Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MBChB Phase 3 > Week 5: Cardiology > Flashcards

Week 5: Cardiology Flashcards

1
Q

What is a 12 lead ECG?

A

A recording of the electrical activity made from the heart on the skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does the P wave mean?

A

The heart beat is generated in the SA node, the impulse then spreads down through the atria triggering atrial contraction.
The atrial depolarisation produces the P wave

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does the PR interval mean?

A

The impulse reaches the AV node where it is delayed to allow time for ventricular filling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the QRS complex?

A

The impulse is conducted to the ventricles through the bundle branches and purkinje fibres. Ventricular depolarisation is the trigger for ventricular contraction and produces the QRS complex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the ST segment?

A

Delay as ventricular action potentials are in their plateau phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the T wave?

A

Ventricular cell repolarisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Summarise the meaning of each wave on the ECG

A 
P = Atrial Depolarisation 
PR = AV nodal delay
QRS = Ventricular depolarisation
ST = ventricular plateau 
T = Ventricular repolarisation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What do chest leads V1-4 show?

A

Electrical activity recorded from the anterior surface of the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What shows the lateral aspect of the heart?

A

V5, V6, limb leads 1, aVL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What shows the inferior surface of the heart?

A

Limb leads 2/3, aVF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the QRS axis?

A

The average direction of depolarisation of the ventricles. Determines by looking at the QRS polarity in the limb leads. Normal = -30 to +90 degrees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What should the paper speed and gain of an ECG usually be?

A

Paper speed = 25mm/s

Gain = 10mV/mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a clinical trial?

A

Evaluation of new therapeutic intervention in human volunteers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some types of trial?

A

RCT double blind placebo controlled, cluster randomised, factorial, cross over, adaptive trial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is heart failure?

A

Failure of the heart to pump blood at a rate sufficient to meet metabolic requirements of the tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some clinical effects of heart failure?

A

breathlessness, effort intolerance, fluid retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are some common causes of heart failure?

A

Coronary artery disease, MI, idiopathic, toxins, genetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the main types of heart failure?

A

HF-REF, HF-PEF, chronic (congestive), acute (decompensated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the patho-physiology of heart failure?

A

Myocardial injury - left ventricular systolic dysfunction - perceived reduction in circulating volume and pressure - neurohumoral activation - systemic vasoconstriction renal sodium and water retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the stages of the New York Heart Association Functional Classification?

A

1: no symptoms or limitation in ordinary activity
2: mild symptoms and slight limitation
3: marked limitation (even during less than ordinary activity)
4: severe limitations even at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are some investigations for heart failure?

A

ECG, CXR, echo, bloods (UEs, Cr, urea, LFT, urate), haematology, natriuretic peptides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the treatment for heart failure?

A

Beta blocker + ACE inhibitor (or ARB if pt is intolerant due to cough), digoxin, diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How is acute heart failure classified?

A 
Warm-Dry = no congestion, hypoperfusion
Cold-Dry = no congestion, hypoperfusion
Warm-Wet = congestion, no hyperperfusion
Cold-Wet = congestion, hypoperfusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the main radiographic stages of congestive heart failure?

A 
1 = redistribution of pulmonary vessels, cardiomegaly
2 = Kerley Lines, peribronchial cuffing, hazy contours of vessels
3 = consolidation, air bronchogram, pleural effusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are some signs and symptoms of myocardial infarctions?

A

Symptoms: chest pain, jaw pain, sweaty, short of breath
Signs: tachycardia, heart failure, arrhythmia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is troponin?

A

Part of cardiac myocyte, release into blood is marker of cardiac necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is an MI?

A

Elevation in troponin in clinical setting consistent with myocardial ischaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the 6 types of MI?

A 
1 = spontaneous due to primary coronary event 
2 = inc O2 demand, sec O2 supply
3 = sudden cardiac death 
4a = MI w/ percutaneous coronary intervenion
4b = MI stent thrombosis 
4 = MI w/ CABG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are some causes of chronic troponin elevation?

A

renal failure, chronic heart failure, infiltrative cardiomyopathes (eg amyloidosis, haemochromatosis, sarcoidosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is unstable angina?

A

An acute coronary event without a rise in troponin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the different ECG patterns in a STEMI?

