Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Finals: Speciality Blocks > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

An ECG showing an irregularly irregular heart rate and absent p waves are characteristic signs of which ECG pattern?

A

Atrial Fibrillation
This is when the left atrium loses refractoriness before the end of atrial systole, causing recurrent, uncoordinated contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What classification system is used to classify severity of cardiovascular disability in heart failure

A

The New York Heart Association (NYHA) Classification system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ECG features of First Degree Heart Block

A

Prolonged PR interval (>200ms)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How is first degree heart block managed

A

It is a benign condition and does not need treating. However, any pathological underlying cause should be reversed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What inheritance pattern is Hypertrophic obstructive cardiomyopathy

A

Autosomal dominant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hypertrophic obstructive cardiomyopathy are at an increased risk of which conditions

A

Heart failure
Myocardial infarction
Arrhythmias
Sudden cardiac death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

ECG features of Complete Heart Block

A

No relationship between the P waves and the QRS complexes.

This occurs when the electrical impulses do not pass successfully from the atria to the ventricles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

ECG features of Second degree type 2 heart block

A

Fixed prolonged PR interval with intermittently absent QRS complexes following a P wave

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ECG features of Second degree type 1 heart block

A

Gradual lengthening PR interval which eventually leads to an absent QRS complex
Also known as Wenkebach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Characteristic CXR feature of granulomatosis with polyangiitis

A

Bilateral nodular and cavitating infiltrates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What three body systems are typically affected in Granulomatosis with polyangiitis (Wegener’s granulomatosis)

A

Upper respiratory tract e.g. Epistaxis, chronic sinusitis
Lower respiratory tract e.g. Cough, haemoptysis
Renal e.g. Haematuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

A high NT-proBNP is suggestive of what condition

A

A high NT-proBNP suggests ventricular stretch and a likely diagnosis of congestive cardiac failure and pulmonary oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the gold standard investigation to confirm the definitive diagnosis of heart failure

A

Echocardiogram (ECHO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the ECG pattern:

Broad complex tachycardia without P-waves

A

Ventricular tachycardia (VT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the ECG features of P pulmonale?

A

Right atrial enlargement produces a peaked P wave (P pulmonale)

Sign of cor pulmonale i.e. right heart failure secondary to long-standing pulmonary arterial hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Tall, peaked T waves, QTc shortening and ST-segment depression on ECG is characteristic of which electrolyte disturbance

A

Hyperkalaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

T wave inversion, QTc prolongation and visible U waves on ECG is characteristic of which electrolyte disturbance

A

Hypokalaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Isolated QTc shortening on ECG is characteristic of which electrolyte disturbance

A

Hypercalcaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Isolated QTc elongation on ECG is characteristic of which electrolyte disturbance

A

Hypocalcaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

None

A

None

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Short PR intervals and delta waves (slurred upstroke in the QRS complex) is the classical ECG pattern of what condition?

A

Wolff-Parkinson-White syndrome (a type of supraventricular tachycardia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How is Wolff-Parkinson-White syndrome managed?

A

Ablation of the accessory pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

ECG finding in hypothermia

A

Jesus its bloody freezing = J waves, irregular rhythms, bradycardia, first degree heart block

J-wave/Osborne wave are positive deflection is seen occurring at the junction between the QRS complex and the ST-segment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

P pulmonale is an ECG finding of what condition

A

Right atrial enlargement

P pulmonale refers to peaked P wave i.e. P waves have a large amplitude

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

ECG findings of pericarditis

A

Widespread saddle-shaped ST elevation

PR depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Likely Dx:

Pleuritic chest pain that radiates to the back
Pain relieved by sitting up
Pain worse on lying flat
Recent Hx of viral infection

A

Pericarditis (inflammation of the pericardium)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the definitive treatment for cardiac tamponade

A

Pericardiocentesis i.e. insertion of a needle into the pericardium to drain the built up fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Atropine is not working for acute bradycardia with haemodynamically unstable features secondary to beta blocker overdose

What is the next best step

A

Glucagon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the first line management in acute pericarditis

A

Exercise restriction and NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Gold standard investigation to diagnose aortic dissection

A

CT angiogram

A false lumen is a key finding in diagnostic of aortic dissection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the initial management of aortic dissection

A

Dissection occurs when a tear in the tunica intima of the aorta creates a false lumen whereby blood can flow between the inner and outer layers of the walls of the aorta.

