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Cardiovascular Flashcards

1
Q

Arterial aneurysm

  1. Common sites
  2. Causes
  3. Unruptured AAA - definition
  4. At what size should it be measured every 6 months
  5. Considerations for surgery
  6. Clinical features - unruptured
  7. Best imaging
  8. Ruptured - clinical features
  9. Ruptured - clinical approach
  10. Prophylactic antibiotics (2)
  11. Screening
A
  1. Abdominal aorta (infra-renal), iliac, femoral, popliteal
  2. Atheroma, trauma, infection, CTDs, Takayasu
  3. > 3cm
  4. < 5.5cm
  5. > 5.5cm or rapidly expanding
  6. Can be asymptomatic, back/abdominal pain
  7. USS
  8. Abdominal pain radiating to the back, sweating, SOB, shocked, dilated abdomen, expansile pulsating abdominal mass
  9. ABCDE, oxygen, contact vascular team
  10. Cefuroxime, metronidazole
  11. Single abdominal ultrasound for males aged 65
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2
Q

Aortic Dissection

  1. Tear in which wall of aorta
  2. Risk factors (ABC)
  3. Clinical features
  4. ECG changes
  5. Suspected - imaging and findings
  6. Stanford type A - location + management
  7. Stanford type B - location + management
  8. Bedside test
  9. Other imaging
  10. Other management
  11. Acute complications
A
  1. Tunica intima
  2. Age, Baby/BP (HTN most important), CTD
  3. Severe, tearing chest pain radiating to back, aortic regurgitation, HTN, loss of peripheral pulses, radial-radial delay, potentially shock. Also angina (coronary arteries), paraplagia (spinal arteries), limb/renal ischaemia (distal aorta)
  4. None / ST elevation in inferior leads
  5. CT (false lumen), CXR (widened mediastinum)
  6. Ascending aorta, 2/3 of cases, surgical management
  7. Descending aorta, distal to left subclavian origin, 1/3 of cases, medical management (anti-HTN, monitor)
  8. ECG
  9. USS, CT/MR, TO echo
  10. Crossmatch 10 units, ECG, CXR, CT/TOE
  11. MI, acute renal failure (ischaemia), hemiplegia, lower limb ischaemia
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3
Q

Myocardial disease

  1. Primary causes (4 - ‘HARD’)
  2. Secondary causes (4)
  3. Peripheral signs
  4. Heart signs
  5. Lung signs
  6. Abdominal signs
  7. Secondary risk factors
A
  1. Hypertrophic obstructive, Arrhythmogenic RV, Restrictive, Dilated
  2. Systemic, ischaemic, HTN, inflammatory
  3. Cyanosis, oedema
  4. Tachycardia, raised JVP, S3 heart sound
  5. Tachypnoea, basal crepitations, pleural effusion
  6. Ascites, hepatomegaly
  7. HTN, lipids, IHD, DM, FH, smoking, cocaine (young)
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4
Q

Dilated cardiomyopathy - commonest cardiomyopathy

  1. Causes
  2. Pathophysiology
  3. Biopsy findings
  4. Ventricular dilation - complications
A
  1. Idiopathic, myocarditis, HTN, alcohol, chemotherapy
  2. Dilated heart, mostly systolic dysfunction
  3. Haphazard architecture, enlarged myocytes, t cell infiltration, fibrosis
  4. Tachyarrhythmias, LV thrombus w/ embolism causing stroke, valve dysfunction
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5
Q

Hypertrophic obstructive cardiomyopathy (HOCM)

  1. Main cause
  2. How it leads to reduced cardiac output
  3. ECG results
  4. Histology
  5. Patient education
  6. Medical management (3 drugs)
  7. Surgical management
A
  1. Genetic
  2. Stiff ventricular walls/septum lead to reduced diastolic filling + LV outflow obstruction
  3. Normal / ST depression and T wave inversion
  4. Myofibrillar hypertrophy with chaotic and disorganized fashion myocytes (‘disarray’) and fibrosis
  5. Controlled exercise to prevent sudden death
  6. Beta blockers (improve diastolic filling and reduce myocardial demand), CCBs + Disopyramide
  7. Septal ablation, ICD, myomectomy
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6
Q

Restrictive cardiomyopathy

  1. Pathophysiology
  2. Causes
  3. Difficult to clinically distinguish from
  4. Clinical features (peripheral, heart, lungs, abdomen)
  5. ECG changes
  6. Imaging/other invasive test
A
  1. Poor diastolic filling, cannot increase as FIXED stroke volume
  2. Idiopathic, systemic sclerosis, amyloid, post-infectious
  3. Constrictive pericarditis (e.g. post TB)
  4. Peripheral (SOB, fatigue, oedema), cardiac (palpable apex, loud S3+4, rised JVP), respiratory (pulmonary oedema), abdominal (hepatomegaly)
  5. P mitrale + P pulmonale
  6. Echo, cardiac catheterisation
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7
Q

Myocarditis

  1. Causes
  2. Commonest viral cause
  3. Clinical features
  4. Key blood test
A
  1. Infective, post viral, rheumatic fever, transplant reject
  2. Coxsackie virus B
  3. Broad - maybe asymptomatic, maybe heart failure, maybe fever, SOB, chest pain, palpitations, tachycardia
  4. Serology for infectious agents
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8
Q

Valve disease

  1. Imaging
  2. Replacement valve complication
  3. Medical management
  4. Drug to use in regurgitation conditions
  5. Metallic mitral valve - auscultation
  6. Metallic aortic valve - auscultation
A
  1. CXR, echo (TTE / TOE)
  2. Infective endocarditis, PE / DVT, haemolysis / anaemia
  3. AF control, anticoagulation in valve replacement
  4. Vasodilators to reduce afterload
  5. Click replaces S1
  6. Click replaces S2
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9
Q

Mitral stenosis (diastolic)

  1. Main causes
  2. Murmur
  3. Other examination findings
  4. ECG findings
  5. Management
  6. Another differential
A
  1. Senile calcification, rheumatic heart disease, IE
  2. Mid-diastolic, low-pitched (best in expiration, patient to left), can have ‘Graham-Steell’ murmur
  3. Clubbing (heart failure), raised JVP, anaemia signs (haemolysis), malar flush (low CO), pulmonary HTN causes SOB, haemoptysis
  4. AF (higher left atrial pressure), right axis deviation (right heart failure), P mitrale (if in sinus rhythm)
  5. Rate control AF, anticoagulate, diuretics, surgery
  6. Cardiac myxoma
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10
Q

Mitral regurgitation (systolic)