A 
ST elevation (occlusion of coronary artery)
Posterior infarct (location means ST elevation not seen)
Left bundle branch block (new - infarction; old - obscures ST elevation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What drugs are used for secondary prevention of an MI?

A

ACE inhibitors, beta blockers, statins, eplerenone (only for diabetes and LVSD or clinical HF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are some complications of MI?

A

Arrhythmias, heart failure, cardiogenic shock, myocardial rupture, psychological

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the difference between stenosis and regurgitation?

A 
Stenosis = pressure overload
Regurgitation = volume overload
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How does cardiac injury occur in rheumatic valve disease?

A

recurrent inflammation, fibrinous repair, scarring

36
Q

What are some symptoms of aortic stenosis?

A

Shortness of breath, presyncope, syncope, chest pain, reduced exercise capacity

37
Q

What are some causes of mitral stenosis?

A 
rheumatic valve disease 
pressure overload 
dilated LA
atrial fibrillation 
pulmonary hypertension 
secondary right heart dilatation
38
Q

What is endocarditis?

A

Infection of the endocardium. It is the formation of a vegetation and results in damage to the cusp of valves

39
Q

What are 3 types of endocarditis?

A

Endocarditis in IVDUs
PVE: Prosthetic Valve Endocarditis
NVE: native valve endocarditis

40
Q

what are the 2 main signs of endocarditis?

A

Fever with a murmur

41
Q

What are some long term effects of endocarditis?

A

Immunological reaction - splenomegaly, nephritis, vasculitic lesions, clubbing
Tissue damage - valve destruction/abscess

42
Q

What is the difference between a STEMI and NSTEMI?

A

STEMI: ST elevation, coronary blocked, no flow
NSTEMI: coronary arteries partially blocked, persistent flow

43
Q

What are the pros and cons of echocardiography?

A

Pros: cheap, available, portable, no radiation
Cons: requires good acoustic window, user dependent

44
Q

What are the indications for nuclear perfusion imaging?

A

Assess ischaemia, assess ejection fraction

45
Q

What are the pros and cons of nuclear perfusion imaging?

A

Pros: availability
Cons: radiation, no structural assessment

46
Q

What are some pros and cons for cardiac CT?

A

Pros: good rule out for CAD, low risk
Cons: radiation, requires low heart rate, no functional assessment of ischaemia

47
Q

What are some indications for invasive angiography?

A

Ischaemia, primary PCI, valve assessment

48
Q

What are pros and cons for invasive angiography?

A

Pros: gold standard, option for intervention during same procedure, availability
Cons; radiation, risks (CVA, MI, contrast reaction, bleeding, death)

49
Q

What is the ASA score for?

A

To assess the physical status of a patient before surgery

50
Q

What are the stages in the ASA score?

A

1: healthy
2: mild systemic disease
3: severe systemic disease
4: severe disease/ constant threat to life
5: moribund
6: organ donor
E: emergency

51
Q

What is the METs scale?

A

MET = metabolic equivalent of task
1 MET: basal metabolic (tv)
3 METs: walking 100m flat
4 METs: walking up 1 flight of stairs/gardening
7 METs: jogging
10 METs: strenuous sport
<4 METs associated with increased peri-operative risk

52
Q

What are some peri-operative pitfalls?

A

Maintain hydration, avoid PONV, early mobilisation, give medication as appropriate, give appropriate analgesia

53
Q

What is atrial fibrillation?

A

The commonest sustained cardiac arrhythmia

54
Q

What are some symptoms of atrial fibrillation?

A

palpitation, dyspnoea, stroke (complication), pain, syncope

55
Q

What are 3 types of atrial fibrillation?

A

Paroxysmal: intermittent, starting & stopping
Persistent: needs intervention to stop arrhythmia
Permanent

56
Q

What score is used to calculate risk of stroke?

A 
CHA2DS2-VASc
Congestive heart failure 
Hypertension 
Age >75
Diabetes Mellitus 
Stroke 
Vascular disease 
Age 65-74 
Sex (female)
57
Q

What are the new oral anticoagulants

A

dabigatran (thrombin inhibitor), rivaroxaban, apixaban, edoxaban (Factor Xa inhibitors)

58
Q

What is systemic hypertension?

