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Haroon Phase 2A > Cardiology 2 > Flashcards

Cardiology 2 Flashcards

1
Q

Drug class and mechanism of Digoxin?

A

Class: Cardiac glycoside Inhibits Na/K pump and causes: - bradycardia - slows AVN conduction - increased ectopic activity - increased force of contraction

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2
Q

Side effects of digoxin?

A

Narrow therapeutic range Nausea Vomiting Diarrhoea Confusion

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3
Q

Main clinical indication of Digoxin?

A

Atrial fibrillation to reduce ventricular rate response Severe heart failure as +vly ionotropic

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4
Q

Eisenmenger’s syndrome?

A

High pressure pulmonary flow Damages to delicate pulmonary vasculature The resistance to blood flow through lungs increases RV pressure increases Shunt direction reverses Patient becomes BLUE

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5
Q

Clinical signs of atrial septal defects

A

Pulmonary flow murmur Big pulmonary arteries on CXR Big heart on chest x ray Risk of infective endocarditis

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6
Q

Long term problems of coarction

A

-Re coarction requiring repeat intervention -Aneurysm formation at the site of repair Hypertension leads to: - early coronary artery disease/stroke - sun arachnoid haemorrhage

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7
Q

What is pulmonary stenosis?

A

Narrowing of the outflow of the right ventricle can occur in different locations: - Valvar - Sub valvar - Supra valvar - in branches

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8
Q

Severe pulmonary stenosis?

A

Right ventricular failure as a neonate -collapse -poor pulmonary blood flow -RV hypertrophy -tricuspid regurgitation

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9
Q

Moderate/mild pulmonary stenosis?

A

well tolerated for many years -Right ventricular hypertrophy

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10
Q

Treatment of pulmonary stenosis?

A

Balloon valvuloplasty Open valvotomy Open trans-annular patch Shunt (to bypass blockage)

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11
Q

What reduction do you expect with a full dose of any single drug?

A

Systolic: 8-10mmHg Diastolic: 4-6mmHg

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12
Q

Thresholds for treatment for hypertension?

A

Low CVD risk 160/100mmHg High CVD risk 140/90mmHg (Clinic thresholds)

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13
Q

Targets for blood pressure after treatment?

A
  • Routine <140/90 mmHg - Previous stroke < 130/80mmHg - Heavy proteinuria <130/80mmHg - CKD and Diabetes <130/80mmHg - older patients <150/90mmHg
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14
Q

How many drugs are generally needed to control blood pressure?

A

Mostly one or two

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15
Q

Can you lower blood pressure with lifestyle changes?

A

Yes: -Weight loss -Salt restriction -Exercise -Alcohol

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16
Q

Why would blood pressure treatment be withheld?

A

During general anaesthesia hypotension can be a problem and anyihypertensives block attempts to increase BP ==> ACEi + ARBs temporarily stopped

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17
Q

Pathophysiology of aortic stenosis

A

a pressure gradient develops between left ventricle and aorta - LV function initially maintained by compensatory pressure hypertrophy - when compensatory mechanism exhausted, LV function declines

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18
Q

Main phenotypes of heart failure

A

HF with reduced ejection fraction (HFrEF) HF with preserved ejection fraction (HFpEF) HF due to severe valvular heart disease (HF-VHD) HF with pulmonary hypertension (HF-PH) HF due to right ventricular systolic dysfunction (HF-RVSD)

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19
Q

Side effect of GTN spray?

A

Excruciating headache

20
Q

Systolic murmurs?

A

ASMR Aortic Stenosis Mitral Regurgitation

21
Q

Diastolic Murmer?

A

ARMS Aortic regurgitation Mitral stenosis

22
Q

What is coarction of the aorta associated with?

A

Turner’s syndrome and Berry aneurysms of the brain

23
Q

Reasons for imperfect blood supply to the heart?

A

Atherosclerosis - thrombosis - thromboemboli - artery spasm - collateral blood vessels - blood pressure/ cardiac output/ heart rate - Arteritis

24
Q

Another name for pericarditis?

A

Dressler syndrome

25
Q

What investigations need to be done as part of a hypertension screening?

A

Urine dipstick (kidneys = end organ damage) ECG (LVH) HBA1c Renal function Fundosocopy (eyes) Lipid profile Qrisk Only check cortisol if there’s a secondary cause of hypertension

26
Q

What do you need to calculate Qrisk?

A

Lipid profile

27
Q

What changes in the arteries are likely to be seen due to angina?

A

Smooth muscle proliferation and migration from the tunica media to the intima -decreased release of nitric oxide - infiltration of Subendothelial space by Low-density lipoprotein (LDL) particles - formation of foam cells from macrophages

28
Q

Which blood test is the most accurate marker for acute cardiac damage?

A

Troponin T - short term, released by cardiac myocytes

29
Q

Blood marker for heart failure?

A

Brain natriuretic peptide

30
Q

Inflammatory blood marker?

A

C reactive protein

31
Q

Which investigation is diagnostic for heart failure?

A

Echocardiogram- allows you to see ventricles and valves (valves cause murmurs)

32
Q

Which medication can be prescribed to relieve symptoms (swollen ankles) of heart failure?

A

Oral digoxin (cardiac glycoside)

33
Q

Which two medications can cause postural hypertension?

A

Bisproplol Amlodipine

34
Q

Non pharmacological treatment to help with postural hypertension?

A

Increase salt intake Increase oral fluid intake Compression stockings Sit + stand slowly

35
Q

What is postural hypertension?

A

Sustained reduction of systolic blood pressure of at least 20 mmHg or diastolic blood pressure of 10 mmHg within 3 minutes of standing

36
Q

Causes of postural hypersensitivity?

A

Disorders affecting autonomic nervous system (eg. Parkinson’s disease) reduced blood volume, or iatrogenic causes eg. Antihypertensives

37
Q

Pharmovological treatment options of postural hypertension?

A

Oral fludrocortisone

38
Q

Prevalence of postural hypertension?

A

Affects 5% to 30% of people aged over 65 years and up to 60% of people with Parkinson’s disease

39
Q

5 investigations to assess for infective endocarditis?

A

Bedside- ECG, urinalysis Bloods - FBC, CRP, blood cultures Imaging - Echo

40
Q

Low amplitude p wave possible causes?

A

Atrial fibrosis Obesity Hyperkalemia

41
Q

High amplitude p waves possible cause?

A

Right atrial enlargement

42
Q

Broad notched ‘bifid’ p wave possible causes?

A

Left atrial enlargement

43
Q

Broad QRS possible causes?

A

Ventricular conduction delay/ branch bundle block Pre-excitation

44
Q

Small QRS complex possible causes?

A

Obese patient Pericardial effusion Infiltrative cardiac disease

45
Q

What can T wave changes indicate?

A

ischeamia/infarction - myocardial strain (hypertrophy) - myocardial disease (cardiomyopathy)

46
Q

Ecg for ischeamia?

A

T wave flattening inversion ST segment depression

Haroon Phase 2A (14 decks)

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