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medicine phase 2 a > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What are the signs of stable angina?

A

hypoxia, tachycardia, S3 (heart sound) and mitral regurgitation murmur

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2
Q

What does an ECG look like in stable angina?

A

usually normal, can show ST depression, flat or inverted T waves

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3
Q

What is the gold standard investigation for stable angina?

A

CT coronary angiography
perfusion MRI (non-invasive)

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4
Q

What is the 1st line management for stable angina?

A

PRN pain relief, GTN (glyceryl trinitrate) spray
lifestyle modifications

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5
Q

what is the 2nd line treatment for stable angina?

A

beta blocker (propranolol) and or CCB (amlodipine)

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6
Q

What are some revascularisation treatments for stable angina?

A

PCI or CABG

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7
Q

What are the investigations for unstable angina?

A

ECG - may be normal, transient T wave election, T wave changes
high sensitivity troponin - no dynamic elevation (rule out MI)

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8
Q

What is the initial management for acute unstable angina?

A

aspirin and fondaparinux

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9
Q

Give an example of a P2Y12 inhibitor

A

clopidogrel, ticlopidine

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10
Q

What medication are used for secondary prevention of cardiac events?

A

ACEi
BB
dual antiplatelet (aspiprin + fondaparinux)
statin

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11
Q

What is prinzmetal angina?

A

angina due to coronary artery spasm

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12
Q

What are the key presentations of STEMI?

A

central chest pain, squeezing, dyspnoea, pallor

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13
Q

What are the gold standard investigations for STEMI?

A

ECG - ST elevation
cardiac troponin- elevated

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14
Q

What does an ECG look like in STEMI?

A

ST elevation

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15
Q

What is the initial treatment for all MIs?
(MONAC)

A

Morphine
Oxygen
Nitrates (nitroglycerin)
Aspirin
Clopidogrel

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16
Q

What is assessed initially in STEMI patient?

A

eligibility for reperfusion therapy

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17
Q

What reperfusion therapies are used for STEMI?

A

PCI
fibrinolysis (dalteparin)

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18
Q

What is the 1st line medicinal management of STEMI if reperfusion is not possible?

A

Aspirin, anti-platelet therapy (clopidogrel/ticagrelor)

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19
Q

What

A

PCI, p2y12 inhibitor, aspirin

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20
Q

How do women present with NSTEMI?

A

middle/upper back pain or dyspnoea

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21
Q

What do ECGs look like in NSTEMI?

A

St depression and/or T wave inversion, pathological Q wave

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22
Q

What is the initial medicinal treatment for NSTEMI?

A

fondaparinux
Aspirin (300mg)

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23
Q

What is the drug treatment for secondary prevention of MI? (5A’s)

A

Aspirin - 75mg once daily
Another anti-platelet (on top of aspirin) - clopidogrel
Atorvastatin - 80mg once daily
ACEi
Atenolol

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24
Q

Give an example of an ACEi

A

ramipril, enalapril

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25
Q

Give an example of a CCB

A

amlodipine, diltiazem

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26
Q

Give an example of an ARB

A

azilsartan, candesartan

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27
Q

What is a side effect of ACEi?

A

coughing

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28
Q

What anit-hypertensive medications should not be given during pregnancy?

A

ACEi and ARBs as they cause fetotoxicity

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29
Q

Give an example of a P2Y12 inhibitor

A

ticagrelor, clopidogrel

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30
Q

Give and example of an aldosterone antagonist

A

spironolactone, eplerenone

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31
Q

What are the complications of MI?
(DARTH VADER)

A

death
arrhythmia
rupture
tamponade
heart failure

valve disease
aneurysm
Dresslers syndrome
embolism
recurrence/regurgitation

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32
Q

What score is used to assess the 6 month risk of recurrent MI/death?

A

GRACE score

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33
Q

What is dresslers syndrome?

A

a localised immune response that causes pericarditis 2-3 weeks post MI

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34
Q

How is Dressler’s syndrome treated

A

NSAIDS
in severe cases steroids (prednisolone)

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35
Q

how do you differentiate angina and NSTEMI?

A

unstable angina has no troponin rise

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36
Q

What is the ejection fraction in heart failure with reduced ejection fraction?

A

<40%

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37
Q

What is the ejection fraction in heart failure with preserved ejection fraction?

