Cardiology Flashcards
(167 cards)
1
Q
Which congenital heart defect is associated with uneven blood pressure in each arm?
A
Coarctation of the aorta
2
Q
What is eisenmengers syndrome?
A
Reversal of flow for L to R, due to pulmonary hypertension. Causes de-oxygenated blood to skip lungs and go back around the body
3
Q
What are the signs/symptoms of Eisenmengers syndrome?
A
Cyanosis, clubbing, heart failure, syncope, high RBC
4
Q
Name 3 complications of bicuspid aortic valve?
A
Infective endocarditis
Aortic Dilation
Aortic regurgitation
5
Q
In patent ductus arterioles there is a persistent communication between which two structures?
A
Between proximal left pulmonary artery and descending aorta
6
Q
Which congenital heart defect presents with a machinery murmur?
A
Patent ductus arteriosus
7
Q
What are the 4 components of the tetralogy of fallot?
A
- A large ventricular septal defect
- Pulmonary stenosis
- Right Ventricular Hypertrophy
- Overriding aorta
8
Q
Why may toddlers squat in tetralogy of fallot?
A
Increases total peripheral resistance, so helps alleviate some of the L –> R shunt
9
Q
What would you see on an X-ray for a patient with tetralogy of fallot?
A
Boot-shaped heart
10
Q
Which congenital heart defect is associated with Down’s syndrome?
A
Atrio-ventricular septal defect
11
Q
Name a treatment method for pulmonary stenosis?
A
Baloon valvuloplasty
12
Q
On ECG what does the PR interval represent?
A
Delay of AV node to allow ventricles to fill
13
Q
On ECG what does the ST segment represent?
A
Beginning of ventricle repolarisation
14
Q
What does the cardiac axis measure?
A
Overall direction of the wave of ventricular depolarisation
15
Q
What would you see in Lead 1 and Lead 3 in right axis deviation?
A
Lead 1 Negative
Lead 3 Positive
16
Q
What would you see in Lead 1 and Lead 3 in left axis deviation?
A
Lead 1 Positive
Lead 3 Negative
17
Q
Give three causes of left axis deviation?
A
- LBBB
- Left Ventricular Hypertrophy
- Wolff-Parkinson white Syndrome
18
Q
What is the most common cause of right axis deviation?
A
Right ventricular overload, (RVH) or increased strain due to hypertension
19
Q
Which valvular abnormality is associated with broad and notched M shaped P waves?
A
P. Mitrale
Mitral Valve Stenosis
20
Q
What does the heart rate have to be to be classified as bradycardia?
A
< 60 beats per minute
21
Q
What does the heart rate have to be to be classified as tacycardia?
A
> 100 beats per minute
22
Q
Which of the supra ventricular tachycardias have hidden P waves on ECG?
A
AVRNT
23
Q
What type of tachycardia is Wolff-Parkinson White Syndrome?
A
Atrioventricular re-entrant tachycardia (AVRT)
24
Q
Name a treatment method for AVRNT?
A
Catheter ablation - radiofrequency energy directed at slow pathways
25
What are the ECG changes seen in AVRT?
Short PR Interval, delta wave at start of QRS
26
What would you see on ECG of patient with AF?
Absent P waves
| Irregular and Rapid QRS
27
Name 4 causes of AF?
```
Heart failure
Thyrotoxicosis (thyroid disease)
Alcohol and obesity
Valve failure
Hypertension
```
28
Other than heparin and warfarin in anti-coagulation what else could you use?
NOAC/DOAC - Direct Xa Inhibitors
| Rivaroxiban
29
Name a new treatment method for the early stages of AF?
Pulmonary vein isolation
30
Name the CHADS2VASc Criteria in assessing risk of stroke in patient with AF?
```
Congestive HF
Hypertension
Age, >75 (=2), 65-74 (1)
Diabetes
Stroke or TIA = 2
Vascular injury
Sc- Sex (female)
```
31
What does a CHADS2VASc score of 1 mean?
Consider oral anti-coagulation
32
What does a CHADS2VASc score of 2 mean?
Oral coagulation given eg warfarin or rivaroxiban
33
What is the acute management of AF?
