Cardiology Flashcards
(136 cards)
1
Q
What are the features of acute pericarditis?
A
Chest pain: may be pleuritic, is often relieved by sitting forwards
Other symptoms include a non-productive cough, dyspnoea and flu-like symptoms
Pericardial rub
2
Q
What is pericarditis?
A
A condition referring to inflammation of the pericardial sac, lasting for less than 4-6 weeks
3
Q
What are the ECG changes of acute pericarditis?
A
‘Saddle-shaped’ ST elevation
PR depression: most specific ECG marker for pericarditis
4
Q
What is the management of acute pericarditis?
A
Can be managed as an outpatient (patients who have high risk features such as >38C or elevated troponin should be managaed as an inpatinet.
Treat underlying cause
Avoid strenuous physical activity
Combination of NSAIDs and Colchicine is now generally used for first line
5
Q
What are the features of aortic regurgitation?
A
Early diastolic murmur
Collapsing pulse
Wide pulse pressure
De Musset’s sign
6
Q
What is the management of aortic regurgitation?
A
Medical management of any associated heart failure
Surgery for symptomatic patients with severe AR and asymptomatic patients with severe AR who have LV systolic dysfunction.
7
Q
Describe the murmur of aortic stenosis?
A
Ejection systolic murmur (ESM) which classically radiates to the carotids which is decreased following the Valsalva manoeuvre
8
Q
What is arrhythmogenic right ventricular cardiomyopathy?
A
A form of inherited cardiovascular disease which can present with syncope or sudden cardiac death. It has autosomal dominant pattern with variable expression.
9
Q
What is the presentation of Arrhythmogenic right ventricular cardiomyopathy?
A
Palpitations
Syncope
Sudden cardiac death
10
Q
How would a posterior STEMI present on ECG?
A
Causes ST depression in leads V1-V3
Tall R waves in leaves V1-V3
Inverted T-wave in lead aVR
All other T waves are normally orientated
11
Q
What can cause a rise in troponin?
A
A troponin rise may occur in conditions where there is myocardial ischaemia from a supply-demand-mismatch secondary to another primary condition (e.g. sepsis) and not due to plaque rupture.
12
Q
Ischaemic changes in leads V1-V4 most likely caused by a lesion of?
A
Left Anterior Descending
13
Q
Ischaemic changes in leads I, aVL +/- V5-6 would be most likely caused by a lesion of the:
A
Left circumflex artery
14
Q
What is First degree heart block?
A
PR interval >0.2 seconds
Asymptomatic first-degree heart block is relatively common
15
Q
What is Type 1 Second degree heart-block (Wenckeback, Mobitz 1)?
A
Progressive prolongation of the PR interval until a dropped beat occurs
16
Q
What is Type 2 Second degree heart block (Mobitz 2)?
A
PR interval is constant but the P wave is often not followed by a QRS complex
17
Q
What is Third degree heart block?
A
Complete heart block
There is no association between the P waves and the QRS complex
18
Q
Ischaemic changes in leads II, III, aVF would be most likely caused by a lesion of the:
A
Right coronary
Inferior
19
Q
What can cause inverted T waves?
A
MI
Digoxin toxicity
Subarachnoid haemorrhage
Arrhythmogenic right Ventricular cardiomyopathy
20
Q
What is the most common organism implicated in Infective endocarditis?
A
Staphylococcus aureus
21
Q
What are the ECG changes in pericarditis?
A
Changes are often widespread as opposed to territorial like in ischaemic events
‘Saddle-shaped’ ST elevation
PR depression: most specific
22
Q
What are the symptoms of pericarditis?
A
Chest pain: may be pleuritis. Is often relieved by sitting forwards
Non-productive cough, dyspnoea and flu-like symptoms
Pericardial rub
23
Q
Causes of left axis deviation?
A
- Left anterior hemiblock
- Left bundle branch block
- Inferior myocardial infarction
- WPW syndrome - right sided accessory pathway
- Hyperkalaemia
- Congenital: ostium primum ASD, tricuspid atresia
- minor LAD in obese patients
24
Q
Causes of right axis deviation?
