Cardiology Flashcards
(248 cards)
1
Q
central, pleuritic chest pain and fever 4 weeks following a myocardial infarction suggests what?
A
Dresslers - Pericarditis following MI
2
Q
traumatic accident with respiratory distress, hypotension, jugular venous distension, and absent lung sounds suggests what?
A
Tension pneumothorax
3
Q
A third heart sound is considered in patients under what age?
A
<30 years old
4
Q
What are the common causative organisms of infective endocarditis?
A
Most common/IVDU - Staph aureus
Those with poor dental hygiene/post dental proceudure - Strep viridans
Following prosthetic valve surgery - Staph epidermidis
5
Q
Widened mediastinum on CXR with severe chest pain suggests what?
A
Aortic dissection
6
Q
In ALS, if IV drugs cannot be given, how should they be given?
A
Intraosseous
7
Q
What is the most specific ECG finding in acute pericarditis?
A
PR depression
8
Q
Type A (ascending) vs Type B (descending) aortic dissection?
A
A - chest pain
B - upper back pain
9
Q
tall R waves in leads V1-3 are a classic finding for what?
A
Posterior MI
10
Q
What score should be used to assess the risk of bleeding when starting someone on anticoagulation in AF?
A
Orbit
11
Q
What are reversible causes of cardiac arrest?
A
Hypoxia
Hypovolaemia
Hyperkalaemia, hypokalaemia, hypoglycaemia, hypocalcaemia, acidaemia and other metabolic disorders
Hypothermia
Thrombosis (coronary or pulmonary)
Tension pneumothorax
Tamponade – cardiac
Toxins
12
Q
When should warfarin be stopped prior to surgery?
A
5 days before
13
Q
What is the key diagnostic finding of aortic dissection on CT?
A
False lumen
14
Q
What are C/I to thrombolysis?
A
active internal bleeding
recent haemorrhage, trauma or surgery (including dental extraction)
coagulation and bleeding disorders
intracranial neoplasm
stroke < 3 months
aortic dissection
recent head injury
severe hypertension
15
Q
weak or absent carotid, brachial, or femoral pulse
variation in arm BP suggests what?
A
Aortic dissection
16
Q
When can electrical cardioversion be considered for patients with AF?
A
If presenting within 48 hours
17
Q
What medication should be stopped when patients are given a course of macrolides e.g. clarithromycin?
A
Statins
18
Q
Thiazide-like diuretics should not be used in patients with what?
A
Gout
19
Q
ST elevation and acute pulmonary oedema in a young patient with a recent flu-like illness suggests what?
A
Myocarditis
20
Q
When should rhythm control be used for AF instead of rate control?
A
coexistent heart failure, first onset AF or an obvious reversible cause
21
Q
Which medication can reduce hypoglycaemia awareness?
A
Beta blockers
22
Q
Which medication can impair glucose tolerance?
A
Thiazides
23
Q
Widespread ST elevation in V1-4 suggests what?
A
100% occlusion of the LAD
24
Q
Erythromycin can cause which cardiac abnormality?
A
QT prolongation
25
What kind of bacteria is staph aureus?
Gram positive cocci
26
How should a patient with minor bleeding with INR > 8 be managed?
Stop warfarin and give IV Vitamin K with repeat dose of Vit K after 24 hours if INR still high
27
What drugs can cause hypokalaemia?
Loop diuretics e.g. furosemide
28
A new left bundle branch block should raise alarms for what?
ACS
29
What scoring system should be used to identify patients with a pulmonary embolism that can be managed as outpatients?
Pulmonary Embolism Severity Index (PESI)
30
How does fondaparinux work?
Activates antithrombin III
31
What is the management of AF if ChadsVasc is 0?
Echo to rule out valvular causes
32
What are ecg findings of hypokalaemia?
small or absent T waves (occasionally inversion)
prolong PR interval
ST depression
long QT
U waves
33
What is the second-line therapy in patients with HFrEF?
SGLT-2 inhibitors e.g Empagliflozin
34
inferior myocardial infarction and AR murmur suggests what?
Proximal aortic dissection
35
High dose statins should be commenced in stroke patients when?
48 hours after stroke
36
What criteria should be used for infective endocarditis?
