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1ST YR CARDIO > DISEASES > Flashcards

DISEASES Flashcards

1
Q
  • AV conduction and accessory pathway
  • abnormal loop of electrical activity
  • will cause longer ventricular depolarization as the accesory pathway does not have AV nodal delay
A

atrioventricular reentrant tachycardia (AVRT)

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2
Q

treatment for symptomatic brugada syndrome?

A

implantable cardioverter defibrillator

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3
Q

when would surgery be advised for endocarditis?

A
  • high embolic risk
  • persistent sepsis
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4
Q
  • BP > 140/90 mmHg
  • retinopathy (damage to back of eye)
  • headache
  • visual changes
  • chest pain
  • presence of risk factors
A

hypertension

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5
Q

treatment for stabe ventricular tachycardia?

A
  • anti-arrhythmia drugs
  • correct the trigger
  • VT catheter ablation (eliminate areas where erratic electrical impulses hit)
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6
Q

causes of aortic dissection

A
  • atheroma
  • hypertension
  • trauma
  • coarctation (congenital narrowing of a short section)
  • marfan’s syndrome
  • pregnancy
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7
Q

GRADUAL prolongation of PR interval with eventually a dropped QRS

A

MOBITZ I (2nd degree heart block)

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8
Q

what treatment should be used for drug users suffering from endocarditis or severe sepsis on the native valve?

A
  • flucloxacillin (IV)
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9
Q

investigation used for pericarditis?

A
  • ECG
  • CRP and FBC
  • CXR
  • ECHO
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10
Q

what may be a complication resulting from stable angina?

A

acute coronary syndrome

  • sudden reduction in blood flow
  • MI and unstable angina
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11
Q
  • jerky pulse
  • wave in JVP
  • double apex beat
  • 4th heart sound
  • mid systolic murmur
  • exacerbated by valsalva manoeuver
  • chest pain
  • dyspnoea
  • syncope
  • cardiac arrhythmia
  • most commmon cause of cardiac death in young people
A

hypertrophic cardiomyopathy

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12
Q
  • hypertension presents at a young age
  • hypertension may be resistent to treatment
  • diminished lower extremity pulses
  • ejection systolic murmur
  • systolic ejection click
A

coarctation of the aorta

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13
Q

how to treat a valvular disease induced heart failure?

A
  • surgery
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14
Q

what is this condition called?

  • ischaemic necrosis of cardiac tissue secondary to occlusion/reduction in coronary blood supply
A

Acute MI

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15
Q

risk factors for tetralogy of fallot?

A
  • trisomy 21, 13 or 18
  • other mutations in genes causing disorders
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16
Q

investigations for atrial fibrillation

A
  • 12 lead ECG
  • ECHO
  • serum urea and electrolytes
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17
Q
  • hole in the spetum between the two upper chambers of the heart
  • congenital
  • may be found accidentally and may never cause a problem
A

atrial septum defect

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18
Q

what would an ECG look like for an NSTEMI?

A

may be normal

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19
Q

treatment of atrial fibrillation with heart failure?

A
  • digoxin/amiodarone (rate control)
  • +cardioversion
  • +anticoagulation
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20
Q

what treatment would be used for aortic stenosis?

A

Valve replacement

  • trans catheter aortic valve replacement (TAVI)
  • Balloon aortic valvotomy (stretching of the valve)
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21
Q

what treatment may be used for myocarditis?

A

Supportive

  • corticosteroids (reduce inflammation)
  • beta blockers, ACE, ARB
  • rest
  • fluid restriction
  • low salt
  • diuretics to treat fluid overload
  • antibiotics
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22
Q

treatment for DVT?

A
  • anticoagulation (LMWH / NOAC)
  • thrombolysis
  • analgesia
  • compression stockings
  • IVC filter may be used (metal device to stop blood clots from moving)
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23
Q
  • inherited condition
  • involves mutations that affect ion channels involved in myocardial repolarisation
  • prolonged QT interval
  • associated with a high risk of sudden death due to ventricular tacchyarythmias
A

brugada syndrome

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24
Q
  • mutation in the cardiac sodium channel
  • causes a very fast heartbeat and arrhythmias
  • serious, life threatening condition
A

brugada syndrome

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25
Q

treatment of acute lower limb ischaemia (salvagable and non-salvagable)

A

salvagble limb

  • embolectomy (remove embolus)
  • +/- thrombolysis
  • +/- fasciotomies (fascia is cut to relieve tension)

non-salvagable

  • amputation
  • palliation
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26
Q
  • no accessory pathway
  • slow and fast pathway going down AV node
  • slow pathway = short refractory period
  • fast pathway = long refractory period
  • impulse goes down fast pathway and then refractory period then slow impulse reaches this refractory and terminates
  • slow recovers then fast recovers
  • If theres an early beat sent when the fast path is still in refractory, beat will go down slow pathway
  • by the time the impulse reaches the end of the slow pathway, fast is out of refractory so impulse goes to ventricle and goes back up via fast pathway route
  • so signal will keep going round and round
A

AtrioVentricular nodal reentrant tachycardia

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27
Q

what is this condition?

  • chronic lower limb ischaemia
  • occurs due to atherosclerosis
A

peripheral vascular disease

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28
Q

give the line of treatment for stable angina

A
  1. beta blocker OR calcium channel blocker
  2. anti-anginals
    • long acting nitrate
    • ivabradine
    • nicorandil
    • ranolazine
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29
Q

investigations to carry out with any defect in the heart?

A
  • ECHO
  • CXR
  • ECG
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30
Q

how to manage coronary artery disease?

A
  • lifestyle changes
  • Beta blockers
  • CCB
  • cholesterol modifiers
  • ranolazine
  • etc. etc.
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31
Q

what may be some causes of sinus bradycardia?

A
  • physiological (athlete)
  • drugs (beta blocker)
  • ischaemia (common n inferior STEMI)
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32
Q

what does the PR interval represent?

A
  • from the onset of atrial depolarisation to the onset of ventricular depolarisation
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33
Q

give causes of aortic regurgitation

A
  • infective endocarditis
  • rheumatic heart disease
  • marfans syndrome
  • acute aortic dissection
  • connective tissue diseases
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34
Q

how to treat chronic supraventricular tachycardia?

