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Cardiology Flashcards

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1
Q

Healthy size of JVP?

A

3cm

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2
Q

inspiration makes the JVP rise or fall?

A

Fall - negative intrathoracic pressure

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3
Q

Causes of a raised JVP?

A

Heart failure
Fluid overload
Bradycardia

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4
Q

Kaussmauls SIGN

A

raised JVP with inspiration - due to constriction of the pericardium

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5
Q

Raised JVP with no pulsations?

A

SVC obstruction

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6
Q

JVP a wave

A

atrial contraction

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7
Q

JVP c wave

A

closure of tricuspid valve

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8
Q

JVP x descent

A

downward movement of the heart

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9
Q

JVP v wave

A

passive filling of blood in thr atriaum against closedf tricuspid valve

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10
Q

JVP y descent

A

Opening of tricuspid valve

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11
Q

JVP a waves ==absent==

A

AF

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12
Q

JVP a waves ==Large==

A

tricuspid stenosis

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13
Q

JVP cannon a waves

A

AV dissasociation -
Atrial flutter/tachy ,
complete heart block,
VT and ventricular ectopics

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14
Q

JVP V waves - giant

A

tricuspid regurge

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15
Q

JVP x descent - steep

A

tamponade

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16
Q

JVP y descent - steep

A

Cardiac constriction

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17
Q

JVP y descent - slow

A

Tricuspid stenosis

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18
Q

Absent radial pulse, cause?

A 
Iatrogenic - A-lines
Tetralogy of Fallot
Aortic dissection
Trauma
Takayasu Arteritis
Peripheral arterial embolus
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19
Q

Central pulse is for assessing?

A

character of pulse

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20
Q

peripheral pulse is for assessing?

A

rate and rythym

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21
Q

Collapsing pulse?

A

Aortic regurge
AV fistula
PDA

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22
Q

Slow rising pulse?

A

Aortic stenosis

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23
Q

Bisferiens pulse?

A

“double shudder” mixed Aortic valve disease with significant regurgitation

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24
Q

Jerky pulse?