Duke criteria
37
What criteria should be used for rheumatic fever?
Jones criteria
38
What drugs should be used for anticoagulation in those with mechanical heart valves?
Warfarin/LMWH
39
Complete heart block following an MI suggests the lesion is where?
Right coronary
40
Investigation of choice for aortic dissection?
CT Angio
41
Management of aortic dissection
Control BP with IV Labetalol and surgery
42
Most common ECG change of PE?
Sinus tachycardia
43
Management of pericarditis?
NSAIDs plus colchicine
44
PR Depression on ECG is indicative of what?
Pericarditis
45
Medical management of NSTEMI?
dual antiplatelet therapy, an ace inhibitor, a beta-blocker, and a statin
46
What is Beck's triad?
- Raised JVP
- Muffled heart sounds
- Falling BP
47
What is Beck's triad a sign of?
Cardiac tamponade
48
Management of major bleed with someone on warfarin?
stop warfarin, give intravenous vitamin K 5mg, prothrombin complex concentrate
49
How should episodic palpitations be investigated?
Holter monitoring
50
notching of the inferior border of the ribs suggests what?
Aortic coarctation
51
Management of PE with low PESI score?
Can be managed as an outpatient with DOAC
52
Nitrates for MI are contraindicated when?
Patients with hypotension
53
What is the treatment for torsades de pointes?
IV Mag Sulph
54
What is a normal cardiac variant in athletes?
First degree heart block
55
Investigation of choice for someone with PE and renal impairment?
V/Q scan
56
What is normal in an athlete and does not require any intervention?
First degree heart block
57
If angina is not controlled by a beta blocker, what should be added?
Amlodipine
58
What should be used if atropine if not helping with bradycardia?
- transcutaenous pacing
- transvenous pacing
59
Sydenham’s chorea is a complication of what?
Rheumatic fever
60
Management of persistent myocardial ischaemia following fibrinolysis
PCI even if time elapsed
61
What on echo is used to determine the severity of aortic stenosis?
Trans-valvular pressure gradient
62
What is Buerger's disease?
- A small/medium vasculitis which is associated with smoking
- Causes intermittent claudication, Raynaud's and ischaemic ulcers
63
What is the mode of action of statins?
Decrease intrinsic cholesterol synthesis by inhibiting HMG-CoA reductase enzyme
64
How to manage a strong suspicion of PE whilst waiting for scan?
Start treatment dose anticoagulant
65
Electrical alternans is a sign of what?
Cardiac tamponade
66
J waves are associated with what?
Hypothermia
67
Hypertrophic obstructive cardiomyopathy is associated with what?
Wolf-Parkinson-White
68
Management of acute heart failure not responding to furosemide?
Consider CPAP
69
What is a complication of MI?
Pulmonary oedema
70
SVT Management?
1. Valsalva
2. IV Adenosine upto 3 doses
3. Electrical cardioversion
71
Criteria for rate control vs anticoag/cardioversion?
- Under 65
- No Hx of IHD
72
Thrombus in aVL, which artery?
Left circumflex
73
What is Framingham risk score?
estimate the 10-year risk of heart attack
74
severe hypertension and bilateral retinal hemorrhages and exudates
Malignant HTN
75
Endocarditis - which valves are affected?
Mitral - most common
Aortic
Tricuspid - IVDU
76
A patient develops acute heart failure 5 days after a myocardial infarction. A new pan-systolic murmur is noted on examination
VSD
77
Treatment for cardiac tamponade?
Pericardial needle aspiration
78
What is Kussmaul sign?
- JVP rises on inspiration
- Sign of constrictive pericarditis
79
holosystolic murmur, high-pitched and 'blowing' in character
Mitral regurg
80
Tachycardia and tachypnoea with no signs
Think PE
81
Can warfarin be used when breast feeding?
Yes
82
What electrolyte abnormality do thiazide diuretics cause?
- Hypokalaemia
- Hyponatraemia
- Hypercalcaemia
- Gout
- Impaired glucose tolerance
83
Management of irregular broad complex tachycardia
Seek cardiology input
84
What is Takayasu's arteritis?
