Cardiology Flashcards
(126 cards)
1
Q
what should be paid close attention for in diabetes with non specific symptoms and no chest pain present?
A
silent MI
2
Q
if angina is not controlled with a beta blocker what should be added?
A
CCB
3
Q
how does myocarditis present in a young patient?
A
ST elevation
acute pulmonary oedema
flu like symptoms
4
Q
what is the NSTEMI management in unstable patients?
A
immediate coronary angiography
5
Q
what should be investigated for in a patient with new BP >180/120 and no worrying signs
A
urgent investigation for end-organ damage
6
Q
what can pericarditis arrise secondary to?
A
malignancy
7
Q
what should be added to a patient with poorly controlled hypertension already on a CCB?
A
add ACEi or ARB or thiazide-like diuretic
8
Q
what can happen after infarction of a right coronary and why?
A
can cause arrhythmias due to supply of the AV node
9
Q
what are the most common ECG findings in arrhythmogenic right ventricular dysplasia? (ARVD)
A
epsilon wave
10
Q
what is an epsilon wave?
A
small positive deflection at the end of QRS complex
11
Q
what cardiology disease may patients with poor dental hygiene present with?
A
endocarditis secondary to streptococci infection
12
Q
how do diuretics help heart failure?
A
only improve symptoms
no effect on mortality
13
Q
what disease may thiazides cause?
A
gout
14
Q
what diseases is Mitral regurgitation associated with?
A
collagen disorders such as Marfan’s syndrome and Ehlers-Danlos syndrome
15
Q
what is S3 (gallop rhythm) a sign of?
A
LVF
16
Q
what should be done in a suspected PE with wells score <4 and D-dimer is negative
A
stop anticoagulation
consider alternative diagnosis
17
Q
what is the gold standard treatment for patient with STEMI
A
primary percutaneous coronary intervention
18
Q
in heart failure with a reduced EF and maintained symptoms what should be offered after a ACEi and Beta blocker
A
mineralocorticoid receptor antagonist
19
Q
what is aortic regurgitation associated with?
A
Marfan’s syndrome
20
Q
what electrolyte imbalance may thiazide diuretics cause?
A
hypokalaemia
21
Q
what is the investigation for suspected aortic dissection?
A
CT angiography
22
Q
what should be done in new onset AF <48hrs after presentation?
A
electrical cardioversion
23
Q
how long is the treatment for unprovoked PE?
A
6 months
24
Q
what is the investigation for suspected PE with wells score >4
A
D-dimer
25
what is the conservative management for an NSTEMI antiplatelet choice?
aspririn plus either
ticagrelor (not high bleeding risk)
clopidogrel (high bleeding risk)
26
what may orthostatic hypertension be exacerbated by?
venous pooling during exercise
post prandial
post prolonged bed rest (deconditioning)
27
what disease is associated with sudden cardiac disease in young athletes?
hypertrophic obstructive cardiomyopathy
28
how long are provoked PE treated for?
3 months
29
what can cause long QT syndrome?
hypokalaemia
| antidepressants (SSRI and tricyclics)
30
what is stable angina?
chest pain on exertion that is relieved by rest
31
what is the management for stable angina?
beta blockers
GTN spray
risk factor modification
32
what is the cause of stable angina?
mismatch in oxygen supply and demand to myocardium
33
what test should be run in non-ST elevation chest pain?
troponin
34
what is the cause of Non-ST elevation on ECG with high troponins?
NSTEMI
35
what is the cause of non-ST elevation on ECG with normal troponins?
Unstable angina pectoris
36
what are the ECG findings in an NSTEMI?
dynamic T wave inversion
| ST depression
37
what can T wave inversion with sudden chest pain be suggestive of?
myocardial ischaemia
38
what is the immediate and long term management of ACS?
```
MONA BASH
morphine
oxygen
nitrates- GTN spray
antiplatelet- dual- aspirin and clopidogrel or ticagrelor
```
Beta blockers (bisoprolol)
ACEi (ramipril)
Statin (atorvastatin)
heparin
39
what is the management of a STEMI <12 hrs from symptoms
percutaneous coronary intervention if possible within 2 hours or thrombolysis if not within 2 hours
40
what is the management STEMI >12 hrs symptoms?
angiography followed by PCI if necessary
41
what is the management of NSTEMI?
