cardio Flashcards
(105 cards)
1
Q
ASD
A
ESM louder on inspiration
2
Q
MS
A
mid-late diastolic
loud S1, opening snap
3
Q
soft S1
A
MR
4
Q
loud S1
A
MS
5
Q
soft S2
A
AS
6
Q
when is S3 normal
A
<30 years
7
Q
S3
A
LV failure (e.g. dilated cardiomyopathy) constrictive pericarditis (called a pericardial knock) mitral regurgitation
8
Q
when is S4 normal
A
<40 years
9
Q
S4
A
aortic stenosis, HOCM, hypertension
10
Q
HF (chronic) mx
A
BASHeD Beta blocker + ACEi Spironolactone (Get specialist input) Hydralazine + Nitrates e Digoxin
11
Q
STEMI PCI within 120 mins
A
Aspirin 300mg
PCI
Prasugrel
Unfractionated heparin + bailout glycoprotein IIb/IIIa inhibitor
12
Q
STEMI PCI not possible within 120 mins
A
Aspirin 300mg Fibrinolysis Antithrombin Ticagrelor post-prodecure ECG 60-90 mins post-procedure Persistent MI - PCI
13
Q
NSTEMI/unstable angina low risk mortality (<=3%)
A
Aspirin 300mg + Fondaparinux if no immediate PCI planned
Ticagrelor
14
Q
NSTEMI/unstable angina high risk mortality (>3%)
A
Aspirin 300mg (+Fondaparinux if no immediate PCI)
PCI immediately if unstable, otherwise within 72h
Prasugrel or Ticagrelor
Unfractionated heparin
15
Q
SVT ECG
A
narrow complex tachycardia (QRS<120ms)
16
Q
SVT mx
A
vagal manoeuvres
adenosine (CI in asthma, use CCB)
17
Q
P450 inducers (SCARS) what do they do to INR?
A
Smoking Chronic alcohol use Anti-epileptics (phenytoin and carbamazepine) Rifampicin St Johns Wort decrease INR
18
Q
P450 inhibitors (ASS-ZOLES) what do they do to INR?
A
ABX (Ciprofloxacin, Macrolides, Isoniazid) SSRIs Sodium valproate -Zoles (Omeprazole, Ketoconazole) increase INR
19
Q
ejection systolic murmur
A
AS + HOCM - louder on expiration
PS + ASD - louder on inspiration
20
Q
pansystolic murmur
A
MR/TR (TR louder on inspiration)
VSD (‘harsh’)
21
Q
late systolic murmur
A
mitral valve prolapse
22
Q
early diastolic murmur
A
AR
23
Q
mid-late diastolic
A
MS
24
Q
hypercalcaemia ECG
A
shortened QT interval
25
hyperkalaemia ECG
tall tented T waves
flattened P waves
broad QRS
QT prolongation
26
hypokalaemia ECG
U waves
prolonged PR
ST depression
27
loud S2
systemic or pulmonary hypertension
28
PS
ESM
| louder on inspiration
29
complete heart block
P waves and QRS complexes are not related
| P wave may be in the QRS complex
30
first degree heart block
PR interval >0.2s
31
second degree heart block - type 1 (Mobitz I, Wenkebach)
progressive prolongation of PR until dropped beat
32
second degree heart block - type 2 (Mobitz II, Wenkebach)
intermittent non-conducted P waves without progressive prolongation of the PR interval
when P waves conduct the PR is constant
33
target INRs:
- normal
- VTE etc
- if VTE despite warfarin
normal = 0.8-1.2
VTE = 2-3
VTE despite warfarin = 3-4
34
what is Eisenmenger's syndrome
reversal of a L->R shunt associated with VSD, ASD and PDA
35
pharmacological options for treatment of postural hypotension
fludrocortisone
36
ECG changes that indicate need for PCI or thrombolysis (3)
1. ST elevation >2mm in 2 more more consecutive anterior leads
2. ST elevation >1mm in >2 consecutive inferior leads
3. new LBBB
37
medical mx of stable angina
beta-blocker or CCB first line
if beta-blocker used first and not controlled, add CCB (long-acting dihydropyridine such as - Amlodipine, Nifedipine)
CCB monotherapy - Verapamil or Diltiazem
38
adverse effects of ACE inhibitors
cough
hyperkalaemia
angioedema
39
ECG findings for acute pericarditis
saddle shaped ST elevation
| PR depression
40
ECG changes caused by thiazides
thiazides can cause hypokalaemia leading to:
- prolonged PR
- U waves
- flattened T waves
41
mx of AF with CHA2DS2-VASc score of 0
no anticoagulation treatment
42
BP targets
<80 years - clinic BP 140/90, home BP 135/85
| >80 years - clinic BP 150/90, hope BP 145/85
43
features of AR
early diastolic murmur
collapsing pulse
wide pulse pressure
head bobbing
44
adverse effects of nitrates
hypotension
tachycardia
headaches
flushing
45
most important risk factor for aortic dissection
**hypertension**
46
mx of torsades de pointes
magnesium sulphate
47
CHA2DS2-VASc scoring
```
Congestive HF - 1
HTN - 1
Age >=75 - 2 OR Age 65-74 - 1
Diabetes - 1
Prior stroke/TIA - 2
VAascular disease - 1
Sex (F) - 1
```
48
features of VSD post-MI
occurs in first week
acute HF
pansystolic murmur
49
what may cause statin-induced myopathy if prescribed alongside a statin
Erythromycin or Clarithromycin
50
how to differentiate between NSTEMI and unstable angina
NSTEMI - elevated troponin
| unstable angina - normal tropnonin
51
features of acute MR post-MI
due to ischaemia or rupture of papillary muscles
acute **hypotension** and pulmonary oedema (SoB)
early-to-mid systolic murmur
can be seen in acute phase (i.e. before PCI or any mx has been started)
52
hypothermia ECG findings
```
Jesus Quist It's Bloody Freezing
J waves
QT prolongation
Irregular rhythm
Bradycardia
