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Year 3 Conditions > Cardio > Flashcards

Cardio Flashcards

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1
Q

What is a heave

A

Palpable heart beat- LVH or RVH

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2
Q

Drug prefferred in hypertenisive crises

A

IV labetalol then sodium nitropusside and diltiazem

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3
Q

Symptoms of WPWS

A

SOB
Palpitations
Dizziness

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4
Q

What happens in 2nd degree heart block physiology

A

Some P waves manage to get through

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5
Q

How to treat SVT

A

Adenosine 6mg then if fails 12mg if that fails repeat

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6
Q

Where is mitral stenosis best heard

A

Apex when rolled onto left in expiration

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7
Q

What is given after MI to alleviate nausea

A

IV metoclopramide

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8
Q

Complications post MI

A 
VT
Cardiogenic shock
Heart blocks
Mitral regurg
Dresslers syndrome
Ventricular septal defect
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9
Q

What is bisoprolol used for

A

Beta blocker used in AF rate control

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10
Q

Difference between type a and b aortic dissection

A

type a more proximal in ascending aorta whereas b is more distal in descending aorta

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11
Q

What are the risk factors for rheumatic fever

A

poverty
overcrowded living quarters
family history of rheumatic fever
D8/17 B cell antigen positivity

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12
Q

Types of ablation

A

Cryoablation- freezing affected area

Radio frequency ablation- heat on area

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13
Q

What is CHADS VAS score

A 
Congestive heart failure
Htn
Age 64-74 1 point
Diabetes
Stroke history or any other VTE 2 points 
Vascular disease
Age >74 2 points
Sex- female gets a point
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14
Q

What does a canon a wave suggest

A

Sustained V tach

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15
Q

What can an ICD do

A

Monitor ryhtm and rate, if notices abnormality can do 3 things
Pacing
Cardioversion
Defibrillation

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16
Q

What are common signs of rheumatic fever on examination

A 
Heart murmur
Chorea
erythema marginatum
subcutaneous nodules
Pansystolic murmur
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17
Q

How long does sydenhams chorea last

A

1 year

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18
Q

If patient who is a IV drug user has a pansystolic murmur what do you think

A

Tricuspid regurg

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19
Q

Which veins are varicose veins most commonly found along the distribution of

A

Long and short saphenous
Long- groin to medial part of calf
Short- popliteal fossa to lateral malleolus

