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Year 3 > Cardiology Qs > Flashcards

Cardiology Qs Flashcards

1
Q

What drugs can cause torsades de pointes

A

Macrolides [-mycin] e.g. azithromycin/ erythromycin

Antiarrhythmics e.g. amiadarone, sotalol

Tricylic antidepressants

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2
Q

Which drugs is contraindicated in a patient with ventricular tachycardia

A

Verapamil

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3
Q

What arrythmia can a subarachnoid haemorrhage cause?

A

Bleed = tosardes de pointes *polymorphic ventricular tachycardia

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4
Q

Why can heart block occur following and MI?

A

basc in a STEMI you can get heart block features. such as LBBB. But also in the occlusion of the RCA so the inferior leads are affected, the AV node has become ischaemic = block

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5
Q

What is the preferred route of access for a primary PCI?

A

Radial access

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6
Q

Usually Prasugrel is given when arranging for an urgent PCI for MI, when is clopidogrel given instead?

A

If the patient is already taking an oral anticoagulant e.g. apixiban, give clopidogrel

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7
Q

Complication of post MI:

  • weeks after MI
  • persistent ST elevation
  • Bibasal crackles
  • 3rd + 4th heart sound
A

Left ventricular aneurysm

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8
Q

Complication of post MI:

  • within 48 hours
  • chest pain
  • Muffled heart sounds
A

Left ventricular free wall rupture

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9
Q

What is special about a posterior STEMI on ECG?

A

Will only be depression noted on V1-V3
this is because on a 12 lead elevation will not be noticible

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10
Q

When is angioplasty with stenting done for limb ischaemia?

A

if the stenosis in leg is focal or limited to a small area e.g. a thrombus

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11
Q

When is open bypass graft done for a patient with limb ischaemia?

A

if the vascular block is long or multifocal, best revascularisation option is open bypass graft

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12
Q

CXR should be done for PE, when?

A

CTPA is crutial to do after WELLs score, do CXR prior to this to rule out other pathologies

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13
Q

Can a CTPA for a PE be done without contrast

A

no cause u wont see nothing so its not diagnostic, if someone is allergic to contrast cannot do this at all, so give DOAC whilst waiting for next best option which is V/Q scan

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14
Q

when to stop the pill before surgery to reduce PE risk?

A

4 weeks

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15
Q

Common organism if infective endocarditis is <2 months post valve surgery?

A

staphylococcus epidermidis

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16
Q

infective endocarditis organism - hx with dental procedure/poor hygiene

A

streptococcus viridans

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17
Q

infective endocarditis organism linked with colorectal cancer?

A

streptococcus bovis

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18
Q

ARCC risk factors for aortic stenosis

A

A - advanced age
R - rheumatic fever
C - congenital bicuspid
C - chronic kidney disease

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19
Q

SADDD aortic stenosis sx

A

exertion syncope
angina
exertion dyspnoea
dizzy
decreased exercise tolerance

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19
Q

SADDD aortic stenosis sx

A

exertion syncope
angina
exertion dyspnoea
dizzy
decreased exercise tolerance

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20
Q

BPM for atrial fib

A

300-600bpm

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21
Q

Most common cause for Afib?

A

Ischaemic heart disease

( risk factor - advancing age )

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22
Q

pulmonary sign for ventricular tachy?

A

Bibasal crackles (oedema)

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23
Q

drug causes for Vtach?

A

Amiadarone
tricyclic antidepressant
erythromycin

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24
Q

ECG for Brugada?

A

Massive convex ST elevation followed by a negative T wave

elevated is 2mm+ and seen in 1+ Leads from V1-V3

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25
Q

most important cause of Vtach clinically

A

hypoK then hypoM

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26
Q

gut stroke?

gut angina?

colicky abdo pain + diarrhoea + fever but also rectal bleed?

A

gut stroke - good way to recall acute mesenteric ischaemia

gut angina - describes chronic mesenteric ischaemia well

rectal bleed alongside these hypoperfusion symptoms = ischaemic colitis

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27
Q

investigation for a pregnant women with PE and a wells score of 4+?

A

A wells score of 4+ = CT pul angiogram BUT cannot do this in pregnant ( or renal impairment or contrast allergy)

Do V/Q scan

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28
Q

gas gangrene organism

A

clostidium perfringes

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29
Q

wet vs dry gangrene management

A

wet - surgical debridement + broad spec abx

dry - IV heparin + surgical revasc, consider amputation is non viable

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30
Q

aortic aneurysm screening imaging?
aortic aneurysms rupture imaging?
stable px aortic dissection imaging ?
unstable px aortic dissection imaging?