A

> 50%

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38
Q

What is the pathophysiology of heart failure with CAD?

A

blocked arteries- reduced perfusion to heart- BP increases - harder to expel blood from LV - LV hypertrophy - loss of elasticity - decreased ejection fraction

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39
Q

What are the key presentations of left sided heart failure?

A

pulmonary oedema, dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, bibasal fine crackles, pink frothy sputum

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40
Q

What is paroxysmal nocturnal dyspnoea?

A

waking up in the night short of breath

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41
Q

What are the gold standard investigations for heart failure?

A

ECG - shows AF/any abnormality
B-type natriuretic peptide (NT-proBNP)- elevated
echo - EF
X-ray/echocardiography- cardiomegaly

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42
Q

What is the 1st line medical treatment for heart failure?

A

furosemide

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43
Q

What is the 1st line medicinal treatment for heart failure with rEF?

A

ACEi, beta blocker

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44
Q

What is given if symptoms continue in heart failure with rEF?

A

Aldosterone antagonist (spironolactone)

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45
Q

What is the management for heart failure with pEF?

A

manage complications - hypertension, AF
cardiac rehab

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46
Q

What is digoxin and what does it do?

A

its a cardiac glycoside, its used to treat irregular heart beats (is sometimes used to treat heart failure)

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47
Q

What are the most common causes of right sided heart failure?

A

pulmonary hypertension
cor pulmonale

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48
Q

Why does pulmonary hypertension cause right sided heart failure?

A

pulmonary artery hypertension causes right sided hypertrophy

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49
Q

What are the key presentations of right sided heart failure?

A

peripheral oedema, raised oedema, hepatomegaly, weight gain (fluid retention), weight loss (cardiac cachexia)

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50
Q

What are the key presentations of acute heart failure?

A

dyspnoea, peripheral oedema, reduced exercise tolerance, fatigue, cold extremities, elevated JVP

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51
Q

How does acute heart failure effect the physiology of the body?

A

Activation of SNS - tachycardia, increased contractility, peripheral vasoconstriction, activation of RAAS

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52
Q

What are the investigations for acute heart failure?

A

ECG, natriuretic peptides - elevated
echocardiography

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53
Q

What is the treatment for acute heart failure?
(Pour SOD)

A

Pour away (stop) their IV fluids
Sit up
Oxygen
Diuretics (furosemide 40mg)

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54
Q

What BP is considered hypertension?

A

> 140/90 with no secondary cause

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55
Q

Apart from idiopathic, what can causes hypertension? (ROPE)

A

R - renal disease
O - obesity
P - pregnancy
E - endocrine

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56
Q

What are the key presentations of hypertension?

A

asymptomatic
raised BP
retinopathy

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57
Q

What is the gold standard test for hypertension?

A

24hr ambulatory BP monitoring

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58
Q

What is the treatment for hypertensive patients <55 or non black?

A

ACEi (ramipril) or ARB (candesartan)

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59
Q

What is the treatment for hypertensive patients >55 or black or African?

A

CCB (amlodipine)

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60
Q

What is the 2nd line treatment for hypertension in patients <55 or non-black?

A

ACEi or ARB + CCB OR +thiazide-like diuretic (indapamide).

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61
Q

What is the 2nd line treatment for >55 or black hypertensive patients?

A

CCB + ACEi or ARB or thiazide like diuretic

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62
Q

What is the 3rd line treatment for hypertension in all patients?

A

ACEi or ARB + CCB + thiazide like diuretic

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63
Q

What is an example of a thiazide-like diuretic?

A

indapamide

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64
Q

What else can be prescribed in resistant hypertension?

A

if K+ <4.5 - potassium sparing diuretic (sprinolactone)
if K+ >4.5 - alpha blocker (doxazosin) or beta blocker (atenolol)

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65
Q

What is a complication of hypertension treatment?

A

postural hypotension

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66
Q

What is Virchows triad?

A

Vrichows triad - vascular injury, venous stasis and hypercoagulability

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67
Q

What are the key presentations of DVT?

A

calf swelling, localised pain, Dilation or distension of superficial veins, redness and warmth, sometime asymptomatic

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68
Q

What is the 1st line investigation for DVT?

