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cardiovacular > Year 4 > Flashcards

Year 4 Flashcards

1
Q

What does the S1 heart sound represent?

A

Closure of the tricuspid and mitral valves, alongside the systolic contraction of the ventricles.

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2
Q

What causes the production of an S3 heart sound?

A

Chordae tendineae stretching to their maximum, twinging.

May be due to rapid filling, or stiff, weak ventricles.

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3
Q

Can S3 be physiological?

A

Yes, in those under 40 only.

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4
Q

What occurs in S1?

A

AV valves close, meaning blood flows into ventricles and cannot return to atria.

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5
Q

What occurs in S2?

A

Blood leaves hart, with closure of semilunar valves preventing backflow of blood into the ventricles.

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6
Q

Is S4 normal?

A

No, this is always abnormal.

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7
Q

What does S4 indicate?

A

A stiff/hypertrophied ventricle - atria struggles to pass blood downwards.

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8
Q

Where can aortic valve be auscultated?

A

2nd ICS RHS of sternum

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9
Q

Where can pulmonary valve be auscultated?

A

2nd ICS LHS of sternum

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10
Q

Where can tricuspid valve be auscultated?

A

5th ICS LHS of sternum

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11
Q

Where can mitral valve be auscultated?

A

5th ICS LHS at mid-clavicular line

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12
Q

What is Erb’s point?

A

The best place to listen to all heart sounds.

3rd ICS LHS of sternim

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13
Q

How does mitral stenosis affect the left atrium?

A

Causes hypertrophy due to increased pressure to push blood through.

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14
Q

How does aortic stenosis affect the left ventricle?

A

Causes hypertrophy.

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15
Q

How does valvular regurgitation affect the preceding heart chamber?

A

The leakage of blood results in stretching of chamber due to increased volume.

Over time results in dilatation.

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16
Q

What are the 2 main causes of mitral stenosis?

A

Rheumatic heart disease
Infective endocarditis

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17
Q

Which murmur may be described as a mid-diastolic, low-pitched, rumble?

A

Mitral stenosis

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18
Q

Why does mitral stenosis cause a loud S1?

A

As thick valves require high systolic force to shut.

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19
Q

Why does mitral stenosis cause malar flush?

A

Due to backlog of blood in pulmonary circulation - as valve is stenotic. Thus, patient will have raised CO2 and will therefore vasodilate to compensate.

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20
Q

Why does mitral regurgitation cause a pan-systolic murmur?

A

As valvular incompetence may mean a backlog of blood in left side of heart, producing strain - chorda tympani stretch as much as possible.

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21
Q

What is the most common heart valve disease?

A

Aortic stenosis

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22
Q

Which murmur radiates to the carotids?

A

Aortic stenosis

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23
Q

What is a collapsing pulse associated with?

A

Aortic regurgitation

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24
Q

Which murmur radiates to the left axilla?

A

Mitral regurgitation

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25
Q

How does hypercalcaemia affect an ECG?

A

Shortened QT interval

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26
Q

Which pattern of inheritance is seen in HOCM?

A

Autosomal dominant

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27
Q

How can diabetes contribute to postural hypotension?

A

Can cause autonomic nerve dysfunction.

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28
Q

Does isosorbide mononitrate reduce mortality?

A

No, it is a long-acting nitrate.

Provides symptomatic relief only.

29
Q

How long should DOAC therapy be continued in an unprovoked PE/DVT?

A

6 months

Also applies to those developed in context of malignancy due to ongoing hypercoaguable state.

30
Q

What is the only CCB licenced for use in heart failure?

A

Amlodipine

Consider use carefully - ACEi and Beta blockers are first-line.

31
Q

What triad of symptoms are seen in right heart failure?

A

Raised JVP
Ankle oedema
Hepatomegaly

32
Q

What is the mechanism of BNP release in heart disease?

A

Strain of left ventricle triggers release.

High levels within blood are associated with a poor prognosis.

33
Q

Is raised BNP specific to heart failure?

A

No, may be due to a myriad of causes.

34
Q

What are the 2 pathologies through which chronic heart failure can develop?