A

Persistent elevation in arterial blood pressure >140/90

59
Q

What is primary hyperension?

A

Hypertension with no identifiable cause. It is associated with certain risk factors: age, gender, ethnicity, smoking, obesity, alcohol

60
Q

What is secondary hypertension?

A

A raised blood pressure with an aunderlying cause. Eg Cushing’s, NSAIDs, renal artery stenosis

61
Q

What end organ damage can be a result of sustained hypertension?

A

IHD, CHD, PVD, CVA

62
Q

How would you manage hypertension?

A

lifestyle measures, pharmacological management (diuretics, ARB, vasodilator), device based therapy

63
Q

What are the differences between the left and right ventricle?

A 
RV = trabeculated endocardium, chordae, moderator band 
LV = smooth endocardium, ellipsoid cavity
64
Q

What is secundum atrial septal defect?

A

The shunt goes left to right (no cyanosis). So may lead to RV failure, tricuspid regurgitation, atrial arrhythmia

65
Q

What happens in transposition of the great arteries?

A

Rhe aorta and pulmonary arteries switch. This means the aorta is now connected to the right ventricle and the pulmonary artery is connected to the left ventricle

66
Q

What are the components of tetralogy of fallot?

A
  1. Ventricular septal defect
  2. Overriding aorta
  3. ROVT obstruction
  4. Right ventricular hypertrophy
67
Q

What is a univentricular heart?

A

A term for a congenital heart defect where there is only one effective pumping ventricle

68
Q

What is a Fontan circulation?

A

The one functioning ventricle supports systemic circulation by being disconnected from the pulmonary vein and arteries. The IVC and SVC directly connect to the pulmonary artery and is then oxygenated by the lungs

69
Q

What is part of the immediate treatment for MI?

A 
Oxygen
Morphine 10mg IV
Antiemetics (odansetron 4mg)
Clopidogrel 300mg 
Aspirin 300mg orally
70
Q

What is a STEMI?

A

Thrombus formation on a ruptured athermatous plaque in a coronary artery

71
Q

What is a primary PCI?

A

Primary Percutaneous Intervention

Treat by opening affected artery and removing plaque by balloon angioplasty and stent

72
Q

What does thrombolytic therapy involve?

A

Tenecteplase: a tissue plasminogen activator. Fibrinolytic therapy to break up thrombus in coronary artery
Heparin: anticoagulant to prevent further thrombosis

73
Q

What is the first line drug for bradycardia?

A

Atropine 600ug IV bolus

74
Q

What is the purpose of a coronary angioraphy?

A

To identify coronary artery stenoses with a view to revascularisation

75
Q

What is cardiogenic shock?

A

Severe LV damage with hypotension, heart failure and poor cardiac output

76
Q

What are some complications of acute MI?

A

arrhythmia, cardiogenic shock, LV mural thrombus, heart failure, myocardial rupture, pericarditis

77
Q

What drugs are used in secondary prevention of MI?

A

Aspirin, Ticagrelor, Statin, Beta Blocker, ACE inhibitor

78
Q

What is the immediate treatment for arterial occlusion?

A

analgesic, thrombolysis, angioplasty, stent

79
Q

What is the long term management of vascular disease?

A

statin, antihypertensives, aspirin 75mg, lifestyle changes

80
Q

What are the risk factors for peripheral vascular disease?

A

male, age over 40, smoking, hypertension, diabetes

81
Q

How do statins work?

A

They are lipid lowering drugs. They inhibit the enzyme HMG-CoA reductase so reduce cholesterol production

82
Q

How do fibrates work?

A

They reduce triglyceride levels and increase HDL cholesterol

83
Q

What are resins and how do they work?

A

They are bile acid sequestrants which lower LDL cholesterol by sequestering the cholesterol-containing bile acids into the intestine and prevent their reabsorption

84
Q

What is intermittent claudication?

A

Pain in leg brought on by walking and relieved by rest

85
Q

What is intermittent claudication?

A

Pain in leg brought on by walking and relieved by rest

86
Q

What are the signs of critical ischaemia?

A

6 P’s:

Pale, pain, pulseless, paretic, perishingly cold, paraesthetic

MBChB Phase 3 (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions