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Cardio cards stems Flashcards

1
Q

Duke’s criteria? (BE TIMER)
Most common murmur?

A

BE (major) TIMER(minor)
Blood culture x2 12 hrs apart
Echo
Temp 38+
Immunological signs (roth spots, osler’s)
Embolic diease (conjuctivial,
RF
DX: 2 major or 1 major+3minor or 3
Aortic regurg/ new murmur. early diastolic decrescendo murmur

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2
Q

Dressler’s syndrome?

A

2 -3 weeks post MI/ trauma. pericarditis (ST elevation and PR depression)- friction rub, low fever, pleuritic chest pain worse lying down, TX NAIDS/steroids.

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3
Q

Post MI complications?
structural ?
RF?

A

Arrhythmias (VT, VF, total AV block)
ISchaemia (CK-MB, recurrent chest pain)
LV dysfunction, heart failure - killip’s classifcation
Free wall rupture (bleeding into pericardium, tamponade)
Ventricle septal rupture (harsh pansystolic murmur left sternal edge, hypotension, shock, pulmonary oedema, do TOE)
Acute Mitral regurg (post infero-posterio MI, papillary muscle rupture/ necrosis)
Left ventricular outflow obstruction
dressler’s (2 to 4 weeks after)
DVT/PE (systemic)

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4
Q

RF for ventricle septal rupture/ free wall rupture post MI?

A

RF: female, non smoker, HTN, anterior infarction, first MI, 2-7 days after

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5
Q

HTN with t2DM first line drug?
after triple therapy?

A

ACEi/ ARB
already on ARB/ACIe and CCB and thiazide diuretic, give spironolactone if K <4.5 or alpha blocker/ BB if K5.5+

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6
Q

Hyperkalaemia ECG

A

Tall T waves, small p waves, wide QRS

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7
Q

Hypokalaemia ECg

A

small/ inverted T waves, U waves, long PR, depressed ST.

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8
Q

systolic murmur at apex of heart radiating to left axilla.

If person complains of dysopnoaa at rest?

A

MR, most common worldwide. LV blood backflows to LA
ACute MR (post MI/ rupture of chordae tendonae) presents as reduced CO, shock, dysopnoae at rest.

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9
Q

HF classification/ BNP values/ EF values?

TX summary?
BASSSHED

A

BNP refer at: 2000 - 2ww, 400-2000 6ww. , <200 - not confirmed
EF - preserved 50+, <40 severe, 41-49 mild to mod.

TX: acei (ARB candesartan i not toelrate) (UEs at baseline and 1-2 weeks), BB, then spironolactone (U-Es at 7 days)
Others: ivabradine, SGLT2i, digoxin, hydralazine, nitrate, valsartan/ sacubritil

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10
Q

post MI drugs TX?

A

dual antiplatelet (aspirin lifelong, pasugrel P2Y12 i 12 months)
ACE i (lifelong, reduced cardiac vascular resistance and afterload, lower preload.
BB 12 months 9lfielong (LV EF reduced)

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11
Q

DVT/ PE TX summary?
Risks/ complications of DVT

A

wells<2 do dimer. 2+ do USS.
TX: LMWH 5/7 and then dabigatran (crcl 30+)/edoxaban
Crcl 15-50 - apixaban/riveroxaban
<15- LMWH/ UFH (Risk HIT)
warfarin - preferred if 120kg+/liver dysfunction/ egfr <30.
Risk: post thrombotic syndrome (chronic venous hypertension pain swelling, lipodermatosclerosis within 2 yrs)

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12
Q

Flash pulmonary oedema post MI?

A

Post MI/MR

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13
Q

Cx of Heart block?
2nd degree HB?

A

flecanaide, BB, digoxin,
High K, Mg, Addisons,
SLE, scleroderma, RF, sarcoid, endocarditis

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14
Q

Post cardiac cauterization complication?

A

femoral pseudoaneurysm: pulsatile mass, bruit, compromised distal pulses

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15
Q

CI to exercise stress testing?