A

aortic aneurysm screening imaging?
- USS (male 65+)

aortic aneurysms rupture imaging?
- CT angio

stable px aortic dissection imaging ?
- CT angio

unstable px aortic dissection imaging?
- Echo

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31
Q

if acute heart failure is not responding to tx (oxygen, furosemide?

A

CPAP

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32
Q

myocarditis summary?

A

Usually viral hx (flu like illness) in a younger patient

Coxsackie virus is key

acute chest pain
pulmonary oedema
bilateral infiltrates on CXR
ECG may show ST elevation + troponin etc elevated

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33
Q

Pericardial disease summary

A

Acute 4-6 weeks (coxsackie virus)

Chronic 3+ months –> leads to constrictive pericarditis (elevated JVP, positive kussmaul’s, heart failure)

cardiac tamponade –> worst, Becks triad of raised JVP, decrease BP, muffled heart sounds, pulsus paradox

A while after MI - autoimmune drusslers

Kidney failure - uraemic pericarditis

Signs = chest pain better on leaning forward, pericardial rub, signs of heart failure if bad

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34
Q

triad haemochromatosis?

A

Arthralgia
erectile dysfunction
fatigue

+
tanning/bronze skin

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35
Q

Aortic stenosis sounds (mumurs, radiation, heart sounds, pulse signs)

A

Ejection systolic murmur

radiates to carotids

Soft S2 sound

Slow rising carotid pulse
Narrow pulse pressure

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36
Q

Mitral stenosis sounds, murmurs, radiation, other signs?

A

Distolic mumur, low pitch rumble

radiates to apex

palpable apex beat - S1

malar flush

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37
Q

mitral regurgitation murmur, radiation, sounds

A

pansystolic murmur, heard as ‘blowing’

into th axilla

quiet S1 due to valve closure issue

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38
Q

Mitral regurgitation ECG?

A

P mitrale (broad notched P wave due to atrial enlargement)

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39
Q

Aortic regurgitation mumur, accentuation, pulse signs, other signs

A

early diastolic murmur, high pitched

px leaned forward over aortic area

widened pulse pressure + collapsing pulse

  • traube’s sign pistol shot bruit femoral artery
  • muller’s sign - pulsation uvula
  • quinke’s sign - pulsation of the nailbeds
  • de musset sign - head bopping
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40
Q

STEMI mx

A

Aspirin 300mg

PCI possible in 2 hours?
Yes = do it and give prusugrel (clopi if already on anticoag)

No = Thrombolysis with alteplase + antithrombin

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41
Q

Unstable angina/NSTEMI mx?

A

Aspirin 300mg + fondaparinux *

Calculate GRACE score

<3%: aspirin + ticagrelor (or clopi if risk)

> 3%: angiography with PCI in 72 hrs, again give aspirin + ticagrelor

  • do not give fondaparinux in a very high bleeding risk or if PCI is to happen immediately, in that cayse give aspirin + unfractionated heparin ( can reverse easily with protamine sulfate)
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42
Q

Long term mx ACS (secondary prevention post MI)

A

Dual antiplatelet therapy, ACEi, Beta blocker, stain 80g

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43
Q

LBBB in?

A

New heart block in Stemi

LBBB = ‘William’ = W in V1, M in v6

( in comparison RBBB thing ‘MaRRoW’ = M in V1, W in v6

44
Q

Stanford classification for dissection is A (ascending) or B (descending aorta)

DeBakey classification?

A

Type I - ascending + descending
Type II - only ascending
Type III - only descending

45
Q

Pulse signs in dissection?

A

Assymetrical BP and pulse between arms

weak/absent carotid/brachial/femoral

radio-radial delay

aortic regurg can start

46
Q

CT angio is 1st line for dissection, why may it not happen?

A

In unstable patient who cant get to CT scanner, do transoesophageal echocardiography

47
Q

When is rhythm control done before rate control for AF?

A

When there is a clear reversible cause of the AF

48
Q

CHA2DS2VASc score factors?

score 0 = no tx
score 1 = anticoag men
score 2 = anticoag all

(DOAC preferred to warfarin for AF)

A

Embolic event = 2
Age 75+ = 2
Congestive HF = 1
Hypertension = 1
Age 65 - 75 = 1
Diabetes = 1
Vascular disease =1
Female = 1

49
Q

Orbit score factors?

A

Haemoglobin
Age 74+
Bleeding history
Renal impairment
on antiplatelet

50
Q

1st degree heart block?