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20
Q

When would you do Abdo US IE

A

Splenomegaly

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21
Q

ECG diagnosis of irregular QRS and extended QT

A

Torsades des pointes

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22
Q

What are kerley b lines

A

small horizontal lines in lower lobes of lungs

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23
Q

Difference in pain between arterial, venous and neuropathic ulcers

A

Arterial- very painful
Venous- slightly painful
Neuropathic- no pain

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24
Q

How does aortic dissection appear on CXR

A

Widened mediastinum to right

Blunted aortic notch

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25
Differences between critical limb ischaemia and intermittent claudication
Like stable angina vs unstable | Claudication just on exertion but critical limb ischaemia all the time like at night and rest
26
Immediate actions when somenoe goes into V fib
Call for help | Start CPR
27
Cardiac causes of arrythmias
``` IHD Structural heart changes Cardiomyopathy Pericarditis Myocarditis Aberrant conduction pathways ```
28
Causes of sinus tachycardia
Caffeine Alcohol Dehydration Anxiety
29
Main complication of WPWs
Can go into deadly V fib if go into A fib or flutter
30
Mid diastolic murmur
Mitral stenosis
31
Managment of AF BP stable sx started under 48hrs ago
Rate- beta blocker Rythm- DC or chemical Stroke risk- DOAC post evaluation
32
Associated features of neuropathic ulcers
Can get osteomyelitis
33
MONA BASH
``` Morphine Oxygen is sats below 94 Nitrates Anti Platelets Beta blockers ACE inhibitors Statin Heparin ```
34
Chronic management of A fib
Rate control using rate limiting Ca blocker- if fails digoxin and amiodarone Rythm control done via cardioversion, flecainide, ablation or IV amiodarone Anticoagulation with warfarin or heparin- only done if CHADS VAS score above 1
35
What is treatment for type b aortic dissection
blood pressure control and monitoring
36
how to exclude MI from angina diagnosis
Troponin
37
What does cardiomyopathy mean
Heart muscle becoming structurally abnormal in absence of ischaemia etc
38
What is sydenhams chorea
Movement disorder- irregular, abrupt and rapid involuntary movements
39
Presentation of mitral stenosis
Pulnomary hypertension leads to dyspnoea, haemoptysis and chronic bronchitis presentation
40
What is ECG sign of Q wave infarction
Q wave heavily inverted
41
Criteria for HF
New York Heart failure | 1-4
42
Difference between aspirin and warfarin
Aspirin affects platelets and warfarin clotting factors
43
What patients can't adenosine be used in
Asthmatics
44
What is hypertrophic cardiomyopathy
Marked hypertrophy of left ventricel in absence of an identifiable cause such as HTN or valve disease
45
What causes pansystolic murmur
Mitral regurg Tricuspid regurg Ventricular septal defect
46
What does bruits over intercostal spaces suggest
Aortic coarctation
47
Chemical rhythm management of AF
Amiodarone or flecainide
48
What is important to remember when viewing Echo
Upside down so ventricles are atria
49
Once you have checked the rythm after a round of CPR what must you always do
Check pulse as could be PEA
50
How would investigations appear for aortic stenosis ECG CXR
ECG - p mitrale - LVH - LBBB or AVN block CXR - dilation of aorta - LVH
51
What does pericardial friction rub indicate
Pericarditis
52
Risk factors for emboli
AF | Aneurysm
53
Treatment for haemodynaimcally unstable sustained v tach
Immediate cardioversion Follow with amiodarone Pacemaker
54
for pericarditis complications how do you differentiate between congestive heart failure and pericardial effusion
In congestive heart failure the pulnomary vasculature will be congested alongside cardiomegaly whereas pulnomary congestion would be absent in pericardial effusion
55
ECG signs of mitral stenosis
P mitrale as enlarged atrium | Can be signs of AF
56
What are complications of ICD
Bleeding and infection during insertion Leads come off requiring future surgery Damage to left sublcavian Collapsed lung
57
Presentation of critical limb ischaemia
``` Ulcers Gangrene Rest pain Night pain Like unstable angina ```
58
What is cause of sudden death in HCM
Arrythmia
59
What happens to blood pressure in aortic dissection
Hypertensive to begin with but immediately can drop due to haemorrhagic shock
60
What does mid systolic click suggest
Mitral valve prolapse
61
What can cause murmur in HCM
Hypertrophy of septum interfering with mitral valve leaflets
62
What can cause pump failure in relation to HF
Beta blockers Anti-arrythmics Heart block Post MI
63
Management of A fib acute
DC cardioversion if severe signs shown such shock and myocardial ischaemia Drugs such as fleicanide
64
Signs on examination of mitral regurg
Displaced and hyperdynamic apex | Pansystolic murmur radiating to axilla
65
What is pink cheeks a sign of
Mitral stenosis
66
What is common auscultation sign for arrythmias
Varied first heart sounds intensity
67
What does syncope during exercise indicate
Very concerning- condition predisposing to instant cardiac death such as long QT syndrome
68
What is most common PE ECG finding
Sinus tachycardia
69
How will chronic stable angina appear on ECG
At rest normal but during exercise will see ST depression
70
Sign of basal ganglia rhem fever involvement
Sydenhams chorea | Can also get psychiatric
71
Chronic causes of aortic regurg
Hypertension Autoimmune- rheumatoid, rheum fever, SLE, seroneg arthrides Congenital Connective tissue disorders
72
What causes fourth heart sound
Ventricular hypertrophy- sound is atria contracting
73
How will a posterior MI present on ECG
ST depression in V1-3
74
Examples of valsava manoeuvres
Sticking fingers down throat Pressing against eyeballs Dipping face in cold water or swallowing cold drinks/ice Holding breath and trying to exhale
75
Investigations for limb ischaemia
ECG Handheld doppler ABPI Angio MRI/CT
76
What happens in reactive hyperaemia
Massive build up of metabolic waste products
77
Whats a tapping apex
Palpable apex beat and loud first heart sound
78
Immediate management of HF
Sit the patient up | 15L/min oxygen
79
Treatment for haemodynalically stable sustained v tach
IV amiodarone IV sotalol Pacemaker
80
Medical management of HF
IV furosemide GTN Morphine
81
What drugs must be avoided in WPWS
Digoxin Verapamil Bisoprolol All block AV conduction
82
Causes of dilated cardiomyopathy
Idiopathic Infection- cocksackie B causes myocarditis Congenital- duchenne muscular dystrophy, haemochromatosis Alcohol as toxic to myocardium Drugs- cocaine, chemo
83
What is good marker of how severe mitral regurg is
Larger the apex
84
Results of investigations for mitral stenosis
ECG- p mitrale, AF CXR- pulnomary oedema, left atrial enlargement Echo- LAD, mitral orificie reduced size
85
What is brown pigmentation around venous ulcers
Haemodesrin
86
Who do you see splenomegaly in cardio
Infective endocarditis
87
What is osteomyelitis
Infection of bone under skin
88
What is first drug that must be given to patient coming in with ACS and why
Aspirin- stop platelet action
89
What does increased JVP on inspiration suggest
Constricitve pericarditis
90
What arrythmia is associated with death in long QT
Torsade de pointes
91
Most common form of pericarditis
Fibrinous
92
Range of warfarin dose
2mg-10mg
93
What are risk factors for aortic dissection
``` Any connective tissue disorder like Marfans Htn Atherosclerosis Ehlers Danos syndrome Coarctation of aorta Aortic valve defect Patent ductus arteriosus ```
94
What is unsustained v tach
Brief and self resolving Asymptomatic When present with CAD and LVD is risk factor for sudden death
95
What system are clotting factors the problem in
Venous
96
What happens at each HYHFA criteria
1- heart disease but no SOB from undue exercise 2- SOB fine at rest but bad on exertion 3- less than ordinary activities cause SOB 4- SOB present at rest
97
Signs on examination of aortic regurg
``` Collapsing pulse Bounding pulse Early diastolic murmur high pitched Wide pulse pressure Quinckes sign De musset ```
98
What is DC cardioversion
direct current cardioversion- electrodes applied to chest to restore a normal heart rythm from an abnormal one
99
How does p mitrale appear
Bifid p wave
100
How does p pulmonale appear
High p wave
101
Examples of SVTs
AVRT | AVNRT
102
Older surgical treatment for stable angina
Coronary artery bypass graft
103
Investigations for rheumatic fever
Blood cultures Throat swab CRP - very heightened Echo
104
What are different types of v tach
Sustained vs unsustained
105
Difference in appearance on CXR between hypertrophied vs dilated LV
On CXR dilated will appear large whereas LVH appears normal
106
When do you give aspirin
If evidence of atheroma or ischaemia in coronary arteries or carotid
107
ECG v tach
Wide and bizarre QRS' | HR> 100
108
At what size are elective abdo aortas operations organised
When above 5.5cm
109
Investigations for HF
Bloods- BNP CXR ECG Echo
110
Longer term signs of ischaemia wouldnt see in acute limb ischaemia
Hair loss | Ulcers
111
What HF medication is likely to have side effect of yellow tinged vision
Cardiac glycosides such as digoxin
112
What is quinckes sign
Pulsatile nature of aortic regurg means there is bouding pulse so your head almost nods as blood flow reaches it. This can be seen when press nail against surface and the line which is white will move
113
Causes of mitral stenosis
Rheumatic fever Endocarditis Prosthetic valves
114
What symptoms can limb claudication present with other than pain
Parasthesia Cold feet Hair loss Ulcers
115
What is done in carotid sinus massage
Rub carotid on side of neck where bifurcation is
116
How are aortic dissections classified
Type A- ascending aorta | Type B- descending aorta
117
What can cause mitral regurg
``` LV dilation Senile calcification Endocarditis Rheumatic fever Cardiomyopathy Connective tissue disorders ```
118
What would you give an old inactive patient in AF
Digoxin | Anti-coagulate
119
Important investigations in WPWS
TSH | Echo
120
Treatment for unsustained v tach
If no underlying heart condition no treatment needed however if is one then ICD needed and amiodarone secondary to this
121
What could cause sudden death in young healthy person during exercise
HCM
122
What is the name of second part of second heart sound
Pulmonary
123
What presents with syncope, SOB on exertion and angina
Aortic stenosis
124
When are left sided valve problems more common
In high oressure systems
125
Symptoms of A fib
Palpitations Stroke Irregular pulse
126
Dose of aspirin if carotid artery ischaemia or atheroma evidence
300mg
127
STEMI management is dependant upon what
If symptoms started 12 hours ago or less
128
2 problems that can occur at any time following MI
AF | HF or LVD
129
Symptoms for atrial flutter
``` Palpitations Exercise intolerance Confusion and dizziness Chest pain SOB ```
130
Procedure for any sustained v tach
Pacemaker
131
Common presentation of HCM
Normally no symptoms but can be angina dyspnoea or syncopal attacks
132
What is an ICD
Implanted cardiac defibrillator An ICD is placed under the skin to monitor your heart rate, with thin wires connecting it to the heart. An ICD constantly monitors your heart rhythm through the electrode and try and correct any abnormalities it notices
133
1 st degree heart block physiology
Ischaemia at AV node means slowing of beats getting through
134
What type of aortic dissection produces unequal pulses
Proximal to left subclavian artery
135
Main risk factors for PAD
smoking – the most significant risk factor type 1 diabetes and type 2 diabetes high blood pressure high cholesterol
136
What is used to rate control a patient in AF
Beta blocker
137
What is buergers test
Hold patients leg up in air for 2 minutes and look for pallor. Then when patient hangs legs over the bed will see in positive buergers the affected leg going from pallor to very red back to pinkiness
138
First investigation for ACS
ECG- is ST elevation?
139
Very notable sign of mitral stenosis murmur
Very loud S1
140
Differences in accessory pathway WPWS
Can be antegrade so from atria to ventricles- known as orthodromic. Or can be exclusively retrograde and go from ventricles to atria- antidromic
141
Why does inferior STEMI show up on leads II,III and AvF
Leads II, III direction of travel is downwards to feet
142
What is treatment for type a aortic dissection
cardiothoracic surgical intervention
143
What are other changes seen in MI ECG
Reciprocal ST depression | T wave inversion
144
Complications of v tach
Asystole Sudden cardiac death V fib
145
Why does ischaemia predispose to V fib
Myocardium more excitable
146
In leg ischaemia what will what will ABPI be
Less than .7
147
What is 4th HS indicative of
Atrial contraction against stiffened ventricle normally from HTN
148
Minor criteria for IE
Predisposition such as IV drug user Fever over 38C Vascular signs Immunological signs
149
Causes of diastolic HF
Restrictive ardiomyopathy Constrictive pericarditis Tamponade LVH
150
What is multifocal sinus tachycardia caused by
COPD hypoxia
151
What is the inheritance of hypertrophic cardiomyopathy
Autosomal dominant
152
What is sustained v tach
``` Longer than 30s Symptomatic Haemodynamically unstable Life threatening Can lead to v fib ```
153
Why do you get aortic regurg with aortic dissection
Any dilation or ripping of aorta immediately to aortic valve will cause regurg
154
Reference range for uncomplicated DVT warfarin dose
2-3
155
What is a pericardial friction rub
Upon auscultation hear a murmur with 1 systolic and 2 diastolic sounds
156
Signs on examination of aortic stenosis
Narrow pulse pressure Slow rising pulse Ejection systolic murmur which radiates to carotids
157
Most common complication of VSD
Endocarditis
158
What is a U wave
Small deflect after T wave seen in hypokalaemia
