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Medicine Year 3 > General Medicine - Cardiology > Flashcards

General Medicine - Cardiology Flashcards

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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
How is chest pain relieved in Pericarditis?
Sitting forward
26
ECG changes in Pericarditis
Saddle shaped ST elevation
27
Which drug is beta-blockers never prescribed with and why?
Verapamil. Risk of cardiac death
28
Verapamil is never prescibed with which class of drug?
Beta-blockers
29
What is an Osbourne wave on ECG?
Positive deflection of J-point ( negative in aVR and V1)
30
Which electrolytes cause ECG changes?
Calcium, magnesium and potassium
31
ECG changes in hypercalcaemia?
1. Decrease QT interval 2. Lengthened QRS interval 3. Bradycardia
32
ECG changes in hypocalcaemia?
1. Increased QT interval | 2. decreased QRS interval
33
ECG changes in hyperkalaemia?
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
ECG changes in hypokalaemia?
1. T wave wider and reduced amplitude 2. ST depression 3. P-wave increased 4. U-waves present
35
ECG changes in hypermagnesemia?
Third degree heart block/ asystole
36
ECG changes in hypomagnesemia?
Arrhymthmias
37
What is the classification used for Heart Failure? How many stages are there?
New York Heart Association Classification. | 4 stages
38
FL pharma treatment for angina prevention
Betablocker/ CCB
39
What two factors point to myocarditis?
New onset chest pain + recent viral illness
40
Interaction between phenobarbital and warfarin?
Phenobarbital induces CYP1A2 and reduces INR
41
Holter Monitor
24-48 hour ECG monitor. Used for patients who present with palpitations
42
Can Warfarin be taken while breast-feeding?
Yes
43
8 Reversible causes of Cardiac Arrest ( 4 Hs and 4 Ts)
4Hs - Hypothermia, Hypoxia, Hypovolaemia, Hypokalaemia/hyperkalaemia/hypocalcaemia 4Ts - Tension pneumothorax, thrombosis, toxins, tamponade
44
What is the Killip Classification used for?
Used to stratify risk of mortality post MI
45
Reasons for rhythm control in AF
1. Coexistance of HF 2. First onset AF 3. Obvious reversible cause (Eg- Pneumonia)
46
What kind of breath sound can HF produce?
Polyphonic expiratory wheeze
47
Treatment of Torsade de Pointes
IV Magnesium sulfate
48
Presentation of Pulmonary hypertension
syncope, exertional angina, increase in sound of S2
49
Treatment for SVT
IV adenosine
50
Eisenmonger's Syndrome
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
Treatment for major bleeding in patients on Warfarin
4 factor prothrombin complex concentrate 25-50 U/kg
52
ECHO findings in HCOM
MR SAM ASH - Mitral regurgitation, systolic anterior motion of anterior mitral valve leaflet, assymetrical hypertrophy
53
Presentation of HCOM
Young person - sudden colllapse, exertional angina, sudden death
54
Pansystolic murmur and low grade fever. Think?
infective endocarditis
55
Cause of third heart sound?
Normal is under 30 years old. | If not, left ventricular failure - dilated cardiomyopathy, constrictive pericarditis, mitral regurgitation
56
S1Q3T3 changes? which condition?
Saddle PE. S1 - Prominent S-wave in lead 1 Q3 - Q-wave in lead 3 T3 - inverted T-wave in lead 3
57
Collapsing pulse seen in which condition?
Aortic regurgitation
58
Aortic stenosis symptoms pneumonic
SAD Syncope Angina (exertional) Dyspnoea on exertion
59
Elderly and diabetic. Think?
Silent MI
60
Q-waves. Think?
Ongoing/ old MI
61
NICE guidelines for management of provoked VTE
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
V1 - V4, area and artery affected
Anteroseptal, LAD
63
2,3 avF, area and artery affected
Inferior, right coronary
64
V4-V6, 1, avL, area and artery affected
Anterolateral, LAD or left circumflex
65
1,avL +/- V5-V6, area and artery affected
Lateral, left circumflex
66
Tall R waves in V1-V2, area and artery affected
Posterior, left circumflex/ right coronary
67
Immediate management of suspected ACS.
1. GTN 2. Aspirin 300mg 3. If O2 < 94%, then give O2 4. ECG Do not delay transfer to hospital
68
Warfarin target INRs?
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
ECG change caused by Sotalol?
QT prolongation
70
Which factors affected by Warfarin?
2,7 9, 10
71
Emergency anticoagulation reversal?
Four factor prothrombin complex concentrate 25-5- U/kg + 5mg of Vit. K iv, if on warfarin, stop warfarin

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