Electrical (DC shock) or pharmacological (amiodarone) cardioversion
34
What is the long-term management of AF?
Rate control - BB, CCB or Digoxin
| Rhythm Control - Amiodarone or electrical cardioversion + anti-coagulation
35
What are the ECG changes seen in atrial flutter?
Sawtooth appearance
| Narrow QRS complexes
36
What would you expect the atrial and ventricular heart rate to be in atrial flutter?
Atrial - 300
Ventricular - 150
2:1 Heart block pattern
37
Name 4 extrinsic causes of bradycardia?
Drugs -BB and Digoxin
Hypothyroidism
Hypothermia
Increased ICP
38
Name 3 intrinsic causes of bradycardia?
SAN Infarction
Acute Ischaemia
Sick Sinus Syndrome
39
What is sick sinus syndrome?
Bradycardia due to intermittent failure of the SAN depolarisation due to failure of sinus node to propagate to atria
40
What would you see on an ECG in someone with Sick Sinus Syndrome?
Long pauses between consecutive P waves
41
Which type of arrhythmia presents with blackouts?
Heart block
42
What would you see on ECG in patient with 1st degree heart block?
PR interval prolonged >0.2s
43
What would you see on ECG in patient with 2nd degree, Mobitz 1 heart block?
Progressive PR interval prolongation then sudden loss of QRS, then pattern re-sets
44
How would a patient with 2nd Degree Mobitz 1 heart block present?
Diziness, light headed, syncope
45
What would you see on ECG in patient with 2nd degree mobitz type 2 heart block?
Sudden unpredictable loss of AV conduction and loss of QRS
46
How would a patient with 2nd Degree Mobitz 2 heart block present?
Chest pain, SOB and postural hypotension
47
What would you see on ECG in patient with 3rd degree heart block?
P waves and QRS complex appear independently of each other
48
On auscultation what may you hear in a patient with RBBB?
Wide splitting of the second heart sound
49
Name 3 causes of RBBB?
1. Pulmonary embolism
2. IHD
3. Atrio-ventricular septal defect
50
Name 2 causes of LBBB?
1. IHD
| 2. Aortic valve disease
51
What would you see on an ECG of someone with RBBB?
M wave in lead 1
| W wave in lead 5/6
52
What would you see on an ECG of someone with LBBB?
W wave in lead 1
M wave in lead 5/6
Abnormal Q waves
53
On auscultation what may you hear in a patient with LBBB?
Reverse splitting of the second heart sound
54
Name 4 occasions when you would refer someone with an ectopic beat?
1. Refractory to beta blockers
2. High burden ectopy
3. Structural heart defect
4. Syncope
55
What are the 3 main causes of heart failure?
1. Ischaemic heart Disease
2. Cardiomyopathy
3. Hypertension
56
What is HFREF- Left Heart Failure?
Failure to contract = Ejection fraction <40%
57
What is HFPEF - Right Heart Failure ?
Inability to relax and fill. Ejection fraction >50%.
58
What are the 3 main causes of HFREF (LHF)?
IHD, MI and cardiomyopathy
| HTN, aortic disease, arrhythmia
59
What are the 3 main causes of HFPEF - Right heart failure ?
Constrictive pericarditis, cardiac tamponade, pulmonary hypertension, PE, tricuspid regurgitation,
60
What are the 3 compensatory changes in heart failure?
1. Symapthetic stimulation - increase after load by peripheral vasoconstriction
2. RAAS - increase after load and preload by salt and water retention
3. Cardiac changes: ventricular dilation and myocyte hypertrophy
61
What is the definition of after load?
The pressure against which the heart must work to eject blood during systole
62
In which two cardiac conditions would you experience paroxysmal nocturnal dyspnoea?
```
Heart failure (left sided)
Aortic regurgitation
```
63
Name 3 signs of LV failure?
- 3rd and 4th Heart sounds
- Crepitations in lung base
- Displaced apex beat
- Weight loss
64
Name 3 signs of RV failure?
- Hepatomegaly
- Ascites
- Pitting oedema
- Raised JVP
- Pleural effusion
65
Name 3 symptoms of LV failure?
- Exertional dyspnoea
- Fatigue
- Paroxysmal nocturna dyspnoea
66
Name 3 symptoms of RV failure?