159
2 different physiological types of v tach
Focal and reentry
160
what condition can deceivingly elevate troponin
Myopericarditis
161
What causes tapping apex beat normally
Mitral stenosis
162
What is atrial flutter
Circulatory or oscillatory atrial impulses around the atria which occasionally stimulates the AVN
163
When is pericardial rub best heard
At left sternal border leaning forward on expiration
164
5 cardinal signs of rheum fever
``` Pancarditis Arthrits Sydenhams chorea Erythema nodosum Subcut nodules ```
165
When do you see cannon waves at JVP
Third degree HB
166
what is treatment for pericarditis
NSAIDS
167
Drugs preferred in WPWS and why
Amiodarone Flecainide Have less blockage on AV node
168
What does history of IV drug user and recent dental surgery indicate in SBAS
Infective endocarditis
169
Largest cause of death post MI
Cardiogenic shock
170
What system are platelets the problem in
Arterial
171
Differences between dry and wet gangrene
Dry occurs in arterial obstruction whereas wet is when bacteria the site normally post venous obstruction
172
Investigations for mitral regurg
CXR ECG Echo
173
What drug has no evidence for post MI use
Omega 3
174
Where are venous ulcers normally on leg
Lower third of leg between mallelous and lower calf
175
Important question to ask for patient with murmur
Rheumatic fever when a child
176
features of marfans
raised palate lens dislocation arachnodactily
177
How long after does troponin actually become elevated for in MI
12 hours therefore not a good acute investigation
178
How does a flutter appear on ECG
Saw tooth baseline
179
When are cannon waves seen
3rd degree HB
180
What drugs should be given for stable angina
Nitrates- GTN or ISMN Beta blocker- atenolol Aspirin Statin- simvastatin
181
Is CPR always required in V fib
Yes as pulseless
182
What difference in BP between both arms would be significant
20mmHg
183
What is PND
Paroxysmal nocturnal dyspnoea- awake every couple of hours short of breath
184
What is hypertension defined as
BP >140/90
185
Symptoms of aortic regurg
Exertional dyspnoea Orthopnoea PND Rarer- palpitations, syncope, angina
186
What indicates Left bundle branch block other than William
Prolonged QRS complexes
187
Medication given for after MI
``` Clopidogrel Bisoprolol Aspirin 75mg Atorvastatin Ramipril ```
188
When are mitral murmurs heard best
When rolled on side
189
Characteristics of venous ulcers
Shallow Irregular shape- can be champagne shaped Fibrinous material at ulcer bed Flat or steep margin elevation
190
What happens to EF in systolic and diastolic HF
HF preserved in diastolic but less than 40 in systolic
191
What is main life threatening issue of ACS immediately
Ventricular arrythmia
192
What can be done to diagnose a tachyarrythmia when in tachycardia
Carotid sinus massage Valsava IV adenosine
193
What does p mitrale suggest
Left atrial enlargement
194
What is flow chart of progression to limb ischaemia
``` Pale, cool and hair less to Ulcer and gangrene to 6Ps ```
195
What valve causes first heart sound
Mitral (slightly tricuspid)
196
Where is DVT normally managed
In the community
197
What 4 rythm abnormalities can cause cardiac arrest
V fib Asystole Pulseless ventricular tachycardia Pulseless electrical activity (electrical activity and no cardiac output)
198
What causes BBBs normally
IHD
199
Differences in auscultation for chronic and acute rheumatic fever
Acute- pansystolic mitral regurg | Chronic- diastolic mitral stenosis
200
Investigations for aortic stenosis
CXR ECG Echo
201
What is problem with warfarin in MI treatment
Is long acting and produces a pro thrombotic state initially
202
What can be trauma cause of limb ischaemia
Compartment syndrome
203
Associated findings of venous ulcers
``` Lipodermofibrosis Lipodermatosclerosis Brown pigment Telengiectasia Normal cap refill ```
204
Treatment rheumatic fever
Bed rest | Antibiotics
205
What is rheumatic fever
Acute rheumatic fever is an autoimmune disease that may occur following group A streptococcal throat infection. It affects the heart and joints mainly
206
Risk factors for SVT
Underlying cardiac issues such as IHD, cardiomyopathy Hyperthyroidism Excessive alcohol and caffeine consumption
207
What decides whether you cardiovert a patient or just slow their ventricular rythm
If they are fit and healthy then you will want to cardiovert as slowing ventricular rythm still leaves you with a reduced CO
208
How many blood cultures needed for IE
3
209
What tachycardia is caused by WPWS
Atrioventricular re-entry tachycardia
210
Where are neuropathic ulcers generally found
Under any calluses or pressure points on foot such as plantar aspect of first or fifth MTP joint
211
ECG abnormality infective endocarditis
Heart block
212
Mangement of AF BP stable Sx started over 48 hours ago
Rate control and anti-coagulate for 3 weeks then come back
213
Signs on examination of mitral stenosis
Malar flush Tapping apex beat Mid diastolic murmur Thrill
214
ECG finding for WPW syndrome
Delta wave- depolarisation occurs early so R wave starts early missing out Q wave so is upstroke from p wave immediately. PR interval also shorter
215
What does a mid systolic click followed by a late systolic murmur heard at apex indicative of
Barlow syndrome
216
Signs of RHF as opposed to LHF
LHF lung related so orthopnoea, SOB, PND, pinky sputum | RHF pre lung related so ascites, oedema, anorexia and epistaxis
217
Test used to determine sats pressure of heart chambers
Left and right heart catherterisation
218
Pain character in intermittent claudication
Cramping
219
What is a thrill
Vibration felt over a valve- indicates turbulent flow
220
How does abdominal aortic aneurysm present
With back pain once the aneurysm gets so big it begins to press on the lumbar spine- acute onset think ruptured
221
Why does patients leg go very red in buergers test after hanging them off table
Reactive hyperaemia
222
What must be considered when deciding what drug to give for chemical cardioversion in
If structural damage give amiodarone
223
How to evaulate whether patient should be started on a DOAC to reduce stroke risk
Combine both CHAD-VASC and HAS-BLED and determine whether risk of clot outweighs that of bleeding
224
What are varicose veins caused by
Incompetent venous valves
225
What condition are roth spots seen in
IE
226
What is main cause of hospital deaths following MI
Cardiogenic shock- especially if present long after
227
What is wolff-parkinson white syndrome
Congenital heart defect where have an accessory pathway joining atria and ventricles which bypasses AVN resulting in early ventricular depolarisation before purkinjie fibre pathway.
228
Echo findings IE
Vegetations Abcess Abcess prosthetic valve
229
Vascular signs IE
Mycotic emboli | Janeway lesions
230
Observation signs of aortic regurg
Quinckes sign | Nodding head
231
What are causes of RHF
Lung disease leading to cor pulmonale | Pulmonary stenosis
232
How can lower limb purpura suggest AAA
