Cardiovascular Flashcards

Question 1

Q

Define abdominal aortic aneurysm.

Answer

A

Abdominal aortic aneurysm (AAA) is a permanent pathological dilation of the aorta with a diameter >1.5 times the expected anteroposterior (AP) diameter of that segment, given the patient's sex and body size.

Question 2

Q

Explain the aetiology/risk factors of an abdominal aortic aneurysm. Summarise the epidemiology of an abdominal aortic aneurysm.

Answer

A

Cigarette smoking Hereditary/family history Increased age Male sex (prevalence) Female sex (rupture) Congenital/connective tissue disorders Prevalence among men is 4 to 6 times higher than in women.

Question 3

Q

Recognise the presenting symptoms of an abdominal aortic aneurysm.

Answer

A

AAA is usually asymptomatic and is discovered incidentally. In the minority of patients who experience symptoms, abdominal, back, and groin pain are typical.

Question 4

Q

Recognise the signs of an abdominal aortic aneurysm on physical examination.

Answer

A

Pulsatile, expanding abdominal pulse. There may also rarely be a palpable pulsatile abdominal mass.

Question 5

Q

Identify appropriate investigations for an abdominal aortic aneurysm and interpret the results.

Answer

A

Abdominal USS

Question 6

Q

Define amyloidosis.

Answer

A

Any histological tissue specimen that binds the cotton wool dye, Congo red, and demonstrates green birefringence when viewed under polarised light is, by definition, an amyloid deposit. The patient with this deposit has amyloidosis. Deposits of amyloid may be localised in tissue or part of a systemic process. Progressive deposition of amyloid is disruptive to tissue and organ function and manifests its clinical sequelae by the dysfunction of those organs in which it deposits.

Question 7

Q

Explain the aetiology/risk factors of amyloidosis.

Answer

A

Monoclonal gammopathy of undetermined significance (MGUS) Inflammatory polyarthropathy Chronic infections Inflammatory bowel disease Familial periodic fever syndromes

Question 8

Q

Summarise the epidemiology of amyloidosis.

Answer

A

In the UK, the age-adjusted incidence is between 5.1 and 12.8 per 1 million per year, with around 60 new cases annually.

Question 9

Q

Recognise the presenting symptoms of amyloidosis. Recognise the signs of amyloidosis on physical examination.

Answer

A

Fatigue Weight loss Dyspnoea on exertion Jugular venous distention Lower extremity oedema

Question 10

Q

Identify appropriate investigations for amyloidosis and interpret the results.

Answer

A

Serum immunofixation - positive in 60% of patients with amyloidosis Urine immunofixation - positive in 80% of patients with amyloidosis Immunoglobulin free light chain assay - >95% sensitivity Bone marrow biopsy - done on all patients with suspected amyloidosis

Question 11

Q

Define aortic dissection.

Answer

A

Aortic dissection describes the condition when a separation has occurred in aortic wall intima, causing blood flow into a new false channel composed of the inner and outer layers of the media.

Question 12

Q

Explain the aetiology/risk factors of aortic dissection.

Answer

A

Aortic dissection results from an intimal tear that extends into the media of the aortic wall. Cystic medial degeneration predisposes to intimal disruption and is characterised by elastin, collagen, and smooth muscle breakdown in the lamina media. Bleeding from the vasa vasorum can also lead to this condition.

Marfan and Ehlers-Danlos increases the risk of aortic dissection.

Question 13

Q

Summarise the epidemiology of aortic dissection.

Answer

A

The worldwide incidence of aortic dissection is 0.5 to 2.95 cases per 100,000 people annually.

Question 14

Q

Recognise the presenting symptoms of aortic dissection.

Answer

A

Acute severe chest pain Interscapular and lower pain

Question 15

Q

Recognise the signs of aortic dissection on physical examination.

Answer

A

Left/right blood pressure differential Pulse deficit Diastolic murmur Hypertension

Question 16

Q

Identify appropriate investigations for aortic dissection and interpret the results.

Answer

A

ECG CXR Cardiac enzymes CT angiography Renal function tests Liver function tests Lactate FBC

Question 17

Q

Define aortic regurgitation.

Answer

A

Aortic regurgitation (AR) is the diastolic leakage of blood from the aorta into the left ventricle. It occurs due to inadequate coaptation of valve leaflets resulting from either intrinsic valve disease or dilation of the aortic root. It can remain asymptomatic for decades before patients present with irreversible myocardial damage.

Question 18

Q

Explain the aetiology/risk factors of aortic regurgitation.

Answer

A

AR can be caused by primary disease of the aortic valve leaflets or dilation of the aortic root. In developing countries, rheumatic heart disease (rheumatic fever during which the heart valves are damaged) is the most common cause, but congenital bicuspid aortic valve and aortic root dilation account for most of the cases in developed countries.

Question 19

Q

Summarise the epidemiology of aortic regurgitation.

Answer

A

AR is not as common as aortic stenosis and mitral regurgitation. One US study showed a prevalence of 13% in men and 8.5% in women with most being trace or mild; a prevalence of 15.6% was reported in African-Americans. Prevalence increases with age in both genders.

Question 20

Q

Recognise the presenting symptoms of aortic regurgitation.

Answer

A

Dyspnoea Fatigue Weakness Orthopnoea Paroxysmal nocturnal dyspnoea Pallor

Question 21

Q

Recognise the signs of aortic regurgitation on physical examination.

Answer

A

Mottled extremities Rapid and faint peripheral pulse Jugular venous distension Basal lung crepitations Altered mental status Urine output <30 mL/hour Soft S1 Soft or absent A2 Collapsing (water hammer or Corrigan's) pulse Cyanosis Tachypnoea Displaced, hyperdynamic apical impulse

Question 22

Q

Identify appropriate investigations for aortic regurgitation and interpret the results.

