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Cardiology Flashcards

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1
Q

Red flags for chest pain?

A

> acute onset
exertional pain
substernal /left sided pain
quality = crushing, pressure
new murmur
associated SOB
radiation to left arm, jaw or back
distant heart sounds
chest wall crepitus
hypotension
difference >20mmHg in systolic be between arms
pulses paradoxus
hypoxia

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2
Q

What are the life threatening causes of chest pain to rule out?

A

1) MI (STEMI vs nstemi vs unstable angina)
2) PE
3) aortic dissection
4) tension pneumothorax
5) cardiac tamponade
6) oesophageal rupture

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3
Q

Differential in a pain with chest pain

A

Cardiac causes
>MI
>pericarditis
>angina
>pulmonary embolism
>pulmonary hypertension
>aortic dissection

Non cardiac causes
>peptic ulcer disease
>spontaneous pneumothorax
>gastro-oesophageal reflux
>herpes zoster
>musculoskeletal disorder
>anxiety

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4
Q

What causes an S3 sound?

A

The rapid filling and deceleration of blood in the ventricle during diastole when the ventricle reaches its diastolic limit (best heard in mitral region)

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5
Q

In what conditions will you hear a pathological S3?

A

Chronic mitral regurgitation
Aortic regurgitation
Dilated cardiomyopathy
Heart failure
Thyrotoxicosis

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6
Q

When is an S3 heart sound normal?

A

Young (less than 40)
Pregnancy
Athletes

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7
Q

What scoring system is used to determine likelihood of PE?

A

Wells score

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8
Q

What are secondary causes of hypertension?

A

ROPE

Renal disease
Obesity
Pregnancy induced
Endocrine (hyperthyroid, hyperaldosteronism)

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9
Q

Complications of hypertension

A

Ischaemic heart disease
Hypertensive retinopathy
Hypertensive nephropathy
Stroke (CVI)
Heart failure

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10
Q

Target organ damage caused by hypertension

A

1) Heart
>cardiomyopathy
>MI
>arrhythmias
>left ventricular hypertrophy
>aortic valve insufficiency

2) Aorta
>aortic dissection
>artherosclerosis
>aneurysm

3) Peripheral arteries
>artherosclerosis

4) Renal
>CKD

5) Brain
>stroke
>dementia

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11
Q

Side effect of ACE-I

A

Dry cough

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12
Q

Side effect of ARB

A

Angioedema

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13
Q

Presentation of hypertension

A

Usually silent
Non specific signs
>chest palpitations
>headaches in the early morning
>dizziness
>fatigue
>epistaxis

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14
Q

Risk factors for hypertension

A

Non-modifiable
>positive family history
>advanced age
>ethnicity

Modifiable
>obesity
>diabetes
>smoking
>excessive alcohol intake
>poor diet (high in salt)
>physical inactivity
>psychological stress

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15
Q

Difference between hypertensive urgency or hypertensive emergency

A

Both = BP >180/110
But urgency: no signs of end organ damage
Emergency: signs of end organ damage

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16
Q

Red flags in a hypertensive crisis

A

Dyspnoea
Chest pain
Altered mental status
Focal neurological deficit

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17
Q

Define heart failure

A

When the heart is unable to pump enough blood to meet the metabolic demands of the body due to pathological changes in the myocardium

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18
Q

What are the stages of heart failure according to the American heart association?

A

A = at risk
B = abnormal heart structure but no signs/symptoms (previous MI, elevated BNP, asymptomatic valvular disease, LVH)
C = abnormal structure and symptomatic HF
D = end stage (need of heart transplant)

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19
Q

What is the functional classification of HF according to the New York Heart Association?

A

I: No limit to physical activity. No sx HF
II: slight limitation to moderate/prolonged physical activity (sx after climbing 2 flights of stairs) Comfortable at rest
III: Marked limitations during physical activity including activities of daily living. ONLY comfortable at rest
IV: Confined to bed. Symptoms at rest

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20
Q

Define syncope

A

A sudden loss of consciousness due to decreased cerebral perfusion

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21
Q

Define presyncope

A

A lightheadedness where the patient things he or she will fall down

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22
Q

Most important to rule out in pt with acute chest pain:

A

> pulmonary emboli
MI
pericardial effusion
haemo/pneumothorax
aortic dissection
ruptures oesophagus