First degree heart block
```
53
ix for cardiac tamponade
echo
54
appearance of LBBB on ECG
widened QRS complexes and a notched morphology of the QRS complexes in the lateral leads
55
ECG features of Digoxin toxicity
down sloping ST depression
inverted T waves
short QT interval
56
notching of inferior borders of ribs
Coarctation of the aorta
57
dose of amiodarone used in ALS
300mg given after 3rd shock
58
most common cause of death in MI
VF
59
PE CXR findings
normal
60
AR murmur and inferior MI
proximal aortic dissection
61
moa fondaparinux
activates antithrombin III
62
major bleed on warfarin mx
stop warfarin
IV vit K 5mg
prothrombin complex concentrate
63
HF meds that improve survival
ACEi, beta blockers and spironolactone
64
in synchronised DC cardioversion, which part of the QRS is used for synchronisation
R wave
65
drugs to avoid in HOCM
ACEi
Nitrates
Inotropes
66
valvulopathy seen in Marfan’s and Ehlors-Danlos
MR
67
Dressler's syndrome vs LV aneurysm post-MI
Dressler's - similar features to pericarditis (pleuritic pain, fever + raised ESR)
LV aneurysm - persistent ST elevation and LV failure
68
rate control for AF
beta-blockers - Bisoprolol
CCB - Diltiazem
digoxin (not first-line)
69
rhythm control for AF
echo first to check for thrombi
DC cardioversion if <48h of symptom or 3 week anticoagulation
pharmacological cardioversion with amiodarone or flecainide
70
when should rate control be favoured
>65 years
| hx of ischaemic heart disease
71
when should rhythm control be favoured
<65 years
symptomatic
first presentation
congestive HF
72
analgesia CI in any form of CVD
Diclofenac
73
preferred NOAC for patients with renal impairment
Apixaban
74
when is amiodarone used for pharmacological cardioversion
if there is evidence of structural heart disease
75
which imaging should be carried out when investigating a PE
CTPA or V/Q scan
| **CXR**
76
mx of bradycardia with shock
IV atropine 500 micrograms (repeated up to 3mg)
77
what is used for anticoagulation in AF
DOAC
78
which arrest rhythm is seen in tension pneumothorax
PEA
79
adverse effects of beta blockers
```
cold peripheries
fatigue
sleep disturbances
erectile dysfunction
bronchospasm
reduced hypoglycaemic awareness
```
80
how to interpret CHADS-VaSc in terms of annual stroke risk
% adjusted annual stroke risk must be multiplied by the number of years a person has left (based on average life expectancy)
e.g. 63 y/o w CHADS-Vasc of 3%, this means 3% risk per year, they have ~20 years left so their lifetime risk of a stroke is 60% (3x20)
81
best diuretic for HTN if accompanying peripheral oedema
furosemide
82
which cardiomyopathy are alcoholics most at risk of
**dilated** cardiomyopathy
| therefore they will have reduced LV ejection fracture and dilated LV on echo
83
moa of alteplase
activates plasminogen to form plasmin
| altePLASe - activates PLASminogen
84
differentiating between torsades de pointes and VT
while torsades is a type of VT, it has variable QRS height (polymorphic)
85
causes of postural hypotension
hypovolaemia
autonomic dysfunction: diabetes, Parkinson's
drugs: diuretics, antihypertensives, L-dopa
alcohol
86
ECG features of WPW
short PR
| wide QRS complexes with slurred upstroke - delta wave
87
minor bleed on warfarin mx
stop warfarin
give IV vitamin K 1-3 mg
restart warfarin when INR <5
88
mx of regular broad complex tachycardia
IV amiodarone
89
mx of regular narrow complex tachycardia
vagal manoeuvres
| IV adenosine
90
what must be ruled out in chest pain + focal neurology
aortic dissection
91
medication for symptomatic relief in aortic stenosis
furosemide
92
mx of AF post-stroke
anticoagulation is needed - warfarin or DOAC (Dabigatran) should be given 2 weeks after stroke
93
mx of patients on warfarin undergoing emergency surgery
stop warfarin
| give four-factor prothrombin complex concentrate (aka dried prothrombin complex or Beriplex)
94
first-line HTN med if Afro-Caribbean
CCB - Amlodipine
95
ix for suspected aortic dissection
CT aortogram
96
mx of aortic dissection
```
ascending aorta (type A) - IV labetalol and surgery
descending aorta (type B) - IV labetalol
```
97
cardiac pathology in acromegaly
cardiomyopathy
98
mx of diabetes in STEMI
stop oral agents
dose-adjusted IV insulin infusion
regular monitoring of blood glucose
99
HF (acute) mx
```
LMNOP
Loop diuretics
Morphine
Nitrates
Oxygen - CPAP
Position - sit patient up
```
100
meds to give patients with mechanical heart valves
aspirin and warfarin
101
mx of superficial thrombophlebitis
NSAIDs, e.g. Naproxen
102
bumetanide
loop diuretic
103
medication CI in ventricular tachycardia
Verapamil
104
ix for AF if CHADSVASc 0
echo
105
why should metformin be stopped prior to coronary angiography
due to use of contrast agent in angiography which can cause renal failure, this may increase the risk of lactic acidosis with metformin