A

MI in last 2 days, severe AS, uncontrolled angina/ arrhythmias, HF, acute PE/ pericarditis, acute dissection

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16
Q

Aortic dissection pain and areas association?
neck and jaw?
anterior chest pain?
intracapsular region?

A

jawand neck: aortic arch
anterior chest: aortic arch or aortic root
intracapsular: descending aorta,

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17
Q

DVT TX
DOAC not recommended in?

When would you use fondaparinux?

when would you use warfarin instead of DOAC?

If rapid reversal needed/ high risk of bleeding?

A

APLS, pregnancy, breastfeeding, liver impairment, prosthetic heart valves, <40kg/120kg+ (use LMWH/UHF)

riveroxaban has increased risk of GI bleed compared to warfarin

fondap - reserved for people with known HIT

wardarin - if GFR <30, liver dysfunction or 120kg+

high bleeding risk - IV UFH (short half life and reversed with protamine)

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18
Q

61 YO female collapses after 1st MI with distended neck veins

A

Left ventricular free wall rupture (cardiac tamponade - low bp, JVP distended, muffled HS)

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19
Q

High K drug causes?

A

ACEi, BB, ARB, trimethoprim, heparin, digoxin

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20
Q

elderly women, Crushing retrosternal chest painr adiating to jaw, intermittent for 3 yrs. normal cardio ix

A

Oesophageal spasm - corckscrew appearance on barium swallow.

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21
Q

How to hear pericardial friction rub?

A

Sat forward, left sternal border on expriation.
https://youtu.be/-DB_8zyg9W8

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22
Q

ACS contraindication to thrombolytic?

A

Bleeding , recent haemorrhage, trauma, dental extraction, aortic Dissection, neoplasm (intracranial) HTN, stroke <3 months, pericarditis, dissection, endocarditis bacterial,

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23
Q

ST depression, V5, v6 inverted T waves?

A

digoxin toxicity

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24
Q

RAD, RBB, RV strain ECG signs?
St depression, t wave inversion

A

PE. RV strain - ST depression, T wave inversion on leads 1, 2, AVF, V1, V2
in PE. S1Q3T3 is rarer

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25
Q

Hypocalcaemia spot causes?
ECG features?

A

Acute panc, panc surgery, alkalosis (hyperventilation), rhabdomylisis, scepticaemia, osteolytic mets, Parathyroid gland surgery, bisphosponates, calcitonin, phenytoin, foscarnet, phosphate substitution
prolonged St and QT interval

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26
Q

Cardiac tamponade features?
Normal pericardial space- 20-50ml fluid

A

Beck’s triad - hypotension, distended JVP, muffled hs,
pulsus paradoxus
kussmal sign,
ewart/pin’s sign - bronchial sounds below angle of left scapula
CXR: bottle shaped heart.
RF: surggery, mets, end stage renal disease, trauma, TB

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27
Q

ALS: stable narrow complex, regular tachycardia?

A

likely SVT - trial vagal manouvers, then 6mg iv bolus adenosine, then 12mg, then 12mg, escalate

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28
Q

Stable patient, Broad complex, regular tachy?

A

IV amiodarone 300mg

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29
Q

Points when counselling on Af anticoagulation?
Do you offer anti-coagulation to <65YO with no other RF?

A

anticoagulation reduced risk by 2/3. Risk of stroke is x5 higher with AF and risk of severity is higher.
No dont offer if only score is for sex

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30
Q

Driving advice for Mi/ CABG/pacemaker/ angio?

A

no driving for 1 week after angio, pacemaker, successful angio
no driving for 4 weeks after STEMI/ NSTEMI/ CABG
Return to work within 2 months
no sex for 1 month

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31
Q

Cheyne stokes breathing?

A

progressively deeper and shallower in brainstem stroke/ raised ICP

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32
Q

30YO male south eastern patient with collapse? ECG shows?

A

Brugada sign - ST elevation 2mm+ in V1-3 and T wave negative

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33
Q

pansystolic murmur post MI?

