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Year 5 > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

how long do symptoms last in unstable angina vs stable angina?

A

20 minutes

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2
Q

when does troponin start to rise in ACS?

A

4-8 hours

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3
Q

when does troponin peak?

A

18-24 hours

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4
Q

Other than troponin, name 2 other indicators of ACS that can be measured in the blood?

A

myoglobin

CK-MB

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5
Q

Other than ACS what can cause a rise in troponin?

A

HF
Renal failure
sepsis

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6
Q

how does LBBB present on an ECG?

A

WILLIAM (V1+V6)

Abscence of Q waves and broad R in 1, V5 and V6

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7
Q

What is the definition of an MI?

A
  1. Rise in troponin +

2. either symptoms of ischaemia/ ECG changes

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8
Q

What is a pathological Q wave?

A

> 0.04seconds and >4mm deep

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9
Q

Where would ECG changes be seen in an anterior MI and what artery is occluded?

A

V1, V2, V3, V4

LAD

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10
Q

Where would ECG changes be seen in a septal MI and what artery is occluded?

A

V1, V2

LDA

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11
Q

Where would ECG changes be seen in an inferior MI and what artery is occluded?

A

2, 3, AVF

RCA

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12
Q

Where would ECG changes be seen in a lateral MI and what artery is occluded?

A

1, AVL, 5, 6

circumflex artery

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13
Q

Where would ECG changes be seen in a posterior MI and what artery is occluded?

A

dominant R wave in V1-3 and ST depression
V7-9
Right circumflex

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14
Q

what is the initial management of an MI?

A 
MONA
Morphine 2.5-10mg and metaclopromide 10mg IV
O2
Nitrates
aspirin 300mg and clopidogrel 300mg
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15
Q

what is the long-term management post-MI?

A 
BASIC:
BBs- propanalol
Aspirin 75mg and clopidogrel/ ticagrelor
statins
inhibitor of ACE
correction of RFs
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16
Q

which score can be used in ACS to assess mortality?

A

GRACE score

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17
Q

name 3 complications of ACS?

A 
Death
tacchyarrhythmia
HF
stroke
Mitral regurg
Dressler's syndrome
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18
Q

What is Dressler’s syndrome?

A

presents following an MI as pericarditis, treat with NSAIDs and colchicine

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19
Q

at what level does the aorta bifurcate?

A

L4

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20
Q

What does a third heart sound indicate?

A

congestive HF

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21
Q

what are 3 symptoms of left sided HF?

A

pulmonary oedema causing cough, shortness of breath and paroxysmal nocturnal dyspnoea

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22
Q

what are 3 symptoms of right sided HF?

A

raised JVP
peripheral oedema
ascites

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23
Q

what level of BNP/ pro-BNP would indicate HF and what level would require urgent referal?

A

> 100 BNP/ >400 pro-BNP = HF

>400 BNP/ >2000 pro-BNP = Urgent referal

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24
Q

what Xray changes may be seen in HF?

A 
ABCDE
Alveolar oedema (bat wings)
kerley B lines
cardiomegaly
dilated upper lobe vessels
effusion
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25
Q

NY heart association HF staging:

what stage is someone who is able to keep up with peers in normal physical activity?

A

Stage 1

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26
Q

NY heart association HF staging:

what stage is someone who is out of breath on mild exertion e.g. putting on the kettle?

A

Stage 3

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27
Q

NY heart association HF staging:

what stage is someone who is breathless on moderate exertion?

A

stage 2

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28
Q

NY heart association HF staging:

what stage is someone who is breathless on any activity?

A

stage 4

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29
Q

what is the management for an acute exacerbation of HF?

A

forusemide iv, aim to lose 0.5-1kg/ day
morphine
salbutamol nebs PRN
if not on ACEI/ BB do not start until not requiring IV forusemide

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30
Q

when would pharmacological interventions for heart failure be appropriate?

A

LVEF <40%

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31
Q

What are 3 complications of HF?

A

DVT/ stroke
arrhythmia
infections

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32
Q

what is the effect of ACEIs in HF?

A

reduce afterload and fluid retention therefore LV disease progression

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33
Q

What is the effect of BB in HF?

A

Reduce afterload and HR threfore reducing arrhythmias

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34
Q

What is the initial treatment of HF with reduced LVEF?

