Corrections Cardiology 2 Flashcards
What are the major complications of mechanical heart valves? (3)
1) Thrombus formation
2) Infective endocarditis
3) Haemolytic anaemia
What are the secondary causes of hypertension? (5)
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
What are the ECG changes in Wolff-Parkinson-White syndrome? (3)
1) Delta wave (slurred upstroke on QRS)
2) Short PR interval (<0.12 seconds)
3) Widened QRS complex (>0.12 seconds)
How much fluid is normally contained within the pericardial sac? (1)
<50 mls
What condition causes angina-like chest pain without the presence of coronary artery disease when investigated with angiograms? (1)
Cardiac syndrome X
What causes individual, random, abnormal, broad QRS complexes on an otherwise normal ECG? (1)
Ventricular ectopics
What heart valve pathology is best heard with the patient sat up, leaning forward and holding exhalation? (1)
Aortic regurgitation
What examination findings suggest accelerated (or malignant) hypertension in a patient with a blood pressure above 180/120? (2)
Retinal haemorrhages
Papilloedema
What criteria are used for diagnosing infective endocarditis? (1)
Modified Duke criteria
What imaging is used for investigating infective endocarditis? (1)
Transoesophageal echocardiography (TOE)
What surgical options are available to treat angina? (2)
1) PCI
2) CABG
What follow-up blood tests should be arranged after starting statins? (2) When? (1)
LFTs & lipid profile
3 months after starting
What valve pathology can cause left ventricular dilatation? (1)
Aortic regurgitation
What does the term bigeminy describe on an ECG? (1)
When every other beat is a ventricular ectopic
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)
Osler’s nodes
What medical emergency may occur as a complication of pericarditis? (1)
What is the initial treatment? (1)
Cardiac tamponade
Pericardiocentesis
What ECG changes suggest a STEMI? (2)
1) ST segment elevation
2) New LBBB
How should cultures be performed before starting antibiotics in patients with infective endocarditis? (3)
1) 3 blood culture samples
2) Separated by at least 6 hours
3) Taken from different sites
What procedure may be used in patients with severe aortic stenosis who are at high risk for open surgery? (1)
Transcatheter aortic valve implantation (TAVI)
What is the name for the extra electrical pathway in Wolff-Parkinson-White syndrome? (1)
Bundle of Kent
What are the ECG findings in atrial fibrillation? (3)
1) absent P waves
2) irregularly irregular
3) narrow QRS complex tachycardia
What is the next step for terminating an episode of supraventricular tachycardia when medication options fail? (1)
Synchronised DC cardioversion
What blood pressure abnormality is found in aortic stenosis? (1)
Narrow pulse pressure (reduced difference between systolic and diastolic BP)
What is the name for haemorrhages on the retina seen during fundoscopy in patients with infective endocarditis? (1)
Roth spots
What are the features of the murmur caused by mitral stenosis? (2)
1) Mid-diastolic
2) Low pitched ‘rumbling’
Which class of medication may be used to improve cardiac output in patients with acute left ventricular failure after optimising the fluid status? (1)
Inotropes e.g. dobutamine
What short-term intervention may be used in unstable patients with bradycardia? (1)
What are the options for delivering this intervention? (2)
Temporary cardiac pacing:
1) Transcutaneous
2) Transvenous
What chest x-ray findings may be seen in acute left ventricular failure? (5)
1) Cardiomegaly
2) Upper lobe venous diversion
3) Bilateral pleural effusions
4) Fluid in interlobar fissures
5) Fluid in the septal lines (Kerley lines)
Which patients are offered statins for primary prevention without calculating the QRISK3 score? (2)
1) CKD
2) T1DM for >10 years or aged >40
When can supraventricular tachycardia cause a broad complex tachycardia? (1)
If patient also has a BBB
What murmur may be heard in hypertrophic obstructive cardiomyopathy? (1)
Where is it heard loudest? (1)
Ejection systolic
Left lower sternal border
What scoring system is used to assess the severity of liver cirrhosis?
Child-Pugh
What scoring system is used to assesses severity of depression symptoms?
PHQ-9
What scoring system is used in the assessment of suspected obstructive sleep apnoea?
Epworth sleepiness scale
What scoring system is used to help assess the whether induction of labour will be required?
Bishop score
What scoring system is used to screen for malnutrition?
MUST score
What is Buerger’s disease also known as?
Thromboangiitis obliterans
What criteria is used for definitive diagnosis of infective endocarditis?
Duke criteria
What are the 3 criteria of stable angina?
