Cardiology Flashcards
(122 cards)
1
Q
Which artery is most likely to be affected if post M.I there is a brady arrhythmia? and what type of arrhythmia is most common?
A
Inferior M.I due to RCA blockage
1st degree AV block
2
Q
What are some common causes of tachy arrhythmias that can be reversed without shock or anti-arrhythmia drugs?
A
high K+ / Low K+
Hypoxia
Hypercapnia
Acidosis
Hypercalcaemia
3
Q
What scoring system is used for NSTEMIs to predict risk of another MI or stroke within 6 months of a NSTEMI?
A
GRACE score
> 10% = surgical intervention
4
Q
What are the causes of Acute De Novo heart failure?
A
ICHAMP - iatrogenic fluid overload - Coronary syndrome - Hypertension - Arrhythmias - M.I - P.E -
5
Q
What are the key symptoms for heart failure?
A
Breathlessness
Fatigue
Oedema
6
Q
What is the greatest risk factor for endocarditis?
A
Previous endocarditis
7
Q
What important electrolyte abnormalities can cause VT>
A
Hypokalemia
Hypomagnesemia`
8
Q
What is first line management for diabetic patients with hypertension? regardless if they are above or below 55?
A
ACE inhibitor
9
Q
In patients with a provoked P.E (i.e. recent surgery) how long should they be warfarinised following the P.E?
for those who have an unprovoked P.E, how long should they be?
And how long for someone with active cancer?
A
provoked: 3 months
Unprovoked: >3 months
Cancer: 6 months
10
Q
What is needed to have trifascicular block?
A
Anterior or posterior fascicular block \+ RBBB \+ 1st degree heart block
(remember to have left anterior fascicular block you need left axis deviation + rS wave in leads II,III, aVF)
(to have left posterior fascicular block you need right axis deviation + rSV wave in leads II, III, aVF) *rare
11
Q
After initial bloods and ECG what investigations should be done into palpitations?
A
Holter monitor
12
Q
What may be seen with hypothermia on the ECG?
A
Prolonged QT interval
J waves
13
Q
Which type of heart rhythm is always abnormal?
A
LBBB
14
Q
In order for there to be a STEMI what must be present?
A
> 2mm change in two consecutive leads in V1 - V6
or
1mm change in two consecutive leads in limb leads
+/-
LBBB
15
Q
What is a sign of constrictive pericarditis?
A
Raised JVP during inspiration
16
Q
What defect is typically seen with Down’s syndrome babies?
A
Ventricular septal defect
17
Q
What should be offered to all heart failure patients annually?
A
Influenza Vaccine
18
Q
If someone has a stroke due to AF, following the initial aspirin for 2 weeks, what medication should they be started on afterwards?
A
Warfarin
19
Q
What is the biggest risk factor towards aortic dissection?
A
hypertension
20
Q
What disease is most likely if a young female present with episodes of dizziness and lethargy and has an absent pulse on one side - usually left.
A
Takayusa’s vasculitis
- causes inflammation of the large vessels which can cause occlusion on one side
21
Q
What two rhythms cannot be shocked?
A
Pulseless electrical activity
asystole
22
Q
If a patient has suspected P.E but has renal disease, what investigations should be done?
A
V/Q miss match
- not CTPE
because renal function cannot handle the contrast
23
Q
In the setting of infective endocarditis that is causes heart failure, what is the definitive management?
A
Immediate surgical intervention for valvular replacement
24
Q
Where is the QT interval measured from?
A
From the start of the Q wave to the end of the T wave
25
Where is the PR interval measured from?
Start of the P wave to the start of the Q wave
26
What is an abnormal QT interval?
It should be half the cardiac cycle.
at 60bpm it should be
<440m/s in males
<460m/s in females
QTc needs to be established though because as the HR increases the QT reduces.
27
Breathing problems with dropping sats and a clear chest one should think?
P.E
28
What tests are important to do prior to starting amiodarone?
