cardio Flashcards
(119 cards)
1
Q
which leads correspond to anterior ischaemia
A
V1-V4
2
Q
which leads correspond to inferior ischaemia
A
II, III + aVF
3
Q
which leads correspond to lateral ischaemia
A
1, V5, V6
4
Q
blockage in what artery causes lateral ischaemia?
A
left circumflex
5
Q
blockage in what artery causes inferior ischaemia?
A
right coronary artery
6
Q
investigations aortic aneurysm
A
ultrasound first line
CT angiogram for more detail
7
Q
who gets elective repair for abdominal aneursym
A
if symptomatic
if growing >1cm a year
diameter over >5.5cm
8
Q
normal diameter abdominal aorta
A
<3cm
9
Q
BNP levels + indication for an ECHO
A
> 2000 - 2 week referral
400-2000 - 6 week referral
10
Q
NYHA heart failure classification
A
I - no limitation in physical activity
II - comfort at rest, limitation of normal physical activity
III - comfort at rest, limitation of minimal physical activity
IV - not comfortable at rest
11
Q
what percentage defines preserved ejection fraction
A
> 40%
12
Q
first line management heart failure
A
first line = ACE inhibitor + beta-blocker
13
Q
causes heart failure with preserved ejection fraction
A
- hypertrophic obstructive cardiomyopathy
- restrictive cardiomyopathy
- cardiac tamponade
- constrictive pericarditis
14
Q
ECG findings first degree heart block
A
fixed prolonged PR (>200ms)
15
Q
ECG findings mobitz I heart block
A
- prolonged PR interval until dropped beat
16
Q
ECG findings mobitz 2 heart block
A
fixed prolonged PR interval
P:QRS not 1:1
17
Q
management mobitz type II
A
permanent pace maker
18
Q
features mitral stenosis
A
mid diastolic murmur (louder on expiration)
dyspnoea + haemoptysis
loud S1
malar flush (CO2 retention)
AF due to increased atrial pressure
19
Q
what is s4 heart sound?
A
heard just before s1
indicates stiff or hypertrophic ventricle - turbulent flow from atria contracting against non-compliant ventricle
20
Q
what is s3 heart sound?
A
heard after s2
indicates rapid ventricular filling
can indicate heart failure
low pitched
20
Q
what is s3 heart sound?
A
heard after s2
indicates rapid ventricular filling
can indicate heart failure
low pitched
21
Q
which murmur is quieter when squatting
A
HOCM
22
Q
which murmurs get louder with valsalva manouvre?
A
HOCM + mitral regurg
23
Q
microorganism associated with infective endocarditis due to poor dental hygeine
A
strep viridans
24
organism associated with infective endocarditis <2 months after prosthetic valve surgery
coag -ve staph e.g. staph epidermis
25
signs on examination infective endocarditis
janeway lesion - non-painful red spots on palms and soles of feet
osler nodes - painful red nodules on pads of fingers and toes
roth spots - exudative haemorrhagic retinal lesions
splinter haemorrhages
26
first line investigation infective endocarditis
transthoracic echo
27
what is long QT syndrome
delayed repolarisation of ventricles
28
what can long QT syndrome lead to
ventricular tachycardia/torsades de pointes
collapse/sudden death
29
normal corrected QT interval?
<440 ms in males
<460 ms in females
30
what are LQT1 + LQT2 caused by?
defect in alpha subunit of potassium rectifier channels
31
drug causes prolonged QT interval
amiodarone, sotalol (anti-arrhythmics)
TCAs, SSRIs
methadone
antihistamine (non-sedating) e.g. terfenadine
erythromycin
haloperidol
ondansetron
32
non-drug or congenital causes long QT
electrolytes - hypokalaemia, hypocalcaemia, hypomagnesaemia
MI
hypothermia
SAH
33
pathophysiology rheumatic fever
occurs 2-4 week post group A strep (typically strep. pyogenes) infection
type 2 hypersensitivity, cross-reactive immune response + molecular mimicry
antibodies cross react with myosin + smooth muscles of arteries
34
presentation rheumatic fever
2-4 weeks after strep throat e.g. tonsilitis
fever
joint pain
rash
SOB
carditis
skin - subcutaneous nodules + erythema marginatum
neuro - chorea (muscle movement)
35
major JONES criteria for rheumatic fever
j - joint arthritis
o - organ inflammation e.g. carditis
n- nodules
e - erythema marginatum rash
s - sydenham chorea
36
minor jones criteria
fever
ECG changes
raised inflam markers
arthralgia with no arthritis
37
how to diagnose rheumatic fever
2 major OR
1 major + 2 minor
38
management rheumatic fever
IV benzyl penicillin STAT followed by 10 day course phenoxymethylpenicillin
39
classification of stages of hypertension
1. single reading >140/90 + average/ambulatory readings 135/85
2. single reading > 160/100 + average readings/ambulatory 150/95
3. single reading systolic > 180 or diastolic > 110
40
indications to start pharmacological treatment for hypertension
- stage 1 <80 years old AND target organ damage, CVD , renal disease, diabetes or a QRISK >10%
- anyone with stage 2 or up
41
haemochromatosis pathophyiology
mutations in HFE gene on chromosome 6
autosomal recessive
42
presentation haemochromatosis
fatigue, erectile dysfunction, arthralgia
bronzed skin
diabetes mellitus
liver disease symptoms
cognitive symptoms
43
blood tests haemochromatosis
deranged LFTs
raised transferrin
raised ferritin
44
complications haemochromatosis
liver cirrhosis + hepatocellular carcinoma
T1DM
endocrine + sexual problems
chondrocalcinosis/pseudogout
45
important blood tests in PE
- ABG
- U&Es to assess renal function before CTPA
- clotting function
- D dimer to rule out
46
ECG changes pericarditis
PR depression
wide spread saddle shaped ST elevation
47
management pericarditis
1st line - NSAIDs + colchicine
2nd line - corticosteroids
48
what well's score indicates likelihood for DVT
>2
49
what wells score indicates PE likely?
