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1
Q

Give 3 clinical features of stable angina.

A

Exacerbated by exercise
Relieved by rest or GTN
Chest pain that radiates

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2
Q

What modifiable risk factors make up the QRISK?

A

Smoking, diabetes, cholesterol, blood pressure, BMI

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3
Q

What is QRISK?

A

A score that predicts the risk of cardiovascular disease

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4
Q

What non-modifiable risk factors make up the QRISK?

A

Age
Gender
Ethnicity
Diagnosis of AF, RA, SLE

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5
Q

Give 3 examples of ACE inhibitors.

A

Ramipril, enalapril, lisinopril

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6
Q

Give 4 side effects of ACE inhibitors.

A

Dry cough, headache, fatigue, hyperkalaemia

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7
Q

What is seen on ECG in the few hours after MI?

A

ST elevation, tall T waves

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8
Q

What is seen on ECG in the few days after MI?

A

T wave inversion, pathological Q waves

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9
Q

What are the 3 cardinal symptoms of heart failure?

A

Peripheral oedema, shortness of breath, fatigue

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10
Q

What signs are visible on X-ray in a patient with heart failure?

A

Mnemonic ABCDE

A - alveolar oedema 
B - kerley B lines
C - cardiomegaly 
D - dilated prominent upper lobe vessels 
E - pleural Effusion
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11
Q

What are the four features of tetralogy of fallot?

A

Overriding aorta
Right ventricular outflow tract obstruction
Right ventricular hypertrophy
Ventricular septal defect

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12
Q

In what condition would you see saddle shaped ST elevation?

A

Pericarditis

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13
Q

What is the first line hypertension treatment in Afro-carribbean patients?

A

Calcium channel blockers - amlodipine

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14
Q

What ECG findings are seen in patients with AF?

A

Irregularly irregular QRS complexes
F waves
No P waves

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15
Q

Give 3 clinical features of aortic dissection.

A

Sudden tearing chest pain (may radiate to the back)
Unequal arm pulses and BP
Acute limb ischaemia

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16
Q

What are the four stages of limb ischaemia?

A

Stage 1 - asymptomatic
Stage 2 - intermittent claudication
Stage 3 - rest pain/nocturnal pain
Stage 4 - necrosis/gangrene

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17
Q

Give 4 secondary causes of hypertension.

A

Phaeochromocytoma
CKD
Polycystic kidney disease
Cushing’s

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18
Q

Give 4 categories of ‘shock’

A

Cardiogenic
Septic
Anaphylactic
Haemorrhagic

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19
Q

Give 3 complications of an aneurysm.

A

Rupture
Pressing on other structures
Thrombosis

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20
Q

What causes a pansystolic murmur?

A

Mitral regurgitation

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21
Q

What are the inferior ECG leads?

A

II, III, aVF

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22
Q

What artery do the inferior ECG leads correspond to?

A

Right coronary artery

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23
Q

What are the anteroseptal ECG leads?

A

V1-V4

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24
Q

What artery do the anteroseptal ECG leads correspond to?