A

quantitative D-dimer level - shows that body is forming and breaking down clots (doesnt confirm diagnosis)

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69
Q

What is the gold standard investigation for DVT?

A

compression ultrasound

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70
Q

What is VTE prophylaxis?

A

venous thromboembolism prophylaxis - prevention of clot with low molecular weight heparin (LMWH) (dalteparin/fondaparinux)
or DOAC

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71
Q

What do you do if DVT is suspected?

A

immediate DOAC - apixaban or rivaroxiban

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72
Q

What are the long term treatments for DVT?

A

DOAC, LMWH (1st line in pregnancy) or VKA (warfarin)

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73
Q

What are the complications of DVT?

A

PE, complications associated with anticaogs

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74
Q

What are the key presentations of PE?

A

dyspnoea, pleuritic chest pain, hypoxaemia

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75
Q

What are the main investigations for PE?

A

D-dimer - elvated
CTPA - computed tomography pulmonary angiography - will show occlusion

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76
Q

What can be done to stop PEs from happening?

A

VTE prophylaxis, hyrdation, mobilisation, compression stockings

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77
Q

What are the treatments for PE?

A

supportive care->resp support,O2
initially use LMWH
swap to long term anticoag

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78
Q

What is peripheral arterial disease?

A

a range of symptoms caused by atherosclerotic obstruction of lower-extremity arteries

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79
Q

What are the key presentations of peripheral arterial disease? (6P’s)

A

Pain
Pulselessness
pallor
perishingly cold
paraesthesia
paralysis

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80
Q

What is the 1st line investigation for peripheral arterial disease?

A

ankle brachial index (ABI) ratio of ankle to brachial systolic BP <0.9

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81
Q

What is the gold standard investigation for peripheral arterial disease?

A

CTA/MRA - to see where occlusions are

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82
Q

What is the 1st line treatment for acute limb ischaemia?

A

assessment for revascularisation or amputation + anti-platelet (aspirin/ticagrelor) + analgesia + anticoag (warfarin, DOACS, heparin)

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83
Q

What is the treatment for ongoing claudication (pain in arms/legs while walking/running)?

A

anti- platelet therapy, exercise, risk factor mod

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84
Q

what is the treatment for chronic severe limb ischaemia?

A

assessment for revasc + anti-platelet therapy + risk factor mod

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85
Q

What is infective endocarditis?

A

infection of the endocardial surface of the heart (valves, chordae tendinae)

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86
Q

What is the most common cause of infective endocarditis?

A

bacterial infection - S. viridans

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87
Q

What are the other causes of infective endocarditis?

A

fungi (candida), lupus, malignancy

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88
Q

What are the key presentations of infective endocarditis?

A

fever/malaise/fatigue/weight loss
finger clubbing, splinter haemorrhages, janeway lesions, osler nodes, roth spots

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89
Q

What are splinter haemorrhages?

A

longitudinal red brown haemorrhage under nail

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90
Q

What are janeway lesions?

A

irregular non tender haemorrhagic macules on the palms and plantar surfaces of feet

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91
Q

What is the gold standard investigation for IE?

A

blood cultures - Dukes criteria
transoesophageal echocardiogram

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92
Q

How do you manage IE?

A

antibiotics (6 weeks), 2 weeks IV 4 weeks oral
surgery
Abx prophylaxis if high risk

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93
Q

What are the complications of IE?

A

acute heart failure, system embolisation, AKI

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94
Q

What are the causes of pericarditis?

A

idiopathic (80-90%)
viruses, autoimmune, malignancy, neoplasm

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95
Q

What are the key presentations of pericarditis?

A

severe, sharp chest pain, exacerbated by lying down, relieved by sitting forward

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96
Q

What does and ECG look like in pericarditis?

A

ECG upwards concave ST segment elvation, PR depressions

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97
Q

What is the criteria for pericarditis diagnosis?

A

2 of…
chest pain
friction rub
ECG changes
pericardial effusion (build up of fluid of pericardium)

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98
Q

What can be prescribed to manage pericarditis?

A

NSAIDS + PPI (omeprazole) + colchicine (3 weeks)

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99
Q

What non medicine treatments are there for pericarditis?

A

pericardiectomy - in restrictive pericarditis

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100
Q

What are the complications of pericarditis?