  1. Causes
  2. Murmur and radiation
  3. Apex beat
  4. ECG features
  5. CXR features
  6. Symptoms
  7. Medical management
  8. Other potential differentials (3)
A
  1. Valve prolapse, RF, post-MI papillary muscle rupture post MI, endocarditis
  2. Pansystolic, high-pitched, radiating to axilla
  3. Displaced
  4. Atrial fibrillation, P mitrale (? LAH), LVH
  5. Pulmonary oedema
  6. Dyspnoea, fatigue, palpitations
  7. Diuretics, ACE-i, treat AF
  8. Aortic stenosis, VSD, tricuspid regurgitation
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11
Q

Heart failure - general

  1. Definition
  2. Left causes (2 broad and examples)
  3. Signs/symptoms
  4. Right causes
  5. Signs/symptoms
  6. Classification in terms of symptoms (NY, 1-4)
  7. Diagnosis, including which criteria
A
  1. Ejection fraction <40%
  2. Low output (IHD, valve disease, HTN, myopathy), increased demand (pregnancy, anaemia)
  3. SOB worse on exertion, cough (prink frothy sputum), orthopnoea, paroxysmal nocturnal dyspnoea, peripheral cyanosis, clubbing, tachycardia, palpitations, chest pain, syncope, abdominal pain/distention, displaced apex, 3rd heart sound, basal crepitations ‘wet’
  4. Pulmonary HTN, left HF, ischaemia, myocarditis
  5. Raised JVP, oedema (sacral/pedal), hepatomegaly
  6. 1 (none), 2 (on exertion), 3 (mild effort), 4 (at rest)
  7. Check ECG/BNP (likely if >400ng/L). Framingham criteria for symptoms/signs
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12
Q

Aortic stenosis (systolic)

  1. Causes (3)
  2. Presentation
  3. Murmur and radiation
  4. Heart sounds
  5. Pulse
  6. Apex beat
  7. ECG features / common arrhythmia (+ cause)
  8. Management - medical + surgical
  9. Other potential differentials (3)
  10. Aortic sclerosis - definition
  11. Medication to avoid
A
  1. Valve calcification (ageing), bifid valve, RH disease
  2. Triad - angina, syncope, HF (+ SOB)
  3. Ejection systolic, high-pitched, radiating to carotids
  4. 4th heart sound
  5. Slow rising, narrow pulse pressure
  6. Heaving, not displaced
  7. LVH / LV strain; AV block (calcification in this area)
  8. Treat HTN, open valve replacement / TAVI
  9. Aortic sclerosis, mitral regurgitation, hypertrophic cardiomyopathy
  10. Valve leaflets thickening NOT causing haemodynamic changes, so ejection systolic murmur but not radiating to carotids, and normal pulse
  11. Drugs that reduce after load e.g. nitrates and ACE-is
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13
Q

Aortic regurgitation (diastolic)

  1. Causes
  2. Murmur
  3. Pulse
  4. Apex beat
  5. Symptoms
  6. Signs
  7. Management
A
  1. Infective endocarditis, rheumatic fever, connective tissue disease, ascending aortic dissection
  2. Early diastolic at left sternal edge, high pitched, (expiration, sat forward).
    ‘Austin Flint’ if severe (rumbling instead of soft)
  3. Collapsing and wide pulse pressure (‘water hammer’)
  4. Displaced inferiorly and laterally
  5. Exertional dyspnoea, orthopnoea, PND, palpitations, angina, syncope
  6. Corrigan’s (carotid pulsation), de Musset (head nod with heart beat), Quincke (nail bed capillary pulse)
  7. Reduce systolic HTN; ACE-i, echo every 6-12 months, surgery before reaching severe LV dysfunction
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14
Q

Acute LV failure (HF decompensation)

  1. Triggers (4)
  2. Auscultation + pulse - findings
  3. Simple tests
  4. CXR findings
  5. Gold standard imaging
  6. Acute management - general
  7. If BP >100
  8. If BP <100
A
  1. Iatrogenic (aggressive fluids), sepsis, MI, arrhythmias
  2. 3rd heart sound (rapid V filling, normal up to 40yo, other causes = MI, cardiomyopathy, HTN, MR/AR), pulsus alternans
  3. FBC, U+E, LFT, BNP, TFT, bone/clotting, fasting glucose/lipids, urine dip, ECG, CXR, troponin if ? MI
  4. Aveolar oedema, Kerly B lines (interstitial oedema),
    Cardiomegaly, Dilated upper lobe vessels, pulmonary Effusions
  5. Echo
  6. Sit up, stop fluid, O2 (if <95%), ECG, CXR, blood, ABG
  7. IV furosemide 40mg stat, GTN, opiates
  8. Consider CPAP for pulmonary oedema, consider ICU
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15
Q

Infective endocarditis

  1. Commonest organisms (2)
  2. Risk factors
  3. Non-infective causes
  4. Commonest valve
  5. Commonly affected valve/heart side in IVDU
  6. Signs to raise suspicion of IE
  7. Other clinical features
  8. Hand signs
  9. Bloods and results
  10. Culture diagnostic criteria
  11. Bedside tests
  12. Imaging and results
  13. Dukes criteria diagnosis
  14. Major criteria
  15. Minor criteria
  16. Medical management
  17. Surgical management - indications
A
  1. Staph. aureus; Strep. viridans in developing countries
  2. IVDU, rheumatic heart disease, prosthetic valve, congenital heart defects, surgery, hepatic/renal failure
  3. SLE, marantic (non-bacterial thrombotic)
  4. Atrial
  5. Tricuspid valve; right hand side
  6. New murmur and fever
  7. Rigors, sweats, malaise, fatigue, anorexia, big spleen
  8. Clubbing, splinter haemorrhages, osler’s nodes, janeway lesions, roth spots
  9. CRP, FBC, LFT, U+E, (normochromic, normocytic anaemia, neutrophilia, high ESR/CRP)
    BLOOD CULTURES (3 sites, 1-2 hours apart)
  10. Must be positive culture in two
  11. ECG, urine dip (microscopic haematuria)/culture, swab
  12. TOE, CXR (cardiomegaly, pulmonary oedema)
  13. Either 2 major, major + 3 minor, or all 5 minor
  14. 2 separate positive cultures, positive echo (vegetation/abscess), new regurgitation
  15. Risk factors (IVDU/heart disease), fever >38, vascular/ immune phenomena, only one positive culture
  16. Blind (amoxicillin + gentamicin), staphylococcus (flucloxacillin), streptococcus (benzylpenicillin), add gentamicin if prosthetic valve
  17. Heart failure, valvular obstruction, repeat emboli, fungal, persistent bacteraemia, myocardial abscess, unstable infected prosthetic valve
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16
Q