A

HOCM

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25
Alternans pulse?
occurs in LV distortion - reduced EJ % which due to frank-sterling physiology improves the EF of the next beat
26
Paradoxical pulse?
Reduction in the pulse with inspiration - LV compression ie. tamponadde pericarditis and severe asthma
27
Loud first heart sound cause?
``` Mobile Mitral stenosis hyperdynamic states tachycardia left to right shunt short PR interval ```
28
Soft first heart sound cause?
``` immobile mitral stenosis Hypodynamic states Mitral regurge Poor ventricular function Long PR interval ```
29
Split first heart sound cause?
``` LBBB RBBB VT Inspiration Ebsteins anomoly ```
30
Variable first heart sound cause?
``` AF heart block (complete) ```
31
What causes the first heart sound?
closure of mitral and tricuspid valve
32
What causes the second heart sound?
closure of the aortic and pulmonary valves
33
Loud second heart sound cause?
Hypertension Tachycardia ASD
34
Soft or absent second heart sound cause?
Severe aortic stenosis
35
Fixed splitting of the second heart sound cause?
ASD
36
Widely split second heart sound cause?
RBBB Pulmonory stenosis Deep inspiration Mitral regurge
37
Single S2 sound cause?
Pulmonary stenosis/aortic stenosis hypertension elderly ToF
38
Reversed split S2 cause?
LBBB Right ventricular pacing PDA AS
39
Third heart sound cause?
audible in children - pathalogical in rapid left ventricular filling - eg mitral regurge
40
Fourth hearth sound cause?
LVH | amyloid
41
causes of valvular clicks?
AS bicuspid aortic valve valve replacement
42
causes of opening snap?
Mitral stenosis
43
ECG tall R waves in V1
QRS is usually negative in V1 caused by right ventricular hypertrophy RBBB posterior infarction
44
Causes of LBBB
ischemia hypertension aortic valve disease
45
Causes of RBBB
Normal variant in young PE ASD Ischemic heart disease
46
Causes of St elevation
early repolarisation Acute MI pericarditis coronary artery spasm
47
ECG changes in ischaemia? (other than ST-e)
St depression | t inversion and peaking
48
ECG changes on Digoxin?
downsloping | st depression
49
ECG changes in hypertrophy?
St depression | T inversion
50
ecg changes in hyperventilation?
ST depression | T inversion and peaking
51
ecg changes in oesophogeal irritation
ST depression | T inversion
52
ECG changes in mitral valve prolapse?
T wave inversion
53
ecg chnages in strokes?
St depression | T wave inversion
54
ECG changes in hyperkalemia
Tall T waves Prolonger PR interval Absent P waves
55
ECG changes in severe hyperkalemia
Wide QRS sine wave pattern VT
56
ECG changes in hypokalemia
Flat T waves/inverted T waves Prolonged PR interval St depression U waves
57
Mid- late systolic murmur cause?
``` innocent? AS Coarctation HCM ASD Mitral valve prolapse ```
58
mid-diastolic murmurs cause?
Mitral stenosis - austin flint murmur Rhematic fever mitral/tricuspid regurge Atrial tumour
59
Symptoms of severe Mitral Stenosis?
Dyspneoa heamoptysis dysphagia due to left atrial enlargement palpitations
60
CXR findings of Mitral Stenosis?
Left atrial or right ventricular enlargement | splaying of the subcarinal angle >90 degrees
61
Signs of mitral stenosis
low pulse pressure soft first heart sound Long diastolic murmur
62
Causes of mitral regurge?
``` Ventricular dilatation Mitral valve prolapse ischaemic papillary rupture collagen disorders endocarditis ```
63
indicators of severe Mitral regurge?
``` small volume pulse LV enlargement S3 sound AF Cardiac failure ```
64
Conditions associated with Mitral valve prolapse?
``` Coronary artery disease polycystic kidney disease HCM PDA Marfans SLE ```
65
Causes of aortic regurge?
``` infective endocarditis RA/SLE Syphillis/ankspond Aortic dissection hypertension Collagen disorders ```
66
Causes of Aortic Stenosis
congenital bicuspid valve calcification in elderly HCM IHD
67
LVOT velocity of 1?
Normal
68
LVOT velocity of 0.25?
Severe
69
Indicators of severe AS
syncope LV failure Valve area greater than 0.5cm on echo
70
Causes of Tricuspid regurge
functional due to right ventricular dilatation - ie with MR Infection - ie venous cannula Carcinoid Ebstein's anomoly - pt have cynanosis and commonly ASD
71
Types of valve replacement?
Mechanical - ball and cage, single tilling disc, bileaflet | Tissue - allograft - porcine. Or cadaveric homograft.
72
Infection of prosthetic valve features?
``` High mortality rate - 60% Within six months of implant usually staph epidermis septal abcess heamolysis - increased urobilligin ```
73
Signs of infective endocarditis
``` Fever arthropathy splinter haemorrhages and painful oslers nodes hepatosplenomegaly stroke/digital ischaemia vasculitis rash ``` (ONLY TEN PERCENT are IVDU - 40% no previous valve disease)
74
Re-entry tachy
usually anatomical
75
atomaticity in tachy
secondary arrythmia due to electrolyte imbalance or sepsis
76
triggered activity in tachy
Seen in both primary and drug toxicity
77
SVT two main groups?
AV nodal re-entry tachycardia | AV reentry tachycardia - accessory pathway between atria and ventricles at distance from AV node.
78
AF - to anticoagulate or not?
Chadsvasc score | hasbled score
79
Hs and Ts
hypoxia hypovolemia hypo/er kalemia hypothermia Tensioning PTX Tamponade Toxins Thrombus
80
Angina variants?
Decubitus - on lying down - dreaming Prinzmetals' - unpredictable and at rest due to coronary artery spasm Syndrome X - very small vessel diseases - normal coronary arteries on testing but positive exercise test
81
other causes of troponin rises other than MI
``` sepsis hypotension pre-eclampsia IECOPD AAA chemo ```
82
Absolute contraindication to thrombolysis
``` active internal bleeding aortic dissection suspected head truma in last two weeks intracranial cancer heamoraggic stroke <2/12 pregnancy ```
83
Relative contraindications to thrombolysis
``` CPR bleeding disorders recent surgery active diabetic heamorage intracardiac thrombus INR > 1.8 ```
84
Length of time on ticagralor after MI and study
1 year | PLATO study
85
Length of time on beta blockers post MI and study
life | ISIS
86
Length of time on ACEi after MI
life | SAVE study
87
length of time on aldosterone antaganoists post mi
life | ephesus study
88
common aldoserone antagonists
spironolactone | Epleronone
89
Length of time on statin after MI
life | MIRACL study
90
Cant drive after TLOC ?
6/12 after last episode - NB: vasovegal while erect does not preclude driving
91
Cant drive after PCI?
1 week
92
Cant drive after MI?
1 month
93
HF-PEF?
Diastolic heart failure - preserved ejection fraction pt is breathless but no signs of fluid overload
94
classification of heart failure
new york heart association
95
NYHA Class 1 heart failure
asytomatic - 5% mortality at one year
96
NYHA Class 2 heart failure
slight limitation of DAL - 15% oym
97
NYHA Class 3 HF
marked limitation of DAL - 30% oym
98
NYHA Class 4 HF
dyspneoa at rest - 50-60 one year mortality rate
99
heart failure echo?
EF <40% | 5 year survival at 40% is 60% compared with 95% in EF>50%.
100
DCM?
Dilated cardiomyopathy
101
Causes of DCM
``` Etoh hypertension auto immune thiamine deficiancy HIV Drugs sarcoidosis AF/tachy states uncontrolled Diabetes ```
102
Restrictive cardiomyopathy
symptoms similar to pericarditis due to rigid ventricles
103
Causes of restrictive cardiomyopathy
scleroderma amyloid/sarcoid/heamochromatosis malignancy radiotherapy
104
Myocarditis signs?
``` young patient acute hx viral prodrome neutrophilia ECG changes elevated troponin ``` HIGH MORBIDITY AND MORTALITY
105
Common cause of acute paroxysmal AF in young patient?
Etoh | if not totally abstaining 50% will die within 5 years
106
Constrictive pericarditis? signs/causes
similar to restrictive myocarditis but also bright pericardium on echo/soft heart sounds/pulsus paradoxus rarely - diastolic knock. ``` Caused by TB radiotherapy post viral or bacterial pericarditis trauma connective tissue disease ```
107
Signs of pericardial effusion?
pulsus alternans or paradoxus | electrical alternans on ecg
108
signs/symptoms of restrictive cardiomyopathy /constrictive pericarditis?
Raised JVP AF non pulsatile hepatomegaly
109
Hypertension - single episode - greater than 190/x or y/110 ?
Treat
110
BP 140-159/90-99 - multiple episodes - no comorbidities -
annual assessment
111
First line treatment for hypertension aged >55 or BLack
Calcium blocker or thiazide
112
First line treatment for hypertension aged <55
ACEi or ARB

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