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Cardiology Flashcards

1
Q

Name 3 modifiable and 3 non modifiable risk factors of an ACS?

A

Modifiable: smoking, hypertension, DM, hyperlipidaemia, obesity, sedentary life style

Non-modifiable: age, male, FHx of IHD

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2
Q

Name 4 symptoms of an ACS?

A 
Central chest pain
Nausea
Sweatiness
Dyspnoea
Palpitations
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3
Q

Which tests would you order in a suspicion of ACS? 4 things

A 
Glucose-hyperglycaemia 
FBC-platelets, anaemia
ECG-ST elevation
CXR-oedema, Cardiomegaly 
Cardiac enzymes-cardiac troponins T & I, creatine kinase
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4
Q

Give 5 aspects of managing an ACS?

A 
Attach ECG
O2 15L aiming for 95%
IV Access
Morphine IV + antiemetic
Aspirin 
Nitrites (GTN spray)
DVT prophylaxis-Clopidogrel/Dalteparin

PCI or thombolysis

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5
Q

What is the criteria for thrombolysis in ACS?

A
  • ST elevation >1mm in 2 or more limb leads OR >2mm in 2 or more chest leads
  • New LBBB
  • Posterior changes
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6
Q

Give 5 contraindications for thrombolysis?

A 
Internal bleeding past 4 weeks
Recent surgery 3 weeks
Hypertension 200/120
Previous allergic reaction
Recent haemorrhagic stroke 3 months
Oesophageal varices
Trauma
Pregnancy
Active peptic ulcer disease
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7
Q

Give 2 thrombolysing agents that could be used in ACS?

A

Streptokinase (don’t repeat unless within 4 days due to immunity development)
Alteplase

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8
Q

What is involved in the long term management of an ACS? 3 things

A 
DVT Prophylaxis until fully mobile
Aspirin 
Beta blockers
ACEi
Statin (simvastatin)
Address modifiable risk factors
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9
Q

What is the door to needle time in relation to ACS?

A

Treat MI within 36 minutes

From seeing ST elevation to PCI/Thrombolysis should be 36mins

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10
Q

What is bradycardia and how might you treat it?

A

<40bpm without symptoms

Atropine OR
Pacing wire

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11
Q

What is narrow complex tachycardia?

A

> 100bpm

QRS <120ms=3 small boxes

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12
Q

Give 3 options for managing SVT?

A

Vagal manoeuvres
IV Adenosine
IV Verapamil
DC Cardioversion

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13
Q

What are the complications of a STEMI? 5 things

A 
SPREAD butter
Sudden death
Pump failure/Pericarditis
Rupture papillary muscles/septum
Embolism
Aneurysm/Arrhythmias
Dressler's syndrome
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14
Q

What is the difference between SVT an VT?

A

SVT slowed or terminated by vagal manoeuvres/adenosine
SVT has atrial and ventricular coupling

VT has independent atrial activity
VT can contain fusion/capture beats

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15
Q

Give 6 causes of AF?

A 
Heart failure
MI
Hypertension
Valve disease
PE
Pneumonia
Hyperthyroidism
Alcohol/Caffeine
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16
Q

What is the CHA2DS2VAS score?

A

Assesses the risk of a thrombo-embolic stroke in AF patients

Congestive Heart failure
Hypertension
Age >75 = 2 points
Diabetes
Systemic embolic event (stroke/TIA) = 2 points
Vascular disease
Age > 65
Sex (female)
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17
Q

Give 5 symptoms of Left sided HF?

A 
Dyspnoea
Fatigue
Orthopnoea
PND
Cold peripheries
Weight loss
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18
Q

Give 3 symptoms of right sided HF?

A

Peripheral oedema
Ascites
Nausea
Epistaxis

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19
Q

Name 3 investigations in HF?

A

Bloods: BNP
CXR: Cardiomegaly, dilated upper lobe vessels, alveolar shadowing etc.

Echocardiography: LV dysfunction, cause

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20
Q

How is the diagnosis of HF made?

A

Using the Framingham criteria

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21
Q

What are the changes seen on CXR in HF?

A 
Alveolar oedema
B lines (interstitial oedema) 
Cardiomegaly
Dilated upper lobe vessels
Effusion (pleural)
22
Q

What are the 3 common causes of HF?

A
  • Ischaemic heart disease
  • Non-ischaemic dilated cardiomyopathy
  • Hypertension
23
Q

What are the pathophysiological changes seen in HF? 4 things

A 
Ventricular dilatation
Myocyte hypertrophy
Increased ANP
Salt and water retention
Sympathetic stimulation
Peripheral vasoconstriction
24
Q

What is starlings law?