A

cardiac tamponade, pericardial effusion
chronic constructive pericarditis

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101
Q

What is pericardial effusion?

A

fluid in the pericardial space exceeding 50mL

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102
Q

What is cardiac tamponade?

A

a medical emergency where pericardial effusion is enough to raise pericardial pressure

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103
Q

What are the key presentations of pericardial effusion?

A

distant heart sounds, pulsus paradoxus, dyspnoea, elevated JVP, hypotension, tachycardia

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104
Q

What is the gold standard investigation for pericardial effusion?

A

transthoracic echocardiography

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105
Q

What is the treatment for stable pericardial effusion (pre tamponade)?

A

anti inflammatory treatment + gastroprotection + observation (treatment of pericarditis)

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106
Q

What is the treatment for unstable pericardial effusion (tamponade)?

A

pericardiocentesis or surgical drainage

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107
Q

What is the most common cause of aortic stenosis?

A

calcification of trileaflet valve

108
Q

What is the pathophysiology of aortic stenosis?

A

endocardial injury-> inflammation->leaflet fibrosis+deposition of calcium on valve->calcification and limited mobility of valve

109
Q

What are the key presentations of aortic stenosis?

A

chest pain, exertional dyspnoea/syncope, fatigue, ejection systolic murmur

110
Q

What is the main investigation for aortic stenosis?

A

transthoracic echocardiogram (LV size and function) + doppler

111
Q

What is the management for clinically unstable aortic stenosis ?

A

medical therapy or ballon valvuloplasty

112
Q

What is the management for clinically stable aortic stenosis?

A

aortic valve replacement, antibiotic prophylaxis
long term anticoag

113
Q

What is aortic regurgitation?

A

diastolic leakage of blood from the aorta into the LV

114
Q

What are the valvular causes of aortic regurgitation?

A

congenital, infective endocarditis, rheumatic fever, rheumatoid arthritis, prosthetic malfunction

115
Q

What are the non-valvular aortic regurgitation causes?

A

aortic dissection, chest trauma

116
Q

what are the key manifestations of aortic regurgitation?

A

diastolic murmur

117
Q

What are the symptoms of aortic regurgitation?

A

dyspnoea, fatigue, chest pain, pink frothy sputum, wheeze

118
Q

What is the gold standard investigation for aortic regurgitation?

A

echocardiography

119
Q

What is the management of acute aortic regurgitation?

A

inotropes (dopamine), vasodilators (ACEi), urget aortic valve replacement

120
Q

What is the management of chronic aortic regurgitation?

A

treatment of underlying cause, vasodilator or ACE therapy, aortic valve replacement

121
Q

What is the pathophysiology of mitral stenosis?

A

increased left atrial pressure referred to lungs, limited LV filling, atrial pressure increase, pulmonary vasoconstriction and pulmonary hypertension

122
Q

What are the key presentations of mitral stenosis?

A

dyspnoea, orthopnoea (SOB lying flat), opening snap on auscultation, diastolic murmur, loud P2, neck vein distension

123
Q

What are the main symptoms of mitral stenosis?

A

flushed cheeks, palpitations, chest pain, dizziness, hemoptysis (bronchial haemorrhage)

124
Q

What is the 1st line investigation for mitral stenosis?

A

ECG, chest X ray, trans thoracic echocardiogram (gold standard)

125
Q

What is the 1st line treatment for mitral stenosis?

A

no therapy or diuretic

126
Q

What are other treatments for mitral valve stenosis?

A

balloon valvotomy, valve replacement/rapair
beta blocker (bisoprolol) or ivabradine (reduces heart rate)

127
Q

What are the complications of mitral valve stenosis?

A

AF, stroke, warfarin-induced haemorrhage

128
Q

What is the pathophysiology of mitral regurgitation?

A

increased LA pressure = pulmonary congestion = dyspnoea

129
Q

What are the key presentations of mitral regurgitation?

A

dyspnoea on exertion
decreased exercise tolerance
lower body oedema
holosystolic murmur

130
Q

What is the 1st line investigation for mitral regurgitation?

A

transthoracic echo
ECG

131
Q

What is the gold standard investigation for mitral regurgitation?

A

echocardiography

132
Q

How do you manage mitral valve regurgitation?