A

Mitral regurg (damage to papillary muscle) - can be 3-5 days after/ VSD - can present1-2 weeks post mi

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34
Q

Features of mitral stenosis?

A

rumbling mis-diastolic murmur loud on expiration with patient on left side., malar flush, AF, fatiuge, SOB, palpatations

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35
Q

Causes of IE?

A

Staph A
Staph A (coagulase negative)

Streptococci (viridans, subacute)
Group D streptococcus (acutre and subacute)
strept intermedius
A, C, G - acute, high mortality
GBS - pregnancy, elderly
HACEK
fungi
enterococci

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36
Q

ECG: J waves, long PR, long QRS, long QT, AF

A

Hypothermia

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37
Q

24 YO footballer, LAD, sinus brady, LVH, SOB, chest pain, dizziness after training, systolic murmur on left sternal edge

A

Hypertrophic cardiomyopahty
AUtosomal D,exercsie testing to see severity,

Digoxin contraindicated in aF, anticoagulate, counsel, amiodarone for arrhythmias,
outflow obstruction - BB/verapamil. prophylactic abx bc raised risk of IE/

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38
Q

pulseless paradoxus seen in?

A

12+ raise in BP on inspiration (abnormal)
PE, constrictive pericarditis, rapid and laboured breathing, RV infarction with shock, restrictive cardiomyopathy, severe obstructive pulmonary disease,

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39
Q

Lone AF?

A

AF in <60 with no evidence of cardiac conditon

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40
Q

Advice to give when someone has 1st degree HB?

A

reassure, caution when using BB/ diltiazem, digoxin, declare on driving/ health insurance. small risk of aF developing.

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41
Q

Angina TX?

If using CCB with BB/ ivabradine?

A

1) BB or CCB (DHP, rate limiting verapamil/ diltiazem) if CI
2) Beta blocker + CCB (non-DHP - amlodipine/felodipine/nifedipine)
3) Add nitrate, ivabradine, nicorandil (ulceration risk) or ranolazine

Amlodipine can be used if HF
Verpamil and BB = very bad

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42
Q

Post Mi complications timing of conditions?

A

0-4hrs - Cardiogenic Shock, CHF, arrhythmia
4-24hrs - Arrhythmia
1-3 days - Pericarditis
4-7 days - Rupture of ventricular free wall, interventricular septum, or papillary muscle
Months - Dressler syndrome, aneurysm, mural thrombus

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43
Q

67 YO man, home BP is 145/95, QRISK is 8%. MX?

what if BP is 150/100?

A

stage 1 HTN - treat if end organ damage/ QRISK 10%, known CVD/DM.
If stage 2 treat regardless of age. (150/95+ at home)

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44
Q

PERC rule to rule out PE?

A

if all abscent can rule out:
age 50+, HR100+, unilateral swelling, on HRT/ COCP, o2<94, previous DVT/PEsurgery/ trauma in 4 weeks, haemoptysis

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45
Q

75 nocturnal sob, occasional palpitations and tight chest pain. collapsing pulse and a laterally shifted apex beat. head bobs in time with his pulse

A

Quincke’s sign (nailbed pulsation)
De Musset’s sign (head bobbing)
Aortic regurgitation, early diastolic murmur increased when squeezing hand.
(backflow during ventricular diastole)

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46
Q

Causes of AR?

A

RF (common, developing world)
Marfans/ SLE/EDS/ ank spond/ bicuspid Aortic valve
Acute: infective endocarditis/ aoritc dissection

47
Q

SE and CI of nicorandil?

A

headache
flushing
skin, mucosal and eye ulceration
gastrointestinal ulcers including anal ulceration
Contraindications
left ventricular failure

48
Q

HF MX summary?