First line is ABCDE with resuscitation if required

Control the blood pressure to prevent further extension of the dissection with IV beta blocker, most commonly IV metoprolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Radio-radial delay and radio-femoral delay are clinical signs of what condition

A

Aortic dissection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What affect does Clarithromycin have on ECG

A

Prolongs the QTc interval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the normal QT interval

A

< 440ms (two large squares)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

When is the QT interval considered prolonged

A

> 450 ms (two large squares)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

A collapsing pulse is pathognomonic feature of what condition

A

Aortic regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Name the murmur

Early diastolic murmur which is heard best over the left sternal edge

A

Aortic regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Malar flush is a feature of what type of murmur?

A

Mitral stenosis

Malar = Mitral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Wide pulse pressure is associated with what type of murmur?

A

Aortic regurgitation i.e. the systolic and the diastolic are wide apart such as 157/61 mmHg

The pulse is wide so you have to Reach for it (Reach = Regurgiation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Narrow pulse pressure is associated with what type of murmur?

A

Aortic stenosis i.e. the systolic and the diastolic are close together

Narrow valve flaps in stenosis= narrow pulse pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the first line imaging investigation for infective endocarditis

A

Transthoracic echocardiogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Although not the first line imaging investigation for infective endocarditis. Which test is the most sensitive diagnostic test

A

Transoesophageal echocardiogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the name of the criteria used as a diagnostic guide for infective endocarditis (IE), but should be used together with clinical judgement.

A

Modified Duke criteria

Definite IE :-
Two major criteria
OR
One major + three minor criteria
OR
All five minor criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Why is prolonged PR interval on ECG, with evidence of aortic valve involvement on echocardiogram an indication for surgery in infective endocarditis

A

This finding is highly associated with an aortic root abscess, a potentially fatal complication of infective endocarditis

An aortic root abscess requires prompt and extensive surgical debridement of infected and necrotic tissue, with subsequent prosthetic valve reconstruction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What type of heart block is this?

ECG finding: PR interval >200ms

A

First degree heart block

Caused the prolonged conduction of electrical activity through the AV node

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Name a cause of first degree heart block

A

High vagal tone (e.g. athletes)
MI (mainly inferior)
Electrolyte abnormalities (e.g. hyperkalaemia)
Drugs: NHP-CCBs, beta-blockers, digoxin, cholinesterase inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

How is first degree heart block managed

A

First degree heart block itself is benign and does not need treating. However, any pathological underlying cause should be reversed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What type of heart block is this?

Progressive lengthening of the PR interval until the P wave drop beat occurs

A

2nd Degree heart block - Mobitz type I

Usually due to reversible conduction block at the AV node

Usually a pattern such as 2:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Name a cause of 2nd Degree heart block - Mobitz type I

A

High vagal tone (e.g. athletes)
MI (mainly inferior)
Myocarditis
Cardiac surgery
Drugs such as beta/calcium channel blockers, digoxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Management of 2nd degree heart block Mobitz Type I

A

Generally asymptomatic and does not require any specific management as the risk of high AV block/ complete heart block is low.

If symptoms do arise, ECG monitoring may be required, exclude precipitating drugs and if bradycardic may require atropine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What type of heart block is this?

