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Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Pathophysiology of atherogenesis

A

Damage to endothelial cells → endothelium secretes chemoattractants → leukocytes migrate and accumulate in intima → foam cells/macrophages/T-lymphocytes form fatty streaks → foam cells rupture, releasing lipids + SMC migrate from media to intima → dense, fibrous cap w necrotic core formed
This plaque can partially occlude the lumen → blood flood is restricted → ischemia
Plaque can rupture → thrombus formed →lumen is fully occluded → infarction

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2
Q

Which arteries are affected most by atherogenesis?

A

LAD
Circumflex
RCA

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3
Q

Risk factors for ischaemic heart disease

A

Age
Smoking
Obesity, high serum cholesterol
Diabetes
Hypertension
Family history
M>F

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4
Q

Prinzmetal’s angina features + associations

A

Coronary artery spasms occuring at rest or at night

Cocaine and alcohol use

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5
Q

Ischaemic heart disease investigations

A

1st: Routine bloods: FBC, TFTs
ECG
Best: CT coronary angiography

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6
Q

Acute management of unstable angina/NSTEMI

A

Beta-blocker
Morphine
Oxygen if < 94%
Aspirin
Nitrate

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7
Q

Management of acute STEMI

A

PCI if within 120 minutes

Otherwise, thrombolytics: alteplase, streptokinase

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8
Q

Long term management of ischaemic heart disease

A

Dual antiplatelet: aspirin + clopidogrel
Nitrate: GTN spray
Statin: simvastatin

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9
Q

Complications post-MI

A

0-24hr post-MI: ventricular arrhythmia, HF and cardiogenic shock

1-3 days: fibrinous pericarditis

3-14 days: free wall rupture, papillary muscle rupture and LV pseudoaneurysm

2 weeks to several months: Dressler syndrome, HF, arrhythmias, mural thrombus

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10
Q

Anteroseptal ECG leads

A

V1-V4

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11
Q

Inferior ECG leads

A

II, III, aVF

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12
Q

Anterolateral ECG leads

A

V4-6, I, aVL

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13
Q

Lateral ECG leads

A

I, aVL +/- V5-6

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14
Q

Posterior ECG leads

A

V1-V2
Tall R waves

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15
Q

Anteroseptal coronary artery

A

LAD

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16
Q

Inferior coronary artery

A

Right coronary

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17
Q

Anterolateral coronary artery

A

LAD / left circumflex

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18
Q

Lateral coronary artery

A

Left circumflex

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19
Q

Posterior coronary artery

A

Left circumflex / right coronary

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20
Q

Pathophysiology of heart failure

A

Heart begins to fail, compensation occurs to maintain CO and perfusion:

[sympathetic system activation] BP falls → detected by baroreceptors → sympathetic activation → positively inotropic/chronotropic → CO increases
RAAS system

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21
Q

5 causes of heart failure

A

Ischaemic heart disease
Cardiomyopathy
Valvular heart disease (AS/MR)
Hypertension
Alcohol excess
Cor pulmonale
Anaemia, arrhythmias, hyperthyroidism

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22
Q

Types of heart failure

A

Systolic HF: inability of ventricle to contract properly

Diastolic HF: inability of ventricle to relax and fill

HF reserved ejection fraction
- systolic, EF <40%
HF preserved ejection fraction
- diastolic, EF > 40%

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23
Q

Clinical manifestations of heart failure

A

SOB
Orthopnoea
Fatigue
Ankle swelling
Pulmonary oedema
Cold peripheries

Raised JVP
End respiratory crackles

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24
Q

Heart failure CXR findings

A

Alveolar oedema
B-lines (Kerley)
Cardiomegaly
Dilated upper lobe vessels
Effusion (pleural)

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25
Q

Investigations for heart failure

A

Bloods: brain natriuretic peptide (best)

ECG
CXR
Echo (best imaging)

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26
Q

Medical management for heart failure

A

1st line: ACE-I + B-blocker
2nd line: ARB instead of ACEi
3rd line: Nitrate or hydralazine
4th line: Digoxin
Diuretics: Furosemide (symptom relief)

27
Q

Stage 1 hypertension values

A

BOTH
>140/90 mmHg
and
ABPM >135/85

28
Q

Stage 2 hypertension values

A

> 160/100
or
ABPM 150/95

29
Q

Malignant hypertension values

A

> 180/110

30
Q

Blood pressure target < 80

A

< 140/90

31
Q

Blood pressure target > 80

A

< 150/90

32
Q

Management of stage 1 hypertension

A

QRISK to decide treatment

33
Q

Indications for same-day admission with hypertension

A

Malignant hypertension
+
Signs of papiloedema / signs of retinal haemorrhage
or
Life-threatening symptoms
or
Suspected pheochromocytoma

34
Q

Contraindications to use of ACE inhibitors

A

Pregnancy
General anaesthesia

35
Q

Anti-hypertensives stepwise management

A

1st: ACEi / ARB
Or CCB if Afro-Caribbean / > 55 years (unless diabetic)