A
  • avoid stimulants
  • electrophysiological study (look at hearts electrical acitivity in detail)
  • radiofrequency ablation (wire put into the heart to correct rhythm)
  • beta blockers
  • antiarrhythmic drugs
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35
Q

treatment for diabetic foot sepsis?

A
  • remove all infected tissue
  • open the wound to encourage drainage
  • antiobiotics ASAP
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36
Q

how to treat ACUTE supraventricular tachycardia?

A
  • increase vagal tone (e.g. valsalva - breathing technique, carotid massage)
  • slow conduction in the AV node
    • IV adenosine
    • verapamil (calcium antagonist)
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37
Q

what would this treatment be used for?

  1. anti-platelet therapy
  2. lipid lowering agent
  3. lifestyle modifications
  4. hypertensive therapy
A

transient ischaemic attack stroke

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38
Q
  • early diastolic murmur
  • left sternal edge
  • collapsing pulse
  • displaced apex
  • breathlessness
A

aortic regurgitation

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39
Q

what are the risk factors for myocarditis?

A
  • infection
  • HIV
  • auto-immune disease
  • small pox vaccination
  • enteroviruses
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40
Q

treatment for a ruptured abdominal aortic aneurysm?

A
  1. standard rescucitation
  2. urgent surgical repair
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41
Q
  • presentation is constrictive pericarditis
  • loud 3rd and 4th heart sound
  • raised JVP
  • hepatomegaly
  • oedema
  • ascites
  • dyspnoea
  • fatique
  • embolic symptoms
A

restrictive cardiomyopathy

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42
Q
  • may present with long QT syndrome
  • then long QT syndrome evolves to typical ECG changes
  • ECG
    • ST elevation in V1-V3
    • Right bundle branch block in V1-V3
A

brugada syndrome

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43
Q

what is a false aneurysm?

A
  • blood vessle wall is injured
  • blood collects around the surrounding tissue
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44
Q

what investigations would be done for suspected bradycardia?

A
  • 12 lead ECG
  • event monitoring
  • exercise testing
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45
Q

heart rate less than 50bpm

A

sinus bradycardia

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46
Q

what treatment should be given to patients suffering an NSTEMI?

A
  • antiplatelet
  • oxygen
  • GTN
  • +/- morphine
  • betablocker, CCB
  • assess for percutaneous coronary intervention (PCI)
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47
Q

how is a patent ductus arteriosus treated?

A

catheter procedure

  • catheter sent into a blood vessel in the groin
  • sent up to heart
  • plug or coil is inserted in to close the ductus arteriosus
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48
Q
  • broad QRS complex
  • tachycardia
  • hypotension
  • weak pulse
  • palpitations
  • chest pain
  • syncope
A

ventricular tachycardia

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49
Q

key signs of a transient ischaemic attack?

A
  • focal neurological symptoms
  • resolves within 24 hours
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50
Q

give some risk factors for an abdominal aortic aneurysm?

A
  • age
  • gender
  • smoking
  • hypertension
  • atherosclerosis
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51
Q
  • accumulation of pericardial fluid, blood, pus or air within the pericardial space creating an increase in intra-pericardial pressure
  • restricts cardiac filling, decreases cardiac output
A

cardiac tamponade

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52
Q
  • condition causing an abnormal and irregularly fast heart beat
  • prevelance increases with age
  • paroxysmal <48 hours
  • persistent >48 hours
  • permanent : not solved by drugs or cardioversion
A

atrial fibrillation

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53
Q

investigations for fallots tetralogy?

A
  • CXR
  • ECHO (look for disruptions in heart beat)
  • heart MRI (look for structural problems)
  • pulse oximetry (measure oxygen level in blood)
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54
Q

what is the treatment for cor pulmonale?

A
  • diruetics
  • oxygen
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55
Q
  • hardening of mitral valves
  • cause: rheumatic heart disease
A

mitral stenosis

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56
Q

treatment of unstable cardiac tamponade?

A
  • pericardiocentesis (drainage)
  • surgical drainage (incision)
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57
Q

treatment for unstable ventricular tachycardia?

A

DC cardioversion

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58
Q
  • dilated ventricular chambers
  • systolic dysfunction
  • preserved wall thickness
  • incidence increases with age
  • may present with…
    • HF
    • arrhythmias
    • conduction defects
    • thromboembolism or sudden death
A

dilated cardiomyopathy

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59
Q

investigation done for suspected 1st degree heart block?

A
  • 12 lead ECG
  • serum troponin, potassium, calcium
  • 24 hour ECG
  • CXR
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60
Q

dropped QRS every so often but but no progressive PR interval

A

Mobitz II

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61
Q

causes of aortic stenosis

A
  • degenerative (age)
  • congenital (e.g. bicuspid valve instead of tricuspid)
  • rheumatic
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62
Q

what does cardioversion do?

A

sending electric shocks to the heart to restore normal rhythm

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63
Q
  • swollen foot
  • tender foot
  • ulcer and pus at foot
  • patches of rapidly developing necrosis
  • pyrexic
  • tachycardic
  • tachypnoea
  • confusion
  • hyperventilation (kussmauls breathing)
A

diabetic foot sepsis

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64
Q

risk factors for cardiac tamponade?

A
  • malignancy
  • aortic dissection
  • purulent pericarditis
  • pericardial effusion idiopathic
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65
Q

treatment of long QT syndrome without a previous cardiac event?

A
  • lifestyle changes
  • maybe a beta blocker
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66
Q
  • walls of the ventricles become stiff and resist filling
  • decreased or normal volume of ventricles with a bilateral atrial enlargement
A

restrictive cardiomyopathy

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67
Q

investigations carried out for acute lower limb ischaemia?

A
  • pulse
  • FBC
  • Us and Es
  • CK
  • coagulation test
  • troponin
  • ECG (MI, dysrhythmia)
  • CXR
  • CT angiogram if unsure of history of claudication
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68
Q

condition is usually asymptomatic (found accidentally on imaging/screening)

symptoms…

  • abdominal/back/groin pain
  • hypotension
  • palpable pulsatile abdominal mass
A

abdominal aortic aneurysm

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69
Q

treatment of unstable atrial fibrillation?