A

ACEI + BB

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35
Q

If a patient with HF who is on ACEI and BB is still symptomatic what is the next line of management?

A

mineralocorticoid receptor antagonist e.g. spironolactone

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36
Q

If a patient with HF who is on ACEI, BB and spironolactone is still symptomatic what is the next line of management?

A

if HR >70 ivabradine
if QRS> 130 consider ccardiac resynchronisation therapy
if still no response: hydralazine + nitrates/ transplant/ LV assist device

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37
Q

which drugs improve prognosis in HF?

A

ACEI
cardioselective BB
Spironolactone
loop diuretics, digoxin and nitrates purely to improve symptoms

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38
Q

name 3 causes of secondary hypertension?

A

renal disease e.g. RAS
endocrine (cushings/ phaeochromocytoma)
coarctation of the aorta
obstructive sleep apnoaea

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39
Q

how would a phaeochromocytoma present?

A

HTN
postural hypotension
headache
diaphoresis

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40
Q

define stage 1 HTN

A

clinic BP >140/90 or ABPM >135/85

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41
Q

define stage 2 HTN

A

clinic BP >160/100 or ABPM >150/95

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42
Q

define accelerated HTN

A

clinic BP >180/110 + end organ damage

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43
Q

when are pharmacological interventions for HTN appropriate?

A

stage 2

stage 1 + end organ damage/ DM/ QRISK2 >20%

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44
Q

What score in a 2 level Well’s score would make you suspect a DVT?

A

2+

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45
Q

name 3 causes of a raised D dimer

A

malignancy
inflammation
trauma- post-op

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46
Q

what difference in leg measurement is significant if suspecting a DVT?

A

> 3cm

measured 10cm below tibial tuberosity

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47
Q

what test is the gold standard if suspecting a DVT?

A

Venography, however compression USS usually used as cheap and easy- note only 50% sensitivity for DVT below knee, 90% above

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48
Q

Why are LMWH used when warfarin is started?

A

warfarin increases coagulability in first few days

takes few days to achieve target INR

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49
Q

How long is warfarin/ DOAC continued after first DVT?

A

6 months, unless post-op (3 months) or if continued risk e.g. cancer or genetic clotting disorder

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50
Q

what is Virchow’s triad?

A

stasis of blood
vessel wall injury
increased coagulation

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51
Q

how is heparin monitored?

A

APPT

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52
Q

How is warfarin monitored?

A

INR

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53
Q

how long before an operation should the COCP be stopped to prevent DVT?

A

4 weeks

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54
Q

ejection systolic murmur

A

aortic stenosis
pulmonary stenosis
ASD/ TOF

55
Q

Pansystolic murmur

A

mitral/ tricuspid regurg

VSD “Harsh in character”

56
Q

late systolic murmur

A

mitral valve prolapse

coarctation of aorta

57
Q

early diastolic murmur

A

aortic/ pulmonary regurg “high pitched and blowing”

58
Q

mid-late diastolic

A

mitral stenosis “rumbling”

59
Q

continuous machine like murmur

A

PDA

60
Q

what are the 6 Ps of acute limb ischaemia?

A 
pallor
pulseless
painful
parasthaesia 
perishingly cold
paralysis
61
Q

what does fixed mottling of skin indicate?

A

irreversible ischaemia

62
Q

how would you roughly locate the location of a thrombus causing acute limb ischaemia?

A

the bifurcation distal to the last palpable pulse

63
Q

what 2 treatment options are available for acute limb ischaemia?

A
  1. thrombolysis with tPA given over 8-24hrs
  2. open surgery/ angioplasty
    give heparin after both
64
Q

what device is used in acute limb ischaemia to locally deliver tPA?

A

Fogarty catheter

65
Q

what is tPA?

A

tissue plasminogen activator

66
Q

name 3 complications of acute limb ischaemia

A

reperfusion causing hyperkalaemia -> ECG changes/ AKI
chronic pain syndrome
compartment syndrome

67
Q

name 3 drugs that can cause complete heart block

A

BB
CCB
digoxin

68
Q

name 3 causes of complete heart block

A 
congenital (aortic stenosis)
CHD
infective- rheumatic fever/ endocarditis
autoimmune- SLE
hyperkalaemia
69
Q

what is the acute treatment of complete heart block in a haemodynamically unstable patient?

