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Yr 4 - ACC > Corrections - Cardiology pt 3 > Flashcards

Corrections - Cardiology pt 3 Flashcards

1
Q

What is Takayasu’s arteritis?

A

A large vessel vasculitis that primarily affects the aorta and its main branches.

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2
Q

Who is Takayasu’s arteritis more common in?

A

Younger gemales (10-40 y/o) and Asian people.

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3
Q

Features of Takayasu’s arteritis?

A
  • systemic features of vasculitis e.g. malaise, headache
  • unequal BP in upper limbs
  • carotid bruit and tenderness
  • absent or weak peripheral pulses
  • aortic regurg (20%)
  • upper and lower limb claudication on exertion
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4
Q

In patients with CKD, what potassium level should prompt the cessation of ACEi (once other agents that promote hyperkalaemia have been stopped)?

A

> 6 mmol/L

Swap for another antihypertensive

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5
Q

What is Takotsubo cardiomyopathy?

A

Also known as ‘broken heart syndrome’.

A cardiomyopathy induced by severe stressful triggers e.g. emotional upset in bereavement.

More common in women.

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6
Q

How can loop diuretics affect K+?

A

Hypokalaemia

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7
Q

What class of medication is bumetanide?

A

Loop diuretic

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8
Q

What are the lateral ECG leads?

A

I, aVL and V6

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9
Q

What are the posterior ECG leads?

A

V1-V3

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10
Q

What is a bisferiens pulse?

A

A double pulse

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11
Q

What cardiac condition is associated with a bisferiens pulse?

A

HOCM

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12
Q

What are the 3 key features of autonomic neuropathy?

A

1) Postural hypotension

2) Loss of respiratory arrhythmia

3) Erectile dysfunction

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13
Q

What heart sound does HOCM classically cause?

A

S4

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14
Q

Following an ACS, what should all patients be offered?

A

ACEi
Beta blocker
Statin
Dual antiplatelet (aspirin + one other)

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15
Q

Reversal agent of dabigatran?

A

Idarucizumab

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16
Q

What can be offered to patients with HF with reduced EF who continue to have symptoms (if they are already taking ACEi/ARB)?

A

Mineralocorticoid receptor antagonist e.g. spironolactone, eplerenone

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17
Q

What is a 3rd heart sound (S3) often associated with?

A

Conditions that lead to rapid filling on the ventricles e.g. dilated cardiomyopathy

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18
Q

How does dilated cardiomyopathy cause a 3rd heart sound?

A

This condition is characterised by dilation and impaired contraction of the L or both ventricles.

Increased volume load leads to rapid early diastolic filling, causing an audible S3.

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19
Q

How does warfarin interact with fluconazole?

A

Fluconazole results in an increased in INR when taken wtih warfarin.

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20
Q

Which macrolides interact with warfarin (and raise INR)?

A

Erythromycin & clarithromycin

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21
Q

What should an inferior MI and aortic regurgitation murmur raise suspicions of?

A

Proximal (ascending) aortic dissection.

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22
Q

What ECG changes can be seen in an aortic dissection?

A

The majority of patients have no or non-specific ECG changes.

In a minority of patients, ST-segment elevation may be seen in the inferior leads (II, III, aVF).

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23
Q

What is Hypertrophic obstructive cardiomyopathy (HOCM)?

A

An autosomal dominant disorder of muscle tissue caused by defects in the genes encoding contractile proteins.

This is the most common cause of sudden cardiac death in the young.

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24
Q

Pathophysiology in HOCM?

A

1) defects involve a mutation in the gene encoding β-myosin heavy chain protein or myosin-binding protein C

2) results in predominantly diastolic dysfunction

3) left ventricle hypertrophy → decreased compliance → decreased cardiac output

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25
Q

Features of HOCM?

A
  • often asymptomatic
  • exertional dyspnoea
  • angina
  • syncope (typically following exercise)
  • sudden death (most commonly due to ventricular arrhythmias), arrhythmias, heart failure
  • jerky pulse, large ‘a’ waves, double apex beat
    systolic murmurs
  • ejection systolic murmur
  • pansystolic murmur
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26
Q

What does syncope typically follow in HOCM?

A

Exercise

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27
Q

Cause of syncope in HOCM?

A

Due to subaortic hypertrophy of the ventricular septum, resulting in functional aortic stenosis

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28
Q

What is sudden death most commonly due to in HOCM?

A

Ventricular arrythmias

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29
Q

What 2 murmurs are seen in HOCM?

A

1) ejection systolic murmur

2) pansystolic murmur

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30
Q

Management of major bleeding (i.e. intracranial haemorrhage) in patients on warfarin?

A

1) Stop warfarin

2) IV vitamin K 5mg

3) PCC (if not available then FFP)

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31
Q

An atrial septal defect can allow a ‘paradoxical stroke’.