A
- Right ventricular hypertrophy
- Left posterior hemiblock
- Lateral myocardial infarction
- Chronic lung disease –> Cor Pulmonale
- PE
- Ostium secundum ASD
- WPW syndrome- Left sided accessory pathway
- Normal in infant <1 year old
- Minor RAD in tall people
25
What is the most common form of cardiomyopathy?
Dilated cardiomyopathy
26
What is the name of the criteria used in infective endocarditis?
Dukes criteria
27
Other than splinter haemorrhages, name 3 signs of Infective endocarditis
Janeway lesions – palms and soles
Oslers nodes – painful pulp infarcts on end of fingers.
Roth spots - boat-shaped retinal haemorrhages
28
What is the 1st line antibiotic treatment in IE for a native valve whilst awaiting culture and sensitivities?
IV amoxicillin. If pen allergy - vancomycin
29
Name an ECG finding which indicates the need for surgical intervention in IE?
PR prolongation – as this can be secondary to aortic root abscess
30
What do you give for SVT?
Adenosine
31
What do you give for VT/VF?
Amiodarone
32
What do you give for bradycardias?
Atropine
33
Give three symptoms of severe aortic stenosis?
Syncope
Angina
Dyspnoea
34
Complications of AS?
LV failure
Sudden cardiac death
35
List 3 tests to investigate for end-organ damage in hypertension
- Urine dip and albumin:creatinine level
- Blood glucose, lipids and renal function
- Fundoscopy for evidence of hypertensive retinopathy
- ECG: look for evidence of LV hypertrophy
36
Complications of HTN?
Heart failure
Renal failure
Stroke
CAD, PVD
37
Which cardiac node is affected in AF?
AV node
38
Give some non-cardiac causes of AF?
Infection
Dehydration
Hyperthyroidism
PE, pneumonia
Hypokalaemia
Alcohol abuse
39
Give some cardiac causes of AF?
Myocarditis
Pericarditis
HTN
Ischaemic heart disease
40
What do you give for heart failure with reduced ejection fraction?
ACEI + BB
41
What do you give for heart failure with reduced ejection fraction who is not controlled on ACE and BB?
Add a Aldosterone Antagonist
42
How is typical angina like pain defined?
- Constriction/heavy discomfort to chest that may radiate to the jaw/neck/arm
- Brought on by exertion
- Alleviated by rest (<5 minutes) or GTN spray.
3/3 = Typical angina pain
2/3 = Atypical angina pain
0 or 1/3 = Non-anginal pain
43
What is the pathophysiology of angina?
Occurs as a result of a mismatch of myocardial oxygen supply and demand.
Most commonly it is due to coronary artery disease.
44
What are the investigations for angina in primary care?
ECG - to assess for ischaemic changes or previous MI
Bloods - FBC and TFT
Consider cardiovascular risk factors
45
What are the 1st line investigations for angina in secondary care?
CT Coronary angiogram - indicated if typical/atypical angina pain or if ECG shows ischaemic changes in chest pain with < angina features
46
What are the causes of high output heart failure?
- Anaemia
- Arteriovenous malformation
- Paget's disease
- Pregnancy
- Thyrotoxicosis
- Thiamine deficiency
47
What are the common causes of right sided heart failure?
Cor Pulmonale and pulmonary or tricuspid valve disease
48
What are the ECG findings in hypokalaemia
- ST depression
- T-wave inversion
- U waves
- Long QT/U interval
49
What is Atrial flutter?
It is a type of narrow-complex tachycardia
- Characterised by re-entry circuits of distinct lengths to the right atrium
- Saw tooth pattern commonly seen in leads II, III, aVF
50
What is a Ventricular Tachycardia?
A broad-complex tachycardia which is often monomorphic in nature.
51
What is Brugada syndrome?
It is a genetic condition characterised by a sodium channelopathy that predisposes individuals to dangerous arrhythmias and sudden cardiac death.
52
What is the epidemiology of Brugada syndrome?
High incidence of the condition in Southeast asian males and a common cause of cardiac death.
Autosomal dominant pattern
53
54
What are the Symptoms of Brugada syndrome?
Commonly asymptomatic or can present with the following syndrome:
- Palpitations
- Exertional syncope
- Sudden cardiac death
55
What are the triggers for the onset of Arrhythmias in Brugada syndrome?