A

atropine- 0.5mg, repeat every 3-5 mins to 3mg

consider transcutaneous pacing/ dopamine infusion/ adrenaline infusion

70
Q

what is a normal PR interval?

A

120-200ms (3-5 small squares)

71
Q

what is mobitz 1 second degree heart block?

A

progressive lengthening of PR interval until beat dropped (Wenckebach)

72
Q

What is mobitz 2 second degree heart block?

A

normal PR with occasional dropped beat e.g. 2:1

73
Q

which type of second degree heart block may require prophylactic pacing to prevent progression to complete heart block?

A

mobitz 2

74
Q

what is the definiton of postural hypotension?

A

drop in BP more than 20/10mmHg <3 minutes after standing

75
Q

what lifestyle advice might you advise in postural hypotension

A

stand slowly
sleep with head of bed tilted up
may need compression socks

76
Q

what medication can be used in postural hypotension when lifestyle interventions have failed?

A

fludrocortisone

77
Q

what 3 symtpoms constitute typical angina?

A

chest pain
brought on by exertion/ emotional stress
relieved by GTN in <5 minutes

78
Q

true or false: all cases of angina need urgent referral to cardiology

A

false: only if rapidly progressing or getting pain at rest. Although all cases should be referred to rapid access chest clinic to assess extent of damage

79
Q

how many doses of GTN should you try before calling 999?

A

3 (5 minutes apart therefore 15 minutes total)

80
Q

First line medication for stable angina?

A

BB (or CCB)

also RF control: aspirin 75mg, statin, ACEI (if DM)

81
Q

what score on CHAD2S2VASc would you consider anticoagulation

A

2+

82
Q

what are the rules on driving with AF?

A

if symptomatic no driving until symptom free for 4 weeks

83
Q

if less than 48 hours of onset of AF, what treatment should be used?

A

if haemodynamically unstable cardioversion (electric/ amiodarone),
if over 48 hours 3 weeks of rate control and anticoagulation/ TTE first

84
Q

treatment for recurrent AF?

A

BB
CCB
if no response catheter radiofrequency ablation/ rhythm control with butilide etc

85
Q

what values would you expect HR to be in SVT?

A

140-250bpm

86
Q

name 3 vagal manouvres

A

facial immersion in cold water
blow into syringe
carotid massage

87
Q

if no response to vagal manouvres what is the next step of management in SVT?

A

adenosine 6mg-> 12mg-> 12mg

88
Q

what size should the QRS be on an ECG?

A

<120ms

89
Q

name 2 shockable rhythms

A

pulseless VT

VF

90
Q

if unstable pulsed VT what would you give?

A

amiodarone

91
Q

3 causes of mitral regurg?

A

rheumatic fever
infective endocarditis
CHD

92
Q

which valve is most commonly affected by rheumatic fever?

A

mitral valve causing mitral stenosis or regurg (less common)

93
Q

which organism causes rheumatic fever?

A

group A B-haemolytic strep pyogenes

94
Q

what is a complication of mitral regurg?

A

LA dilatation leading to AF

95
Q

what signs might you see in a patient with mitral stenosis?

A

signs of RV failure- raised JVP
peripheral oedema
hepatomegaly

96
Q

what is a complication of mitral stenosis?

A

pulmonary hypertension leading to R-sided HF

97
Q

With which murmur might you associate a widened pulse pressure?

A

aortic regurg

98
Q

name 2 causes of aortic stenosis

A

calcification

congenital bicuspid aortic valve

99
Q

With which murmur might you associate a slow rising pulse?

A

aortic stenosis

100
Q

With which murmur might you associate a narrow pulse pressure?

A

aortic stenosis

101
Q

With which murmur might you associate a thrusting and downward displaced apex beat?

A

aortic stenosis

102
Q

which murmur most commonly radiates to the carotids?

A

aortic stenosis

103
Q

name 3 signs you might find on a patient with infective endocarditis?

A

splinter haemorrhages
fever
osler’s nodes/ janeway lesions

104
Q

what are osler’s nodes

A

red tender nodules on pulp of terminal phalanges fond in infective endocarditis, immunological cause, part of Duke’s criteria

105
Q

what are janeway lesions?

