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Vasvular Flashcards

1
Q

Three characteristics of stable angina

A

squeazing, crushing sensation in chest

1) precipitated by stress or exercise
2) relieved by rest or nitrates
3) recover lasts less than 15 min

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2
Q

ECG findings in pericarditis

A

Saddle shaped ST elevation

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3
Q

Systolic ejection murmur

A

Pulmonary stenosis

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4
Q

Type A vs type B aortic dissection

A

Type A: ascending aorta or arch

Type B: the rest

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5
Q

Treatment for haemodynamically unstable AF.

A

Synchronised cardioversion

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6
Q

How does GTN spray work

A

Forms free NO which increases cGMP in smooth muscle and toner tissues, leading to decreased intracellular calcium and vasodilation

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7
Q

Hypertension levels

A

140/90 or 135/85

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8
Q

Mid systolic click, late systolic murmur

A

Mitral prolapse

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10
Q

Medical management of MI pre PCI

A 
MONA
Metoclopramide
Opiates/oxygen 
GTN
Aspirin 
Plus antiplatelet
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11
Q

5H and 4T of pulseless cardiac arrest

A

Hypovolaemia, hypoxia, hydrogen ions (acidosis), hyper/hypokalaemia, hypothermia
Toxins (tricyclics, cocaine), tamponade, tension pneumo, thrombosis

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12
Q

First line medication for 2nd degree block

A

Atropine

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13
Q

Diastolic murmur, pounding heart when lying on left side. Best heard at right parasternal edge

A

Aortic regurgitation

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14
Q

Gold standard investigation for unstable angina

A

Coronary angiography (if GRACE risk >3%) with PCI if indicated

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15
Q

Risks in AF

A

Stroke, HF. Consider anticoagulation using CHADS.

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16
Q

Medical management of heart failure and effects of medications

A

Loop diuretics: increase sodium and water excretion in the ascending loop of henle.
ACE inhibitors usually started first, then add a beta blocker.
If intolerant to ACE, can give Angiotensin II blockers instead.
Add an aldosterone antagonist (e.g. spironolactone if needed).

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17
Q

Indications for PCI in MI

A

Presentation within 12h and PCI can be delivered within 120min of time when fibrinolysis could have been given,

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18
Q

Diastolic murmur, loud P2, pink cheeks

A

Mitral stenosis

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19
Q

Management of aortic dissection

A

Type A usually always need surgical repair.

Type B can be conservative management, with fastidious blood pressure control (b blockade, sodium nitroprusside).

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21
Q

Investigations in stable angina

A

If 1 characteristics, do ecg and check if abnormal. If it is or 2 + characteristics, do ecg and CTPA.

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22
Q 
Arteries blocked in:
Buttock and hip
Thigh
Upper 2/3 calf 
Lower 1/3 calf 
Foot
A 
Buttock and hip: iliac / aorta
Thigh: common femoral
Upper 2/3 calf: superficial femoral 
Lower 1/3 calf: popliteal
Foot: tibial/ peroneal
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22
Q

When to reverse anticoagulation in warfarin asymptomatic patient

A

INR > 8

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23
Q

Mid-late systolic murmur, crescendo decrescendo pattern, slow rising pulse, carotid radiation

A

Aortic stenosis

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24
Q

What investigations to perform in atrial fibrillation

A

ECG, cardiac enzymes (exclude MI), Sats to check for shock. If patient is going to have cardio version (synchronised on R wave), a transesophageal echo is required to check for any thrombus which may be dislodged during procedure

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25
Q

Second degree type I and II block and II:I block

A

Type I: lengthening PR
Type II sudden non progressive lengthening of PR interval and block of QRS complex.
2:1 block is 2 p wave for each QRS

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27
Q

management of patients with QRISK >10%

A

Offer: atorvastatin 20mg. If existing CV disease, atorvastatin 80mg.

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28
Q

When is surgical valve replacement/ repair indicated

A

LVEF <50%, end diastolic volume >75 or end systolic volume >55

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28
Q

First line investigation in AAA suspicion

A

Abdo US

29
Q

What medication should be avoided with b blockers

A

Verapamil

30
Q

Post MI medications

A 
B blocker
Ace inhibitor/ ang II 
High dose statin 
PPI 
Aspirin (life) + second clopidigrel (min 12 months)
31
Q

Common cause of endocarditis in IV drug users

A

Coagulase negative streptococci

31
Q

Antihypertensive managements

A

55+ or black: Ca channel blocker (e.g. ramipril)
55- and white or renal impairment: start ACE inhibitor (e.g. verapamil)

Second line add the other one. Consider ACE + thiazides diuretic.

B blocker if concomitant heart failure

32
Q

Absence of P wave with irregularly irregular ventricular rhythm and chaotic atrial rhythm

A

Atrial fibrillation

33
Q

Pan systolic murmur at the apex radiating to the axilla, AF.