Random P wave block (no pattern)

Constant PR intervals and then randomly a block occurs

A

Second degree heart block Mobitz type II

Usually caused by conduction system failure, especially at the His-Purkinje system

Different to Mobitz type I as type I has a prolonging PR interval before a drop beat and usually a pattern e.g. 3:1 block.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Name a cause of second degree heart block Mobitz Type II

A

Infarction particularly anterior MI which damages the bundle branches

Surgery: mitral valve repair or septal ablation

Inflammatory/autoimmune: rheumatic heart disease, SLE, systemic sclerosis, myocarditis

Fibrosis: Lenegre’s disease

Infiltration: sarcoidosis, haemochromatosis, amyloidosis

Medication: beta-blockers, calcium channel blockers, Digoxin, amiodarone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is the definitive management of second degree heart block mobitz type II

A

Second-degree requires Secondary input

Permanent pacemaker as these patients are at risk of risk of complete heart block and becoming haemodynamically unstable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What heart block is this?

Severe bradycardia and dissociation between the P waves and the QRS complexes.

A

Third degree heart block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Name a cause of Third Degree Heart Block

A

MI (mainly inferior)

Drugs acting at the AV node (beta blockers, calcium channel blockers)

Idiopathic fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is the definitive management of Third Degree Heart Block

A

Permanent pacemaker due to the risk of sudden death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Delta waves is an ECG finding of what condition

Delta waves are intermittent QRS complexes with pre-excitation

A

Wolff-Parkinson-White syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is the definitive management of Wolff-Parkinson-White syndrome

A

Catheter ablation of the accessory conduction pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is the management of Wolff-Parkinson-White syndrome in unstable patients

A

Urgent direct current (DC) cardioversion

Unstable patients (blood pressure <90/60mmHg or with signs of systemic hypoperfusion or fast atrial fibrillation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is the first line management option for Wolff-Parkinson-White syndrome in a stable patient

A

Vagal manoeuvres (carotid sinus massage or Valsalva manoeuvre)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Vagal manoeuvres (carotid sinus massage or Valsalva manoeuvre) is the first line management option for Wolff-Parkinson-White syndrome in a stable patient.

If that fails what is second line?

A

IV adenosine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

De Musset’s sign is when there is a rhythmic head nodding or bobbing in-sync with each heart beat.

Which type of murmur is this associated with?

A

Aortic regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What criteria is used to classic findings to aid the diagnosis of Rheumatic Fever

A

Jones criteria

Classifies the findings into major and minor manifestations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What drug may be used fourth-line in hypertensive patients who have a potassium greater than 4.5 mmol/L

A

Beta blocker e.g. Propranolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What drug may be used fourth-line in hypertensive patients who have a potassium less than 4.5 mmol/L

A

Mineralocorticoid receptor antagonists e.g. Spironolactone as it is potassium-sparing, which means it can increase potassium levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

First-line treatment for hypertension in patients of any age with a history of type 2 diabetes

A

ACE-inhibitor e.g. Ramipril

If unable to tolerate ACE-inhibitor then switch to Angiotensin Receptor Blocker e.g. Candesartan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

First-line treatment for hypertension in patients over 55 years of age with no history of type 2 diabetes

A

Calcium channel blocker e.g. Amlodipine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

First-line treatment for hypertension in patients under 55 years of age with no history of type 2 diabetes

A

ACE-inhibitor e.g. Ramipril

If unable to tolerate ACE-inhibitor then switch to Angiotensin Receptor Blocker e.g. Candesartan

69
Q

First-line treatment for hypertension in patients of any age of a Black African or Afro-Caribbean family heritage

A

Calcium channel blocker e.g. Amlodipine

70
Q

What is the second line treatment for hypertension

A

Calcium channel blocker e.g. Amlodipine

AND

ACE-inhibitor e.g. Ramipril

71
Q

What is the third line treatment for hypertension

A

Calcium channel blocker e.g. Amlodipine

AND

ACE-inhibitor e.g. Ramipril

AND

Thiazide like diuretic e.g. Indapamide

72
Q

How should I manage a person with confirmed heart failure with reduced ejection fraction?

A

Ensure drugs which may cause or worsen heart failure are reviewed and stopped if appropriate.