- Systemic features of vasculitis
- Unequal BP in upper limbs
- Carotid tenderness
- Absent/weak peripheral pulses
- Associated with renal artery stenosis
- MRA/CTA to treat with steroids
85
Low pitched diastolic murmur?
Mitral stenosis
86
Acute mitral valve regurg + pulmonary oedema
Think MI
87
What is the dose of adrenaline used in cardiac arrest?
1mg of IV adrenaline
88
Breathing problems with clear chest
PE
89
What is Brugada syndrome?
- AD disorder which can cause sudden death
- ECG shows ST elevation and T wave inversion (may become clearer after giving flecainide_
- Tx is implantable cardioverter-defib
90
Most common place of inhaled foreign body?
Right inferior bronchus
91
Findings for aortic stenosis?
narrow pulse pressure
slow rising pulse
a thrill palpable over the cardiac apex
a fourth heart sound (S4) indicative of left ventricular hypertrophy
a soft/absent S2
92
Which medications can cause torsades de pointes?
Macrolides e.g. azithromycin
93
What condition are ACE inhibitors C/I with?
Renovascular disease
94
What causes the acute mitral regurg following MI?
Rupture of the papillary muscle/ischaemia
95
When can you commence spironolactone for HTN?
When already taking ACE, CCB and thiazide-like diuretic + K is below 4.5
96
When should adrenaline be given for shockable rhythms?
After 3 unsuccessful shocks
97
Pericarditis vs Myocarditis?
Myocarditis -> elevated troponin
98
Which markers can you test for STEMI?
Troponin, CK, AST, LDH
99
What ECG changes might be seen following STEMI?
T wave inversion, pathological Q waves
100
Driving rules post MI
- No need to inform DVLA
- Can drive after1 week if successful angioplasty
- Can drive after 4 weeks if no angio/unsuccessful angio
101
Complication of coronary angio
Bleeding, haemorrhage, infection, MI, stroke, damage to coronary vessels, death
102
What triggers are there for angina?
Exertion, cold weather, emotions such as anger, vivid dreams
103
How does aspirin work?
Inhibits COX which inhibit thromboxane which inhibits platelets aggregation
104
Abnormally large drop in BP during inspiration?
Pulsus paradoxus -> Cardiac tamponade
105
How should diabetes be managed following MI?
Use IV insulin infusion and stop the oral diabetes meds
106
patients with a GRACE score > 3% should have what?
Coronary angio within 72 hours
107
Management of persistent MI following fibrinolysis
PCI
108
What is the treatment of broad complex tachycardias?
- Amiodarone
109
Single episode of paroxysmal AF?
ChadsVasc and consider DOAC
110
Management of IE causing congestive cardiac failure
Emergency valve replacement
111
What is the alternative to 3 weeks of anticoagulation for someone having cardioversion with AF?
Transoeseophageal echo to exclude left atrial appendage thrombus
112
What are warfarin INR targets for mechanical valves?
Aortic - 3.0
Mitral - 3.5
113
What is the NYHA heart failure classification?
Class 1 - no symptoms and no limitations
Class 2 - mild symptoms with slight limitation (some fatigue, dyspnoea)
Class 3 - moderate symptoms with marked reduction in activity (symptoms anytime except rest)
Class 4 - severe symptoms and symptoms of HF present even at rest
114
When is AAA screening done?
Men aged 65
115
How is AAA screening managed?
< 3 cm - normal
3 - 4.44cm - rescan every 12 months
4.45 - 5.4cm - rescan every 3 months
>5.5 - refer to vascular surgery within 2 weeks
Other referral criteria
- Rapidly growing (>1cm per year)
116
What is the biggest indicator of a poor prognosis in someone with MI?
Cardiogenic shock
117
What would an ABG for pulmonary embolism show?
Respiratory alkalosis -> hyperventilation
118
When is staph epidermidis the most common organism causing endocarditis?
If <2 months post valve surgery
119
Why is verapamil C/I in heart failure + VT?
It can slow down contractility of the heart even further
120
What is the most common cause of death in patients post MI?
V Fib
121
Haemoptysis can be a symptom of what?