A

Left anterior descending

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25
What are the lateral ECG leads?
I, aVL, V5-V6
26
What artery do the lateral ECG leads correspond to?
Left circumflex
27
What are the anterolateral ECG leads?
I, aVL, V4-V6
28
What arteries do the anterolateral ECG leads correspond to?
Left anterior descending or left circumflex
29
What is seen on an ECG in hypokalaemia?
Small T waves, ST depression, U waves, PR prolongation
30
How long is a normal PR interval?
120-200ms
31
How long is the PR interval in first degree heart block?
>200ms
32
What is the first line treatment for hypertension in all patients with T2 DM?
ACE inhibitor (regardless of age or race)
33
What is the first line medication for rate control in AF?
Beta blocker (or CCB - beta blocker contraindicated in asthma)
34
Describe mobitz type 1 heart block.
Progressive PR prolongation, followed by a dropped QRS complex
35
What is the first line investigation for peripheral arterial disease?
ABPI (ankle brachial pressure index) and doppler ultrasound
36
What is the definition of intermittent claudication?
Ischaemic pain/cramping on exertion
37
Give 5 risk factors for an atypical MI presentation.
``` Female Non-white Prior stroke Heart failure Diabetes ```
38
Give 3 symptoms of an atypical MI presentation.
Nausea, vomiting, dizziness
39
What is the first line management of supra ventricular tachycardia?
Valsalva manoeuvre and carotid sinus massage
40
What is the next line management of supra ventricular tachycardia?
Cardioversion with atropine
41
What is the valsalva manoeuvre?
Where the patient blows against resistance e.g into a syringe
42
What features are seen on ECG in hyperkalaemia?
Tall tented T waves P wave flattening Wide QRS
43
What features are seen on ECG in hypokalaemia?
T wave inversion ST depression Prominent U wave
44
What organism is IE caused by dental surgery likely to be?
Viridans streptococci
45
What is the most common causative organism of IE overall?
Staphylococcus aureus
46
What is the gold standard investigation for aortic dissection?
CT angiography
47
What kind of arrhythmia does long QT syndrome predispose a patient to?
Ventricular tachycardia, specifically torasade-de-pointes
48
Give 5 causes of RBBB.
``` Right ventricular hypertrophy PE MI Atrial septal defect Cardiomyopathy ```
49
What is the most common congenital heart defect in Down's syndrome?
Ventricular septal defect
50
What organism causes rheumatic fever?
Streptococcus pyogenes
51
What lancefield group does streptococcus pyogenes belong to?
Group A
52
What is the first line diuretic in heart failure?
Furosemide
53
What are the first line medications for optimisation of heart function in heart failure?
Bisoprolol/ramipril
54
What is seen on ECG in third degree heart block?
No association between P waves and QRS complexes
55
What is the emergency treatment of third degree heart block?
Fit with pacemaker
56
What is the mechanism of action of apixaban?
Direct oral anticoagulant - inhibits factor Xa
57
What pattern is seen on ECG in atrial flutter?
Sawtooth pattern
58
Give 2 risk behavioural risk factors for atrial flutter.
Alcohol and cocaine
59
What is the first line treatment of ongoing atrial flutter?
Catheter ablation
60
Give 6 clinical signs of heart failure.
``` Shortness of breath Peripheral oedema Bibasal crepitations Orthopnea Nocturnal dyspnoea ```
61
Give 5 chest X-ray findings in a patient with heart failure.
Mnemonic ABCDE ``` A - alveolar oedema B - kerley B line C - cardiomegaly D - dilated prominent upper lobe vessels E - pleural effusion ```
62
What blood test can be done to confirm a diagnosis of heart failure?
BNP
63
What is the pharmaceutical management of heart failure?
Mnemonic ABAL A - ACE inhibitor B - beta blocker A - aldosterone antagonist L - loop diuretic
64
What is the difference between essential and secondary hypertension?
Essential - no identifiable cause | Secondary - has an identifiable cause
65
Give 4 pieces of lifestyle advice for someone with hypertension.
Stop smoking Reduce salt/alcohol consumption Eat a healthy balanced diet Exercise more regularly
66
What is the most common cause of secondary hypertension?
Conn's syndrome
67
What is the scoring system used for risk of cardiovascular disease?
QRISK
68