Atrial Fibrillation

  1. Underlying causes
  2. ECG findings
  3. Complications (2)

Chronic AF - rate control + anticoagulation

  1. 1st line
  2. If sedentary (+ classic cause of toxicity)
  3. If evidence of LV dysfunction
  4. Rhythm control - indications
  5. Acute + stable
  6. Acute + unstable (e.g. HF)
  7. Amiodarone - mechanism of action
  8. Side effects
  9. Delayed DC cardioversion - give what before (3)
  10. Do before if evidence of conduction system disease
  11. Anticoagulants
  12. Paroxysmal - management if rare/no structure problem
A
  1. Cardiac (HTN, valve, IHD, heart failure), respiratory (infection, cancer), systemic (alcohol, hyperthyroid, low electrolyte, infection, diabetes), obesity
  2. No P, irregularly irregular (ventricular ectopics also cause this but disappear when HR up), varying rate
  3. Systemic embolisation, heart failure
  4. Beta blockers OR CCB e.g. diltiazem (NOT in HF)
  5. Digoxin, toxicity can occur if low K+
  6. Digoxin / diltiazem
  7. <48 hours, reversible cause, causing HF, symptomatic despite rate control
  8. Chemical cardioversion - flecainide/amiodarone (if structural defect)
  9. Immediate DC cardioversion
  10. Potassium channel blocker
  11. Thyroid dysfunction, corneal deposits, pulmonary fibrosis/pneumonitis, liver fibrosis/hepatitis, peripheral neuropathy photosensitivity, ‘slate-grey’ appearance, bradycardia, thrombophlebitis, injection site reactions
  12. 3 weeks rate control, anticoagulation, amiodarone
  13. Pacemaker insertion
  14. Heparin until stable, then warfarin/DOAC for chronic
  15. Anticoagulation, + flecainide ‘pill in pocket’
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17
Q

Atrial flutter

  1. Pathophysiology
  2. Usually accompanied with which arrhythmia
  3. ECG changes
  4. Treatment strategies (2)
A
  1. SVT + succession of rapid atrial depolarisation waves
  2. AV block
  3. Saw-tooth pattern, and as the underlying atrial rate is often around 300/min the ventricular or heart rate is dependent on the degree of AV block
  4. Anticoagulation, rate control (beta blockers), or curative (DC cardioversion / radiofrequency ablation)
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18
Q

Wolff Parkinson White

  1. Definition
  2. ECG changes
  3. Management - invasive
  4. Management - medical
A
  1. Atrial re-entry tachycardia + accessory pathway (Bundle of Kent) linking atrium + ventricle
  2. Short PR (<0.12), delta wave, wide QRS (>0.12)
  3. DC cardioversion / ablation
  4. Rate control - beta blocker / calcium channel blocker
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19
Q

Ventricular tachycardia

  1. Commonest causes (4)
  2. ECG findings
  3. Management - medical
  4. Management - invasive (1st time and recurring)
  5. Main complication
  6. Torsades de pointes - definition
  7. Management
A
  1. Ischaemia, drugs, metabolic problems, long QT syndrome (chanelopathy)
  2. Broad complex tachycardia
  3. Amiodarone infusion / lidocaine
  4. DC cardioversion; if recurrent then ICD
  5. Ventricular fibrillation
  6. Polymorphic VT with QT prolongation
  7. Magnesium infusion, correct electrolyte abnormality
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20
Q

Heart block - definitions

  1. 1st degree - definition
  2. 2nd degree Mobitz type 1 (Wenckebach)- definition
  3. 2nd degree Mobitz type 2 - definition
  4. 3rd degree - definition
  5. 1st/2nd degree - causes
  6. 3rd degree - causes
  7. AV block - medical management
  8. Symptomatic 2nd/3rd degree - management
A
  1. PR longer than 5 small squares
  2. PR interval lengthens then drops
  3. 1:3 or 1:2 p to QRS ratios (no link to PR interval)
  4. No association between P and QRS
  5. Normal, athletes, sick sinus, IHD (inferior MI), myocarditis, drugs (b-blockers, digoxin)
  6. IHD (inferior MI), idiopathic fibrosis, congenital, aortic valve calcification, digoxin toxicity, trauma/infiltration
  7. Atropine
  8. Cardiac pacing
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21
Q

Long QRS - issues

  1. Left BBB (WM) - pattern
  2. Causes
  3. Right BBB (MW) - pattern
  4. Causes
  5. Bifascicular block - ECG findings
  6. Trifascicular block - ECG findings, can lead to what
A
  1. QRS >0.12, dominant S V1, TWI in V5-6
  2. IHD, HTN, cardiomyopathy, STEMI if new
  3. QRS >0.12, dominant R V1, slurred S V6, TWI in V1-3
  4. Normal variant (isolated), PE, cor pulmonale
  5. RBBB + left/ right axis deviation
  6. RBBB, left/ right axis deviation, and above + AV node block (1st degree heart block), can lead to 3rd degree HB
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22
Q

Hypertension

  1. Essential (primary) definition (stages 1-3)
  2. Secondary - causes (ROPE)
  3. Other risk factors
  4. Bloods
  5. Management - medical indication
  6. BP treatment goal
  7. 1st line (+ common SEs)
  8. What not to give if diabetic
  9. 2nd line + 3rd line
  10. Malignant hypertension - definition + hallmark
  11. In HTN emergency, should be lowered at what rate
A
  1. Stage 1 (140/90), 2 (160/100), 3 (180/12)
  2. Renal disease, obese, pregnant, endocrine (Conn’s)
  3. Metabolic syndrome, alcohol, DM, black, 60+, FH
  4. Lipids, U+E, fasting glucose
  5. Stage 1 plus comorbidity, any stage 2
  6. <140/90 (<130/80 in DM, <150/90 if aged 80+)
  7. ACE-i (cough) or ARB if <55, CCB (oedema) if >55/black
  8. CCB (ACE-i 1st line at any time/age)
  9. 2nd- ACE-i/ARB + CCB, 3rd add indapamide (or add if evidence of heart failure)
  10. 200/130 - hallmark is ‘fibrinoid necrosis’
  11. 25% in 4 hours
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23
Q

CV disease prevention - medications

  1. Primary - score to calculate, do what when
  2. Statins - mechanism
  3. Other cohorts needing primary prevention
  4. Monitoring requirements
  5. Expected abnormal result
  6. Secondary prevention - 4 As
  7. Aspirin - mechanism of action
  8. Clopidogrel - MoA
  9. Ticagrelor - MoA
  10. Beta blockers - side effects
  11. Statins - side effects
A
  1. QRISK 3 (likelihood of stroke/MI in next 10 years), if >10% then start 20mg atorvastatin (primary prevention)
  2. HMG-CoA reductase inhibitor
  3. All patients with CKD/T1DM for >10 years
  4. Lipids at 3 months (increase until >40% less non-HDL cholesterol), LFT within 3 months + at 12 months
  5. Mild AST + ALT rise in 1st few weeks, only stop if >3x upper limit of normal
  6. Aspirin 75mg (+ 2nd antiplatelet for 12 months)
    Atorvastatin 80mg
    A beta-blocker (bisoprolol) titrated to maximum dose
    ACE inhibitor (ramipril) titrated to maximum dose
  7. Thromboxane A2 inhibitor (less activation/aggregation)
  8. Stops ADP induced platelet aggregation
  9. Inhibits platelet aggregation
  10. Bradycardia, heart block, hypotension, fatigue, impotence
  11. Myopathy, T2DM, haemorrhagic stroke
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24
Q

