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CVS > Concepts to Remember > Flashcards

Concepts to Remember Flashcards

1
Q

What is the normal PR interval?

A

120 - 200 mS
(0.12 - 0.20 seconds)
3-5 small squares

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2
Q

What is the normal QRS complex time?

A

<120 mS

< 0.12 seconds

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3
Q

Formula for BP?

A

BP = CO x PR

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4
Q

Formula for CO?

A

CO = SV x HR

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5
Q

Formula for SV?

A

EDV - ESV

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6
Q

Formula for Ejection Fraction?

A

SV/EDV

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7
Q

There are normally 2 heart sounds (S1 and S2). What does S3, an additional heart sound, represent?

A

increased filling pressure due to ventricular dilation

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8
Q

There are normally 2 heart sounds (S1 and S2). What does S4, an additional heart sound, represent?

A

high atrial pressure due to ventricular hypertrophy (non-compliance)

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9
Q

What is papilloedema?

A

is optic disc swelling that is caused by increased intracranial pressure due to any cause

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10
Q

What is the definition of cardiac output?

A

amount of blood your heart pumps out each minute

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11
Q

What occurs to the blood pressure in vasoconstriction?

A

BP increases

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12
Q

What occurs to the blood pressure in vasodilation?

A

BP decreases

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13
Q

What is a parasternal heave normally caused by?

A

right ventricular hypertrophy

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14
Q

What does the T wave represent?

A

repolarisation of the ventricles

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15
Q

What does the U wave present?

A

repolarisation of the purkinje fibres

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16
Q

What is the of the 2 hypertrophy voltage criteria?

A

hypertrophy will lead to an increased amount of muscle which will lead to more electrical activity present

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17
Q

What is the neurotransmitter of the sympathetic nervous system?

A

norepinephrine

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18
Q

What is the neurotransmitter of the parasympathetic nervous system?

A

acetylcholine

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19
Q

What is another term for a sympathomimetic?

A

adrenergic agonist

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20
Q

What is another term for a sympatholytic?

A

adrenergic antagonist

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21
Q

What is another term for a parasymapthomimetic?

A

muscarinic agonist

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22
Q

What is another term for parasympatholytic?

A

muscarinic antagonist

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23
Q

What is the function of alpha 1 receptors?

A

vasoconstriction, contraction + urinary retention

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24
Q

What is the function of beta 1 receptors?

A

increase heart rate, increase contractility, increase conduction in heart

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25
Q

What is the function of beta 2 receptors?

A

vasodilation + bronchodilation

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26
Q

Give 2 examples of non-selective alpha receptor antagonists and why they may not be used anymore

A
  1. Phenoxybenzamide
  2. Phentolamine

not used b/c they increase cardiac output + induce tachycardia, dysrhythmias and increased GIT activity

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27
Q

List the uses of beta receptor antagonists

A
  • arrhythmias
  • angina, MIs
  • cardioprotective (after an MI)
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28
Q

What is a cardioselective beta blocker?

A

beta1 receptor antagonist

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29
Q

List 3 side effects of atenolol

A
  • cold extremities
  • insomnia
  • depression
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30
Q

What is the MOA of M1, M3, and M5 receptors?

A
  • increase cellular excitability
  • act via the inositol phosphate pathway
  • essentially increasing calcium
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31
Q

What is the MOA of M2 and M4 receptors?

A
  • decrease cellular excitability
  • inhibit adenylate cyclase
  • essentially decreasing calcium
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32
Q

What is myasthenic crisis?

A

Myasthenia gravis may cause respiratory failure (due to exhaustion of the respiratory muscles)

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33
Q

What test is used to diagnose myasthenia gravis?

A

Edrophonium Test

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34
Q

List some of the effects of augmenting the parasympathetic system (i.e. cholinergic agonists)

A
  • hypotension
  • bradycardia
  • bronchoconstriction
  • increased secretions
  • GIT hypermotility
  • decreased intraocular pressure
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35
Q

List the 4 muscarinic receptor antagonists (cholinergic receptor antagonists)

A
  1. Atropine
  2. Ipratropium (M3-selective)
  3. Darifenacin (M3-selective)
  4. Pirenzepine (M1-selective)
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36
Q

Botulin Toxin (Botox) is a indirectly-acting cholinergic receptor ANTAGONIST. List some of the SIDE EFFECTs of botox

A
  • progressive parasympathetic + motor paralysis
  • dry mouth
  • blurred vision
  • difficulty in swallowing
  • respiratory paralysis
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37
Q

What is a side effect of broad spectrum cholinergic receptor agonists?

A

potentiates all nicotinic and muscarinic actions

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38
Q

What is a side effect of broad spectrum cholinergic receptor antagonists?

