BIBLE Cardio Flashcards
(119 cards)
1
Q
What is a side effect of ACEi and when are they contraindicated?
A
Dry cough
Contraindicated in Renal artery stenosis
2
Q
What is an irregularly irregular pulse associated with?
A
AF
3
Q
Dry cough and hyperkalaemia are associated with which drug?
A
ACEi
4
Q
On an ECG what is associated with tall tented T waves and wide QRS complex?
A
VT
5
Q
What is associated with a saw tooth ECG?
A
Atrial flutter
6
Q
What causes rib-notching on a CXR?
A
Coarctation of the aorta
7
Q
What can be associated with a radial-radial delay?
A
Aortic dissection/coarctation of aorta
8
Q
What is a collapsing pulse caused by?
A
Aortic regurgitation
9
Q
What causes a slow rising pulse?
A
Aortic stenosis
10
Q
Splinter haemorrhages are a sign of what?
A
Infective endocarditis
11
Q
What is associated with descend-decrescendo murmur?
A
Aortic stenosis
12
Q
What are the two organisms causing infective endocarditis?
A
Staph. Aureus (main cause)
Step. Viridans (a haemolytic)
13
Q
What causes a staph aureus infection in infective endocarditis?
A
Prosthetic valves or IV drug users
14
Q
What causes a strep viridans infection in infective endocarditis?
A
Present in the mouth after dental surgery
15
Q
What are the steps in the treatments of acute AF?
A
Treat underlying cause (MI, Pneumonia, PE, HF etc.)
Control ventricular rate
16
Q
What is the 1st line treatment in controlling ventricular rate in AF?
A
Beta blocker or Ca2+ blocker (using both is contraindicated)
17
Q
What is the 2nd line treatment in acute AF?
A
Same as 1st line but add Digoxin or Amiodarone
18
Q
What other treatment is given alongside 1st and 2nd line in acute AF?
A
Anticoagulate with Heparin
Consider cardioversion if acutely ill
19
Q
How is Chronic AF treated differently from acute AF?
A
Anticoagulate with Warfarin (long term therapy compared to verapamil)
Ventricular rate controlled the same
20
Q
What is paroxysmal AF?
A
Short spells of AF that come and go
21
Q
How is paroxysmal AF treated?
A
1st line - Beta-blocker (verapamil in young patients)
2nd Line - Amiodarone
3rd Line - Digoxin
22
Q
What is a complication of AF?
A
STROKE
23
Q
How is the risk of stroke assessed?
A
CHA2DS2 score
High risk give Warfarin!
24
Q
What type of drug is Warfarin?
A
Vitamin K antagonist
Anticoagulant
25
What factors does Warfarin render inactive?
II, VII, IX, X
26
What process does factors II, XII, IX and X undergo to become active and what enzyme is involved?
Gamma carboxylation
| Gamma Carboxylase
27
What does Heparin bind to and how does it prevent coagulation?
Anti-thrombin III
| Increases its affinity for clotting factors to increase their rate of inactivation
28
What does LMWH inhibit?
Xa
29
What is ductus arteriosus?
Connection between pulmonary artery and descending aorta in foetal development to bypass the lungs
30
What is indicative of a continuous machine like murmur?
Patent Ductus arteriosus
| Connection between aorta and pulmonary artery that remains open
31
What is associated with strawberry milkshake coloured blood?
Hyperlipidaemia
32
At what dermatome level does Herpes zoster virus occur?
T4/T5
33
What is the rate limiting enzyme in cholesterol synthesis?
HMG-CoA reductase
34
What is the drug target for cholesterol lowering drugs?
HMG-CoA reductase
35
What are statins competitive inhibitors of?
HMG-CoA reductase
36
What are side effects of statins?
Rhabdomyolysis
| Myositis
37
What is associated with central abdominal pain and an expansile pulsatile mass?
AAA
38
What investigations are done for AAA?
1st line USS
| CT more accurate - shows anatomical relationship to renal and visceral vessels
39
What medical management is taken for AAA?
Careful control of Hypertension
Stop smoking
Lipid lowering medication
AAA>5.5cm follow up regular USS
40
How can AAA be surgically repaired?
Dacron or Gore-Tex graft
41
What non-surgical approach can be taken to repair AAA?
Endovascular stent (via femoral or iliac arteries)
42
What alternative approach can be taken for AAA repair?
Laparoscopic
43
How is mean arterial blood pressure calculated?
