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Yr 5 Cardiology > Year 5 passmed > Flashcards

Year 5 passmed Flashcards

1
Q

what is a type 2 MI

A

A Type 2 heart attack happens when there is insufficient blood flow (therefore oxygen) to the heart muscle to meet the demand required at the time.

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2
Q

if blood pressure drop for long period can you damage all organs

A

yes

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3
Q

causes of syncope

A

Reflex syncope (neurally mediated)

vasovagal: triggered by emotion, pain or stress. Often referred to as ‘fainting’ - type of fainting that occurs when your body overreacts to a trigger and your blood pressure and heart rate suddenly drop - vagal nerve stimulation causes BP to drop and HR to drop

situational: cough, micturition, gastrointestinal

carotid sinus syncope

Orthostatic syncope
primary autonomic failure: Parkinson’s disease, Lewy body dementia
secondary autonomic failure: e.g. Diabetic neuropathy, amyloidosis, uraemia
drug-induced: diuretics, alcohol, vasodilators
volume depletion: haemorrhage, diarrhoea

Cardiac syncope
arrhythmias: bradycardias (sinus node dysfunction, AV conduction disorders) or tachycardias (supraventricular, ventricular)
structural: valvular, myocardial infarction, hypertrophic obstructive cardiomyopathy
others: pulmonary embolism

hypoglycaemia

summarised
Hypovolaemic
cardiogenic
distributive
obstructive vc

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4
Q

what is the consequence of taking BB and CCB together

A

heart block

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4
Q

nicorandil moa

A

relaxes coronary vascular smooth muscle by stimulating guanylyl cyclase and increasing cyclic GMP (cGMP) levels

potassium channel activator

used in treating angina

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5
Q

what drug to hold in sinus rythm - keep out of SVT

A

beta blockers

slow conduction at AV node

nearly all SVT in the nodes itself

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6
Q

A 65-year-old man with heart failure presents to his GP with some questions about some of his medications. He would like to know which of his drugs will help him to live longer and not just improve his symptoms.

A

Diuretics only improve symptoms of heart failure and have no effect on mortality

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7
Q

adults with chronic HF have a one off pnuemococal vaccine when might they need a booster every 5 yr

A

adults usually require just one dose but those with asplenia, splenic dysfunction or chronic kidney disease need a booster every 5 years

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8
Q

PCI what artery do you use

A

radial artery

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9
Q

side effects of GTN (3) -why

A

Hypotension + tachycardia + headache

he vasodilation causes hypotension (lowering of blood pressure), which can result in reflex tachycardia (increased heart rate) as the body tries to maintain adequate perfusion. Headache is also a common side effect due to the dilation of cerebral blood vessels.

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10
Q

what is takayasus arteritis

A

Takayasu’s arteritis is a large vessel vasculitis.

It typically causes occlusion of the aorta with absent limb pulse. Younger asian females

Features
systemic features of a vasculitis e.g. malaise, headache
unequal BP in the upper limbs
Carotid bruit and tenderness
absent/weak peripheral pulses
upper and lower limb claudication on exertion
aortic regurgitation (around 20%)

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11
Q

why do you get haemoptysis in mitral stensosi

A

due to pulmonary pressures and vascular congestion
may range from pink frothy sputum to sudden haemorrhage secondary to rupture of thin-walled and dilated bronchial veins

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12
Q

ix 1st line for angina pectoris

A

CT angiography

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13
Q

The ECG shows sinus rhythm, but the patient has no pulse.

A

PEA

as non shcocktabel

give adrenaline

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14
Q

when do you give adrenaline in CPR

A

adrenaline 1 mg as soon as possible for non-shockable rhythms

during a VF/VT cardiac arrest, adrenaline 1 mg is given once chest compressions have restarted after the third shock

repeat adrenaline 1mg every 3-5 minutes whilst ALS continues

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15
Q

when do you give amiodarone in CPR

A

amiodarone 300 mg should be given to patients who are in VF/pulseless VT after 3 shocks have been administered.

a further dose of amiodarone 150 mg should be given to patients who are in VF/pulseless VT after 5 shocks have been administered

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16
Q

ECG finding in pericarditis

A

PR depression

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17
Q

Witnessed cardiac arrest while on a monitor jow mnay shocks can you give

A

up to three successive shocks before CPR

unwitnessed 1

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18
Q

in STEMI Mx when do you give prasugrel or clopidorgrel in addtion to asprin before PCI depending on what conditions

A

STEMI management: if patient is having PCI then prasugrel is given in addition to aspirin. If patient is on an anticoagulant then clopidogrel used instead

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19
Q

All patients with non-ST elevation myocardial infarction should receive

A

aspirin

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20
Q

A 70-year-old woman is prescribed bumetanide for congestive cardiac failure. Where is the site of action of bumetanide? - loop iuretic

A

ascending limb

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21
Q

what electrolyte abnromality is the most common cause of a bradycardia

A

hyperkalaemia

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22
Q

feature of hyperkalaemia post peaked t waves (3)