A
  • results in loss of all autonomic function

- impair voluntary movement

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39
Q

What is another term for HMG-CoA Reductase Inhibitors?

A

Statins

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40
Q

List the first-line treatment and other treatment options for dyslipidaemia

A

First Line Treatment: Statins

  • Bile Acid Binding Resins/Sequestrants
  • Fibrates
  • Nicotinic Acid
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41
Q

What is the most common drug a/w statin-induced myopathy?

A

Gemfibrozil

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42
Q

List drugs that are a/w statin-induced myopathy

A
  • Gemfibrozil (most common)
  • Macrolide antibiotics
  • Azole antifungals
  • Cyclosporine
  • HIV protease inhibitors
  • Amiodarone
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43
Q

Statin-induced myopathy can be caused by drugs that interfere with which enzyme?

A

CYP3A4 (involved in statin oxidation)

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44
Q

List 2 possible ECG changes of a STEMI

A
  1. ST Elevation

2. New LBBB

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45
Q

List 2 possible ECG changes of a NSTEMI

A
  1. ST Depression

2. T Wave Inversions

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46
Q

What disorder can cause psychogenic pseudo-syncope?

A

Somatization Disorder

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47
Q

What investigation is typically always done when investigating syncope?

A

12 Lead ECG

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48
Q

List 2 possible treatments for heart block management. (be specific)

A
  1. Medications
    a) Atropine
    b) Dopamine
    c) Dobutamine
  2. Pacing (for complete AV block or symptomatic 2nd degree block)
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49
Q

What is the purpose of CHADS2VASc score?

A

rating the risk of thromboembolism + stroke in NON-VALVULAR atrial fibrillation

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50
Q

What anti-thrombotic drug(s) should be given to someone with NON-VALVULAR atrial fibrillation?

A
  • warfarin
    OR
  • direct oral anticoagulants (DOACs)
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51
Q

What anti-thrombotic drug(s) should be given to someone with VALVULAR atrial fibrillation?

A
  • ONLY warfarin

- do NOT given DOACs

52
Q

What is the ABC treatment in atrial fibrillation?

A

A - Anticoagulation/Anti-thrombotic therapies
- warfarin/DOACs

B - Better Symptom Control (either rate* or rhythm)

  • i) Beta Blockers*
  • ii) Calcium Channel Blockers*
  • iii) Digoxin
  • iv) Amiodarone (last resort)

C - Cardiovascular risk factors

53
Q

How long should the QT interval be in males and females?

A

Males: < 450 mS/0.45 seconds

Females: < 470 mS/0.47 seconds

54
Q

What is the normal ejection fraction of the heart?

A

b/w 50 - 70%

55
Q

Why can those with hypertrophic cardiomyopathy have angina?

A

because increased muscle requires more oxygen (supply does not satisfy the demand)

56
Q

Hypertrophic Cardiomyopathy is mainly caused by inefficiency of what?

A

inefficiency of ATP utilization

- triggers Ca2+ dependent hypertrophy

57
Q

What proteins (gene mutations) are mainly a/w hypertrophic cardiomyopathy?

A

sarcomeric proteins

58
Q

What is the most common arrhythmia?

A

Atrial Fibrillation

59
Q

What is Jervell Lange-Nielson disease and what does it cause?

A
  • autosomal recessive
  • causes Long QT syndrome
  • a/w deafness
60
Q

What is Romano-Ward disease and what does it cause?

A
  • autosomal dominant

- causes Long QT syndrome

61
Q

List 3 possible treatments for Long QT syndrome

A
  1. Beta Blockers
  2. Left Cardiac Sympathetic Denervation
  3. Implantable Cardiac Defibrillator (ICD)
62
Q

What is Brugada Syndrome? How can it be treated?

A
  • autosomal dominant
  • structurally normal heart
  • but ST segment elevation in right heart leads
  • SUSCEPTIBLE TO V. TACH

treat w/ implantable cardiac defibrillator (ICD)

63
Q

What is the Vaughan Williams Classification?

A

used to classify different anti-arrhythmic drugs

64
Q

List the SIRS/Sepsis Criteria. If 2 or more criteria are present, this means that SIRS is present

A
  1. Temperature (>38 OR <36)
  2. Heart Rate > 90 bpm
  3. Respiratory Rate > 20
  4. WBC (>12 000 OR <4 000)

+ suspected/present infection (to turn it into sepsis)

65
Q

Bernard-Souilier Syndrome is a platelet disorder. What is defective?

A

defective GPIb receptor

66
Q

Grey Platelet Syndrome is a platelet disorder. What is defective?