Systolic + (2 x Diastolic) / 3
44
What drug classes are used in anti-hypertensive treatment?
```
Diuretics
Beta-blockers
Calcium channel antagonists
Vasodilators
ARB
```
45
Give examples of diuretics used in anti-hypertensive treatment
Thiazide diuretics - mild - Bendrofluazide
| Loop diuretics - Stronger - Furosemide
46
What is the mechanism of Diuretics?
Promote Na+ and water secretion from the kidneys by inhibiting reabsorption in the loop of henle or distal tubule
47
List some side effects of diuretics
```
Hypokalaemia
Arrhythmias
Hyperglycaemia
Increased uric acid - Gout
Impotence
```
48
Give examples of beta-blockers used in anti-hypertensive treatment
Cardioselective - Atenolol
| Non-selective Propanolol
49
Give examples of calcium channel antagonists used in anti-hypertensive treatment
Dihydropyridines - Amlodipine
| Rate limiting - Verapamil, diltiazem
50
List some side effects of Calcium channel antagonists
Ankle oedema
Hypotension
Dizziness
Amlodipine better as less unwanted effects on cardiac muscle
51
Give examples of vasodilator drugs used in anti-hypertensive treatment
Alpha blockers - Prazosin
| ACEi - Lisinopril
52
Give an example of an ARB used in anti-hypertensive treatment
Losartan
53
How many classes of anti-arrhythmic drugs?
4
54
What is the mechanism of ALL class I anti-arrhythmic drugs?
Block voltage-gated Na+ channels with preference to the most active ones (tachyarrhythmic areas)
55
Give an example of a Class Ia drug and its mechanism
Disopyramide
| Moderate rate of dissociation, slow rise of AP, prolonged refractory period
56
Give an example of a class Ib drug and its mechanism
Lignocaine
| Fast rate of dissociation, prevents premature beats
57
Give an example of a Class Ic drug and its mechanism
Flecainide
| Slow rate of dissociation, depress conduction
58
Give an example of a class II drug and its mechanism
Metaprolol
| Beta adrenoceptor as antagonists, decrease rate of depolarization in SA and AV nodes
59
Give an example of a Class III drug and its mechanism
Amiodarone Target voltage-activated K+ channels, prolong AP duration, increase refractory period
60
Give an example of a class IV drug and its mechanism
Verapamil
| Target voltage-activated Ca+ channels, decrease force of contraction
61
What do ALL patients with acute heart failure require?
Prophylactic anticoagulation with Heparin
62
What is the investigation for heart failure?
B-type natriuretic peptides
63
What is the 1st line drug management for heart failure?
ACEi and Beta-blocker
64
What is the 2nd line drug treatment for heart failure?
Aldosterone antagonist
| Angiotensin II receptor blocker or Hydralazine (vasodilator) in combination with a nitrate
65
If symptoms of heart failure persist what treatment should be considered?
Cardiac resynchronization therapy or digoxin
66
What drug treatment should be given for fluid overload in heart failure?
Diuretics
67
When does acute HF normally occur?
Secondary to abnormal cardiac function
68
How is acute HF diagnosed?
12 ECG
CXR
Bloods
Transthoracic echo to confirm diagnosis and possibly identify the cause
69
What is the initial therapy for acute heart failure?
Oxygen
Diuretics (Furosemide)
Vasodilator therapy (GTN infusion)
70
What support can be added if an additional response is needed in acute heat failure?
Inotropic support (dobutamine, phosphodiesterase inhibitors)
71
What is given if the BP is low in HF?
Noradrenaline
72
What is the drug treatment for clinical endocarditis, awaiting culture results with no suspicion of staph?
Penicillin + Gentamicin
73
What endocarditis is associated with IV drug users, recent intravascular devices or cardiac surgery)?
Staphylococcal endocarditis
74
How is a suspected staphylococcal endocarditis (IV drug user, recent intravascular devices or cardiac surgery) treated?
Vancomycin + Gentamicin
75
How is Streptococcal endocarditis treated?
Penicillin + Gentamicin
76
How is Enterococcal endocarditis treated?
Ampicillin/Amoxicillin + Gentamicin
77
How is Staphylococcal endocarditis treated?
Vancomycin OR Flucloxacillin OR Benzylpenicillin + Gentamicin
78
What effect does the parasympathetic nervous system have on the heart?
Negative chronotropic effect via the vagus nerve - Decreases heart rate (main innervation at rest too keep HR low)
79
What is the receptor and target for the parasympathetic nervous system?
