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Flashcards in Cardiology Deck (62):
1

Cardiology: What is the definition of syncope?

A transient loss of consciousness due to transient global cerebral hypoperfusion characterized by rapid onset, short duration and complete recovery.

2

Cardiology: What features would suggest vasovagal syncope?

• Long-history of syncope
• Prolonged standing
• Noxious stimulus
• Nausea and vomiting associated.
• Absence of cardiac disease
• After exertion
• After head tilting / carotid pressure

3

Cardiology: What features would suggest cardiac syncope?

• Known history of cardiac disease
• Evidence of structural abnormality
• Preceded by chest pain / palpitations
• During exercise

4

Cardiology: What is the treatment for syncope? (In broad terms)

Treat the underlying condition.
E.g. Ischaemia, drug-induced.

5

Cardiology: What is the normal PR interval? (In squares and time)

120-200ms
3-5 small squares

6

Cardiology: What is the normal size of a QRS?

120ms
3 small squares

7

Cardiology: What is the first-line treatment for symptom relief in chronic stable angina?

Nitrates, e.g. GTN

8

Cardiology: What is the mechanism of action of nitrates?

Release of NO to activate and increase cyclic-GMP which causes smooth muscle relaxation and subsequent cardiac vasodilation.

9

Cardiology: What are the side-effects of nitrates?

• Hypotension
• Headache
• Flushing

10

Cardiology: What are the contraindications of nitrates?

• Hypotension
• Aortic/ Mitral stenosis
• Hypertrophic cardiomyopathy

11

Cardiology: What is the first-line treatment of chronic stable angina?

Beta-blockers

12

Cardiology: What is the mechanism of action for beta-blockers in the treatment of chronic stable angina?

• Reduces sympathetic stimulation to the heart, causing a reduction in heart rate and myocardial contraction.
• Reduces cardiac workload to increase exercise tolerance and reduce symptoms.

13

Cardiology: If a patient is contra-indicated for beta-clockers what is the first-line treatment for the management of chronic stable angina?

• Non-dihydropyridine calcium channel blocker.
• E.g. Verapamil, Diltiazem

14

Cardiology: What are the side-effects of beta-blockers?

Bronchospasm, bradycardia, cold peripheries, sleep disturbance, sexual dysfunction, fatigue.

15

Cardiology: What are the contra-indications of beta-blockers?

Asthma
Bradycardia
Uncontrolled heart failure
2/3rd degree heart block
Severe peripheral arterial disease

16

Cardiology: Which medications may be added for treatment of chronic stable angina if beta-blockers are not provided sufficient relief?

• 2nd Line - Calcium-channel blockers (Amlodipine, Felodipine, Nifedipine)
• Longer-acting nitrates
• Potassium channel activators (Nicorandil)

17

Cardiology: What is the mechanism of action of calcium channel blockers in the treatment of chronic stable angina?

• Smooth muscle relaxation due to inhibition of influx of calcium ions.
• Relaxation of coronary and peripheral smooth muscle.

18

Cardiology: Non-dihydropyridine calcium channel blockers (Verapamil, Diltiazem) have an additional mechanism to other calcium channel blockers, what is it?

Slows conduction of AV node so has a rate limiting effect.

19

Cardiology: What are the side-effects of dihydropyridine calcium channel blockers? (amlodipine, felodipine, nifedipine)

• Flushing
• Dizziness
• Ankle-swelling
• Hypotension
• Headache

20

Cardiology: What are the contraindications for the use of dihydropyridine calcium channel blockers? (Amlodipine, felodipine, nifedipine)

• Uncontrolled heart failure
• Within one month post-MI
• Severe aortic stenosis

21

Cardiology: What are the side-effects of non-dihydropyridine calcium channel blockers? (Verapamil, diltiazem)

• Bradycardia
• AV/SA heart-block
• Constipation (Verapamil)

22

Cardiology: What are the contraindications of non-dihydropyridine calcium channel blockers? (Verapamil, diltiazem)

• Bradycardia
• 2/3 degree heart block
• Verapamil not to be used with beta-blocker
• Heart failure
• Acute porphyria

23

Cardiology: What is the mechanism of action of nicorandil in the treatment of chronic stable angina?