A

DC cardioversion

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70
Q

risk factors for DVT

A
  • virchows triad
  • malignancy
  • travel
  • hospital stay
  • surgery
  • immobility
  • pill
  • pregnancy
  • history of DVT
  • obesity
  • thrombophilia (condition that increase blood clot risk)
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71
Q

what type of endocarditis would these organisms cause?

  • staph epidermidis
  • staph aureus
A

prosthetic valve endocarditis

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72
Q
  • occurs on minimal exertion or at rest
  • is not relieved by rest
  • chest pain (retrosternal - behind breast bone)
  • pain radiates to jaw, arm and neck
  • dyspnoea
  • 4th heart sound
A

unstable angina

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73
Q

when does the tachyarrthymia occur with AVRT?

A
  • premature beat goes from SA node to AV node
  • AND accessory pathway in refractory period (no electrical impulses can pass)
  • signal will go down from AV through the ventricles
  • when signal reaches the accessory pathway from ventricles it wont be in refractory period
  • so signal can go back via there and stimulate the AV node
  • creating the reentry circuit
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74
Q
A
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75
Q
  • abnormal arrangement of the…
    • SVC
    • IVC
    • aorta
    • pulmonary veins/artery
  • these may be swapped about
A

transposition of the great vessels

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76
Q

what is the 1st line response for patients with unstable angina?

(acute coronary syndrome)

A

MONAC

  • morphine
  • oxygen
  • nitrates
  • aspirin
  • clopidogrel/aspirin (ANTIPLATELET)
  • beta blockers
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77
Q

how long should a normal PR interval be?

A

0.12-0.20 seconds

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78
Q

what is troponin?

A
  • help regulate contractions of the heart and skeletal muscle
    • heart releases troponin in response to an injury e.g. heart attack
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79
Q

risk factors for ventricular tachycardia

A
  • heart disease history
  • cardiomyopathy
  • myocarditis
  • sometimes occurs after heart surgery
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80
Q

complications of coarctation of the aorta?

A
  • heart failure
  • infective endocarditis
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81
Q
  • heart rate 200-259 bpm
  • irregular rhythm
  • Long QT
  • changing amplitude and twisting of the QRS
A

torsade de pointes

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82
Q

what is cardiomyopathy?

A
  • general term for disease of the heart muscle
  • walls of the heart chambers have become stretched
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83
Q

complications of transposition of the great vessels?

A

congestive heart failure

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84
Q

how are the treatments given (for valve type of causative organsim)?

A
  1. anntibiotics 4-6 weeks
  2. culture guided
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85
Q

what is this condition?

  • insufficient blood reaching muscles that are exercising
  • patient smokes, is hypertensive, has diabetes, high cholesterol
A

intermittent claudication

(chronic/critical limb ischaemia)

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86
Q

what conditions does pericarditis often occur with?

A

myocarditis

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87
Q

investigations carried out for aortic stenosis

A
  • transthoracic ECHO
  • ECG
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88
Q
  • dyspnoea on exertion or rest (sudden)
  • othopnoea (SOB flat)
  • paroxysmal nocturnal dyspnoea
  • pulmonary oedema
  • pink, frothy sputum
  • tachycardic
  • fine crepitations
  • pleural effusion
  • 3rd Heart sound
A
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89
Q

line of treatment for ischaemic stroke?

A
  • thrombolysis (if no contraindications)
  • aspirin
  • statins
  • antihypertensive
  • stent
  • DVT prophylaxis (prevention)
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90
Q

what causes a haemorrhagic stroke?

A
  • increased BP
  • weakened blood vessel wall (e.g. due to aneurysm)
  • inflammation
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91
Q

what would be seen in a CXR for tetralogy of fallot?

A
  • boot shaped heart with an upturned cardiac apex
    • due to right ventricular hypertrophy and concave pulmonary arterial segment
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92
Q

complications leading from stroke?

A
  • DVT
  • infection seizure
  • aspiration
  • pneumonia (from aspiration due to impaired swallowing with neurological damage)
  • delirium
  • depression
  • stroke
  • MI
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93
Q
  • chaotic ventricular activity
  • heart loses ability to function as a pump
A

ventricular tachycardia

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94
Q

complications of pericarditis?

A
  • chronic recurrent pericarditis
  • cardiac tamponade
  • constrictive pericarditis
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95
Q
  • genetic disorder characterised by left ventricular hypertrophy without an identifiable cause
  • most common genetic heart disease
  • most frequent cause of cardiac death in young people
A

hypertrophic cardiomyopathy

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96
Q
  • fever
  • chest pain
  • SOB
  • palpitations
  • arrhythmia
  • cardiac failure
  • slighlty higher chance in males
A

myocarditis

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97
Q
  • calf swelling
  • localised pain along deep venous system
  • assymetric oedema
  • collateral superficial veins
A

DVT

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98
Q

what would be seen on an ECG for atrial fibrilation?

A
  • irregularly irregular
  • atrial rate >300
  • absent P waves (P waves are hidden within the QRS complexes)
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99
Q

investigations carried out for suspected myocarditis?

A
  • ECG
  • serum CK
  • viral PCR
  • throat swab + stool for enterovirus
  • throat swab for influenza
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100
Q
  • congenital heart disorder affecting blood flow to the heart
  • involves 4 key features
    • ventricular septal defect
    • pulmonary stenosis
    • RV hypertrophy
    • overriding aorta (aorta positioned directly over ventricular septal defect)
A

tetralogy of fallot

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101
Q

what would be done to treat DVT in pregnant patients?

A
  • LMWH
  • stockings
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102
Q

what type of endocarditis would these orgnaisms cause?

  • staph aureus
  • strep viridans
  • enterococcus sp
  • staph epidermis
A

naative valve endocarditis

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103
Q

initial treatment of hypertrophic cardiomyopathy?

A
  • implantable cardioverter defibrillator
  • restriction from high intensity athletics
  • observation
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104
Q

is brugada syndrome inherited?

A
  • inherited as an autosomal dominant condition
  • one copy of the gene is enough to cause the disorder
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105
Q

give some complications that may result from an acute MI?

