45
Q

What drugs can be given for symptomatic bradycardia?

A

Theophyllines

46
Q

What is 1st degree AV block and give 2 causes

A

Fixed prolongation of PR interval >0.2sec

Normal in athletes/Post-MI

47
Q

What is Mobitz type 1 and give 2 causes

A

Progressive prolongation of PR interval then dropped QRS

Beta blockers/Inferior MI

48
Q

What is Mobitz type 2 and give 2 causes

A

Consistent PR interval with intermittently dropped QRS, 3:1 or 4:1

MI/Lupus

49
Q

What is complete heart block and give 2 causes?

A

No association between P and QRS

Ischaemic heart disease/Post surgery

50
Q

Give 5 signs of heart failure on a CXR

A 
Alveolar oedema 
Kerley B lines
Cardiomegaly 
Dilated upper lobe vessels 
Pleural effusions
51
Q

Define heart failure

A

Failure to adequately perfuse tissues, characterised by systemic vasoconstriction and neurohumoral activation

52
Q

Give 3 causes of heart failure

A

MI
HTN
Toxins e.g. alcohol

53
Q

Give 3 symptoms of heart failure

A

Dyspnoea
Orthopnoea
Ankle swelling

54
Q

Give 3 signs of heart failure

A

Displaced apex beat
3rd heart sound
Elevated JVP

55
Q

Outline the pathophysiology of heart failure

A

Myocardial injury

LVS dysfunction

Less pressure and volume

Vasoconstriction/water and Na retention

56
Q

Give 4 treatment options for heart failure

A
  1. ACEI/ARB
  2. Mineralocorticoid RA
  3. Salcubitril/Valsartan (Entresto)
  4. Ivabradine
57
Q

Define endocarditis

A

Infection of the lining of the heart by bacterial species which leads to vegetation formation, resulting in damage to the cusp of valves

58
Q

Give 3 types of endocarditis and the most commonly implicated organism in each

A

Native valve: strep viridans

IVDUs: staph aureus

Prosthetic valve: gram negative organisms

59
Q

Give 4 signs and symptoms of endocarditis

A

Fever
Murmur
Splinter haemorrhage
Conjunctival Petechiae

60
Q

Give 2 risk factors of endocarditis

A

Male

Increasing age

61
Q

Give 2 complications of endocarditis

A

Congestive HF

Systemic embolisation

62
Q

Define postural hypotension

A

Fall in systolic BP of at least 20mmHg and/or 10mmHg diastolic within 3 mins of standing

63
Q

Give 2 causes of postural hypotension

A

Age due to decreased autonomic buffering capacity

Medications e.g. Alpha blockers

64
Q

Give 3 symptoms of postural hypotension

A

Dizziness
Weakness
Confusion

65
Q

Outline the pathophysiology of postural hypotension

A

Failure of venous return on standing resulting in decline in cardiac output

66
Q

Give 2 treatment options for postural hypotension

A

Eliminate aggravating factors e.g. medications

Fludrocortisone for volume expansion

67
Q

Give 2 groups of people who may suffer from postural hypotension

A

Elderly

Those with neurodegenerative disease

68
Q

Define dyslipidemia

A

Abnormal lipid levels in blood, usually asymptomatic until cholesterol and/or triglyceride levels are severely elevated

69
Q

Give 3 causes of dyslipidemia

A

Genetic
Obesity
Cushing’s syndrome

70
Q

Give 2 signs which may be seen on examination in dyslipidemia

A

Corneal arcus

Xanthelasma

71
Q

Give 2 treatments and 2 complications of dyslipidemia

A

T: lifestyle advice
Statins

C: CVD
MI

72
Q

Define aortic stenosis and give 2 signs on examination

A

Increased LV pressure = LV hypertrophy

Ejection systolic murmur and heaving apex

73
Q

Define aortic regurgitation and give 2 signs on examination

A

Volume overload leading to LV dilatation

Early diastolic murmur and collapsing pulse

74
Q

Define mitral stenosis and give 2 signs on examination

A

Pressure overload = dilated LA

Diastolic murmur and heaving apex

75
Q

Define mitral regurgitation and give 2 signs on examination

A

Volume overload of LA/LV = dilatation

Pansystolic murmur and displaced apex

76
Q

Define cardiomyopathy and give 2 symptoms

A

Group of heart muscle diseases associated with mechanical and/or electrical dysfunction

Dyspnoea + Palpitations

77
Q

Name 2 types of congenital heart defect

A

Atrial septal defect

Patent ductus arteriosus

78
Q

Name the 4 components of Tetralogy of Fallot

A

VSD
Pulmonary stenosis
Overriding aorta
RV hypertrophy

79
Q

Define pericarditis and list the clinical triad

A

Inflammation of pericardium, acute is new-onset inflammation lasting <4-6 weeks

Triad:

  • Chest pain
  • Pericardial Rub
  • Serial electrocardiography changes
80
Q

Give 3 risks of pericarditis

A

Male
20-50 years old
Cardiac surgery

81
Q

What could an ECG of pericarditis show?

A

Upwards concave ST segment elevation globally with PR depressions

82
Q

Define aortic dissection

A

Separation has occurred in aortic wall intima, causing blood flow into a new false channel composed of inner and outer layers of media

83
Q

Give 2 symptoms and 1 sign of aortic dissection

A

Acute severe CP
Interscapular and lower pain
Diastolic murmur

84
Q

Give 3 risks of aortic dissection

A

Marfan syndrome
Ehlers-Danlos syndrome
HTN

85
Q

What may an ECG and CXR show in aortic dissection?

A

ECG: ST depression

CXR: widened mediastinum

4th Year Exam (20 decks)

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