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Year 5 > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What are some features of an innocent murmur?

A

Common 1 in 3
Systolic, quiet, no radiation, not continuous, no thrill, postural variation, intensifies on increased CO (exercise, illness), rest of exam is normal

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2
Q

What is Eisenmenger syndrome?

A

When there is a congenital heart lesion such as VSD, ASD or PDA and the pulmonary pressure rises beyond the systemic causing a R-L shunt and so cyanosis

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3
Q

A patient who has a DVT has had a large stroke. What underlying defect might they have had?

A

Asymptomatic ASD

DVT is in the venous system and a stroke is in the arterial system - if it stayed n the venous - PE

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4
Q

What defects may cause ASD?

A

Patent foramen ovale (not technically one)
Ostium Secundum
Ostium Primum

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5
Q

What other conditions may be linked to PFO?

A

Migraine with aura

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6
Q

What signs might indicate a ASD?

A

Mid-systolic crescendo-decrescendo murmur, loudest at the upper left sternal border
Fixed split second heart sound (doesn’t vary with resp)

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7
Q

What murmur may be heard in VSD?

A

Pansystolic murmur heard at left lower sternal edge

May be systolic thrill

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8
Q

What are the components of tetraolgy of fallot?

A

VDS, PS, Overriding aorta, RVH

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9
Q

What is a tet spell?

tetraolgy of fallot

A

An intermittent symptomatic period where the R-L shunt gets temporarily worse precipitating cyanosis.
Brough on by physical exertion or crying - Inc PVR or dec SVR. ?inc CO2 (vasodilates)
Management - Child can squat
Infant - bring knees up to chest

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10
Q

What is the medical management of a tet spell in tetraolgy of fallot?

A

O2, IV fluids?, Beta blockers?, Morphine?, sodium bicarbonate?, Phenylephrine infusion?

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11
Q

What are the stages of the cardiac cycle?

A 
Diastole - 
1. Isovolumetric relaxation
2. Passive ventricular filling/ rapid filling
3. Diastasis
4. Atrial contraction
Systole - 
1. Isovolumetric contraction
2. Ejection
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12
Q

What might you suspected if a child has a persistent fever for >5 days?

A

RED FLAG

Kawasaki’s disease?

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13
Q

When is one of the few scenarios you would give a child Aspirin?

A

Kawasaki’s disease to reduce the risk of thrombosis

Aspirin can cause Reye’s syndrome

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14
Q

What is Kawasaki’s disease?

A

A systemic, medium vessel vasculitis
Affects children < 5
No clear cause or trigger

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15
Q

What are some features of Kawasaki’s disease?

A

Persistent high fever >5 days
Widespread erythromatous maculopapular rash, with desquamation (skin peeling) on palms and soles
Strawberry tongue (red with large papillae)
Cracked lips
Bilateral conjunctivitis, cervical lymphadenopathy

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16
Q

What is a key complication of Kawasaki’s disease?

A

Coronary artery aneurysm

Give IVIg to try reduce risk and echo monitoring

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17
Q

What might bloods show in Kawasaki’s disease?

A

Anaemia, leukocytosis, thrombocytosis, elevated LFTs, raised ESR

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18
Q

What is rheumatic fever?

A

A multisystem autoimmune condition triggered by a streptococcal infection
Commonly Group A beta haemolytic strep (e.g. strep pyogens) causing tonsilitis

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19
Q

What causes rheumatic fever?

A

Recent strep infection
Body makes ab to bacteria but it targets bodys antigen - type 2 hypersensitivity reaction
Delayed by 2-4 weeks post infection

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20
Q

What are some clinical features of rheumatic fever?

A

Delayed - 2-4 weeks after initial infection
Joints - migratory arthritis - large joints. Red, hot and swollen
Skin - SC nodules on extensor surfaces, or Erythema marginatum (pink rings on torso and prox limbs)
Cardiac - inflammation - carditis - murmur? tachy or brady? pericardial rub? HF?
CNS - Chorea

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21
Q

JONES criteria is used to diagnose Rheumatic fever, what is it?

A

Evidence of a recent strep infection (ASO ab titre) + 2 Major or 1 Major and 2 minor
Major - JONES
Joint arthritis, Organ inflammation (carditis), Nodules, Erythema marginatum, Sydenhams chorea

Minor - FEAR
Fever, ECG changes without carditis (prolonged PR?), Arthralgia without arthritis, raised inflammatory markers

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22
Q

How would you investigate for Rheumatic fever?

A

Throat swab
Anti-steptococcal antibody titre
Echo, ECG, CXR

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23
Q

How would you manage a patient with Rheumatic fever?

A

Antibiotics for strep infections - Phenoxymethylpenicillin (penicillin V) 10d
Refer to a specialist -
NSAIDs - joint pain
Aspirin and steroids - carditis
Prophylactic abx
Monitoring and management of complications - Recurrent rheumatic fever, mitral stenosis *, chronic HF

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24
Q

What are some characteristic of turners syndrome (45 XO)?