Commence a beta blocker and ACE inhibitor

Loop diuretic e.g. Bendroflumethiazide, if they have symptoms of fluid overload are present

73
Q

Right sided murmurs are exacerbated by what:
A) Inspiration
B) Expiration

A

Right sided murmurs are exacerbated by inspiration

Tricuspid and Pulmonary murmurs are right sided

“rIght = Inspiration”

74
Q

Left sided murmurs are exacerbated by what:
A) Inspiration
B) Expiration

A

Left sided murmurs are exacerbated by expiration

Mitral and Aortic murmurs are left sided

“lEft = Expiration”

75
Q

What is the commonly encountered single valve lesion secondary to rheumatic heart disease

A

Mitral stenosis

Diastolic murmur (typically mid-diastolic) exacerbated by expiration (hence left sided). Pliable valves sometimes have an audible opening “snap”.

The stenosis also leads to left atrial dilatation, increasing the risk of atrial fibrillation (AF), which is a common complication of MS

76
Q

Metallic heart valves should be anti-coagulated with what type of anticoagulant

A

Warfarin i.e. vitamin K antagonist

77
Q

Aortic stenosis (AS) is associated with a classic triad of symptoms

A

1) Heart failure
2) Syncope
3) Angina

78
Q

Pulsatile liver can be examination finding of what type of murmur?

A

Severe tricuspid regurgitation due to backflow of blood into the liver during systole. It may be associated with hepatomegaly.

The patient may also have other features of right-sided heart failure including peripheral oedema and ascites.

79
Q

Chest pain is a feature of what murmur?

A

Aortic stenosis

This is because the reduced blood flow across the aortic valve means that there is reduced blood flow to the coronary arteries, which branch directly off the aorta superior to the aortic valve

80
Q

What murmur radiates to the carotid arteries

A

Aortic stenosis

81
Q

What vascular obstruction causes an ST elevation in leads II, III and aVF

A

These leads correspond with an inferior-MI

Right coronary artery - supplies blood to the right ventricle, the right atrium, and the sinoatrial (SA) and atrioventricular (AV) nodes

82
Q

What vascular obstruction causes an ST elevation in leads V4, V5, V6, I and aVL

A

These leads correspond with an antero-lateral MI

Left anterior descending artery (LAD) - supplies blood to the front of the left side of the heart

83
Q

What vascular obstruction causes an ST elevation in leads I, aVL, V5 and V6

A

These leads correspond with a posterior MI

Left circumflex artery (LCx) - supplies blood to the back of the heart

Tall R waves in V1-V2

84
Q

What type of aortic dissection typically causes radial-femoral delay rather than radial-radial delay

A

Aortic dissection (Type B)

85
Q

Aortic dissection (Type B) refers to aortic dissection in which part of the aorta

A

Dissection in the descending portion of the aorta

BD - Type B Descending

Causes radial-femoral delay rather than radial-radial delay

86
Q

What type of aortic dissection typically causes radial-radial delay rather than radial-femoral delay

A

Aortic dissection (Type A)

87
Q

Aortic dissection (Type A) refers to aortic dissection in which part of the aorta

A

Dissection in the ascending portion of the aorta

All the doubles:
AA- Type A Ascending
RR - Radial Radial Delay

Causes radial-radial delay rather than radial-femoral delay

88
Q

Bilateral hilar lymphadenopathy on chest x-ray is a chest x-ray finding in what condition

A

Sarcoidosis

89
Q

What is the most common viral cause of myocarditis

A

Coxsackievirus B

90
Q

What medication is first-line option for rate control of atrial fibrillation.

A

Beta blockers e.g. bisoprolol

91
Q

What are the four components to assess for haemodynamic stability

A

Shock (suggests end organ hypoperfusion)

Syncope (evidence of brain hypoperfusion)

Chest pain (evidence of myocardial ischaemia)

Pulmonary oedema (evidence of heart failure)

92
Q

What is the first line treatment for patients in fast AF who are haemodynamically unstable

A

Synchronised DC cardioversion

93
Q

What is the first line treatment in AF patients who are stable and who present within 48 hours of onset of symptoms

A

Rhythm control with either synchronised DC cardioversion or pharmacological cardioversion

After 48 hours they need to be anticoagulated as a thrombus may have formed

94
Q

AF is >48 hours (or onset is uncertain) but you want to rhythm control them with synchronised DC cardioversion.

