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
2
Q
Which drugs is contraindicated in a patient with ventricular tachycardia
A
Verapamil
3
Q
What arrythmia can a subarachnoid haemorrhage cause?
A
Bleed = tosardes de pointes *polymorphic ventricular tachycardia
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
5
Q
What is the preferred route of access for a primary PCI?
A
Radial access
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
7
Q
Complication of post MI:
- weeks after MI
- persistent ST elevation
- Bibasal crackles
- 3rd + 4th heart sound
A
Left ventricular aneurysm
8
Q
Complication of post MI:
- within 48 hours
- chest pain
- Muffled heart sounds
A
Left ventricular free wall rupture
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
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
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
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
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
14
Q
when to stop the pill before surgery to reduce PE risk?
A
4 weeks
15
Q
Common organism if infective endocarditis is <2 months post valve surgery?
A
staphylococcus epidermidis
16
Q
infective endocarditis organism - hx with dental procedure/poor hygiene
A
streptococcus viridans
17
Q
infective endocarditis organism linked with colorectal cancer?
A
streptococcus bovis
18
Q
ARCC risk factors for aortic stenosis
A
A - advanced age
R - rheumatic fever
C - congenital bicuspid
C - chronic kidney disease
19
Q
SADDD aortic stenosis sx
A
exertion syncope
angina
exertion dyspnoea
dizzy
decreased exercise tolerance
19
Q
SADDD aortic stenosis sx
A
exertion syncope
angina
exertion dyspnoea
dizzy
decreased exercise tolerance
20
Q
BPM for atrial fib
A
300-600bpm
21
Q
Most common cause for Afib?
A
Ischaemic heart disease
( risk factor - advancing age )
22
Q
pulmonary sign for ventricular tachy?
A
Bibasal crackles (oedema)
23
Q
drug causes for Vtach?
A
Amiadarone
tricyclic antidepressant
erythromycin
24
ECG for Brugada?
Massive convex ST elevation followed by a negative T wave
elevated is 2mm+ and seen in 1+ Leads from V1-V3
25
most important cause of Vtach clinically
hypoK then hypoM
26
gut stroke?
gut angina?
colicky abdo pain + diarrhoea + fever but also rectal bleed?
gut stroke - good way to recall acute mesenteric ischaemia
gut angina - describes chronic mesenteric ischaemia well
rectal bleed alongside these hypoperfusion symptoms = ischaemic colitis
27
investigation for a pregnant women with PE and a wells score of 4+?
A wells score of 4+ = CT pul angiogram BUT cannot do this in pregnant ( or renal impairment or contrast allergy)
Do V/Q scan
28
gas gangrene organism
clostidium perfringes
29
wet vs dry gangrene management
wet - surgical debridement + broad spec abx
dry - IV heparin + surgical revasc, consider amputation is non viable
30
aortic aneurysm screening imaging?
aortic aneurysms rupture imaging?
stable px aortic dissection imaging ?
unstable px aortic dissection imaging?
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
31
if acute heart failure is not responding to tx (oxygen, furosemide?
CPAP
32
myocarditis summary?
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
33
Pericardial disease summary
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
34
triad haemochromatosis?
Arthralgia
erectile dysfunction
fatigue
+
tanning/bronze skin
35
Aortic stenosis sounds (mumurs, radiation, heart sounds, pulse signs)
Ejection systolic murmur
radiates to carotids
Soft S2 sound
Slow rising carotid pulse
Narrow pulse pressure
36
Mitral stenosis sounds, murmurs, radiation, other signs?
Distolic mumur, low pitch rumble
radiates to apex
palpable apex beat - S1
malar flush
37
mitral regurgitation murmur, radiation, sounds
pansystolic murmur, heard as 'blowing'
into th axilla
quiet S1 due to valve closure issue
38
Mitral regurgitation ECG?
P mitrale (broad notched P wave due to atrial enlargement)
39
Aortic regurgitation mumur, accentuation, pulse signs, other signs
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
40
STEMI mx
Aspirin 300mg
PCI possible in 2 hours?
Yes = do it and give prusugrel (clopi if already on anticoag)
No = Thrombolysis with alteplase + antithrombin
41
Unstable angina/NSTEMI mx?