What medication is prescribed for a QRISK score of more than 10%?
Statins
69
Give a side effect of statins.
Myalgia
70
What is the gold standard investigation for pulmonary embolism?
CT pulmonary angiography
71
What is the first line management of pulmonary embolism?
Low molecular weight heparin such as dalteparin
72
What is the long term treatment of PE?
Warfarin or direct oral anticoagulant sch as apixaban o r rivaroxaban
73
What is the first line investigation for IE?
Blood culture
74
What is the gold standard investigation in IE?
Echocardiogram
75
What is characteristic of Prinzmetal's angina?
Pain usually occurs in the morning, and at rest
76
How is prinzmetal's angina differentiated from stable/unstable angina?
Prinzmetal's - ST elevation | Stable/unstable angina - ST depression
77
What improves the pain in pericarditis?
Leaning forwards
78
What is the presentation of rheumatic heart disease?
Subcutaneous nodules, arthritis, chorea
79
What is pulsus paradoxus?
A significant drop in blood pressure on inspiration (more than 10mmHg)
80
What is pulsus paradoxus a sign of?
Cardiac tamponade
81
Define cardiac tamponade.
Accumulation of a large amount of fluid in the pericardial sac, which compresses the heart and reduces cardiac function
82
Define pericardial effusion.
Accumulation of fluid in the pericardial sac, which does not reduce cardiac function
83
What is Kussmaul's sign?
Increase in JVP on inspiration
84
What are the four features of tetralogy of fallot?
Overriding aorta Right ventricular hypertrophy Ventricular septal defect Pulmonary artery stenosis
85
Why does right ventriular hypertrophy occur in tetralogy of fallot?
As a response to pulmonary artery stenosis to try and maintain cardiac output
86
Which type of heart failure is ascites a symptom of?
Right sided heart failure
87
Give 4 features of left sided heart failure.
Dyspnoea Orthopnoea Raised JVP Reduced ejection fraction
88
What blood test is used to confirm a diagnosis of heart failure?
BNP - brain natriuretic peptide
89
Where is BNP released from?
Ventricles in the brain in response to stretching of the heart
90
What is decubitis angina?
Angina that occurs at night on the patient lying down
91
Give 4 causes of hypovolaemic shock.
Severe burns Ruptured aortic aneurysm Vomiting Trauma causing bleeding
92
What does the HAS-BLED score calculate?
The risk of a patient with AF having a major bleed within one year
93
What does the ABCD2 score calculate?
The risk of having a stroke in patients who have had a TIA
94
Which ECG abnormality is most associated with Wolff-Parkinson White syndrome?
Delta wave
95
What happens to the PR interval in Wolff Parkinson White syndrome?
PR interval decreases
96
What type of murmur is mitral stenosis?
Mid diastolic rumbling murmur
97
In what murmur would you see a slow rising pulse?
Aortic stenosis
98
What type of murmur is aortic stenosis?
Ejection systolic murmur
99
How long after an MI does Dressler's syndrome develop?
2-10 weeks
100
What is Dressler's syndrome?
An autoimmune type of pericarditis seen after MI
101
What is secondary prevention?
Methods to detect and address existing disease prior to the appearance of symptoms
102
What is the first line investigation for patients with stable angina?
CT angiography
103
What is the first line treatment for angina?
Beta blocker - bisoprolol (or cardioselective CCB - verapamil)
104
What is the second line treatment for angina?
Add a non-cardio-selective calcium channel blocker (such as nifedipine) to the beta blocker
105
What is the first line pharmacological management of heart failure?
ACE inhibitor and beta blocker
106
What is the second line management of heart failure?
Add an aldosterone antagonist to ACE inhibitor and beta blocker
107
Give 4 secondary causes of hypertension.
Cushing's syndrome ADPKD Coarctation of the aorta Conn's syndrome
108
What is the first line treatment of hypertension in diabetes patients?
ACE inhibitor
109
What is the second line treatment of hypertension in diabetes patients?
Thiazide-like diuretic
110
What is the most common cause of aortic stenosis?
Senile calcification of the valve
111
What anticoagulants are used to prevent stroke in patients with AF?
DOACs or warfarin
112
Which anticoagulants are preferred in patients with a prosthetic valve?
