Cardiology Flashcards
(103 cards)
1
Q
Which conditions does ACS refer to
A
Unstable angina
NSTEMI
STEMI
2
Q
What is the gold standard investigation of ACS
A
CT coronary angiogram
3
Q
A STEMI can be defined as
A
ACS with ST elevation or new LBBB on ECG
4
Q
How could you describe the difference between STEMI and NSTEMI to patients
A
STEMI is full vessel occlusion and ischaemia/infarction of the entire myocardial thickness
NSTEMI is partial vessel occlusion that caused ischaemia/infarction part of the myocardium wall (not the full thickness)
5
Q
How can you differentiate unstable angina from MI
A
Trop rise - present in MI, absent in unstable angina
6
Q
Which are the most cardiospecific troponins?
A
I and T
7
Q
How long should you wait between repeating troponin levels?
A
4-6 hours
8
Q
Causes of raised troponin levels
A
MI HF Renal failure/CKD PE Arrhythmias
9
Q
How long after an MI do troponins stay raised
A
7-10 days
10
Q
Describe the sequence of ECG changes during a STEMI
A
Hyperacute T waves ST elevation/new LBBB Pathological Q waves T wave inversion ST normalisation T wave normalisation
11
Q
Possible ECG changes in NSTEMI/unstable angina
A
ST depression
T wave inversion
Loss of R wave
Normal
12
Q
Which are the inferior leads on ECG
A
II + III + aVF
13
Q
Which are the lateral leads on ECG
A
I + aVL + V5 + V6
14
Q
Which are the septal leads on ECG
A
V1 + V2
15
Q
Which are the anterior leads on ECG
A
V3 + V4
16
Q
Which vessel supplies the inferior territory on ECG
A
Right coronary artery
Posterior descending branch
17
Q
Which vessel supplies the lateral territory on ECG
A
Left coronary artery
Circumflex branch
18
Q
Which vessel supplies the septal and anterior territories on ECG
A
Left anterior descending artery
Septal branch = septal
Diagonal branch = anterior
19
Q
How soon after an MI do troponins rise
A
6-8 hours
20
Q
Differentials for ST elevation on ECG
A
STEMI LBBB Pericarditis Hyperkalaemia PE Tricyclic antidepressants
21
Q
General management for all ACS
A
Morphine + metoclopramide
Nitrates (GTN, not if inferior)
Oxygen (if sats <94%)
Aspirin 300mg
22
Q
Describe the specific management of STEMI
A
If symptoms started >12 hours ago then give fondaparinux
If symptoms started <12 hours ago then for reperfusion therapy: if can get to PCI within 120 mins the PCI. If cant get to PCI within 120 mins then thrombolyse
23
Q
What is the time window from symptom onset for a STEMI to qualify for reperfusion therapy
A
<12 hours
24
Q
If a STEMI had symptom onset <12 hours ago, how long do you have to get them to the cath lab to be able to perform PCI?
A
120 minutes
25
Contraindications to thrombolysis
```
Previous intracranial bleed
Ischaemic stroke <6 months ago
Cerebral malignancy or AVM
Major trauma or surgery <3 weeks ago
GI bleed <1 months ago
Known bleeding disorder
Aortic dissection
Recent biopsy/lumbar puncture (<24hrs ago)
```
26
What cardioprotective medication do you initiate after ACS
Aspirin for life + Ticagrelor/Clopidogrel for 12 months
Beta blocker
ACEi
High dose statin
27
MI complications most common in the first 0-24hrs
Ventricular arrhythmia - VT, AV block - causes sudden cardiac death
Acute left heart failure
Cardiogenic shock
28
MI complications most common 1-3 days after
Early infarct associated pericarditis - can cause haemopericardium/pericardial tamponade
29
MI complications most common 3-14 days after
Papillary muscle rupture - acute mitral regurgitation
Ventricular septal rupture
Left ventricular free wall rupture
30
MI complications most common two week-months after
```
Atrial/ventricular aneurysms
Dressler syndrome
Arrhythmia/AV block
Congestive heart failure
Reinfarction
```
31
What is the GRACE score used for
Inpatient and 6 month mortality risk following ACS
32
What is the CRUSADE score used for
Predicts risk of major bleeding in patients diagnosed with ACS, especially NSTEMI - used to help inform about risk of thrombolysis
33
What is the HAS-BLED score used for
To assess 1-year risk of major bleeding in patients taking anticoagulants with atrial fibrillation
34
What is the QRISK2 score used for
Risk of MI or stroke over the next 10 years
35
What is the CHADSVASC score used for
Assesses embolic risk in patient with AF
36
Causes of angina
Atheroma
Anaemia
Aortic stenosis
Tachyarrhythmias
37
Describe stable angina
Induced by effort, relieved by rest
38
Describe unstable angina
Angina of increasing frequency/severity/occuring on minimal exertion/at rest
39
What 3 features need to be present for angina to be classed as typical?
1. Constricting discomfort in the front of the chest, or in the neck/shoulders/jaw/arms
2. Precipitated by physical exertion
3. Relieved by rest or GTN in 5 mins
40
What advice do you give to patients on what to do when they have an angina attack?
Stop and rest
Use GTN and wait 5 mins
Second dose of GTN and wait 5 min
Call 999 (or earlier if pain is intensifying/feel unwell)
41
How do you manage angina
Address causative/exacerbating factors (anaemia, thyroid)
Secondary prevention of CVD - lifestyle modification, control of HTN and DM
GTN for symptom relief
Beta blocker +/ calcium channel blocker
42
Name some narrow complex tachycardias
Sinus tachycardia
Atrial flutter
Atrial fibrillation
43
Narrow complex tachycardias represent the electrical signal being initiated where?
Supraventricular
44
Broad complex tachycardias represent the electrical sign being initiated where?
Ventricular
45
Name some broad complex tachycardias
Premature/ectopic ventricular beats
VT
Torsade de pointes
VF
46
Name some bradycardias
Sinus bradycardia
First degree heart block
Second degree heart block
Third degree heart block
47
Endocrine causes of secondary HTN
```
Primary hyperaldosteronism (Conn syndrome)
Primary hyperparathyroidism
Pheochromocytoma
Cushings syndrome
Hyperthyroidism
Acromegaly
Congenital adrenal hyperplasia
```
48
Renal causes of secondary HTN
Renal artery stenosis
ADPKD
Renal failure/decreased GFR
Glomerulonephritis
49
Fundoscopic features of hypertensive retinopathy
```
Cotton wool spots
Flame haemorrhages
Hard exudates
AV nicking
Papilloedema
```
50
How do you assess for hypertensive end-organ damage?
ECG/echo
Fundoscopy
Renal function + Urinalysis
51
What is the difference between hypertensive urgency and hypertensive emergency
Hypertensive urgency does have signs of end-organ damage
| Hypertensive urgency has signs of end-organ damage
52
How do you manage hypertensive urgency?
Oral antihypertensives
53
How do you manage hypertensive emergency?
IV antihypertensives
54
How do you go about diagnosing hypertension
2 readings in clinic 140/90 or above then ABPM or HBPM average reading of 135/85 or more
55
How often does ABPM take readings
2 measurements every hour
56
How often does HBPM take readings
2 measurement twice a day
57
Describe the pathway for treating with antihypertensives
Step 1: ACEi/ARB if <55, CCB if >55 or Afro-Caribbean
Step 2: ACEi/ARB + CCB
Step 3: ACEi/ARB + CCB + Thiazide diuretic
Step 4: A + C + D + alpha/beta blocker
58
Side effects of calcium channel blockers
Flushes/headache
Ankle oedema
Fatigue
59
Side effects of ACE inhibitors
Dry cough
High K
Angioedema/rash
Dizziness/headache
60
Side effects of ARBs
Dizziness/headache
Urticaria/pruritus
High K
Cough
61
Side effects of beta blockers
Dry mouth/skin/eyes
Cold peripheries
Dizziness
GI upset
62
Causes of left heart failure
```
Hyperdynamic circulation - anaemia, thyrotoxicosis
Arrhythmia - AF
Valvular disease - MR, AR, AS
HTN
MI
Congenital defects - ASD, VSD
```
63
Signs/symptoms of left heart failure
```
Dyspnea
Orthopnea
Pulmonary oedema
Bilateral basal crackles
Paroxysmal nocturnal dyspnea
Cool peripheries
Sweating
Cerebral/renal dysfunction
```
64
Causes of right heart failure
```
Left heart failure
COPD
Pulmonary hypertension
Tricuspid regurgitation
Atrial septal defect
```
65
Signs/symptoms of right heart failure
Peripheral pitting oedema
Raised JVP with hepatojugular reflex
Hepatosplenomegaly
Ascites
66
NYHA classification of heart failure
I. no limitation/sx with normal physical activity
II. slight limitation/sx of normal physical activity
III. marked sx with less than normal physical activity e.g. getting dressed
IV. sx at rest, can't really do any physical activity
67
Which blood test can assess for heart failure?