A

1st line: ACEi/BB(Bisoprolol, Carvedilol)
2nd line Aldosterone antagonist(Spironolactone, Eplerenone)/ SGLT2i
3rd line: involve a specialist for
-Ivabradine(SR, HR>75+ EF <35%)
-Sacubitril-valsartan( EF 35%+ Symptoms despite ACEi/ARB)
-Digoxin( if coexistent AF)
- Hydralazine+Nitrate( in Afro-Caribbean)
-Cardiac resynchronization therapy( Widened QRS e.g. LBBB)
Role of SGLT2i in preservd EF

49
Q

Orthostatic hypotension - DX?
TX?

A

BP > 20 mmHg or diastolic BP > 10 mmHg or decrease in systolic BP < 90 mmHg is considered diagnostic

fludrocortisone, midodrine, compression, salt intake, head elevation

50
Q

When to give 20 mg atorvastatin to t1dM?

A

40+, DM for 10 yrs+
Have established nephropathy
Have other CVD risk factors (such as obesity and hypertension)

51
Q

Statin SE
monitoring
CI other drugs?

A

Myopathy, LFTs, CI- macroglides (clarithromycin) and pregnancy,LFTs at baseline, 3 months and 12 months - stop if 3x upper limit

52
Q

History of asthma, Marfan’s etc
Sudden dyspnoea and pleuritic chest pain

A

pneumothorax

53
Q

Central crushing pain with absent distal pulse?

If patient is too unstable for this imaging

unequal arm pulses?

A

Dissecting aorta
CXR - wide mediastinum
CT angio CAP
TOE - if unstable to get to CT scanner
Risk of backward tear - inferior MI/ AR
Risk of forward tear- unequal arm pulses, stroke, renal failure
Standford and debakey classification

54
Q

Syncope, chest pain, SOB, ES murmur that reduces with valsalva manouver?

A

AS. CX:
<65 - bicuspid, >65 - degenerative calcification, post rF, HOCM
chjildren - balloon
Surgical AVR - if 40mmHG +/ symptomatic
TAVR - for high risk (transcatheter AVR)

55
Q

CX of IE associated with colorectal cancer?

AF with indwelling lines?

A

Streptococcus bovis

staph epidermis

56
Q

TX of IE for native valve?

suspected MRSA/ penicillin allergy or sepsis?

NVE with severe sepsis/ RF for gram negative?

Prosthetic valve endocarditis?

A

NVE): amoxicillin + gentamicin
sepsis/allergy/MSRA: vancomycin + gentamicin

NVE with severe sepsis and risk factors gram negative infection: vancomycin + meropenem

Prosthetic valve endocarditis: vancomycin, gentamicin + rifampicin

57
Q

What drug reduced efficacy of clopidogrel?

A

omeprazole

58
Q

PE causes resp acidosis or alkalosis?

A

alkalosis (hyperventilation)

59
Q

NSTEMI tx?

A

DAPT ticegralor and aspirin 12 months

60
Q

persistent ST elevation post MI, no chest pain?

A

left ventricular aneurysm
do echo after as thrombus can developFc

61
Q

Post MI 2-5 days inferior MI, pulmoary oedaema sx?

A

papillary muscle rupture

62
Q

2 weeks after MI, ST elevation with PR depression widespread, pleuritic chest pain, fever?

A

dressler’s syndrome

63
Q

factors that can icnrease BNP?

A

LVH, ischaemia, PE, GFR <60, sepssi, COPD, DM, 70YO+, liver cirrhoris

64
Q

factors that reduce BNP?

A

obestity, diuretics, Acie, BB, ARB, aldosterone antagonists

65
Q

BB SE:

HF tx that causes ototoxicity?

A

nightmares, sleep disturbances, ED, cold peripheries, fatigue, CI: verapamil, asthma, uncontrolled hf

furosemide - ototoxic

66
Q

Post MI, pansystolic murmur, reduced hs. after 1-2 weeks?

A

VSD 9do echo to exclude MR

67
Q

posterior/ inferior MI with new pulmonary oedema, HTN post MI 3-5 days?

A

acute MR. due to papillary muscle rupture/ischaemia

68
Q

most common cx of death inpost MI?