A

Prolonged conduction through AV node (1 large square)

usually asymptomatic

51
Q

2nd degree heart block?

A

split into

  • Mobitz I = progressive prolonation resulting in on Atrial impulse not getting conducted

this may br a normal variant on athelete ecg

  • Mobitz 2 - intermittent or regular failure of conduction, may cause stokes adams attacks
    intermittently a P wave is not followed by a QRS (PR interval is constant)
52
Q

3rd degree heart block?

JVP sign

A

Complete block, no relationship between atria and ventricles contracting

JVP = cannon A waves, bradycardic px

This may happern after right coronary artery occlusion MI

53
Q

antiphospholipid syndrome?

A

predisposition to venous and arterial thrombosis
recurrent fetal loss + thrombocytopenia

secondary to SLE or primary issue

  • anticardiolipin antibodies
  • anti-beta2 glycoprotein I (anti-beta2GPI) antibodies
  • prolonged APTT
54
Q

What 4 arrhythmias can cause cardiac arrest?

A

Ventricular fib
Pulseless VT
PEA (normal ecg, no pulse)
asystole

55
Q

Mx for shockable rhythm cardiac arrest? (pulseness VT/VF)

A

CPR30:2 then defibrillate

CPR 2 mins

IV adrenaline after 3rd shock then every other cycle

persisting - IV amiodarone 300mg

56
Q

Mx for non shockable rhythms cardiac arrest?

A

CPR 2 minutes

IV adrenaline 1mg then after every other cycle

Atropine once if beat falls below 60bpm

57
Q

Homan’s sign?

A

Calf pain on dorsiflexion of foot for DVT

58
Q

gas gangrene caused by

A

clostridium perfringes

59
Q

ACEi side effects?

A

Angioedema
cough
elevated potassium

renal impairment if rental artery stenosis occurs

60
Q

Infective endocarditis ix?

A

diagnostic and first line = transthoracic echocardiogram - can see mobile vegetations

Most sensitive = transoesophageal echocardiogram.

61
Q

infective endo indication for surgery?

A

PR prolongation

62
Q

young patient following cocaine use can do what to their colon?

A

Ischaemic colitis : colicky abdo pain, rectal bleed, diarrhea, fever

63
Q

Poor prognosis in pericarditis?

A

Large pleural effusion 20mm+
High fever 38<
Subacute course
failure to respond to NSAIDs in 7 days

64
Q

leriche syndrome

A

Differentetial wen considering peripheral vascular disease

aortoiliac occlusive disease, causes buttock claudication, impotence, weak/absent pulses

65
Q

endovascular revascularisation e.g. angioplasty vs bypass for Critical limb ischaemia?

A

10cm bigger = angioplasty
10cm smaller = bypass

66
Q

medications a person with Claudication should be on?

A

excersize +

clopidogrel 75mg
statin 80mg

67
Q

Pulmonary HTN measurement?

A

mean pulmonary arterial pressure of 20+ at rest

68
Q

Signs of pulmonary HTN?

A

RHF signs

parasternal heave = right ventricular hypertrophy

Loud S2

early diastolic murmur = pulmonary regurg

69
Q

transthoracic echo is 1st line in all px with pulmonary HTN but what is the confirmatory test?

A

Right heart catherisation, will show the mPAP as 20mmHg+ and extent of disease

70
Q

tall R wave in V1?

A

Sign of Right ventricular hypertrophy

71
Q

first line pulmonary vasodilator therapy for patients with idiopathic pulmonary HTN and no signs of RHF?

A

Calcium channel blocker (CCB)

72
Q

Why may tricuspid regurg happen?

A

IE in IV users

RV dilation due to pul HTN

Rheumatic fever

73
Q

why may tricuspid stenosis occur?

A

Rheumatic fever, alongside another valve affected

74
Q

What causes pulmonary stenosis?

A

tetrology of fallot (congenital)

75
Q

murmurs:

tricuspid regurgitation?
tricuspid stenosis?
pulmonary rugurgitation?
pulmonary stenosis?

remember these right sided murmurs will be louder on inspiration

A
  • pansystolic murmur
  • early diastolic murmur
  • decrescendo murmur in early diastole
  • ejection systolic murmur
76
Q

vasovagal syncope key features?

A
  • short post ictal phase
  • twitching of limbs blackout
  • volume expansion by inc salt and fluid
  • may give fludrocortisone (corticosteroid)
77
Q

vasovagal syncope key features?