Angina

  1. Stable - definition
  2. Causes
  3. Modifiable risk factors
  4. Non-modifiable risk factors
  5. Gold-standard imaging
  6. Management - 1st line, long-term
  7. Management - acute
  8. Secondary prevention
  9. Invasive treatment - what, offered when
  10. Unstable/crescendo - definition
  11. ECG findings
  12. Decubitus - precipitated by
  13. Prinzmetal (variant) - cause, management
A
  1. Relieved by 5 mins rest/GTN, brought on by prolonged physical activity
  2. Atherosclerosis, anaemia, aortic stenosis, tachyA
  3. Obesity, diet, smoking, DM, sedentary, stress, alcohol
  4. FH, age, male, post-menopausal, Asian
  5. CT coronary angiography (contrast)
  6. B-blockers (bisprolol 5mg), CCBs (amlodopine 5mg)
  7. Sublingual GTN - take, repeat after 5 minutes, call ambulance if pain still there 5 minutes after 2nd dose
  8. Aspirin 75mg, atorvastatin 80mg, ACE-i
  9. If proximal/extensive on CTCA, PCI with coronary angioplasty. CABG if ‘severe stenosis’ on CTCA
  10. Severe and persistent, not relieved by rest
  11. ST depression, flat/inverted T
  12. Lying flat
  13. Coronary artery spasm, CCB/long acting nitrate
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25
Q

Acute coronary syndrome

  1. Right coronary artery - supplies
  2. Circumflex artery (from LC) - supplies
  3. LAD (from LC) - supplies
  4. Investigation - 1st line
  5. Then what
  6. NSTEMI ischaemic changes (3)
  7. MI definition (2 of)
  8. Immediate medical management (MONAC)
  9. Bloods
  10. STEMI interventional management - how to choose
  11. Score to assess PCI need in NSTEMI
  12. Post-MI - medications (5)
  13. Anticoagulate with what until discharge
A
  1. Right atrium/ventricle, inferior LV, posterior septum
  2. Left atrium, posterior left ventricle
  3. Anterior left ventricle, anterior septum
  4. ECG - STEMI if new LBBB or ST elevation >2mm in two congruent leads (V1-6) OR 1mm in limb leads
  5. Troponin (serial) - NSTEMI if positive (other ischaemic changes), unstable angina if negative
  6. ST depression (in a region), deep T wave inversion, pathological Q waves (deep infarct, late sign)
  7. Chest pain >15 minutes with clinical history, troponin rise, or dynamic ECG changes
  8. Morphine, oxygen (if <94%), nitrates, aspirin 300mg, clopidogrel/ticagrelor, anti-emetic
  9. FBC, U+E, troponin, glucose
  10. PCI if <2 hours since presentation, fibrinolysis if not (alteplase)
  11. GRACE (repeat MI/death risk), consider PCI within 4 days if medium (5-10%) or high (10%) risk
  12. Aspirin 75mg, + clopidogrel for minimum 12 months
    Atorvastatin 80mg (immediate)
    A beta blocker (bisoprolol) (immediately + titrate up)
    ACE-i (ramipril)
  13. Fondaparinux/LMWH
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26
Q

Pericarditis

  1. Causes (infective, vascular, metabolic, autoimmune, trauma)
  2. ECG changes
  3. Presentation (+ exacerbating/relieving factors)
  4. Management
  5. Constrictive - cause
  6. Signs
  7. CXR
  8. Management
A
  1. Virus, TB, rheumatic fever, post-MI, uraemia (acute renal failure), autoimmune (CTD, SLE), trauma (post-surgery bleed)
  2. Widespread concave ST elevation
  3. Central chest pain worse on inspiration/lying flat, better sitting forward
  4. NSAIDs (+ PPI), treat the cause
  5. Unknown, or TB
  6. Right heart failure, raised JVP
  7. Small heart, pericardial calcification
  8. Surgical excision
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27
Q

Pericardial effusion

  1. Definition
  2. Causes (vascular, infection, trauma, autoimmune, malignancy, metabolic)
  3. Clinical features
  4. Heart sounds
  5. Investigations (CXR, ECG, echo)
A
  1. Fluid build up in the pericardium
  2. Vascular (MI, aortic dissection), TB, trauma (post-surgery), autoimmune, malignancy, metabolic (renal failure)
  3. Dyspnoea, chest pain, local structure compression - hiccoughs (phrenic nerve), nausea (diaphragm), bronchial breathing at left base (Ewart’s sign - LLL compression)
  4. Muffled
  5. Enlarged, globular heart (CXR), low voltage QRS/alternating morphologies (ECG), echo free zone around heart (echo)
28
Q

Cardiac tamponade

  1. Definition
  2. Pulse finding (and what it is)
  3. Beck’s triad (3 Ds)
  4. Diagnostic criteria
A
  1. Heart cannot properly due to a pericardial effusion
  2. Pulsus paradoxus (large BP drop on inspiration)
  3. Distant heart sounds, distended jugular veins (raised JVP, Kussmaul’s sign if in inspiration), decreased arterial pressure (low cardiac output)
  4. Echo free zone around heart + diastolic collapse of RA and RV
29
Q

Limb ischaemia - general

Acute

  1. Causes
  2. Clinical features (6 Ps)
  3. Sign suggesting acute occlusion in chronic PAD
  4. Imaging

Chronic

  1. Risk factors
  2. Symptoms
  3. Claudication - locations suggest what
  4. Critical ischaemia cardinal features (3)
  5. Signs
  6. Signs found in severe ischaemia
A
  1. Vascular (thrombosis from atheroma, embolus from the heart), trauma, post-op graft occlusion
  2. Pale, perishingly cold, pulseless, pain, paralysed, paraesthetic
  3. Deep duskiness of limb
  4. Arteriography
  5. Atherosclerosis, DM, hyperlipidaemia, FH, smoking
  6. Claudication at certain distance, relieved by rest
  7. Calf (femoral disease), buttock (iliac disease)
  8. Rest pain (burning at night, hang foot off bed for relief), ulceration, gangrene
  9. Absent femoral/popliteal/foot pulses, white atrophic skin, punched out painful ulcers, postural colour change
  10. Buerger’s angle (<20 degrees), CRT >15 seconds
30
Q