Whats the plan

A

Patient must be anticoagulated for at least 3 weeks before DC cardioversion can be done.

Alternatively the patient can have a transoesophageal ECHO to rule out a thrombus in the left atrial appendage before cardioversion.

You want to do this for those that have AF with a reversible cause, who have heart failure thought to be primarily caused by AF or for whom a rhythm control strategy would be more suitable based on clinical judgement.

95
Q

Rate or rhythm control the AF?

AF has a reversible cause

A

Rhythm control with either synchronised DC cardioversion or pharmacological cardioversion

After presenting after 48 hours of symptom onset they need to be anticoagulated for at least 3 weeks before DC cardioversion can be done as a thrombus may have formed

96
Q

Rate or rhythm control the AF?

Heart failure thought to be primarily caused by AF.

A

Rhythm control with either synchronised DC cardioversion or pharmacological cardioversion

After presenting after 48 hours of symptom onset they need to be anticoagulated for at least 3 weeks before DC cardioversion can be done as a thrombus may have formed

97
Q

Rate or rhythm control the AF?

New onset AF (presenting within 48 hours)

A

Rhythm control with either synchronised DC cardioversion or pharmacological cardioversion

98
Q

What are the 4 situations in which you would choose rhythm control over rate control in AF

A

1) Reversible cause for AF
2) Heart failure thought to be primarily caused by AF
3) New-onset AF
4) Rhythm control strategy would be more suitable based on clinical judgement.

99
Q

Raised JVP on examination is most likely to be seen in:

A) Left-sided heart failure
B) Right-sided heart failure

A

Right sided heart failure

100
Q

Ankle oedema on examination is most likely to be seen in:

A) Left-sided heart failure
B) Right-sided heart failure

A

Right sided heart failure

101
Q

Ascites on examination is most likely to be seen in:

A) Left-sided heart failure
B) Right-sided heart failure

A

Right sided heart failure

102
Q

Orthopnoea on examination is most likely to be seen in:

A) Left-sided heart failure
B) Right-sided heart failure

A

Left sided heart failure

103
Q

What is the first line diagnostic investigation for stable angina

A

CT coronary angiography

104
Q

What surgical intervention is preferred for severe aortic stenosis in patients under 75 years old

A

Surgical aortic valve replacement

105
Q

What surgical intervention is preferred for severe aortic stenosis in patients over 75 years old

A

Transcatheter aortic valve implantation (TAVI)

Preferred over more invasive surgical aortic valve replacement

106
Q

Spironolactone is a potassium-sparing diuretic which acts as an anti-mineralocorticoid. A common side effect of spironolactone is:
A) Hypokalaemia
B) Hyperkalaemia

A

B) Hyperkalaemia

107
Q

Percutaneous coronary intervention (PCI) is available to patients who present within how many occurs since the onset of chest pain

A

12 hours

108
Q

Percutaneous coronary intervention (PCI) is available to patients who have been diagnosed with STEMI within what time frame

A

PCI should occur within 2 hours of diagnosis for STEMI

109
Q

What is a notorious side effects of dihydropyridine calcium channel blocker e.g. Amlodipine

A

Lower leg oedema

110
Q

Brugada’s syndrome is caused by a mutation in what gene?

A

Sodium ion channel gene mutation (SCN5A)

This gene codes for a voltage-gated sodium channel

111
Q

What is the definitive treatment of Brugada’s syndrome

A

Implantable cardioverter defibrillator (ICD)

Reduces the risk of sudden death from arrhythmias such as VT/VF.

112
Q

What are the ECG findings suggestive of Hypertrophic cardiomyopathy

A

Left ventricular hypertrophy (S wave depth in V1 + tallest R wave height in V5-V6)
Abnormal Q waves
Deep inverted T waves

113
Q

What is the inheritance pattern for hypertrophic cardiomyopathy

A

Autosomal dominant

114
Q

Hypertrophic cardiomyopathy is a congential condition as a result of mutations in genes coding for what protein?

