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FINALS > Cardiology & Vascular > Flashcards

Cardiology & Vascular Flashcards

1
Q

Types of Aortic dissection

A

Type A = Ascending aorta (most common) - proximal to left SCA
Type B = Descending aorta - distal to left SCA

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2
Q

Acute management of Type A Aortic dissection

A

ABCDE, O2, fluids, X-match

BP control + urgent surgery (Aortic root replacement +/- aortic valve replacement

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3
Q

Acute management of Type B Aortic dissection

A

ABCDE, O2, fluids, X-match

Control BP (<120 mmHg)
IV then PO antihypertensives

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4
Q

Long term management of aortic dissection

A

Antihypertensives
Surveillance imagining (at 3m, then 6m, then yearly)
If Type B get complications —> surgical repair

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5
Q

Complications of Aortic dissection

A

End organ damage
Cardiac tamponade (retrograde spread into pericardial sac)
Aortic regurgitation
Rupture —> massive haemorrhage

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6
Q

Presentation of aortic dissection

A

Sudden TEARING Chest pain
Radiates to back/arm
Marked Hypertension
Signs of distal trunk occlusion (decreased peripheral pulses)
Murmur: aortic regurgitation

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7
Q

4 risk factors for aortic dissection

A

Atherosclerosis
HTN
CTD (marfans/Ehlers-danlos)
Male sex

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8
Q

Which type of aortic dissection has radio-radial delay

A

Type A

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9
Q

Which type of aortic dissection has radio-femoral delay

A

Type B

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10
Q

Clinical presentation of infective endocarditis (MAJOR PEN)

A

Murmur & Microscopic haematuria
Anaemia
Janeway lesions (spots on palms)
Osler’s nodes (nodules on fingers)
Roth spots (eyes)
Pyrexia
Emboli
Nail splinter haemorrhages

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11
Q

Modified Dukes Criteria for Infective endocarditis - MAJOR criteria

A

2 positive blood cultures
Positive echo
New valvular regurgitation

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12
Q

Modified Dukes Criteria for Infective endocarditis - MINOR criteria

A

Predisposing heart condition
IVDU
Fever > 38
Vascular phenomena (major emboli, splinter haem, janeway lesions, petechiae/purpura)
Immunological phenomena (glomerulonephritis, osler’s nodes, roth spots)

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13
Q

What is Kussmaul’s sign

A

Raised JVP that doesn’t fall with inspiration - seen in constrictive pericarditis
Paradoxical rise in right atrial pressure during inspiration (usually declines with inspiration)
Can be used to differentiate cardiac tamponade from constrictive pericarditis

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14
Q

What is Pulsus Paradoxus

A

Occurs in cardiac tamponade (and rarely in constrictive pericarditis)
Exaggerated drop in systemic BP during inspiration

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15
Q

What is Takayasu’s arteritis

A

Large vessel arteritis
Typically causes occlusion of the aorta and absent limb pulse
Young Asian women
Associated with Renal artery stenosis
Unequal blood pressure in upper limbs
Upper and lower limb claudication
Systemic features (malaise, headache)
carotid bruit and tenderness

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16
Q

Features of autonomic neuropathy

A

Postural hypotension
Loss of respiratory arrhythmia
Erectile dysfunction

Caused by: diabetes, Parkinson’s

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17
Q

Treatment of torsades de pointes

A

IV magnesium sulphate

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18
Q

Causes of torsades de pointes

A

Associated with long QT interval
E.g. caused by - antiarrhythmics, TCAs, Antipsychotics, hypothermia, electrolyte disturbances (Hypocalacemia, hypokalaemia, hypomagnesaemia)

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19
Q

Consequence of torsades de pointes

A

—> VF —> sudden death

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20
Q

Drop in BP required to diagnose orthostatic hypotension

A

Drop in systolic BP of at least 20 mmHg +/or drop in diastolic BP of at least 10 mmHg after 3 mins standing

21
Q

Pharmacological treatment of orthostatic hypotension

A

Fludrocortisone
Midodrine

22
Q

ECG abnormality seen with hypercalcaemia

A

Shortening of the QT interval

23
Q

ECG abnormality seen with hyperkalaemia

A

T waves: Tall tented
P waves: small
QRS: Widened

24
Q

ECG abnormalities seen with hypokalaemia

A

U waves
PR interval: Elongated
ST: Depression

25
Q

CVS cause of horners syndrome (ptosis, miosis, anhidrosis)

A

Due to compression on the sympathetic trunk
- aortic dissection
- carotid artery dissection

26
Q

What is “broken heart syndrome”

