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Yr 5 - CVS > Revision > Flashcards

Revision Flashcards

1
Q

What is Buerger’s disease AKA?

A

Thromboangiitis obliterans

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2
Q

What is Buerger’s disease?

A

A small and medium vessel vasculitis strongly associated with smoking.

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3
Q

Features of Buerger’s disease?

A

1) Raynaud’s phenomenon (discolouration of extremities with cold exposure)

2) Extremity ischemia leading to intermittent claudication (pain in legs which occurs during exercise and is relieved by rest).

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4
Q

What is the most specific ECG marker for pericarditis?

A

PR depression

There is also saddle shaped ST elevation

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5
Q

What is indicated in patients with clinical signs of heart failure and raised BNP greater than 400 pg/ml?

A

Urgent (within 2 weeks) specialist review & echo

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6
Q

Give some symptoms of acute mitral regurgitation

A

Flash pulmonary oedema:

  • acute onset shortness of breath
  • bibasal crackles
  • hypotension
  • systolic murmur
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7
Q

What 2 things should be measured when starting an ACEi?

A

Potassium levels & serum creatinine

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8
Q

What rise in creatinine and potassium is acceptable after starting an ACEi?

A

1) rise in creatinine up to 30% from baseline

2) rise in K+ up to 5.5 mmol/L

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9
Q

At what K+ level should treatment be immediately offered?

A

≥6.5 mmol/l

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10
Q

What electrolyte abnormalities can cause a long QT interval?

A

Hypokalaemia
Hypocalcaemia
Hypomagnesaemia

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11
Q

Describe the murmur in mitral stenosis

A

Mid-late diastolic (‘rumbling’)

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12
Q

Most likely infective organism in infective endocarditis in patients with no medical history?

A

S. aureus

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13
Q

Mechanism of thiazide diuretics?

A

Inhibit sodium reabsorption by blocking the Na+Cl- symporter at the beginning of the distal convulted tubule.

Hence why thiazide diuretics can cause HYPERcalcaemia.

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14
Q

Adverse effects of PPIs?

A

1) hyponatraemia, hypomagnesaemia

2) osteoporosis

3) microscopic colitis

4) increased risk of C. diff infection

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15
Q

If a patient has a BP of >/= 180/120 mmHg and no worrying signs, what is next step?

A

urgent investigation for end organ damage

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16
Q

How does a posterior MI typically present on an ECG?

A

Tall R waves V1-2

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17
Q

In what trimester are ACEi contraindicated?

A

2nd & 3rd

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18
Q

Threshold for transfusion of RBCs in patients with ACS?

A

Hb <80 g/L

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19
Q

What is most common cause of acute pericarditis?

A

Viral infection (patient may have had flu-like symptoms)

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20
Q

In AF, there is a subgroup of patients for whom a rhythm control strategy should be tried first (before rate control).

What are these exceptions?

A

1) First onset AF

2) Co-existent HF

3) Where there is an obvious reversible cause

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21
Q

If a patient has been in AF for more than 48 hours then anticoagulation should be given for at least 3 weeks prior to cardioversion.

What is an alternative?

A

An alternative strategy is to perform a transoesophageal echo (TOE) to exclude a left atrial appendage (LAA) thrombus

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22
Q

If a patient has a new BP >= 180/120 mmHg AND retinal haemorrhage or papilloedema, what is next step?

A

Admit for specialist assessment

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23
Q

ECG changes seen in TCA overdose?

A
  • sinus tachy
  • QRS widening
  • QT prolongation
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24
Q

Why is amiodarone contraindicated in TCA overdose?

A

As it prolongs the QT interval

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25
Q

Major risk factor for spontaneous intracranial hypotension?

A

Connective tissue disorders e.g. Marfan’s

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26
Q

Describe HR and BP in increased ICP?

A

1) HTN with wide pulse pressure

2) Bradycardia

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27
Q

Adverse effects of adenosine?

A
  • Feeling of doom
  • Chest pain
  • Bronchospasm
  • Transient flushing
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28
Q

Inheritance of HOCM?