A

Impaired LV contraction (systolic failure)
Impaired LV relaxation (diastolic failure)

35
Q

What is orthopnoea?

A

Shortness of breath which worsens when lying flat.

36
Q

How should heart failure be managed medically?

A

Think ‘ABAL’

ACE inhibitor
Beta blocker
Aldosterone antagonist
Loop diuretic

37
Q

When should ACE inhibitors be avoided in the context of cardiac pathology?

A

Valvular heart disease

Causes reduced perfusion of cardiac muscle.

38
Q

Which side-effect is seen in both ACE inhibitors and aldosterone antagonists?

A

Hyperkalaemia

39
Q

What should be monitored regularly in heart failure?

A

Urea and electrolytes

Due to side-effect profile of the medications used.

40
Q

What is an important cause to exclude in pyrexia of unknown origin?

A

Infective endocarditis

41
Q

What form of medication is eplerenone?

A

Aldosterone antagonist

Same drug class as spironolactone.

42
Q

Do loop diuretics improve prognosis in heart failure?

A

No, only improves symptoms.

43
Q

How is orthostatic hypotension measured?

A

After 3 minutes of standing, check BP.

If >/= 20mmHg systolic drop or 10mmHg diastolic drop - this is diagnostic.

Think ‘3, 2, 1, drop!’

44
Q

What should be carried out to screen for end-organ damage in BP> 180/120mmHg?

A

ECG
Urine dipstick
Bloods

45
Q

How should bradycardia WITH signs of shock be managed?

A

IV atropine

46
Q

What are ectopics?

A

Extra systolic beats.

Described like ‘‘one big thump’’ - these are very common.W

47
Q

What % of SVT patients resolve with vasovagal manoeuvres?

A

Around 85%

48
Q

How long should a QRS complex last?

A

<0.12s

49
Q

Which electrolyte disturbances produces flattened T waves?

A

Hypokalaemia

50
Q

How long should PR interval last?

A

0.12-0.2s

Delay suggests issue with AV node conduction.

51
Q

What is meant by Wenckebach phenomenon?

A

Progressive prolongation of PR interval until a QRS is not produced.

Also called Mobitz I.

52
Q

What leads are affected in lateral MI?

A

Leads I, aVL, V4-V6.

Circumflex artery is affected.

53
Q

What leads are affected in an anteroseptal MI?

A

Leads V1-V3.

Left anterior descending artery affected.

54
Q

What leads are affected in an inferior MI?

A

Leads II, III, aVF.

May also produce heart block.

55
Q

Which valve is most commonly affected in infective endocarditis?

A

Mitral valve

56
Q

How many positive blood cultures are needed to diagnose infective endocarditis?

A

Two - requires presence of typical causative organism.
OR
Three with atypical organism present.

57
Q

What scoring system is used in endocarditis diagnosis?

A

Modified Duke’s criteria.

58
Q

What is the most specific ECG change in pericarditis?

A

PR depression

Classically cause widespread saddle ST elevation.

59
Q

What is Kussmaul’s sign?

A

A paradoxical rise in JVP seen during inspiration.

Common in constrictive pericarditis.

60
Q

What is the first-line management of acute pericarditis?

A

NSAIDs and colchicine

61
Q

In which condition are janeway lesions seen?

A

Staph. aureus

62
Q

What form of medication is eplerenone?

A

Aldosterone antagonist - like spironolactone.

63
Q

Do loop diuretics improve prognosis in heart failure?

A

No, only improve symptoms.

64
Q

How is orthostatic hypotension measured?

A

After 3 minutes of standing, check BP.

If >20mmHg systolic drop or >10mmHg diastolic drop.

Think ‘3, 2, 1 drop’.

65
Q

What should be carried out to screen for end-organ damage in BP > 180/120mmHg?

A

ECG
Urine dipstick
Bloods

66
Q

How should bradycardia WITH signs of shock be managed?

A

IV atropine

67
Q

What are ectopics?

A

Extra systolic beats.

Described as ‘‘one large thump’’.

68
Q

What % of SVT patients resolve with vasovagal maneouvres?

A

Around 85%.

69
Q
A

cardiovacular (13 decks)

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