A
  • death
  • arrhythmias (VF)
  • structural problems (rupture, regurg)
  • functional dysfunction
  • acute pericarditis (dresslers syndrome)
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106
Q

what would be seen on a CXR for mitral regurgitation?

A

cardiomegaly

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107
Q

inflammation of the pericardium

A

pericarditis

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108
Q

investigations carried out for mitral stenosis?

A
  • transthoracic ECHO
  • ECG (AF possible)
  • CXR (may have straight left heart border)
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109
Q
  • sudden onset
  • epigastric/central pain
  • may radiate to back
  • collapse
  • may mimic renal colic
A

abdominal aortic aneurysm rupture

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110
Q

when is right sided endocarditis usually seen?

A

with IV drug users

  • as this causes pulmonary hypertension causing increased turbulent blood flow and endothelial damage in tricuspid and pulmonary valves
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111
Q

what is this condition?

  • acute onset of focal neurological symptoms
  • caused by disruption of blood supply
  • end organ complication of poor vascular health
A

stroke

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112
Q

line of treatment for aortic dissection?

A
  • life support
  • beta blockers
  • opioid analegsia
  • open surgery or endovascular stent graph repair
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113
Q

line of treatment for hypertension?

A
  1. age <55 = ACEI or ARB — age 55 or older or black = CCB
  2. ACEI and CCB
  3. ACEI, CCB and thiazide-like diuretic
  4. (resistent hypertension) :ACEI, CCB, thiazide like diuretic, more diruetic + alpha/beta blocker
  5. refer to specialist
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114
Q

what is type A aortic dissection?

A

tear in ascending aorta

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115
Q

hardening of the aortic valve

A

aortic stenosis

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116
Q

premature beat that start from the ventricles instead of top of the heart

  • pretty common
A

ventricular ectopics

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117
Q

drug treatment for patients with torsade de pointes?

A
  • IV magneisum
118
Q

treatment for aortic regurgitation?

A
  • ACE inhibitors (vasodilator to decrease peripheral vascular resistence)
  • ARB
  • Diruetics
  • surgery valve replacement
119
Q

cause of an ischaemic stroke?

A

vascular occlusion

  • thrombotic
  • embolic
  • hypoperfusion
120
Q

what complications may arise from aortic dissection?

A
  • aortic incompetence
  • inferior MI
121
Q
  • dysfunction in the sinus node
  • causes…
    • bradycardia
    • sinoatrial block
    • or SVT alternating with bradycardia/asystole (no QRS complexes)
A

sick sinus syndrome

122
Q

investigations carried out for intermittent claudication?

A
  • ankle brachial pulse index (<0.9)
  • duplex ultrasound
  • MR angiography
  • CT angiography
  • catheter angiography
  • exercise ABPI
123
Q

what are the main causes for right sided heart failure?

A
  • secondary to left sided HF
  • cor pulmonale (from pulmonary hypertension)
  • congenital heart disease
124
Q

pharmacologic treatment used for cardiomyopathy?

A
  • ACE inhibitors
  • ARBS
  • beta blockers
  • rate limiting calcium antagonists
  • diuretics
  • anticoagulation
  • anti arrhythmics (amiodarone, digoxin)
  • also treat underlying symptoms
125
Q

treatment for unstable wolff parkinson white syndrome?

A

direct current cardioversion

126
Q
  • abnormal hole in the heart that forms between the hearts lower pumping chambers
A

ventricular septal defect

127
Q

complications of sinus bradycardia?

A
  • syncope
  • congestive heart failure
  • arrhythmias
128
Q
  • weakness (one sided)
  • impaired coordination
  • slurred speech
  • loss of vision
  • headache
  • confusion
  • history
A

stroke

129
Q

what may an ECG show with hypertension?

A

left ventricular hypertrophy

  • increased amplitude of the QRS complex
130
Q
  • narrow complex tachycardia
  • rate more than 100bpm
  • QRS width less than 0.12 secs
  • P and T waves together
A

supraventricular tachycardia

  • more symptomatic and usually faster than sinus tachycardia (150-250bpm)
131
Q

treatment of ventricular septal defect?

A

for small/ asymptomatic

  • observation and prophylactic antibiotics

symptomatic

  • surgery to patch up the hole
132
Q

treatment for mitral stenosis?

A
  • diuretics
  • treat AF
  • balloon valvuloplasty
  • valve replacment

NOTE: give warfarin if there is MS and AF together

133
Q

complications of atrial fibrillation?

A

stroke

134
Q

treatment for prosthetic valve infective endocarditis?

A
  1. vancomycin (IV) + gentamicin (IV)
  2. add rifampicin PO
  3. may require valve replacement
135
Q

treatment for ventricular ectopics when required?

A
  • beta blockers
  • ablation of focus
136
Q

main cause of myocarditis?

A

enteroviruses

  • coxsackie A + B
  • cause a number of mild infectious illnesses
137
Q

investigations carried out for suspected heart block?

A
  • 12 lead ECG
  • serum troponin, potassium and calcium
  • 24 hour ECG
  • CXR
138
Q

what investigations should be carried out for suspected endocarditis?

A
  • 3 blood cultures before any antibiotics
  • ECG
  • transthoracic echo
  • TOE if transthoracic echo is positive
139
Q
  • pansystolic murmur
  • radiates to axilla (armpit)
  • displaced apex (due to volume overload)
  • lower extremity oedema
  • breathlessness
  • fatigue
A

mitral regurgitation

140
Q

what does an elevated CRP mean?

A

marker of inflammation

(in the heart or otherwise)

141
Q

how to treat fast atrial fibrillation induced myocardial infarction?

A
  • digoxin (slows HR and make it beat stronger)

or

  • DC shock
142
Q
  • tear in the middle layer of the aorta
  • blood surges through the tear causing the inner and middle layers of the aorta to seperate
A

aortic dissection

143
Q

treatment for stable atrial fibrillation?

A
  • beta blockers (rate control)
  • CCBs
  • +anticoagulation
  • +cardioversion
144
Q

what does troponin indicate?

A
  • released by heart and skeletal muscle
  • high levels indicate damage to the heart as heart releases it more
145
Q

what is CRP?

A

C-reactive protein

  • made by liver in response to inflammation sent into the bloodstream
146
Q

treatment for stable cardiac tamponade?