Mitral stenosis
122
mid-diastolic low-pitched rumbling murmur
mitral stenosis
123
Management of BP > 180/120 in GP
If unstable/signs of papilloedema/retinal haemorrhages -> refer to specialist
If stable then arrange urgent investigations for organ damage eg. bloods, urine ACR, ECG
124
What is the normal QRS value?
<0.12s / 3 small squares
125
What are signs of left ventricular failure?
Dyspnoea, reduced exercise tolerance, fatigue, paroxysmal nocturnal dyspnoea, orthopnoea, wheeze, cough (worse at night), pink, frothy sputum
126
What are signs of right ventricular failure?
Peripheral oedema, facial engorgement and abdominal distension
127
What are causes of AF?
Pneumonia, MI, PE, Alcohol excess, HF, Endocarditis
128
What are signs of aortic regurg?
- Collapsing pulse
- Early diastolic murmur
- Wide pulse pressure
- Displaced apex
- Carotid pulsation: Corrigans sign
- pulsation of nail bed: Quincke's sign
129
Absent arm pulses in a young woman?
Think Takayasu's arteritis
130
AF + mass in left atrium
Cardiac myxoma - bengin tumour of the heart
131
Patients with aortic valve IE are at risk of what?
Developing aortic valve abscess (prolongation of PR can be first sign)
132
What pulse can you get with heart failure?
Pulsus alternans - strong and weak beats due to varying systolic pressure
133
When is rhythm control used in AF treatment over rate control?
- Coexistent HF
- First onset AF
- Obvious reversible cause
- Use amiodarone/flecainide
134
What is the inheritance of HOCM?
AD
135
What is the pathophysiology of HOCM?
- Diastolic dysfunction as LVH causes decreases compliance and decreased CO
- Biopsy shows myofibrillar hypertrophy with disarrayed myocytes
136
ECG findings for hypercalcaemia?
Short QT
137
What are the components for JONES criteria?
Joint involvement
<3 - Myocarditis
Nodules
Erythema marginatum
Sydnehams chorea
138
Post MI patient develops pulmonary oedema and has pansystolic murmur?
Think acute mitral regurg
139
What can cause orthostatic hypotension?
- Excercise induced
- After meals
- After prolonged bed rest
- Drugs such as CBB, Levodopa
140
QT prolongation with no electrolyte abnormalities?
Think hereditary long QT syndrome -> caused by loss of function/blockage of K+ channels
141
When should LFTs be checked with statins?
Baseline, 3 months and 12 months
142
What murmur do you get with VSD?
Pansystolic murmur - entire systolic period
143
Which drug when used alongside clopidogrel can make it less effective?
Omeprazole/Esomeprazole
144
What dose of amiodarone is given in ALS?
Initially 300mg
After 5th shock, an additional 150mg can be given alongside 1mg of adrenaline
145
What will type A aortic dissection cause?
Acute aortic regurg
146
What is the treatment for rheumatic fever?
IM BenPen or Oral PenV with NSAIDs
147
Patients taking isosorbide mononitrate should use what dosing regime?
Asymmetric dosing interval to prevent nitrate tolerance
148
NSTEMI in an unstable patient?
Immediate coronary angio
149
Which antihypertensive cause hyperkalaemia?
ACE
150
What is tongue and facial swelling?
Angioedema -> ACE inhibitor
151
What are examination signs of pericarditis?
-Pericardial rub
- Quiet heart sounds
- Raised JVP
152
What are causes of pericarditis?
- Infective
- Malignancy
- MI complication
- SLE
- RA
153
3 main investigations for IE?
- Blood cultures
- Echo
- ECG
154
What are some triggers for worsening pulmonary oedema?
- Arrhythmia
- MI
- Sepsis
155
What is the most common cardiomyopathy?
Dilated
156
management of mitral stenosis?
Asymptomatic - Monitor with regular echo
Symptomatic - Percutaneous mitral commissurotomy
157
When fibrinolysis is done for ACS, when should ECG be repeated?
60-90 minutes
158
What are the ChadsVasc categories?
Congestive HF
HTN
Age >75 (2), >65 (1)
Diabetes
Stroke/TIA/VTE
Vascular disease
Sex (Female)
159
Where is access preferred for PCI?
Radial artery
160
Which medications can worsen glucose tolerance?
