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A final year of medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

When is thrombolysis used instead of PCI?

A

If it would be impossible to deliver PCI within 120 minutes of the time that thrombolysis could be given

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2
Q

Do you need to await troponin before treating STEMI?

A

No!

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3
Q

How does Ebstein’s anomaly present?

A

Presents in childhood and young adulthood with fatigue, palpitations, cyanosis and SOB on exertion, due to abnormalities of RV and tricuspid. May be tricuspid regurg. on auscultation, first heart sound may be widely split.

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4
Q

ECG in Ebstein’s?

A

RBBB and signs of atrial enlargement (tall, broad P waves)

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5
Q

Causes of prolonged PR?

A

Normal variant, medications (digoxin, B-blockers, CCBs), electrolyte derangement (hyperkalaemia), post MI

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6
Q

ECG in HCM?

A

May include LVH, ST or T wave changes, arrhythmias etc.

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7
Q

Presentation of HCM?

A

SOB, syncope, palpitations, incidentally, or with SCD

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8
Q

Hypertension in young, high sodium and low potassium?

A

Aldosterone-secreting adrenal adenoma or renal artery stenosis. Do aldosterone-to-renin ratio: in renal artery stenosis both renin and aldosterone elevated, while in hyperaldosteronism get suppressed renin

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9
Q

Investigating hyperaldosteronism?

A

Do aldosterone-to-renin ratio, not aldoesterone alone. Once confirmed as high aldo and suppressed renin, do CT or MR of adrenals (only after bloods to avoid incidentalomas). Then adrenal vein sampling if needed.

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10
Q

Two causes of renal artery stenosis?

A

FMD and atherosclerosis

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11
Q

Patho of renal artery stenosis?

A

Get reduced renal blood flow so increased renin and aldo to increased flow

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12
Q

ECG features of posterior MI?

A

STD and tall R waves in V1 and V2

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13
Q

Causes of low-voltage QRS?

A

Dampening of fat, fluid or air. E.g. obesity, pericardial or pleural effusions, pneumothorax or emphysema

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14
Q

ECG findings in PE?

A

Most commonly sinus tachy, 20% have S1Q3T3, others include RV strain, RBBB, P pulmonale

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15
Q

Two types of WPW?

A

Type A causes positive R wave in V1 (left AV connection), type B causes negative R wave in V1 (right AV connection)

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16
Q

Classification of HF?

A

NYHA classification, I-IV. IV is symptoms at rest. I is no limitation of ordinary physical activity.

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17
Q

ECG findings of high K+?

A
  1. Tall tented T waves
  2. Broad QRS
  3. Prolonged PR
  4. Flattened P wave
  5. VT/VF/sine wave
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18
Q

ECG findings of low K+?

A
  1. Increased amplitude and width of P wave
  2. T wave flattening and inversion
  3. ST depression
  4. Prominent U waves
  5. Prolonged PRi
  6. SVT and tachycarrhythmias, ventricular ectopic and ventricular arrhythmias
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19
Q

Murmur in HCM?

A

Ejection systolic, decreased by squatting (septum hypertrophies to cause LVOT) and reduced CO. Squatting means bigger LV so less obstruction and murmur decreased

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20
Q

Squatting and murmurs?

A

Usually makes them louder by increased preload and afterload

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21
Q

Signs of HCM?

A

Ejection systolic murmur, decreased by squatting, jerkyl pulse, double apex beat

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22
Q

Inheritance of HCM?

A

AD

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23
Q

Murmur in AR?

A

Early diastolic, heard best at LLSE with patient leaning forward at end of expiraiton

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24
Q

Three conditions causing pansystolic murmurs?

A

MR, VSD, tricuspid regurg.

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25
Q

What are the two pericardial sinuses?

A

Transverse sinus (behind great vessels emerging from ventricles, in front of SVC) and oblique sinus

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26
Q

Another name for visceral pericardium?

A

Epicardium

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27
Q

Three layers of pericardium?

A

Fibrous, and serous (parietal and visceral i.e. epicardium)

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28
Q

Treating mitral stenosis?

A
  1. If symptomatic, with mobile valve, can do balloon valvuloplasty
  2. If anatomy not suitable, do mitral valve repair
  3. If signs of heart failure and severe symptomatic MS, do mitral valve replacement
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29
Q

Why is repair preferred to mitral valve replacement?

A

Need very high anticoagulation with metallic valve

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30
Q

What is a Blalock-Taussig shunt?