Acetylcholine Muscarinic M2 receptors in the SA node
80
What effect does the parasympathetic nervous system have on the heart?
Negative inotropic
| Reduces slope of pacemaker potential
81
What is the target an receptor for the sympathetic nervous system?
Noradrenaline
| B1 receptors
82
What effect does the sympathetic nervous system have on the heart?
Increase the slope of the pacemaker potential
Increase rate of conduction through AV node
increase rate of myocardial relaxation
83
What supplies the SA node?
Right Coronary Artery
84
What causes the first heart sound and when does it occur?
```
Mitral + Tricuspid valve closure
Phase 3 (isometric ventricular contraction)
```
85
What causes the second heart sound and when does it occur?
```
Aortic + Pulmonary valve closure
Phase 4 (ventricular ejection)
```
86
What are the side effects of spironolactone?
Gynaecomastia and hyperkalaemia
87
What is contained in the tetralogy of fallot?
Ventricular septal defect
Overriding aorta
Pulmonary stenosis
Right ventricular hypertrophy
88
What is contained in the anterior branches of the thoracic aorta?
```
Bronchial
Oesophageal
Mediastinal
Pericardial &
Phrenic Arteries
```
89
What is a counter regulatory mechanism to the RAAS system?
ANP
90
When is ANP released?
In response to atrial distension/hypervolemia
91
What does ANP do?
Acts as a vasodilator and decreases renin release
92
Where is the carotid sinus found?
Proximal part of internal carotid artery
93
What is the carotid sinus innervated by?
Glossopharyngeal nerve
94
What is the role of the carotid sinus?
Detects stretching of the walls for BP changes
| Monitors blood gas and pH
95
What is the 3rd heart sound and when can it be heard?
Passive filling of ventricle (phase 1)
Early diastole
Physiological or HF in elderly
96
What is the 4th heart sound and when can it be heard?
Late diastole
Active filling of stiff ventricle by atrial contraction
Pathological (usually LV hypertrophy)
97
What causes normal splitting of the 2nd heart sound?
Inspiration (closing of the aortic and pulmonary valves)
98
Give examples of orally given anticoagulants
Warfarin
Dabigatran
Rivaroxaban
99
What type of tachycardia is broad complex?
Ventricular
100
What type of tachycardia is Narrow complex?
Atrial
101
How is sinus tachycardia treated?
Rate control with Beta-blocker
102
How is stable VT treated?
Amiodarone
103
How is unstable VT with a pulse treated?
Cardioversion
| Anti-arrhythmic medication - Amiodarone
104
How is acute VT treated?
Adenosine OR Calcium antagonist OR Beta-blocker
105
How is Torsades de pointes treated?
magnesium sulphate
isoprenaline
Temporary or permanent pacing
106
How is catecholaminergic polymorphic VT treated?
Beta-blocker then implantable defib
107
What rhythms are shockable?
VF and pulseless VT
108
What is atropine an antagonist of and when is it used?
Competitive antagonist of muscarinic ACh receptors (M1, M2, M3) blocks parasympathetic
Reverses bradycardia following MI
109
Where is the azygous vein found?
Right side of the thoracic vertebra
110
What causes a slate grey rash side effect?
Amiodarone
111
Antiemetic given for gastroparesis and following an MI?
Metoclopramide
112
What is used for immediate symptomatic relief of stable angina?
GTN Spray
113
What dug is used in long term therapy for stable angina?
Isosorbide mononitrate
114
What other drugs can be used in the treatment of stable angina?
Ivabradine
Nicorandil
Ranolazine
Statin, aspirin, ACEi
115
What is the treatment of an MI (STEMI)?
```
MONA+C
Diamorphine + Anti-emetic (Metoclopramide)
Oxygen
Nitrates
Aspirin
Clopidogrel
Immediate PCI
```
116
When should thrombolysis (streptokinase) be administered?
If PCI is not possible within 120 mins
117
What drug therapy is given after acute care has been administered in an MI?
```
BADS
Beta-blocker (12 months)
ACEi (life long)
Dual anti-platelet therapy (Aspirin (lifelong) and clopidogrel (4 weeks post MI)
Statin (life long)
```
118
What life style factors should be changed post MI?
Stop smoking
Healthier diet - less salt, reduce cholesterol
Exercise 20-30 mins a day
119
What is the treatment for an NSTEMI or unstable angina?
MONA+C
LMWH
PCI/CABG if necessary