Answer

A

ECG CXR Echo Colour flow Doppler Pulsed wave Doppler Continuous wave Doppler

Question 23

Q

Define aortic stenosis.

Answer

A

Aortic stenosis (AS) represents obstruction of blood flow across the aortic valve due to pathological narrowing. It is a progressive disease that presents after a long subclinical period with symptoms of decreased exercise capacity, exertional chest pain (angina), syncope, and heart failure. Can be due to aortic calcification.

Question 24

Q

Explain the aetiology/risk factors of aortic stenosis.

Answer

A

Age >60 years Congenitally bicuspid aortic valve Rheumatic heart disease Chronic kidney disease

Question 25

Q

Summarise the epidemiology of aortic stenosis.

Answer

A

AS is the most common valvular disease in the US and Europe and is the second most frequent cause for cardiac surgery. It is largely a disease of older people, and patients typically present in the seventh or eighth decade of life.

Question 26

Q

Recognise the presenting symptoms of aortic stenosis.

Answer

A

Dyspnoea Chest pain Syncope

Question 27

Q

Recognise the signs of aortic stenosis on physical examination.

Answer

A

Ejection systolic murmur S2 diminished and single

Question 28

Q

Identify appropriate investigations for aortic stenosis and interpret the results.

Answer

A

Transthoracic echocardiogram (including Doppler) ECG

Question 29

Q

Define arterial ulcers.

Answer

A

Arterial ulcers are caused by ischaemia to the leg. The ulcers are painful and more painful on elevation. Patients often say the ulcers are painful enough to wake them up at night and that they obtain relief by lowering their leg over the side of the bed.

Question 30

Q

Explain the aetiology/risk factors of arterial ulcers.

Answer

A

Smoking Diabetes mellitus Hypertension Hyperlipidaemia Strong family history of atherosclerotic disease Male

Question 31

Q

Summarise the epidemiology of arterial ulcers.

Answer

A

Arterial ulcers are more common in males and people who have risk factors. They occur where the blood supply is the worst.

Question 32

Q

Recognise the presenting symptoms of arterial ulcers. Recognise the signs of arterial ulcers on physical examination.

Answer

A

Painful, especially on elevation Deep, punched out, dry and often elliptical sore Location: between toes, ball of foot, lateral malleolus and bony prominence Cold, pale limbs Poor capillary refill Venous guttering Absent or weak pulses Atrophic skin changes

Question 33

Q

Identify appropriate investigations for arterial ulcers and interpret the results.

Answer

A

Investigate for signs of atherosclerotic disease: BM FBC Fasting lipids Urinalysis Biopsy Buerger’s test: Blanching of the foot on elevation to 15 degrees

Question 34

Q

Define atrial fibrillation.

Answer

A

Atrial fibrillation (AF) is a supraventricular tachyarrhythmia. It is characterised by uncoordinated atrial activity on the surface ECG, with fibrillatory waves of varying shapes, amplitudes, and timing associated with an irregularly irregular ventricular response when atrioventricular (AV) conduction is intact.

Question 35

Q

Explain the aetiology/risk factors of atrial fibrillation.

Answer

A

Coronary artery disease (CAD), hypertension, heart failure, valvular disease, diabetes, thyroid disorders, COPD and obstructive sleep apnoea, and advanced age are known risk factors for the development of new-onset AF.

Heavy alcohol intake can also increase the risk of atrial fibrillation.

Question 36

Q

Summarise the epidemiology of atrial fibrillation.

Answer

A

The incidence of AF increases progressively with age. Incidence is higher in men butmortality is higher in women.

Question 37

Q

Recognise the presenting symptoms of atrial fibrillation.

Answer

A

SOB Palpitations Chest tightness

Question 38

Q

Recognise the signs of atrial fibrillation on physical examination.

Answer

A

Hypotension Elevated jugular venous pressure Added heart sounds

Question 39

Q

Identify appropriate investigations for atrial fibrillation and interpret the results.

Answer

A

ECG Serum electrolytes Cardiac biomarkers Thyroid function tests CXR Transthoracic echocardiogram Transoesophageal echocardiogram (TOE)

Question 40

Q

Generate a management plan for atrial fibrillation.

Answer

A

The 3 elements in the management of new-onset AF are:

Ventricular rate control Restoration and maintenance of sinus rhythm Prevention of thromboembolic events.

Question 41

Q

Identify the possible complications of atrial fibrillation and its management.

Answer

A

Acute stroke MI Congestive heart failure

Question 42

Q

Summarise the prognosis for patients with atrial fibrillation.

Answer

A

The prognosis depends on the onset, age and lifestyle of the patient.

Question 43

Q

Define atrial flutter.

Answer

A

Typical atrial flutter (anti-clockwise cavotricuspid isthmus-dependent atrial flutter) is a macro-reentrant atrial tachycardia with atrial rates usually above 250 bpm up to 320 bpm.

Question 44

Q

Explain the aetiology/risk factors of atrial flutter.

Answer

A

Increasing age Valvular dysfunction Atrial septal defects Atrial dilation Recent cardiac or thoracic procedures Surgical or post-ablation scarring of atria Heart failure Hyperthyroidism COPD Asthma Pneumonia

Question 45

Q

Summarise the epidemiology of atrial flutter.

Answer

A

The overall incidence has been reported as 88/100,000 person-years, with increasing rates with older age.

Question 46

Q

Recognise the presenting symptoms of atrial flutter. Recognise the signs of atrial flutter on physical examination.

Answer

A

Palpitations Fatigue or lightheadedness Jugular venous pulsations with rapid flutter waves Chest pain Dyspnoea Syncope Hypotension

Question 47

Q

Identify appropriate investigations for atrial flutter and interpret the results.

Answer

A

ECG: In the typical form, this entity is characterised electrocardiographically by flutter waves, which are a saw-tooth pattern of atrial activation, most prominent in leads II, III, aVF, and V1. TFTs Serum electrolytes CXR

Question 48

Q

Generate a management plan for atrial flutter.