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)
42
Long term mx ACS (secondary prevention post MI)
Dual antiplatelet therapy, ACEi, Beta blocker, stain 80g
43
LBBB in?
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
Stanford classification for dissection is A (ascending) or B (descending aorta)
DeBakey classification?
Type I - ascending + descending
Type II - only ascending
Type III - only descending
45
Pulse signs in dissection?
Assymetrical BP and pulse between arms
weak/absent carotid/brachial/femoral
radio-radial delay
aortic regurg can start
46
CT angio is 1st line for dissection, why may it not happen?
In unstable patient who cant get to CT scanner, do transoesophageal echocardiography
47
When is rhythm control done before rate control for AF?
When there is a clear reversible cause of the AF
48
CHA2DS2VASc score factors?
score 0 = no tx
score 1 = anticoag men
score 2 = anticoag all
(DOAC preferred to warfarin for AF)
Embolic event = 2
Age 75+ = 2
Congestive HF = 1
Hypertension = 1
Age 65 - 75 = 1
Diabetes = 1
Vascular disease =1
Female = 1
49
Orbit score factors?
Haemoglobin
Age 74+
Bleeding history
Renal impairment
on antiplatelet
50
1st degree heart block?
Prolonged conduction through AV node (1 large square)
usually asymptomatic
51
2nd degree heart block?
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
3rd degree heart block?
JVP sign
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
antiphospholipid syndrome?
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
What 4 arrhythmias can cause cardiac arrest?
Ventricular fib
Pulseless VT
PEA (normal ecg, no pulse)
asystole
55
Mx for shockable rhythm cardiac arrest? (pulseness VT/VF)
CPR30:2 then defibrillate
CPR 2 mins
IV adrenaline after 3rd shock then every other cycle
persisting - IV amiodarone 300mg
56
Mx for non shockable rhythms cardiac arrest?
CPR 2 minutes
IV adrenaline 1mg then after every other cycle
Atropine once if beat falls below 60bpm
57
Homan's sign?
Calf pain on dorsiflexion of foot for DVT
58
gas gangrene caused by
clostridium perfringes
59
ACEi side effects?
Angioedema
cough
elevated potassium
renal impairment if rental artery stenosis occurs
60
Infective endocarditis ix?
diagnostic and first line = transthoracic echocardiogram - can see mobile vegetations
Most sensitive = transoesophageal echocardiogram.
61
infective endo indication for surgery?
PR prolongation
62
young patient following cocaine use can do what to their colon?
Ischaemic colitis : colicky abdo pain, rectal bleed, diarrhea, fever
63
Poor prognosis in pericarditis?
Large pleural effusion 20mm+
High fever 38<
Subacute course
failure to respond to NSAIDs in 7 days
64
leriche syndrome
Differentetial wen considering peripheral vascular disease
aortoiliac occlusive disease, causes buttock claudication, impotence, weak/absent pulses
65
endovascular revascularisation e.g. angioplasty vs bypass for Critical limb ischaemia?
10cm bigger = angioplasty
10cm smaller = bypass
66
medications a person with Claudication should be on?
excersize +
clopidogrel 75mg
statin 80mg
67
Pulmonary HTN measurement?
mean pulmonary arterial pressure of 20+ at rest
68
Signs of pulmonary HTN?
RHF signs
parasternal heave = right ventricular hypertrophy
Loud S2
early diastolic murmur = pulmonary regurg
69
transthoracic echo is 1st line in all px with pulmonary HTN but what is the confirmatory test?
Right heart catherisation, will show the mPAP as 20mmHg+ and extent of disease
70
tall R wave in V1?
Sign of Right ventricular hypertrophy
71
first line pulmonary vasodilator therapy for patients with idiopathic pulmonary HTN and no signs of RHF?
Calcium channel blocker (CCB)
72
Why may tricuspid regurg happen?
IE in IV users
RV dilation due to pul HTN
Rheumatic fever
73
why may tricuspid stenosis occur?
Rheumatic fever, alongside another valve affected
74
What causes pulmonary stenosis?
tetrology of fallot (congenital)
75
murmurs:
tricuspid regurgitation?
tricuspid stenosis?
pulmonary rugurgitation?
pulmonary stenosis?
remember these right sided murmurs will be louder on inspiration
- pansystolic murmur
- early diastolic murmur
- decrescendo murmur in early diastole
- ejection systolic murmur
76
vasovagal syncope key features?