Aneurysms have turbulent flow so leads to embolic formation
233
What pain can ruptured abdominal aorta present with
Any abdominal pain anywhere even loin to groin pain
234
what do kerley b lines suggest
pulnomary oedema
235
What is management of NSTEMI
Give fondaparinaux and GRACE score risk stratification. If low risk then medical management however if high risk do angiography
236
What is used to monitor warfarin dose
INR
237
Modern day surgical treatment for stable angina
Angioplasty- out a wire in and blow up a balloon and put a stent in sometimes ALOT LESS invasive
238
At what level does aorta bifurcate
L4- same as umbilical therefore have to always have to palpate above umbilicus
239
What is A fib
Chaotic and irregular atrial rythm
240
How does tourniquet test work for varciose veins
Hold patients leg above level of bed and "milk" blood out of the veins Place tourniquet over saphofemoral junction(2/3cm lateral and inferior to pubic tubercle) Get patient to stand up and view if varicose veins fill or not If veins dont fill then veins collapse so problem is at level of SFJ If do fill then must move down leg to find level of problem
241
Overall management guidance for arrythmias
Conservational- treat immediate cause like less caffeine or pill in pocket Medication- rythm and rate control or medical cardioversion Interventional- DC cardioversion, pacemaker, ablation
242
5 major criteria for rheumatic fever
``` Carditis Arthritis Erythema marginatum Sub cut nodules Chorea ```
243
Rare presentation of mitral stenosis
Hoarse voice Dysphagia All from enlarged LA putting pressure on left recurrent laryngeal nerve
244
What are indicated in immobility
Clotting factors
245
What to use if adenosine contraindicated in SVT
Verapamil
246
What causes venous ulcers
Venous HTN leads to capillary leakage
247
What is kussmauls sign
Increased jugular distension on inspiration
248
Treatment paroxysmal A fib
Pill in pocket of sotalol or flecainide
249
Associated findings with arterial ulcers
Consistent with chronic ischaemia- hair loss, pale, pulseless and extended cap refill
250
What artery is normally affected when get mitral regurg
RCA
251
Risk factors for clot forming in situ
Cancer Coagulopathy Pregnancy
252
Dose of aspirin for coronary artery ischaemia evidence
75mg
253
Define SVT
A regular narrow complex tachycardia with no p waves and a sv origin
254
What is epistaxis
Nose bleed spontaneously
255
What are risk factors for WPWS
Ebsteins anomaly Cardiomyopathy Septal defects Valve defects
256
What is major RF for acute limb ischaemia
AF
257
Pathway to ACS
``` Risk factors Coronary artery inflammation Atherosclerosis Plaque rupture Atherothrombosis ACS ```
258
Complications of IE
``` Heart block TIA AKI HF Vertebral osteomyelitis ```
259
What presents with ST elevation, unraised troponin and chest pain in am or in night
Variant angina
260
Management of AF BP stable 3 main aims of treatment
Rate Rhythm Stroke risk
261
Why does left sides STEMI show up on lead l
Direction of its travel is to left
262
when to consider marfans
unusually tall with very long limbs
263
What changes can be seen in NSTEMI
T wave inversion | ST depression
264
Why are complexes narrow in SVT
It starts at level below atria so start at same time
265
Ebsteins anomaly on ECG
Tall and broad p waves Prolonged PR intervals Right bundle branch patterns Tachyarrythmias
266
What must be taken into account when prescribing LMWH
Weight of patient | Renal function
267
What is the name of first part of second heart sound
Aortic
268
Management of Stable angina
Beta blockers GTN Rf modification
269
Most common cause angina
Atherosclerosis
270
Management path of SVT
If haemodynamically unstable then DC | If stable do vagal manoeuvres and then course of adenosine
271
Longer term management of HF
Beta blocker ACE inhibitor RF management
272
Common risk factors for A flutter
Heart failure very common surgical or post-ablation scarring of atria, increasing age, valvular dysfunction, chronic ventricular failure, atrial septal defects, atrial dilation, recent cardiac or thoracic procedures, hyperthyroidism, COPD, asthma, or pneumonia.
273
problem with viral serology test
takes 2 weeks for test to come back so useless in acute diagnoses
274
How does congestive heart failure appear on CXR
Cardiomegaley Pleural effusion- can't see costophrenic angle Kerley B lines
275
Which drugs commonly affect heart valves
Appetite suppressants
276
Differentiate between unstable and stable angina
stable only feels pain on exertion whereas unstable can be at rest and sporadic
277
What causes low output HF by category
Excessive preload- fluid overload from IV fluid xs, mitral regurg Pump failure- diastolic and systolic causes Chronic excessive afterload- aortic stenosis and HTN
278
What to do if STEMI Sx started less than 12 hours ago
PCI- if going to be 2 hours until PCI due to site of hospital then give thrombolysis
279
Treatment for complete heart block
Pacemaker
280
How does treatment vary between AF and a flutter
DC cardioversion preffered over medication. Recurrence rates common so radio frequency ablation
281
What is buergers angle
The angle at which the leg is positive for burgers
282
What can make a MI very hard to diagnose
ST segments are interpretable in BBBs
283
Typical presentation of rheumatic fever
History of recent throat infection Fever and joint pain Apical heart murmur Ring like rash on abdomen and thighs
284
What causes third heart sound
HF- ventricular filling
285
Results of investigations for mitral regurg
CXR- pulnomary oedema, large LA and LV | ECG- pulnomale mitrale, LVH
286
What are indications for DC cardioversion
Any arrythmia most commonly A fib or A flutter
287
What can cause bradycardia after an MI
Heart block- side dependant on side of artery damaged | Most cases normally resolve within a few days
288
Long term management of STEMI
Bisoprolol ACE inhibitor Atorvastatin
289
What happens to BNP in HF
Goes up
290
What drugs must be avoided after a MI
NSAIDS as CVS side effects
291
Rarer types of angina
Decubitus angina Prinzmetal angina Chest syndrome x
292
What can make a MI very hard to diagnose
ST segments are uninterpretable in BBBs
293
Treatment for suspected aortic dissections
Have to control pain and maintain BP around a stable level with anti-hypertensives
294
Investigations for infective endocarditis
Echo | Three sets of blood cultures
295
What causes radiofemoral delay
Aortic coarctation | Aortic dissection
296
What does treatment for AF depdend on
If Sx started within or after 48hrs
297
T2 second degree HB ECG
All p waves aren't followed by a QRS so is disparity. Could be in a 2:1 or 3:1 ratio
298
Tests to be carried out for arrythmias
``` U and Es FBC Glucose TSH ECG potential tape Echo Provocation ECG Stress test ```
299
Common abdo finding IE
Splenomegaly
300
What arrythmia is associated with death in WPWS
A flutter or fib leading to V fib
301