Answer

A

Synchronised cardioversion until stable. Once stable:

1st line:Beta-blocker or CCB or amiodarone Plus: Anticoagulation Treat co-existing acute disease process

Question 49

Q

Identify the possible complications of atrial flutter and its management.

Answer

A

Myocardial ischaemia Acute stroke

Question 50

Q

Summarise the prognosis for patients with atrial flutter.

Answer

A

In approximately 60% of cases, atrial flutter occurs in the setting of an acute process. Once that process has been treated, sinus rhythm is usually restored and chronic therapy is not required.

Question 51

Q

Define cardiomyopathy.

Answer

A

Primary disease of the myocardium. Cardiomyopathy can be split into three different categories, dilated, hypertrophic and restrictive.

Question 52

Q

Explain the aetiology/risk factors of dilated cardiomyopathy.

Answer

A

Flabby heart of unknown cause.

<ul> <li>Alcohol</li> <li>Hypertension</li> <li>Viral infection</li> <li>Autoimmune</li></ul>

Question 53

Q

Explain the aetiology/risk factors of hypertrophiccardiomyopathy.

Answer

A

Obstruction of outflow tract from asymmetric septal hypertrophy.

<ul> <li>Inherited (autosomal dominant)</li></ul>

Question 54

Q

Explain the aetiology/risk factors of restrictive cardiomyopathy.

Answer

A

<ul> <li>Amyloidosis</li> <li>Haemochromatosis</li> <li>Sarcoidosis</li> <li>Scleroderma</li></ul>

Question 55

Q

Summarise the epidemiology of cardiomyopathy.

Answer

A

Dilated cardiomyopathy is the most common form and affects five in 100,000 adults and 0.57 in 100,000 children. It is the third leading cause of heart failure in the United States behind coronary artery disease (CAD) and hypertension.

Question 56

Q

Recognise the presenting symptoms of cardiomyopathy. Recognise the signs of cardiomyopathy on physical examination.

Answer

A

Angina Dyspnoea Syncope Sudden death

Question 57

Q

Identify appropriate investigations for cardiomyopathy and interpret the results.

Answer

A

ECG Echocardiogram. MRI scan. Heart rhythm monitor (24 or 48-hour ECG monitor) Exercise tests Family tree/genetic screening

Question 58

Q

Define constrictive pericarditis.

Answer

A

This is an inflammation of the pericardium.

Question 59

Q

Explain the aetiology/risk factors of constrictive pericarditis.

Answer

A

Acute pericarditis can be idiopathic or due to an underlying systemic condition (e.g. systemic lupus erythematosus).

Question 60

Q

Summarise the epidemiology of constrictive pericarditis.

Answer

A

Acute pericarditis is more common in adults (typically between 20 to 50 years old) and in men. It is the most common disease of the pericardium encountered in clinical practice.

Question 61

Q

Recognise the presenting symptoms of constrictive pericarditis.

Answer

A

Chest pain Fever

Question 62

Q

Recognise the signs of constrictive pericarditis on physical examination.

Answer

A

Pericardial rub Ankle oedema Ascites

Question 63

Q

Identify appropriate investigations for constrictive pericarditis and interpret the results.

Answer

A

ECG CXR CRP Serum troponin Pericardial fluid/blood culture ESR Serum urea FBC Echocardiography

Question 64

Q

Define deep vein thrombosis (DVT).

Answer

A

A blood clot in the deep vein of the leg.

Answer 65

A

Being immobile for long periods The Pill (increases chance of blood clots) Age Trauma Active cancer Pregnancy Clotting disorder Smoking

Answer 66

A

Venous thromboembolism (VTE) is a relatively common medical problem with a yearly incidence of approximately 1 in every 1000 adults. About two thirds of these cases are DVT and one third progress to a PE.

Answer 67

A

Pain in leg Asymmetric oedema Prominent superficial vein

Answer 68

A

Wells' score - Risk of DVT or PE Quantitative D-dimer level - Tells you how much FDP (fibrin degradation product), doesn’t work for pregnancy or cancer as these can affect clotting. Proximal duplex ultrasound Whole-leg ultrasound INR and activated partial thromboplastin time (aPTT) Urea and creatinine LFTs FBC

Answer 69

A

Heparin

Adjunct: Stockings

Answer 70

A

The clot could travel to the lungs and cause a PE.

Answer 71

A

Patient should be fine as long as they start heparin. It depends on what caused the DVT (e.g. cancer).

Answer 72

A

Gangrene is a complication of necrosis characterised by the decay of body tissues. There are two major categories: infectious gangrene (wet gangrene) and ischaemic gangrene (dry gangrene).

Answer 73

A

Diabetes Smoking Atherosclerosis Renal disease Drug and alcohol abuse Malignancy Trauma or abdominal surgery Contaminated wounds Malnutrition Hypercoagulable states Prolonged use of tourniquets

Answer 74

A

Gangrene occurs equally in men and women. Type I necrotising fasciitis occurs most commonly in patients with diabetes and patients with peripheral vascular disease. It is the most common form of necrotising fasciitis in the general population.

Answer 75

A

Pain Oedema Skin discoloration Crepitus (gas gangrene) Diminished pedal pulses and ankle-brachial index (ischaemic gangrene) Low-grade fever and chills (infectious gangrene)

Answer 76

A

FBC Comprehensive metabolic panel Serum LDH Coagulation panel Blood cultures Serum C-reactive protein Plain x-rays CT of affected site MRI of affected site Doppler ultrasonography

Answer 77

A

Cardiac electric disorder characterised by delayed (or absent) conduction from the atria to the ventricles.

Answer 78

A

Hypertension Increased vagal tone AV-nodal blocking agents Chronic stable CAD Acute coronary syndrome CHF Hypertension Cardiomyopathy

Answer 79

A

The epidemiology of AV block is not well characterised.