A

anti-inflammatory

  • ibuprofen or aspirin or colchicine
147
Q

what is CK (creatine kinase)?

A
  • an enzyme that leaks out of damaged heart muscle
148
Q

give the treatment used for native valve endocarditis

A
  • amoxicillin
  • gentamicin
149
Q
  • mainly affects the right ventricle with fatty replacement of myocytes
  • leads to dilation
  • risk of sudden death in early stages
A

arrhythmogenic cardiomyopathy

150
Q

treatment for 2nd and 3rd degree heart block?

A

ventricular pacing

151
Q

what is a CT angiography good for showing?

A

blockages in blood vessels

152
Q

treatment for sinus tachycardia?

A
  • treat underlying cause
  • beta blockers
153
Q

give the drugs used for secondary prevention in stable angina so it does not progress to acute coronary syndrome

A
  • statins
  • aspirin and ACEI for high BP
154
Q

complications of endocarditis?

A
  • vegetation may break off and become lodged in capillary bed
    • cause abscess/haemorrhage
155
Q
  • heart rate more than 100bpm
  • may be caused by anxiety, hypotension, fever or drugs
A

sinus tachycardia

156
Q

how does location of DVT affect whether it should be treated or not?

A
  • ABOVE popliteal: TREAT IT!!
  • Below popliteal (distal): doesnt always need to be treated
157
Q

leakage of blood through aortic valve each time the left ventricle relaxes

A

aortic regurgitation

158
Q

what are the main causes for left sided heart failure?

A

pressure build up in the left ventricle, pump is weakened

  • ischaemic heart disease
    • ​heart becomes starved for oxygen and nutrients and cant pump as well
  • cardiomyopathy
  • valvular disease
159
Q

treatment for atrial flutter

A
  • catheter ablation
  • anticoagulation
  • beta blocker or CCB
160
Q

treatment of fallots tetralogy

A
  • closure of ventricular septal defect
  • shunt to increase blood flow to lungs
  • oxygen
  • beta blocker
  • endocarditis prophylaxis
161
Q
  • ductus arteriosus fails to close after birth
  • allows some oxygenated blood to flow back into the lungs via the pulmonary artery from the aorta as the aorta has a higher pressure
A

patent ductus arteriosus

162
Q

investigations for coarctation of the aorta?

A
  • ECG
  • CXR
    • may be normal
    • may be cardiomegaly
    • posterior rib notching
  • ECHO
    • narrowing of thoracic aorta
    • narrowe pressure gradient across
163
Q

how would a haemorrhagic stroke be investigated?

A
  • investigate cause of bleeding
  • FBC
  • CT of head
  • clotting tests
  • platelet function test
164
Q
  • clinic BP > 140/90 mmHg

AND

  • ABPM or HBPM daytime average > 135/85 mmHg
A

stage 1 hypertension

165
Q

complications of DVT?

A
  • PE
  • post-throbotic syndrome (ongoing symptoms of DVT)
166
Q
  • mid diastolic rumbling
  • localised murmur to apex
  • tapping apex beat
  • malar flush
  • AF/palpitations
  • breathlessness
  • tiredness
A

mitral stenosis

167
Q
  • syncope
  • heart rate <40bpm
  • fatigue
  • dyspnoea
  • chest pain
  • palpitations
  • nausea/vomiting
  • cannon A waves (large pressure wave against the vein)
A

1st degree heart block

168
Q

investigations used for DVT?

A
  • D-dimer level (ONLY to RULE OUT)
    • negative result means the DVT or PE would be ruled out
    • if test positive still need another test to confirm
    • venous duplex ultrasound
    • urea+creatinine
    • LFTs
    • FBC
169
Q
  • SOB
  • failure to thrive
  • machine-like continuous murmur
  • low diasoltic BP
  • S3 at apex
  • mid diastolic rumble at apex
  • bounding peripheral pulses
A

patent ductus arteriosus

170
Q

what is the ankle brachial pulse index?

A
  • ratio of BP in ankle compared to the arm
  • ankle BP / branchial BP
171
Q

how does fluid build up in myocarditis?

A

the blood doesnt pump properly to remove the excess

172
Q

what complications may occur with unstable angina?

A
  • stroke
  • MI
173
Q
  • pain
  • pallor
  • pulseless
  • perishingly cold
  • tingling
  • paralysis
  • 0-4 hours: white foot, painful, sensory+motor deifict
  • 4-12 hours: mottled (marbling of skin usually before death), branches on pressure
  • >12 hours: irreversible mottling, non-blanching, tender, paralysis
A

acute lower limb ischaemia

174
Q

risk factors for DVT?

A
  • age
  • pregnancy
  • trauma
  • surgery
  • obesity
  • cancer
  • immobility
  • thrombophilia (imbalance of naturally occuring blood clotting factors)
175
Q

what is DC cardioversion?

A

defribrillator is used to send a controlled shock to your heart to correct the rhythm

176
Q

investigations carried out on suspected peripheral vascular disease?

A
  • ankle brachial index
  • ultrasound
  • pressure examination
  • physical signs
177
Q
  • inability to provide adequate blood supply for the myocardium
  • mainly caused by ahterosclerosis of the epicardium coronary arteries
  • symptoms are manageble and not rapidly progressive
  • no signs of cardiac necrosis
  • angina symptoms
  • epigastric discomfort
  • jaw pain
A

ischaemic heart disease or coronary heart disease

178
Q

what is this?

A

pericarditis

  • enlarged cardiac sillhouette
  • could also be normal
179
Q

give the acute treatment for heart failure

A
  • sit up
  • oxygen
  • IV furosemide (diuretic - reduces fluid in body lowers BP)
  • IV diamorphine (pain)
180
Q

complications of brugada syndrome?

A
  • polymorphic ventricular tachycardia (tachycardia with a varying QRS complex morphology)
  • ventricular fibrillation
  • atrial fibrillation
181
Q

Score used to assess risk of DVT?

A

WELL’S clinical probability tool

  • score of 2 or more
182
Q
  • can be symptomatic
  • chest pain
  • palpitations
  • pre-syncope
  • dyspnoea
  • sweatiness
  • fatigue
A

atrial fibrillation

183
Q

complications that may occur from an abdominal aortic aneurysm?