What is drug used to convert fast af to slow af
Digoxin
302
What is used to monitor LMWH dose
APTT
303
What is done in valsava manoeuvre
Manouevres that strain against a close glottis
304
What are 5 main causes of pleuritic pain
``` Pneumothorax Pericarditis PE Pneumonia Pleuracy ```
305
Acute causes of aortic regurg
Trauma Infective endocarditis Type A aortic dissection
306
What is difference between WPW pattern and syndrome
Pattern asymptomatic and without arrythmias
307
Typical presentation of aortic coarctation
Congenital young person Atherosclerotic elderly RFx Radiofemoral delay Bruits over intercostal spaces
308
Investigations for DVT
Doppler US Venometry D-dimer
309
What murmur associated with aortic dissection
Early diastolic
310
What is given when adenosine contraindicated in asthmatics for SVT
Flecainide
311
What is asystole
When no cardiac electrical activity
312
What tends to precipitate arterial ulcers
Trauma to that area
313
Clinical symptoms of v tach
Light headedness Chest pain Palpitations SOB
314
Why do patients stay in hospital after angioplasty
Strong chance of going into V fib as very reactive fibres
315
Problem of warfarin
Have to have INR checked regularly as warfarin has narrow therapeutic window
316
What do you see quinckes sign in
Aortic regurg
317
What is cardiac arrest
sudden state of circulatory failure due to a loss of cardiac systolic function
318
What are indications for an ICD
``` Arrythmias Conditon that could predispose you to issue in future- cardiomyopathy and long QT syndrome Structural heart conditions Previous cardiac arrest V tach and v fib in particular ```
319
What is pain like in aortic dissection
Sudden shearing pain that radiates to back
320
Characteristics of neuropathic ulcers
Punched out with deep sinus | Variable depth- can involve down to bone
321
What does ST depression suggest
NSTEMI and ischaemia long term
322
Cardinal symptoms of mitral stenosis
SOB | Fatigue
323
What are 6 Ps for limb ischemia
``` Pallor Pain Parasthesia Pulseless Paralysis Perishingly cold ```
324
Antibodies made in rheum fever
Anti-streptolysin
325
What can rheumatic fever be caused by
Type A strep throat infection | Scarlet fever
326
What is catheter ablation
Process used to destroy or scar area of heart giving you the problems
327
What part of virchows triad are anti-platelets aimed at
Vessel wall damage as leads to platelet activation
328
What HS is associated with HF
3rd- ventricular filling
329
What to do if STEMI Sx started more than 12 hours ago
Angiography followed by PCI if needed
330
Where are arterial ulcers normally on leg
Distal- on dorsum of toes or feet
331
What is target BP for people
Over 80 aim for below 145/85 | Under 80 aim for below 135/85
332
What tests do you need to do after stable angina history
Exercise test and monitor ECG
333
What happens to pulse pressure as get older
Widens
334
How best to visualise if an aortic aneursym is leaking
CT aorta
335
Main investigations post MI
ECG CXR Enzymes
336
Third degree heart block physiologically
Atria contracting completely independant of ventricles
337
Pills that can lead to coagulopathy
Warfarin | OCP
338
If recurrent PEs without RFx what would be thing to check
Thrombophilic screen
339
What does QRS look like in heart blocks
Narrow in bilateral blocks
340
Tests for varicose veins
Tourniquet/Tredelenburg test | Doppler
341
What is word normally used to describe hyperkalaemia on ECG
Tented
342
Management of HCM
CCB and B blockers which reduce load on LV and then amiodarone to reduce chance of arrythmias ICD Surgery when aortic outflow becomes impaired
343
What part of virchows triad are anticoagulants aimed at
Stasis as leads to activation of coagulation factors
344
Presentation of mitral regurg
SOB Fatigue Palpitations
345
How does hypokalaemia appear on ECG
U wave
346
What exclusively normally causes mitral stenosis
Rheumatic fever
347
3 types of limb ischaemia
Intermittent claudication- stable angina Critical limb ischaemia-unstable angina Acute limb ischaemia- STEMI
348
What are 5 wave forms of JVP
ACXVY
349
What else would present with ST elevation
Ventricular aneurysms
350
How best to listen to aortic regurg murmur
In expiration sat forward
351
Difference in heart muscle diastolic vs systolic HF
Weak heart muscle in systolic from dilatation whereas in diastolic heart muscle stiff so doesnt fill
352
Investigations for heart failure bedside, bloods, imaging
Bedside- ECG Bloods- ABG, troponin, BNP Imaging- CXR, Echo
353
Management options if adenosine doesnt work on SVT
IV beta blocker IV digoxin IV amiodarone DC cardiovert
354
What could be cause of red swollen leg after an operation
DVT | Post operative leg oedema
355
Typical presentation of aortic stenosis
Chest pain, syncope and exertional dyspnoea Very commonly seen in heart failure Other symptoms include dizziness and dyspnoea at rest
356
What test is used to visualise where blockage in coronary artery is
Angiogram
357
Causes of cardiac murmurs
``` Senile calcification Rheumatic fever ever Cardiomyopathy IHD Infective endocarditis Physiological ```
358
How would leaking abdominal aorta present on examination
Tender Palpable Pulsatile Expansile AA Lower limb purpura
359
What does pain relieved by GTN suggest
Unstable angina
360
How to take palpitations history
``` Nature- fast/slow? regular/irregular? What precipitates it Duration Any accompanying symptoms Drug history Medical history of cardiac problems Does it happen during exercise? ```
361
Causes of aortic stenosis
SEEN IN OLD AGE due to senile calcification and fibrosis Bicuspid aortic valve Rheumatic fever
362
What does shortened PR interval show
WPWS
363
Urgent reatment for any septal defect
Intra aortic balloon pump
364
Appropriate investigations for mitral stenosis
ECG CXR Echo
365
What is stable angina
Partly blocked coronary artery that when HR increases iscahemia becomes significant. Lactate accumulates as aerobic exercise impossible due to lavk of oxygen leading to ST depression
366
Complications of DC cardioversion
Clot dislodgement burns bradycardia can develop further arrythmias
367
How is pleuritic pain normally described
sharp
368
What would shallow t wave inversion in pericarditis suggest
Myopericarditis
369
How does AAA appear on AXR
Curved and calcified
370
Most definitive test for HF
Echo
371
What causes tachypnoea post MI
Pain
372
What is acronym for treating MI
MONA BASH
373
What are main symptoms of rheumatic fever
Joint pain Fever Malaise
374
What if is no ST elevation
Is troponin elevated? Yes is NSTEMI No is UAP
375
Immediate generic management of ACS
Morphine O2 if required GTN spray Dual Antiplatelet therapy
376
Lifestyle suggestions post MI
``` Reduce fat intake Increase intake of whole grains, nuts and veg Graded exercise programme Stop smoking Alcohol in regulation Avoid NSAIDS ```
377
How can pneumonia cause AF
In middle lobe irritates atrium
378
What could be seen on ECG limb ischaemia
AF | Signs of ichaemia
379
