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FCM > CVS > Flashcards

CVS Flashcards

1
Q 
Hypotension 
Muffled heart sound 
raised JVP 
tachycardia 
dyspnoea
A

Cardiac tamponade

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2
Q

ECG = electrical alternans

A

cardiac tamponade

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3
Q

Management of Cardiac tamponade

A

Urgent pericardiocentesis

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4
Q 
splinter haemorrhages 
roth spots 
janeway lesions 
new murmur (regurg)
osler's nodes 
fever
A

Infective endocarditis

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5
Q

RFs for infective endocarditis

A

valvular disease
prosthetic valve
IV drug use

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6
Q

diagnostic investigations for infective endocarditis:

A

multiple +ve blood cultures (staph aureus) and ECHO (check valves)

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7
Q

management for infective endocarditis:

A

penicillin amocillin and gentamicin

penicillin allergy/severe case = + vancomycin
HF signs - urgent valve replacement/surgery

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8
Q 
severe tearing chest pain - sometime radiation of pain to back 
pulse deficit/wide pulse pressure 
aortic regurg
dyspnoea 
hypotension

widened mediastinum, false lumen on CT CAP/TOE

A

Aortic dissection

ascending/type A = radiate to thoracic region

descending type B = radiates to back

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9
Q

type A aortic dissection mx

A

surgical repair and IV labetalol (aim for SBP - 100-120mmHg)

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10
Q

Type B aortic dissection mx

A

IV labetalol
bed rest
analgesia

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11
Q

ejection systolic (crescendo-decrescendo) murmur radiating to carotids

A

aortic stenosis

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12
Q 
early diastolic (decrescendo) murmur 
de mussets = head bobbing 
de quincke's = nailbed pulsation
A

aortic regurgitation

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13
Q

dizziness, less exercise tolerance/dyspnoea, palpitations,
irregularly irregular pulse
absent p waves

A

Atrial fibrillation

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14
Q

management of Atrial fibrillation

A 
<48hr = heparin and cardiovert
>48hr = anticoagulate (DOAC) for 3wks and cardiovert 
CHA2DS2VASC = 2+ = anticoagulate 
ORBIT score 
0-2 - low risk 
3 - medium risk 
4-7 - high risk

rate control of initiated if presentation>48hrs = beta blocker/diltiazem/verapamil

anticoagulation with DOACs
warfarin second line

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15
Q

palpitations, dyspnoea, fatigue, syncope, SOB
ventricular rate above 300/min/very tachycardic
sawtooth appearance on ECG

A

Atrial flutter

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16
Q

management of Atrial flutter

A

cardiovert

radiofrequency ablation of tricuspid valve

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17
Q

ejection systolic murmur + split S2, louder on inspiration
heard in the left sternal edge
Acyanotic
symptomatic in adulthood

A

atrial septal defect

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18
Q

what is the management of ASD

A

surgery

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19
Q 
mid-late diastolic murmur, loud S1 and opening snap 
best on expiration 
rheumatic fever hx 
malar flush 
atrial fibrillation
A

mitral stenosis

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20
Q

pansystolic ‘blowing’ murmur, best @ apec and radiates to axilla
marfans/ehlers-danhlos hx

A

mitral regurgitation

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21
Q 
erythema marginatum 
subcuatneous nodules
fever 
polyarthritis 
carditis/valvulitis = chest pain, SOB, regurg murmur 
chorea 
hx or sore throat a couple week back
A

acute rheumatic fever

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22
Q

diagnose rheumatic fever

A

+ve throat swabs
raised ESR/CRP
ASO titre
ECHO = HF signs

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23
Q

management of acute rheumatic fever

A

oral penicillin V + NSAIDs

treat HF

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24
Q

usually asymptomatic

may present with headaches, visual changes or palpitations in severe cases

A

hypertension

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25
Q

HTN diagnosis and checks

A

a clinic reading persistently above >= 140/90 mmHg, or:

a 24 hour blood pressure average reading >= 135/85 mmHg

fundoscopy: to check for hypertensive retinopathy

urine dipstick: to check for renal disease, either as a cause or consequence of hypertension