A

surgery
diuretics (furosemide) /beta blocker (bisoprolol) / ACEi (ramipril)
intra-aortic balloon counterpulsation (EF<30%)

133
Q

What are the key presentations of AF?

A

palpitations
irregular pulse
tachycardia

134
Q

What are the symptoms of AF?

A

dyspnoea
chest pain
fatigue
dizziness
polyuria
syncope

135
Q

What is the 1st line investigation for AF?

A

ECG (gold standard)
irregularly irregular R-R intervals, absence of distinct P waves

136
Q

How do you manage HR in AF? (1st line)

A

beta blocker (bisoprolol) /CCB (amlodipine)/digoxin

137
Q

What medications can be used for pharmacological cardioversion?

A

flecainide/amiodarone (antiarrhythmetics)

138
Q

What are the long term treatments for AF?

A

beta blocker/dronedarone/amiodarone

139
Q

What else might be given in AF to prevent stroke?

A

anticoag - warfarin/DOACs

140
Q

What are the key presentations of atrial flutter?

A

worsening HF or pulmonary symptoms

141
Q

What are the symptoms of atrial flutter?

A

palpitations, fatigue, chest pain, dyspnoea, sycnope

142
Q

What are the 1st line investigations for atrial flutters?

A

ECG (gold standard) - continuous regular electrical activity, saw tooth pattern

143
Q

What are the managements of atrial flutter?

A

same as AF:
beta blocker
cardioversion
anticoag

144
Q

What is wolff-parkinson-white syndrome?

A

Delay of conduction in the AV node, conduction from atria reaches ventricles by accessory pathways

145
Q

What is AV reentrant tachycardia (AVRT)?

A

Electrical impulses travelling down normal AV node and accessory pathway (AP) causing rapid atrial contraction

146
Q

What are the symptoms of AVRT/WPW?

A

Palpitations, dizziness, dyspnoea, chest pain

147
Q

What is the 1st line and gold standard investigation for AVRT/WPW?

A

12 lead ECG

148
Q

How do you manage AVRT/WPW?

A

Direct current cardioversion, carotid sinus massage/valsalva manoeuvre, IV adenosine, AV nodal blocking drugs, antiarrythmetics, catheter ablation

149
Q

What are the key presentations of AVNRT?

A

palpitations, dizziness, diuresis

150
Q

What are the symptoms of AVNRT?

A

diaphoresis (sweating), neck pulsations, fullness of chest, dyspnoea, chest pain, (pre)syncope

151
Q

What is the 1st line and gold standard AVNRT?

A

12 lead ECG

152
Q

How do you manage heamodynamically unstable AVNRT?

A

cardioversion, IV amiodarone

153
Q

How do you manage haemodynamically stable AVNRT?

A

vagal manoeuvre - valsalva manoeuvre
IV adenosine

154
Q

How do you manage recurrent AVNRT?

A

catheter ablations

155
Q

What is heart block?

A

impaired conduction from atria to ventricles

156
Q

How does 1st degree heart block effect the heart?

A

delays communications between atria and ventricle - prolonged PR interval

157
Q

What can cause first degree heart block?

A

hypokalaemia
myocarditis
inferior MI
AV blocking drugs (BB, CCB, digoxin)

158
Q

How does 2nd degree, mobitz type 1, show on an ECG?

A

is transient
PR intervals get bigger and bigger until QRS complex is missed

159
Q

What can cause type 1 mobitz heart block?

A

AV blocking drugs, inferior MI, fit athlete due to vagal toning

160
Q

How does 2nd degree, mobitz type 2, heart block effect the ECG?

A

constant prolonged PR interval and QRS dropped every so often

161
Q

What can cause mobitz type 2 heart block?

A

anterior MI
Lyme disease
Rheumatic fever

162
Q

What is 3rd degree heart block?

A

P wave is not associated with QRS at all

163
Q

What can cause 3rd degree heart block?

A

structural heart disease
MI
hypertension
endocarditis

164
Q

What are the key presentations of heart block?

A

syncope, heart rate <40

165
Q

What are the symptoms of heart block?

A

syncope, fatigue, dyspnoea, chest pain

166
Q

What is the first line investigation for heart block?

A

12 lead ECG
serum troponin

167
Q

What is the gold standard treatment for heart block?