A

defective granule secretion

67
Q

Glazmann Thrombasthenia is a platelet disorder. What is defective?

A

defective GPIIb/IIIa receptor

68
Q

What is the main risk for anti-platelet therapies?

A

Bleeding

69
Q

List some contraindications to aspirin (an anti-platelet therapy)

A
  • allergic to ibuprofen
  • NSAID precipitated bronchospasm
  • kidney disease
  • peptic ulcers
  • gastritis
  • patients w/ bleeding risks
70
Q

List 3 complications of Implantable Cardioverter Defibrillators (ICDs)

A
  1. Pneumothorax
  2. Perforation
  3. Bleeding
71
Q

List some complications of catheter ablation for ventricular arrhythmias

A
  • cardiac tamponade
  • stroke
  • heart block
  • vascular access complications
72
Q

What is the function of dihydropyridine calcium channel blockers? Give 2 examples

A
  • reduce BP
  1. Nifedipine
  2. Amlodipine
73
Q

What is the function of non-dihydropyridine calcium channel blockers? Give 2 examples

A
  • decreases HR
  1. Verapramil
  2. Diltiazem
74
Q

What is the most common and the 2nd most common causative organism of infective endocarditis?

A
  1. Staph. aureus
  2. Strep. viridans
    (third is coagulase-negative Staph)
75
Q

Which criteria is used to diagnose infective endocarditis?

A

Duke’s Criteria

76
Q

What are the 2 major criteria of the Duke’s Criteria that is used to diagnose infective endocarditis?

A
  1. Blood Cultures

2. Imaging (echocardiogram)

77
Q

List 3 causes of culture-negative infective endocarditis

A
  1. Prior Antibiotic Therapy
  2. HACEK Organisms
  3. Uncommon Bacteria (e.g. bartonella, chlamydia, Q fever, brucella, legionella…)
78
Q

List the HACEK organisms that may cause infective endocarditis

A
  • Haemophilus species
  • Aggregatibacter species
  • Cardiobacterium hominis
  • Eikenella corrodens
  • Kingella species
79
Q

Antibiotic prophylaxis may be used for high-risk groups to prevent infective endocarditis. Which antibiotic(s) may be given?

A

Amoxicillin

If allergic, Clindamycin or Azithromycin

80
Q

List the viral and bacterial causes of pericarditis

A

Viral:

  • Coxsackie
  • Influenza
  • Adenovirus

Bacterial:

  • Staph
  • Strep
  • Chlamydia
  • TB
81
Q

List the clinical features + symptoms of pericarditis

A
  • sharp, pleuritic chest pain
  • chest pain relieved by sitting up and leaning forward
  • friction rub
  • new widespread ST elevation or PR depression
82
Q

If there is a new widespread ST elevation or PR depression on ECG, what condition is this suggestive of?

A

pericarditis

83
Q

What is the treatment for pericarditis?

A
  • NSAIDs ± Cochicine or Steroids
  • drainage of pericardial effusion
  • antimicrobials (if bacteria identified)
84
Q

List the possible causative organisms of myocarditis

A
  • Coxsackie
  • Influenza
  • Corynebacterium diphtheriae
  • Toxoplasmosis
85
Q

List the clinical features + symptoms of myocarditis

A
  • rise in cardiac biomarkers (troponin)
  • ECG changes
  • acute chest pain
  • new/worsening SOB
  • palpitations/unexplained arrhythmias
86
Q

What organisms are mainly involved in cardiac device infections?

A

Staph. epidermidis
Staph. aureus

aka skin flora

87
Q

How does a cardiac device infection present?

A
  • local cellulitis w/ discharge + pain
  • blood stream infection
  • ± endocarditis (usually right-sided endocarditis)
88
Q

What organisms may be involved in vascular infections (e.g. stent infections)?

A 
Skin Flora: S. epidermidis, S. aureus
Enteric Flora (if groin infection): E. coli, Pseudomonas aeruginosa
89
Q

What should the total cholesterol level be?

A

< 5.0 mmol/L

90
Q

What should the LDL cholesterol level be?

A

< 3.0 mmol/L

91
Q

What should the HDL cholesterol level be?

A

> 1.0 mmol/L

92
Q

List the clinical features of rheumatic fever

A
  • pancarditis (endocarditis, myocarditis, pericarditis)
  • migratory polyarthritis
  • subcutaneous nodules
  • erythema marginatum
  • sydenham chorea
93
Q

Which organism mainly causes prosthetic valve infective endocarditis?

A

Staph. epidermidis

note: S. aureus mainly causes IVDU endocarditis

94
Q

Which criteria is used to diagnose rheumatic fever?

