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Yr 4 - CCC > Corrections Cardiology 2 > Flashcards

Corrections Cardiology 2 Flashcards

1
Q

What are the major complications of mechanical heart valves? (3)

A

1) Thrombus formation

2) Infective endocarditis

3) Haemolytic anaemia

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2
Q

What are the secondary causes of hypertension? (5)

A

1) Renal disease e.g. renal artery sclerosis, CKD

2) Obesity

3) Pregnancy induced or pre-eclampsia

4) Endocrine disease e.g. hyperaldosteronism or Cushing’s syndrome

5) Drugs e.g. steroids

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3
Q

What are the ECG changes in Wolff-Parkinson-White syndrome? (3)

A

1) Delta wave (slurred upstroke on QRS)

2) Short PR interval (<0.12 seconds)

3) Widened QRS complex (>0.12 seconds)

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4
Q

How much fluid is normally contained within the pericardial sac? (1)

A

<50 mls

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5
Q

What condition causes angina-like chest pain without the presence of coronary artery disease when investigated with angiograms? (1)

A

Cardiac syndrome X

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6
Q

What causes individual, random, abnormal, broad QRS complexes on an otherwise normal ECG? (1)

A

Ventricular ectopics

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7
Q

What heart valve pathology is best heard with the patient sat up, leaning forward and holding exhalation? (1)

A

Aortic regurgitation

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8
Q

What examination findings suggest accelerated (or malignant) hypertension in a patient with a blood pressure above 180/120? (2)

A

Retinal haemorrhages
Papilloedema

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9
Q

What criteria are used for diagnosing infective endocarditis? (1)

A

Modified Duke criteria

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10
Q

What imaging is used for investigating infective endocarditis? (1)

A

Transoesophageal echocardiography (TOE)

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11
Q

What surgical options are available to treat angina? (2)

A

1) PCI
2) CABG

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12
Q

What follow-up blood tests should be arranged after starting statins? (2) When? (1)

A

LFTs & lipid profile

3 months after starting

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13
Q

What valve pathology can cause left ventricular dilatation? (1)

A

Aortic regurgitation

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14
Q

What does the term bigeminy describe on an ECG? (1)

A

When every other beat is a ventricular ectopic

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15
Q

What is the name for the tender red/purple nodules on the pads of the fingers and toes seen in patients with infective endocarditis? (1)

A

Osler’s nodes

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16
Q

What medical emergency may occur as a complication of pericarditis? (1)

What is the initial treatment? (1)

A

Cardiac tamponade

Pericardiocentesis

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17
Q

What ECG changes suggest a STEMI? (2)

A

1) ST segment elevation
2) New LBBB

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18
Q

How should cultures be performed before starting antibiotics in patients with infective endocarditis? (3)

A

1) 3 blood culture samples

2) Separated by at least 6 hours

3) Taken from different sites

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19
Q

What procedure may be used in patients with severe aortic stenosis who are at high risk for open surgery? (1)

A

Transcatheter aortic valve implantation (TAVI)

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20
Q

What is the name for the extra electrical pathway in Wolff-Parkinson-White syndrome? (1)

A

Bundle of Kent

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21
Q

What are the ECG findings in atrial fibrillation? (3)

A

1) absent P waves

2) irregularly irregular

3) narrow QRS complex tachycardia

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22
Q

What is the next step for terminating an episode of supraventricular tachycardia when medication options fail? (1)

A

Synchronised DC cardioversion

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23
Q

What blood pressure abnormality is found in aortic stenosis? (1)

A

Narrow pulse pressure (reduced difference between systolic and diastolic BP)

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24
Q

What is the name for haemorrhages on the retina seen during fundoscopy in patients with infective endocarditis? (1)

A

Roth spots

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25
Q

What are the features of the murmur caused by mitral stenosis? (2)

A

1) Mid-diastolic

2) Low pitched ‘rumbling’

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26
Q

Which class of medication may be used to improve cardiac output in patients with acute left ventricular failure after optimising the fluid status? (1)

A

Inotropes e.g. dobutamine

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27
Q

What short-term intervention may be used in unstable patients with bradycardia? (1)

What are the options for delivering this intervention? (2)

A

Temporary cardiac pacing:
1) Transcutaneous
2) Transvenous

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28
Q

What chest x-ray findings may be seen in acute left ventricular failure? (5)

A

1) Cardiomegaly

2) Upper lobe venous diversion

3) Bilateral pleural effusions

4) Fluid in interlobar fissures

5) Fluid in the septal lines (Kerley lines)

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29
Q

Which patients are offered statins for primary prevention without calculating the QRISK3 score? (2)

A

1) CKD

2) T1DM for >10 years or aged >40

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30
Q

When can supraventricular tachycardia cause a broad complex tachycardia? (1)

A

If patient also has a BBB

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31
Q

What murmur may be heard in hypertrophic obstructive cardiomyopathy? (1)

Where is it heard loudest? (1)

A

Ejection systolic

Left lower sternal border

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32
Q

What scoring system is used to assess the severity of liver cirrhosis?

A

Child-Pugh

33
Q

What scoring system is used to assesses severity of depression symptoms?

A

PHQ-9

34
Q

What scoring system is used in the assessment of suspected obstructive sleep apnoea?

A

Epworth sleepiness scale

35
Q

What scoring system is used to help assess the whether induction of labour will be required?

A

Bishop score

36
Q

What scoring system is used to screen for malnutrition?

A

MUST score

37
Q

What is Buerger’s disease also known as?

A

Thromboangiitis obliterans

38
Q

What criteria is used for definitive diagnosis of infective endocarditis?

A

Duke criteria

39
Q

What are the 3 criteria of stable angina?

