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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

23
Q

what kind of defib do you need for bradycardia

A

pacing defib

24
Q

what drugs are contraindicated in aortic stenosis

A

ACEi - vasodilator effects reduction in the coronary perfusion pressure (hypotension) therefore lead to cardiac ischaemia in these patients

beta blockers often avodied to

25
Q

how does a bifasicular block present

A

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
Q

right reaching in terms of axis deviation

A

right axis deviation
negative lead 1
positve lead aVF

27
Q

causs of bifasciualr block

A

ischaemic heart disease
aortic stenosis
congential, structural
hyperkalamia

28
Q

trifasicuclar block has what 3 features

A

Right bundle branch block
Left axis deviation (Left anterior fascicular block)
Third degree heart block

29
Q

hypotension and reflex tachycardia caused by what condition

A

POTS

30
Q

Hoffman’s sign

A

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
Q

pulmonary hypertension caused by what

A

pulmoanyr arterial hypetension - idiopathic
pulmonary hypertension caused by left-sided heart disease
caused by lung disease
blood clots

32
Q

complications fo pulmonary hypertension

A

Right-sided heart enlargement and heart failure. Also called cor pulmonale,
blood clots
bleeding into the lugn
irregualr beats

33
Q

pulmonary hypertension ecg features

A

Right axis deviation
Right bundle branch block
Right ventricular hypertrophy
QTc prolongation

34
Q

classification for pulmonary hypertension

A

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
Q

what is afterload

A

Afterload is the amount of pressure the heart needs to exert to pump blood out of the heart during ventricular contraction

36
Q

what is preload

A

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
Q

drugs that increase afterload

A

adrenaline

38
Q

drugs that decrease afterload

A

ACEi
ARB
hydralazine and morphine

39
Q

drugs that decrease preload

A

nitrates

40
Q

what is conns syndrome

A

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
Q

1:10000 means

A

1:10 000 Adrenaline (epinephrine) = 1 mg in 10mL
cardiac arrest

42
Q

what is paroxysmal af

A

Paroxysmal atrial fibrillation (AFib) is a type of irregular heartbeat that occurs in brief episodes, or paroxysms, that usually stop within 24 hours

43
Q

interstil oedema of cxr

A

flufffy pathces - like candy floss

44
Q

difference between dols and IMCA

A

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
Q

hypothyroidism leading to macrocytic anaemia how

A

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
Q

qucik description of all sections

A

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
Q

posterior MI what is seen on exg

A

tall r waves in lead V1-3

48
Q

Intravenous drug users are at high risk of ……… …….. cardiac valvular endocarditis.

A

right sided

49
Q

how long does troponin and CK-MB remain elevated

A

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
Q

difference between time frames in dressler syndrome and pericarditis post myocaridal infarctions

A

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
Q

do you get a raised ESR in pericarditis

A

yes

52
Q

acute mitral regurg may happen post myocardial infaraction when

A

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
Q

acute heart failure associated with a pan-systolic murmur post mi

A

Ventricular septal defect

54
Q

how does a left ventricular free wall rupture present like

A

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
Q

with persistent ST elevation and left ventricular failure post mi

A

left ventricular anerysm - need anticoag as risk of stroke

Yr 5 Cardiology (17 decks)

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