- short post ictal phase
- twitching of limbs blackout
- volume expansion by inc salt and fluid
- may give fludrocortisone (corticosteroid)
77
vasovagal syncope key features?
- short post ictal phase
- twitching of limbs blackout
- volume expansion by inc salt and fluid
- may give fludrocortisone (corticosteroid)
78
venous ulcers summary
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
If CTPA is done for a PE but is negative what next?
Consider proximal leg ultrasound if DVT is suspected instead of PE
80
How to treat MI secondary to cocaine use?
Benzodiazepine
81
Stable angina 1st ix
stable angina 1st mx?
Ct coronary angio
Beta blocker or CCB
( if want to give two can give amlodipine with Beta blocker, not verapamil / Diltiazem)
82
A px with MI risk factors has a collapse and a hx of diabetes?
Silent MI in Diabetics
83
PAILS?
Posterior Anterior
Inferiors Lateral
E.g. posterior lead elevation will have anterior lead depression
84
Aortic dissection Type A = surgery
Type B mx?
IV labetalol
Bed rest
85
Supraventricular tachycrdia ECG?
mx?
narrow complex, no p waves, regular
mx : 1 = vagal manouvres
2 = IV adenosine 6mg, 12mg, 12mg
use verapamil in asthmatics
86
SVT vs VT?
Narrow QRS = <120ms
broad QRS = 120ms<
87
VT mx if stable
VT mx if unstable
torsades de points mx (if stable)
IV amiadarone
DC cardioversion
IV Mg sulfate
88
Arterial ulcers location
Lateral malleolus, toe tips,
well demarcated, night pain
IX with USS and ABPI
89
Heart failure first line Ix?
BNP
echo for diagnosis
90
Heart faliure Xray features?
Alveolar Oedema
Kerly B lines
Cardiomegaly
Diversion of blood to upper lobe
Pleural Effusion
ABCDE
91
Heart failure clinical diagnosis made using?
Framingham criteria
Need two Major
1 Major two minor
92
Cardiac arrest reversible causes?
4Hs
Hypoxia, Hypothermia, hypo/erK, hypovolaemia
4Ts
Toxins, Thrombosis, tension pneumothorax pea, tamponade
93
acute heart failure mx?
Oxygen, morphine, sit up patient
IV furosemide
if shock -> Ionotrope (dobutamine)
94
chronic heart failure mx?
ACEi, Beta Blocker, spironolactone
95
patient with gout has HTN, needs more meds, which HTN med is C/I?
Thiazide diuretics
go straight to alphablocker vs spironolactone
96
HyperT retinopathy (organ damage assessment) ?
Silver wiring
AV nipping
Flame haemorrhage + Cotton wool spots
Papilloedema
in that order going from G1-G4 staging
97
Major dukes criteria?
Blood culture typical organism, 2 in 12 hrs
Imaging - echo, new regurg
98
IE mx
- broad
- Staph A native valve
- Staph A prosthetic valve
- amoxicillin
- flucloxacilin
- flucloxacillin + rifampcin + gentamicin
* for viridans in teeth issues give benzylpenicillin
* for epidermidis use vancomycin
99
Intestinal ischaemic Ix?
Ischaemic colitis ix?
CT for all
do CT, but on barium AXR - thumbprinting also seen
100
What can cause secondary mitral regurg?
Post MI papillary wall rupture
101
Fontaine stages?
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
artery affected for calf pain
for butt/thigh pain
- femoral artery
- iliac artery
103
Ix for PAD?
for claudication / chronic = USS
for acute limb = arterial doppler -> CT angio site confirmation = surgery
104
medication for pain in pAD?
naftidrofuryl oxalate = dilator
105
axis deviation and wolf parkinson white?
Will be opposite to where the accessory pathway is
LAD if right sided pathway. RAD if right sided pathway.
106
what in a MI indicated poor prognosis?
Px in cardiogenic shock - low BP
107
both aortic dissection and carotid artery dissection can cause horners syndrome, how to differentiate?
Aortic dissection presents with bad chest pain