A

1) constricting discomfort in the front of the chest, or in the neck, shoulders, jaw or arms
2) precipitated by physical exertion
3) relieved by rest or GTN in about 5 minutes

40
Q

Typical vs atypical angina?

A

Typical –> patients have all 3 features

Atypical –> patients have 2/3 features

41
Q

What can be used for rate control in AF if beta blockers are contraindicated?

A

CCBs e.g. diltiazem

42
Q

What does P mitrale on an ECG represent?

A

Left atrial hypertrophy e.g. in mitral stenosis

43
Q

What is P mitrale?

A

A bifid P wave –> this is because the enlarged LA now makes a greater contribution to the P wave contour.

44
Q

What is the commonest cause of P mitrale on an ECG?

A

Mitral stenosis

45
Q

1st line & 2nd line therapy in HF?

A

1st –> ACEi & beta blocker

2nd –> aldosterone antagonist +/- SGLT-2 inhibitor e.g. dapagliflozin

46
Q

What is Quincke’s sign?

A

Nailbed pulsation

47
Q

What cardiac defect is Quincke’s sign a clinical sign of?

A

Aortic regurgitation

48
Q

Management of warfarin with INR 5-8 but no bleeding?

A

Withold 1 or 2 doses, reduce subsequent maintenance dose.

49
Q

What is the most common cause of mitral stenosis?

A

Rheumatic fever

50
Q

How do ALS guidelines change in cases of hypothermia causing cardiac arrest?

A

In cases of hypothermia causing cardiac arrest, defibrillation is LESS effective.

Only 3 shocks should be administered before the patient is rewarmed to 30 degrees.

51
Q

What does 1st line management of acute pericarditis involve?

A

NSAIDs + colchicine

52
Q

When should beta blockers be stopped in acute HF? (3)

A

1) HR <50/min

2) 2nd degree AV block

3) 3rd degree AV block

4) Shock

53
Q

What drug is the usual pill-in-the-pocket treatment for paroxysmal atrial fibrillation? (1)

A

Flecainide

54
Q

What is the usual initial medication used to terminate an episode of supraventricular tachycardia? (1)

How is it given? (2)

What doses? (3)

A

Adenosine

Given as a rapid IV bolus into a large proximal cannula

6mg, then 12mg, then 18mg.

55
Q

What are the causes of mitral regurgitation? (5)

A

1) Post-MI (papillary muscle rupture) i.e. IHD

2) Rheumatic heart disease

3) Infective endocarditis

4) Age-related weakness

5) Connective tissue disorders e.g. Marfans, Ehlers-Danlos

56
Q

When would clopidogrel be the first-line antiplatelet for secondary prevention? (2)

A

1) Peripheral arterial disease
2) Ischaemic stroke

57
Q

What are the causes of aortic regurgitation? (3)

A

1) Idiopathic age-related weakness
2) Bicuspid aortic valve
3) Connective tissue disorders e.g. Marfans, Ehlers-Danlos

58
Q

What are the features on auscultation with tricuspid regurgitation? (2)

A

1) Pansystolic murmur
2) Split 2nd heart sound

59
Q

At what point is the QT interval considered prolonged in men and women?

A

Women: >460ms

Men: >440ms

60
Q

What valve pathology can cause left atrial dilatation? (1)

A

Mitral regurgitation

61
Q

What is the most common long-term combination of medications for atrial fibrillation? (2)

A

Beta blocker + DOAC

62
Q

What investigation options are available to help support a diagnosis of angina? (3)

A

1) Cardiac stress testing
2) CT coronary angiography
3) Invasive coronary angiography

63
Q

What medications are avoided with hypertrophic obstructive cardiomyopathy? (2)

A

1) ACEi
2) Nitrates

64
Q

What JVP findings may be seen with pulmonary stenosis? (2)

A

Raised JVP
Giant A waves

65
Q

Other than blood tests, what baseline investigations are required in patients with a new diagnosis of hypertension? (3)

A

1) Urine albumin:creatinine ratio for proteinuria

2) Dipstick for microscopic haematuria

3) ECG

66
Q

What are the causes of aortic stenosis? (3)

A

1) Age-related calcification
2) Bicuspid valve
3) Rheumatic heart disease

67
Q

Give four rare but significant side effects of statins. (4)

A

Myopathy
Rhabdomyolysis
T2DM
Haemorrhagic stroke

68
Q

What medication may be used longer-term (e.g., 3 months) in patients with pericarditis to reduce the risk of recurrence? (1)

A

Colchicine

69
Q

What is the only CCB licensed for use in HF?

A

Amlodipine

70
Q

What drugs used in IBD are associated with acute pancreatitis?

A

5-ASAs

Mesalazine is worse than sulfasalazine

71
Q

Mx of AAA <4.5cm?

A

12 monthly US assessment

72
Q

Mx of AAA 4.5-5.4cm?

A

3 monthly US assessment

73
Q

Mx of AAA ≥5.5cm?

A

Urgent surgical referral to vascular surgery (2ww)

74
Q

Mx of rapidly enlarging AAA of any size?

A

Ugent referral for endovascular repair (2ww)

75
Q

What Abx can increase the risk of idiopathic intracranial hypertension?

A

Tetracyclines

76
Q

How can 1ary and 2ary aldosteronism be differentiated?

A

By looking at the renin levels

High –> 2ary cause e.g. renal artery stenosis

Low –> 1ary cause

77
Q

In what 3 situations is rhythm control indicated > rate control in AF?

A

1) co-existent HF

2) first onset HF

3) obvious reversible cause e.g. pneumonia

78
Q

When is cardiac resynchronisation therapy (CRT) indicated in HF?

A

If not responding to triple therapy –> ACEi + beta blocker + aldosterone antagonist

79
Q
A

Yr 4 - CCC (53 decks)

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