2nd: ACEi / ARB + CCB + thiaizide
Give CCB before diuretic, unless evidence of oedema

3rd: ACEi / ARB + CCB + thiazide

Resistant hypertension
4th: + spironolactone / high dose thiazide-like diuretic / alpha blocker / beta blocker

36
Q

Causes of pericarditis

A

Infectious:
Viral (common)
- Coxsackievirus

Bacterial
- Mycobacterium
- Tuberculosis

Non-infectious
Trauma (common)
Uraemia, MI

37
Q

Pericarditis clinical manifestations

A

Chest pain
- Relieved by sittin forward
- Worsened by inspiration / lying down

Fever
SOB
Pericardial friction rub

38
Q

Pericarditis investigations + findings

A

ECG:
- Saddle shaped ST elevation
- PR depression

Diagnostic:
- Echocardiogram

39
Q

Pericarditis management + complications

A

NSAIDs + colchicine

Cardiac tamponade

40
Q

Cardiac tamponade symptoms

A

Beck’s triad:
Hypotension
Elevated JVP
Quiet heart sounds

Pulsus paradoxus

41
Q

Mechanism of cardiac tamponade reducing cardiac output

A

Accumulation of fluid in the pericardial space → compression of the heart chambers → decrease in venous return → decrease in filling in the heart → reducing cardiac output

42
Q

Cardiac tamponade investigations

A

Gold: Echocardiogram

43
Q

Cardiac tamponade management

A

Pericardiocentesis

44
Q

Likely causative of infective endocarditis of prosthetic valve

A

Staph epidermis

45
Q

Likely causative of infective endocarditis after dental procedure

A

Strep viridans

46
Q

Likely causative of infective endocarditis associated with IVDU

A

Staph aureus

47
Q

Infective endocarditis clinical manifestations

A

Fever
Roth spots
Osler nodes
Murmur
Janeway lesions
Anaemia
Nail-bed haemorrhage (splinter haemorrhages)

48
Q

Difference between osler nodes and janeway lesions

A

Osler nodes are painful

49
Q

Critieria for infective endocarditis

A

Duke’s critieria:
Major criteria: blood culture +ve, evidence of endocarditis on echo
Minor criteria: predisposing factors, fever, vascular phenomenon, immune phenomenon, equivocal blood cultures

2 major / 1 major + 3 minor / 5 minor

50
Q

Diagnostic investigation for infective endocarditis

A

Echocardiogram

51
Q

Infective endocarditis antibiotic management

A

Staph: Flucloxacillin + gentamicin
MRSA: vancomycin + rifampicin + gentamicin

Strep: BenPen + gentamicin

Not sure which organism (first line): FAG (flucloxacillin + ampilicin + gentamicin)

52
Q

Aortic regurgitation murmur

A

Early diastolic descrendo

53
Q

Aortic stenosis murmur

A

Ejection systolic

Crescendo/decrescendo

54
Q

Mitral stenosis murmur

A

Rumbling mid-diastolic

Decrescendo-crescendo

55
Q

Mitral regurgitation murmur

A

Holo/pan systolic radiating to left axilla

56
Q

Miteral stenosis signs

A

Malar flush
A fib
Loud S1

57
Q

Mitral regurgitation signs

A

A fib
Displaced, thrusting apex
Soft/absent S1

58
Q

Aortic stenosis signs

A

Slow rising pulse
Soft S2
Narrow pulse pressure

59
Q

Aortic regurgitation signs

A

Wide pulse pressure
Displaced apex
Corrigan’s sign: carotid pulsation
De Musset’s sign: head nodding with heartbeat
Quincke’s: capillary pulsation in nail bed

60
Q

NYHA classification of heart failure

A

I - no limitation in physical activity
II - slight limitation of physical activity, comfort at rest
III - marked limitation in physical activity, but comfort at rest. Minimal physical activity causes fatigue (less than ordinary).
IV - inability to carry on any physical activity without discomfort, with symptoms occurring at rest

61
Q

Management of atrial fibrillation

A

Rate control (rhythm control also possible)
1: B blocker
2: CCB
3: Digoxin

Anticoagulation:
1: Warfarin
2: DOACs

62
Q

Causes of atrial fibrillation

A

Sepsis
Mitral Valve Pathology (stenosis or regurgitation)
Ischemic Heart Disease
Thyrotoxicosis
Hypertension

(Smith AF)

63
Q

When can rhythm control be offered to people with atrial fibrillation?

A

Reversible cause for their AF
New onset (<48 hours)
AF is causing heart failure
Remain symptomatic despite being effectively rate controlled

64
Q

Rhythm control options for atrial fibrillation

A

Cardioversion:
Pharmacological-
1: Flecanide
2: Amiodarone
Electrical-
Difibrillator

Long term rhythm control
1: Beta blockers
2: Dronedarone
3: Amiodarone

Medicine (13 decks)

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