Advanced AV block (usually type II second-degree and third-degree) is usually anatomically infranodal and is seen in advanced His-Purkinje disease.

Answer 80

A

Syncope Bradycardia <40 bpm Fatigue Dyspnoea Chest pain Palpitations Nausea/vomiting

Answer 81

A

High blood pressure Sometimes low blood pressure

Answer 82

A

ECG Serum troponin Serum potassium Serum calcium Serum pH Serum digitalis level

Answer 83

A

Asymptomatic 1st line:Monitoring

Symptomatic 1st line: Discontinuation of AV-nodal blocking medications. 2nd line: Infrequently: PPM (permanent pacemaker) or cardiac resynchronisation therapy ± ICD placement.

Answer 84

A

Asymptomatic or mildly to moderately symptomatic 1st line: Condition-specific management and discontinuation of AV node-blocking drugs. 2nd line: PPM or cardiac resynchronisation therapy ± ICD placement

Severely symptomatic 1st line: Condition-specific management, discontinuation of AV-nodal blocking drugs, and temporary (transcutaneous or transvenous) pacing. 2nd line: PPM or cardiac resynchronisation therapy ± ICD placement.

Answer 85

A

In the short term, periprocedurally, the risks associated with pacemaker implantation are low: in the range of 2% to 3%. These include bleeding, infection, vascular trauma, pneumothorax, cardiac tamponade, lead dislodgement, and pocket haematoma development. The risk of MI, stroke, and death is <1%.

Long-term complications include pulse generator or lead malfunction and infection. The pulse generators run on batteries that average 7 to 10 years in longevity. Battery depletion requires replacing the pulse generator.

Over a lifetime, there is some risk of infection of the lead, which may require extraction, a complex procedure that should be performed at specialised centres.

Answer 86

A

The prognosis is related to the degree of AV block and the severity of associated symptoms. In certain conditions, such as sarcoid or amyloid heart disease or acute anterior MI, the underlying condition strongly determines prognosis.

Answer 87

A

Hypercholesterolaemia, an elevation of total cholesterol (TC) and/or low-density lipoprotein cholesterol (LDL-C) or non-high-density lipoprotein cholesterol (HDL-C).

Answer 88

A

Insulin resistance and type 2 diabetes mellitus Excess body weight (body mass index >25 kg/m²) Hypothyroidism Cholestatic liver disease

Answer 89

A

Approximately 28.5 million adults or nearly 12% of the adult population in the US have total cholesterol levels ≥6.2 mmol/L (≥240 mg/dL).

Answer 90

A

Family history of early onset of coronary heart disease or dyslipidaemia in first-degree relatives History of cardiovascular disease Excess body weight (especially abdominal obesity) Xanthelasmas Corneal arcus

Answer 91

A

Lipid profile Serum thyroid-stimulating hormone (TSH) Lipoprotein(a)

Answer 92

A

Statins Lifestyle modifications Can use ezetimibe or PCSK9 inhibitor

Answer 93

A

Ischaemic heart disease Peripheral vascular disease (PVD) Acute coronary syndrome Stroke Erectile dysfunction

Answer 94

A

If the treatment plan includes detection and management of other factors that contribute to the development of coronary heart disease (CHD), such as hypertension, diabetes mellitus, and smoking, the overall prognosis of hypercholesterolaemia is improved.

Answer 95

A

Hypertriglyceridaemia is defined by the National Cholesterol Education Program Adult Treatment Panel III as fasting plasma triglyceride level ≥2.3 mmol/L (≥200 mg/dL).

Answer 96

A

Family history of hyperlipidaemia Family history of diabetes Overweight/obese patients High-saturated-fat diet High-carbohydrate diet Insulin resistance Liver disease Hypothyroidism Renal disease Excessive alcohol consumption HIV infection Cystic fibrosis

Answer 97

A

The 90th percentile for triglyceride levels has been historically noted to be approximately 2.8 mmol/L (250 mg/dL) in the US. Because hypertriglyceridemia is related to insulin resistance,its prevalence is expected to continue to increase in industrialised countries.

Answer 98

A

Lipaemia retinalis Eruptive xanthoma Obesity/overweight Diabetes Coronary artery disease Angina/claudication

Answer 99

A

Fasting triglycerides

Answer 100

A

IV insulin + dextrose Lifestyle modification

Answer 101

A

Coronary events Acute pancreatitis

Answer 102

A

The prognosis for patients with respect to coronary artery disease or acute pancreatitis is improved significantly with lowering of triglyceride levels to the recommended targets. This will require ongoing long-term therapy with monitoring of plasma lipids as well as side effects.

Answer 103

A

Resting blood pressure over 140/90 mmhg.

Answer 104

A

Blood pressure naturally increases as you grow older, however diastolic generally doesn’t change that much.

There are some important risk factors e.g. smoking, obesity, low activity, high cholesterol, poor diet etc.

Answer 105

A

Worldwide, it is estimated that 1 billion people are hypertensive, accounting for an estimated 7.1 million deaths per year. It is becoming an increasingly common problem because of increased longevity and the prevalence of contributing factors such as obesity, physical inactivity, and unhealthy diet.

Answer 106

A

Hypertension is generally asymptomatic.

Serious hypertension may present with signs such as headache, vision changes, SOB etc.

Answer 107

A

A sustained resting blood pressure of 140/90 mmhg. Retinopathy may also be present.

Answer 108

A

ECG Fasting metabolic panel with estimated GFR Lipid panel Urinalysis Hb Thyroid-stimulating hormone

These tests are to find the cause of the hypertension rather than to confirm the presence of hypertension.

Answer 109

A

An infection of the endocardium or heart valves. Staphylococcus aureus followed by Streptococci of the viridans group and coagulase negative Staphylococci are the three most common organisms responsible for infective endocarditis.