1. immediate ACS protocol
2. fondaparinux
3. risk stratify high or low
42
what is the treatment for high risk stratified NSTEMI?
angiography within 48-72 hours
43
what is the treatment for low risk stratified NSTEMI?
medical management
44
what are the signs of right heart failure backlog in veins?
peripheral oedema
45
what are the signs of left heart failure
pulmonary oedema - breathlessness, cant lie flat, wake at night breathless
46
what are the causes of heart failure?
valvular disease
cardiomyopathy
hypertenion
IHD
47
what are the bedside tests for heart failure?
ECG
48
what are the bloods for heart falure?
ABG
troponin
BNP
49
what is BNP released in response to?
ventricular stretch
50
what imaging can be done for heart failure?
CXR- pulmonary oedema
| echo
51
what is the immediate management for heart failure?
sit the patient up
| high flow oxygen (15L/min via non-rebreathe mask)
52
what is the medical management for heart failure?
IV furosemide (loop diuretic)
GTN or isosorbide mononitrate
morphine
53
what is the long term management for HF?
beta blocker (bisoprolol)
ACEi( ramipril)
risk factor modificaiton
54
what are the signs of pulmonary oedema on CXR?
```
alveolar shadowing
kerly B lines
cardiomegaly
upper lobe diversion
PE
```
55
what are the causes of AF?
```
idiopathic
pneumonia
IHD
valvular disease
hyperthyroidism
alcohol
PE
```
56
what is the ECG signs of AF?
irregularly irregular narrow complex tachycardia with no p-waves
57
what is the management of hemodynamically unstable AF?
DC cardioversion
58
what can be used for rate control in AF?
beta blocker (bisoprolol)
59
what is used for rhythm control in AF
when clear reversible cause <48hrs --> DC or chemical cardioversion
>48hrs --> anticoagulated 3-4 weeks first
60
what drugs can be used for chemical cardioversion?
amiodarone
| flecainide
61
what score can be used to calculate stroke risk after AF?
CHADS-Vasc
62
what score is used for risk of bleeding if anticoagulated?
HAS-BLED
63
what is used to minimise stroke risk after AF
DOAC (apixaban)
| after calculating CHADS-Vasc vs HAS-BLED
64
what is virchow's triad?
factors contributing to abnormal clot formation
Stasis
hypercoagulability
vessel wall injury
65
what may cause stasis?
activation of clotting factors from
| AF or venous clots (PE/DVT))
66
what pathway do anticoagulants act on
Stasis
| inactivation of clotting factors
67
what does vessel wall injury result in?
platelet activation resulting in a clot formation
68
what may vessel wall injury cause?
arterial thrombosis (MI, stroke)
69
what do anti-platelets work on?
inhibit platelet activation after vessel wall injury
70
what is SVT?
regular narrow complex tachycardia with no P-waves and supraventricular origin
71
what electrical abnormalities can cause SVT?
AVNRT
| AVRT
72
what causes AVNRT
nodal circuit formed within AV node that randomly fires off causing ventricular depolarisation
73
what causes AVRT
accessory pathway between atria and ventricles
74
what ECG abnormality may be present after the termination of the SVT?
delta wave (slurred upstroke of QRS complex)
75
what disease may have the presence of an accessory pathway that pre-disposes to SVT?
WPW syndrome
76
what is the management for haemodynamically unstable SVT?
DC cardioversion
77
what is the management for haemodynamically stable SVT?
1. vagal manoeuvres
2. if unsuccessful- Adenosine 6mg
3. If unsuccessful- adenosine 12mg
4. if unsuccessful - adenosine 12mg again
5. if unsuccessful again Beta blockers, IV digoxin, IV amiodarone, synchronised DC cardioversion
78
what drug used in SVT is contraindicated in asthma? and what should be used instead?
adenosine - use verapamil
79
what type of murmur is aortic stenosis?
ejection systolic
80
what type of murmur is mitral stenosis
mid diastolic
81
what type of murmur is aortic regurgitation?
early diastolic
82
what type of murmur is mitral regurgitation?
pan systolic
83
what are the right sided murmurs?
tricuspid and pulmonary
84
when are right sided murmurs heard loudest?
inspiration
| as blood goes IN the right side
85
what are the left sided murmurs
mitral and aortic
86
when are left sided murmurs heard loudest?