A

Takotsubo cardiomyopathy
Presents with Sx and ECG changes of a STEMI but normal angiogram
I.e. no obstructive coronary artery disease

27
Q

Causes of ST elevation

A

STEMI
Pericarditis / myocarditis
Normal variant - ‘high take off’
Left ventricular aneurysm
Coronary artery spasm (Prinzmetal’s angina)
Takotsubo cardiomyopathy (broken heart syndrome)

Rarely - subarachnoid haemorrhage

28
Q

Name 8 MI complications

A
  1. Cardiac arrest (due to VF)
  2. Cardiogenic shock
  3. Chronic HF
  4. Arrthymias - Tachyarrhythmias (VF) /Bradyarrthymias (AVN block)
  5. Pericarditis
  6. Left ventricular aneurysm
  7. Left ventricular wall rupture / cardiac tamponade
  8. Acute mitral regurgitation - ischaemia/rupture of the papillary muscle —> acute hypotension and pulmonary oedema
29
Q

First line imaging in peripheral arterial disease

A

Duplex ultrasound

30
Q

3 main patterns of presentation in patients with peripheral arterial disease

A

Intermittent claudication
Critical limb ischaemia
Acute limb-threatening ischaemia

31
Q

What is a normal Ankle Brachial Pulse Index (ABPI)

A

1 = normal

32
Q

What are abnormal ABPI values

A

0.9-0.6 = claudication

0.3 - 0.6 = rest pain

<0.3 = impeding gangrene

33
Q

Differential diagnoses for intermittent claudication (4)

A

Spinal stenosis
Venous claudication
Sciatica
Popliteal artery entrapment

34
Q

What is critical limb-threatening ischaemia

A

Ischaemic rest pain > 2 weeks
+ ABPI < 0.4

Can cause development of ulcers & gangrene (increased risk if DM)

35
Q

What is Buerger’s angle

A

Angle leg is raised before pallor in peripheral arterial disease
< 20 degrees

36
Q

Medical management of peripheral arterial disease

A

Anti platelet - 75mg Clopidogrel
Vasoactive drugs

37
Q

Surgical management of Peripheral arterial disease

A

Percutaneous transluminal angioplasty (PTA) or stenting
Surgical reconstruction (bypass graft)
Last resort - amputation

38
Q

Common sites for atherosclerosis

A

Coronary arteries
Major branches of aortic arch
Visceral branches of abdo aorta
Terminal abdominal aorta + branches

39
Q

What is upper lobe vessel diversion?

A

Look like stag antlers (Antler sign/inverted moustache sign)

Normal:
Lower lobe vessels = more prominent than upper lobe vessels on normal chest X-ray due to the effect of gravity.

In pulmonary venous hypertension, they become less prominent due to vasoconstriction in the lower zones so that there is a redistribution of pulmonary blood flow to the upper zones.

It is a sign of acute HF / early sign of pulmonary oedema reflecting increased left atrial pressure

40
Q

Which murmurs are diastolic?

A

Aortic regurgitation

Mitral stenosis

Tricuspid stenosis

Pulmonary regurgitation

41
Q

Which murmurs are systolic

A

Aortic stenosis
Mitral regurgitation
Tricuspid regurgitation

42
Q

Most common cause of an irregular broad complex tachycardia in a stable patient

A

Atrial fibrillation with bundle branch block

43
Q

What is used in the interim between suspecting a DVT and diagnosing a DVT

A

DOAC - interim therapeutic anticoagulation

44
Q

Management:

High INR + Major bleeding

A

Stop warfarin
Give intravenous vitamin K 5mg
Prothrombin complex concentrate - if not available then FFP

45
Q

Management:

Minor bleeding + INR > 8.0

A

Stop warfarin
Give intravenous vitamin K 1-3mg
Repeat dose of vitamin K if INR still too high after 24 hours
Restart warfarin when INR < 5.0

46
Q

Management:

No bleeding + INR > 8.0

A

Stop warfarin
Give vitamin K 1-5mg PO
Repeat dose of vitamin K if INR still too high after 24 hours
Restart when INR < 5.0

47
Q

Management:

Minor bleeding + INR 5.0-8.0

A

Stop warfarin
Give IV vitamin K 1-3mg
Restart when INR < 5.0

48
Q

Management

INR 5-8 + no bleeding

A

Withhold 1 or 2 doses of warfarin
Reduce subsequent maintenance dose

49
Q

Types of heart block thats a normal varient in atheletes

A

Mobitz type 1 (wenckebach phenomenon)
sinus bradycardia
junctional rhythm
first degree heart block

FINALS (19 decks)

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