A

erythematous macules on thenar/ hypothenar eminences in infective endocarditis. vascular cause, part of Duke’s criteria

106
Q

what criteria can be used to determine the likelihood of infective endocarditis?

A

Duke’s criteria, differentiates into definite/ possible/ rejected

107
Q

which other body system may be affected in infective endocarditis?

A

renal- glomerulonephritis/ AKI

108
Q

what is trendelenberg’s test used for?

A

to identify the level of incompetent valves in varicose veins

109
Q

what are some surgical options for treating varicose veins?

A

stripping
foam sclerotherapy
endothermal ablation

110
Q

what are 3 complications of varicose veins?

A

thrombophlebitis
venous ulcers/ eczema
haemorrhage

111
Q

what is the most common presentation of ischaemic rest pain?

A

increased pain at night, relieved by hanging foot off edge of bed

112
Q

3 symptoms of PAD

A

hair loss on leg
ulcers
reduced pulses
poor wound healing

113
Q

if a diabetic patient presents with a new food/ leg ulcer how soon should they be seen in MDT foot clinic?

A

24hours as high risk of infection and reduced wound healing so high risk for amputation

114
Q

how would you calculate ankle-brachial pressure index?

A

SBP at ankle/ SBP in brachial artery

note higher reading from left/ right arm and ankle is used

115
Q

what ABPI would indicate intermittent claudication?

A

0.5-0.9

116
Q

what ABPI would indicate critical limb ischaemia?

A

<0.5, <0.3= high risk of gangrene

117
Q

what are possible surgical interventions for PAD if lifestyle/ aspirin have failed?

A

percutaneous transluminal angioplasty (not surgery under GA? but high recurrence/ clotting of stent)
thromboendarterectomy (bypass if obvious occlusion and able to survive surgery)
limb compression several times a week if unsuitable for surgery

118
Q

What are the monitoring options for AAA?

A

3-4.4cm annually
4.5-5.5cm 3 monthly
>5.5cm elective EVAR/ open repair

119
Q

What should you cross match in AAA?

A

10 units RBCs
FFP
platelets
aim for SBP <90

120
Q

according to DVLA when post-MI can patient drive?

A

4 weeks

121
Q

name 3 causes of acute pericarditis

A

infetion (coxsachie B/ echovirus)
post MI pericarditis/ Dressler’s syndrome (AI)
HIV- staphylococcal

122
Q

typical pericarditis pain is:

A

retrosternal
aggrevated by deep breathing
releived by leaning forward
associated pericardial friction rub on auscultation

123
Q

Typical ECG changes in pericarditis

A

widespread saddle shaped ST elevation

pr depression

124
Q

first line treatment for pericarditis?

A

NSAIDs (not in first few days post-MI)

bed rest

125
Q

what are pulsus paradoxus(stron pulse on inspiration and very weak expiration) and Kussmaul’s sign (raised JVP and increased neck vain distention in inspiration) a sign of?

A

cardiac tamponade

126
Q

what is pericardial effusion?

A

collection of fluid most commonly due to pericarditis, can result in tamponade. low voltage QRS on ECG, muffled heart sounds and enlarged heart on CXR

127
Q

what are the 3 main types of cardiomyopathy?

A

dilated (CAD/ MI)
hypertrophic (congenital)
restrictive (idiopathic/ haemochromatosis)

128
Q

how might aortic dissection present?

A

haemodynamic instability and syncope

tearing pain

129
Q

in which layers does an aortic dissection occur?

A

separation in aortic wall intima leading to blood flow between inner and outer layers of media

130
Q

define mesenteric ischaemia?

A

compromised blood supply to small intestine leading to severe pain, N+V, bloody stool, hx of AF/ CVD

131
Q

how might SVCO/ thrombosis present?

A

breathlessness
facial swelling and redeness
visible swollen veins on chest/ neck
headaches- worse on bending forward

132
Q

Raynauds cause

A

overreaction to cold by peripheral BVs, primary or due to working with drills etc/ atherosclerosis/ scleroderma/ carpal tunnel/ BB

133
Q

whta is lymphoedema?

A

lymphatic obstruction due to malignancy, post-irradiation, surgery, recurrent infection, lymphatic hypoplasia

Year 5 (12 decks)

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