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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
What is first and second line treatment for HTN in over 55s and those who are African-Caribbean?
1st: Ca channel blocker 2nd: ACEI or ARB
26
Give 3 possible complications of HTN
CVD Cerebrovascular event Nephropathy
27
What are the 4 adverse features of tachyarrhythmia's?
Shock Syncope HF Myocardial ischaemia
28
Define atrial fibrillation
Supraventricular tachycardia with uncoordinated atrial electrical activation
29
Give 3 symptoms of AF
Palpitations SOB Chest pain
30
Give 3 risks of AF
Age HTN Diabetes
31
Outline the pathophysiology of AF
Atria dilate due to fibrosis and inflammation Causes difference in refractory periods within atria and promotes electrical re-entry
32
What does an ECG of AF show?
Absent P waves, irregularly irregular
33
Give 3 treatment options for AF
Rate control (e.g. beta blocker or rate limiting Ca channel blocker) Anticoagulation Electrical cardio version
34
Give 2 complications of AF
MI | Stroke
35
Define Wolff-Parkinson-White syndrome (a SVT)
One or more accessory pathways connects the atrium to ipsilateral ventricle and conduction reaches earlier causing pre-excitement of ventricle
36
What can be seen on an ECG in Wolff-Parkinson-White syndrome and what treatment can be used?
Delta waves Catheter ablation
37
Define ventricular tachycardia
Ventricular rhythm faster than 100bpm lasting >30 seconds or requiring termination due to haemodynamic instability
38
Give 2 causes of VT
Ischaemic heart disease | Coronary artery disease
39
What is seen on an ECG of VT?
Wide complex tachycardia (QRS>120ms)
40
What can be seen on an ECG of Torsades de Pointes?
Twisting morphology in QT prolongation and pathological U wave, commonly drug induced or due to hypokalaemia or low magnesium
41
Define Ventricular Fibrillation
Life threatening, high-frequency, irregular waves, pt. is unconscious and unresponsive to stimuli
42
Give 3 causes of ventricular fibrillation
Chronic cardiac disease MI Hypo/hyperkalaemia
43
Define sinus bradycardia and give 3 symptoms
HR<60 BPM Dizziness Syncope SOB
44
Outline the pathophysiology of sinus bradycardia
Anything causing sinus node automaticity or conduction through AV node and/or His Purkinje system can cause bradycardia
45
What drugs can be given for symptomatic bradycardia?
Theophyllines
46
What is 1st degree AV block and give 2 causes
Fixed prolongation of PR interval >0.2sec Normal in athletes/Post-MI
47
What is Mobitz type 1 and give 2 causes
Progressive prolongation of PR interval then dropped QRS Beta blockers/Inferior MI
48
What is Mobitz type 2 and give 2 causes
Consistent PR interval with intermittently dropped QRS, 3:1 or 4:1 MI/Lupus
49
What is complete heart block and give 2 causes?
No association between P and QRS Ischaemic heart disease/Post surgery
50
Give 5 signs of heart failure on a CXR
``` Alveolar oedema Kerley B lines Cardiomegaly Dilated upper lobe vessels Pleural effusions ```
51
Define heart failure
Failure to adequately perfuse tissues, characterised by systemic vasoconstriction and neurohumoral activation
52
Give 3 causes of heart failure
MI HTN Toxins e.g. alcohol
53
Give 3 symptoms of heart failure
Dyspnoea Orthopnoea Ankle swelling
54
Give 3 signs of heart failure
Displaced apex beat 3rd heart sound Elevated JVP
55
Outline the pathophysiology of heart failure
Myocardial injury LVS dysfunction Less pressure and volume Vasoconstriction/water and Na retention
56
Give 4 treatment options for heart failure
1. ACEI/ARB 2. Mineralocorticoid RA 3. Salcubitril/Valsartan (Entresto) 4. Ivabradine
57
Define endocarditis
Infection of the lining of the heart by bacterial species which leads to vegetation formation, resulting in damage to the cusp of valves
58
Give 3 types of endocarditis and the most commonly implicated organism in each
Native valve: strep viridans IVDUs: staph aureus Prosthetic valve: gram negative organisms
59
Give 4 signs and symptoms of endocarditis
Fever Murmur Splinter haemorrhage Conjunctival Petechiae
60
Give 2 risk factors of endocarditis
Male | Increasing age
61
Give 2 complications of endocarditis
Congestive HF | Systemic embolisation
62
Define postural hypotension
Fall in systolic BP of at least 20mmHg and/or 10mmHg diastolic within 3 mins of standing
63
Give 2 causes of postural hypotension
Age due to decreased autonomic buffering capacity Medications e.g. Alpha blockers
64
Give 3 symptoms of postural hypotension
Dizziness Weakness Confusion
65
Outline the pathophysiology of postural hypotension
Failure of venous return on standing resulting in decline in cardiac output
66
Give 2 treatment options for postural hypotension
Eliminate aggravating factors e.g. medications Fludrocortisone for volume expansion
67
Give 2 groups of people who may suffer from postural hypotension
Elderly Those with neurodegenerative disease
68
Define dyslipidemia
Abnormal lipid levels in blood, usually asymptomatic until cholesterol and/or triglyceride levels are severely elevated
69
Give 3 causes of dyslipidemia
Genetic Obesity Cushing's syndrome
70
Give 2 signs which may be seen on examination in dyslipidemia
Corneal arcus | Xanthelasma
71
Give 2 treatments and 2 complications of dyslipidemia
T: lifestyle advice Statins C: CVD MI
72
Define aortic stenosis and give 2 signs on examination
Increased LV pressure = LV hypertrophy Ejection systolic murmur and heaving apex
73
Define aortic regurgitation and give 2 signs on examination
Volume overload leading to LV dilatation Early diastolic murmur and collapsing pulse
74
Define mitral stenosis and give 2 signs on examination
Pressure overload = dilated LA Diastolic murmur and heaving apex
75
Define mitral regurgitation and give 2 signs on examination
Volume overload of LA/LV = dilatation Pansystolic murmur and displaced apex
76
Define cardiomyopathy and give 2 symptoms
Group of heart muscle diseases associated with mechanical and/or electrical dysfunction Dyspnoea + Palpitations
77
Name 2 types of congenital heart defect
Atrial septal defect | Patent ductus arteriosus
78
Name the 4 components of Tetralogy of Fallot
VSD Pulmonary stenosis Overriding aorta RV hypertrophy
79
Define pericarditis and list the clinical triad
Inflammation of pericardium, acute is new-onset inflammation lasting <4-6 weeks Triad: - Chest pain - Pericardial Rub - Serial electrocardiography changes
80
Give 3 risks of pericarditis
Male 20-50 years old Cardiac surgery
81
What could an ECG of pericarditis show?
Upwards concave ST segment elevation globally with PR depressions
82
Define aortic dissection
Separation has occurred in aortic wall intima, causing blood flow into a new false channel composed of inner and outer layers of media
83
Give 2 symptoms and 1 sign of aortic dissection
Acute severe CP Interscapular and lower pain Diastolic murmur
84
Give 3 risks of aortic dissection
Marfan syndrome Ehlers-Danlos syndrome HTN
85
What may an ECG and CXR show in aortic dissection?
ECG: ST depression CXR: widened mediastinum

4th Year Exam (20 decks)

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