Answer 110

A

Poor dentition/gingivitis Prior hx of infectious endocarditis Presence of artificial prosthetic heart valves Certain types of congenital heart disease Post-heart transplant (patients who develop cardiac valvulopathy)

Answer 111

A

Men are affected 2.5 times more often than women, and there does not appear to be any difference among people of different ancestries.

Answer 112

A

Chest pain SOB Fever Night sweats/fatigue/malaise

Answer 113

A

Janeway lesions Osler nodes Splinter haemorrhages

Answer 114

A

ECG Echo Serum chemistry panel with glucose FBC Urinalysis Blood cultures

Answer 115

A

Determine which antibiotics the bacteria is sensitive to and administer those antibiotics. Macrolides are usually popular (gentamicin etc.)

Surgery may be considered in severe cases.

Answer 116

A

Congestive heart failure (CHF) Systemic embolisation Anterior mitral valve vegetation >10 mm Valvular dehiscence, rupture, or fistula Splenic abscess Mycotic aneurysms

Answer 117

A

There are no comprehensive studies that have looked at overall prognosis in patients with IE. Congestive heart failure remains the single greatest predictor of prognosis in patients, regardless of the offending micro-organism. Surgery, if indicated, has been associated with a lower overall mortality; however, patients with definitive indications for surgery tend to be critically ill and carry a high intra-operative mortality rate.

Answer 118

A

Failure of the mitral valve which causes backwash of blood from the left ventricle into the left atrium.

Answer 119

A

Mitral valve prolapse Hx of rheumatic heart disease Infective endocarditis Hx of cardiac trauma Hx of MI Hx of cvs disease Hypertrophic cardiomyopathy Anorectic/dopaminergic drugs

Answer 120

A

Although the exact incidence and prevalence of MR is unknown it has been suggested that the prevalence probably exceeds 5,000,000 worldwide.

Answer 121

A

SOB on exertion Orthopnoea Palpitations Decreased exercise tolerance Fatigue

Answer 122

A

S3 sound Lower extremity oedema Diminished S1 sound

Answer 123

A

ECG Echocardiogram

Answer 124

A

Narrowing of the mitral orifices which can be caused by rheumatic valvulitis producing fusion of the valve commissures and thickening of the valve leaflets.

Answer 125

A

Streptococcal infection

Answer 126

A

Females are more likely to get mitral stenosis. Most cases of mitral stenosis are caused by rheumatic fever. While rheumatic fever is now very rare in developed nations, it remains epidemic in much of the world.

Answer 127

A

Loud S1 Irregularly irregular pulse Malar flush Hx of orthopnea Dyspnoea

Answer 128

A

ECG Echo CXR

Answer 129

A

Inflammation of the myocardium in the absence of the predominant acute or chronic ischaemia characteristic of coronary artery disease. It is a clinical syndrome of non-ischaemic myocardial inflammation resulting from a heterogeneous group of infectious, immune, and non-immune diseases.

Answer 130

A

Infection HIV Smallpox vaccine Autoimmune disease Peripartum and postnatal periods

Answer 131

A

Autopsy studies reveal myocarditis in 1% to 9% of routine postmortem examinations, and a prospective postmortem study of sudden cardiac death in young adults suggests myocarditis as the aetiology in approximately 10% of cases.

Answer 132

A

Chest pain SOB Fatigue Palpitations

Answer 133

A

S3 gallop Sinus tachycardia Elevated neck veins

Answer 134

A

ECG CXR Troponin Echo CK BNP

Answer 135

A

ST-elevation myocardial infarction (STEMI) is suspected when a patient presents with persistent ST-segment elevation in 2 or more anatomically contiguous ECG leads in the context of a consistent clinical history.

Answer 136

A

Smoking Hypertension Diabetes Obesity Metabolic syndrome Physical inactivity Dyslipidaemia Renal insufficiency Established coronary artery disease Family history of premature coronary artery disease Cocaine use Male sex Advanced age

Answer 137

A

The overall prevalence of MI in the US is around 2.8% in adults aged 20 years or over. The estimated incidence is 550,000 new and 200,000 recurrent MIs annually.

Answer 138

A

Chest pain Dyspnoea Pallor Diaphoresis Cardiogenic shock Nausea and/or vomiting Dizziness or light-headedness Weakness Tachycardia Additional heart sounds

Answer 139

A

ECG Troponin Electrolytes, urea, and creatinine Serum lipids CXR Coronary angiogram

Answer 140

A

Aspirin

Adjunct: GTN or morphine

Answer 141

A

Sinus bradycardia Heart block Recurrent chest pain Acute mitral regurgitation Ventricular septal defects (VSD) Acute pericardial tamponade Post-infarction pericarditis (Dressler's syndrome) Congestive heart failure Ventricular arrhythmias Recurrent ischaemia and infarction

Answer 142

A

About 15% of people who have an acute MI in the US will die of it, half within the first hour of symptoms. Prognosis for patients with STEMI varies depending on time to presentation after onset of chest pain and time to treatment after presentation.

Answer 143

A

Non-ST-elevation myocardial infarction (NSTEMI) is an acute ischaemic event causing myocyte necrosis. The initial ECG may show ischaemic changes such as ST depressions, T-wave inversions, or transient ST elevations; however, it may also be normal or show non-specific changes.

Answer 144

A

Atherosclerosis Diabetes Smoking Dyslipidaemia Age >65 years Hypertension Obesity and metabolic syndrome phenotype Physical inactivity Cocaine use Depression Stent thrombosis or restenosis Chronic kidney disease Sleep apnoea

Answer 145

A

Epidemiology data have shown that acute coronary syndrome (ACS) cases with ST-elevation myocardial infarction (STEMI) appear to be declining and that NSTEMI occurs more frequently than STEMI.