• NO donor to acticate cyclic-GMP to act as a vasodilator to both venous and arteries.
• Opens K channels resulting in efflux of K and reduction in Ca causing smooth muscle relaxation.

24

Cardiology: What are the side-effects of nicorandil?

• Headache
• GI irritation
• Hypotension

25

Cardiology: What is the acronym for the initial management of a suspected ACS?

MONA
• Morphine (5-10mg Given by slow I.V, an anti-emetic will also be needed)
• Oxygen
• Nitrates
• Aspirin (300mg stat)

26

Cardiology: What is the MI-5? (Secondary prevention for an ACS)

• Aspirin
• ACE-I
• Beta-blocker
• Statin
• Clopidogrel

27

Cardiology: What is the mechanism of action of aspirin?

• Irreversibly inhibits COX-1 and COX-2.
• This inhibits the production of Thromboxane A2.
• Which in turn inhibits platelet aggregation.

28

Cardiology: What are the side-effects of aspirin?

• GI irritation
• Bronchospasm

29

Cardiology: What are the contra-indications and interactions of aspirin?

• Active peptic ulceration, hypersensitivity, bleeding disorder.
• Any other drugs that increase the risk of bleeding.

30

Cardiology: What is the mechanism of action of clopidogrel?

• A prodrug converted to active metabolite by CYP enzymes.
• Irreversibly blocks py12 receptor on platelet surface.

31

Cardiology: What are the side-effects of clopidogrel?

• GI irritation

32

Cardiology: What are the contra-indications and interactions of clopidogrel?

• Active bleeding.
• Any other drug which increases bleeding risk, Fluoxetine (reduces antiplatelet effect), Enzyme inducers (carbamazepine, fluconazole, PPIs)

33

Cardiology: What is the mechanism of action of ACE-I?

• Reduces formation of Angiotensin II from angiotensin I.
• Results in reduced vasoconstriction and reduced formation of Aldosterone (Which promotes sodium and water retention)

34

Cardiology: What are the side-effects of ACE-I?

• Cough
• Hyperkalaemia
• Renal impairment
• Hypotension
• Angioedema
• Hepatic impairment

35

Cardiology: What are the contra-indications and interactions of ACE-I?

• Use with caution in renal impairment. Bilateral renal artery stenosis, severe aortic stenosis.

• Diuretics, nephrotoxic drugs.

36

Cardiology: What is the mechanism of action of ARBs (sartans)?

• Direct antagonist of Angiotensin II - blocks the vasoconstriction and aldosterone release.

37

Cardiology: What are the side-effects of ARBs?

• Hypotension
• Angioedema
• Renal impairment
• Hyperkalaemia

38

Cardiology: What are the contra-indications and interactions of ARBs?

• Cautions - renal artery stenosis, renal impairment.

• Diuretics, use with ACE-I only under specialist supervision.

39

Cardiology: What is the definition of hypoxia?

• A lack of oxygen resulting in a decrease in aerobic oxidative respiration resulting in cell injury.

40

Cardiology: What is the definition of ischaemia?

A lack of blood supply to a tissue or drainage away from a tissue due to stenosis or obstruction of a vessel. This results in a loss of oxygen and a build up of toxic metabolites. Tissue injury is quicker from ischaemia than hypoxia.

41

Cardiology: What is the definition of infarction?

Irreversible damage to a tissue due to ischaemia and hypoxia.

42

Cardiology: What are the mechanisms of cell injury?

• Decreased ATP production
• Membrane damage
• Increased intracellular calcium
• Increased oxygen derived free radicals

43

Cardiology: Give some differentials for chronic stable angina.