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
Typical vs atypical angina?
Typical –> patients have all 3 features
Atypical –> patients have 2/3 features
What can be used for rate control in AF if beta blockers are contraindicated?
CCBs e.g. diltiazem
What does P mitrale on an ECG represent?
Left atrial hypertrophy e.g. in mitral stenosis
What is P mitrale?
A bifid P wave –> this is because the enlarged LA now makes a greater contribution to the P wave contour.
What is the commonest cause of P mitrale on an ECG?
Mitral stenosis
1st line & 2nd line therapy in HF?
1st –> ACEi & beta blocker
2nd –> aldosterone antagonist +/- SGLT-2 inhibitor e.g. dapagliflozin
What is Quincke’s sign?
Nailbed pulsation
What cardiac defect is Quincke’s sign a clinical sign of?
Aortic regurgitation
Management of warfarin with INR 5-8 but no bleeding?
Withold 1 or 2 doses, reduce subsequent maintenance dose.
What is the most common cause of mitral stenosis?
Rheumatic fever
How do ALS guidelines change in cases of hypothermia causing cardiac arrest?
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.
What does 1st line management of acute pericarditis involve?
NSAIDs + colchicine
When should beta blockers be stopped in acute HF? (3)
1) HR <50/min
2) 2nd degree AV block
3) 3rd degree AV block
4) Shock
What drug is the usual pill-in-the-pocket treatment for paroxysmal atrial fibrillation? (1)
Flecainide
What is the usual initial medication used to terminate an episode of supraventricular tachycardia? (1)
How is it given? (2)
What doses? (3)
Adenosine
Given as a rapid IV bolus into a large proximal cannula
6mg, then 12mg, then 18mg.
What are the causes of mitral regurgitation? (5)
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
When would clopidogrel be the first-line antiplatelet for secondary prevention? (2)
1) Peripheral arterial disease
2) Ischaemic stroke
What are the causes of aortic regurgitation? (3)
1) Idiopathic age-related weakness
2) Bicuspid aortic valve
3) Connective tissue disorders e.g. Marfans, Ehlers-Danlos
What are the features on auscultation with tricuspid regurgitation? (2)
1) Pansystolic murmur
2) Split 2nd heart sound
At what point is the QT interval considered prolonged in men and women?
Women: >460ms
Men: >440ms
What valve pathology can cause left atrial dilatation? (1)
Mitral regurgitation
What is the most common long-term combination of medications for atrial fibrillation? (2)
Beta blocker + DOAC
What investigation options are available to help support a diagnosis of angina? (3)
1) Cardiac stress testing
2) CT coronary angiography
3) Invasive coronary angiography
What medications are avoided with hypertrophic obstructive cardiomyopathy? (2)
1) ACEi
2) Nitrates
What JVP findings may be seen with pulmonary stenosis? (2)
Raised JVP
Giant A waves
Other than blood tests, what baseline investigations are required in patients with a new diagnosis of hypertension? (3)
1) Urine albumin:creatinine ratio for proteinuria
2) Dipstick for microscopic haematuria
3) ECG
What are the causes of aortic stenosis? (3)
1) Age-related calcification
2) Bicuspid valve
3) Rheumatic heart disease
Give four rare but significant side effects of statins. (4)
Myopathy
Rhabdomyolysis
T2DM
Haemorrhagic stroke
What medication may be used longer-term (e.g., 3 months) in patients with pericarditis to reduce the risk of recurrence? (1)
Colchicine
What is the only CCB licensed for use in HF?
Amlodipine
What drugs used in IBD are associated with acute pancreatitis?
5-ASAs
Mesalazine is worse than sulfasalazine
Mx of AAA <4.5cm?
12 monthly US assessment
Mx of AAA 4.5-5.4cm?
3 monthly US assessment
Mx of AAA ≥5.5cm?
Urgent surgical referral to vascular surgery (2ww)
Mx of rapidly enlarging AAA of any size?
Ugent referral for endovascular repair (2ww)
What Abx can increase the risk of idiopathic intracranial hypertension?
Tetracyclines
How can 1ary and 2ary aldosteronism be differentiated?
By looking at the renin levels
High –> 2ary cause e.g. renal artery stenosis
Low –> 1ary cause
In what 3 situations is rhythm control indicated > rate control in AF?
1) co-existent HF
2) first onset HF
3) obvious reversible cause e.g. pneumonia
When is cardiac resynchronisation therapy (CRT) indicated in HF?
If not responding to triple therapy –> ACEi + beta blocker + aldosterone antagonist