ECG: to check for left ventricular hypertrophy or ischaemic heart disease

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26
Q 
breathlessness, oedema, 
reduced exercise tolerance/fatigue
raised JVP
displaced apex beat 
bibasal crackles
A

acute heart failure

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27
Q 
dyspnoea 
cough (frothy sputum)
orthopnoea
PND 
weight loss 
bibasal crackles 
ankle oedema 
raised JVP 
hepatomegaly
A

chronic heart failure

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28
Q

heart failure Ix

A 
CXR = cardiomegaly and interstitial oedema 
BNP = >100mg/L
ECHO = pericardial effusion - definitive
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29
Q

management of heart failure

A

first line = ACEi + Beta blocker

second line = spironolactone

specialist care with hydralazine and ivabradine, nitrates and digoxin

offer annual influenza vaccine
offer pneumococcal vaccine every 5 years

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30
Q

heavy constricting chest pain
relieved by rest or GTN spray
~10-15mins

A

Stable angina

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31
Q

Management of stable angina

A

beta-blocker or CCB (verapamil/diltiazem)

long acting nitrate if not controlled with adjunct tx Ivabradine, nicorandil or ranolazine if contraindicated - third drug only added if awaiting pci/cabg

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32
Q

chest pain typically at rest
very short lived
radiated to the back
SOB

transient ST elevation in ECG

A

prinzmetal angina

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33
Q

management of prinzmetal angina

A

CCB - reduce no, of spasms

GTN fo symptomatic relief

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34
Q

heavy constricting chest pain
radiation to left arm, jaw, or neck
not releievd by rest/GTN

A

unstable angina

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35
Q

management of unstable angina

A

unstable angina - no ECG changes and no trop raise

aspirin + ticagrelor and fondaparinux

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36
Q 
central/left-sided chest pain, heavy and constricting 
radiation to the left jaw, neck and arm 
dyspnoea 
sweating
palpitations
A

Acute myocardial infarction

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37
Q

Initial management of acute MI

A
  1. 300mg Aspirin
  2. Oxygen - if O2 stats are <94%
  3. Morphine IV for pain
  4. Nitrates - IV or sublingual

STEMI = need to have PCI done - if not available with 120mins/2hrs then start fibrinolysis

NSTEMI = fondaparinux and GRACE assessment
high risk - PCI within 72hrs (have patient on ticagrelor and heparin)
low risk - ticagrelor

38
Q

differentiate between first and second degree heart block

A

First degree = PR interval is >0.20s (usually asymptomatic)
delayed conduction

Second degree
type 1 = progressive prolongation of the PR interval till the missed beat
type 2 = constant PR interval till a missed beat

39
Q 
syncope 
heart failure 
regular bradycardia 
wide pulse pressure 
variable intensity of S1

ECG = no association of P and Q waves

A

3 degree heart block

40
Q

heart failure in infancy / low birth weight
HTN in adults

radio-femoral delay
mid-systolic murmur (more over back)
notching of the border of the ribs in young children

link to Turner’s syndrome
more common in males

A

coarctation of the aorta

41
Q

Definitive Ix for coarctation of the aorta

A

ECHO

ECG &CXR are the other

42
Q

management of coarctation of the aorta

A

treat any resulting heart failure, HTN symptoms

Ultimately surgery is required to repair narrowing

43
Q 
classic HF findings 
systolic murmur (mitral/tricuspid regurg)
S3 heart sound 
systolic dysfunction
A

Dilated cardiomyopathy

44
Q

Investigation for dilated cardiomyopathy

A

CXR = balloon appearance

45
Q

managment of dilated cardiomyopathy

A

lifestyle measures
HF medication
Surgery or heart transplant if severe

46
Q

most common . in young pts

can often be asymptomatic

exertional dyspnoea/syncope
angina
sudden death
syncope often following exercise/exertion
ejection systolic murmur - increased by valsava and decreased by squatting

autosomal dominant - FHx

A

hypertrophic obstructive cardiomyopathy

47
Q

Ix for hypertrophic obstrcutive cardiomyopathy

A

ECHO = mitral regurg, systolic anterior motion & asymmetric hypertrophy

ECG = LVH, deep Q waves, ST segment changes, T wave abnormalities

48
Q

management of hypertrophic obstructive cardiomyopathy

A 
A = amiodarone
B = beta blockers 
C = cardioverter defibrillator 
D = dual chamber pacemaker
E = endocarditis prophylaxis
49
Q 
SOBOE
orthopnea 
fatigue 
leg and ankle swelling 
cough