What is ebsteins anomaly
Ebstein anomaly is a rare heart defect in which the tricuspid valve — the valve between the upper right chamber (right atrium) and the lower right chamber (right ventricle) of the heart — isn't formed properly. As a result, blood leaks back through the valve and into the right atrium. Very common for accessory pathways to form around the TV
380
Signs examination of mitral regurg
AF PSM Displaced hyperdynamic apex
381
If patient has previous MI what must consider when looking at their obs
Might be on Beta blockers so will mask signs of shock
382
How would investigations appear for aortic regurg ECG CXR
ECG- LVH CXR- pulnomary oedema, cardiomegaly, dilated ascending aorta Echo
383
How do you exclude a pericardial effusion
Echo
384
For rheumatic fever does infection have to have affected pharynx
Yes- always type a beta haemolytic strep infections
385
Dual antiplatelet therapy used in ACS management
Aspirin and Clopidogrel
386
What is management of SVT
Adenosine 6mg-> if fails another 6mg then if fails again -> 12mg
387
1st degree heart block ECG
Long PR interval
388
T1 second degree HB ECG
PR interval increasing until missed P wave then reverts to normal
389
Definition of AF
Irregulalrly irregular narrow complex tachycardia with no p waves
390
Immunological signs IE
Osler nodes Positive RhF Glomerulonephritis Swollen fingers or toes
391
What does pulsatile liver suggest
Tricuspid regurg
392
What does ABPI do
Checks pressure difference between brachial and ankle to give index. Ankle/brachial systolic
393
How to diagnose a ventricular spetal defect
Check sats of blood in each chamber- if defect will be massive disparity between atria and ventricle
394
Pathogenesis of rheum fever
Antibodies produced against strep infection that then attacks proteins mimicked in body such as in heart, joints and brain
395
How to define SVT
Abnormally fast heart rate (100bpm
396
Symptoms of mitral regurg
Dyspnoea- pulnomary hypertension Palpitations Fatigue Fever depending on cause
397
What is most common cause of aortic stenosis in under 60s
Bicuspid aortic valve
398
Major criteria for IE diagnosis
Positive echo finding | Positive blood culture
399
Investigations A fib
ECG Bloods for normal arrythmia investigations Echo
400
Managment of acute limb ischaemia
IV heparin immediately | Refer to vascular surgery where could emolectomy, bypass or amputation
401
Common valvular dysfunction post MI
Mitral regurg due to papillary muscle necrosis
402
Do you use vagal maoeuvres in AF
No only in SVT
403
What is aspirin dose post MI
300mg stat
404
What is done immediately post MI low BP with fluid in lungs
CPAP to force fluid back into vasculature and improve BP | DONT give fluids
405
Differentials for broad complex tachycardia
V fib V tachycardia Torsades de pointes tachycardia Antidromic AVRT
406
What happens to valves in cardiomyopathy
As walls extend the valves get pulled apart meaning cant shut properly- get regurg disease
407
What causes A fib
``` HF PE Mitral valve disease Caffeine Alcohol Thyroid issues Electrolyte issues ```
408
What does p pulmonale suggest
Right atrial enlargement
409
Treatment options for acute limb ischaemia
``` Moving in severity IV heparin Emolectomy Intra arterial thrombolysis Amputation ```
410
What is name given to area where venous ulcers are found on leg
Gaiter area
411
Management of AF haemodynamically unstable
DC cardioversion
412
When do you hear a bruit
Anywhere with turbulent flow such as aneurysm or narrowing in vessel
413
Complications of Acs
``` Pump failure Rupture of Paillard muscle or septum Aneurysm Embolism Dressler syndrome PRAED ```
414
what is sign on examination of pericardial tamponade
raised jvp
415
What is ABPI
Ankle brachial pressure index
416
Causes of bradycardia
``` Hypothermia Hypothyroidism Aerobic training Legionnaires disease MI ```
417
What is the mitral stenosis murmur
Low rumbling diastolic
418
difference in history between pericarditis and PE
PE very acute onset
419
how can heart failure be excluded from a heart problem diagnosis
CXR
420
When best to hear mitral stenosis murmur
On expiration with patient rolled over to left
421
Presentations of arrythmias
``` Palpitations Syncope Chest pain Hypotension Can be asymptomatic and finding is incidental ```
422
What drugs cant be given if patient hypotensive
Nitrates
423
What does pericardial rub sound like
Scratching
424
Appropriate investigations for aortic regurg
ECG CXR Echo
425
Problem with beta blockers for angina patients
Reduce exercise tolerance
426
What is pulse pressure
Difference between systolic and diastolic pressure
427
What to think in broad complex QRS
VT | BBB
428
What is dressler syndrome
Chronic pericarditis
429
What electrolyte disorder is associated with long QT changes
Hypocalcaemia
430
Causes of AF
``` Idiopathic Pneumonia PE Alcohol IHD Valvular disease Hyperthyroidism ```
431
Characteristics of arterial ulcers
Irregular edge Poor granulation Dry Punched out with sharp demarcation
432
When can feel apex thrill what is this most likely
Mitral stenosis
433
Complications of VSD
Pulmonary HTN Endocarditis HF Shunt reversal
434
Non cardiac causes of arrythmias
``` Caffeine Smoking Pneumonia Alcohol Electrolyte imbalances (K,Ca,Mg) Hypoxia and hypercapnia Thyroid ```
435
What is barlow syndrome
Most common murmur | A mitral valve prolapase where doesnt close properly
436
Important thing check as cause of hypotension in severely ill patients
Renal function
437
Differences between antidromic and orthodromic accessory pathways on ECG
Orthodromic appears with delta wave and is narrow complex | Antidromic conceals the accessory pathway and appears wihtout delta wave but has broad complex
438
What is focal atrial tachycardia often caused by
Digoxin toxicity
439
What layer is affected in aortic dissection
Tunica intima- this shears and blood falls goes into layers
440
Complications of aortic dissection
``` Rupture into mediastinum Aneurysm Cardiac tamponade Aortic regurg Blockage of branch of coronary artery or aortic arch ```
441
Gold standard investigation for aortic dissection
CT aorta showing false lumen
442
What can cause pericarditis
``` URTI recently TB Lupus, RA etc Cancer diagnosis Uraemia Post MI ```
443
What are key defining features of pericarditis ECG
Widespread concave ST elevation | AvF often spared and has PR elevation + ST depression
444
How do pericarditis and MI differ on serial ECGs
Pericarditis often stays the same whereas MI will change dynamically
445
Complications of pericarditis
HF Tamponade Recurrent pericarditis Restrictive pericarditis
446
What is pulsus alternans seen in
Pericardial effusion | HF
447
What investigation can help determine cause of pericarditis
Pericardiocentesis- high protein may suggest infective cause or cytology may show cancer as cause
448
What are biphasic T waves
Where initially T wave elevates and then is inversed
449
What is difference physiologically between NSTEMI and STEMI