>4
50
target INR for warfarin when treating DVTs
2-3
if VTE recurrent while on warfarin, increase to 3-4
51
if conduction through AV node is normal - where is pacemaker placed
right atrium
52
if conduction through AV node is abnormal - where is pacemaker placed
right ventricle
53
which part of the waveform on an ECG is a shock synchronised with
R wave - ventricular contraction
54
why do we use SYNCHRONISED cardioversion
to avoid delivering a shock on the t wave - can lead to ventricular fibrillation
55
aortic regurg features
early diastolic murmur
wide pulse pressure
bobbing head
nailbed pulsation
56
beta-blockers side effects
bronchospasm
sleep disturbances
erectile dysfunction
cold peripheries
fatigue
57
features of ventricular free wall rupture post MI
rapid tamponade + cardiac arrest within seconds
poor prognosis
58
features ventricular septal defect post MI
occurs within first week after infarction
SOB
CP
heart failure
pan-systolic murmur along sternal border
59
features + management dressler's syndrome
fever + pleuritic chest pain 2-3 weeks or a month after MI
manage with NSAID e.g. high dose aspirin or ibuprofen
60
what kind of arrhythmia is a right coronary artery infarct likely to cause
complete heart block - supplies AV node
61
ABPI results and what they indicate
0.6-0.9 = mild peripheral arterial disease
0.3-0.6 = moderate to severe
<0.3 = severe
62
what is a TIA
sudden onset of a focal neurologic symptom and/or sign lasting typically less than an hour
63
LACI presents with:
1 of
- unilateral hemiparesis/hemisensory loss of face + arm, arm + leg or all three
- pure sensory stroke
- ataxic hemiparesis
64
how does wallenbergs syndrome/lateral medullary syndrome present
posterior inferior cerebellar artery infarct
- ipsilateral horners
- ipsilateral loss of facial pain and temp
- contralateral loss of limb/torso pain and temp
65
how does lateral pontine syndrome present
anterior inferior cerebellar artery infarct
- ipsilateral horners
- ipsilateral facial loss pain and temp
- contralateral torso/leg loss pain and temp
- facial paralysis + deafness
66
which vaccinations are offered to patients with heart failure
annual influenza
one off pneumococcal
67
ECG finding LVH
S wave in V1 + R wave in V6 >35mm
68
2 level wells score + points
clinical signs + symptoms DVT - 3 points
most likely diagnosis - 3 points
HR > 100 - 1.5 points
immobilisation or surgery - 1.5 points
previous DVT/PE - 1.5 points
haemoptysis - 1 point
malignancy - 1 point
69
ECG criteria STEMI
≥ 2 contiguous leads of:
2.5 mm (i.e ≥ 2.5 small squares) ST elevation in leads V2-3 in men < 40 years, or ≥ 2.0 mm ST elevation in leads V2-3 in men > 40 years
1.5 mm ST elevation in V2-3 in women
1 mm ST elevation in other leads
new LBBB
70
STEMI criteria ECG
>2 anatomically contiguous leads
71
pathophysiology AF
abnormal electrical activity between pulmonary veins and left atria
intermittently conducted through AV node - irregularly irregular ventricular rate
72
rate control first line in AF unless:
- reversible cause
- new onset (<48 hours)
- haemodynamically unstable
- heart failure
- still symptomatic despite rate control
beta blocker (not sotalol) or calcium channel blocker (e.g. verapamil or diltiazem)
73
when is immediate cardioversion used in AF
- AF < 48 hours
- life-threatening haemodynamic instability
74
non-acute management atrial flutter
radiofrequency ablation of tricuspid valve
75
management SVT, patient stable, regular rhythm
first line - vagal manoeuvres
if this fails - adenosine 12mg, then another 12mg
76
what does LAD mean in wolff parkinson white?