Answer 146

A

Chest pain Diaphoresis Physical exertion Shortness of breath Weakness Anxiety Nausea Vomiting Abdominal pain Hypertension

Answer 147

A

ECG Troponin Glucose U+Es Creatinine Cardiac angiogram CXR LFTs CK

Answer 148

A

1st line: Antiplatelet therapy (aspirin + clopidogrel, ticagrelor or prasugrel)

Adjunct: Oxygen Glyceryl trinitrate ± morphine Beta-blocker Calcium-channel blocker

Answer 149

A

Cardiac arrhythmias Congestive heart failure (CHF) Cardiogenic shock Ventricular rupture or aneurysm Acute mitral regurgitation Post-MI pericarditis (Dressler syndrome) Venous thromboembolism (VTE)

Answer 150

A

Patients who have experienced NSTEMI have a high risk of morbidity and death from a future event. The rate of sudden death in patients who have had a myocardial infarction (MI) is 4 to 6 times the rate in the general population.

Answer 151

A

An inflammation of the pericardium. The acute form is defined as new-onset inflammation lasting <4-6 weeks. It can be either fibrinous (dry) or effusive with a purulent, serous, or haemorrhagic exudate.

Answer 152

A

Having cardiac surgery or being on dialysis can also increase the risk of getting pericarditis. Viral or bacterial infections can also cause this.

Answer 153

A

Acute pericarditis is more common in adults (typically between 20 to 50 years old) and in men. It is the most common disease of the pericardium encountered in clinical practice. The true incidence and prevalence of the disease are unknown and there are a large number of undiagnosed cases.

Answer 154

A

Chest pain Pericardial friction rub Fever

Answer 155

A

Symptoms and signs of right-sided heart failure, including fatigue, ankle oedema, and, in severe cases, ascites.

Answer 156

A

ECG Echocardiogram CXR Serum urea FBC Blood culture Troponin

Answer 157

A

Pericardiocentesis + systemic antibiotics Non-steroidal anti-inflammatory drug (NSAID) Proton-pump inhibitor Exercise restriction

Second line treatment is a pericardiectomy.

Answer 158

A

Pericardial effusion with or without cardiac tamponade Chronic constrictive pericarditis

Answer 159

A

Prognosis generally depends on the underlying cause and disease severity. Features associated with a poor prognosis include: Evidence of a large pericardial effusion (i.e., diastolic echo-free space >20 mm) High fever (i.e., >38°C) Sub-acute course (i.e., symptoms over several days without a clear-cut acute onset) Failure to respond within 7 days to a non-steroidal anti-inflammatory drug (NSAID).

Answer 160

A

Peripheral arterial disease (PAD) includes a range of arterial syndromes that are caused by atherosclerotic obstruction of the lower-extremity arteries.

Answer 161

A

Smoking Diabetes Hypertension Hyperlipidaemia Age >40 years History of coronary artery disease/cerebrovascular disease Low levels of exercise

Answer 162

A

The prevalence of PAD increases with age, beginning after 40 years of age. In the UK, one-fifth of people aged 65 to 75 years have evidence of PAD on clinical examination.

Answer 163

A

Asymptomatic Intermittent claudication Thigh or buttock pain with walking that is relieved with rest Diminished pulse

Answer 164

A

Ankle-brachial index Doppler ultrasound MRA Dupplex scan Angioplasty

Answer 165

A

Pulmonary embolism (PE) is a consequence of thrombus formation within a deep vein of the body, most frequently in the lower extremities. Approximately 51% of DVT will embolise to the pulmonary embolus which results in a PE.

Answer 166

A

Sitting for long periods of time without movement

Smoking

Increased age

Broken bones (fat embolus)

Clotting disorders which cause clots to form more easily.

Answer 167

A

In the UK, 47,594 cases of PE were reported in the 1-year period between 2013 and 2014. Incidence increases with increased age.

Answer 168

A

SOB Chest pain Cough

Answer 169

A

Tachycardia Tachypnoea Swelling in leg Haemoptysis

Answer 170

A

Wells criteria/Geneva score Multiple-detector computed tomographic pulmonary angiography (CTPA) Ventilation-perfusion (V/Q) scan Coagulation studies Urea and creatinine FBC Pulmonary Embolism Rule-Out Criteria (PERC) D-dimer test

Answer 171

A

<ol> <li>Respiratory support</li> <li>Intravenous fluids</li> <li>Vasoactive agents</li> <li>Anticoagulation</li> <li>Thrombolysis or embolectomy or catheter-directed therapy</li></ol>

Adjunct: Venous filter

Answer 172

A

Acute bleeding during treatment Pulmonary infarction Cardiac arrest/death Chronic thromboembolic pulmonary Heparin-associated thrombocytopenia (HIT) Recurrent venous thromboembolic event

Answer 173

A

Patients in the high-risk category have a short-term mortality of 10.9%, while patients in the low-risk category have 30-day mortality of 1%.

Answer 174

A

Idiopathic pulmonary arterial hypertension (IPAH) is a disease of the small pulmonary arteries characterised by vascular proliferation and remodelling. It results in a progressive increase in pulmonary vascular resistance (PVR) and, ultimately, right ventricular failure and death.

Answer 175

A

Bone morphogenetic protein receptor type 2 (BMPR2) mutations Appetite suppressants

Answer 176

A

While pulmonary artery hypertension remains a rare disease, it is being increasingly recognised, with an estimated prevalence of 15.0 cases per million adult inhabitants and incidence of 2.4 cases per million adult inhabitants per year.

Answer 177

A

SOB Fatigue

Answer 178

A

Peripheral oedema Cyanosis Accentuated pulmonic component (P2) to the second heart sound Tricuspid regurgitation murmur

Answer 179

A

CXR ECG Transthoracic Doppler BNP FBC LFT

Answer 180

A

Rheumatic fever is an autoimmune disease that may occur following group A streptococcal throat infection. It can affect multiple systems, including the joints, heart, brain, and skin. Only the effects on the heart can lead to permanent illness.