A

12 lead ECG

168
Q

How do you manage heart block?

A

monitor it, discontinuation of AV nodal blocking medications, resynchronisation therapy, temporary pacing (ASAP for 3rd degree)

169
Q

What is bundle branch block (BBB)?

A

complete or partial interruption of electrical pathways between the 2 ventricles

170
Q

What is the pathophysiology of Right BBB?

A

early part of QRS normal but RV activation delayed - secondary R wave in precordial leads and wide slurred S wave in lateral leads
normal cardiac axis

171
Q

What is the pathophysiology of left BBB?

A

conduction travels from RV then to LV, tall R waves in lateral leads and deep S waves in the right precordial leads, M shaped R wave in lateral leads (extended QRS)

172
Q

What are the symptoms of BBB?

A

sometimes asymptomatic
RBBB can make HF symptoms worse
dyspnoea
fatigue
syncope

173
Q

What is the first line and gold standard investigation for BBB?

A

12 lead ECG

174
Q

What does the ECG look like in LBBB?

A

QRS>120
dominant S wave in V1
broad R wave in lateral leads
absence of Q waves in lateral leads
prolonged R wave >60 ms in V5-6

175
Q

What does the ECG look like in RBBB?

A

QRS duration >120ms
RSR pattern in V1-3
wide, slurred S wave in lateral leads

176
Q

What is the management of BBB?

A

symptom management
treat underlying condition
pacemaker
resynchronisation therapy

177
Q

What are the key presentations of a ruptured abdominal aortic aneurism (AAA)?

A

abdominal pain
collapse
expansile abdominal mass
shock

178
Q

What are the signs of AAA?

A

palpable pulsatile abdominal mass
hypotension
abdominal distension

179
Q

What are the symptoms of AAA?

A

abdominal flank
loss of consciousness
fever
pallor

180
Q

What is the 1st line and gold standard investigation for AAA?

A

aortic ultrasound

181
Q

How do you manage abdominal aortic aneurysm?

A

surgical repair
resus measures
abx
risk management

182
Q

What is (thoracic) aortic dissection?

A

a separation in the intima of the aorta allowing blood to flow in between the layers of media

183
Q

What are the key presentations of thoracic aortic dissection?

A

acute severe chest pain
interscapular and low pain
left/right BP change
pulse deficit
diastolic murmur

184
Q

What are the symptoms of thoracic aortic dissection?

A

syncope
dyspnoea
paraplegia
abdo pain
limb pain/pallor

185
Q

What are the first line investigations for aortic dissection?

A

ECG
imaging

186
Q

what are the gold standard investigations for aortic dissection?

A

CT - chest abdo pelvis

187
Q

What is the initial management of aortic dissection?

A

advanced life support + haemodynamic support + opioid analgesic

188
Q

What is the management for acute aortic dissection?

A

1st line - beta blocker/ non-dihydropyridine CCB + opioid
open surgery/endovascular repair

189
Q

What is the 1st line management for chronic aortic dissection?

A

beta blocker,
lifestyle advice/risk factor management

190
Q

What is type A aortic dissection?

A

involves ascending aorta with or without involvement of arch and descending aorta -70%

191
Q

What is type B aortic dissection?

A

dissection does not involve ascending aorta
involves only descending thoracic and/or abdominal aorta -30%

192
Q

What is rheumatic fever?

A

an autoimmune disease following group A streptococcal (S.pyrogenes) throat infection

193
Q

What are the key presentations of rheumatic fever?

A

fever
joint pain

194
Q

What are the symptoms of rheumatic fever?

A

recent sore throat/scarlet fever
dyspnoea
chest pain
swollen joint

195
Q

How do you diagnose rheumatic fever?

A

Jones critera
2 major OR 1 major + 2 minor
MAJOR:carditis, arthritis, chorea, erythema, subcutaneous nodules
MINOR:raised ESR or CRP, pyrexia, arthralgia

196
Q

What is the 1st line treatment for rheumatic fever?

A

abx - penicillin OR erthyromycin

197
Q

What is the treatment for RF with arthritis?

A

abx + salicylate therapy

198
Q

What is the treatment for RF with HF?

A

abx + diuretic/ACEi

199
Q

What is the treatment for RF with AF?