• Reflux oesophagittis
• PE
• Pneumothorax
• Aortic Dissection
• Costochondral pain
• Pleuritis
• Varicella zoster

44

Cardiology: What are the three indications for coronary bypass surgery (According to AHA)

• 3 vessel disease
• 2 vessel disease with LV impairment
• LMS

45

Cardiology: What are the four life-threatening causes of chest pain that you should never miss?

• MI
• PE
• Tension pneumothorax
• Dissecting thoracic aneurysm

46

Cardiology: What are the three main causes of aortic stenosis?

• Calcific degeneration
• Bicuspid valve
• Rheumatic

47

Cardiology: What are the complications of aortic stenosis? (Cardiac)

Pressure build up in the left ventricle leading to left ventricular hypertrophy, LV dilation and LV failure.

48

Cardiology: What pulse do you get with aortic stenosis?

Slow-rising

49

Cardiology: What is the classification of severe aortic stenosis, in terms of mean gradient mmHg, Jet velocity and valve area.

• Mean gradient >40mmHg
• Jet velocity m/s >4.0
• Valve area cm2

50

Cardiology: In which four situations is AVR recommended for aortic stenosis?

• Symptomatic severe AS.
• Severe AS undergoing CABG
• Severe AS undergoing surgery on aorta or other heart valves.
• Severe AS and LV systolic dysfunction.

51

Cardiology: What are the two structures that allow blood to bypass the lungs in the fetal circulation?

• Ductus arteriosus
• Foramen Ovale

52

Cardiology: What changes occur in the fetal lungs following birth?

• Birth causes the infant to take first breaths.
• Lungs fill with air and alveolar fluid is cleared.
• Pulmonary capillaries absorb oxygen from the air, pulmonary arterioles dilate causing pulmonary vascular resistance to fall dramatically.
• Blood flows into the pulmonary vascular system.

53

Cardiology: What causes the ductus arteriosus to close following birth?

• Due to decreased pulmonary vascular resistance, the pressure in the pulmonary artery falls.
• This causes blood to flow from the aorta through the Ductus arteriosus into the pulmonary artery.
• The ductus closes in response to oxygen by the contraction of smooth muscle.

54

Cardiology: How does the foramen ovale close following birth?

• Due to increased blood flow returning from the lungs, the pressure in the left atrium increases.
• As blood flow returning from placaenta is decreased, the pressure in the right atrium decreases.
• Both these changes close the foramen ovale by pressing the septum primum against the septum secundum.

55

Cardiology: What structures do the ductus arteriosus, ductus venosus, umbilical arteries and umbilical vein become?

• Ductus arteriosus - ligamentum arteriosum
• Ductus venosus - ligamentum venosum
• Umbilical arteries - Medial umbilical ligaments
• Umbilical vein - ligamentum teres

56

Cardiology: What are the symptoms of persistent pulmonary hypertension of the newborn?

• Right to left shunting across PDA and PFO
• Cyanosis
• Acidosis
• Lower limb sats

57

Cardiology: What is the treatment for pulmonary hypertension of the newborn?

• Oxygen, ventilation, nitric oxide.
• Extracorporeal membrane oxygenation.

58

Cardiology: What is Starling's law of the heart?

The ability of the heart to change its force of contraction and therefore stroke volume in response to changes in venous return.

59

Cardiology: The presence of a bicuspid aortic valve is associated with which conditions?

• Aortic root dilation
• Heyde's syndrome
• Coarctation
• Williams syndrome
• PDA
• Turner's syndrome

60

Cardiology: What are the symptoms of aortic stenosis?

SAD
- Syncope - Exertional
- Angina
- Dyspnoea
(May be asymptomatic in earlier stages)

61

Cardiology: What are the initial investigations for suspected aortic stenosis?

• FBC - ensure not anaemic
• Renal function
• ECG (Heart block, LBBB)
• CXR (coarctation, heart failure, aneurysm.)
• Echocardiogram

62

Cardiology: What are the four types of mechanical heart valves?

• Ball and cage
• Tilting disk
• Bi-leaflet
• Tri-leaflet