A 
Short stature
Broad chest with widely spaced nipples
Webbed neck
High arched palate 
Cubitus valgus (exaggerated angle at the elbow away from body)
Late or incomplete puberty
Infertile

Associated with - Coarctation of aorta, recurrent UTIs and Otitis media, hypothyroid, HTN, diabetes, obesity, LD?

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25
Q

What are the management options in Turners?

A

GH - to help with height
Oestrogen and progesterone - puberty
Fertility treatment

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26
Q

What is cardioplegia?

A

A K rich solution used in coronary artery surgery. It is injected into the coronary arteries and it arrests the heart without causing ischaemia. It allows for a static operatig field

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27
Q

What vessels can be used in CABG?

A

Long saphenous VEIN (aorta to diatal occlusion)

Left internal mammary artery (detach one side then attach to LAD)

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28
Q

What are some vascular phenomenons in IE?

A

Septic emboli, IC haemorrhage, conjunctival haemorrhage, Janeway lesions

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29
Q

What are some immunological phenomenons in IE?

A

Roth spots, Oslers nodes, RF, glomerulonephritis

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30
Q

What abx might you give for IE caused by Strep?

A

Benzylpenicillin ± gentamicin
Prosthetic? 6 weeks IV
Native? 4 Wks IV

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31
Q

What abx might you give in IE due to MRSA?

A

Vancomycin ± Gentamicin

32
Q

Give an example of some ACEi that are given first line for HTN in a patient < 55 or diabetic pt.

A

Captopril, Enalopril, ramipril
1.25/2.5mg OD (up to 10mg)
Contraindicated - pregnancy, renal artery stenosis, angioedema, hypotension
SE - cough, hypotension, angioedema

33
Q

What is the mechanism of ACEi in HTN?

A

Reduce aldosterone secretion, reduces ADH –> reducing fluid volume
Reduces sympathetic activity and vasoconstriction

34
Q

Give an example of a CCB used in HTN in >55 or black African patients.

A

Amlodipine 5mg OD
Interactions - CYP3A4
SE - peripheral oedema *, gingival hyperplasia, constipation, dizzy

35
Q

What is the mechanism of action of amlodipine?

A

Inhibits L type Ca channels, reducing IC ca

Relaxes vascular smooth muscle, reduces contractility and reduces SAN rate

36
Q

What thiazide diuretic can be given in HTN?

A

Indapamide 2.5mg OD
SE - erectile dysfunction, hyponatraemia and hypokalaemia, maculopapular rash, exacerbate gout
Monitor - U&Es, Na, K

37
Q

How does Indapamide work?

A

Inhibits Na/ Cl co-transporter at DCT, inhibiting water reabsorption allowing more to be excreted
Peripheral vasodilation

38
Q

Beta blockers can be used after A + C + D if HTN is still not effectively controlled, give an example and some cautions and SE.

A

Bisoprolol 5mg OD
CAUTION- Asthma, COPD, don’t give with CCB
SE - erectile dysfunction, cool peripheries, bradycardia, headache

39
Q

How do beta blockers work?

A

Strong for beta 1 - reduce HR (negatively Chronotropic) and contractility (negatively Inotrophic), reduces renin release
Low affinity for beta 2 - vasodilation of vascular and bronchial sm

40
Q

What dose of furosemide can you give?

A

20-40mg OD but can give up to BD

Monitoring of U&Es

41
Q

What are some side effects of furosemide?

A

Acute gout, renal failure, electrolyte abnormalities

42
Q

What is the MoA of furosemide?

A

Acts of Na/Cl/K on the loop of henle - reducing water reabsorption
Monitor U&Es (K!)

43
Q

What spironolactone dose can you give?

A

25mg PO OD, up to 400mg MAX

CONTRAINDICATIONS - Hyperkalaemia, Addisons disease

44
Q

What advice should you give to someone with HOCM

A

Try and avoid doing bursts of activity or heavy lifting

45
Q

What medications should you AVOID in HOCM?

A

Digoxin, dilators, diuretics

46
Q

What is HOCM?

A

LV outflow tract obstruction due to asymmetrical sepatal myomectomy
AD? or mutation to myosin, alpha tropomyosin or troponin I
FHX of sudden cardiac death
May not have sx until strain is put on the heart

47
Q

What murmur may be heard in HOCM?

A

Harsh ejection systolic crescendo-decrescendo

Dute to diastolic dysfunction

48
Q

What is used in the immediate management of a STEMI?

A

MONAD
Morphine - pain relief
O2 if sats <94%
Nitrates to improve blood flow to myocardium
Antiemetics - metaclopromide
Dual antiplatlete - 300mg Aspirin + 180mg ticagrelor/ 300mg clopidogrel

49
Q

What reperfusion therapy is used in STEMI?

A

Within 120min of ECG diagnosis - Percutaneous coronary intervention - balloon angioplasty and stenting
Thrombolysis

50
Q

What is the long term management after an NSTEMI or STEMI?