- Peripheral oedema
- Nausea
- Anorexia
67
What blood test can be used to diagnose Heart failure?
BNP - if normal excludes diagnosis
68
Why is BNP not specific?
Can also be raised in PE
69
Name 4 complications of heart failure?
1. Renal dysfunction
2. Thromboembolism - DVT and PE
3. Pleural effusion
4. LBBB and bradycardia
70
What is the first line medication for heart failure?
ACE-I and a Beta Blocker
71
What is the second line treatment for heart failure ?
Aldosterone antagonist - spironolactone
72
If you have heart failure and are ACE and ARB intolerant which drug would you use?
Hydralazine
73
If all other drugs have failed in heart failure treatment what is the final medication you would try?
Digoxin
74
Name 4 investigations you would do in heart failure?
1. Chest Xray
2. ECG underlying causes
3. Bloods: FBC, LFT, U&E
4. Echocardiogram
75
Patient with radio-femoral delay, what disease is underlying cause? and how would you diagnose this?
Coarctation of the aorta
| CT-angiogram
76
What does the wells risk score calculate?
The risk of DVT
77
What does the ABCD2 score calculate?
Risk of stroke after TIA
78
What does the QRISK2 score calculate?
The risk of developing cardiovascular disease
79
At what sats should you prescribe oxygen to a patient who has just had an MI?
Under 94%
80
Name 2 advantages and 2 disadvantages of PCI?
Adv - Less invasive, convenient, repeatable
| Dis - Risk of stent thrombosis , risk of restenosis
81
Name 2 advantages and 2 disadvantages of CABG?
Adv - better prognosis, used in stable patients, deals with the disease
Dis - Long recovery and hospital stay, risk of stroke, can't perform on frail
82
When else would troponin levels be elevated?
PE, myocarditis, pericarditis , tacyarrhythmia, gram -ve sepsis, iatrogenic eg DC cardioversion
83
Name 5 serious complications post MI?
1. Heart failure
2. AF
3. Chronic pericarditis (due to dresslers)
4. Bradyarrythmia
5. Cardiac rupture
84
What are the 6P's of limb ischaemia?
Pain, Pallor, Paralysis, Parasethesia, Perishing cold, Pulseless
85
After an Acute MI which drug is given for thrombolysis?
Streptokinase or plasminogen tissue activator
86
What are the 4 components of an atherosclerotic plaque?
Lipid, necrotic core, connective tissue, fibrous cap
87
What are the 5 stages of atherosclerosis?
1. Fatty streak formation
2. Intermediate lesions
3. Fibrous cap
4. Plaque rupture
5. Plaque erosion
88
What are the components of the fatty streak?
Foam cells (lipid laden macrophages) and T-lymphocytes within the intima of vessel wall
89
What is the fibrous plaque composed of?
ECM proteins eg collagen and elastin, laid down by smooth muscle cells
90
Where does the pain radiate to in pericarditis?
Trapezius Ridge
91
Name 5 organisms which caused IE?
```
Strep viridian's
Strep pneumoniae and staph aureus (in normal valves)
Candida alhbicans (yeast)
Staph epidermidis
Enterococci
```
92
What type of anaemia do you see in a patient with IE?
Normocytic anaemia
93
Name the 2 major criteria of Duke's Criteria?
1. Positive blood cultures (2 separate cultures, 3 .12 hours apart)
2. Echo - show vegetation, abscess or new valvular regurgitation
94
Name the 5 minor criteria in Duke's classification?
1. Predisposing eg IVDU
2. Fever >38
3. Valvular/immunological signs
4. +ve blood culture (don't meet major)
5. Echo (doesn't meet major)
95
How would you treat strep virdans causing IE?
Benzylpenicillin and gentamycin
96
How would you treat staph aureus causing IE?
Flucoxacillin
97
How would you treat enterococci causing IE?
Amoxicillin + gentamycin
98
What are the 3 clinical indications for ACE?
Hypertension, heart failure, diabetic nephropathy
99
What are the 4 side effects of ACE related to reduced angiotensin 2 formation?
