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Flashcards in Cardiology 1 Deck (66):
1

What are the common presenting symptoms of aortic stenosis?

Syncope
CP
SOB, orthopnoea, PND, palps, fatigue

2

Clinical signs of aortic stenosis?

Narrow pulse pressure, slow rising pulse
Heaving LV apex
Soft or absent HS2 plus ejection systolic murmur

3

Complications of aortic stenosis?

LVF
Endocarditis
Damage to AV node -> heart blocks/arrhythmias

4

Surgical options for aortic stenosis?

Transcatheter Aortic Valve Implantation TAVI

5

5 causes of aortic regurgitation?

Aortic dissection
Congenitally bicuspid
Infection
Degenerative
Inflammatory

6

Clinical signs of aortic regurgitation?

End diastolic murmur (Austin Flint), 3HS if lean forward
Apex beat moves due to LVH
Wide pulse pressure, bounding pulse effects in various places

7

What is the most common cause of congenital tricuspid regurgitation?

Ebsteins anomaly

8

Clinical signs of tricuspid regurgitation?

Signs of RVF incl Rosenbach pulsatile liver
Parasternal heaves/thrills
Pansystolic murmur at LSF louder on inspiration

9

Common causes of mitral regurgitation?

Usuals
Papillary muscle rupture - MI, IE
Ring dilatation secondary to LVF

10

Clinical signs of mitral regurgitation?

Signs of LVF
Apical thrill
Pansystolic murmur radiating to axilla

11

What arrhythmia is related to mitral stenosis and how?

Mitral stenosis causes increased LA pressure and can cause AF

12

3 main causes of aortic stenosis?

Congenitally bicuspid
Degenerative
Infective (rheumatic - though normally mitral)

13

3 types of ACS?

Unstable angina
STEMI
NSTEMI

13

What is the difference between stable and unstable angina?

Stable is atheromatous plaque formation in coronary arteries leading to chest pain, SOB, tachy, palps etc. on exertion
Unstable is rupture of plaque causing resting symptoms

13

What combo of investigations/clinical picture is suggestive of unstable angina?

Symptoms occurring at rest
Normal ECG and cardiac markers

14

First line management and advice of stable angina?

Short acting nitrate PRN (GTN spray)
Advise of SEs, tell to use twice 5 mins apart and if not better after 10 call ambulance

15

Apart from GTN spray, first line drugs for stable angina?

Beta blockers or calcium channel blockers

16

Management of angina after first line?

Long acting nitrate (isosorbide)
Nicorandil
Add either to B blocker or Ca channel blocker

17

Secondary prevention drugs in ischaemic heart disease?

Aspirin
Statins
ACEi

18

2 operations for revascularisation in IHD?

CABG
PCI

19

Drug of choice for symptom management in CCF?

Diuretics (furosemide)

20

3 drugs to slow disease process in CCF?

ACEi
B blockers
Digoxin

21

2 most common causes of heart failure?

Hypertension
IHD

22

Normal PR interval?

120-200ms

23

What is first degree heart block?

A long PR interval >200ms

24

What is Mobitz type I second degree heart block?

Wenkebach - progressive PR elongation until dropped QRS
E.g. 4:3 Mobitz I

25

What is Mobitz type II second degree heart block?

Intermittent non-conduction of P->QRS complexes with no change in PR interval

26

What helps to differentiate type I from type II second degree heart block?

Progressive PR elongation in I
No change in II

27

What does type I second degree heart block suggest malfunction of?

AV node

28

What does type II second degree heart block suggest malfunction of?

Purkinje fibres/His bundle

29

Which type of second degree heart block is Wenkebach?

Type I

30

Which type of second degree heart block is worse and why?

Type II because it can progress to complete heart block

31

What is third degree heart block?

Complete lack of atrial-> ventricular conduction, leading to separate atrial and ventricular rhythms

32

What infectious disease can cause complete heart block?

Lyme disease

33

Management of third degree heart block?

Needs dual chamber pacemaker

34

What does a LAD artery blockage result in?

An anterior MI with ST elevation in V1-6

35

What artery is responsible for an anterior MI?

LAD

36

What artery is responsible for an inferior MI?

RCA

37

Which artery is responsible for a lateral MI?

Left circumflex

38

Progression of acute STEMI on ECG?

Ischaemia - ST depression, T wave elevation and inversion
Injury - ST elevation
Infarct and tissue necrosis - Q wave depth (pathological)

39

What are pathological Q waves due to?

Scar tissue formation

40

What normally constitutes sinus arrhythmia?

HR increasingly slightly on inspiration due to inhibition of vagal tone and increased sympathetic activity

41

What is pulsus paradoxus?

BP fall of over 10mmHg on inspiration due to pressure equalisation in the heart chambers

42

Major causes of pulsus paradoxus?

Cardiac tamponade, constrictive pericarditis
Massive PE, pneumothorax, COPD
Shock

43

Normal paper speed of ECG trace?

25mm/sec

44

How long is one big square in ECG trace?

0.2 seconds

45

How to work out rate from rhythm strip?

300/no. of big squares between QRS
OR 6x no. of QRS in the rhythm strip in 10s

46

Normal QRS interval on ECG?

Less than 200ms

47

2 shockable heart rhythms?

Pulseless VT
VF

48

What is the QRS hallmark of VT?

Broad complex tachycardia

49

What might you suspect in an otherwise CV-healthy patient who presents with mild CP, SOB, fever following a viral illness?

Myocarditis

50

Describe pericarditic chest pain?

Sharp pain at left precordium radiating through to back, better sitting forward

51

Differentiating angina vs pericarditic pain?

Pericarditic is affected by posture (better sitting forward) not activity
Angina often activity-dependant and doesn't radiate through to back

52

What disease can cause a cardiac tamponade over a long period of time which can accumulate large volumes of fluid?

Hypothyroid (myxoedema)

53

Becks triad of cardiac tamponade?

Hypotensive
Distended jugular veins
Distant heart sounds

54

2 differentials for AF? (Irregularly irregular pulse)

Multifocal ventricular ectopics
SVT with variable AV block

55

Is a fourth heart sound ever normal?

No

56

Which murmur is listened for with the patient rolled onto their left in expiration?

Mitral stenosis

57

Which murmur is listened for with patient leaning forward in expiration?

Aortic regurgitation

58

What type of murmurs generally are best listened for with the patient in expiration?

Diastolic murmurs

59

Which valve disease causes a malar flush?

Mitral stenosis

60

Which valve disease is characterised by an opening snap followed by a low pitched mid diastolic murmur?

Mitral stenosis

61

First line investigation of heart failure if previous MI?

Echo within 2 weeks

62

First line investigation if heart failure suspected but no previous MI?

Measure serum BNP

63

5 causes of a falsely elevated BNP?

CKD
Liver cirrhosis
Chronic hypoxia (COPD)
Sepsis
Old age

64

4 features of ToF?

Large VSD
Overriding aorta
Pulmonary stenosis
RVH