STEMI affects whole myocardium whereas NSTEMI affects only subendocardium
450
Progression to ACS flow chart
``` Risk factors Coronary artery inflammation Atherosclerosis Plaque rupture Atherothrombosis ACS ```
451
What causes mitral regurg post MIs
Papillary muscle necrosis
452
What causes pulmonary oedema
Mitral valve conditions Dysrrythmias Renal failure Acute MI
453
What is the NYHA HF classification used for
Chronic HF
454
What do wires over sternum suggest on CXR
Previous sternotomy
455
Bloods ordered for HF
``` FBC Renal profile BNP Troponin ABG ```
456
Long term management of HF
ACEi or ARB B blockers Spironolactone Cardiac resynchronisation therapy- dual chambered ICD
457
Causes of aortic dissection
``` Marfans Ehlers danlos HTN Previous cardiac surgery Vasculitis ```
458
What is difference in pain between Type A and B dissection
Type A to retrosternal | Type B to interscapular
459
O/E aortic dissection
``` HTN Aortic regurg BP difference in arms HF Tampondade Neuro sx- limb weakness, horners syndrome, SVC syndrome Asymmetrical pulses ```
460
Bloods ordered for aortic dissection
FBC-leukocytosis Cross match D-dimer Troponin
461
Aortic dissection indications for surgery
Type A | Rupture
462
How do systolic murmurs sx tend to differ from diastolic ones
Systolic tend to present with exertional dyspnoea whereas diastolic tends to present with fatigue palpitations as well as HF signs
463
What congenital syndrome can cause aortic stenosis
Williams- due to high levels of calcification
464
What presents with outgoing personality, mild learning difficulties, large forehead and a short nose
Williams syndrome
465
O/E aortic stenosis
``` ESM Slow rising pulse Left ventricular heave Narrow pulse presssure Silent S2 in severe AS ```
466
Causes of aortic stenosis
Calcification with age LV dilation Rupture of chordae tendinane and papillary muscle post MI
467
O/E mitral regurg
Irregularly irregular as AF common LV heave PSM
468
What is pulsus tardus and parvus felt in
Aortic stenosis
469
Causes of tricuspid regurg
Infective endocarditis Carcinoid syndrome RV dilation Ebstein anomaly
470
O/E tricuspid regurg
Raised JVP PSM Pulsating hepatomegaly Parasternal heave
471
O/E aortic regurg
``` Wide pulse pressure Displaced apex Corrigans Quinkes De musset Waterhammer pulse Early diastolic murmur ```
472
What is austin flint murmur caused by
Severe aortic regurg as blood even regurgitates into the LA
473
Where is austin flint murmur heard best
Apex- mid diastolic
474
Where is aortic regurg murmur heard best
Left sternal edge 3rd/4th ICS
475
What is parasternal heave indicative of
Tricuspid regurg | Mitral stenosis
476
O/E mitral stenosis
``` Malar flush Tapping apex Low rumbling murmur mid diastolic- doesnt radiate Opening snap AF common Parasternal heave ```
477
What presents with chest pain when lying down
Decubitus angina
478
Other than troponin and CKMB what other cardiac enzymes can get elevated plus how long they take to be elevated
AST- 24 hrs | LDH- 48 hrs
479
How to class HF
Pump failure | Increased demands
480
How to classify causes of LHF
Valvular Myocardium Systemic
481
Valvular causes of HF
Mitral regurg Aortic stenosis Aortic regurg
482
Myocardial causes of HF
IHD Cardiomyopathy Myopericarditis Arrythmias
483
Systemic causes of HF
Amyloidosis HTN Drugs- cocaine, chemo
484
Increased demands causes of HF
Anaemia Hyperthyroidism Pregnancy
485
Signs on examination of HF
``` Arryhtmia could be cause Murmur could be cause 3rd/4th HS Displaced apex Pulsus alternans Increase BP and HR Fine end inspiratory crackles Cardiac asthma ```
486
What is high output HF
When demands of body overwhelm the heart
487
Diagnositc method for HF
TTE coupled with doppler colour
488
What is cut off for reduced ejection fraction HF
Less than 40
489
Why is echo so useful in HF
Visualise the heart and any potential causes | Can work out EF
490
To diagnose preserved ejection fraction HF what must EF be
Over 50
491
What diagnositic criteria is used to diagnose HF clinically
Framingham 2 major with 1 minor 1 major with 2 minor
492
Long term management of HF principles
Treat the cause Lifestyle management Drugs- ABD
493
Way to remember drugs used in chronic HF
ABD devilliers ACEi Beta blockers Diuretics- spironolactone, loop
494
What drugs are considered in HF as further management
Digoxin Hydralazine nitrates like ivabradine
495
What further drugs are considered in HF patients who are black
Hydralazine | Nitrates like ivabradine
496
What is last considered option for chronic HF
Cardiac resynchronisation therapy
497
Complications of HF
Death Resp failure Kidney failure Acute exacerbations
498
Generally how does cardiomyopathy present
SOB on exertion Fatigue Fainting
499
Generally how would investigate cardiomyopathy
ECG Bloods- BNP, tropinin etc Echo Cardiac catheterisation
500
O/E cardiomyopathy
HF signs
501
Key finding on examination of dilated cardiomyopathy
Displaced apex
502
What causes dilated cardiomyopathy
Alcohol Idiopathic Post viral- from myocarditis
503
What is main problem of dilated cardiomyopathy
Leads to poor elecetrical conduction and arrythmias | Only in HOCM does prevent by obstruction
504
What causes hypertrophic cardiomyopathy 50% of time
Familial
505
What is inheritance of HOCM
A Dominant
506
Typical presentation of hypertrophic cardiomyopathy
``` Can just be death SOBOE Angina Syncope Arrythmias ```
507
What is jerky carotid pulse seen in
HCM
508
Examination findings HCM
S4 ESM Double apex beat with heave Jerky carotid pulse
509
Investigations for HCM
ECG- Left axis deviation, Q waves, LVH | Echo- LVH
510
Causes of restrictive cardiomyopathy
Sarcoidosis Haemochromatosis Amyloidosis Familial
511
Presentation of restrictive cardiomopathy
Asymptomatic or HF signs
512
O/E restrictive cardiomyopathy
``` S3 Ascites Hepatomegaly Oedema Kussmals sign ```
513
What can be seen on CXR of myocarditis
Pericardial calcification
514
How can echo differentiate constrictive pericarditis from restrictive cardiomyopathy
Pericarditis has pericardial thickening whereas restrictive cardiomyopathy will be normal heart muscle
515
How can you cure chronic pericarditis
Remove pericardium
516
What is resultant cardiomyopathy myocarditis can lead to
Dilated
517
Presentation of myocarditis
Pleuritic chest pain worse on lying down SOB Palpitations Flu like prodrome
518
Most common cause of myocarditis
Post cocksackie B virus
519
Causes of myocarditis
Post cocksackie B virus Cocaine Metals Radiation
520
How can CK and troponin differentiate myocarditis from pericarditis
Myocarditis theyre much more elevated
521
ECG changes seen in myocarditis
Random ST elevation and T wave changes
522
Test ordered for myocarditis
ECG CK and troponin Endomyocardial biopsy
523
Diagnostic test for myocarditis
Endomyocardial biopsy
524
If has angina as PC what are some causes
Hypertrophic cardiomyopathy | Aortic stenosis

Year 3 Conditions (33 decks)

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