Cardiology Flashcards

(69 cards)

1
Q

What is paroxysmal nocturnal dyspnoea?

A

Suddenly waking up at night with a severe attack of shortness of breath and cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the first line medical treatment for heart failure (ABAL)?

A

ACE inhibitor (up to 10mg OD)
Beta blocker (up to 10mg OD)
Aldosterone antagonist when symptoms not controlled with A and B (spironolactone or eplerenone)
Loop diuretics improves symptoms (e.g. furosemide 40mg OD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the monitoring requirement for diuretics, ACE inhibitors and aldosterone antagonists?

A

U&Es

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What drug should be avoided in patients with valvular heart disease until indicated by a specialist?

A

ACE inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the difference between systolic and diastolic heart failure?

A

Systolic = impaired left ventricular contraction
Diastolic = impaired left ventricular relaxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What BNP requires an urgent specialist referral?

A

A BNP over 2000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is cor pulmonale?

A

Right sided heart failure caused by respiratory disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the pathophysiology of cor pulmonale?

A

Increased pressure and resistance in the pulmonary arteries (pulmonary hypertension) results in the right ventricle being unable to effectively pump blood out of the ventricle and into the pulmonary arteries.
Back pressure of blood in the right atrium, the vena cava and the systemic venous system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the causes of cor pulmonale?

A

COPD
PE
Interstitial lung disease
CF
Primary pulmonary hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the main symptoms of cor pulmonale?

A

Often asymptomatic
SOB
Peripheral oedema
Increased breathlessness on exertion
Syncope
Chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some signs of cor pulmonale?

A

Hypoxia
Cyanosis
Raised JVP
Peripheral oedema
Third heart sound
Murmurs (e.g. pan-systolic in tricuspid regurgitation)
Hepatomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the management of cor pulmonale?

A

Treat symptoms and underlying cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What causes a third heart sound?

A

Rapid ventricular filling
Cause chord tendineae to twang
Either because they are young and healthy or because the ventricles are stiff and weak and so reach their limit much faster than normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What causes a fourth heart sound?

A

S4 is heard directly before S1.
Always abnormal, rare
Stiff or hypertrophic ventricle
Caused by turbulent flow from an atria contracting against a non-compliant ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the locations for auscultation of the different heart valves?

A

Pulmonary: 2nd ICS left sternal border
Aortic: 2nd ICS right sternal border
Tricuspid: 5th ICS left sternal border
Mitral: 5th ICS mid clavicular line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How do you grade a murmur?

A
  1. Difficult to hear
  2. Quiet
  3. Easy to hear
  4. Easy to hear with a palpable thrill
  5. Can hear with stethoscope barely touching chest
  6. Can hear with stethoscope off the chest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What valvular disease causes hypertrophy?

A

Stenosis:
Mitral stenosis causes left atrial hypertrophy
Aortic stenosis causes left ventricular hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What valvular disease causes dilatation?

A

Regurgitation
Mitral: left atrial dilatation
Aortic: left ventricular dilatation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What can cause mitral stenosis?

A

Rheumatic heart disease
Infective endocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does a mitral stenosis murmur sound like?

A

Mid-diastolic, low pitched rumbling (low velocity of blood)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is mitral stenosis associated with?

A

Malar flush (due to rise in CO2 and vasodilation)
AF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What does a mitral regurgitation murmur sound like?

A

pan-systolic, high pitched whistling (high velocity of blood)
Radiates to left axilla
May heart a third heart sound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is mitral regurgitation associated with?

A

Congestive Cardiac failure (reduced ejection fraction and backlog of blood)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What can cause mitral regurgitation?