A

Risk factor modifications
Cardiac rehabilitation - education, improving quality of life and psychological well being
ACEi, statin, BB, Aspirin (+ for 6-12m Clopidogrel or ticagrelor)

51
Q

How can you estimate the 6 month mortality from an NSTEMI?

A

GRACE score - Can help decide if to intervene with catheterisation or stenting

52
Q

What dose of morphine would you give in acute management of STEMI and what does it do?

A

5-10mg IV
Rapid pain relief ~5min
Acts on mu receptors to reduce neuronal excitability and pain transmission

53
Q

What are some contraindications to morphine?

A

Acute respiratory depression

Head injury

54
Q

What does of antiplatelets should be given for long term after a STEMI?

A

75mg aspirin life long

90mg ticagrelor for ~3 months

55
Q

What is the MoA of digoxin?

A 
Negatively chronotrophic (reduces HR), positively inotropic (increased force of contraction)
Reduces AVN conduction and so reduces Ventricular rate
56
Q

Due to digoxin toxicity, you need to check a serum level, what time should you do this after a loading dose?

A

6 hours take a serum level

Loading ~500micrograms, then maintenance ~125-250micrograms daily

57
Q

What does Warfarin do?

A

Vitamin K antagonist - inhibits formation of vit K dependent factors - 2,7,9,10 and also protein C and S

58
Q

What do you need to consider when prescribing warfarin?

A

INR monitoring (2-3)
It is reversible!
Has lots of interactions
Bleeding risk!!

59
Q

What criteria fits with a transudate?

A

High glucose, high pH (alkaline), low LDH, low protein, low cells
Due to increased hydrostatic pressure

60
Q

What criteria fits with exudate?

A

Low glucose, low pH, high protein, high LDH, lots of cells

Due to inflammation and so increased capillary permeability

61
Q

What is lights criteria?

A

IF any are true its an exudate:
Pleural fluid: serum LDH >0.6
Pleural fluid : serum protein >0.5
Pleural fluid LDH>2/3 the upper limit of normal

62
Q

What is the MoA of beta 2 agonists?
Salbutamol, terabutaline
Salmeterol, formeterol

A

Specific for pulmonary beta 2
Stimulate adenyl cyclase
Increases IC cAMP
Relaxing bronchial smooth muscles

63
Q

Give some SE of beta 2 agonists.

A

Hypokalaemia, tremor, hyperglycaemia, muscle cramps

64
Q

What is the MoA of ICS?

A

Suppress multiple pro-inflammatory genes

Budesonide, fluticasone

65
Q

What is the action of Muscarinic antagonists?

A

Bind to M1 and M3
M1 - directly counteracts bronchoconstriction
M3 - increased NO, causing vasodilation

66
Q

What are some SAMAs and LAMAs?

A

SAMA - Ipratropium bromide

LAMA - Tiotropium, glycopyrronium

67
Q

What are Methylxanthines Moa?

A

Non-selective inhibitors of phosphodiesterase, increasing IC cAMP relaxing bronchial smooth muscle
Immunomodulatory - improving mucociliary clearance and anti-inflammatory effects

68
Q

What is the MoA of magnesium sulphate?

A

Relaxes smooth muscle, inhibits release of histamine from mast cells and acetylcholine release from nerve endings

69
Q

What are some SE of magnesium sulphate?

A

Hypermagnesaemia, muscle weakness, respiratory failure

70
Q

What drugs can be used in prophylaxis for exercise induced asthma or allergic rhininitis?

A

Used for MAINTENANCE not acute!!!
Leukotriene receptor antagonists - Montelukast, Zifirlukast
Reduce airways oedema and smooth muscle contraction

71
Q

What is the MoA of omalizumab?

A

4wkly SC
Monocloncal Anti-IgE
SE - hypersensitivity reaction

72
Q

What is the MoA of mepolizumab?

A

4wkly SC
Anti-IL5 monoclonal antibody, reducing eosinophil production
SE - headache

73
Q

What criteria must be reached before discharging a patient who had an asthma exacerbation?

A 
Been stable on discharge medication for 24 hours
Had inhaler technique checked
PEF >75% predicted
Steroids and bronchodilator therapy 
Their own PEF meter and management plan
GP appointment within 1 week
Resp appointment within 4 weeks
74
Q

What is the MoA of Roflumilast?

A

It is used to reduce COPD exacerbations

It selectively inhibits phosphodiesterase 4 and increases IC cAMP. This reduces the release of proinflammatory mediators and cytokines.

75
Q

What is the MoA of Azithromycin?

A

Reduces exacerbations of COPD

macrolide antibiotic
Inhibits proinflammatory cytokines and mucin release

76
Q

What is the MoA of carbocystine?

A

Reduces exacerbations of COPD

mucolytic
Reduces mucous viscosity and improves mucociliary clearance

77
Q

What is the management in COPD?

A 
Smoking cessation
Saba or sama 
Laba or lama
Laba + lama or laba + ics
Laba + lama + ics
\+ macrolide or theophylline

Year 5 (9 decks)

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