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Medicine Year 3 > General Medicine - Cardiology > Flashcards

General Medicine - Cardiology Flashcards

1
Q

What is the pharmacological secondary prevention of MI?

A

ACEi + Statin + Beta-blocker + Dual platelet therapy ( aspirin + clopidogrel)

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2
Q

What is the Tetralogy of Fallot? What are the four constituents?

A

Group of four structural abnormalities of the heart that occur together.

  1. Pulmonary Stenosis
  2. Ventricular Septal Defect
  3. Overriding aorta
  4. Thick Right Ventricle
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3
Q

What is an atrial myzoma?

A

Non-cancerous tumour. Grows in the left or right inter-atrial septum.

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4
Q

Drugs for pharmacological cardioversion for AF?

A
  1. Flecainide/Amiodarone (if no known structural abnormality of the heart)
  2. Amiodarone ( if known structural abnormality)
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5
Q

ABCDE of Heart Failure on CXR

A 
A - Alveolar oedema
B- kerley B lines
C- Cardiomegaly
D- Dilated prominent upper lobe vessels
E - Pleural Effusion
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6
Q

Guidelines for Pharmacological treatment of hypertension

A

FL- ACEi/ARB - if under 55 and not Black
CCB - if over 55 and Black
2nd - Thiazide- like diuretic (Eg - Indapamide)
3rd - Beta- blocker or alpha-blocker (if beta blocker CI, eg on salbutamol inhaler)
4th - Aldosterone antagonist (Spirinolactone) can be given if K+ < 4.5

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7
Q

What are Roth’s spots? Which condition do they present in?

A

Haemorrhages seen in the eye. Also called Litten’s sign.

Seen in Infective Endocarditis.

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8
Q

What criteria is used for the diagnosis of Infective Endocarditis?

A

Duke’s Criteria

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9
Q

Takayasu arteritis?

A

rare type of vasculitis. affects young Asian women. causes occlusion of aorta. usually presents with absent limb pulse. associated with renal artery stenosis. managed with steroids

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10
Q

What is the main cause of death in HCOM?

A

Ventricular arrhythmias

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11
Q

What can of inheritance pattern does HOCM follow?

A

Autosomal dominant inheritance pattern

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12
Q

What is a common side effect of beta blockers to warn patients about?

A

Insomnia/ difficulty sleeping

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13
Q

What kind of pulse is seen in aortic stenosis?

A

Slow rising pulse

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14
Q

What are the main causes of aortic stenosis in under 65s?

A

Bicuspid aortic valve

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15
Q

What is the main cause of aortic stenosis in over 65s?

A

Calcification of aortic valve

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16
Q

What is the time frame to classify an aortic dissection as acute?

A

If symptoms present within 14 days. More than that then it is chronic

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17
Q

What kind of Aortic Dissection indicates surgery?

A

Stanford Type A, or Type B where there is evidence of end organ ischaemia

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18
Q

Describe DeBakey Type 1 aortic dissection.

A

AD propagate from ascending aorta and external arch of the aorta (may continue distally)

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19
Q

Describe DeBakey Type 2 AD

A

AD confined to ascending aorta

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20
Q

Describe DeBakey Type 3 AD

A

AD limited to descending aorta

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21
Q

Describe Stanford A AD

A

AD involves ascending aorta and transverse aorta

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22
Q

Describe Stanford B AD

A

AD involves descending aorta only

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23
Q

How is Stanford B AD managed.

A

Managed with Beta-blockers and analgesia

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24
Q

Which kind of chest pain is relieved by sitting forward?

A

Pericarditis

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25
Q

How is chest pain relieved in Pericarditis?

A

Sitting forward

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26
Q

ECG changes in Pericarditis

A

Saddle shaped ST elevation

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27
Q

Which drug is beta-blockers never prescribed with and why?

A

Verapamil. Risk of cardiac death

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28
Q

Verapamil is never prescibed with which class of drug?

A

Beta-blockers

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29
Q

What is an Osbourne wave on ECG?

A

Positive deflection of J-point ( negative in aVR and V1)

30
Q

Which electrolytes cause ECG changes?

A

Calcium, magnesium and potassium

31
Q

ECG changes in hypercalcaemia?

A
  1. Decrease QT interval
  2. Lengthened QRS interval
  3. Bradycardia
32
Q

ECG changes in hypocalcaemia?

A
  1. Increased QT interval

2. decreased QRS interval

33
Q

ECG changes in hyperkalaemia?

A
  1. pointed T-waves
  2. P-waves wider and reduced amplitude
  3. Increased PR interval
  4. ST elevation in V1-V3
  5. QRS wider
34
Q

ECG changes in hypokalaemia?

A
  1. T wave wider and reduced amplitude
  2. ST depression
  3. P-wave increased
  4. U-waves present
35
Q

ECG changes in hypermagnesemia?