TFTs - thyrotoxicosis
LFTs - hepatitis
U&Es - detect hypokalamia which may cause the arrhythmias
CXR - underlying fibrosis or pneumonia
29
What type of breath sound may be heard with acute heart failure? outwith things such as crackles
Polyphonic wheeze
- due to oedema build up
30
What are the reversible causes of a cardiac arrest?
Hypothermia
Hypoxia
Hypovolaemia
Hypokalaemia / hyperkalaemia / hypoglycaemia
Tension pneumothorax
Toxins
Tamponade
Thrombosis
31
If there is systolic murmur which radiates to the back with splitting of S2, what is likely defect?
Atrial septal defect
32
List some differentials for ST elevation:
```
Myocardial infarction
pericarditis
Takotsubo cardiomyopathy
Intracranial hemorrhage
Left ventricular aneurysm
```
33
In a thoracic arotic disection, what ECG findings would you likely see?
ST elevation in inferior leads
- aVF
- II
- III
34
What does T wave inversion suggest?
Ischemia
Left ventricular hypertrophy
35
If a patient requires emergency surgery and is on warfarin, what should be done?
Prothrombin complex concentrate
36
What is the most common ECG finding of a P.E?
Sinus Tachycardia
37
What is the drug of choice for chemical cardioversion if there is no structural heart disease?
Flecainide
38
What is the most common cause of sudden death syndrome in young people, how is it inherited and name some clinical findings:
Hereditary obstructive cardiomyopathy
Autosomal dominant
- Exertional syncope
- systolic ejection murmur
39
How is Torsades de Pointes treated?
IV magnesium sulphate
40
In cardiac asystole what is the management?
Chest compression. stop every 2 mins and reasss. Adrenaline given every 3-5mins
41
What are the indications for transcutaneous cardiac pacing?
Complete AV block
- and M.I with instability
Secondary degree heart block
- with M.I and instability
First degree
- with instability
Bradycardia with adverse signs when atropine has been ineffective
42
In orthostatic hypotension, what drop in blood pressure is needed?
>20mmHg
43
What drug is contraindicated in aortic stenosis?
GTN
44
Which two beta blockers have been showing to reduce mortality in heart failure?
Carvedilol
Bisoprolol
45
Statins can induce an increase in liver enzymes, when should they be discontinued?
LFTs need to be >3x normal limit before being discontinued.
46
Following an M.I, how long until you can drive again?
4 weeks
47
Which commonly used anti- hypertensive is contraindicated in pregnancy?
ACE inhibitors
48
How long should a patient be observed for following an anaphlyatix reaction?
6-12 hours
| - due to biphasic reaction
49
In bradycardia if there is a risk of asystole or the patient is unstable, what is the first line? and what is second line?
First line:
* Atropine 500mcg IV
No improvement:
* Atropine 500mcg IV repeated to 3mg
* Other inotropes
* Transcutaneous cardiac pacing (using defibrillator)
50
What is the immediate management for NSTEMI?
```
Clopidogrel
Aspirin
Heparin
+/-
Beta blockers
+/-
Nitrates
+/-
Oxygen
```
51
Following an NSTEMI a grace score should be calculated, if >10% what should be done?
inpatient coronary angiography
CABG
PCI
- if symptomatic
52
2-3 weeks following an MI a patient develops pleuritic chest, pericardial rub and fever.
ECG shows global ST elevation and bloods increased CRP and ESR.
what does this patient have? and how is it managed?
Dressler's syndrome
- post immune mediated
* NSAIDs
* Steroids
* pericardiocentesis
53
What are some aetiologies to AV block?
Congenital
Idiopathic fibrosis
MI/ Ischemia - Right coronary artery
Inflammation
- infective endocarditis
- Sarcoidosis (chronic), Chaga's disease
Trauma
Drugs
- Beta blockers
- digoxin
54
What are some aetiologies of RBBB?
Normal variant
Right Ventricular hypertrophy/ strain
- P.E
Coronary heart disease
Atrial septal defect
55
What are some aetiologies of LBBB?
Coronary heart disease
Hypertension
Cardiomyopathy
Aortic Valve disease
56
What are some of the conditions/ states that are associated with atrial flutter?