Hypotension, acute renal failure, hyperkalaemia, teratogenic effects in pregnancy
100
Name 3 side effects of ARB?
Rash, symptomatic hypotension, hyperkalaemia, angio-oedema
101
What are the 3 clinical indications for CCB?
Hypertension, IHD (angina) and arrhythmia (tachycardia)
102
Which CCB commonly causes constipation?
Veramapril
103
Which CCB acts as an artery; vasodilator?
Amlodipine
104
Dihydropyradines (amlodipine) cause peripheral (artery) vasodilation, what are the side effects of this?
Flushing
Headache , oedema
Palpitations
105
Name 4 side effects of beta blockers?
Erectile dysfunction
Hypotension
Cold peripheries
Bradycardia
106
What are the side effects of diuretics?
Low serum K, Ca, Mg, Na
Raised uric acid --> gout
Hypovolaemia
Hypertension
107
What is the mechanism of Abciximab?
Gp IIb/IIIa inhibitor so prevents fibrinogen binding to platelets
108
What are the side effects of amiodarone?
Sun sensitivity, slate grey skin discolouration, optic neuropathy, corneal micro deposits, abnormal liver function
109
What can drugs which cause QT prolongation (amiodarone and solatol) cause?
Polymorphic ventricular tachycardia
110
What is the mechanism of Digoxin?
Cardiac glycoside, which inhibits the Na/K pump
111
What are the side effects of Digoxin?
Narrow therapeutic range, nausea, diarrhoea, confusion
112
Which three symptoms are associated with Ascending cholangitis?
Fever, rigors and jaundice (charcot's triad)
113
Give 3 secondary prevention strategies of angina?
1. Lifestyle changes
2. Control risk factors
3. Aspirin and a statin
114
To diagnose an MI which 3 factors need to be present?
1. Raised troponin
2. ECG changes consistent with MI
3. Chest pain consistent with MI
115
What are the acute management stages of STEMI?
MONA
| Morphone, oxygen (if hypoxic), nitrates and aspirin
116
Name 4 long term management strategies of acute coronary syndromes?
1. Aspirin 75mg daily
2. Beta blocker
3. Statin
4. ACE inhibitor
5. No driving for a month
117
Name 3 health conditions that hypertension causes?
Stroke, MI, Heart failure, peripheral vascular disease, renal failure
118
Give 4 primary causes of hypertension?
Genetic factors, obesity, salt intake, alcohol, stress, idiopathic
119
Give 3 endocrine causes of hypertension?
Conns, Adrenal hyperplasia, cushings, acromegaly
120
Give 3 renal causes of hypertension?
PKD, glomerulonephritis, diabetic nephropathy
121
Give 3 other causes of hypertension?
Pregnancy, coarctation of aorta, steroids
122
Give 3 modifiable risk factors of hypertension?
Obesity, dietary salt intake, lack of physical activity, excess alcohol, stress
123
What is the classification of stage 1 hypertension?
>140, >90
124
What is the classification of stage 2 hypertension?
>160, >100
125
Other than adulatory blood pressure monitoring give three other investigations you would do in hypertension?
1. Urine dipstick for protein and blood
2. Serum creatinine and electrolytes
3. 12 lead ECG
4. Echocardiography
126
Give 5 non-pharmacological management steps of HTN?
Weight loss, reduced salt intake, regular exercise, smoking cessation, reduce alcohol intake
127
When should you not treat a patient with hypertension?
Patients over 80 with stage 1 hypertension
128
Describe the pathophysiology of heart failure?
Failing heart, reduced CO, activate RAAS, vasoconstriction and sodium retention, increased peripheral resistant --> failing heart
129
What are the ABCDE signs you would see on an X-ray of heart failure?
```
Alevolar oedema
kerley B lines
Cardiomegaly
Dilated upper lobe vessels
pleural Effusion
```
130
Name 3 non-pharmalogical management steps of heart failure?
Education, lifestyle measures, correct aggrevating medical factors eg anaemia, vaccinate against pneumonocaal disease and influenza
131
Give 2 signs of an atrial septal defect?
Mid-systolic ejection murmur
| Fixed splitting of S2
132
Give 2 signs of ventricular septal defect?
Pansystolic murmur, left parasternal heave
133
What are the indications for surgery in a ventricular septal defect?