A

Autosomal dominant

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29
Q

Pathophysiology of HOCM?

A

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

2) results in predominantly diastolic dysfunction: left ventricle hypertrophy –> decreased compliance –> decreased cardiac output

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30
Q

Most common cause of sudden death in HOCM?

A

Ventricular arrhythmia

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31
Q

If a patient’s AF has been going on for >48 hours, what is most appropriate action?

A

1) control rate with bisoprolol

2) anticoagulate for 3 weeks

3) then safe to electrically cardiovert

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32
Q

What is the indication for immediate electrical cardioversion in AF?

A

Acute presentation of AF plus signs of haemodynamic instability (e.g. hypotension, HF)

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33
Q

What ECG sign is considered pathognomic for cardiac tamponade?

A

Electrical alterans

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34
Q

Triad of symptoms in cardiac tamponade?

A

1) raised JVP

2) muffled heart sounds

3) hypotension

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35
Q

What abx can cause idiopathic intracranial HTN?

A

Tetracyclines

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36
Q

Which CCB is used in rate control AF (e.g. if beta blocker is contraindicated)?

A

Verapamil

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37
Q

What is considered as 3rd line therapy for HF management in Afro-Caribbean patients (i.e. not responding to ACE-inhibitor, beta-blocker and aldosterone antagonist therapy)?

A

Hydralazine & nitrate

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38
Q

What is a systemic complication of acute pancreatitis?

A

ARDS

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39
Q

Which drug is indicated as 3rd line therapy in management of HF if there is coexistent atrial fibrillation?

A

Digoxin

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40
Q

What is rapid drainage of a pneumothorax a risk factor for?

A

Re-expansion pulmonary oedema

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41
Q

How can 1ary and 2ary aldosteronism be differentiated?

A

Look at renin levels:

If renin low: 1ary cause more likely
If renin high: 2ary cause more likely

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42
Q

2nd line therapy in HF?

A

1) aldosterone antagonist

2) SGLT-2 inhibitors e.g. dapagliflozin

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43
Q

In patients with acute HF and respiratory failure, management option?

A

CPAP

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44
Q

How does liver feel in RHF?

A

Firm, smooth, tender and pulsatile liver edge

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45
Q

With an irregularly irregular pulse, what does a regular heart rate during exercise suggest a diagnosis of ?

A

Ventricular ectopics

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46
Q

When would rhythm control be offered to patients with AF (instead of rate control)?

A

1) reversible cause

2) new onset AF (<48h)

3) HF caused by AF

4) symptoms despite being effectively controlled

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47
Q

What are 3 options for rate control in AF?

A

1) beta blockers (cardio-specific)

2) CCBs (diltiazem or verapamil - not indicated in HF)

3) digoxin

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48
Q

What are 2 options for rhythm control in AF?

A

1) cardioversion
2) long-term rhythm control using medications

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49
Q

When is immediate cardioversion used in AF?

A

1) Present <48h

2) Causing life-threatening haemodynamic instability

50
Q

What are the 2 options for immediate cardioversion in AF?

A

1) electrical
2) pharmacological

51
Q

What is the drug of choice for pharmacological cardioversion in patients with structural heart disease?

A

Amiodarone

52
Q

What can be considered before and after electrical cardioversion to prevent AF from recurring?

A

Amiodarone

53
Q

What is first line option for long-term rhythm control in AF?

A

Beta blockers

54
Q

What are 3 pharmacological options for long term rhythm control?

A

1) beta blockers

2) amiodarone

3) dronedarone

55
Q

Management of paroxysmal AF?

A

Patients may be appropriate for a “pill-in-the-pocket” approach –> they take a pill to terminate their AF only when they feel the symptoms starting.

Anticoagulation based on CHA2DS2-VASc score

56
Q

What is reversing agent for apixaban and rivaroxaban?

A

Andexanet alfa

57
Q

What is the reversal agent for dabigatran?

A

idarucizumab

58
Q

Mechanism of warfarin?

A

Vitamin K antagonist - prolongs prothrombin time (PT)

59
Q

What does the INR measure?

A

Prothrombin time

60
Q

What does an INR of 2 mean?