A

PR prolongation - first degree heart block
broad QRS
bradycardic

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23
Q

what kind of defib do you need for bradycardia

A

pacing defib

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24
what drugs are contraindicated in aortic stenosis
ACEi - vasodilator effects reduction in the coronary perfusion pressure (hypotension) therefore lead to cardiac ischaemia in these patients beta blockers often avodied to
25
how does a bifasicular block present
RBBB with either left anterior fasicular block manifested as Left axis deviation or RBBB with left post fascicular block as right axis deviation predisposes you to heart failure and rhythm abnormalities
26
right reaching in terms of axis deviation
right axis deviation negative lead 1 positve lead aVF
27
causs of bifasciualr block
ischaemic heart disease aortic stenosis congential, structural hyperkalamia
28
trifasicuclar block has what 3 features
Right bundle branch block Left axis deviation (Left anterior fascicular block) Third degree heart block
29
hypotension and reflex tachycardia caused by what condition
POTS
30
Hoffman's sign
The patient holds their arm out, opens their palm down, and extends their fingers. The examiner then flicks the patient's middle fingernail A positive Hoffman's sign occurs when the thumb or index finger flexes involuntarily. This indicates that the nervous system is overreacting to the flick, which is known as hyperreflexia. seen in MS , cervical myelopaty , hypethyrodisim and anxiety
31
pulmonary hypertension caused by what
pulmoanyr arterial hypetension - idiopathic pulmonary hypertension caused by left-sided heart disease caused by lung disease blood clots
32
complications fo pulmonary hypertension
Right-sided heart enlargement and heart failure. Also called cor pulmonale, blood clots bleeding into the lugn irregualr beats
33
pulmonary hypertension ecg features
Right axis deviation Right bundle branch block Right ventricular hypertrophy QTc prolongation
34
classification for pulmonary hypertension
Pulmonary arterial hypertension (PAH) is a collective term for a group of conditions characterized by progressive elevation of the mean pulmonary arterial pressure (mPAP) to more than 25mmHg at rest or more than 30mmHg on exercise.
35
what is afterload
Afterload is the amount of pressure the heart needs to exert to pump blood out of the heart during ventricular contraction
36
what is preload
The force that stretches the heart's muscle before it contracts. It's also known as left ventricular end-diastolic pressure (LVEDP). Preload is a key factor in determining the amount of blood the heart pumps out, or stroke volume.
37
drugs that increase afterload
adrenaline
38
drugs that decrease afterload
ACEi ARB hydralazine and morphine
39
drugs that decrease preload
nitrates
40
what is conns syndrome
Conn's syndrome, also known as primary aldosteronism, is a condition that occurs when the adrenal glands produce too much of the hormone aldosterone reatment: Surgery to remove adenomas, medications to inhibit aldosterone, and lifestyle changes like a low-salt diet, limiting alcohol, and exercising regula
41
1:10000 means
1:10 000 Adrenaline (epinephrine) = 1 mg in 10mL cardiac arrest
42
what is paroxysmal af
Paroxysmal atrial fibrillation (AFib) is a type of irregular heartbeat that occurs in brief episodes, or paroxysms, that usually stop within 24 hours
43
interstil oedema of cxr
flufffy pathces - like candy floss
44
difference between dols and IMCA
The Deprivation of Liberty Safeguards are a part of the Mental Capacity Act and are used to protect patients over the age of 18 who lack capacity to consent to their care arrangements if these arrangements deprive them of their liberty or freedom. Independent Mental Capacity Advocates (IMCAs) are individuals who support people who lack the capacity to make decisions in their best interests, including those who may be subject to the Deprivation of Liberty Safeguards (DoLS)
45
hypothyroidism leading to macrocytic anaemia how
Hypothyroidism can cause anaemia because the thyroid hormone affects hematopoiesis, or the production of red blood cells Megaloblastic anaemia, which is caused by a deficiency of vitamin B12 or folate Non-megaloblastic anaemia, which can be caused by liver dysfunction, alcoholism, myelodysplastic syndrome (MDS), or certain drugs
46
qucik description of all sections
section 5(4) allows nurses to pass to doctors to hold as section 5(2) - then this allows doctors to get a proper assessment for assessment to be detained under section 2 (28days) or then section 3 (6months)
47
posterior MI what is seen on exg
tall r waves in lead V1-3
48
Intravenous drug users are at high risk of ......... ........ cardiac valvular endocarditis.
right sided
49
how long does troponin and CK-MB remain elevated
Creatine kinase (CK-MB) remains elevated for 3 to 4 days following infarction. Troponin remains elevated for 10 days. This makes CK-MB useful for detecting re-infarction in the window of 4 to 10 days after the initial insult
50
difference between time frames in dressler syndrome and pericarditis post myocaridal infarctions
Pericarditis in the first 48 hours following a transmural MI is common (c. 10% of patients). The pain is typical for pericarditis (worse on lying flat etc), a pericardial rub may be heard and a pericardial effusion may be demonstrated with an echocardiogram. Dressler's syndrome tends to occur around 2-6 weeks following a MI. The underlying pathophysiology is thought to be an autoimmune reaction against antigenic proteins formed as the myocardium recovers. It is characterised by a combination of fever, pleuritic pain, pericardial effusion and a raised ESR. It is treated with NSAIDs.