usually caused by amyloidosis, post radiotherapy or loeffers endocarditis

A

restrictive cardiomyopathy

50
Q

Ix of choice for restrictive cardiomyopathy

A

ECHO - thickened walls

51
Q

Management for restrictive cardiomyopathy

A 
manage HF 
amiodarone for arrhythmias
anticoagulation 
implantable cardioverter defibrillator 
surgery indicated in some cases
52
Q

sudden onset of palpitations/heart beating faster
tired
weak or lightheaded
nauseous

ECG findings
narrow QRS complexes
rate 140-280
absent p waves

A

supraventricular tachycardia

53
Q

management of SVT

A

acute = vasovagal maneuvers = either valsave or carotid sinus massage
IV adrenaline 6mg, then 12m and then another 12mg (verapamil in asthmatics)

electrical cardioversion if all else fails.

54
Q

hypotension
collapse
acute HF

ECG = broad QRS complexes 
HR = >100bpm
A

ventricular tachycardia

55
Q

management of ventricular tachycardia

A

amiodarone, lidocaine and procainamide

if this fails, electrophysiological study & ICD

56
Q

often occurs following an MI
chaotic, irregular deflections of varying amplitudes
no identifiable P waves ,QRS complexes or T waves

A

ventricular fibrillation/flutter

57
Q

management of VF

A

defibrillation and stop all antiarrhythmics

in the long run - ICD implantation

58
Q

lead V1 = M shaped QRS
lead V6 = W shaped QRS
split S2

A

RBBB

59
Q

Lead V1 = W shaped QRS

Lead V6 = M shaped QRS

A

LBBB

60
Q

What is a new onset LBBB a sign of ?

A

Myocardial Infarction

61
Q

management of bundle branch blocks

A

Cardiovert and manage the complications

62
Q

often asymptomatic

may have complaints of headaches, visual disturbance or in very severe cases seizures

A

Hypertension

63
Q

diagnosis of HTN?

A

a clinic reading persistently above >= 140/90 mmHg,
or:
a 24 hour blood pressure average reading >= 135/85 mmHg

OTHER CHECKS:
fundoscopy: to check for hypertensive retinopathy
urine dipstick: to check for renal disease, either as a cause or consequence of hypertension
ECG: to check for left ventricular hypertrophy or ischaemic heart disease

64
Q

management of HTN

A

if under 55/not african-caribbean/diabetic
= start on ACEi/ARB
(Then stepwise addition of CCB or thiazide and then triple therapy)

If above 55/non-diabetic/African-carribbean
= start on CCB
(add on thiazide or ACEi/ARB, and then triple therapy)

if still hypertensive - check K+ level

  • if above 4.5mmol/L = alpha/beta blocker
  • if below 4.5mmol/L = low dose spironolactone
65
Q

describe stages of HTN

A

Stage 1 hypertension — clinic blood pressure ranging from 140/90 mmHg to 159/99 mmHg and subsequent ABPM daytime average or HBPM average blood pressure ranging from 135/85 mmHg to 149/94 mmHg.

Stage 2 hypertension — clinic blood pressure of 160/100 mmHg or higher but less than 180/120 mmHg and subsequent ABPM daytime average or HBPM average blood pressure of 150/95 mmHg or higher.

Stage 3 or severe hypertension — clinic systolic blood pressure of 180 mmHg or higher or clinic diastolic blood pressure of 120 mmHg or higher.