A

Surgical shunt between subclavian and pulmonary artery to palliate cyanotic CHD

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31
Q

Dopamine and renal function?

A

Low dose improves renal blood flow by acting on dopamine-1 receptors and causing vasodilatation of renal vasculature; higher dose causes vasoconstriction through alpha-adrenergics and risks renal failure

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32
Q

MI Cx (DEPARTS)?

A 
Death/Dresslers
Emboli
Pericarditis
Arrythmia or aneurysm (both ventricular)
Rupture (myocardial/septal)
Tamponade
Shock (cardiogenic)
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33
Q

Surgical temporary measure in cardiogenic shock?

A

Intra-aortic balloon pump

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34
Q

Third heart sound and raised JVP indicate?

A

Pulmonary oedema (or tricuspid regurg)

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35
Q

Hallmarks of tricuspid regurg?

A

Ascites, pulsatile liver, peripheral oedema, right atrial hypertrophy. Raised JVP (V waves)and third heart sound!

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36
Q

Features of LA myxoma?

A

Systemic embolisation, intracardiac calcification on CXR, loud first heart sound, plopping sound in early diastole. Surgical resection needed.

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37
Q

Patho of rheumatic heart disease?

A

Immune reaction to GAS. Get acute pancarditis (myo/endo/epicardium); chronically get valvular fibrosis (can lead to stenosis or incompetence)

38
Q

Causes of mitral stenosis?

A

RHD most common. Others include congenital, SLE, LA myxoma, malignancy

39
Q

O/E for mitral stenosis?

A

Loud first heart sound, tapping undisplaced apex beat, opening snap after second heart sound, rumbling mid-diastolic murmur over apex

40
Q

O/E for mitral regurg?

A

Displaced apex beat, L parasternal heave, soft S1 and loud S2, pansystolic murmur at apex radiating to axilla

41
Q

Aortic regurg on exam? WATCH HEAD UP

A

Waterhammer pulse (Corrigan’s pulse)/wide pulse pressure
Apex displaced and hyperdynamic
Traube’s (pistol shot femorals)
Carotid pulsation (Corrigan’s sign)/Capillary pulsation in nailbed (Quincke’s)
Head nodding (de Musset’s)
Hill sign (de Musset nail femoral arteries)
Easy fatiguability
Austin Flint murmur (crescendo-decrescendo mid-systolic)
Duroziez’s sign
Uvula has pulsation (Muller’s sign)
Pupils have pulsations

42
Q

Classic aortic regurg murmur?

A

Early diastolic murmur at LLSE, louder in expiration

43
Q

Causes of pericarditis?

A

Viral infection, post MI, Tb, uraemia

44
Q

Symptoms of pericarditis?

A

Chest pain, pleuritic, relieved by sitting forward, worse on exertion and lying down. May have dry cough, SOB, flu-like symptoms. Key sign is percardial rub.

45
Q

Causes of cardiac tamponade?

A

Haemopericardium, pericardial effusion, chronic constrictive pericarditis, restrictive cardiomyopathy

46
Q

Signs of cardiac tamponade?

A

Heart failure, raised JVP with Kussmaul’s sign (paradoxical rise in JVP in inspiration, normally opposite), pulsus paradoxus (drop in systolic BP >10mmHg during respiration)

47
Q

Causes of SVC obstruction?

A

Local infiltration by lung cancer, lymphoma, compression by multinodular goitre

48
Q

Signs of SVC obstruction?

A

Neck distension, raised JVP, plethoric face, rib notching, chemosis (oedema of conjunctiva)

49
Q

Marfan’s pathology?

A

AD CTD with FBN1 mutation

50
Q

Cardiac associations of Marfans?

A

Assoicated with aortic root dilatation (predisposes to aortic dissection), which stretches aortic valve annulus and get aortic regurgitation. Also associated with MR.

51
Q

Features of coarctation?

A

Associated with Turners. Get HTN in upper extremities and hypotension in lower. May have rib notching on CXR

52
Q

Considerations when treating AF?

A

If have heart failure and sedentary, diogxin could be good choice. B-blockers good if HF but if hypotensive etc. then is contraindicated. CCBs bad in HF as increase systolic dysfunction

53
Q

Contraindications to B-blockers in AF?

A

Chronically hypotensive, asthma

54
Q

Where does RCA run?

A

In coronary sulcus

55
Q

Murmurs in bicuspid aortic valve?