Venous insufficiency

  1. Doppler US looks for
  2. Duplex US looks for
  3. Signs

Varicose veins

  1. Pathophysiology
  2. Causes
  3. Risk factors
  4. Symptoms
  5. Management
A
  1. Reflux
  2. Anatomy/flow of vein
  3. Oedema, eczema, venous ulcers, haemosiderin, haemorrhage, lipodermatosclerosis
  4. Valve failure between deep and superficial veins
  5. Primary mechanical failure (95%), obstruction (DVT, pelvic mass), AV malformation, cyclist (big muscle pump)
  6. Prolonged standing, obesity, pregnancy, FH, COCP
  7. Often asymptomatic, but pain, cramps, tingling, heaviness, restless legs
  8. Treat cause, education (avoid prolonged standing, elevate legs, stockings, walk often), endovascular
31
Q

Skin ulcers

  1. Contributing factors
  2. History
  3. Examination
  4. Investigation
  5. Management
  6. Arterial - location, appearance
  7. Arterial - presentation
  8. Venous - commonest location, appearance
A
  1. Neuropathy, lymphoedema, vasculitis, malignancy, infection, trauma
  2. Number, pain (SOCRATES), trauma, PMH
  3. Site, temperature (cold in ischaemia, warm if local), surface area, shape, edge, base, depth, discharge, associated lymphadenopathy, sensation
  4. Skin/ulcer biopsy potentially
  5. Treat cause/risk factors optimise nutrition, bandages
  6. Heel and toes, punched-out edge
  7. Foot is painful, cold, difficult to feel pulses, low ABPI
  8. Above medial malleolus - ‘gaiter’ area, wider
32
Q

Thrombosis

  1. Virchow’s triad
  2. Blood stasis - causes
  3. Abnormal vein wall - causes
  4. Hypercoagulability

Thrombophilia

  1. Hereditary causes
  2. Commonest hereditary cause and effects
  3. VTE - acute management
  4. Post-VTE anticoagulation
  5. Ways to reduce thrombotic risk peri/postoperatively
A
  1. Abnormal blood flow (stasis), vessel wall abnormalities (endothelial dysfunction), hypercoagulable state
  2. Dehydration, nephrotic syndrome, post-op, immobility
  3. Trauma, varicose veins, phlebitis
  4. Pregnancy, COCP, obesity, malignancy, hereditary (e.g. thrombophilia)
  5. Factor V leiden, antiphosopholipid syndrome, protein C and S deficiency, antithrombin deficiency
  6. Factor V leiden (autosomal dominant) - results in overactivity of the clotting cascade
  7. LMWH/fondaparinux if stable, unfractioned heparin/thrombolysis if unstable e.g. hypotensive
  8. 3-6 m if known trigger eliminated, long term if not
  9. Compression stockings, early mobilisation, LMWH
33
Q

Describing a murmur

T
I
P1
P2
Q
R
S
A

Timing - diastolic/systolic
Intensity - grade 2 if quiet and grade 3 if loud
Position on chest where it is loudest
Position of the patient when it is loudest
Quality
Radiation
Systemic features - e.g. valve complications signs

34
Q

Cardiovascular history - differentials

Chest pain

  1. Character
  2. Radiation
  3. Precipitants
  4. Relieving factors
  5. Pleuritic pain
  6. Dyspnoea
  7. Palpitations
  8. Syncope
A
  1. Constricting (angina, oesophageal spasm, anxiety), sharp (pleura, pericardium, chest wall), prolonged, dull, central crushing (MI), tearing (AD)
  2. Shoulder, arms, neck/jaw, epigastric (MI), back/interscapular (dissection)
  3. Cold/exercise/palpitations/emotion (cardiac, anxiety), food/hot drinks/lying flat/alcohol (oesophageal)
  4. Rest/GTN (angina), antacids (GI), leaning forward (pericarditis)
  5. Exacerbated by inspiration, implies inflammation of pleura from infection/inflammation/infarction
  6. Heart failure (LV), PE, respiratory, anaemia, pain, anxiety
  7. Ectopics, sinus tachycardia, AF, SVT, VT, thyrotoxicosis, anxiety, phaeochromocytoma
  8. Cardiac vs CNS
35
Q

ECG - axis

  1. What is this
  2. How to calculate
  3. Left axis deviation - causes
  4. Right axis deviation - causes
A
  1. Overall direction of depolarisation across patient’s anterior chest
  2. Look at QRS in leads I and III/aVF. Normal both positive, left ‘leaving’, right ‘reaching’
  3. Left anterior/posterior hemiblock, inferior MI, WPW
  4. RVH, PE, anterolateral MI, WPW, left posterior hemiblock
36
Q

ECG - P wave

  1. Upright normal in which leads (3)
  2. Down normal in which lead
  3. Absent P wave - causes
  4. P mitrale - what it looks like, cause
  5. P pulmonale - what it looks like, causes
A
  1. II, III, aVF
  2. aVR
  3. AF, hidden due to junctional/ventricular rhythm
  4. Bifid; left atrial hypertrophy
  5. Peaked; right atrial hypertrophy, low K+
37
Q

ECG - PR interval

  1. Where to measure
  2. Normal range
  3. Short PR interval - causes
  4. Long PR interval - causes
A
  1. Start of P wave to start of QRS
  2. 0.12-0.2 seconds (3-5 small squares)
  3. Unusually fast AV conduction down accessory pathway e.g. WPW
  4. Delayed AV conduction (1st degree heart block)
38
Q

ECG - QRS complex

  1. Normal duration
  2. Wide QRS - causes

Q waves

  1. Normally seen
  2. What they represent
  3. Pathological - what they look like, when
  4. Low voltage (small) QRS - causes
A
  1. <0.12 seconds (<3 small squares)
  2. Ventricular conduction defect (e.g. BBB, metabolic disturbance, ventricular origin e.g. ectopic)
  3. Leads I, aVL, V5, V6
  4. Septal depolarisation
  5. Deep and wide; within a few hours of acute MI
  6. Hypothyroid, COPD, high haematocrit, PE, BBB etc.
39
Q

ECG - QT interval

  1. How to measure
  2. Normal length
  3. Short - causes
  4. Long - causes
A
  1. Start of QRS to end of T
  2. 0.38-0.42 seconds (approximately 10 small squares)
  3. Hypercalcaemia
  4. Ischaemia, mitral valve prolapse, HIV, anti-Ro/SSA, low K+/Mg2+/Ca2+, drugs (amiodarone, erythromycin, domperidone, haloperidol, risperidone, tricyclics, SSRIs)
40
Q

ECG - ST segment

  1. Usually
  2. Elevation >1mm - causes
  3. Depression >0.5mm - causes

STEMI - leads and coronary artery

  1. Anterior
  2. Lateral
  3. Anterolateral
  4. Inferior
  5. Posterior
  6. Which coronary artery supplies SA node
A
  1. Isoelectric
  2. Infarction, pericarditis (widespread, concave), aortic dissection (inferior leads), Prinzmetal’s angina, LV aneurysm, normal variant (high take off)
  3. Ischaemia (horizontal - angina, NSTEMI, posterior MI if V1-3), normal variant (upward sloping), digoxin toxicity (downward sloping)
  4. V1-4 - LAD
  5. I, aVL, V5-6 - left circumflex
  6. I, aVL, V1-4 - LAD/circumflex (left coronary)
  7. II, III, aVF - right coronary
  8. Tall R/STD/TWI in V1-2 - left circumflex/right coronary
  9. Right coronary
41
Q