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23
Q

Causes of sinus bradycardia

Study These Flashcards
A

Hypothermia
Hypothyroidism
Drugs

24
Q

Causes of sinus tachycardia

Study These Flashcards
A

Pregnancy
Exercise
Increased sympathetic activity
Other = anaemia, fever, drugs

25
Differential diagnosis for prolonged QT interval
Electrolyte imbalances >hypokalaemia >hypocalcaemia >hypomagnesaemia Hypothermia Drugs (anti-arhythmic) Congenital Cardiomyopathy CAD CNS Injury
26
ECG changes in Hyperkalaemia
Initially peaked, tall, symmetrical T waves then >ST segment depression >prolonged QT interval >widened QRS >flattened P wave >prolonged PR
27
Wolf Parkinson white syndrome ECG features
TRIAD 1) shortened PR interval <0,12secs 2) broad QRS complex >0,12secs 3) delta wave or slurred upstroke of QRS complex
28
Phases of an acute MI on ECG
1) tall upright/inverted T-waves 2) ST elevation (leads facing infarcted wall = upright, opposite leads = ST depression) 3) 8-12hrs after MI = new pathological Q wave
29
Cardiovascular causes of syncope
>tachyarrythmias (VT, a-flutter, a-fib) >bradyarrythmias (2nd or 3rd degree heart block, sinus bradycardia) >primary pulmonary hypertension >left ventricle outflow lesion (stenosis, hypertrophic cardiomyopathy) >left ventricle inflow obstruction (mitral stenosis)
30
What causes a 4th heart sound?
The atria contracting against the high pressures of the ventricles at the end of diastole
31
What are the pathological causes of S4 if palpable?
Ventricular hypertrophy Ischaemic cardiomyopathy Acute MI
32
Causes of left axis deviation on ECG
Wolf Parkinson white syndrome Deep Q wave inferior infarct Left anterior hemi-block Primula ASD
33
Causes of right axis deviation on ECG
Wolf Parkinson white syndrome Left posterior hemi-block Antero-lateral infarct Right ventricular hypertrophy
34
Differential for tall R wave in V1
Right ventricular hypertrophy Right bundle branch block Wolf Parkinson white syndrome True posterior infarct Duchesses muscular dystrophy
35
Define a Q wave
A negative deflection not preceded by a positive deflection
36
Causes of ST depression
Non-STEMI MI Myocardial ischaemia Digoxin Ventricular hypertrophy with systolic overload Posterior infarct (in septal leads) Reciprocal changes of an infarct in opposite wall
37
Causes of ST elevation
Acute MI Pericarditis Ventricular aneurysm Prinzmetal angina (ischaemia caused by coronary spasm)
38
Causes of flattened T waves
Ischaemia Pericarditis Myocarditis Hypercalcaemia
39
Causes of peaked T waves
Acute MI Hyperkalaemia
40
Causes of T wave inversion
Bundle branch block MI Myocardial myopathy Ventricular hypertrophy Wolf Parkinson white syndrome Ventricular rhythms Normal in septal leads of black patients
41
Causes of prolonged QT interval
Congenital Hypomagnesaemia Hypocalcaemia Hypokalaemia Drugs (TCA, anti-arrhythmics) Ischaemia/infarction
42
Cause of shortened QT interval
Hypercalcaemia
43
Phases of acute MI on ECG
1) tall upright/inverted T waves 2) STEMI (elevated in leads facing wall, depressed in opposite) 3) new pathological Q wave
44
Causes of atrial fibrillation
Rheumatic heart disease Ischaemic heart disease Cardiomyopathy Hypertensive heart disease Thyrotoxicosis Other >alcohol >PE >pericardial disease >digoxin toxicity >chest infection, pain, surgery (triggers)
45
Precipitating causes of HF (acute or acute-on-chronic)
MI PE Intercurrent illness Decreased meds/pt not taken meds IV fluid overload Increased demand (anaemia, pregnancy, thyrotoxicosis) Arrthymia
46
Clinical features of infective endocarditis
FROM JANE Fever Roths spots (retinal haemorrhages) - yellow centre with red ring Oslers nodes (painful immune complexes) Murmur Janeway lesions (non-tender macular microabscesses from septic emboli) Anaemia Nail bed haemorrhages Emboli Other: Acute Renal injury Neurological manifestations Signs of PE Arthritis Splenomegaly
47
Common pathogens causing infective endocarditis
Staph aureus Strep Viridans Staph epidermidis Enterococci Fungal Coxiella bernetti (can be culture neg) - gram neg doesn’t grow
48
Criteria used for infective endocarditis
Dukes Criteria Major 1) Positive blood culture for typical organisms >2 positive blood cultures from 2 different sites at least 24 hours apart >persistently positive 12 hours apart >1 positive culture for coxiella burnetti 2) vegetation’s seen on echo Minor >fever >38 >predisposing factor >immunological phenomenon (splinter haem or janeway lesions) >positive blood culture that doesn’t meet major criteria >vascular abnormalities 2 major OR 1 major + 3 minor OR 5 minor
49
What does a PE look like on chest X-ray?
Wedge shaped infarct (Hampton Hump), Westermark sign, Fleisher sign
50
Signs of digoxin toxicity
CNS = headache, seizures, confusion GIT = nausea and vomiting, anorexia CVS = ECG changes (AV block, tachyarrhythmias) Eyes = halos, altered colour perception Other = gynaecomastia, rash ECG = paroxysmal atrial tachycardia + AV block First for second degree (Mobitz 1) AV block
51
How to tell if it’s a functional murmur
Usually systolic (hyper dynamic circulation) Usually <3 grade Midsystolic/continuous Position dependent
52
AV firing rate of pacemaker cellls
40-60 per minute
53
Firing rate of purkinje fibre pacemaker cells
20-40 per minute
54
What is the normal ejection fraction?
60-65%
55
What does an increased troponin level indicate?
Myocardial necrosis (NOT ischaemia)
56
What can mimic acute coronary syndrome?
Cardiac >left valvular disease >hypertrophic CMO >uncontrolled HPT >pericarditis >aortic dissection Lung >PE >pneumonia GORD Arthritis
57
What does BNP stand for?
Brain natriuretic peptide

Internal Medicine (9 decks)

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