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AMK > Cardiology > Flashcards

Cardiology Flashcards

1
Q

what type of murmur is aortic regurgitation

A

early diastolic

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2
Q

what type of murmur is aortic stenosis

A

ejection systolic

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3
Q

what type of murmur is mitral regurgitation

A

pan systolic

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4
Q

what type of murmur is mitral stenosis

A

mid diastolic

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5
Q

most common cause of mitral stenosis

A

rheumatic fever

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6
Q

acute management of Atrial Fibrillation

A

immediate DC cardioversion

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7
Q

management of paroxysmal Atrial Fibrillation

A

dont require long term anti-arrythmic therapy
flecainide (pill in pocket)

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8
Q

electrical cardioversion

A

done in A fib.
patient needs to be anti coagulated (DOaC e.g. edoxaban)
or transesophageal echo to check for thrombus

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9
Q

pharmacological cardioversion

A

flecainide or amiodarone
still needs anticoagulation

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10
Q

treatments for persistent/permanent a fib

A

verapamil
carvedilol
digoxin

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11
Q

aortic dissection presentation and classification

A

tearing chest pain
Stanford type A = ascending aorta
type B = descending aortia

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12
Q

investigation + management of aortic dissection

A

CT aortogram/angiogram = diagnosis
ECG / echo to investigate

Type A = surgical (valve graft)
Type B = medical (labetalol to control arterial BP)

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13
Q

indications of amiodarone

A

arrhythmias, only used as last resort

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14
Q

what is brugada syndrome, affected population, Mx

A

inherited arrhythmia
causes sudden death in east asian males with structurally normal hearts

Implantable Cardioverter - Defibrillator

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15
Q

ECG for brugada syndrome

A

cove shaped ST segment with negative T wave

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16
Q

how to diagnose brugada syndrome

A

ECG (cove shaped ST segment with negative T wave)
+ family history / V fib / syncope

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17
Q

pathophysiology of Wolff-Parkinson White syndrome

A

accessory pathway opens between SA node and AV node, ventricles contract too early (accessory pathway doesn’t account for the normal delay)
supraventricular tachycardia

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18
Q

ECG findings for WPW

A

delta wave (slurred upstroke of the QRS)

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19
Q

Mx for stable and unstable patients with WPW

A

stable: vagal manoeuvres/meds (amiodarone)
unstable: immediate DC cardio version

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20
Q

definitive treatment for WPW

A

radiofrequency ablation of the accessory pathway

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21
Q

Wellen syndrome ECG

A

biphasic/negative T wave in leads V2 + V3

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22
Q

cause of wellen syndrome

A

stenosis of LAD, major risk for MI

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23
Q

meds for heart failure

A

ABAL
ACEi , beta blocker, aldosterone antagonist, loop diuretic

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23
Q

meds for heart failure

A

ABAL
ACEi , beta blocker, aldosterone antagonist, loop diuretic

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24
Q

irregular R R interval

A

a fib

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25
Q

what is cardiac resynchronisation therapy (CRT) used for

A

connects to the ventricles, allows them to contract properly. used in severe heart failure

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26
Q

what is cardioversion used for

A

reset to sinus rhythm

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27
Q

what is a permanent pacemaker used for

A

takes over entire electrical conduction

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28
Q

broad complex is defined as?

A

> 120ms

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29
Q

presentation of aortic stenosis

A

pulmonary edema
low volume pulse
low pulse pressure
slow rising carotid pulse
ejection systolic murmur and 4th heart sound
forceful apex beat
unheard A2 (aortic closure sound)

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30
Q

indications for embolectomy vs thrombolysis

A

embolectomy: remove an embolus (a blood clot originating from elsewhere and moving to this location)
thrombolysis: break down a clot that has formed there

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31
Q

non specific symptoms e.g. cough, fatigue, weight loss, hoarseness, night sweats
dockyard worker

A

malignant pleural mesotheliomaM

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32
Q

Mx of a Malignant pleural mesothelioma

A

combination therapy (chemo + radio)

33
Q

management of peripheral arterial disease

A
  1. 12 week exercise program
  2. Stenting and angioplasty
  3. Bypass surgery
  4. Naftidrofuryl oxalate
34
Q

Mx of acute arterial embolus

A

fogarty embolectomy

35
Q

initial Mx of hyponatremia

A

fluid restriction

36
Q

diagnosis of renal artery stenosis

A

MRI with gadolinium contrast of renal arteries

37
Q

how does cardiac contraction occur

A

increase CAMP activates protein kinase A which stimulates calcium release
this acts on Calcium sensitive calcium channels to release even more calcium
binds to Troponin C
exposes the actin binding site
actin binds to myosin
CONTRACTION

38
Q

cardiac output equation

A

heart rate x stroke volume

39
Q

what is preload

A

degree of stretch applied to the cardiac muscle during filling (end of diastole and before systole)

40
Q

what is afterload

A

force against which the heart has to overcome to contract

41
Q

what are the two waveforms on JVP and what do they indicate?