A

Idiopathic weakening of the valve with age
Ischaemic heart disease
Infective endocarditis
Rheumatic heart disease
Connective tissue disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What does an aortic stenosis murmur sound like?
Ejection systolic, high pitched murmur Crescendo-decrescendo
26
What are some other signs of aortic stenosis?
Radiates to carotids Slow rising pulse and narrow pulse pressure Exertional syncope
27
Causes of aortic stenosis?
Idiopathic age related calcificaiton Rheumatic heart disease
28
What does an aortic regurgitation murmur sound like?
Early diastolic, soft murmur Associated with a Corrigan's pulse (collapsing pulse) - a rapidly appearing and disappearing pulse at carotid as the blood is pumped out by the ventricles and then immediately flows back through the aortic valve. Results in heart failure Can also cause an 'Austin-flint' murmur (heart at apex and is an early diastolic rumbling murmur)
29
Causes of aortic regurgitation?
Idiopathic age related weakness Connective tissue disorders
30
What are the four cardiac arrest rhythms?
Shockable: ventricular tachycardia and ventricular fibrillation Non shockable: Pulseless electrical activity or asystole
31
How do you manage supraventricular tachycardias?
Vagal manoeuvres Carotid sinus massage Adenosine (or alternatively verapamil) Direct current cardio version may be required
32
How do you manage ventricular tachycardia?
If stable: amiodarone infusion If unstable: 3 shocks and then consider amiodarone
33
What causes atrial flutter?
Re-entrant rhythm Sawtooth appearance on ECG
34
What are some associated conditions with atrial flutter?
Hypertension Ischaemic heart disease Cardiomyopathy Thyrotoxicosis
35
What causes supra ventricular tachycardias?
Re-entrant electrical signals. Results in a fast, narrow complex tachycardia
36
How does adenosine work?
Slows cardiac conduction primarily through the AV node - resets it to sinus rhythm.
37
When should you avoid adenosine?
Asthma/COPD/Heart failure/heart block/severe hypotension
38
What is the extra pathway in Wolff-Parkinson White Syndrome called?
Bundle of Kent
39
What ECG changes do you see in Wolff-Parkinson White?
Short PR interval Wide QRS complexes Delta wave (slurred upstroke on the QRS complex)
40
What can cause a prolonged QT?
Long QT syndrome Medications (antipsychotics, citalopram, flecainide, stall, amiodarone, macrolide antibiotics) Electrolyte disturbance (hypokalaemia, hypomagnesaemia, hypocalcaemia)
41
What can a prolonged QT progress to?
Torsades de pointes (which can then progress to ventricular tachycardia and cardiac arrest)
42
What is the acute management of Torsades de pointes?
Correct the cause Magnesium infusion (even if normal magnesium) Defibrillation if VT occurs
43
Long term management of prolonged QT syndrome?
Avoid medications that prolong the QT interval Correct electrolyte disturbances Beta blockers (not stall) Pacemaker or implantable defibrillator
44
What is the difference between different types of heart block?
First degree: delayed AV conduction (long PR interval) Second degree: some atrial pulses don't make it through - Wenkebach's phenomenon (Mobitz type 1) = atrial impulses become gradually weaker until it does not pass through AV node and then restarts strong. See increasing PR interval and then an absent QRS complex. - Mobitz type 2 = intermittent failure or interruption. Missing QRS complexes. Usually a ratio of P waves to QRS complexes. PR interval normal. Third degree = Complete heart block: no observable relationship between P waves and QRS complexes
45
How do you treat unstable heart block or risk of systole? (Mobitz type 2, complete heart block or previous systole)
Atropine 500 mcg IV, repeated until improvement or add inotropes. Temporary trans venous cardiac pacing or pacemaker if available
46
How does atropine work?
Antimuscarinic Inhibits the parasympathetic nervous system Side effects: pupil dilatation, urinary retention, dry eyes , constipation
47
How do dihydropyridine calcium channel blockers work to reduce blood pressure?
Reduce calcium ion influx into cells, increasing peripheral vasodilation
48
What are the two non dihydropyridine calcium channel blockers?
Verapamil Diltiazem
49
How do non dihydropyridine calcium channel blockers work?
Act both peripherally and centrally: increase peripheral vasodilation and block calcium influx on SAN and AVN in the heart to reduce HR, contractility, conduction - mainly work to correct arrhythmias, less effect on CO
50
Where does furosemide work in the kidneys?
Na+ K+/2Cl- cotransporter Loop of Henle
51
How do diuretics work?
Reduce salt reabsorption in the kidneys to increase water excretion
52
How do ACE inhibitors work?
Work to prevent the production of angiotensin II, preventing an increase in aldosterone which would increase salt reabsorption It also prevents breakdown of bradykinin which increases vasodilation
53
Where does aldosterone work?
Principle cells of the collecting ducts to increase the number of Na+/K+ pumps
54
What are two alpha-1 blockers?
Doxasozin or Prazosin These block alpha receptors in the peripheral arteries increasing peripheral vasodilation
55
What are two non-selective beta blockers?
Labetalol and Carvediol
56
How do non selective beta blockers affect the RAAS system?
Inhibit beta receptors in the kidneys, reducing secretion of renin, reduced RAAS
57
What are three selective beta -1 blockers?
atenolol Metoprolol Bisoprolol
58
How do selective beta blockers reduce blood pressure?
Reduce cardiac output
59
Where is angiotensinogen made?
Liver
60
What converts angiotensinogen to angiotensin I?
Renin
61
How do class I antiarrhythmic drugs work?
Block sodium channels, decrease rate of depolarization, slowing conduction velocity
62
How do Class II anti-arrhythmic drugs work?
Beta-1 blockers Depress SA node automaticity, decreasing heart rate and decreasing contractility
63
How do Class III anti-arrhythmic drugs work?
Block K+ channels, delaying repolarization, increasing the refractory period
64
How do Class IV anti-arrhythmic drugs work?
Block calcium channels during depolarization, slowing conduction and decreasing contractility
65
What class is Procainamide?
Class Ia (moderate) anti arrhythmic
66
What class is Lidocaine?
Class Ib( weak) anti-arrhytmic
67
What class is Flecainide?
Class Ic (strong) anti-arrhythmic
68
What class are the following drugs: Amiodarone, Dronedarone, Sotalol, Dofetilide?
Class III
69
What class are Verapamil and Diltiazem?
Class IV anti-arrhythmic drugs - calcium channel blockers during depolarisation