A

(Duckett) Jones criteria

95
Q

The Jones criteria may be used to diagnose rheumatic fever. List the 5 major and 4 minor criteria for the Jones criteria.

A

MAJOR:

  1. Migratory Polyarthritis
  2. Pancarditis
  3. Sydenham’s Chorea
  4. Subcutaneous Nodules
  5. Erythema Marginatum

MINOR:

  1. Fever
  2. Arthralgia
  3. Elevated CRP or ESR
  4. Prolonged PR Interval
96
Q

What is the most common valvular lesion in the elderly?

A

Aortic Stenosis

97
Q

List 2 investigations that can be done when investigating PAD

A
  1. Doppler Ultrasonography

2. Ankle-Brachial Index (ABI)

98
Q

List 2 initial treatments of symptomatic PAD

A
  1. Supervised Exercise Program

2. Cilostazol (phosphodiesterase inhibitor)

99
Q

Give 1 drug that may be given to treat symptomatic PAD. What type of drug is it?

A

Cilostazol - Phosphodiesterase Inhibitor

100
Q

Which 2 imaging techniques can be done to diagnose an abdominal aneurysm?

A
  1. Ultrasound*

2. CT Angiogram

101
Q

List 5 indications for surgery for an abdominal aneurysm

A
  1. Rupture
  2. Symptomatic
  3. Rapid Increase in Size (> 1.0 cm/year)
  4. Asymptomatic >5.5 cm
  5. Fistulas (aortacaval or aorta-enteric)
102
Q

What are the 2 treatment options for an abdominal aneurysm?

A
  1. EVAR - Endovascular Aneurysm Repair

2. Open Surgery (this is more durable, but more invasive)

103
Q

When looking at the size of the heart on a PA CXR, what would be considered a normal size?

A

Diameter of Heart = 50% of Diameter of Thorax

104
Q

List some of the CXR findings of pulmonary oedema

A
  • dilated upper zone vessels (vascular redistribution)
  • Kerley B Lines (septal lines)
  • increased interstitial markings
  • pleural effusions
  • airspace opacification
  • Batwing (perihilar) distribution
105
Q

What are Kerley B lines on CXR and what condition are they a/w?

A
  • due to thickened, oedematous interlobular septa
  • due to interstitial oedema
  • a/w pulmonary oedema
106
Q

What disease is a/w polyarteritis nodosa (PAN)?

A

Hepatitis B

107
Q

In a thoracic aortic dissection, what is usually seen in the walls?

A

Cystic Medial Degeneration

108
Q

List 3 genetic conditions a/w berry aneurysms

A
  • AD polycystic kidney disease (ADPKD)
  • Ehler-Danlos
  • Marfan’s syndrome
109
Q

Where do syphilitic aneurysms normally occur?

A

Thoracic Aorta

110
Q

Where do capillary micro-aneurysms normally occur?

A

Intracerebral - Hypertension

Retinal - Diabetics

111
Q

Where do mycotic aneurysms normally occur?

A

cerebral arteries

YES. Mycotic and syphilitic aneurysms are different.

112
Q

List some of the secondary causes of hyperlipidaemia

A
  • diabetes mellitus
  • hypothyroidism
  • obesity
  • alcohol ingestion
113
Q

Which stain may be used to stain for myocardial fibrosis?

A

Masson Trichrome

114
Q

What is the Levine sign?

A

pt cannot qualify the nature of their discomfort but places their clenched fist in centre of chest
– sign of an MI

115
Q

Which 2 drugs may be given to treat orthostatic syncope?

A
  1. Fludrocortisone

2. Midodrine

116
Q

What is the most common cardiomyopathy?

A

Dilated

117
Q

Why isn’t salbutamol used as an anti-hypertensive?

A

it causes strong sympathetic reflex tachycardia

118
Q

List the side effects of amiodarone

A

thyroid disorders
photosensitivity
liver damage
pulmonary alveolitis

119
Q

What is the MOA of Class 3 anti-arrhythmic agents?

A

act by slowing repolarization (phase 3); prolonging the action potential duration

120
Q

An atrial septal defect is a/w with what condition?

A

Down’s Syndrome (Trisomy 21)

121
Q

A ventricular septal defect is a/w what condition?

A

Foetal Alcohol Syndrome

122
Q

A patent ductus arteriosus is a/w what condition?

A

Congenital Rubella Infection

123
Q

Coarctation of the aorta is a/w what condition?

A

Turner’s Syndrome (45XO)

124
Q

List 2 sounds/murmur characteristics of mitral valve prolapse

A

mid-systolic click

late systolic murmur

125
Q

HFrEF has an ejection fraction of…

A

< 40%

126
Q

HFpEF has an ejection fraction of…

A

> 50%

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