What is this?

A

Where an embolism from peripheral veins may bypass the pulmonary circulation and lodge in the systemic circulation.

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32
Q

Does the murmur is tricuspid regurgitation become louder on inspiration or expiration?

A

Tricuspid regurgitation –> louder on inspiration (as blood flow into RA and RV are increased during inspiration)

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33
Q

Mneumoic for murmurs –> RILE

A

Right Inspiration Left Expiration

Right sided mumurs (tricuspid/pulmonary) tend to be heard better on inspiration.

Left sided murmurs (mitral/aortic) tend to be heard better on expiration.

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34
Q

Management of rheumatic fever?

A

One off dose of IV benzylpenicillin

If refused –> course of oral penicillin V

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35
Q

What condition does a recent sore throat + rash + arthritis indicate?

A

Rheumatic fever

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36
Q

What is used 1st line to prevent angina attacks?

A

Beta blocker or CCB (note - diltiazem or verapamil if CCB is monotherapy)

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37
Q

What condition may it indicate if a patient has an acute significant drop in renal function after starting an ACEi?

A

Bilateral renal artery stenosis

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38
Q

Infective endocarditis in IVDU most commonly affects which valve?

A

Tricuspid

39
Q

Mechanism of alteplase?

A

Activates plasminogen to form plasmin

40
Q

In ALS, what can be used instead of amiodarone?

A

Lidocaine

41
Q

What is an alternative treatment to atropine/transcutaneous pacing for symptomatic bradycardia?

A

Isoprenaline/adrenaline infusion

42
Q

Murmur heard in aortic regurgitation?

A

Early diastolic

43
Q

Which diuretic can worsen glucose tolerance?

A

Thiazide-like diuretics e.g. indapamide

44
Q

How is the QT interval measured on an ECG?

A

Time between start of Q wave and end of T wave

45
Q

What condition is most associated with pulsus paradoxus?

A

Cardiac tamponade

46
Q

What is pulsus paradoxus?

A

Refers to an exaggerated fall in a patient’s blood pressure during inspiration by greater than 10 mm Hg.

47
Q

What score is used to help identify patients with a PE that can be managed as outpatients?

A

PESI score (PE severity score)

48
Q

What makes an ejection systolic murmur associated with aortic stenosis quieter?

A

LV systolic dysfunction –> results in a decreased flow rate across the aortic valve (and hence a quieter murmur).

49
Q

What does the presence of an S3 heart sound indicate?

A

LVF - suggests the LV is larger than normal (S3 represents the sloshing of blood into a large ventricle during diastole).

50
Q

What does the presence of an S4 heart sound indicate?

A

Suggests that the LV is stiffer than normal (as S4 represents the forceful atrial push of blood against a hard ventricular wall).

51
Q

What class of medication is contraindicated in aortic stenosis?

A

Nitrates (due to the theoretical risk of profound hypotension).

52
Q

What is the appropriate management of coarctation of the aorta in neonates?

A

1) give prostaglandins to maintain a patent ductus arteriosus

2) corrective surgery

53
Q

If thrombolytic drugs (e.g. alteplase) are given during ALS, how long should CPR be continued for?

A

A prolonged period of CPR should be considered e.g. 60-90 mins

54
Q

What is a dermatological side effect of warfarin?

A

Skin necrosis

55
Q

Following a TIA, when should anticoagulation for AF be started?

A

Immediately once imaging has excluded haemorrhage

56
Q

When should beta blockers be stopped in acute HF?

A

If patient has HR <50/min, 2nd or 3rd degree AV block, or shock.

57
Q

In AF, if a CHA2DS2-VASc score suggests no need for anticoagulation, what investigation should be done?

A

Transthoracic echocardiography (TTE) –> to exclude valvular heart disease.

58
Q

What is an echo indicated in AF if the CHA2DS2-VASc score suggests no need for anticoagulation?

A

As if there is an underlying valvular heart disease (particularly mitral stenosis) that leads to AF, anticoagulation becomes imperative.

59
Q

In ventricular fibrillation, what should be administered after the 3rd shock has been given?

A

Adrenaline & amiodarone

Adrenaline 1mg IV after the 3rd shock (while CPR is ongoing to minimise any interruptions).

Amiodarone loading dose 300mg IV after the 3rd shock.

60
Q

When is adrenaline given in shockable vs non-shockable rhythms?

A

Shockable - after 3rd shock

Non-shockalbe - as soon as IV access is obtained

61
Q

How often can amiodarone & adrenaline be given in VF?

A

Given after the 3rd shock, then given every 2 cycles (e.g. given again after 5th shock).

62
Q

If a patient’s monitoring changes from VF to organised electrical activity, what is the next immediate step?