A

Third degree heart block/ asystole

36
Q

ECG changes in hypomagnesemia?

A

Arrhymthmias

37
Q

What is the classification used for Heart Failure? How many stages are there?

A

New York Heart Association Classification.

4 stages

38
Q

FL pharma treatment for angina prevention

A

Betablocker/ CCB

39
Q

What two factors point to myocarditis?

A

New onset chest pain + recent viral illness

40
Q

Interaction between phenobarbital and warfarin?

A

Phenobarbital induces CYP1A2 and reduces INR

41
Q

Holter Monitor

A

24-48 hour ECG monitor. Used for patients who present with palpitations

42
Q

Can Warfarin be taken while breast-feeding?

43
Q

8 Reversible causes of Cardiac Arrest ( 4 Hs and 4 Ts)

A

4Hs - Hypothermia, Hypoxia, Hypovolaemia, Hypokalaemia/hyperkalaemia/hypocalcaemia
4Ts - Tension pneumothorax, thrombosis, toxins, tamponade

44
Q

What is the Killip Classification used for?

A

Used to stratify risk of mortality post MI

45
Q

Reasons for rhythm control in AF

A
  1. Coexistance of HF
  2. First onset AF
  3. Obvious reversible cause (Eg- Pneumonia)
46
Q

What kind of breath sound can HF produce?

A

Polyphonic expiratory wheeze

47
Q

Treatment of Torsade de Pointes

A

IV Magnesium sulfate

48
Q

Presentation of Pulmonary hypertension

A

syncope, exertional angina, increase in sound of S2

49
Q

Treatment for SVT

A

IV adenosine

50
Q

Eisenmonger’s Syndrome

A

Eisenmenger’s syndrome is defined as the process in which a long-standing left-to-right cardiac shunt caused by a congenital heart defect (typically by a ventricular septal defect, atrial septal defect, or less commonly, patent ductus arteriosus) causes pulmonary hypertension and eventual reversal of the shunt into a cyanotic right-to-left shunt.

51
Q

Treatment for major bleeding in patients on Warfarin

A

4 factor prothrombin complex concentrate 25-50 U/kg

52
Q

ECHO findings in HCOM

A

MR SAM ASH - Mitral regurgitation, systolic anterior motion of anterior mitral valve leaflet, assymetrical hypertrophy

53
Q

Presentation of HCOM

A

Young person - sudden colllapse, exertional angina, sudden death

54
Q

Pansystolic murmur and low grade fever. Think?

A

infective endocarditis

55
Q

Cause of third heart sound?

A

Normal is under 30 years old.

If not, left ventricular failure - dilated cardiomyopathy, constrictive pericarditis, mitral regurgitation

56
Q

S1Q3T3 changes? which condition?

A

Saddle PE.
S1 - Prominent S-wave in lead 1
Q3 - Q-wave in lead 3
T3 - inverted T-wave in lead 3

57
Q

Collapsing pulse seen in which condition?

A

Aortic regurgitation

58
Q

Aortic stenosis symptoms pneumonic

A

SAD
Syncope
Angina (exertional)
Dyspnoea on exertion

59
Q

Elderly and diabetic. Think?

60
Q

Q-waves. Think?

A

Ongoing/ old MI

61
Q

NICE guidelines for management of provoked VTE

A

Warfarin - 3 months, then assess
LMWH/Fondaparinux - continued for atleast 5 days or INR >/= 2 for at least 24 hours, if active cancer, continue for 6 months

62
Q

V1 - V4, area and artery affected

A

Anteroseptal, LAD

63
Q

2,3 avF, area and artery affected

A

Inferior, right coronary

64
Q

V4-V6, 1, avL, area and artery affected

A

Anterolateral, LAD or left circumflex

65
Q

1,avL +/- V5-V6, area and artery affected

A

Lateral, left circumflex

66
Q

Tall R waves in V1-V2, area and artery affected

A

Posterior, left circumflex/ right coronary

67
Q

Immediate management of suspected ACS.

A
  1. GTN
  2. Aspirin 300mg
  3. If O2 < 94%, then give O2
  4. ECG
    Do not delay transfer to hospital
68
Q

Warfarin target INRs?

A

VTE - 2.5, if recurrent = 3.5
AF - 2.5
Mechanical valves, depends on valve type,
mitral INR > aortic INR
If INR = 5-8, skip 1-2 doses, reduced subsequent maintainence dose

69
Q

ECG change caused by Sotalol?

A

QT prolongation

70
Q

Which factors affected by Warfarin?

71
Q

Emergency anticoagulation reversal?

A

Four factor prothrombin complex concentrate 25-5- U/kg + 5mg of Vit. K iv, if on warfarin, stop warfarin

Medicine Year 3 (4 decks)

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