Answer 181

A

Poverty Overcrowded living quarters Family history of rheumatic fever D8/17 B cell antigen positivity HLA association Genetic susceptibility

Answer 182

A

Primary episodes of acute rheumatic fever occur mainly in children aged 5 to 14 years and are rare in people over 30 years old. More than 2.4 million children have rheumatic heart disease worldwide; 94% of these are in developing countries.

Answer 183

A

Sore throat Chest pain Shortness of breath Palpitations Heart murmur Pericardial rub Signs of cardiac failure Swollen joints Restlessness, clumsiness Emotional lability and personality changes Jerky, uncoordinated choreiform movements

Answer 184

A

ESR CRP WBC count Blood cultures Electrocardiogram CXR Echocardiogram Throat culture Rapid antigen test for group A streptococci Anti-streptococcal serology

Answer 185

A

Supraventricular tachycardia is characterised as a rapid regular rhythm arising from a discrete area within the atria. It occurs in a wide range of clinical conditions, including catecholamine excess, digoxin toxicity, paediatric congenital heart disease, and cardiomyopathy.

Answer 186

A

Supraventricular tachycardia has a variety of causes. It may occur in healthy people, although often there is underlying cardiac pathology. Associated conditions include cardiomyopathies, ischaemic heart disease, previous cardiac surgery, and hyperthyroidism.

Answer 187

A

Focal atrial tachycardia is a relatively uncommon arrhythmia that occurs in all age groups and represents approximately 3% to 17% of the patients referred for supraventricular tachycardia ablation. There is no particular pattern in relation to sex or ancestry.

Answer 188

A

Palpitations Fatigue, weakness SOB

Answer 189

A

Rales Oedema

Answer 190

A

ECG Digoxin level Theophylline level CXR Electrolytes Toxicology screen

Answer 191

A

<ol> <li>Beta-blocker or calcium-channel blocker</li> <li>Ibutilide or amiodarone</li> <li>Third-line pharmacotherapy or direct current (DC) cardioversion + cardiology consult</li></ol>

Answer 192

A

Congestive heart failure Resistance to therapy Cardiomyopathy

Answer 193

A

Prognosis depends on the ability to control the arrhythmia. This is further influenced by the patient's age, underlying cause of the arrhythmia, tolerance of adverse effects of the chosen treatment, and comorbidities.

Answer 194

A

Tricuspid regurgitation (TR) occurs when blood flows backwards through the tricuspid valve. In the vast majority of patients, this occurs during systole, but severely elevated right ventricular filling pressure can be associated with diastolic TR.

Answer 195

A

Left-sided heart failure Dilated tricuspid annulus Rheumatic heart disease Permanent pacemaker Endocarditis Carcinoid heart disease

Answer 196

A

Some degree of valvular regurgitation is a quite common accidental finding in colour Doppler imaging. In fact, two-dimensional echocardiography has demonstrated that 50% to 60% of asymptomatic young adults exhibit mild tricuspid regurgitation.

Answer 197

A

Fatigue and effort intolerance Dyspnoea Palpitations

Answer 198

A

Jugular venous abnormality Irregular heart rhythm Parasternal systolic murmur Increased systolic murmur on inspiration (Carvallo's sign) Peripheral oedema

Answer 199

A

ECG Doppler USS Echo LFTs Serum urea and creatinine FBC

Answer 200

A

Varicose veins are subcutaneous, permanently dilated veins 3 mm or more in diameter when measured in a standing position.

Answer 201

A

Increasing numbers of births DVT Occupation with prolonged standing Obesity

Answer 202

A

Prevalence estimates vary based on population, selection criteria, disease definition, and imaging techniques. Generally, prevalence rates are higher in industrialised countries and in more developed regions.

Answer 203

A

Dilated tortuous veins Leg fatigue or aching with prolonged standing Leg cramps Restless legs

Answer 204

A

Haemosiderin deposition Corona phlebectatica

Answer 205

A

Duplex ultrasound

Answer 206

A

Patients should also be counselled on lifestyle modifications including weight loss, leg elevation, and exercise. Use of compression stockings can also help the physician and patient to determine whether symptoms are truly related to varicosities.

Answer 207

A

Chronic venous insufficiency Haemorrhage Venous ulceration Lipodermatosclerosis Haemosiderin deposition

Answer 208

A

Although there are small variations in overall efficacy depending on the type of intervention, generally resolution of symptoms occurs in >95% of patients. However, patients need to be counselled that new varicosities will very likely occur with time.

Answer 209

A

Vasovagal syncope occurs when you faint because your body overreacts to certain triggers, such as the sight of blood or extreme emotional distress. It may also be called neurocardiogenic syncope. The vasovagal syncope trigger causes your heart rate and blood pressure to drop suddenly.

Answer 210

A

Prior syncope Prior history of arrhythmias, myocardial infarction, heart failure, or cardiomyopathy Severe aortic stenosis Prolonged standing Emotional stress (especially in a warm, crowded environment) Dehydration/hypovolaemia Preceding episode of nausea and/or vomiting Prior syncope Prior history of arrhythmias, myocardial infarction, heart failure, or cardiomyopathy Severe aortic stenosis Prolonged standing Emotional stress (especially in a warm, crowded environment) Dehydration/hypovolaemia Preceding episode of nausea and/or vomiting

Answer 211

A

Prevalence of syncope varies in the population: 15% of children (<18 years) 25% of a military population aged 17 to 26 years 16% and 19%, respectively, in men and women aged 40 to 59 years Up to 23% in a nursing home population aged >70 years.

Answer 212

A

Nausea Lightheadedness Pallor Diaphoresis Diminished vision or hearing Fatigue after episode

Answer 213

A

Palpitations Bradycardia

Answer 214

A

12-lead ECG Serum haemoglobin Plasma blood glucose Serum beta-human chorionic gonadotropin - rules out syncope caused by the effects of pregnancy Cardiac enzymes D-dimer level - rules out pulmonary embolism Serum cortisol Urea or serum creatinine

Answer 215

A

Venous ulcers are caused by venous stasis in the leg and thus less painful when elevated and drained of blood. Only 30% of venous ulcers are painful.