A

rupture and death

184
Q

what is seen on a wolf parkinson white patient ECG and why?

A
  • shortened PR interval <0.12 secs
    • due to pre-excited ventricular system being excited before normal
  • delta wave (slow rise QRS)
    • due to action potential from SA node being able to conduct very quickly to ventricles through accessory pathway
185
Q

risk factors for hypertrophic cardiomyopathy?

A
  • family history of HCM
  • sudden cardiac death
186
Q

line of treatment for peripheral vascular disease?

A
  • assess for revascularisation (widening of blocked artery)
    • angioplasty
    • stent
    • bypass
  • amputation
  • modify risk factors (exercise, smoking cessation)
187
Q
  • tachycardia
  • hypotension
  • distant heart sounds
  • elevated JVP
  • dyspnoea
  • pulsus paradoxus >10mmHg (decrease in systolic BP, stroke volume)
A

cardiac tamponade

188
Q

how does valve damage lead to endocarditis?

A
  1. valve is damaged
  2. blood flow is turbulent over the roughened endothelium
  3. platelets/fibrin deposited (clotting blood)
  4. bacteraemia
  5. vegetation (growth of bacteria on a heart valve)
189
Q

when does acute lower limb ischaemia become irreversible?

A

after 12 hours

  • fixed mottling
  • non blanching
  • tender compartments
  • paralysis
190
Q

what investigations would be done for a patient with suspected unstable angina?

A
  1. CT angiography (x-ray to provide detailed pictures of heart and blood vessels to show blockages)
  2. ECG (may be normal)
191
Q

investigations for coronary heart disease?

A
  • ECG
  • haemoglobin
  • lipid profile
  • fasting blood glucose
  • Cardiac CT angiography
192
Q
  • endothelial damage causes transendothelial migration
  • macrophages stimulate lipid uptake
  • lipid uptake, smooth muscle proliferation, collagen and fibrin accumulation form fibrofatty plaque
A

atheroma

193
Q
  • hypercyanotic episodes (fall in oxygen saturation - profound cyanosis and hypoxia)
  • clubbing
  • harsh ejection systolic murmur
  • cyanosis (blue cast to skin)
  • tachypnoea
  • usually presents in neonatal period with a murmur
A

tetralogy of fallot

194
Q

what treatment is used for haemorrhagic stroke?

A
  • craniotomy
    • part of the skull is removed to remove the bleeding
195
Q

back flow of blood through the mitral valve due to floppy valves

A

mitral regurgitation

196
Q

what treatment is used for transposition of the great vessels?

A
  • endovascular atrial septosomy
    • this cuts and enlarges the foramen ovale
    • used until definitive surgery can be performed
197
Q

what is type B aortic dissection?

A

tear in the descending part of the aorta

198
Q

what is this?

  • chest pain brought on by exertion
  • relieved by rest
  • may radiate to neck, arms, jaw or teeth
  • may occur with heavy meals, cold weather or emotion
  • associated symptoms: dyspnoea, nausea, sweatiness, faintness
A

Stable Angina

199
Q

treatment for a symptomatic but unruptured abdominal aortic aneurysm?

A
  1. semi-urgent surgical repair
  2. reduce CV risk
200
Q

what kind of treatment should be given for pericarditis

A

supportive unless its caused by bacteria

  • often goes away on its own
201
Q

CXR findings…

  • cardiomegaly
  • bats wings shadows (bilateral perihilar shadowing)
  • interstitial fluid
A
202
Q

what type of condition do these fall into?

  • coarctation of the aorta
  • tetralogy of fallot
  • transposition of the great vessels
  • ventricular septal defect
  • atrial septal defect
  • patent ductus arteriosus
A

congenital heart disease

203
Q

what is the condition called for myocardial ischaemia mostly caused by an atheroma?

A

angina (stable or unstable)

204
Q
  • ischaemic pain with exercise
  • pain subsides with rest
  • diminished/absent pulses
A

intermittent claudication

205
Q

complications of mitral regurgitation?

A
  • heart failure
  • AF
  • endocarditis
  • pulmonary hypertension
206
Q
  • sharp, severe retrosternal chest pain
  • worse on inspiration and supine (lying down)
  • pain relieved by sitting forward
  • pericardial friction rub (rasping/creaking sound at left lower sternal border)
  • low grade fever
A

pericarditis

207
Q
  • systolic murmur at left parasternal edge
  • failure to thrive
  • SOB
  • loud S2
A

ventricular septal defect

208
Q

treatment for people with ventricular ectopics?

A
  • beta blockers
  • cardiac ablation (destroy signals in the heart that cause an abnormal rhythm)
209
Q

what may be done to investigate heart failue?

A
  • transthoracic ECHO
  • ECG
  • CXR
  • FBC
210
Q

hypertension risk factors

A
  • smoker
  • high fat diet
  • high alcohol
  • high salt intake
  • low exercise
  • overweight
211
Q

name some investigations that may be carried out for suspected UNSTABLE angina

A
  • ECG
  • cardiac biomarkers
  • FBC (may show troponin, LDL, cholesterol)
  • CXR
  • coronary angiography (contrast dye)
212
Q
  • most patients asymptomatic
  • symptoms may include…
    • symptomatic ventricular arrhythmia
    • syncope or sudden death
    • may present as right sided heart failure (more common in later stages of disease)
  • patients may be detected through family screening
A

arrhytmogenic cardiomyopathy

213
Q

complications of atrial flutter?

A

usually progresses to atrial fibrillation

may result in thrombo embolism

214
Q
  • rapid and regular form of atrial tachycardia
  • usually paroxysmal
  • saw tooth waves due to reentrant rhythm (II, III, aVF and V1)
A

atrial flutter

215
Q

treatment for mitral regurgitation?

A
  • diuretics (decreases fluid in blood)
  • treat heart failure
  • surgery (valve replacement)
  • ACEI, digoxin, warfarin
216
Q

investigations carried out for mitral regurgitation?

A
  • transthoracic ECHO
  • ECG
217
Q

treatment for stable wolff parkinson white syndrome?