Accelerated (or malignant) hypertension is a severe increase in blood pressure to 180/120 mmHg or higher (and often over 220/120 mmHg) with signs of retinal haemorrhage and/or papilloedema (swelling of the optic nerve). q

66
Q

pain
erythema around the affected area
may be able to feel harder lumps underneath the skin

A

phlebitis/thrombophlebitis

67
Q

management of phlebitis/thrombophlebitis

A

Oral NSAIDs/heparinoids
compression stocking (measure ABPI prior)
LMWH/fondaparinux

US may be done to exclude DVT

68
Q

aching/burning in muscles following exertion
relieved within minutes of stopping exertion or resting
calves affected > than thigh/buttock

ABPI = 0.6-0.9

A

intermittent claudication

69
Q 
pale 
pulseless
painful
paralysed 
paresthetic 
poikilothermic (cold)
A

arterial occlusion/acute limb ischaemia

70
Q

management of peripheral arterial disease

A

intermittent claudication

  • supervised exercise programme
  • optimise comorbidities 80mg atrovastatin and 75mg clopidogrel 3-6/12
  • naftiodrofuryl oxalate

Acute limb ischaemia

  • Vasc MDT
  • paracetamol/opiods
  • endovascular or surgical options
acute limb-threatening ischaemia 
- ABC and IV opioids 
- IV UFH 
emergency assessment by vasc specialist
definitive - endovascular therapies or surgical interventions
71
Q

Ix of choice for peripheral arterial disease

A

duplex ultrasound

72
Q

aching, throbbing or itching in the lower limbs
tortuous superficial veins

RFs = female, pregnant, obesity and increasing age

A

varicose veins

conservative management = leg elevation, weight loss, regular exercise & graduated compression stockings

possible Txs

  • endothermal ablation
  • foam scleropathy
73
Q 
unilateral localised throbbing pain particularly on walking 
or weight bearing 
calf swelling & tenderness 
oedema, redness and warmth 
vein distension
A

DVT

74
Q

Assessing for DVT

A

compare the circumference between the legs - >3cm
Wells DVT score - 2 or more is likely
1 or below = unlikely

75
Q

management of unlikely DVT

A

offer D-dimer in 4hrs if not offer interim anticoagulation
D-dimer +ve = doppler US
D-dimer -ve = stop anticoagulation

76
Q

management of likely DVT

A

proximal leg vein US within 4hrs

if not D-dimer and interim anticoagulation (DOAC - apixaban)

77
Q

management in provoked and unprovoked DVT

A

provoked DVT = continue for 3 months

unprovoked DVT = consider undiagnosed cancer and thrombophilia testing

78
Q

tetralogy of fallot characteristics?

A

ventricular septal defect
overriding aorta
right pulmonary stenosis
right ventricular hypertrophy

cyanosis and ejection systolic murmur

79
Q

management of tetralogy of fallot

A

surgical repair and beta blocker

80
Q

failure to thrive
HF symptoms - hepatomegaly, tachycardia/pneoa
pallor
pan-systolic murmur

A

ventricular septal defect

81
Q

management of VSD

A

small VSD = usually asymptomatic - requires close monitoring and typically closes spontaneously

moderate-large VSD = nutritional support, diuretics for HF, surgical closure of the defect

82
Q 
large volume, bounding, collapsing pulse 
wide pulse pressure 
heaving apex beat 
left subclavicular thrill 
continuous 'machinery murmur'
A

patent ductus arteriosus

83
Q

patent ductus arteriosus management

A

indomethacin or ibuprofen (inhibition of prostaglandin synthesis closes the connection)

84
Q 
mid-diastolic murmur (expiration>>)
SI opening snap
malar flush 
low volume pulse 
AF, raised JVP and displaced apex beat
A

mitral stenosis

85
Q

typically asymptomatic
some fatigue, SOB and oedema
pan-systolic ‘blowing murmur’, split S2

A

mitral regurg

86
Q

management for mitral regurg

A

medical mx = nitrates/diuretics, digoxin, intra-aortic balloon pump
signs of HF = ACEi, BB and spironolactone

severe = surgery

87
Q

atypical chest pain/palpitations
mid-systolic click
later systolic murmurs
varies when sitting/standing

common cause = myxomatous degeneration

A

mitral valve prolapse

88
Q

management of mitral valve prolapse

A

dependent on severity
no tx
beta blockers
surgical repair/replacement

89
Q

systolic murmur louder on inspiration

A

Pulmonary stenosis

90
Q

pansystolic murmur louder on inspiration

A

tricuspid regurg

91
Q

a drop in BP (usually >20/10 mm Hg) within three minutes of standing

presyncope
syncope

A

orthostatic hypotension

92
Q

management of orthostatic hypotension

A

treatment options include midodrine and fludrocortisone

FCM (16 decks)

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