Warfarin
113
What is the appropriate initial treatment for pain in pericarditis?
Ibuprofen and colchicine
114
`What is decubitus angina?
Angina that is worse when lying down
115
What is seen on ECG in Dressler's syndrome
PR depression, ST elevation
116
What is uraemic pericarditis?
Pericarditis due to high urea
117
What kind of murmurs are pansystolic?
Mitral and tricuspid regurgitation
118
When is mitral regurgitation louder?
On expiration
119
When is triscuspid regurgitation louder?
On inspiration
120
If the lungs are clear with a pansystolic murmur, what does this indicate?
Clear lungs with a pansystolic murmur indicates right sided heart failure, and a tricuspid regurgitation
121
What is the most important first line step in treating sepsis?
IV fluids
122
What makes up sepsis 6?
``` O2 Blood culture IV antibiotics Fluid challenge Measure lactate Measure urine output ```
123
What is Buerger's test?
Tests for sufficient arterial supply to the leg
124
What is seen on ECG in hypercalcaemia?
Tall T waves, short QT interval,
125
What organism most likely causes IE in IVDU?
Staph aureus
126
What organism mostly likely causes IE in patients with prosthetic valves?
Staph epidermis
127
What is the most likely tissue outcome of MI?
Organisation
128
What is Beck's triad?
Muffled heart sound, raised JVP, hypotension
129
What condition is Beck's triad seen in?
Cardiac tamponade (or pericardial effusion)
130
What is a coronary artery steal?
Rerouting of blood to other arteries when one is narrowed
131
What changes are seen in atherosclerosis?
``` T lymphocytes Lipid deposits Thinning of tunica media Macrophages Lumen narrowing ```
132
What does aortic stenosis sound like?
Early diastolic murmur | Collapsing pulse
133
What would be seen on chest X-ray in mitral stenosis?
Dilated left and right ventricles
134
What would be heard in mitral stenosis?
Pansystolic murmur | Soft S1 sound
135
Define atherosclerosis.
An accumulation of lipids, macrophages and smooth muscle cells in the tunica intima of medium and large arteries.
136
Other than chest pain, give 4 symptoms of an MI.
Nausea/vomiting Pallor Sweating Palpitations
137
Define embolism.
A blocked vessel caused by a foreign body.
138
Define thrombosis.
Formation of a blood clot inside a blood vessel, which obstructs flow.
139
Define infarction.
The death of cells due to reduced or absent blood supply
140
Define ischaemia.
Restriction in blood flow causing a reduction in oxygen needed for the cells function
141
Give 4 effects of activation of the RAAS system.
Arteriolar vasoconstriction Increased aldosterone ADH secretion Increase in blood pressure
142
Give 5 causes of secondary hypertension.
``` Conn's syndrome Chronic kidney disease Phaeochromocytoma Pre-eclampsia Hypothyroidism ```
143
What murmur is a collapsing pulse seen in?
Aortic regurgitation
144
What murmur is a slow rising pulse seen in?
Aortic stenosis
145
What is recommended to help with exercise in patients with intermittent claudication?
Smoking cessation and an exercise programme
146
What is the most appropriate investigation for suspected aortic stenosis?
Echocardiogram
147
What is the most common myocardial dysfunction that leads to heart failure?
Ischaemic heart disease
148
What does a high INR put a patient at risk of?
Bleeding problems
149
What is the gold standard investigation of unstable angina?
CT coronary angiography
150
What drugs are used for secondary prevention of acute coronary syndrome?
Dual antiplatelet - aspirin and clopidogrel Beta blocker or calcium channel blocker ACE inhibitor Statin
151
What score is used to predict the risk of stroke after a TIA?
ABCD2
152
What are the components of the ABDC2 score?
A - age > 60 - 1 point B - blood pressure >140/90 - 1 point C - clinical features - speech disturbance 1 point, unilateral weakness 2 points D - duration - <1 hour 1 point, >1 hour 2 points D - Diabetes - 1 point
153
What is the classification of ABCD2 scores?
0-3 - low risk 4-5 - moderate risk 6-7 - high risk
154
What is the first line treatment of ischaemic stroke?
If within 4.5 hours - thrombolysis (with alteplase)
155
What is the protocol for taking blood cultures in suspected IE?
Take 3 blood cultures, from 3 different places, at 3 different times
156
Give 4 complications of infective endocarditis.