A

Without calcification, get early systolic ejection click WITHOUT MURMUR and can get blowing early diastolic murmur too (some degree of regurg). As age, prone to calcification and get stenosis and then get systolic ejection murmur

56
Q

Course of bicuspid aortic valve?

A

More prone to calcification and fibrosis. No murmur or symptoms until calcifies in 50-60s, then get stenosis

57
Q

Flow murmurs are always…

A

Systolic!

58
Q

Congenital rubella syndrome is associated with which cardiac defects?

A

PDA, ASD, pulmonary stenosis

59
Q

Turners is associated with which cardiac defects?

A

Coarctation, AS, bicuspid aortic valve, aortic dissection

60
Q

Most worrying symptom in AS?

A

Syncope (reflects massively decreased cerebral perfusion. Is indication for valve replacement!

61
Q

What class of drug is amiodarone?

A

Class III anti-arrhythmic, blocks potassium efflux. This is why toxicity is worsened in hypokalaemia (bind to same site on Na+/K+ ATPase

62
Q

Side effects of amiodarone?

A

Deranged TFTs and LFTs, nausea and vomiting, bradycardia, ILD, bluish haloes (corneal deposits), grey skin (photosensitive)

63
Q

Side effecs with propanolol?

A

Nightmares, insomnia, bronchospasm, hypotension, bradycardia, heart block

64
Q

Indications for digoxin?

A

SVT and HF; no place in VT.

65
Q

Digoxin action?

A

Inhibits Na+/K+/ATPase, increasing IC sodium and therefore IC calcium so increasing contractility while reduced SAN firing and HR.

66
Q

Side effects of digoxin?

A

Nausea and vomiting, bradycardia, dizziness, yellow vision, eosinophilia. Toxicity = confusion, yellow vision, AV block

67
Q

Side effects of diltiazem?

A

Hypotension, bradycardia, flushing and dizzinesss

68
Q

Diltiazem mechanism?

A

Class IV anti-arrhythmic

69
Q

Two causes of hyperacute T waves?

A

Early STEMI, Prinzmetal

70
Q

Manifestations of diastolic heart failure?

A

LV hypertrophy, lack of cardiomegaly or LV dilatation, S4 heart sounds

71
Q

Pressures and volumes in diastolic heart failure?

A

Get LV hypertrophy and stiffness. Impaired LV relaxation, therefore increased LV EDP, normal EDV (as systolic function intact)

72
Q

Pressues and volumes in systolic heart failure?

A

Get impaired LV contraction,, increased LV EDP, increased LV EDV (so LV dilates)

73
Q

Manifestations of systolic heart failure?

A

S3 heart sounds, reduced LV EF, cardiomegaly

74
Q

Cuff size and BP?

A

Cuff too large = underestimates BP and vice versa

75
Q

CHADVASC score and management?

A

Men with score of 1 or above, women with 2 and above should have anticoagulation considered

76
Q

Management of AVNRT acutely?

A

Vagal manoeuvres (e.g. blow into 50ml syringe), then bolus of 6mg adenosine if needed

77
Q

Difference between WPW and AVNRT?

A

In WPW, re-entry circuit is outside of the AV node

78
Q

Beck’s triad?

A

Muffled heart sounds, hypotension, distended neck veins

79
Q

What causes P pulmonale and P mitrale?

A

Right and left atrial hypertrophy respectively

80
Q

STE in which leads = high lateral?

A

1 and aVL

81
Q

Treatment aim for statins in primary prevention?

A

Reduce non-HDL cholesterol by 40% after three months; adjust dose if not achieved

82
Q

Three types of AF?

A

Paroxysmal, persistent and permanent

83
Q

Investigating AF?

A

12 lead, echo, TFTs; if paroxysal do 24 hour tape

84
Q

Risk factors for AF?

A

Alcohol, any heart disease, hyperthyroidism, age

85
Q

Options for rate control?

A

Digoxin, B-blockers, rate-limiting CCBs

86
Q

Drugs for secondary prevention post MI?

A

ACEI, B-blocker, antiplatelet therapy and high dose statin (usually atorvastatin 80mg OD)

87
Q

Why is atorvastatin preferred to simva?

A

Lower incidence of myopathy

88
Q

Most common cause of paroxysmal SVT?

A

AVNRT

89
Q

Do atrial flutter and AF response to vagal manouvres?

A

No

90
Q

Managing severe pericardial effusion causing tamponade?

A

Need urgent pericardicentesis. Small boluses of fluid better than large volumes as this can worsen pericardial fluid.

A final year of medicine (20 decks)

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