Cardiomyopathy
thyrotoxicosis
Hypertension
Ischemic heart disease
57
What is the management for Atrial flutter?
Rhythm/ Rate control
Radiofrequency ablation
Anti-coagulation
58
What does AVNRT stand for?
Atrial ventricular nodal reentry tachycardia
59
What are the three main types of SVT?
AVNRT
AVRT
Atrial Tachycardia (tachy originates in atrium)
60
What is the long term management for SVT?
Medication
- beta blockers, Ca2+ blockers, Amiodarone
Radiofrequency ablation
61
What is the accessory pathway in wolf -parkinson white syndrome called? and what medications are contraindicated in this condition?
Bundle of Kent
Calcium channel blockers, Beta blockers and adenosine are contraindicated.
- they significant increase the risk of slowing conduction through the AV node, encouraging the current through the bundle's of kent.
- this can put the patient in a polymorphic wide complex tachycardia
62
Briefly outline the pathophysiology behind Torsade de Pointes:
Prolonged repolarization of the ventricles leads to some myocytes to undergo spontaneous depolarisation - called [afterdepolarisations].
These then trigger further depolarisations prior to ventricles fully repolarizing
63
What is the management for torsades de pointes?
Remove causative medications
- macrolides
- citalopram
- amiodarone
IV magnesium infusion
Defib if VT develops
64
How big are the boxes in 1st degree heart block?
5 small or 1 big box
| - 0.2m/s
65
Which types of heart block increase the risk of asystole?
Mobitz type II
3rd degree heart block
66
What are some side effects of atropine?
Pupil dilation/ mydriasis
Dry mouth
Dry eyes
Urinary retention
67
What are some x-ray signs of heart failure?
Upper lobe venous diversion
Kerley B lines
Fluid within the intralobular fissures
Bat-wing sign
Bilateral pleural effusions
68
What is the management of severe pulmonary oedema that is not responding to diuretics, sitting up and oxygen alone?
```
CPAP
Dilators - morphine
ITU admission
+
Diuretics
Sitting up
```
69
How many small squares should the QRS be?
< 3 = <120m/s
70
What is the criteria used for rheumatic fever?
```
Jone criteria:
Evidence of Strep infection +
1 major + 1 Minor
or
2 Majors
```
Step infection:
- Streptolysin O antigen
- recent strep throat
Major:
Pericarditis
- murmur
- pericardial rub
Polyarthritis
Subcutaneous nodes
Erythema Marginatum
Chorea movements
Minor:
- fever
- arthralgia
- Raised ESR
- Previous Rheumatic fever
71
How is rheumatic fever treated?
Benzylpenicillin STAT
followed by:
- phenoxymethylpenicillin 10 days
NSAIDs
+/-
prednisolone
Haloperidol
72
What are the blood pressure targets:
<80: <140/90
>80: <150/90
Diabetics: <130/80
73
What score is used to assess if a P.E patient should be managed in hospital?
PESI
74
What are the clinical findings of infective endocarditis?
```
Janeway lesions
Osler's nodes
Splinter Hemorrhages
Roth Spots
Finger clubbing
Anaemia
Splenomegaly
Haematuria
Murmur
```
75
What is the adrenaline dose given to patients:
0-6 years = 0.15ml in 1 in 1000 = 150 micrograms
6 - 12 years = 0.3ml in 1 in 1000 = 300 micrograms
>12 years = 0.5ml in 1 in 1000 = 500 micrograms
76
What are the two broad types of heart failure?
Reduced ejection fraction:
- Coronary heart disease
- Younger patients
- Males
Preserved ejection fraction:
- elderly
- females
- Hypertension
- Ventricular hypertrophy
High Output failure:
- Anaemia
- pregnancy
- Hyperthyroidism
77
How is acute heart failure managed?
Sit patient up
100% oxygen
Slow titrated morphine
+/- antiemetic
Furosemide
x2
- if needing more referral to senior staff
GTN
Consider:
- CPAP
- referral to senior staff in ICU
PODMAN
- Position up right
- oxygen
- Diuretics
- Morphine
- Anti emetics
- NItrates
78
What are some contraindications to CPAP?