- Sleep
- Eating heavy meals
- Dehydration
- Excess alcohol
- Medications (Fleicanide, Verapamil, tricyclic antidepressants)
- Electrolyte abnormalities
- Fevers
56
What are some ECG findings in Brugada syndrome?
VF or polymorphic VT.
Family history of sudden cardiac death under the age of 45.
Syncope or ECG signs in the family
Inducible VT
Nocturnal agonal breathing
57
What is the definitive management of Brugada syndrome?
- Insertion of an ICD to reduce the risk of sudden death from arrhythmias such as VT/VF
58
What are the ECG findings in Pulmonary Embolism?
- Normal or Sinus tachycardia
- In Massive PE there may be evidence of right-heart strain such as P pulmonale, Right axis deviation, RBBB and non-specific ST/T wave changes
- S1Q3T3 (deep S waves in lead I, pathological Q waves in lead III, and inverted T waves in lead III)
59
What is the mechanism by which Cocaine causes cardiac issues?
Caused by coronary artery spasm
60
Which cardiac enzymes can rise following cardiac damage?
Troponin I/T
CK
CKMB
LDH
AST
61
What ECG changes may you see a week after STEMI?
- T Wave inversion
- Pathological Q waves
62
What are the complications of cardiac angiography?
- Bleeding
- Infection
- MI
- Stroke
- Damage to coronary vessels requiring intervention
- Allergy to contrast
63
How does aspirin reduce the risk of coronary events
Irreversibly inhibits cyclooxygenase, which prevents further
production of TxA2 (throm boxine) from platelets as they do
not have a nucleus, shifting the balance o f PGI2 : TxA 2 towards inhibiting platelet aggregation
64
Other than exertion what else can trigger angina?
- Cold weather
- Emotion (Anger/Excitement)
- Lying down (decubitus angina)
- Vivid dreams (nocturnal angina).
65
What signs of acute pulmonary oedema could you find on examination?
Tachypnoea, tachycardia, raised JVP, fine lung crepitations,
wheeze, additional heart sounds/gallop rhythm , dull percussion of
bases, cyanosis, decreased tactile/vocal fremitus.
66
What electrolyte imbalances can predispose to VT/VF?
Mg2+ and K+
67
What intervention could you give in acute heart failure not responding to treatment?
CPAP
68
What is the treatment of Dressler's syndrome?
High doses of aspirin
69
What clinical signs could be elicited to point towards a diagnosis of coarctation of the aorta?
- Radio-femoral delay
- Left Ventricular heave
- Weak peripheral pulses in the legs
- Ejection systolic murmur
70
What investigations can you do to confirm a diagnosis of Coarctation of the aorta?
- Echocardiography
- CT aorta
- Cardiac catheterisation
71
What valve pathology can cause malar flush?
Mitral stenosis
72
What abdominal findings may be seen in tricuspid regurgitation?
- Pulsatile Liver
- Ascites
73
What examination findings suggest accelerated (or malignant) hypertension in a patient with a blood pressure above 180/120?
- Retinal Haemorrhages
- Papilloedema
74
What are the main side effects of GTN spray?
Dizziness
Headache
75
How do statins work?
- They reduce cholesterol production in the liver
- By inhibiting HMG Co-A reductase
76
What imaging investigations could you do for diagnosing hypertrophic obstructive cardiomyopathy?
- Echocardiogram
- Cardiac MRI
77
What is the treatment of polymorphic ventricular tachycardia (e.g. torsades de pointes) in a haemodynamically stable patient?
- IV magnesium
78
What are the causes of aortic stenosis?
- Idiopathic age-related calcification
- Bicuspid aortic valve
- Rheumatic heart disease
79
What murmur may be heard in HOCM?
- Ejection systolic murmur which is heard loudest at the lower left sternal border
80
What are the first line medical options for long-term symptomatic relief of angina?
- Beta blockers (e.g. bisoprolol)
- Calcium channel blockers (e.g. diltiazem or verapamil
81
What is the name for treatment with a triple chamber pacemaker in severe heart failure with an ejection fraction of less than 35%?
Cardiac Resynchronisation therapy
82
What are the causes of mitral regurgitation?