A

ventricular fibrillation

69
Q

Conditions that predispose to pericarditis?
Dr Is TRUMP

A

DR Is TRUMP
Dressler, Radiotherapy, infection (coxsackie), SLE, TB, RA, Uraemia, Malignancy, Post MI

70
Q

HCOM: most likely cx of death?

ECHO features? MR SAM ASH

ECG features?

A

ventricular arrhtymias,

echi: MR, systolic anterior motion of anterior mitral valve leaflet, asymmetric hypertrophy

ECG: LVH - deep ST depression, T waves inversions,

71
Q

ace i SE:

A

angiodaema, CI b/l RAS, pregnancy, creatine rise 30%+ baseline

72
Q

STEMI mx?
time for PCI
anticoagulation?
radial/femoral access?

fibrinolysis?

A

aspirin,PCI within 12 hrs of sx and 120 mins faster than med
give pasugel (if no other anticoagulant), chlopi (if on other blood thinners)
radial access - give UFH, with GIP bailout.
femoral access - give bivalirudin with bailout GPI

fibrinolysis - antithrombin and repeat ecg in 60 mins-90 mins. pci if still MI

73
Q

NSTEMI MX
for immediate PCI?
for not immediate PCI?

conservative mx?

PCI MX? - what to give before

which one better for raised bleeding risk/ on other antivoagulants?

A

aspirin
fondaparinux - if not having PCI immediately, not at high risk of bleed
unfractionated heparin - if creatin 265+, immediate PCI plan

Conservative mx:
DAPT with ticegralor/ chlopidogrel

PCI within 72 hrs:
UFH before and DAPT after

74
Q

STEMI dx values?

A

ACS sx 20 mins+ 2ECG leads :
2.5 mm (i.e ≥ 2.5 small squares) STEMI in V2-3 in men under 40 years, ≥ 2.0 mm (40 M +)
women: 1.5 mm STEMI V2-3
1 mm ST elevation in other leads
new LBBB

75
Q

HTN Mx summary?

A

140/90+ do Home
tx stage 1 - if <80/ t2dm/ckd/end organ dysfunction
2) 150/90 at home/ 160/100 in clinic tx whatever age
3)180/120+
<55YO/ T2DM/ not black - give A over CCB

76
Q

Acute HF Mx?

A

HF with BP< 85 - inotropic agents in ITU
if respiratory failrue - CPAP
continue regular meds unless BB - stop if HR <50

77
Q

Post MI MX?

A

echo at 3 months (immediately after mi can giv efalse low EF)
give BB, ACe, high statin dose, DAPT - aspirin lifelong, other for 1 month

78
Q

Vasculitis AF smoking and raynaud’s phenomenon/ intermittent claudication/ ischaemic ulcers/ superficial thrombophlebitis?

A

buerger’s disease

79
Q

Major bleeding with warfarin - IC bleed?

mx if any bleeding?
if INR 8+
INR 5-8?
no bleeding?

A

regardless of INR, give iv vit K, prothrombin complex

if bleeding , give iv vit K, repeat in 24 hrs restart when <5.
INR 8+ - no bleed, give Po
5-8 - with-hold or give iv if bleeding.

80
Q

when to start Af anticoagulaion in TIA and stroke?

A

TIA - start DOAC of warfarin asap
stroke - wait 2 weeks

81
Q

post inferior MI, sx of left ventricular failur, drop in BP, eary-mid systolic murmur?

A

papillary muscle rupture causing acute mitral regurg

82
Q

4 weeks post anterior MI with pulmonary oedema, persistent STEMI in anteiror leads?

A

left ventricular aneurysm

83
Q

AS features?

A

narrow pulse oressure, slow rising pulse, LVH, soft S2, thrill over cardiac apex
ESMurmur decreased post valsalva manouver

84
Q

ST change leads 2, 3 , AVF

A

RCA, inferior MI
AVN supply - also present with arrhythmia

85
Q

ST changes anterolateral MI>

A

V1-6, lead 1, AVL

86
Q

ST changes in V1-4?

A

LAD, anteroseptal

87
Q

Left circumflex A ST changes?