A
  • short post ictal phase
  • twitching of limbs blackout
  • volume expansion by inc salt and fluid
  • may give fludrocortisone (corticosteroid)
78
Q

venous ulcers summary

A

Large, shallow, kinda/not rlly painful, superior to MEDIAL malleoli

less pain when elevated

signs of venous insufficiency

  • normal ABPI
  • duplex USS

MX = compression bandaging to reduce venous stasis C/I in arterial disease!!!

79
Q

If CTPA is done for a PE but is negative what next?

A

Consider proximal leg ultrasound if DVT is suspected instead of PE

80
Q

How to treat MI secondary to cocaine use?

A

Benzodiazepine

81
Q

Stable angina 1st ix

stable angina 1st mx?

A

Ct coronary angio

Beta blocker or CCB
( if want to give two can give amlodipine with Beta blocker, not verapamil / Diltiazem)

82
Q

A px with MI risk factors has a collapse and a hx of diabetes?

A

Silent MI in Diabetics

83
Q

PAILS?

A

Posterior Anterior
Inferiors Lateral

E.g. posterior lead elevation will have anterior lead depression

84
Q

Aortic dissection Type A = surgery

Type B mx?

A

IV labetalol
Bed rest

85
Q

Supraventricular tachycrdia ECG?

mx?

A

narrow complex, no p waves, regular

mx : 1 = vagal manouvres
2 = IV adenosine 6mg, 12mg, 12mg

use verapamil in asthmatics

86
Q

SVT vs VT?

A

Narrow QRS = <120ms

broad QRS = 120ms<

87
Q

VT mx if stable

VT mx if unstable

torsades de points mx (if stable)

A

IV amiadarone

DC cardioversion

IV Mg sulfate

88
Q

Arterial ulcers location

A

Lateral malleolus, toe tips,

well demarcated, night pain

IX with USS and ABPI

89
Q

Heart failure first line Ix?

A

BNP

echo for diagnosis

90
Q

Heart faliure Xray features?

A

Alveolar Oedema
Kerly B lines
Cardiomegaly
Diversion of blood to upper lobe
Pleural Effusion

ABCDE

91
Q

Heart failure clinical diagnosis made using?

A

Framingham criteria

Need two Major
1 Major two minor

92
Q

Cardiac arrest reversible causes?

A

4Hs

Hypoxia, Hypothermia, hypo/erK, hypovolaemia

4Ts

Toxins, Thrombosis, tension pneumothorax pea, tamponade

93
Q

acute heart failure mx?

A

Oxygen, morphine, sit up patient
IV furosemide
if shock -> Ionotrope (dobutamine)

94
Q

chronic heart failure mx?

A

ACEi, Beta Blocker, spironolactone

95
Q

patient with gout has HTN, needs more meds, which HTN med is C/I?

A

Thiazide diuretics

go straight to alphablocker vs spironolactone

96
Q

HyperT retinopathy (organ damage assessment) ?

A

Silver wiring
AV nipping
Flame haemorrhage + Cotton wool spots
Papilloedema

in that order going from G1-G4 staging

97
Q

Major dukes criteria?

A

Blood culture typical organism, 2 in 12 hrs

Imaging - echo, new regurg

98
Q

IE mx
- broad
- Staph A native valve
- Staph A prosthetic valve

A
  • amoxicillin
  • flucloxacilin
  • flucloxacillin + rifampcin + gentamicin
  • for viridans in teeth issues give benzylpenicillin
  • for epidermidis use vancomycin
99
Q

Intestinal ischaemic Ix?

Ischaemic colitis ix?

A

CT for all

do CT, but on barium AXR - thumbprinting also seen

100
Q

What can cause secondary mitral regurg?

A

Post MI papillary wall rupture

101
Q

Fontaine stages?

A

For claudication

1 = no symptoms
2 = exertion pain
- 2a = can walk 200m+
- 2b = cannot walk 200m+
3 = ischaemic pain at rest
4 = necrosis, ulcers, gangrene

102
Q

artery affected for calf pain
for butt/thigh pain

A
  • femoral artery
  • iliac artery
103
Q

Ix for PAD?

A

for claudication / chronic = USS

for acute limb = arterial doppler -> CT angio site confirmation = surgery

104
Q

medication for pain in pAD?

A

naftidrofuryl oxalate = dilator

105
Q

axis deviation and wolf parkinson white?

A

Will be opposite to where the accessory pathway is

LAD if right sided pathway. RAD if right sided pathway.

106
Q

what in a MI indicated poor prognosis?

A

Px in cardiogenic shock - low BP

107
Q

both aortic dissection and carotid artery dissection can cause horners syndrome, how to differentiate?

A

Aortic dissection presents with bad chest pain

Year 3 (14 decks)

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