A

Sarcomeric protein in cardiac myocytes

115
Q

Driving advice post pacemaker implantation or cardiac resynchronization therapy

A

Notify DVLA and resume driving after 1 week

116
Q

Why should beta-blockers and verapamil never be prescribed together

A

Risk of exacerbating atrioventricular conduction disorders, precipitating bradycardia and acquired complete heart block

117
Q

What murmur is commonly seen 2-10 days post myocardial infarction

A

Acute mitral regurgitation

Medical emergency and needs mitral valve repair or replacement

118
Q

Where in the heart is brain natriuretic peptide secreted from

A

Cardiac ventricles in response to increased stress which can develop due to heart failure

119
Q

Hypocalcaemia does what to the QT interval

A

Prolongs the QT interval

120
Q

Hypercalcaemia does what to the QT interval

A

Shortens the QT interval

121
Q

What are the three steps you need to take if you have a major bleed in a patient who is on warfarin

A

Stop warfarin
Give intravenous vitamin K 5mg
Prothrombin complex concentrate

122
Q

NSTEMI patients with a GRACE score > 3% should have coronary angiography within what time period since admission

A

72 hours

123
Q

What risk stratifying system is used to determine the patients risk of future adverse cardiovascular events and ultimately decided the management option (in patients with ACS)

A

Grace score

124
Q

What is the next step of management in a patient with new BP greater or equal to 180/120 mmHg with associated retinal haemorrhage or papilloedema

A

Admit for specialist assessment

125
Q

What vaccines should be offered to patients with heart failure

A

Annual Influenza vaccine
AND
Single pneumococcal vaccination

126
Q

What drugs should be a patient be discharged with following an MI

A

6 As:
Aspirin
Another antiplatelet e.g. Clopidogrel or Ticagrelor
Atorvastatin (Statin)
ACEi
Atenolol (beta blocker)
Aldosterone antagonist (if they have heart failure)

127
Q

What medication is used for pharmacologically cardioversion in AF

A

Amiodarone
AND
Flecainide

128
Q

Widened mediastinum is pathognomonic of what condition

A

Aortic dissection

129
Q

Side effects of GTN spray

A

‘3 H’s’

  1. Headache
  2. Hypotensive
  3. HR increase
130
Q

Likely Dx:

Chest pain, SoB, dizziness
Post-menopausal woman
Recent Hx of emotionally stressful experience or situation

A

Takotsubo cardiomyopathy

131
Q

Echo finding of Takotsubo cardiomyopathy

A

Hypokinetic apex.

132
Q

How is Takotsubo cardiomyopathy managed

A

Conservative management
Self-resolves

133
Q

What organism classically causes infective endocarditis in patients with poor dental hygiene or following a dental procedure

A

Streptococcus viridans

134
Q

New onset murmur and low grade fever is pathognomonic of what condition

A

Infective endocarditis

135
Q

What type of antibiotic leads to a prolonged QT interval which is associated with torsades de pointes

A

Macrolides such as erythromycin

136
Q

Women with absent arm pulses is pathognomonic of what condition

A

Takayasu’s arteritis (larger artery vasculitis)

137
Q

What investigation is the primary test for the diagnosis and evaluation of severity in aortic stenosis

A

Echocardiography

138
Q

What is the first line management option for Dressler’s syndrome

A

High doses of non-steroidal anti-inflammatory drugs (NSAIDs), tapered down after two weeks

139
Q

What is the next step in managing a patient with two measured BP >140/90

A

Offered either ambulatory BP monitoring or home blood pressure monitoring.

140
Q

Patients with ‘provoked’ pulmonary embolism should be anticoagulated for how long?

A

3 months

141
Q

Patients with ‘unprovoked’ pulmonary embolism should be anticoagulated for how long?