LA and LV enlargement, pulomary HTN, HF symptoms
134
Give 2 signs of tetraology of fallot?
Clubbing, harsh ejection systolic murmur
135
Give 3 symptoms of coarctation of the aorta?
Headache and nose bleed due to HTN, claudification and cold legs
136
Give 3 causes of aortic stenosis?
Calcification , congenital eg bicuspid valve, rheumatic fever, outflow obstruction
137
Give 3 symptoms of aortic stenosis?
Exercise induced angina, syncope, breathlessness
138
Give 3 signs of aortic stenosis?
Slow rising pulse
Sustained apex beat
Ejection systolic murmur - radiates to carotid
Soft S2
139
Give 2 investigations of aortic stenosis?
ECG-LVH and Echo = diagnostic
140
Which valve disease can you get acutely or chronically?
Aortic regurgitation
141
Give 3 causes of a) Acute and b) chronic aortic regurgitation?
a) Rheumatic fever, IE, aortic dissection
| b) Autoimmune, syphillis, bicuspid valve
142
Give 3 signs of aortic regurgitation?
LVF - blood overloading heart
Waterhammer pulse
Early diastolic murmur
143
What is the only cause of mitral stenosis?
Rheumatic fever - now rare in UK
144
Give 2 symptoms of mitral stenosis?
Paroxysmal nocturnal dyspnoea, orthopnoae, haemoptysis
145
Give 3 signs of mitral stenosis?
Malar flush, AF, Mid diastolic murmur
146
Give 3 causes of mitral regurgitation?
Mitral valve prolapse, IE, IHD
147
Give 2 signs of mitral regurgitation?
Pansystolic murmur radiating to axilla
| Third heart sound
148
Give 2 viral causes of pericarditis? 2 bacterial causes? and 2 other causes?
a) Viral = coxsackie and echovirus
b) Pneumococci, TB
c) Dresslers, SLE
149
Give 2 signs of hypertrophic cardiomyopathy?
Atrial and ventricular arrythmia, carotid pulse, ejection systolic
150
Give 2 medications you could give traduce risk of sudden death in hypertrophic cardiomyopathy?
Amoidarone
| Beta Blocker
151
Give 2 causes of acute limb ischamia?
Embolism
| Thrombosis
152
Give 3 causes of heart block?
CAD, Cardiomyopathy, fibrosis in conducting tissue
153
What do you see in QRS complexes of supraventricular tachycardias?
Narrow QRS
154
Give 3 symptoms of supra ventricular tacycardia?
Rapid palpitations, dizziness, dysnpnoea, central chest pain, syncope
155
Give 3 causes of atrial flutter?
IHD, cardiomyopathy, thyrotoxicosis, pneumonia, pericarditis
156
Which two biochemical markers would you test for in a patient with ACS?
Troponin, creatinine kinase, myoglobin
157
What is the most common cause of aortic stenosis?
Calcification of the valve
158
Which organism causes rheumatic fever?
Strep pyogenes
159
In pericarditis what may you hear on a) auscultation and b) CXR?
a) Pericardial rub
| b) Pericardial effusion
160
How does angiotensin 2 work?
Vasocontriction, stimulates aldosterone release which promotes sodium retention from kidneys
161
Where does angiotensin 2 act?
Efferent glomerular arteriole
162
How do beta blockers control heart rate?
Prolong refractory period of AV node
163
Give 4 medications you would use in a patient with NSTEMI and unstable angina?
Antiplatelts eg Tirofiban
Anticoagulation eg fondaparinoux
Beta blockers, nitrates and ACE
164
Give 3 differences in the ECG with NSTEMI and STEMI?
STEMI - ST elevation, Q waves, T wave inversion
| NSEMI - ST depression, no Q waves and T wave inversion
165
What is the 3rd line medication for a 52 year old man with hypertension?
ACE/ARB + CCB + Thiazide like diuretic
166
If all hypertensive medications are failing what would you consider using?
Spironalactone, digoxin, beta blocker
167
Give 4 general management advice for heart failure?
1. Education
2. Pneumococcal vaccine
3. Optimise risk factors
4. Lifestyle measures