right sided accessory pathway
type B - most common
77
normal PR interval
120-200ms
78
normal QRS interval
80-120ms
79
definition broad QRS
>120ms
80
definitive management WPW
radiofrequency ablation accessory pathway
81
management Vfib
ABCDE
CPR
shockable rhythm - unsynchronised
- 1mg adrenaline + 300mg amiodarone after 3rd shock, adrenaline administered every 3-5 mins after alternate shocks
82
management pulseless VT
ABCDE
CPR
shockable - unsynchronised
1mg adrenaline + 300mg amiodarone after 3rd shock
adrenaline administered every 3-5 mins after alternate shocks
83
management VT with pulse + adverse features
synchronised DC cardioversion
amiodarone
84
management VT with pulse + no adverse features
amiodarone 300mg IV over 20-60 mins
900mg over 24 hours
85
cause of torsades de pointes
prolonged QT interval
86
management torsades de pointes if patient haemodynamically stable
IV magnesium sulphate (2g over 10 mins)
87
management acute bradycardia
atropine 500mcg IV
88
mechanism atropine
blocks vagal activity on AV node
89
what is takotsubo cardiomyopathy
broken heart syndrome
stress induced cardiomyopathy
'octopus trap'
90
management PAD stenosis <10cm
endovascular revascularisation surgery (angioplasty)
91
management stable angina
- aspirin + statin
- GTN + beta-blocker or rate-limiting calcium channel blocker (verapamil or diltiazem) first line
- beta blocker + long-acting dihydropyridine CCB (e.g. amlodipine)
- if persistent, re-vascularisation
92
indications for CABG > PCI in angina
>65
diabetic
3 vessel disease
93
management type A aortic dissection
surgical management
blood pressure controlled before
94
management type B aortic dissection
conservative
bed rest
reduce blood pressure with IV labetalol
95
which medication should be added to CCB if hypertension not controlled in a black man
ARB
preferential to an ACEi
96
second line therapy heart failure
aldosterone antagonist e.g. spironolactone, eplerenone
SGLT-2 inhibitors
97
side effect loop diuretics
hypotension
hyponatraemia
hypokalaemia
98
DVLA hypertension rules
can't drive lorries/van if consistently stage 3
99
DVLA rules after angioplasty
1 week off
100
DVLA rules after CABG
4 weeks off
101
DVLA rules after ACS
4 weeks off
1 week if successful angioplasty
102
DVLA rules pacemaker insertion
1 week off
103
DVLA rules aortic aneursym
notify DVLA if >6cm
>6.5cm - can't drive
104
what do u waves signify
hypokalaemia
- deflection after t wave in same direction
105
ECG findings digoxin toxicity
down-sloping ST depression 'reverse tick'
inverted t wave
short QT interval
106
features coarctation of aorta
narrowing around ductus arteriosus
associated with Turners syndrome
reduction of blood pressure distal to narrowing and increase pressure in areas proximal to narrowing
causes hypertension in adults
107
gold standard diagnostic test asthma
FeNO + spirometry with bronchodilator reversibility
FeNO measures inflammation with eosinophils
108
gold standard diagnostic test asthma
FeNO + spirometry with bronchodilator reversibility
FeNO measures inflammation with eosinophils
109
which patients with NSTEMI/unstable angina should have coronary angiography? (and PCI if needed)
immediate - clinically unstable e.g. hypotensive
within 72 hours - patients with GRACE score >3%
110
second line management AF rate control
digoxin
diltiazem (non-hydropyridine CCB) (verapamil cannot be used in combination with beta blocker)
111
useful biomarker to check for reinfarction
CK-MB (creatine kinase)
112
step 4 treatment hypertension (i.e. already taking A + C + D)
if potassium < 4.5 - spironolactone
if potassium > 4.5 - alpha or beta-blocker
113
investigations mesothelioma
CXR - shows effusion or pleural thickening
pleural CT next step
thoracoscopy
if nodularity seen on CT - pleural biopsy
114
stages of COPD according to FEV1
stage 1 - > 80%
stage 2 - 50-79%
stage 3 - 30-49%
stage 4 - < 30%
115
how much fluid should be given in initial resuscitation
500ml
250ml if cardiac disease or elderly
116
maximum fluid given until patient considered fluid non-responsive
2L
117
indications surgery IE
- severe valvular incompetence
- aortic abscess (prolonged PR)
- infections resistant to abx
- cardiac failure refractory to normal management
- recurrent emboli
118
rate control AF if beta-blocker contraindicated
rate-limiting CCB e.g. verapamil, diltiazem