- Idiopathic age-related weakness
- Ischaemic heart disease
- Infective endocarditis
- Rheumatic heart disease
- Connective tissue disorders (e.g., EDS, Marfans)
83
At what point is the QT interval considered prolonged?
- More than 440ms in men
- More than 460ms in women
84
What is the name for the extra electrical pathway in Wolff-Parkinson-White syndrome?
Bundle of Kent
85
What investigation options are available to help support a diagnosis of angina?
- Cardiac stress testing
- CT Coronary angiography
- Invasive coronary angiography
86
What causes individual, random, abnormal, broad QRS complexes on an otherwise normal ECG?
Ventricular ectopics
87
Where on the chest is the tricuspid area?
5th intercostal space, left sternal border
88
What does stroke volume refer to?
The volume of blood ejected by the left ventricle during each systolic contraction
89
What ambulatory or average home blood pressure results indicate stage 1 hypertension?
Above 135/85
90
What ambulatory or average home blood pressure results indicate stage 2 hypertension?
Above 150/95
91
What coexisting pathologies are present in tetralogy of Fallot?
VSD
Overriding aorta
Pulmonary valve stenosis
Right ventricular hypertrophy
92
Which patients are offered statins for primary prevention without calculating the QRISK3 score?
- Chronic Kidney disease
- Type 1 diabetes for more than 10 years or aged over 40
93
What is in Beck's triad?
- Hypotension
- Raised JVP
- Muffled heart sounds
94
What is the management of Cardiac tamponade?
Urgent pericardiocentesis
95
What are the causes of constrictive pericarditis?
- Any cause of pericarditis
- Particularly TB
96
What are the features of constrictive pericarditis?
- Dyspnoea
- Right heart failure: Elevated JVP, Ascites, Oedema, hepatomegaly
- JVP shows prominent x and y descent
- Pericardial knock - loud S3
- Kussmaul's sign is positive
97
What would you see on a CXR in constrictive pericarditis?
- Pericardial Calcification
98
What should you do if there is a massive PE with Hypotension?
Thrombolyse
99
What are the signs of Coarctation of the Aorta in an infant?
- Most common is weak femoral pulses in a neonate
- Systolic murmur
- Tachypnoea and increased work of breathing
- Poor feeding
- Grey and floppy baby
Classically high bp in the arms and low blood pressure in the legs
100
What is the Pathophysiology of Hypertrophic obstructive cardiomyopathy?
- The most common defects involve a mutation in the gene encoding β-myosin heavy chain protein or myosin-binding protein C
results in predominantly diastolic dysfunction
- left ventricle hypertrophy → decreased compliance → decreased cardiac output
101
What might you find on an ECHO in HOCM?
- Mitral regurgitation
- Systolic anterior motion of the anterior mitral valve leaflet
- Asymmetric hypertrophy
102
What are the cardiac manaifestations of Takayasu's arteritis?
- Unequal blood pressure in the upper limbs
- Carotid bruit and tenderness
- Absent or weak peripheral pulses
- Upper and lower limb claudication on exertion
-Aortic regurgitation (around 20%)
103
How do you treat Dressler's syndrome?
NSAIDs
104
What would you see in Dressler's syndrome?
It is characterised by a combination of fever, pleuritic pain, pericardial effusion and a raised ESR.
105
What would a CXR show in Aortic Dissection?
- Wedened Mediastinum
106
What is the investigation of choice for Aortic dissection and what would it show?
Chest X Ray - Widened mediastinum
107
What is the underlying pathology of ACS?
Acute Atherosclerotic plaque rupture with superimposed thrombosis and acute luminal narrowing
108
What is angina caused by?
Caused by atherosclerosis affecting the coronary arteries, narrowing the lumen and reducing blood flow to the myocardium.
109
What drugs can be given 1st line for secondary prevention of angina?
A beta-blocker or a calcium-channel blocker
110
What drugs can be given 2nd line for prevention of anginal symptoms?
Long acting nitrate (isosorbide mononitrate), nicorandil, ivabradine or ranolazine
111
What medications would you give for secondary prevention in stable angina?