Thiazides
161
widespread pansystolic murmur, hypotension, pulmonary oedema post MI?
Acute mitral regurg
162
Management of suspected HF in GP?
Measure BNP and refer for TTE if elevated
163
What does a loud opening snap indicate?
The mitral valve leaflets are still mobile in mitral stenosis
164
What can indicate the severity of the mitral stenosis?
Length of murmur increases
165
What are components of orbit score?
- Haemoglobin
- Age
- Bleeding history
- Renal impairment
- Treatment with anti platelets
166
Nailed pulsation?
Quincke's sign -> aortic regurgitation
167
Rate control for AF?
Beta blocker
CCB
Digoxin
168
Management of continued pain post PCI for MI?
Urgent CABG
169
Reverse nike sign?
Digoxin
170
Persistent ST elevation post MI?
Left ventricular aneurysm
171
What are signs of aortic coarctation?
- radio-femoral delay
- mid systolic murmur
- weak peripheral pulses in legs
- Left ventricular heave
172
Investigations to confirm aortic coarctation?
- Echo
- CT aorta
- Cardiac catheterisation
173
Management options for aortic coarctation?
- Open surgery
- Balloon angioplasty and stent insertion
- Mild cases can be controlled with antihypertensives
174
What carries the worst prognosis in symptomatic aortic stenosis?
Exertional syncope
175
What medication should be avoided in someone with aortic stenosis?
Nitrates
176
When should adenosine be avoided?
Asthmatics
177
What is the definitive management of bradycardia?
Permanent pacemaker
178
Which organisms often cause rheumatic fever?
Strep pyogenes
179
Stroke + AF?
2 weeks of aspirin then warfarin/DOAC
180
ADPKD is associated with what?
Mitral valve prolapse
181
S3 vs S4 sounds
CCF - 3 letters - S3
HOCM - 4 letters - S4
182
What does aortic dissection cause?
Weak/absent carotid, brachial or femoral pulses
183
HF with rEF vs HF with pEF?
rEF - systolic dysfunction e.g. IHD, arrythmias
pER - diastolc dysfunction e.g. HOCM, cardiac tamponade
184
What can be done for patients not responding to medications for HF?
Cardiac resynchronisation therapy if wide QRS
185
Raised JVP, ankle oedema, hepatomegaly
Right sided HF
186
What are causes of torsades de pointes?
- Congenital
- Macrolides
- Subarachnoid haemorrhage
- Hypothermia
- Electrolyte disturbances
187
What is torsades de pointes?
Polymorphic VT
188
Heart failure management
1. ACE + BB
2. Spironolactone/Eplerenone
3rd lines
- Ivabradine if HR > 75 and reduced EF
- Hydralazine with nitrate for Afro-Caribbean patients
- Sacubitrtil-valsartan for patients with reduced EF after ACE/ARB wash out period
- Digoxin if sinus rhythm
189
What vaccines should be given to HF patients?
Annual flu
One off PCV
190
Sudden heart failure, raised JVP, pulsus parodoxus post MI?
Left ventricular free wall rupture
191
What ABG picture will hyperaldosteronism cause?
Metabolic alkalosis with hypokalaemia
192
What can cause high output heart failure?
Anaemia
193
When is DC cardioversion done for arrhythmias?
Systolic < 90
194
How to manage HTN when patient is on ACE/CCB/Thiazide and K+ > 4.5?
Add alpha/beta blocker
195
AF with sudden onset abdo pain?
Think acute mesenteric ischaemia -> treat with immediate laparotomy
196
Management of ruptured AAA?
Crossmatch 6 units of blood
197
When is amiodarone preferred for pharmacological cardioversion?
Evidence of structural heart disease
198
Chest pain + neurology?
Think aortic dissection
199
new BP >= 180/120 mmHg + new-onset confusion, chest pain, signs of heart failure, or acute kidney injury
Refer for assessment
200
CCB side effects
headache, flushing, ankle oedema
201
Amlodipine can cause what?
Gingival hyperplasia
202
What is the cut off for aortic valve surgery if no symptoms?
Valvular gradient > 40 with features of left systolic dysfunction
203
pre-excitation syndrome that occurs due to the presence of an accessory electrical pathway between the atria and ventricles
Wolf-Parkinson-White
204
Gallop rhythm is a sign of what?