A

abx + amiodarone/digoxin

200
Q

What is the treatment for RF with valve leaflet/CT rupture?

A

abx + emegency valve therapy

201
Q

What do you give for RF and chorea?

A

abx + anticonvulsants

202
Q

What are ectopic heartbeats?

A

changes to a normal heartbeat that cause extra or skipped heartbeats

203
Q

What are the key presentations of ectopic heart beats?

A

palpitations
syncope
chest pain
fatigue

204
Q

What are the symptoms/signs of ectopic beat

A

feeling like heart has stopped, sudden forceful beat

205
Q

What is the gold standard and first line investigation for ectopic heartbeat?

206
Q

What does an ECG with ventricular ectopic heart beat look like?

A

ventricular trigeminy - premature ventricular contraction in pattern of three beats

207
Q

What is the management of ventricular ectopic?

A

lifestyle changes - limit caffeine, alcohol, exercise
only treat if symptoms are severe
beta blocker, CCB

208
Q

What are the key presentations of QT syndrome?

A

syncope during: heightened adrenergic tone, arousal or suprise
syncope with bradycardia
palpitations

209
Q

What are the symptoms of QT syndrome?

A

periodic paralysis
dizziness
oliguria
tetany
cold/pale extemities

210
Q

What is the first line treatment for QT syndrome?

A

ECG - for long QTs (gold standard)
hypokalaemia/magnesemia/calcaemia

211
Q

How do you manage QT syndrome?

A

beta blocker
lifestyle modification
pacing
implantable cardioverter-defibrillator
mexiletine (fix irregular heartbeats)

212
Q

What are the three types of shock?

A

cardiogenic shock - heart not working
hypovolemic shock - low fluid
distributive shock - change in fluid status

213
Q

What are the three types of distributive shock?

A

septic - abnormal response to infection
neurogenic - loss of sympathetic tone
anaphylactic

214
Q

What are the key presentations of shock?

A

hypotension
skin changes
oliguria
mental state changes
chest pain
dyspnoea
hypoxaemia

215
Q

What are the first line tests for shock?

A

VBG/ABG
glucose
FBC/U&Es
ECG

216
Q

What is the 1st line treatment for all shock patients?

A

supportive management of airway + breathing
treat underlying cause

217
Q

What is the treatment for cardiogenic shock?

A

IV fluids
loop diuretic
vasodilator
vasoactive drug

218
Q

What is the treatment for haemorrhagic shock?

A

major haemorrhage protocol (blood transfusion)
consider IV fluids

219
Q

What is the treatment of anaphylactic shock?

A

IM adrenaline - 0.5mg
IV chlorpheniramine + hydrocortisone

220
Q

What is the treatment for neurogenic shock?

A

vasopressor -> dopamine/adrenaline/noradrenaline

221
Q

what is the treatment for septic shock?

A

abx +/- other antimicrobials + fluids + oxygen

222
Q

What are the 4 common finding in pts with tetralogy of fallot (TOF)?

A

ventricular septum defect
RV hypertrophy
pulmonary artery obstruction
overriding aorta (aorta placed over VSD)

223
Q

What are the key presentations of TOF?

A

hypercyanotic spell (episodes of severe cyanosis(blueskin/lips))
harsh systolic ejection murmur
cyanosis
tachypnoea
(shock)

224
Q

What are the first line investigations for TOF?

A

pulse oximetry
ECG (gold standard)
echo

225
Q

How can you manage hypercyanotic spells (1st line)?

A

valsalva manoeuvre sitting to squatting

226
Q

What are the 2nd and 3rd line treatments for hypercyanotic spells?

A

2 - beta blocker
3 phenylephrine

227
Q

What is the treatment for non-remitting severe cyanosis?

A

1st line - surgical shunt
extracorporeal membrane oxygenation (ECMO)

228
Q

what is the treatment for a neonate with profound cyanosis and severely limited pulmonary blood flow?

A

1st line - alprostadil
supportive care

229
Q

What is coarctation of the aorta?

A

narrowing of the aorta at the site of the ductus arteriosus

230
Q

What is the cause of coarctation of the aorta?

A

normally congenital malformation

231
Q

What are the key presentations of coarctation of the aorta?