51
do you get a raised ESR in pericarditis
yes
52
acute mitral regurg may happen post myocardial infaraction when
More common with infero-posterior infarction and may be due to ischaemia or rupture of the papillary muscle. Acute hypotension and pulmonary oedema may occur
53
acute heart failure associated with a pan-systolic murmur post mi
Ventricular septal defect
54
how does a left ventricular free wall rupture present like
cardic tamponade This is seen in around 3% of MIs and occurs around 1-2 weeks afterwards. Patients present with acute heart failure secondary to cardiac tamponade (raised JVP, pulsus paradoxus, diminished heart sounds). Urgent pericardiocentesis and thoracotomy are required.
55
with persistent ST elevation and left ventricular failure post mi
left ventricular anerysm - need anticoag as risk of stroke
56
sgarbossa criteria
In patients with left bundle branch block (LBBB) or ventricular paced rhythm, infarct diagnosis based on the ECG can be difficult Concordant ST elevation ≥ 1 mm in ≥ 1 lead Concordant ST depression ≥ 1 mm in ≥ 1 lead of V1-V3 Proportionally excessive discordant STE in ≥ 1 lead anywhere with ≥ 1 mm STE, as defined by ≥ 25% of the depth of the preceding S-wave
57
vomiting cause what on acid-base distrubance hydrogen ions lost in vomit
metabloci alkalosis vomiting / aspiration (e.g. peptic ulcer leading to pyloric stenos, nasogastric suction) vomiting may also lead to hypokalaemia
58
diarrhoea causes what on acid base disturbance bicarb lost in stool
mtabolic acidosis prolonged diarrhoea: may also result in hypokalaemia bicarb
59
what blood pressure are nitrites contraindicated in
under 90
60
cardiac output hihg in what shock
septic Decreased SVR is a major feature of sepsis. A hyperdynamic circulation is often present. This is the reason for the use of vasoconstrictors.
61
difference between carduogenic shock and hypovolaemic - both have decreased CO and hgih resistance
In cardiogenic shock pulmonary pressures are often high. This is the basis for the use of venodilators in the treatment of pulmonary oedema. Cardiac output is lowered in hypovolaemia due to decreased preload.
62
tricuspid regurg often occur secondary to
pulmonary hypertension - resp issue long standing such as COPD
63
first line management of acute pericarditis involves
combination of NSAID and colchicine
64
why is flecanide not advised in strucurala heart disease
as is will cause a high proarrhythmic risk
65
1st line for angina
A beta-blocker or a calcium channel blocker is used first-line to prevent angina attacks
66
if a patient is taking both a beta-blocker and a calcium-channel blocker then only add a third drug whilst a patient is awaiting assessment for PCI or CABG what potential options
a long-acting nitrate ivabradine nicorandil ranolazine
67
A 54-year-old man with angina. allergic to asthma He is started on sublingual glyceryl trinitrate and oral verapamil, which initially relieve his symptoms. However, he returns two months later with a recurrence of symptoms, still occurring only on exertion. Which option is the best next step in his management? Add a long-acting nitrate Add atenolol Add diltiazem Refer for coronary artery bypass graft Refer for percutaneous coronary intervention
long acting nitrate
68
when might we electriclaly cardiovert someone with AF
emergency if usntabel elcdtirla or pharmacological cardioversion consideres as elective proceudre when rhtyhm control preferred New onset AF is considered for electrical cardioversion if it presents within 48 hours of presentation
69
when shoudl PCI and fibrinolysis be offered in stemi
should be offered if the presentation is within 12 hours of the onset of symptoms AND PCI can be delivered within 120 minutes of the time when fibrinolysis could have been given (i.e. consider fibrinolysis if there is a significant delay in being able to provide PCI) fibrinolysis should be offered within 12 hours of the onset of symptoms if primary PCI cannot be delivered within 120 minutes of the time when fibrinolysis could have been given
70
whta is a stokes adams attack and what rhythm normally causes it
A Stokes-Adams attack is a sudden, brief loss of consciousness caused by a dramatic drop in cardiac output due to an abnormal heart rhythm, typically resulting from complete heart block,
71
aortic dissection mx
CT angio if stable if not TOE
72
native valve endocarditis tx
IV amox If penicillin allergic, MRSA or severe sepsis vancomycin + low-dose gentamicin If prosthetic valve vancomycin + rifampicin + low-dose gentamicin if staph straight to fluclox streph is benzylpen prosetheitc valve need 3 abx fluclox gent and rif
73
Tension pneumothorax is a reversible cause of PEA in cardiac arrest resulting from trauma what is the underlying pathology why it causes a problem
cardiac outflow obstruction
74
fasciculations
ALS MND - both UMN and LMN
75
The pH is low confirming acidaemia. The pCO2 is high confirming a respiratory acidosis. The HCO3- is high confirming a partially compensating metabolic alkalosis. Since metabolic compensation takes time to occur, the very high level of bicarbonate is suggestive of a chronic respiratory acidosis, most likely due to the patients COPD.

Yr 5 Cardiology (17 decks)

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