A

A wave - R atrial contraction
V wave = R atrial venous filling

42
Q

what heart failure drugs improve morbidity and mortality

A

ACE inhibitors and beta blockers

43
Q

what heart failure drugs improve mortality only

A

mineralocorticoid receptor antagonists (spironolactone)
ivabradine
hydralazine + nitrate

44
Q

causes of constrictive pericarditis

A

TB
mediastinal irradiation
cardiac surgery

45
Q

signs of constrictive pericarditis

A

pericardial knock in early diastole (ventricle cannot fill effectively)
kussmauls sign (paradoxical rise in JVP upon inspiration)

46
Q

what criteria is used to diagnose rheumatic fever

A

Jones major and minor
evidence of strep A infection in past week AND 2 major OR 1 major 2 minor

47
Q

major jones criteria

A

JONES
polyarthritis
carditis
subcut nodules
erythema migratum
sydenham chorea

48
Q

minor jones criteria

A

CRPPPF
raised CRP
Previous rheumatic fever
polyarthralgia
fever >38

49
Q

Mx of acute rheumatic fever

A

bed rest
1mg benzyl penicillin or 10 days PO phenoxymethylpencillin
high dose aspirin
ACEIs and corticosteroids for caridtis

50
Q

complications of acute rheumatic fever

A

mitral stenosis
infective endocarditis

51
Q

where is best to hear mitral stenosis

A

apex beat

52
Q

hypokalaemia ECG changes

A

small T waves
ST depression
U waves

53
Q

hyperkalemia ECG changes

A

tall tented T waves
broad QRS
absent P waves

54
Q

hyperkalemia management

A

30ml of 10% calcium gluconate

55
Q

mitral valve prolapse findings (x2)

A

mid systolic click
late systolic murmur

56
Q

mitral stenosis findings (x1)

A

mid diastolic murmur over apex

57
Q

what coronary artery commonly causes inferior MI

A

right coronary artery

58
Q

what coronary artery commonly causes anteroseptal MI (what leads)

A

left anterior descending
V1-4

59
Q

what vein is the best to measure JVP and why

A

right internal jugular vein
it has a straight continuation with the brachiocephalic and SVC

60
Q

AVNRT + management

A

AV nodal reentrant tachycardia
Impulse re-enters the AV node
Mx:
1) vagal maneuvres
2) 6mg adenosine
3) 12 mg adenosine
4) 12mg adenosine

61
Q

clinic and ABPM target for >80

A

clinic 150/90
ABPM 145/85

62
Q

clinic and ABPM target for <80

A

clinic 140/90
ABPM 135/85

63
Q

indications for Ambulatory blood pressure monitoring

A

everyone in clinic with BP >140/90

64
Q

nitrates are contraindicated in

A

aortic stenosis

65
Q

when is digoxin used in AF Mx

A

when they do little exercise / bed bound

66
Q

what meds are used for rate control

A

beta blocker
verapamil
diltiazem
digoxin

67
Q

when is rate control indicated

A

fast ventricular rate

68
Q

when is rhythm control indicated

A

reversible cause of AF
heart failure
acute AF

69
Q

> 48 since AF onset
what to do, what is preferred

A

anticoagulation for 3 weeks
electrical cardioversion preferred

70
Q

<48 hrs since AF onset
what to do, what is preferred

A

pharmacological cardioversion is preferred
amiodarone, flecainide

71
Q

when is flecainide contraindicated and what is used instead

A

structural heart disease
amiodarone used instead

72
Q

aortic dissection urgent management

A

limited fluid rhesus (permissive hypotension)
CT scan
refer to cardiothoracic surgeon

73
Q

indications for CABG

A

more than 50% narrowing plus:
left ventricular dysfunction
triple vessel disease
angina persisting despite all steps of medical management
left main stem narrowing

74
Q

what are all the steps of medical management for angina

A

lifestyle changes
sublingual GTN to use for attacks
1. beta blocker
2. Add a dihydropyridine CCB e.g. amlodipine
3. long acting nitrate (isosorbide nitrate) / ivabradine
**aspirin and statin for prevention

75
Q

symptoms of DVT and right side weakness
what is it
Ix

A

venous thrombosis becoming an arterial embolus due to patient foramen ovale or ASD
Ix: transoesophageal echo

76
Q

6 absolute contraindications to thrombolysis

A

active internal bleeding or uncontrollable external bleeding
suspected aortic dissection
recent head trauma (< 2 weeks)
intracranial neoplasms
history of proved haemorrhagic stroke or cerebral infarction < 2 months earlier
uncontrolled high blood pressure (> 200/120 mmHg).

77
Q

6 relative contraindications to thrombolysis

A

pregnancy
peptic ulcer
INR >1.8
prolonged CPR
bleeding disorders
recent surgery

78
Q

8 reversible causes of cardiac arrest

A

4Hs: hyper/hypokalaemia, hypothermia, hypoxia, hypovolemia

4Ts: thrombosis, tamponade, tension pneumo, toxins

79
Q

why is adrenaline used in cardiac arrest

A

it causes systemic vasoconstriction (alpha effect)
increased cerebral and coronary perfusion pressure

80
Q

5 waveforms on the central venous pressure graph and what they show

A

a: atrial contraction
c: tricuspid closes
x: ventricular contraction
v: atrial filling
y: tricuspid opening

81
Q

regularly spaced QRS complexes
no P waves
tachycardic

A

atrioventricular nodal re-entrant tachycardia

AMK (29 decks)

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