A

6 months

142
Q

Patients with ‘unprovoked’ pulmonary embolism with active cancer should be anticoagulated for how long?

A

3-6 months

143
Q

Infective endocarditis in intravenous drug users most commonly affects what valve

A

Tricuspid valve

144
Q

Infective endocarditis in patients with previously normal valve most commonly affects what valve

A

Mitral valve

145
Q

What three medications should be prescribed in stable angina

A

Beta blocker or calcium channel blocker e.g. verapamil

Aspirin

Statin

146
Q

What anticoagulants is used as first line therapy for anticoagulation in patients with atrial fibrillation

A

Direct oral anticoagulants (DOACs) e.g. Apixaban

147
Q

If angina is not controlled with a beta-blocker what medication should be added?

A

Longer-acting dihydropyridine calcium channel blocker e.g. amlodipine

148
Q

What murmur causes P Mitrale appearance on ECG

A

Mitral stenosis

149
Q

The first-line treatment for heart failure is ACE-inhibitor and a beta-blocker.

What is the second line treatment?

A

Addition of aldosterone antagonist e.g. spironolactone

Serum potassium levels should be monitored as both ICE inhibitors and aldosterone antagonists both cause hyperkalaemia

150
Q

Trifasicular block is an important differential for falls in the elderly.

What is the triad of features

A

Right bundle branch block

Left anterior or posterior hemiblock

1st-degree heart block

151
Q

In what three situations would a beta-blockers be stopped in acute heart failure

A

Heart rate < 50/min
Second or third degree AV block
Shock

152
Q

S1Q3T3 is a ECG pattern for what condition

A

Pulmonary embolism

Describes a deep S wave in lead I, a Q wave in lead III and an inverted T wave in lead III.

Not a common finding and more commonly, sinus tachycardia is seen in pulmonary embolism.

153
Q

Mobitz type I AV block with haemodynamic compromise.

Patient already received 3mg of atropine.

What is the next step in management

A

Transcutaneous pacing

154
Q

CHA2DS2-VASc score is important consideration following a diagnosis of AF to reduce stroke risk.
A score of 1 (males) or 2 (females) indicates the patient should be started on medication to reduce the stroke risk.

What is the first line management for long-term risk reduction in strokes

A

DOAC such as rivaroxaban

155
Q

Definitive management for Brugada syndrome

A

Implantable cardioverter-defibrillator

156
Q

If angina is not controlled with a beta-blocker, what medication should be added

A

Longer-acting dihydropyridine calcium channel blocker

157
Q

First line management of stable angina

A

Either a beta-blocker or a calcium channel blocker

All patient should be prescribed a statin, aspirin and GTN spray

158
Q

If patients have persistent myocardial ischaemia following fibrinolysis then what is the next step of management

A

Transfer the patient for PCI

159
Q

Q-Risk score of what indicates adding statin in hypertension management

A

> 10%

160
Q

First line investigation for chronic heart failure

A

N-terminal pro-B-type natriuretic peptide (NT‑proBNP)

161
Q

What is the antidote for dabigatran

A

Idarucizumab

162
Q

What is the antidote for warfarin

A

Phytomenadion

WARfarin = FIGHT (phyto)menadion

163
Q

What is the antidote for heparin

A

Protamine

“Hep is a Pro”

164
Q

Management of type A aortic dissection

A

Control BP (IV labetalol) + surgery

Problem is in the ascending aorta

165
Q

Management of type B aortic dissection

A

Control BP(IV labetalol)

Problem is in the descending aorta

166
Q

If the first 6mg bolus of adenosine does not work for Supraventricular tachycardia what is next step in management

A

if unsuccessful give 12 mg → if unsuccessful give further 18 mg

167
Q

In constrictive pericarditis, the JVP will rise on inspiration

What sign is this

A

Kussmaul’s sign

168
Q

What is Kussmaul’s sign

A

Raised JVP on inspiration

Typical of constrictive pericarditis

169
Q

Treatment of torsades de pointes

A

IV magnesium sulfate

Finals: Speciality Blocks (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions