Cardiology Flashcards
(199 cards)
1
Q
fever, pleuritic pain that is relieved by sitting up and leaning forwards
A
pericarditis
2
Q
non productive cough, dyspnoea, flu-like symptoms, tachy-pnoea/cardia, pericardial rub
A
pericarditis
3
Q
what can cause pericariditis
A
viral (coxsackie), TB, uraemia (fibrinous percarditis), trauma post MI (dresslers), connective tissue disease, hypothyroidism
4
Q
saddle-shaped ST elevation, PR depression
A
pericarditis
5
Q
dresslers syndrome triad
A
fever, pleuritic pain, pericardial effusion
6
Q
janeway lesions/ osler’s nodes
A
subacute bacterial endocarditis
7
Q
which valve more commonly affected by endocarditis
A
mitral
8
Q
when does tricuspid valve get endocarditis
A
IV drug users- staph aureus
9
Q
what are the risks for endocarditis
A
IV drugs, cardiac lesions, rheumatoid arthritis, dental treatment
10
Q
what are the hacek organisms
A
normal flora in oral pharyngeal region
haemophilus, actinobacillus, cardiobacterium, eikenella, kingella
11
Q
what are the causative organisms of endocarditis
A
staph viridans, aureus, epidermis
diphtheroids microaerophilic strep
HACEK
12
Q
how is endocarditis classifies
A
dukes criteria
13
Q
what are the major criteria in dukes
A
2 separate blood cultures
endocardial involvement
14
Q
what are the minor dukes criteria
A
fever >38 degrees
IV drug user
predisposing heart condition
immunological phenomena (olser’s nodes, roth spots)
vascular phenomena (mycolytic aneurysm/ janeway lesions)
echocardiograph findings
15
Q
what are the symptoms of endocarditis
A
fever roth spots osler's nodes new murmer janeway lesions anaemia splinter haemorrhages emboli
16
Q
what investigations are done into endocarditis
A
blood cultures (3 SEPARATE CULTURES FROM 3 PERIPHERAL SITES)
blood for anaemia
urinalysis (microscopic haematuria)
CXR
echo (transoesophageal/ transthoracic) for vegetations
17
Q
Tx for native (subacute) endocarditis
A
amoxicillin IV and gentamicin
18
Q
Tx for native valve acute with severe sepsis endocarditis
A
flucloxacillin IV
19
Q
TX for prosthetic valve/ suspected MRSA endocarditis
A
vacomycin IV and rifampicin PO and gentamicin IV
20
Q
TX for native valve, severe sepsis and risk factors for resistant pathogens
A
vancomycin IV and meropenem IV
21
Q
complications of endocarditis
A
heart failure, arrhythmia, abscess formation in cardiac muscle, embolic formation (stroke, vision loss, infection spread)
22
Q
when do you treat bradycardia
A
when hr <40 bpm
23
Q
tx for bradycardia
A
atropine, subcutaneous pacing
24
Q
what is sick sinus syndrome
A
sinus node dysfunction causes bradycardia +/- arrest, sinoatrial block or SVT alternating with bradycardia/ systole
25
what can be a complication of sick sinus syndrome
AF and thromboembolism
26
when and how do you treat sick sinus syndrome
if symptomatic- pace
27
narrow complex tachycardia
SVT- QRS < 0.12seconds
28
tx foe SVT
vagal manoeuvres, IV adenosine or verapamil
DC shock if compromised
29
what is the maintenance therapy for SVT
BBs or verapamil
30
irregularly irregular pulse, absent P waves
AF
31
saw tooth baseline + 150 bpm
atrial flutter
32
how do you treat pre-excited AF
flecainide
33
broad complex tachycardia
VT
34
acute treatment for VT
IV amiodarone or IV lidocaine
if no response/ compromised DC shock
35
congenital accessory conduction pathway between atria and ventricles
WPW
36
short PR interval, wide QRS, delta wave, ST-T changes
WPW
37
how does WPW present
SVT, pre excited AF or pre excited atrial flutter
38
what is a pre excited beat
impulse conducted through the accessory pathway
39
tx for WPW
ablation
40
what is holiday heart syndrome
seen in binge drinking with no other heart disease, can result in SVT or AF, tx is to stop drinking
41
irregularly irregular
AF
42
slow rising pulse
aortic stenosis
43
collapsing pulse
aortic regurgitation
44
bounding pulse
acute CO2 retention, hepatic failure, sepsis
45
radiofemoral delay
coarctation of aorta
46
jerky pusle
HOCM, mitral regurg
47
pulsus bisferiens
mixed aortic valve disease, HOCM
48
pulsus paradoxus
constrictive pericarditis, cardiac tamponade
49
describe a slow rising pulse
time to peak increase, whole pulse flattened and small
50
describe a pulsus bisferiens
2 peaks in pulse (brachial/ femoral)
51
describe a pulsus paradoxus
systolic pressure drop >10mm Hg with inspiration
52
what is hypertension
>140/90
53
young patients with acute onset hypertension with a history of renal or endocrine disorders
secondary hypertension
54
what can cause secondary hypertension
diabetes complications (diabetic nephropathy), polycystic kidney disease, glomerular disease, renovascular hypertension, cushing syndrome, aldosteronism, pheochromocytoma, thyroid problems
lifestyle factors contribute: stress, smoking and obesity
55
what is pre hypertension
120-130/ 80-89
56
what is stage one hypertension
140-159/90-99
57
stage 2 hypertension
160-179/100-109
58
what is severe hypertension
>/= 180/ >/= 110
59
what bloods should be done for hypertension
FBC, LFTs, U/Es, creatinine, serum urea, cGRR, lipid levels, glucose, serum Ca2+
60
what might be seen on an ECH in hypertension
LV hypertropy
61
what might be seen in hypertension in a urine dipstick
haematuria and proteinuria
62
what are the complications of hypertension
MI, heart failurem renal impairment, stroke, hypertensive retinopathy
63
how is resistant hypertension treated
higher doses of thiazide or spironolactone. add alpha or beta blocker if Diuretic insufficient
64
rib notching on CXR
coarctation of the aorta- due to dilatation of the intercostal arteries
65
cyanosis first day of birth, boot shaped heart
tetralogy of fallot
66
components of tetralogy of fallot
overriding aorta, pulmonary stenosis, ventricular septal defect, RV hypertrophy
67
wide, fixed split S2, ejection systolic murmur 2nd/3rd intercostal space
atrial septal defect
68
radiofemoral delay, hypertension
coarctation of the aorta
69
harsh pansystolic murmur at the left sternal edge
ventricular septal defect
70
continuous machinery murmur below left clavicle
persistent ductus arteriosus
71
cyanosis first day of birth, egg shaped ventricles
transposition of great vessels
72
what congenital heart problems making you cyanotic
tetraology of fallot
transposition of great arteries
tricus. artresia
pulmonary stenosis
73
when does fallots usually present
1-2 months
74
louder in left lateral position on expiration
mitral stenosis
75
tappping apex, loud S1, rumbling mid-diastolic
mitral stenosis
76
soft S2, ejection systolic, radiates to carotids, crescendo decrescendo, slow rising pulse, heaving
aortic stenosis
77
soft S2
aortic stenosis
78
loud s1
mitral stenosis
79
bets heard on expiration leaning forwards
mitral regurg
80
large systolic JVP 'v' waves, pansystolic at lower left sternal edge
tricuspid regurgitation
81
what murmurs can rheumatic heart disease cause
MR, MS, AS
82
causes of mitral stenosis
calcification, RA, AS, malignant carcinoid, SLE
83
what can cause mitral regurgitation
papillary muscle rupture muscle rupture, infective endocarditis, prolapse
84
raised fixed JVP
superior vena cava obstruction
85
JVP rising on inspiration
cardiac tamponade, constrictive pericarditis- look for pulsus paradoxicus
86
large v waves
tricuspid regurgitation
87
absent a waves
atrial fibrillation
88
cannon a waves
complete heart block, AV dissociation, ventricular arrhythmias
89
what is jvp an indicator of
central venous pressure
90
a wave
atrial contraction
91
c wave
tricuspid valve bulging into atrium
92
v wave
rise in atrial pressure during filling
93
blurred yellowing vision headache
digoxin toxicity
94
s2 split during inspiration
normal
95
s3
normal if <30 (in women up to 50)
may be heard in LVF and constrictive pericarditis
96
s4
HOCM, hypertension
97
fever, conjunctivitis, bright red cracked lips, strawberry tongue, cervical lymphadenopathy, red palms of hands/ soles of feet
kawasaki disease
98
how is kawasaki treated
aspirin (high dose), IV immunoglobulins, ECHO
99
complications of kawasaki
coronary artery syndrome
100
why is aspirin not usually indicates in children
reye's- swelling in liver and brain while recovering from viral infection
101
SV x TPR =
CO
102
MAP formulas
((2 x diastolic) + systolic) / 3
diastolic + 1/3 (systolic -diastolic)
103
where to place the chest leads:
| V1
right sternal edge, 4th intercostal space
104
where to place the chest leads:
| V2
left sternal edge, 4th intercostal space
105
where to place the chest leads:
| V3
halfway between V2 and V4
106
where to place the chest leads:
| V4
5th intercostal space, mid clavicular line
107
where to place the chest leads:
| V5
anterior axillary line
108
where to place the chest leads:
| V6
mid axilliary line
109
tall tented P waves, prominent U waves (and wide QRSs)
hyperkalaemia- muscle weakness, cramps, tetany
110
flattened T waves, prominent U waves (and wide QRS's)
hypokalaemia- muscle weakness, cramps
111
long q t interval
hypocalcaemia
112
absent p wave
sinoatrial block
113
bifid p wave
LA hypertrophy (e.g mitral stenosis)
114
peaked P waves
right atrial hypertrophy (e.g. pulmonary hypertension, tricuspid stenosis)
115
ST depression
myocardial ischaemia
116
ST elevation
acute MI, LV aneursym
117
LBBB
W seen in V1, V2
M seen in V4-V6
118
RBBB
M seen in V1
W seen in V5-V6
119
what can cause RBBB
age, RV hypertrophy, cor pulmonale (raised RV pressure), MI, atrial septal defect, cardiomyopathies, myocarditis
120
how long is a P wave and what is it
atrial depolarisation
| 0.08-0.1s
121
how long is the QRS complex and what is it
ventricular depolarisation <0.12s
122
what is the T wave
ventricular repolarisation
123
how long should the PR interval be
0.12-0.2s
124
how to calculate heart rate from an ECG
if regular 300/ large boxes between beats
if irregular no of QRS in 30 large squares and multiply by ten
125
how long is a large box
0.2 secs
126
how long is a small box
0.04 secs
127
normal ecg axis
complexes in I and II and predominantly positive
128
lead 1 pos lead aVF +
normal axis
129
lead 1 + leade aVF -
left axis deviation
130
lead 1 - lead aVF +
RAD
131
lead 1 - lead a VF -
extreme axis deviation
132
what can cause LAD
left anterior hemiblock, inferior MI, VT from LV focus, WPW syndrome, LVH
133
what can cause RAD
RVH, PE, anterolateral MI, WPW syndrome, left posterior hemiblock
134
hyperacute T waves (inverts later), ST elevation, Q wave fromation
localising infarct
135
II, III, aVF
inferior MI
136
right coronary leads
II, III, aVF (inferior)
137
I, aVL, V2-6
anterolateral
138
LAD/ left cicumflex leads
(anterolateral) I, aVL, V2-6
139
V2-5
anterior
140
LAD leads
V2-5 (anterior)
141
V1-4
anteroseptal (LAD)
142
subendocardial infarct
ST and T changes with no Q waves
143
posterior MI
V1,2 (tall R waves, ST depression, tall upright T waves)
144
what artery is posterior
left circumflex, right coronary
145
where do atrial ectopic beats originate from
pulmonary veins
146
pathophysology of A fib
atrial ectopic beats cause dysfunction of electric signalling
147
what are the causes of A fib
idiopathic, ischaemic heart disease, heart failure, valve disease, hypertension, hyperthyroidism, alcohol induced, familial
148
abscent P waves, irreg R-R intervals, undulating baseline
A Fib
149
investigations into A fib
ECG, holter monitoring (ambulatory ECG), ECHO, Thyroid function tests, CXR
150
what are the complications of A fib
stroke heart failure, sudden death
151
what is the treatment for A fib
```
restore rate
BB
CCB
Digoxin
amiodarone
```
restore rhythm
BB
DC cardioversion
amiodarone
anticoagulant- warfarin, apixaban, dabigatran , rivaroxaban
152
sense of impeding doom
MI
153
what are the acute coronary syndromes
STEMI, NSTEMI, unstable angina
154
how long do MI symptoms have to last to become worrying
>20 mins
155
who gets a silent MI
diabetics
156
what are the signs (not symptoms) of an MI
raised JVP, increased pulse + BP changes, pallor and anxiety
157
transmural infarct
all of myocardial wall, ST depression
158
what is seen on an ECG of an MI
ST elevation/depression, inverted T waves, LBBB, pathological Q waves
159
what is seen on an MI CXR
cardiomegaly, pulmonary oedema, widening of mediastinum
160
what bloods for MI
troponin I and T
161
what is PCI
angiography-images coronary vessels can be used for MI surgical intervention
162
what is the acute treatment for an MI
```
MONA T
morphine + anti emetic
oxygen
nitrates
anticoagulants
```
ticagrelor
163
drugs for discharged MI
aspirin, ACEi, BB (2nd CCB), statin
164
what are the complications of MI
```
cardiogenic shock arrhythmia
pericarditis
emboli
aneurysm
rupture of ventricle
dresslers syndrome
rupture of free wall
papillary muscle rupture
```
165
can you give PCI in NSTEMI
yes
166
what do you give if you cant do PCI immediately
fondaparinux or LMWH (subcutaneously)
167
malar (cheek) flush
mitral stenosis
168
pulsatile hepatomegaly
tricuspid regurgitation
169
carotid pulsation (corrigans)
aortic regurg
170
head nodding (de musset's sign)
aortic regurg
171
capillary pulsations in nail bed
aortic regurgitation
172
pisto shot heart over femorals
aortic regurgitation
173
roth spots (boat shaped retinal haemorrhages)
infective endocarditis
174
olsers nodes (painful, hard swellings on fingers/toes)
infective endocarditis
175
janeway lesions (painless erythematous blanching macules seen on palmar surface)
infective endocarditis
176
what criteria asses severity of heart failure
framingham (2 major/ 1 major + 2 minor)
177
what are the major criteria for heart failure
```
paroxysmal nocturnal dyspnoea
acute pulmonary oedema
increased heart size/ CVP
neck vein dilatation
S3 gallop
```
178
what are the minor criteria for heart failure
pleural effusion, ankle oedema, increased HR, nocturnal cough
179
new york heart assoc classification of CCF
I- no limitation
II-slight
III-marked
IV- inability to carry out physical activity
180
what are the signs of RVF
peripheral oedema and ascites
181
what can cause RVF
LVF, tricus/pulm valve disease, pulmonary vascular disease
182
what are the signs of LVF
PND, wheeze, nocturnal cough with pink sputum (pulmonary oedema)
183
what can cause LVF
coronary artery disease, hypertension, aortic/ mitral disease, myocardial disease
184
LVF and RVF both cause
ischameic injury and reduction in myocardial efficiency
| -causes increased work load, decreased CO and contractility
185
what are the compensatory mechanisms of heart failure
RAAS, SNS activation, increase in myocyte size
186
what does activation of RAAS cause
Na+ ion and H2O retention and peripheral vasoconstriction= increased preload and venous return
187
what does SNS activation cause
increased HR, peripheral vasoconstriction, increasing afterload
188
what does chronic activation of heart failure compensatory mechanisms cause
makes heart failure worse
189
how does heart failure cause hepatomegaly
congestion of the hepatic portal system
190
causes of angina pectoris
atherosclerosis, anaemia, tachyarrhythmia
191
what can precipitate angina
exercise, cold weather, heavy metals
192
decubitus angina
triggered y lying flat
193
prinzmetal angina
coronary artery spasm
194
which type of angina causes ST elevation
prinzmetal
195
what investigations for angina
ECG, CT scan, Caclium score (measured on CT), coronary angiography (gold standard), thallium scan
196
complications of angina
MI and stroke
197
process of atheroma formation
fatty streak, fibrolipid plaque formation, complicated atheroma (prone to rupture)
198
drugs for angina
GTN, aspirin, BB, CCB, K+ channel acitvator (nicorandil)
199
surgery for angina
PCTA, or CABG