Expiration
| as blood EXits the left side of the heart
87
what are the causes of murmus?
```
infective endocarditis
senile calcification (especially aortic valve)
rheumatic heart disease
cardiomyopathy
physiological (high turbulent flow)
ischaemic heart disease
```
88
what side heart murmurs are more common and why?
left- higher pressure system
89
what are right sided heart murmurs commonly caused by?
IV drug users by S. aureus infection
90
what is acute limb ischaemia?
sudden decrease in limb perfusion that threatens the viability of the limb
91
what is a major risk factor for acute limb ischaemia?
AF
92
what is the presentation of acute limb ischaemia?
```
6P's
pale
pulseless
painful
perishingly cold
paralysis
paraestheia
```
93
what is the management for acute limb ischemia?
IV heparin immediately
refer vascular surgery
options: embolectomy, bypass, amputation
94
what is peripheral vascular disease?
limb ischaemia resulting from atherosclerosis in the lower limb vasculature
95
what is the presentation of mild peripheral vascular disease?
intermittent claudication
96
what is intermittent claudication
cramping leg pain after walking
relieved by rest
peripheral parallel of stable angina
97
what are the signs of a severe form of PVD?
ulcers (tissue loss)
gangrene
limb pain at rest
night pain
98
what are the investigations for PVD?
ABPI (ankle brachial pressure index)
duplex USS
CT/MRI angiography
dealt with by vascular surgeons
99
what should be given before angiography?
IV unfractionated heparin
100
what are stents infused with for anti-proliferative agent?
tacrolimus
101
what are the consequences of tacrolimus for anti-proliferation in stents?
decreased endothelialisation requiring Dual antiplatelet therapy for 1 year, after which can continue on one antiplatelet
102
what can cause a raised BNP?
heart failure
left ventricular dysfunction (MI or valvular disease)
chronic kidney disease
103
what factors reduce BNP levels
ACEi
ARB
diuretics
104
when should antihypertensive treatment initially be offered
<80YO stage 1 hypertension with organ damage, established CVD, diabetes, renal disease and >10% QRISK
stage 2 hypertension always
105
what is the diagnosis of stage 1 hypertension?
BP >140/90 clinically
| ABPM >135/85
106
what is diagnosis of stage 2 hypertension
BP >160/100 clinically
| ABPM >150/95
107
what is diagnosis severe hypertension
clinical systolic >180 or diastolic >110
108
what is the first line treatment for hypertension?
<55 or diabetic ACEi or ARB
| >55 of black african/acro-caribbean = CCB
109
what are the ECG findings suggestive of cardiac tamponade?
electrical alternans (varying heights of QFS complex)
110
what is used to counteract warfarin
vitamin K
111
what should be done in a patient with INR > 5 <8 with minor bleeding
withold warfarin until INR <5
| give vitamin K
112
what should be done in a patient >8 no bleeding
stop warfarin
give vitamin K
restart when INR <5
113
what should be done in patient with 5
withold couple doses warfarin
| no vit K
114
if angina is not being controlled with a beta blocker what should be added?
CCB (amlodipine)
115
what are the signs of VSD?
symptoms of heart failure
pansystolic murmum at lower left sternal edge (blood rushing across septum from left to right ventricle)
louder P2
116
what is the most common cause of mitral stenosis?
rheumatic fever
117
what is used to treat torsades de pointes?
IV magnesium sulfate
118
what are a side effect of thiazide diuretics?
hypercalcaemia and hypocalciuria
119
what is the likely diagnosis in a patient with persistent ST elevation 4 weeks post MI with bibasal crackles and S3 and S4 heard
left ventricular aneurysm
120
what should be given to paitents with >10% CVD risk?
statins
121
for black african or african-caribbean origin taking a CCB for hypertension what is the preferred second agent if required?
ARB over ACEi
122
what is used to treat symptomatic bradycardia first line?
atropine
123
what is used to treat symptomatic bradycardia if atropine fails?
external pacing
124
what is the likely diagnosis of a young male smoker with symptoms similar to limb ischaemia?
Buerger's disease
125
what drug may be associated with visual disturbances including phosphenes and green luminsecence?
ivabradine
126
what do statins commonly have interaction with?
clarithromycin/erythromycin