ECG - T wave

  1. Normal inversion - leads
  2. Abnormal inversion - leads
  3. Peaked - causes
  4. Flattened - causes
  5. Inverted - causes
  6. Inversion - normal when
A
  1. aVR, V1, V2 (or lead III in isolation)
  2. I, II, V4-6
  3. Hyperkalaemia
  4. Hypokalaemia
  5. HOCM, MI (fixed)/ischaemia (dynamic), RBBB, RVH/strain, PE (lead III)
  6. In children
42
Q

ECG changes - causes

  1. J wave
  2. Sinus bradycardia
  3. Pulmonary embolism
  4. RV strain
  5. Digoxin
  6. Hyperkalaemia
  7. Hypokalaemia
  8. Hypocalcaemia
  9. Left ventricular hypertrophy
  10. Right ventricular hypertrophy
A
  1. Hypothermia, SAH, high Ca2+
  2. Fitness, vasovagals, sick sinus, drugs (B blocker, digoxin, amiodarone), hypothyroidism, hypothermia, raised ICP
  3. Sinus tachycardia, RBBB, RV strain, S1Q3T3 (deep S, pathological Q, inverted T)
  4. Right axis deviation, dominant R wave and T wave inversion/ST depression in V1/2
  5. Down-sloping ST depression + T wave inversion in V5-6 (reversed tick)
  6. No P, long PR, wide QRS, tall tented T, ‘sine wave’
  7. Small T, prominent U, peaked P
  8. Long QT, small T
  9. R wave in V6 >25mm
  10. Dominant R V1, TWI V1-3, deep S V6, R axis deviation
43
Q

CXR - cardiac findings

  1. Cardiac failure
  2. Aortic dissection
  3. Infective endocarditis
  4. Pericardial effusion
  5. Coarctation of aorta
A
  1. ABCDE - Aveolar oedema, Kerly B lines (interstitial oedema), Cardiomegaly, Dilated upper lobe vessels, Pulmonary effusions
  2. Widening of mediastinum
  3. Cardiomegaly, pulmonary oedema
  4. Globular heart
  5. Rib notching
44
Q

Cardiac catheterisation - complications

  1. Contrast reaction - suspect if
  2. Loss of peripheral pulse - causes (3)
  3. Pericardial effusion - suspect if
  4. Pericardial tamponade - suspect if
A
  1. Post-procedure pyrexia
  2. Dissection, thrombosis, arterial spasm
  3. Unexplained continued chest pain
  4. Hypotension and anuria
45
Q

Anticoagulants - general

  1. Long term examples
  2. Acute hospital examples + MOA
  3. If mechanical valve, use what
  4. Score to assess embolic stroke risk
  5. Score to assess bleeding risk

Surgery - advice

  1. Warfarin
  2. DOAC
  3. Antiplatelets
  4. Dabigatran - reversal agent
A
  1. Warfarin, or DOACs (e.g. apixaban, dabigatran)
  2. LMWH (Xa/thrombin), fondaparinux (just Xa)
  3. Warfarin
  4. CHADSVASC - CHF, HTN, Age (64-74/75+), DM, previous Stroke, Vascular disease, Sex Category (female)
  5. HASBLED - Labile INR, >65, use of NSAIDs/antiplatelets, alcohol, uncontrolled HTN, history of bleeding, renal/liver disease, previous stroke
  6. Don’t stop if INR <3.5 and minor, stop 3-5 before if >3.5 or major
  7. OK just before next dose if no bleeding risk, omit for 24 hours if low risk, 48 hours if high risk
  8. Specialist decision
  9. Idarucizumab
46
Q

Beta blockers

  1. Mechanism of action
  2. Important contraindications
  3. Important side effects
A
  1. Block B-adrenoceptors, thus antagonising sympathetic nervous system and slowing HR
  2. Severe asthma/COPD, heart block
  3. Lethargy, erectile dysfunction, headaches
47
Q

ACE inhibitors

  1. Mechanism of action
  2. Important counselling points
  3. Side effects
A
  1. Stop conversion of angiotensin I to II so lowering BP
  2. Renal implications - check U+Es 1-2 weeks after starting, if GFR reduced then consider RAS. Hold in AKI, hyperkalaemia, dehydration
  3. Dry cough, urticaria
48
Q

Diuretics

  1. Loop - example
  2. Indication/MOA
  3. Side effects
  4. Thiazide/thiazide like - example
  5. Indication
  6. Side effects
  7. Potassium-sparing - example
  8. MOA
A
  1. Furosemide
  2. Heart failure; inhibit Na/2Cl/K co-transporter
  3. Dehydration, ototoxic, low Na+/K+/Ca2+
  4. Indapamide, chlorthalidone, metolazone
  5. I, C (HTN), M (HF)
  6. Low K+/Mg2+, high Ca2+/urate (gout), impotence
  7. Spironolactone, eplerenone, amiloride
  8. S, E (directly block aldosterone receptors), A (blocks epithelial sodium channel in distal convoluted tubule
49
Q

Calcium antagonists (CCBs)

  1. MOA and consequence
  2. Dihydropyridines - examples (2)
  3. Where they work
  4. Used in, with
  5. Non-dihydropyridines - examples (2)
  6. Where they work
  7. Used in, NOT with (+ contraindications)
  8. Side effects
A
  1. Decrease Ca2+ entry into cells via L-type voltage-sensitive channels in smooth muscle, so more coronary/peripheral vasodilation and less myocardial oxygen consumption
  2. Amlodipine, nifedipine
  3. Peripheral/coronary vasodilator + reflex tachycardia
  4. HTN, angina, with beta blockers
  5. Verapamil, diltiazem
  6. Also slow conduction at AV/SA nodes
  7. Dysrhythmias, angina, HTN, NOT with B-blockers (and contraindicated in heart block)
  8. Flushes, fatigue, ankle oedema, gum hyperplasia
50
Q

Digoxin

  1. MOA
  2. Indication
  3. When to half digoxin dose
  4. Side effects
  5. Toxicity suspected - bloods
  6. Toxicity - ECG findings
  7. Contraindicated in
A
  1. Blocks Na+/K+ pump
  2. Slowing pulse in fast AF, heart failure
  3. If on amiodarone
  4. Arrhythmia (SVT with AV block suggestive), nausea, loss of appetite, confusion, gynaecomastia
  5. ECG, digoxin level, K+/Mg2+/Ca2+
  6. Down-sloping ST depression + T wave inversion in V5-6 (reversed tick)
  7. HOCM, WPW syndrome
51
Q