Answer 216

A

Varicose veins Immobility Malnourished (reduced healing) Patients with recurrent DVT Pelvic mass (compressing iliac veins) Arteriovenous malformations Major joint replacement

Answer 217

A

Venous ulcers commonly present in older people who have varicose veins are quite immobile.

Answer 218

A

Location: where venous pressure is highest (e.g. medial malleolus) Shallow, wet, irregular borders that look white and fragile Oedema Extravasation Death of erythrocytes (atrophie blanche) Superficial varicose veins

Answer 219

A

Investigate for signs of atherosclerotic disease: BM FBC Fasting lipids Urinalysis Venous duplex ultrasound Ankle-brachial pressure index Biopsy

Answer 220

A

Adequate nutrition Lifestyle modification Leg elevation Compression bandages Graduated class I or II elastic stockings Varicose vein surgery

Answer 221

A

Risk of infection Blood loss

Answer 222

A

With management, 80% of venous ulcers will heal within 6 months.

Answer 223

A

Ventricular fibrillation is a heart rhythm problem that occurs when the heart beats with rapid, erratic electrical impulses. This causes pumping chambers in your heart (the ventricles) to quiver uselessly, instead of pumping blood.

Answer 224

A

A previous episode of ventricular fibrillation A previous heart attack Congenital heart disease Cardiomyopathy Injuries that cause damage to the heart muscle, such as electrocution Use of illegal drugs, such as cocaine or methamphetamine Significant electrolyte abnormalities, such as with potassium or magnesium

Answer 225

A

Idiopathic ventricular fibrillation occurs with a reputed incidence of approximately 1% of all cases of out-of-hospital arrest, as well as 3–9% of the cases of ventricular fibrillation unrelated to myocardial infarction, and 14% of all ventricular fibrillation resuscitations in patients under the age of 40.

Answer 226

A

Chest pain Rapid heartbeat (tachycardia) Dizziness Nausea Shortness of breath Loss of consciousness

Answer 227

A

ECG CXR CT Angiogram FBC Serum potassium Serum magnesium

Answer 228

A

Beta blockers Permanent pacemaker

In acute ventricular fibrillation (VF), drugs (eg, vasopressin, epinephrine, amiodarone) are used after three defibrillation attempts are performed to restore normal rhythm.

Answer 229

A

Ventricular fibrillation is the most frequent cause of sudden cardiac death. The condition's rapid, erratic heartbeats cause the heart to abruptly stop pumping blood to the body. The longer the body is deprived of blood, the greater the risk of damage to your brain and other organs. Death can occur within minutes. The condition must be treated immediately with defibrillation, which delivers an electrical shock to the heart and restores normal heart rhythm.

Answer 230

A

The rate of long-term complications and death is directly related to the speed with which you receive defibrillation.

Answer 231

A

In ventricular tachycardia (V-tach or VT), abnormal electrical signals in the ventricles cause the heart to beat faster than normal, usually 100 or more beats per minute, out of sync with the upper chambers.

Answer 232

A

Lack of oxygen to the heart due to tissue damage from heart disease Abnormal electrical pathways in the heart present at birth (congenital heart conditions, including long QT syndrome) Cardiomyopathy Medication side effects An inflammatory disease affecting skin or other tissues (sarcoidosis) Abuse of recreational drugs, such as cocaine Imbalance of electrolytes, mineral-related substances necessary for conducting electrical impulses

Answer 233

A

The prevalence of VT was 16% in men and 15% in women with CAD, 9% in men and 8% in women with hypertension, valvular disease, or cardiomyopathy without CAD, and 3% in men and 2% in women with no cardiovascular disease.

Answer 234

A

Dizziness Shortness of breath Lightheadedness Palpitations Angina Seizures

Sustained or more serious episodes of ventricular tachycardia may cause: Loss of consciousness or fainting Cardiac arrest (sudden death)

Answer 235

A

ECG Electrolytes Troponin I CK-MB Investigations to consider Transthoracic echocardiogram

Answer 236

A

<ol> <li>Antiarrhythmic medications + treatment of reversible cause (if present)</li> <li>Synchronised cardioversion ± antiarrhythmic medications</li></ol>

Answer 237

A

Complications of ventricular tachycardia vary in severity depending on such factors as the rate, and duration of a rapid heart rate, the frequency with which it happens, and the existence of other heart conditions. Possible complications include:

<ul> <li>Inability of the heart to pump enough blood (heart failure)</li> <li>Frequent fainting spells or unconsciousness</li> <li>Sudden death caused by cardiac arrest</li></ul>

Answer 238

A

Idiopathic VT generally carries a favourable prognosis. In most patients, idiopathic VT is not a progressive condition.

Answer 239

A

Wolff-Parkinson-White occurs when one or more strands of myocardial fibres capable of conducting electrical impulses (known as accessory pathways or bypass tracts) connect the atrium to the ipsilateral ventricle across the mitral or tricuspid annulus.

Answer 240

A

Ebstein's anomaly Hypertrophic cardiomyopathy Mitral valve prolapse Atrial septal defect Ventricular septal defect Transposition of great vessels Coarctation of aorta Dextrocardia Coronary sinus diverticula Right and left atrial aneurysms Cardiac rhabdomyomas Marfan's syndrome Friedreich's ataxia Family history

Answer 241

A

The prevalence of WPW-pattern ECG in the general population is 0.1% to 0.3%. The yearly incidence is 0.004% to 0.1% (50% of these are asymptomatic).

Answer 242

A

Palpitations Dizziness Shortness of breath Chest pain Atrial fibrillation Atrial flutter Congenital cardiac abnormalities

Answer 243

A

ECG: Slurred PQ (delta waves) Echocardiogram Treadmill exercise test Electrophysiology study

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Cardiovascular Flashcards

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