Aspirin 75mg once daily
Atorvastatin 80mg once daily
ACE i
Already on a beta-blocker for symptomatic relief
112
What are the two surgical options for angina?
- Percutaneous coronary intervention
- Coronary artery bypass graft
113
What are the three main options for graft vessels in CABG?
- Saphenous vein
- Internal thoracic artery
- Radial artery
114
What is a Type 1 MI?
Traditional MI due to an acute coronary event
115
What is a Type 2 MI?
Ischaemia secondary to increased demand or reduced supply of oxygen
116
What is a Type 3 MI?
Sudden cardiac death or cardiac arrest suggestive of an ischaemic event
117
What is a Type 4 MI?
MI typically associated with procedures such as PCI, Coronary stenting and CABG
118
What does SVT refer to?
Supraventricular tachycardia (SVT) refers to when abnormal electrical signals from above (supra-) the ventricles cause a fast heart rate (tachycardia).
Supraventricular tachycardia is caused by the electrical signal re-entering the atria from the ventricles
119
What are the steps in management of SVT?
Step 1: Vagal manoeuvres
Step 2: Adenosine
Step 3: Verapamil or a beta blocker
Step 4: Synchronised DC cardioversion
120
What is Atherosclerosis?
Athero-soft
Sclerosis-hardening
Atherosclerosis is a combination of atheromas (fatty deposits in the artery walls) and sclerosis (hardening or stiffening of the vessel walls)
121
What is the pathophysiology of atherosclerosis.
It is caused by chronic inflammation and activation of the immune system in the artery wall.
This causes the deposition of lipids in the artery wall, followed by the development of fibrous atheromatous plaques
These plaques result in:
- Stiffening
- Stenosis
- Plaque rupture
122
What is ACS?
Acute coronary syndrome (ACS) is usually the result of a thrombus from an atherosclerotic plaque blocking a coronary artery.
123
What are the causes of radio-radial delay?
Subclavian artery stenosis
Aortic dissection
Aortic coarctation
124
What is the pathophysiology of pericardial effusion?
Pericardial effusion is when the potential space of the pericardial cavity fills with fluid. This creates an inward pressure on the heart, making it more difficult to expand during diastole.
125
What is the pathophysiology of pericardial tamponade?
Pericardial tamponade (or cardiac tamponade) is where the pericardial effusion is large enough to raise the intra-pericardial pressure. This increased pressure squeezes the heart and affects its ability to function. It reduces heart filling during diastole, decreasing cardiac output during systole.
126
What is BNP?
B-type natriuretic peptide (BNP) is a hormone released from the heart ventricles when the cardiac muscle (myocardium) is stretched beyond the normal range.
127
Heart failure: Tried ACEi+BB+MRA
with ejection systolic <35
Replace ACEi with Sacubitril valsartan
128
Heart failure: Tried ACEi+BB+MRA for
sinus rhythm with
heart rate >75 and
ejection fraction <35%?
Add Ivabradine
129
Heart failure: Tried ACEi+BB+MRA and is of African/Caribbean descent?
Hydralazine and nitrate
130
What is pulmonary stenosis?
Pulmonary stenosis is a narrowed pulmonary valve, restricting blood flow from the right ventricle into the pulmonary arteries.
131
Where is a blood clot most likely to come from in AF?
Uncontrolled and unorganised activity in the atria leads to blood stagnating in the left atrium, particularly in the left atrial appendage.
132
What is included in CHA2DS2-VASc?
When should you offer anticoagulation?
C – Congestive heart failure
H – Hypertension
A2 – Age above 75 (scores 2)
D – Diabetes
S2 – Stroke or TIA previously (scores 2)
V – Vascular disease
A – Age 65 – 74
S – Sex (female)
0 – no anticoagulation
1 – consider anticoagulation in men (women automatically score 1)
2 or more – offer anticoagulation
133
What is Atropine?
It is an antimuscarinic medications and works by inhibiting the parasympathetic nervous system
134
What is Virchow's triad?
Stasis
Hypercoagulability
Endothelial damage
135
What increases your risk of digoxin toxicity?
Hypokalaemia
136
When should you consider aortic valve replacement?
The aortic valve gradient of 50mmHg is considered the level where aortic valve replacement should be considered.