A

1, AVL, V5-6

88
Q

HF drugs that actually reduce mortality?

A

BB.ACEi/ARB, alodsterone antagonist, hydralazine and nitrates

89
Q

Heart Block mneumonic?

A

longer longer, drop, wenchebech
if some Ps dont get through, you’ve got mobitz 2, if Ps and Qs dont agree, you’ve got 3rd degree

90
Q

normal variant in athelete?

warrents urgent referral on ECG?

A

1st HB, mobitz 1 (wenchebach, junctional rhythm, sinus bradycardia

HCOM ECG:

91
Q

secondary HTN CX: pregnant 10 weeks with K+ of 3.1?

A

primary hyperaldosteronism (most common cx of secondayr htn)

92
Q

HTn, headahce,s excessive sweating, bitemp hemianopia?

A

acromegaly

93
Q

HTN with asymmetrical kidney disease and IHD cx?

A

B/L renal artery stenosis

94
Q

frug cx of secondary THN?

A

leflun0mide, NSAIDs, COCP, seeroids, MOAi

95
Q

medical cardioversion of AF?
Structual?

A

flecainide
amiodarone - if any structural heart disease

96
Q

Conservative mx of NSTEMI?

A

fondaparinux, ticegralor and aspirin
2nd line is chlopidogrel if high bleeding risk

97
Q

BP targets for 80YO+
<80

A

150/90 at home: 145/85
<80: 140/0 (at home: 135/85)

98
Q

if statin 20mg is started for primary prevention when would you increase it to 80mg?

A

if non HDL has not fallen by 40%

99
Q

central chest pain with diastolic murmur. what is shown on angiogrpahy?

A

ascending aorta - giving AR.
aortic dissection shows false lumen

100
Q

post tx of SVT, sudden chest pain after resolution?

A

adenosine used for SVT.
SE: flushing, chest pain, bronchospasm (CI asthma)

101
Q

HTN already on indapamide, amlodipine, acie,. K is 4.5+ what can be added

A

doxazosin/ BB
if K <4.5, can add spironolactone

102
Q

Low voltage QRS causes?

A

pericardial effusion, obesity, emphysema, pneumothorax, myxoedema, restrictive cardiomyopathy, scleroderma, constrictive pericarditis, MI previously

103
Q

criteria used to diagnose familial hypercholesterolaemia?

A

TC 7.5+/ LDL 4/9+ tendon xanthomata in patient/ 1st/2nd degree relative
simon broome criteria

104
Q

when should you stop statin before trying to conceive?

A

3 months before

105
Q

definition of prolonged pericarditis?

A

recurrent - 4-6 weeks after fist ep
chronic - 3 months
admit after 1 week

106
Q

when to admit for pericarditis?

A

fever, tamponade (risk), troponin, trauma, on anticoagulants, nsaids dont work, immunosuppression

107
Q

pericarditis ECG changes?

A

saddle shapes ST elevtaion/ concave and PR depression acutely with reciprocal changes
then late stage t waves inversions

108
Q

ejection systolic murmur that diappears when squatting

A

HCOM (auto. dom)
most common cardio genetic condition

109
Q

ECG of HCOM?

A

LVh (increased voltages), dagger life deep narrow Q waves, left atrial enlargment (p mitrale), arrhythmias

110
Q

IX for HTN?

A

ECG urinalysis,, hba1c, 12 lead ecg, U+Es

111
Q

black person with HTn, no other sx and obese?

A

essential HTN

112
Q

east asian man, intverted t waves in right pericordial leads and ST elevation? FH early death during day time car crash?

A

brugada syndrome (AF sudden unexplained noctunal dath syndrome/

113
Q

sick sinus syndrome definition?

A

abnormal SAN function, bradycardia, cardiac insufficiency.

114
Q

peripheral arterial disease tx?
level of ABPI?

A

structured exercise.
offer naftidrofuryl oxalate
ABPI <0.9
<0.5 is critical limb
1.4+ suggests calcification/ vascultiis/ dm

MSRA my cards (26 decks)

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