A

Assess carotid pulse - to establish if spontaneous circulation has returned.

If returned - start post-resus care.

63
Q

For patients with infective endocarditis 2ary to Viridans streptococci e.g. Streptococcus sanguinis, what investigation is required next?

A

Dental review: viridans group streptococci are commensal in the mouth and invasive infection is associated with dental disease.

64
Q

TIA is now tissue based not time based.

What does this mean?

A

A TIA is a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction

65
Q

What is 2ary prevention following ischaemic stroke caused by AF?

A

Warfarin or DOAC

66
Q

What is the first-line treatment for regular broad complex tachycardias without adverse features?

A

IV amiodarone

67
Q

What condition does a regular broad complex tachycardia typically indicate?

A

VT

68
Q

What medication is contraindicated in ventricular tachycardia (broad regular tachycardia)?

A

Verapamil

This is because VT causes the cardiac output to reduce dramatically.

As a CCB, verapamil can reduce the contractility of the heart even further, possibly resulting in death.

69
Q

In the context of a tachyarrhythmia, what systolic BP indicates the need for synchronised DC cardioversion?

A

<90 mmHg

70
Q

What is the management of a beta blocker overdose?

A

Glucagon

71
Q

Post-MI management?

A

1) Aspirin 75mg daily + 2nd antiplatelet e.g. clopidogrel 75mg

2) Beta blocker

3) ACEi

4) High dose statin e.g 80mg atorvastatin

72
Q

Which 2 arteries supply the lateral wall of the left ventricle?

A

Circumflex & LAD

73
Q

What is the mechanism of action of amiodarone?

A

Class III antiarrhythmic (potassium channel blocker) –> prolongs the refractory period

74
Q

Management of torsades de pointes in haemodynamically stable patients?

A

IV magnesium sulphate

75
Q

What are the examination findings in patients with ventricular septal defect post-MI? (3)

A

1) Harsh loud pansystolic murmur along left sternal border.

2) Palpable parasternal thrill.

3) Features associated with low cardiac output.

76
Q

Management of Atrial fibrillation with onset >48 hours with DC cardioversion? (2)

A

1) Patient must be anticoagulated for 28 days before DC cardioversion can be done.

2) Alternatively, the patient can have a transoesophageal ECHO to rule out a thrombus in the left atrial appendage before cardioversion.

77
Q

Purpose of a transoesophageal ECHO in AF?

A

To rule out a thrombus in the left atrial appendage before cardioversion.

78
Q

Which antibiotics are associated with prolongation of the QT interval? (3)

A

1) Macrolides

2) Quinine

3) Hydroxychloroquine

79
Q

What is the next step in management if a transoesophageal echo shows a left atrial thrombus in a patient with new-onset AF?

A

Rate control, LMWH and load on warfarin which should be continued for 3-4 weeks before cardioversion is attempted.

80
Q

Which group of patients are more suitable for rate control in AF?

A

Rate control is more suitable in elderly patients (>70 years) and those who are more prone to drug interactions and the pro-arrhythmic effects of anti-arrhythmic therapy.

81
Q

What is the gold-standard investigation for myocarditis?

A

Endomyocardial biopsy

82
Q

Which sign on ECG may indicate left atrial enlargement?

A

P-mitrale

83
Q

What is LA enlargement typically 2ary to?

A

Mitral stensois

84
Q

Management of myocarditis?

A

Generally supportive involves treating the underlying cause and any complications such as arrhythmias or heart failure.

85
Q

What are patients with acute myocarditis advised to avoid?

A

Strenuous exercise in all forms for several months

86
Q

How is atrial fibrillation with onset >48 hours typically treated if there signs of heart failure?

A

Digoxin

87
Q

Give 4 causes of acute aortic regurgitation involving a native aortic valve

A

1) Infective endocarditis, with valve destruction and leaflet perforation

2) Aortic dissection, can rupture into the LV

3) Aortic dissection

4) Traumatic rupture of the valve leaflets e.g. blunt chest trauma

88
Q

Which 3 beta blockers are licensed for use in chronic heart failure?

A

Bisoprolol
Metoprolol
Carvedilol

89
Q

What is the first-line investigation for cardiac myxoma?

A

ECHO

90
Q

What are the two main procedures used to treat aortic stenosis?

A

1) Transcatheter aortic valve implantation (TAVI)

2) Surgical aortic valve replacement (SAVR)

91
Q

When should patients undergo carotid endarterectomy?

A

If there is carotid artery stenosis of >70% with symptoms in the corresponding vascular territory.

92
Q

What is respiratory arrhythmia?

A

It occurs when a person’s heart rate relates to their breathing cycle.

When the person breathes in, their heart rate increases, and when they breathe out, the rate decreases.

93
Q
A

Yr 4 - ACC (73 decks)

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