A

hypertension at a young age
diminished lower extremity pulse
different upper and lower body pulses

232
Q

What are the signs of coarctation of aorta?

A

systolic ejection murmur
systolic ejection click

233
Q

What are the symptoms of coarctation of the aorta?

A

claudication
headache

234
Q

What is the gold standard investigation for coarctation of aorta?

A

echocardiogram

235
Q

What is the first line investigation for coarctation of aorta?

236
Q

What is the treatment for acute coarctation of the aorta?

A

maintenance of ductal patency/surgical repair

237
Q

What is the treatment for ongoing coarctation of the aorta?

A

<1 yrs - surgical repair
>1yrs - surgical or percutaneous repair (stent)

238
Q

What two factors determine the effects of ventricular septal defect?

A

the size of defect
pulmonary vascular resistance

239
Q

What is it called when the VSD causes pulmonary pressure to rise so much that the shunt reverses?

A

Eisenmengers syndrome

240
Q

What are the key presentations of VSD?

A

systolic murmur
SOB

241
Q

What are the first line tests for VSD?

A

ECG
chest x - ray
echo (gold standard)

242
Q

What is the 1st line treatment for congenital medium or large VSDs?

A

supportive medical therapy with pulmonary vasodilators
prophylactic abx
adjunct
treatment of hyperviscosity

243
Q

What is 2nd line treatment for congenital VSDs?

A

heart-lung transplantation

244
Q

What is the treatment for acquired VSDs?

A

corrective closure following intra-aortic balloon pump insertion
coronary bypass graft
adjunct in all but eisenmengers - abx

245
Q

What are the key presentations of atrial septal defect (ASD)?

A

Systolic ejection murmur
fixed splitting of second heart sound

246
Q

What are the symptoms of ASD?

A

finger clubbing
cyanosis
CHF
symptoms of atrial arrhythmias

247
Q

What are the investigations for ASDs?

A

echocardiogram (gold standard)
ECG chest
Xray

248
Q

What are the treatments for reversible ASDs

A

corrective closure
prophylactic abx

249
Q

What are the treatments for eisenmengers syndrome (irreversible)?

A

supportive medical therapy
vasodilators
prophylactic abx
2nd line - heart-lung transplant

250
Q

What is PDA?

A

patent ductus arteriosus

251
Q

When does PDA show?

A

in infancy

252
Q

What are the signs of PDA?

A

tachypnoea
low diastolic BP
machine-like continuous murumer/gibson murmur

253
Q

What are the symptoms of PDA?

A

SOB
apnoea
diaphoresis
irritability

254
Q

What are the investigations for PDA?

A

ECG
Xray
echocardiogram (gold standard)

255
Q

What are the treatments for PDA?

A

IV indomethacine/ibuprofen
surgical ligation
percutaneous catheter device closure
diuretic

256
Q

What is cardiomyopathy?

A

disease of heart muscle

257
Q

What are the three types of cardiomyopathy?

A

dilated cardiomyopathy
hypertrophic cardiomyopathy
restrictive cardiomyopathy

258
Q

What are the key presentations of cardiomyopathy?

A

dyspnoea
orthopnoea
paroxysmal nocturnal dyspnoea
hypertrophic specifically - asymptomatic and sudden death

259
Q

What are the signs of cardiomyopathy?

A

S3 gallop
systolic murmur (hypertrophic)

260
Q

What are the symptoms of cardiomyopathy?

A

symptoms increase during exercise
- syncope
- angina
- dyspnoea
weakness and fatigue
oedema
ascites

261
Q

What are the 1st line investigations for cardiomyopathy?

A

echocardiogram (gold standard)
chest xray
ECG
troponin
cardiac MRI

262
Q

What does an ECG look like in hypertrophic cardiomyopathy?

A

deep Q waves

263
Q

What does the ECG look like in restrictive cardiomyopathy?

A

low voltage QRS

264
Q

What are the pharmaceutical treatments for cardiomyopathy?

A

diuretics (spironolactone - K+ sparing diuretic) - or fluid restriction
ACEi
beta blocker

265
Q

What are the surgical treatment for cardiomyopathy?

A

heart transplant
implantable cardioverter defibrillator(ICD)

266
Q

What is assessed initially in STEMI patient?

A

eligibility for revascularisation

medicine phase 2 a (10 decks)

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