A

The greater the volume of blood entering the heart during diastole, the greater the volume ejected during systolic contraction

25
Q

What are some non pharmo and non surgical managements for HF? 3 things

A 
Low level exercise
Weight loss
Low salt diet
Stop smoking
Vaccination
26
Q

What are the medical options for treating HF? 4 things

A 
DABS-DN
Diuretics (furosemide)
ACEi
Beta blockers
Spiranolactone
Digoxin
Nitrates
27
Q

Name 3 surgical options for HF?

A

Revascularization
Pacemaker/ICD
Heart transplant
Left ventricular assist device

28
Q

Give 2 organisms that can cause infective endocarditis?

A

Strep viridans

Staph aureus

29
Q

What is the minor criteria in Dukes criteria for diagnosing endocarditis?

A 
Minor
•Predisposition
•Fever
•Vascular/immunological signs
•Positive blood culture (not meeting major)
•Positive echo (not meeting major)
30
Q

What is the empirical treatment of endocarditis?

A

Ben Pen and Gentamicin

31
Q

What is the characteristic symptom of pericarditis?

A

Chest pain worse on inspiration/lying flat

Eased on sitting forward

32
Q

What is the major criteria in Dukes criteria for diagnosing endocarditis?

A

Major
•Positive blood culture
2 separate cultures same organism
3 cultures positive

•Evidence of endocardial involvement
Positive echo
New valve regurgitation

33
Q

Name 3 pre existing diseases that could predispose to endocarditis?

A

Congenital heart disease
Rheumatic heart disease
Cardiac valve anomalies
Artificial heart valves

34
Q

Which coronary arteries are compromised in anterior, lateral, posterior and inferior MIs?

A

Anterior=Left artery descending artery
Lateral=Left Circumflex artery
Posterior=Right or Left Circumflex artery
Inferior=Right coronary artery

35
Q

Give 4 common causes of secondary hypertension?

A 
Renal artery stenosis
COCP
Diabetes
Cushing's disease
Pregnancy
Conns syndrome
36
Q

Give 3 causes of aortic stenosis?

A

Calcification of valve
Congenital aortic stenosis
Rheumatic fever

37
Q

Which class of medications can you use to manage high cholesterol?

A

Statins
Fibrates
Ezetimibe

38
Q

In Pericarditis, what 2 abnormalities might be heard on auscultation?

A

Muffled heart sounds

Pericardial rub

39
Q

What is the characteristic ECG change in pericarditis?

A

Saddle shaped ST segment through most of the leads

40
Q

What is the CXR change seen in pericarditis?

A

Globular heart

41
Q

Name 2 medications involved in the long term management of AF?

A

Digoxin
Beta blockers
Warfarin

42
Q

Give 3 complications an AF patient is at risk of?

A

PE
Stroke
TIA
Collapse

43
Q

Give 2 congenital cardiac causes of cyanosis?

A

Transposition of great arteries
Truncus arteriosus
Tricuspid atresia
Tetralogy of fallot

44
Q

What is tetralogy of fallot?

A

Ventricular septal defect
Pulmonary stenosis
Over riding aorta
Right ventricular hypertrophy

45
Q

Give 3 examples of narrow complex tachycardias?

A

Sinus tachycardia

Supraventricular tachycardia: Atrial Fibrillation, Atrial flutter, Atrial tachycardia

46
Q

How do you manage narrow complex tachycardia? 3 things

A

DC cardioversion if haemodynamically compromised
Vagal manœuvres
Adenosine

47
Q

Give 2 shockable and non shockable rhythms?

A

Shock: VF and pulseless VT

Non shock: Pulseless electrical activity and asystole

48
Q

Give 4 indications for a permanent pacemaker?

A

Symptomatic bradycardias
Persistent AV block post MI
Drug resistant tachyarrythmias
Heart block: 2nd degree (type II) or 3rd degree

49
Q

Give 3 causes of aortic regurgitation?

A

Rheumatic fever
Congenital valve disease
Infective endocarditis

50
Q

Give 3 ECG changes seen in MI in order from earliest?

A

Hours: Hyperacute T waves, ST elevation, New LBBB
Days: T wave inversion
Weeks: Pathological Q waves

51
Q

What are the drugs involved in management of Angina? 6 of them

A 
ABC-KNS
Aspirin
Beta blocker (atenelol)
Calcium channel blockers (amlodipine)
Potassium channel activator (nicorandil)
Nitrates (GTN spray)
Statin

Medicine (17 decks)

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