Left sided heart failure
205
Prosthetic vs mechanical valve?
Mechanical last longer so are given to younger patients
206
What can be considered in CPR if a PE is supected?
Thrombolytic drugs such as alteplase
207
How should 80+ year olds with raised BP be managed?
Lifestyle advice
208
Nifedipine can cause what?
Peripheral vasodilation which can cause reflex tachycardia
209
What is an alternative to amiodarone in arrest?
Lidocaine
210
What drugs are an alternative to atropine?
Isoprenaline/adrenaline infusion
211
How long should CPR be continued when thrombolytic drugs are being given?
60-90 minutes
212
Tension pneumothorax can cause what?
Pulseless electrical activity
213
Clinically unstable aortic dissection?
Transoesophageal echo
214
What is the most common cause of aortic stenosis in young patients?
Congenitally bicuspid valve
215
Hyperlipidaemia can cause what?
Pseudohyponatremia -> serum osmolality will be normal
216
Premature supraventircular beats vs premature ventricular betas on ECG?
Supraventricular - narrowed QRS complexes
Ventricular - widened QRS complexes
217
What is cardiac tamponade?
Accumulation of pericardial fluid causing increased pericardial pressure which compromises ventricular filling, resulting in a
reduced cardiac output.
218
cardiomyopathy + diabetes + joint pain + hepatomegaly
Think haemochromatosis
219
What antibiotic is recommended in COPD patients who continue to have exacerbations?
Azithromycin
220
Chronic infection with Pseudomonas and Bulkholderia in CF
Increased risk of morbidity or mortality
221
Pericarditis vs STEMI ECG?
STEMI will have ST elevation greater in lead III than lead II
222
Aortic dissection can cause what?
Neuro deficits
223
Persistent ST elevation with fatigue
Left ventricular aneurysm
224
When do CK levels normalise after an MI?
48-72 hours -> good to check if suspecting a reinfarction
225
When should sacubitril-valsartan be initiated?
Following an ACE/ARB wash out period
226
What part of the QRS is electrical cardioversion synchronised to?
R wave
227
Mitral regurg is associated with which conditions?
- Marfans
- Ehlers-Danlos
228
DC cardioversion vs unsynchronised cardioversion?
DC- Tachyarrhythmias
Unsynchronised - Cardiac arrest (VT, VF)
229
What is the management of atrial flutter?
1. Beta blocker/CCB
2. Consider cardioversion
3. Catheter ablation
230
Sudden increase in BP associated with ACS?
Treat with IV GTN
231
Elderly patient with ECG with periods of sinus bradycardia + atrial tachycardia?
Sick sinus syndrome
232
What is a normal PR interval?
0.12-0.20s
3-5 small squares
233
Absent P waves + regular rhythm of QRS
SVT
234
What stroke is most likely during cardiac catheterisation?
Embolic -> debris can be scraped from aortic wall
235
Most common cause of left ventricular hypertrophy in a healthy person?
Hypertrophic cardiomyopathy
236
Heart failure + wide QRS?
Consider resynchronisation pacemaker device
237
2nd line investigation for endocarditis if echo is negative but high suspicion?
PET CT
238
What is the PR interval?
Start of P wave to start of QRS complex
239
Indications for DC cardioversion in tachyarrhythmias except shock?
- Syncope
- MI
- Heart failure
240
What are the 2 options for aortic valve replacement?
Surgical - low risk patients
Transcatheter - high risk patients
241
When to do 1 shock vs 3 shocks in shockable rhythms?
3 shocks - if witness cardiac arrest
1 shock - if not witnessed
242
What is a common cause of tricuspid regurg?
Pulmonary HTN e.g. COPD
243
Investigation of choice for cardiac tamponade?
Echo
244
When in CABG indicated?
More significant coronary artery disease e.g. triple vessel
245
Abx for MRSA resistant endocarditis?
Prosthetic valve - Vancomycin, Rifampicin and Gentamicin
Normal valve - Vancomycin and Rifampicin
246
Thiazides can precipitate what?
Digoxin toxicity
247
De Musset sign is a sign of what?
Aortic regurgitation
248