Post-MI complications

  1. Bradyarrythmias - examples and seen in
  2. Tachyarrhythmias - risk factors
  3. RVF/infarct - signs and management
  4. Pericarditis - signs and management
  5. Ventricular septal defect - signs
  6. Dressler’s syndrome - timing, signs and management
  7. LV aneurysm - timing, signs, ECG, management
A
  1. Sinus (inferior MI), 1st degree block (inferior MI), other heart blocks/BBB
  2. Low K+, hypoxia, acidosis
  3. Low CO, raised JVP. Avoid nitrates/diuretics
  4. Central CP relieved by sitting forward; give NSAIDs
  5. Pansystolic murmur, raised JVP, cardiac failure
  6. 2-3 weeks post-MI, recurrent pericarditis, pericardial rub, pleural effusions, low-grade fever, anaemia, raised ESR. ECG: global STE/TWI. Give NSAIDs, pred if severe
  7. 4-6 weeks post-MI, LVF/angina/reccurrent VT/systemic embolism. Persistent ST elevation. Anticoagulate
52
Q

Sick sinus syndrome

  1. Cause
  2. Symptoms
  3. Management
  4. Can lead to
A
  1. Sinus node fibrosis/dysfunction (elderly patients), can lead to brady/tachy-arrhythmia
  2. Syncope, pre-syncope, dizzy, SOB, palpitations
  3. VTE prophylaxis if AF, permanent pacemakers for symptomatic sinus bradycardia or sinus pauses
  4. Tachy brady syndrome
53
Q

Narrow complex (supraventricular) tachycardias

  1. Definition
  2. Regular types
  3. Irregular types
  4. Management (including if broad complex but known SVT with BBB)
A
  1. ECG >100 beats per minute + QRS <0.12 seconds
  2. Sinus, atrial flutter, atrioventricular re-entry (AVRT e.g. WPW), atrioventricular nodal re-entry (AVNRT)
  3. AF, flutter with variable block
  4. Vagal manoevres (valsalva, carotid sinus massage), adenosine (avoid in asthma/COPD/HF/block) / verapamil
54
Q

Brugada syndrome

  1. What is it
  2. ECG findings
  3. Classic findings
  4. Precipitants
A
  1. Sodium chanelopathy
  2. Coved ST elevation in V1-3
  3. Syncope, arrest, FH of sudden cardiac death
  4. Fever, medications, electrolyte imbalances, ischaemia
55
Q

Rheumatic fever

  1. Original infection location
  2. Responsible organism
  3. Evidence of infection
  4. Major criteria (Jones) (evidence + 2 major)
  5. Minor criteria (Jones) (evidence + 1 major + 2 minor)
  6. Management
  7. Secondary prophylaxis
A
  1. Pharynx (typically tonsillitis)
  2. Group A b-haemolytic streptococci
  3. Recent scarlet fever, positive throat culture (usually negative when RF symptoms appear 2-4 weeks later), positive rapid strep antigen test/raised antibody titre (anti-streptolysin O (ASO) or DNase B)
  4. Carditis (e.g. M/A regurgitation, ‘Carey-Coombs’ murmur from thickening of mitral valve leaflets)
    Arthritis (migrating, hot, swollen, painful, large joints),
    Skin - SC nodules (painless, firm, over extensor joints), erythema marginatum (pink rings on torso/proximal limb)
    Neurological - sydenham’s chorea (St Vitus dance)
  5. Fever, raised ESR/CRP, arthralgia, prolonged PR
  6. Bed rest until CRP normal for 2 weeks, benxzylpenicillin stat, phenoxymethlypenicillin 10 days
  7. Penicillin V
56
Q

Right heart valve disease

Tricuspid regurgitation

  1. Causes
  2. Symptoms
  3. Murmur
  4. Other signs

Tricuspid stenosis

  1. Causes
  2. Symptoms
  3. Murmur
  4. Other signs

Pulmonary regurgitation

  1. Causes
  2. Murmur

Pulmonary stenosis

  1. Causes
  2. Symptoms
  3. Murmur
  4. Other signs
  5. Diagnostic test
A
  1. Functional (e.g. RV dilatation from pulmonary HTN), RF, IE, Ebstein’s anomaly (tricuspid valve facing down)
  2. Fatigue, hepatic pain on exertion, ascites, oedema
  3. Pansystolic (lower sternal edge, inspiration)
  4. JVP (giant V waves, prominent Y descent) (give diuretics), RV heave, pulsatile hepatomegaly
  5. Rheumatic fever (almost always with concominant mitral/aortic valve disease), IE, congenital
  6. Fatigue, ascites, oedema (give diuretics)
  7. Early diastolic murmur (left sternal edge, inspiration)
  8. JVP (giant A wave, slow Y descent)
  9. Any cause of pulmonary HTN
  10. Early diastolic ‘decrescendo’ (left sternal edge) - ‘Graham-Steell’ if with mitral stenosis + pulmonary HTN
  11. Congenital (Turner, Noonan, Williams, ToF, rubella)
  12. Dyspnoea, fatigue, oedema, ascites
  13. Ejection systolic, radiating to left shoulder
  14. JVP (prominent A wave), RV heave
  15. Cardiac catheterisation
57
Q

Adult congenital heart disease

  1. Bicuspid aortic valve - which murmurs can develop

Atrial septal defect

  1. Type usually in adult
  2. Signs/symptoms
  3. ECG findings
  4. CXR findings
  5. Complications

Ventricular septal defect

  1. Signs
  2. CXR findings
  3. Complications

Coarctation of the aorta

  1. What it is
  2. Association
  3. Signs
  4. Complications
  5. Tests

Tetralogy of Fallot

  1. The four defects
  2. ECG findings
  3. CXR findings
A
  1. Aortic stenosis, aortic regurgitation
  2. Ostium secundum (high in septum)
  3. Chest pain, palpitations, SOB, fixed split S2, pulmonary HTN
  4. Right axis deviation
  5. Small aortic knuckle, pulmonary plethora, large atria
  6. Reversal of L to R shunt (Eisenmenger’s complex) when right pressure higher than left, so cyanosis
  7. Harsh pansystolic murmur at left sternal edge, systolic thrill, left parasternal heave
  8. Heart size normal/large, pulmonary plethora, pulmonary arteries
  9. Eisenmengers
  10. Congenital narrowing of descending aorta; just distal to origin of left subclavian artery
  11. Boys, bicuspid aortic valve, Turner’s
  12. Radiofemoral delay, weak femoral pulse, HTN, scapular bruit (systolic murmur)
  13. HF from high afterload, IE, intracerebral haemorrhage
  14. CT/MR angiogram; CXR shows rib notching (blood diverts down intercostal arteries)
  15. VSD, pulmonary stenosis, RVH, aorta overriding VSD and accepts right heart blood
  16. RVH with RBBB
  17. Boot shaped heart
58
Q