BNP
68
Which medications improve mortality in heart failure
ACEi/ARBs
Beta blockers
Spironolactone (aldosterone antagonist)
69
Which medications just give symptom relief in heart failure
Furosemide
| Digoxin
70
Describe ECG findings of AF
Irregularly irregular rhythm
Narrow QRS
Absent/indiscernible P waves
Increased rate
71
If AF has been present for >48 hours or an unknown duration, how long would you ideally anticoagulate before cardioversion?
3 weeks
72
Which medications are used for rhythm control in AF
Amiodarone
| Flecainide
73
Which medications are used for rate control in AF
Beta blocker
Non-dihydopyridine calcium channel blockers - Diltiazem, Verapamil
Digoxin
74
Which two scores can you use to assess risk/benefit of starting anticoagulation in AF
CHADSVASC and HAS-BLED
75
Causes of pericarditis
```
Viral infection
Bacterial infection
MI
Trauma/surgery
SLE/RA
Uraemia
Radiation
```
76
Symptoms of pericarditis
Pleuritic chest pain, improved by sitting forwards
Tachypnoea
Dyspnea
Flu like symptoms/low grade fever
77
ECG changes in pericarditis
Diffuse ST elevation - with ST depression in aVR and V1
| Inverted T waves
78
Management of acute pericarditis
Usually self limiting and resolves in 2-6 weeks
NSAIDs/Aspirin
Restrict physical activity
Colchicine to reduce risk of recurrent
79
Which valve is most commonly affected by infective endocarditis in IVDU's
Tricuspid valves
80
Signs/symptoms of infective endocarditis
```
Fever/chills, malaise, B sx
New murmur, arrhythmias, HF
Oslers nodes
Splinter haemorrhages
Janeway lesions
Clubbing
Signs/sx of emboli - kidney, lungs, brain
```
81
What is the name of the criteria used to diagnose infective endocarditis?
Modified Duke's criteria
82
Rheumatic fever occurs after infection with what?
Group A beta-haemolytic streptococcal pharyngitis
83
Clinical features of rheumatic fever
```
Fever, malaise, fatigue
Large joint polyarthritis
Pancarditis
Valvular disease
Sydenham chorea
Subcutaneous nodules
Erythema marginatum
```
84
What is the name of the criteria used to diagnose rheumatic fever
Jones criteria
85
Systolic murmurs
```
AS
PS
MR
TR
MVP
```
86
Diastolic murmurs
AR
PR
MS
TS
87
Describe how you grade a murmur
1 - heard only if you listen hard for ages
2 - faint but heard easily
3 - loud no thrill
4 - loud with thrill
88
Describe the murmur of aortic stenosis
Opening click + ejection harsh systolic murmur
89
Describe the murmur of pulmonary stenosis
Ejection systolic
90
Describe the murmur of mitral regurgitation
Pansystolic
91
Describe the murmur of tricuspid regurgitation
Pansystolic
92
Describe the murmur of mitral valve prolapse
Mid systolic click + mid/late systolic murmur
93
Aortic stenosis findings
Opening click + harsh ejection systolic murmur
Slow-rising small volume pulse, narrow pulse pressure
Displaced heaving apex beat if LVH
Systolic thrill in aortic area
Reduced/absent S2
Radiates to carotids
94
Pulmonary stenosis findings
Ejection systolic murmur
Right-sided heart failure (RV heave, tricuspid regurgitation, raised JVP)
Widely split S2
Right ventricular dilation (right ventricular heave, peripheral signs of right heart failure)
Radiates to left shoulder/infraclavicular
95
Aortic regurgitation findings
Decrescendo early diastolic murmur
Collapsing pulse, wide pulse pressure. Corrigan’s, Quincke’s, de-Musset’s
Displaced hyperdynamic apex beat
Radiates to left sternal edge
96
Mitral stenosis findings
Opening snap + low pitched rumbling mid-diastolic murmur
Loud S1
Tapping apex beat
Low volume pulse
AF
Signs of pulmonary HTN (malar flush, right sternal heave, engorged neck veins)
97
Describe the murmur of aortic regurgitation
Decrescendo early diastolic murmur
98
Describe the murmur of pulmonary regurgitation
Early decrescendo diastolic murmur
99
Describe the murmur of mitral stenosis
Opening snap + low pitch rumbling mid-diastolic murmur
100
Describe the murmur of tricuspid stenosis
Mid-diastolic
101
Getting a patient to sit forward and hold expiration exaggerates which murmur?
Aortic stenosis
102
Getting a patient to lie on their left and hold expiration exaggerates which murmur?
Mitral regurgitation
103
Causes of a third heart sound
Left ventricular failure - dilated cardiomyopathy
Constrictive pericarditis
Mitral regurgitation