A
  • valsalva
  • IV adenosine (slows conduction time through the AV node)
218
Q

inflammation of the heart muscle

  • more common in young people as a cause of sudden death
A

myocarditis

219
Q

investigations for cardiac tamponade

A
  • ECG
  • transthoracic echocardiogram
  • CXR
  • FBC
220
Q

causes of mitral regurgitation?

A
  • rheumatic heart disease
  • myxomatous degeneration (ventricular dilation)
  • endocarditis
  • chordal rupture
  • ischaemia of papillary muscles
  • Atrial Fibrillation
221
Q

antibitotics used for strep viridans endocarditis?

A
  • benzylpenicillin (IV)
  • gentamicin (IV)
222
Q

what is this?

  • blood clot deep within vein (usually leg)
A

Deep Vein Thrombosis

223
Q

what may be shown on an ECG for angina?

A

ST depression

  • may also be normal
224
Q
  • clinic BP > 160/100 mmHg

AND

  • ABPM or HBPM dayime average >150/95 mmHg
A

stage 2 hypertension

225
Q

Prolonged PR interval >0.20secs

  • delayed conduction
A

1st degree heart block

226
Q

what are the three main types of stroke?

A
  • ischaemic
  • haemorrhagic
  • TIA (transient isaechamic attack)
227
Q
  • systolic ejection murmur
  • ejection click (occur at maximal opening of AP valves)
  • slow rising pulse
  • heaving apex beat
  • aortic thrill (vibration)
  • radiates to carotids
  • quiet S2
  • splitting S2
  • breathlessness
  • chest pain
  • syncope
  • hypotension
  • cold peripheries
A

aortic stenosis

228
Q

clinic systolic BP is 180 mmHg or higher

OR

clinic diatolic BP is 110 mmHg or higher

A

hypertension

229
Q
  • severe cyanosis
  • tachypnoea
  • rapid deterioration to death when duct closes (2-7 days)
  • poor/absent pulses
  • crepitations
  • occurs at birth (congenital)
A

transposition of the great vessels

230
Q
  • systolic ejection murmur
  • mid diastolic murmur
  • fixed splitting of the second heart sound
  • filure to thrive
A
231
Q

treatment for asymptomatic brugada syndrome?

A
  • positive family history = implantable cardioverter defibrillator
  • negative family history = no treatment
232
Q

complications of peripheral vascular disease?

A
  • leg/foot ulcers
  • gangrene
  • permanent limb weakness/pain/numbness
233
Q

causes of pericarditis

A
  • viral (mainly)
  • bacterial
  • fungal
  • mycoplasma
  • parasitic
234
Q

treatment for sinus bradycardia if haemodynamically unstable (perfusion failure)?

A
  1. atropine to increase HR
  2. temporary pacing if unresponsive to medication or haemodynamically comprimised
235
Q

what condition is usually due to inadequate cardiac output for the body’s requirments?

A

heart failure

236
Q

what surgical interventions may be given to a patient with stable angina?

A
  • coronary artery bypass graft (CABG)
    • divert blood around the blocked artery
  • Percutaneous coronary intervention (PCI)
    • stent in blood vessel

for patients whose angina is not controlled through drugs

237
Q

treatment of long QT syndrome with a previous cardiac event?

A
  • beta blockers
  • sympathectomy (removal of sympathetic nerve affecting long QT)
  • permanent pacemaker
238
Q

investigations used for a suspected MI?

A
  • ecg
  • cardiac biomarkers (troponin, kinase etc.)
  • CXR
  • coronary angiogram
239
Q

investigations for suspected hypertrophic cardiomyopathy?

A
  • ECG
  • CXR
  • echocardiography
240
Q

complications of mitral stenosis?

A
  • right heart failure
  • cardiac cachexia
241
Q

treatment of atrial septal defect?

A

corrective closure

242
Q
  • pulse <50bpm
  • dizziness/ lightheaded
  • fatigue
  • SOB
  • cannon a waves in JVP (atria contracting against a closed valve, big pressure wave)
A

sinus bradycardia

243
Q

SMALL aortic aneurysm treatment?

A
  • surveillance
  • aggressive management of CV risk
244
Q

give the first line treatment for heart failure

A
  1. ACEI or ARB + Beta Blocker
  2. diruetic
  3. aldosterone antagonist (lower BP) (spironolactone)
  4. long actin nitrate
  5. digoxin
  6. ivabradine (slows HR)
  7. vasopressin antagonist
245
Q

what is the immediate treatment for somebody suffering from an acute MI?

A

MONAC

  • morphine
  • oxygen
  • nitrate if high BP
  • aspirin
  • clpidogrel (antiplatelet)
  • anti-emetic
246
Q
  • oedema
  • elevated JVP
  • hepatomegaly
  • ascites
  • normal CXR
A

right sided heart failure

247
Q

what treatment should be given to a ST elevated MYOCARDIAL INFARCTION after the immediate treatment?

A
  1. PCI (percutaneous coronary intervention) if it is within 90 MINUTES of onset

thrombolysis after 90 minutes

248
Q
  • reentry node tachycardia
  • caused by abnormal accessory pathway between ventricles and atria
  • palpitations
  • SOB
  • dizziness
  • sudden cardiac death
  • delta waves on ECG
A

wolff parkinson white syndrome

249
Q

investigations for aortic dissection

A
  • cross match blood and CT/MRI
  • or transoesophageal echocardiography
250
Q

what is this condition?

  • sudden loss of bloof supply to a limb
  • native artery or bypass graft occluded
  • causes: embolism, atheroebolism, arterial dissection, trauma
A

acute lower limb ischaemia

251
Q
  • dizziness
  • angina
  • fatique
  • oliguria (low urine output)
  • history of known gene mutation
  • use of drugs
  • syncope during arousal or surprise
  • syncope during heightened adrenergic tone (adrenaline)
A

long QT syndrome

252
Q

what is the name of the score used to assess ACUTE CORONARY SYNDROME mortality risk?

A

GRACE score

253
Q

what is D-dimer level and what does it indicate?

A
  • D-dimer is a product of fibrin breakdown
  • fibrin is involved in the clotting of blood
  • positive result is only an indicator of DVT or PE and should be further investigated
254
Q

what is acute coronary syndrome?