A

An INR of 2 means the patient has a prothrombin time twice that of an average healthy adult (it takes them twice as long to form a blood clot).

61
Q

Target INR for AF?

A

2-3

62
Q

Describe CHA2DS2-VASc

A

C - CHF
H - HTN
A - Age ≥75 (2)
D - Diabetes
S - Stroke/TIA (2)

V - Vascular disease
A - Age 65-74
Sc - Sex (female)

63
Q

What is an option for patients with contraindications to anticoagulation and a high stroke risk in AF?

A

Left atrial appendage occlusion

64
Q

Which part of the QRS complex is used for synchronisation in cardioversion?

A

R wave

65
Q

Do patients who have had catheter ablation in AF still require long-term anticoagulation?

A

yes (as per CHA2DS2-VASc score)

66
Q

In hypothermia, what can rapid re-warming result in?

A

Peripheral vasodilation and distributive shock

67
Q

What is HF with preserved ejection fraction a result of?

A

Diastolic dysfunction

i.e. issue with filling of LV

68
Q

What type of valve defect typically causes chronic HF?

A

Aortic stenosis (LV straining against narrowed aortic valve)

69
Q

1st line investigation in HF?

A

NT-proBNP

(N.B. BNP and NT-proBNP can be used in HF diagnosis)

70
Q

Mx of raised vs high BNP results?

A

Raised –> arrange specialist assessment (including transthoracic echocardiography) within 2 weeks

High –> arrange specialist assessment (including transthoracic echocardiography) echocardiogram within 6 weeks

71
Q

Vaccinations in HF?

A

Annual influenza & one-off pneumococcal

COVID vaccine

72
Q

1st line medical management of chronic HF?

A

1) ACEi (as high as tolerated) / or ARB if ACEi not tolerated

+

2) Beta blocker (as high as tolerated)

+

3) Loop diuretic (for symptoms)

73
Q

What can be added in the management of chronic HF if symptoms are not controlled with ACEi and beta blocker?

A

Aldosterone antagonist e.g. spironolactone or eplerenone

74
Q

When are aldosterone antagonists used in chronic HF?

A

When there is a reduced EF and symptoms not controlled by beta blocker & ACEi

75
Q

What surgical procedure may be done in severe HF?

A

1) CRT

2) Heart transplant

76
Q

At what EF is CRT considered?

A

<35%

77
Q

What does Cardiac resynchronisation therapy (CRT) involve?

A

CRT involves biventricular (triple chamber) pacemakers, with leads in the right atrium, right ventricle and left ventricle.

The objective is to synchronise the contractions in these chambers to optimise heart function

78
Q

Define cardiac output

A

Volume of blood pumped out of heart per minut

CO = SV x HR

79
Q

Define stroke volume

A

Volume of blood pumped out of heart with each beat

80
Q

Does raised JVP indicate RHF or LHF?

A

RHF

81
Q

Action of BNP?

A

1) Vasodilator

2) Diuretic action on kidneys

82
Q

What defines cardiomegaly on a CXR?

A

Cardiothoracic ratio >0.5

I.e. when the diameter of the widest part of the heart (the widest part of the cardiac silhouette) is more than half the diameter of the widest part of the lung fields.

83
Q

What are ionotropes?

A

Medications that alter contractility of heart

84
Q

What is the most common cause of an exudative pleural effusion?

A

Pneumonia

85
Q

What is ARDS?

A

caused by the increased permeability of alveolar capillaries leading to fluid accumulation in the alveoli i.e. non-cardiogenic pulmonary oedema

86
Q

Prognosis of ARDS?

A

mortality of around 40% and is associated with significant morbidity in those who survive.

87
Q

Causes of ARDS?

A

1) infection: sepsis, pneumonia

2) massive blood transfusion

3) trauma

4) smoke inhalation

5) acute pancreatitis

6) COVID

7) cardio-pulmonary bypass

88
Q

Clinical features of ARDS?

A

Typically of an acute onset and severe:

  • dyspnoea
  • elevated RR
  • bilateral lung crackles
  • low O2 sats
89
Q

What are the 2 key investigations in ARDS?