Sepsis Pulmonary embolism Stroke Heart failure
157
What signs are seen on X-ray in aortic stenosis?
Calcification of aortic valve Cardiomegaly Pulmonary oedema Dilated ascending aorta
158
What are the symptoms of septic infection?
``` Night sweats Fever Rigors Weight loss Anaemia ```
159
What is a normal ejection fraction?
50-75%
160
How is a clinical reading of hypertension confirmed?
Ambulatory blood pressure readings/home BP monitoring
161
What is the definition of the white coat effect?
A discrepancy of more than 20/10 between clinical and ambulatory blood pressure readings
162
What are the stages of hypertension?
Stage 1 - >140/90 Stage 2 - >160/100 Stage 3 - >180/20
163
What is disseminated intravascular coagulation?
Where there is abnormal activation of coagulation
164
What causes disseminated intravascular coagulation?
Massive haemorrhage, malignancy
165
What is disseminated intravascular coagulation?
Small clots develop throughout the bloodstream. This uses up clotting factors and fibrinogen, leading to excessive bleeding
166
What can trigger disseminated intravascular coagulation?
Trauma Sepsis Malignancies
167
What blood results will be seen in DIC?
Low platelets Prolonged clotting times e.g PT Decreased fibrinogen Elevated D-dimer
168
What is the first line investigation for peripheral arterial disease?
Ankle brachial pressure index
169
What is the first line treatment of chronic peripheral vascular disease?
Aspirin
170
What is the first line treatment of acute limb ischaemia?
Immediate assessment for revascularisation surgery
171
What is the gold standard investigation for peripheral arterial disease?
Contrast angiography
172
What is the appearance of an arterial ulcer?
``` Found at tips of toes/extremities Punched out appearance Absence of hair Shiny Minimally exudative ```
173
What is the appearance of a venous ulcer?
``` Found in the gaiter area - below the knee and above the ankle Highly exudative Irregular/granular appearance Hardening of skin Firm oedema ```
174
Where is the aortic valve auscultated?
2nd intercostal space, left sternal edge
175
What condition is Beck's triad seen in?
Cardiac tamponade
176
What is Beck's triad?
Hypotension, distended jugular veins, muffled heart sounds
177
What investigations are used in patients with cardiac tamponade?
ECG CXR Echocardiogram
178
What is the first line management of cardiac tamponade?
Pericardiocentesis
179
What is the first line of treatment for symptoms of unstable angina?
GTN
180
What are the major criteria for IE?
Evidence of endocardial involvement e.g vegetations seen on echocardiogram
181
What are the minor criteria for IE?
Fever > 38 Predisposing factor e.g IVDU Vascular phenomena Immunologic phenomena
182
Give 4 complications of infective endocarditis.
Pulmonary embolism Stroke Sepsis Valvular regurgitation
183
When is aortic stenosis heard?
Early diastole
184
What is the gold standard investigation for cardiac murmurs?
Echocardiogram
185
What would be seen on CXR in mitral stenosis?
Enlarged left and right ventricles
186
What does mitral stenosis sound like?
Mid-diastolic rumbling
187
When is mitral regurgitation heard?
Throughout systole - pansystolic
188
Give 4 risk factors for infective endocarditis.
Poor dental hygiene IVDU Immunosuppressed Elderly
189
What is the diagnostic criteria for infective endocarditis called?
Dukes criteria
190
What is the appearance of atrial flutter on ECG?
Sawtooth pattern
191
What is the first line management of atrial flutter?
Rate management - beta blocker | Heparin
192
What are the ECG abnormalities in RBBB?
R wave in V1, S wave in V6
193
What are the ECG abnormalities in LBBB?
S wave in V1, R wave in V6
194
Give 3 side effects of beta blockers.
Erectile dysfunction Cold peripheries Bronchospasm
195
What socioeconomic factors contribute to rates of heart disease?
Depression Anxiety Smoking Social isolation
196
What are the most common causes of pericarditis?
Viral and autoimmune
197
What is heard on examination in pericarditis?
Friction rub
198
When is oxygen indicated after an MI?
If oxygen saturation is below 94%
199
What causes a pansystolic murmur?
Mitral regurgitation
200
What causes a mid diastolic rumbling murmur?
Mitral stenosis

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