A

either of…

  • unstable angina
  • NSTEMI
  • STEMI
255
Q

treatment for sick sinus syndrome?

A
  • cardiac ablation
  • av ablation
  • medication to control HR
256
Q
  • hair loss on feet and legs
  • intermittent claudication (pain in legs on mild exertion relieved by rest)
  • numbness/ weakness in legs
  • brittle, slow growing toenails
  • non healing ulcers on feet and legs
  • pale/blue skin on legs
  • shiny skin
  • may be peripheral oedema due to pooling of blood in legs
A

peripheral vascular disease

257
Q

what lifestyle changes would be recommended for a patient with stable angina?

A
  • smoking cessation
  • exercise
  • improved diet
258
Q

who has an increased risk of suffering from peripheral vascular disease?

A
  • smokers
  • diabetes
  • hypertensive patients
  • an elevated C-reactive protein (CRP)
259
Q

give the key differences between angina and myocardial infarction

A

ANGINA

  • 10 mins
  • on exertion
  • usual pain
  • relief from GTN

MYOCARDIAL INFARCTION

  • 30 mins
  • at rest
  • more severe pain
  • no effect using GTN
260
Q

investigations carried out for aortic regurgitation?

A
  • ECG
  • CXR (cardiomegaly)
  • Echo
261
Q

what investigations may be carried out for an abdominal aortic aneurysm?

A
  • abdominal ultrasound
  • CRP
  • FBC
  • CT
  • MR angiography
262
Q
  • overwhelming sepsis
  • cardiac failure
  • fever
  • malaise
  • weight loss
  • tiredness
  • breathlessness
  • roths spots
  • oslers nodes
  • jaenway lesions
  • anaemia
  • splinter haemorrhages
A

endocarditis

263
Q

what would be seen on an ECG for pericarditis?

A
  • diffuse ST elevation
  • PR depression
264
Q

risk factors for coronary heart disease

A
  • age
  • smoker
  • high LDL cholesterol
  • hypertension
265
Q

sudden tearing chest pain with raditation to the back

A

aortic dissection

266
Q

which side of the heart is usually affected in infective endocarditis?

A

left side of heart

  • mitral and aortic valves
267
Q

treatment for coarctation of the aorta?

A
  • balloon angioplasty with or without stenting
268
Q

what investigations may be done for a patient with suspected stroke?

A
  • CT of head
  • MRI brain
  • serum glucose and electrolytes
  • urea and creatinine
269
Q

investigations for ventricular tachycardia?

A
  • ECG
  • electrolytes
  • troponin (sent into bloodstream when heart muscles become damaged
270
Q

what is this condition?

  • biggest complication of diabetes
  • leads to tissue ulceration, necrosis and gangrene
  • diabetic neuropathy, peripheral vascular disease AND infection
A

diabetic foot sepsis

271
Q
  • central crushing pain in chest
  • dyspnoea
  • pallor (pale)
  • nausea
  • tachycardia
  • hypotension
    *
A

Acute Myocardial Infarction

272
Q

causes of restrictive cardiomyopathy?

A
  • idiopathic
  • genetic
  • myocardial fibrosis
  • infiltrative disorders
  • following radiotherapy
273
Q

what would be done to treat DVT associated with drug use?

  • IV opioid has a high risk
A

for lifestylle issues and risk of haemorrhage /embolic disease

  • rivaeoxaban (anti-coagulant)
  • fragmin (type of heparin - anticoagulant)
274
Q

ECG findings

  • ST elevations (in 2 adjacent limb leads)
  • T wave inversion
  • abnormal Q waves >1mm
  • Inferior: II, III, AvF
  • Anterior: V1-6
A

acute myocardial infarction

275
Q

what condition may these factors predispose to?

A
  • heart valve abnormality
  • calcification in elderly
  • post rheumatic fever
  • congenital heart disease
  • IV lines
  • IV drug users
  • prosthetic heart valve
276
Q

what is endocarditis?

A

infection of the endocardium

277
Q

how can mitral stenosis cause right sided heart failure?

A
  • backflow of blood causes pressure to build up the lungs
  • leads to fluid accumulation
  • fluid build up strains the rigt side of the heart
278
Q

what is the speicifc antibiotic used for treatment with staph aureus endocarditis?

A

flucloxacilin (IV)

279
Q

give the more atypical causative organisms of endocarditis

A
  • coxiella burnetti
  • legionella mycoplasma
  • bartonella
280
Q

what will be seen on the ECG for aortic stenosis?

A

left ventricular hypertrophy

281
Q

complete dissociation between P wave and QRS (atria and ventricles)

  • heart beat regular
  • no conduction through the AV node
A

3rd degree heart block

COMPLETE HEART BLOCK

282
Q

how to treat end stage heart failure resulting from hypertrophic cardiomyopathy?

A
  • beta blocker
  • ACE inhibitor/ARB
  • consider implanatble cardioverter defibrillator
  • restriction from high-intensity athletics
283
Q

treatment for symptomatic hypertrophic cardiomyopathy?

A
  1. negative inotropic and chronoctropic agents + restrict from high-intensity athletics
  2. dual chamber pacing
284
Q

aorta is narrow, usually in area where ductus arteriosus inserts

A

coarctation of the aorta

285
Q

what needs to be monitored in a patient with endocarditis?

A

MONITOR

  • CRP
  • temperature
  • cardiac function
286
Q

what is an aneurysm?

  • dilation is more than 50% of its normal diameter
A

bulge in the blood vessel caused by a weakness in the blood vessel wall

287
Q

what treatment should be given to a patient with 1st degree heart block?

A

None

  • monitor them to check it doesnt progress
288
Q

investigations for sinus tachycardia?

A
  • 12 lead ECG
  • event monitoring
  • exercise testing

same as sinus bradycardia

289
Q

LARGE aortic aneurysm treatment?

A
  • surgical repair
  • reduce CV risk
290
Q

what are the three types of supraventricular tachycardia (above the ventricles above AV node)?

A
  • atrioventricular nodal reentrant tachycardia (AVNRT)
  • atrioventricular reciprocating tachycardia (AVRT)
  • atrial tachycardia

1ST YR CARDIO (6 decks)

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