A

1) CXR

2) ABG

90
Q

What type of pleural effusion does hepatitis cause?

A

Transudative (as causes hypoalbuminaemia)

91
Q

What type of pleural effusion does a PE cause?

A

Exudative

92
Q

Role of CPAP in acute HF?

A

1) it increases intrathoracic pressure

2) reduces venous return to the heart

3) ultimately reduces preload and pulmonary venous pressure

4) this reduction in hydrostatic pressure promotes the movement of fluid from the interstitial compartment into the vascular compartment, reducing oedema

93
Q

Max dose of ramipril?

A

10mg daily

94
Q

Max dose of bisoprolol?

A

10mg daily

95
Q

Stage II vs III of NYHA classification for HF

A

II - Normal at rest. Ordinary physical activity causes breathlessness

III - Normal at rest. Less-than-ordinary activity causes breathlessness

96
Q

What class of medication is carvedilol?

A

beta blocker (cardio specific)

97
Q

What heart valve pathology is best heard with the patient sat up, leaning forward and holding exhalation? (1)

A

Aortic regurgitation

98
Q

What examination findings suggest accelerated (or malignant) hypertension in a patient with a blood pressure above 180/120? (2)

A

1) retinal haemorrhages

2) papilloedema

99
Q

What criteria are used for diagnosing infective endocarditis? (1)

A

Modified Duke criteria

100
Q

What valve pathology can cause left ventricular dilatation? (1)

A

Aortic regurgitation

101
Q

What does the term bigeminy describe on an ECG? (1)

A

When every other beat is a ventricular ectopic

102
Q

What medical emergency may occur as a complication of pericarditis? (1)

What is the initial treatment? (1)

A

Cardiac tamponade

Pericardiocentesis

103
Q

How should cultures be performed before starting antibiotics in patients with infective endocarditis? (3)

A

1) 3 blood culture samples

2) Separated by at least 6h

3) Taken from different sites

104
Q

Which patients are offered statins for primary prevention without calculating the QRISK3 score? (2)

A

1) CKD

2) T1DM for >10 years or >40 y/o

105
Q

What murmur may be heard in hypertrophic obstructive cardiomyopathy? (1)

Where is it heard loudest? (1)

A

Ejection systolic

LLSB

106
Q

What scoring system is used to assess the severity of liver cirrhosis?

A

Child-pugh

107
Q

What scoring system is used in the assessment of suspected obstructive sleep apnoea?

A

Epworth sleepiness scale

108
Q

What is the commonest cause of P mitrale on an ECG?

A

Mitral stenosis (indicates enlarged LA)

109
Q

What cardiac defect is Quincke’s sign a clinical sign of?

A

(nailbed pulsation) –> aortic regurgitation

110
Q

Management of warfarin with INR 5-8 but no bleeding?

A

Withold 1 or 2 doses, reduce subsequent maintenance dose.

111
Q

What is the most common cause of mitral stenosis?

A

Rheumatic fever

112
Q

What does 1st line management of acute pericarditis involve?

A

NSAIDs + colchicine

113
Q

When would clopidogrel be the first-line antiplatelet for secondary prevention? (2)

A

1) PAD

2) Ischaemic stroke

114
Q

What valve pathology can cause left atrial dilatation? (1)

A

Mitral regurg

115
Q

What medications are avoided with hypertrophic obstructive cardiomyopathy? (2)

A

1) ACEi
2) Nitrates

116
Q

What medication may be used longer-term (e.g., 3 months) in patients with pericarditis to reduce the risk of recurrence? (1)

A

Colchicine

117
Q

What is the only CCB licensed for use in HF?

A

Amlodipine

118
Q

What drugs used in IBD are associated with acute pancreatitis?

A

5-ASAs

Mesalazine is worse than sulfasalazine

119
Q

When is cardiac resynchronisation therapy (CRT) indicated in HF?

A

If not responding to triple therapy –> ACEi + beta blocker + aldosterone antagonist

120
Q
A

Yr 5 - CVS (6 decks)

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