Heart disease and driving

  1. Angina
  2. MI - group 1 licence
  3. MI - group 2 licence
  4. Dysrhythmias
  5. Pacemaker inplant
  6. ICD implantation
  7. Unexplained syncope with probably cardiac cause
A
  1. Stop if symptoms occur at rest or with emotion; can start when symptom control achieved; no DVLA
  2. If EF >40%, start 1 week post-successful angioplasty/ 4 weeks after unsuccessful angioplasty; don’t tell DVL
  3. Inform DVLA stop driving; may be able to restart in 6 weeks
  4. Stop if likely to cause incapacity; restart once symptom control achieved
  5. Stop for 1 week, must notify DVLA
  6. Yearly review, no shock within 6 months, 1 month post primary prevention, 6 months post secondary
  7. Stop for 1 month if cause identified/treated, 6 months if not or associated with signs of seizure, 1 year if known epileptic
59
Q

Deep vein thrombosis (DVT)

  1. Signs
  2. Differentials (2)

Investigation

  1. First step
  2. Components of first step
  3. DVT not likely - definition and next step
  4. DVT likely - definition and next step
  5. When to do thrombophilia testing
  6. Underlying malignancy - when to look, + investigations
  7. Management
A
  1. Calf warmth, tenderness, swelling, erythema
  2. Cellulitis, ruptured Baker’s cyst
  3. Calculate Well’s score
  4. 1 point: Active cancer, plaster, bedridden, tenderness along deep vein system, entire leg swollen, calf swelling, pitting oedema, collateral veins, previous DVT.
    - 2 points: alternative diagnosis at least as likely
  5. Well’s score 0-1; D-dimer. Excluded if negative, USS if positive (+ treat as DVT if positive)
  6. Well’s score 2+; D dimer and duplex USS. Excluded if both negative, Treat as DVT if just USS positive. Repeat USS in 1 weeks if just D-dimer positive.
  7. Before starting management if unusual, recurrent or unprovoked
  8. If >40 - drine dip, FBC, LFT, Ca2+, CXR +/- CTAP + mammography
  9. LMWH/fondaparinux for 5 days / until INR 2.0, warfarin within 24 hours and minimum 3 months
60
Q

Leg oedema

  1. History questions
  2. Bilateral oedema - differentials
  3. Unilateral oedema - differentials
  4. Investigations
  5. Venous insufficiency - signs
A
  1. One/both, trauma, pain, pregnant, pitting, skin change, mobility, PMH/drugs, other oedema
  2. Right HF, low albumin (renal/liver), vein insufficiency, vasodilators (amlodipine, nifedipine), pregnancy
  3. DVT, inflammation, bone/muscle disease, trauma, compartment syndrome, Baker’s cyst
  4. Proteinuria, hypopoalbuminuria, CCF investigations
  5. Acute (prolonged sitting), chronic (haemosiderin-pigmented, itchy, eczematous skin + ulcers)
61
Q

Gangrene/Necrotising Fasciitis

  1. Gangrene - cause
  2. Wet gangrene - definition
  3. Dry gangrene - definition
  4. Gas gangrene - cause
  5. Necrotising fasciitis - main causative organism
A
  1. Death of tissue from poor vascular supply
  2. Tissue death + infection (with discharge)
  3. Tissue death, no infection
  4. Spore-forming clostridial species
  5. Group A B-haemolytic streptococci
62
Q

Chronic heart failure - management

  1. Patient education
  2. Management - 1st line
  3. 2nd line
  4. 3rd line
  5. Symptom management
  6. Contraindicated drugs and why
  7. Monitoring
  8. Key drugs if reduced ejection fraction (3)
A
  1. Regular vaccinations (flu/pneumococcal), fluid input/output, exercise, good diet, stop smoking
  2. ACE-i (ramipril, max 10mg) / ARB (candesartan, max 32mg) if valve issue
    AND beta blocker (bisoprolol, max. 10mg)
  3. Spironolactone / ARB / hydralazine + nitrate
  4. Digoxin
  5. Furosemide 40mg od
  6. CCBs (verapamil) + NSAIDs - cause decompensation
  7. Regular U+Es (diuretics, ACE-is, spironolactone) for electrolyte disturbances
  8. ACE inhibitor, beta-blocker, loop diuretic
63
Q

Pacemakers

  1. Indications
  2. Location - if SA node problem, AV conduction normal
  3. If abnormal AV conduction
  4. Severe heart failure
  5. ECG changes - single chamber PM
  6. Dual chamber PM
A
  1. Symptomatic bradycardia, mobitz type 2 AV block, 3rd degree block, severe HF, HOCM (ICD)
  2. Right atrium
  3. Right ventricle
  4. Biventricular (RA, RV, LV) - cardiac resynchronisation
  5. Line before either the P (atrial) or QRS (ventricular)
  6. Line before both the P and QRS
64
Q

Limb ischaemia - investigations + management

  1. Bedside tests
  2. How to calculate and interpret ABPI
  3. Cause of false positive ABPI result
  4. 1st line imaging
  5. Bloods - all
  6. Bloods if <50
  7. Management - conservative
  8. Medical
  9. Surgical - single arterial segment
  10. Surgical - extensive disease
A
  1. Cardiovascular exam, ABPI
  2. Divide popliteal systolic by brachial systolic. 1-1.2 is normal. Higher suggests venous disease or calcified, stiff arteries (age/ PAD). <1 suggests arterial disease.
  3. Diabetic hardened veins
  4. Colour duplex USS
  5. ESR/CRP (arteritis), BM (DM), FBC (anaemia, polycythaemia), U+E, lipids, clotting, LFT
  6. Thrombophilia screen, serum homocysteine
  7. Lose weight, good diet, stop smoking
  8. Clopidogrel, statin, control DM (contributing)
  9. Percutaneous transluminal angioplasty
  10. Reconstruction (if distal run off good) / amputation
65
Q

Pulses - found when

  1. Paradoxus (2)
  2. Slow-rising
  3. Collapsing
  4. Alternans
  5. Bisferiens (double pulse)
  6. Jerky
A
  1. Severe asthma, cardiac tamponade
  2. Aortic stenosis
  3. Aortic regurgitation, PDA, hyperkinetic (anaemia, thyrotoxic, fever, exercise/pregnancy)
  4. Severe LV failure
  5. Mixed aortic valve disease
  6. HOCM
66
Q

JVP

  1. Common causes
  2. How to tell from arterial pulse
A
  1. Tricuspid regurgitation, congestive/right heart failure (primary pulmonary HTN)
  2. Not palpable, fills from top, rises if hepato-jugular reflex

Medical School (28 decks)

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