A

Mitral regurgitation

34
Q

CHADVASC score

A

Used for stroke risk in patients with AF

C congestive heart failure
H hypertension
A2 age (65+ 1, 75+ 2)
D diabetes
S2 previous stroke/ thromboembolic disease
VA: vascular Hx, prior MI, peripheral artery disease, aortic plaques.
S: sex (females get a point)

Anticoagulation if 1+ in males and 2+ in females

35
Q

What artery supplies the anteroseptal heart

A

Left anterior descending

36
Q

What artery supplies the lateral heart

A

Left circumflex

37
Q

What artery supplies the inferior aspect of the heart

A

Right coronary artery

38
Q

What artery supplies the anterolateral aspect of the heart

A

Left anterior descending or left circumflex

39
Q

What artery supplies posterior aspect of the heart

A

Left circumflex/ right coronary

40
Q

CHADVASC score

A

Used for stroke risk in patients with AF

C congestive heart failure
H hypertension
A2 age (65+ 1, 75+ 2)
D diabetes
S2 previous stroke/ thromboembolic disease
VA: vascular Hx, prior MI, peripheral artery disease, aortic plaques.
S: sex (females get a point)

41
Q

What artery supplies the anteroseptal heart

A

Left anterior descending

42
Q

What artery supplies the lateral heart

A

Left circumflex

43
Q

What artery supplies the inferior aspect of the heart

A

Right coronary artery

44
Q

What artery supplies the anterolateral aspect of the heart

A

Left anterior descending or left circumflex

45
Q

What artery supplies posterior aspect of the heart

A

Left circumflex/ right coronary

46
Q

Molecule which is highly expressed in atherosclerosis

A

Vascular cell adhesion molecule (VCAM-1)

47
Q

Causes of pericarditis

A

Common in patients with transmural MI, neoplasms, male sex. Dressler’s syndrome is common 2-6 weeks following an MI, autoimmune mediated

48
Q

Signs and symptoms of pericarditis

A

Retrosternal chest pain worst on lying down and inspiration, pericardial friction rub can be heard, fever.

49
Q

Explain ventricular free wall rupture

A

Occurs 1-2 weeks after MI. Patients present with acute heart failure due to cardiac tamponade (raised JVP, pulses paradoxus, diminished heart sounds). Urgent pericardiocentesis and thoracotomy

50
Q

Explain ventricular septal defect in MI

A

Rupture of the interventricular septum, occurs 1-2 weeks after an MI. Patient will present with acute heart failure with a pan systolic murmur. Surgery and echo are warranted.

51
Q

Common complication of infero- posterior infarction

A

Acute mitral regurgitation - due to ischaemia and rupture of papillary muscles.

52
Q

Molecule which is highly expressed in atherosclerosis

A

Vascular cell adhesion molecule (VCAM-1)

53
Q

Causes of pericarditis

A

Common in patients with transmural MI, neoplasms, male sex. Dressler’s syndrome is common 2-6 weeks following an MI, autoimmune mediated

54
Q

Signs and symptoms of pericarditis

A

Retrosternal chest pain worst on lying down and inspiration, pericardial friction rub can be heard, fever.

55
Q

Explain ventricular free wall rupture

A

Occurs 1-2 weeks after MI. Patients present with acute heart failure due to cardiac tamponade (raised JVP, pulses paradoxus, diminished heart sounds). Urgent pericardiocentesis and thoracotomy

56
Q

Explain ventricular septal defect in MI

A

Rupture of the interventricular septum, occurs 1-2 weeks after an MI. Patient will present with acute heart failure with a pan systolic murmur. Surgery and echo are warranted.

57
Q

Common complication of infero- posterior infarction

A

Acute mitral regurgitation - due to ischaemia and rupture of papillary muscles.

58
Q

Troponin complex binding site

A

Troponin C: binds to calcium to activate muscle contraction (cardiac and skeletal)
Troponin T: binds tropomyosin to form complex
Troponin I: binds to actin to hold the complex in place.

T and I are specific markers of myocardial necrosis

59
Q

Wolff Parkinson white syndrome ECG

A

Short PR, delta wave (slurred upstroke QRS). Axis deviation on opposite side of accessory pathway

60
Q

Explain BNP and significance of levels

A

BNP gets released in heart failure due to increased filling pressure. It has diuretics natriuretic and antihypertensive.

BNP: <35
NT pro-BNP: <125

61
Q

When would you recommend cardiac desynchronisation therapy defibrillator?

A

In HF with LVEF <35 despite treatment and sinus rhythm LBBB QRS duration >130ms

62
Q

What is Af

A

AF is chaotic electrical excitation within the atrium, with sites producing depolarization that sometimes conduct to the ventricle leading to irregularly irregular pulse

63
Q

Common area for clot formation in af

A

Atrial appendage

64
Q

Organism causing rheumatic fever

A

Streptococcus pyogenes (group A streptococcus gram +)

65
Q

3 electrolyte causes of long QT

A

Hypokalaemia, hypocalcaemia, hypomagnesemia

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