```
BP <90mmHg
Facial trauma
Pneumothorax
Type II respiratory failure
Reduced consciousness
- not responding to pain
```
79
What are some complications of CPAP?
Hypotension
Aspiration
Gastric distention
Anxiety
80
What investigations should be done into angina?
CT angiography
ECG
Stress ECG
81
What are the secondary prevention medications used for angina?
Aspirin
ACE
Statins
Atenolol (although will usually be on for symptom control)
82
What are some causes of tachyarrhythmias?
Cardiac:
- MI
- Long QT syndrome
- Cardiomyopathy
Non cardiac:
- Hypoxia
- Hypomagnesemia
- Hypokalemia
- Sepsis
- Hypoglycaemia
Drugs:
- Cocaine
- TCAs
- Amphetamines
83
What investigations should be done into tachycardia?
Bloods:
- FBC
- U&Es - K? Mg?
- Bone profile - Ca2?
- TFTs
- coagulation studies
Orifices:
X-ray:
- Chest x-ray
ECG - essential
84
What are some causes to bradyarrhythmias?
Physiological normal in young and extremely fit
Cardiac:
- post MI
- Sinus Node disease
- AV block
Non - cardiac
- vasovagal
- Hypothermia
- hypothyroidism
- raised ICP - cushing's effect
Drug induced
- Calcium channel
- beta blockers
- Digoxin
85
What are the causes of cardiac shock?
```
M.I
Arrhythmias
P.E
Tension pneumothorax
Aortic dissection
```
86
How is cardiogenic shock managed?
ABCDE approach
Investigate the cause and look to reverse
Management often requires ICU
- Oxygen
- Morphine for anxiety
- Correction of cause (arrhythmias etc)
- Optimize filling pressures - plasma expanders/ dobutamine if to low
87
What must be present in order to diagnose an M.I?
ECG changes + troponins
Signs and symptoms + troponins
88
What are the other causes which can cause troponins to rise?
```
Congestive heart failure
Sepsis
Chronic renal failure
Tachyarrhythmias
P.E
Infiltrative cardiomyopathies
- Sarcoidosis
- Amyloidosis
```
89
If there is a posterior wall infarction which vessel has been occluded?
Left circumflex
90
What are the stages of hypertension?
Stage 1: >140-160 or >135
Stage 2: >160 - 180 or 155
Stage 3: >180/110
91
What are the causes to hypertension?
Primary
- idiopathic
- low birth weight
- Environmental factors
Secondary
- Primary aldosteronism
- Pheochromocytoma
- Cushing's disease
- Hyperthyroidism
- Renal stenosis
- Drugs - oral contraception
92
How is the diagnosis of hypertension made?
Clinic - 2 reading, 5 mins apart over 2 appointments
- >140/90
Home Ambulatory: >135/85
Night time measuring: >120/80
93
Who always gets treated for hypertension?
>160/100 - stage 2
or
>150/90 Home ambulatory
94
What tests should be conducted in hypertension to exclude secondary causes?
Bloods:
- U&Es
- TFTs
- Lipid profile
- Fasting glucose
Orifices:
- Urine analysis - kidney damage
- Urine metadrenaline - Chromocytoma
- Urinary free cortisol
X-ray
- Echocardiogram
- Renal ultrasound - renal stenosis
ECG
- LVH?
95
If a patient is being thrombolysed following an MI and are on diabetic medication, what should happen with regard to their medication?
Stopped and placed on a insulin infusion
96
What electrical activity can be seen on ECG with a cardiac tamponade?
Electrical alternans
| - QRS fluctuates in size
97
What other symptoms outwith chest pain are associated with angina?
Sweatiness
Dyspnea
Faintness
Nausea
98
What is the management for Angina?
Lifestyle advice
Referral to cardiology
Symptom relieve:
- GTN spray
Symptom control:
- Beta blocker
- Ca2+
- Combined
- Nicorandil
Secondary prevention:
- Aspirin
- ACE
- Atorvastatin
Surgical input
- CABG
- PCI
99
What investigations should you do into postural hypotension?
Sit to rising - Taking times at 2,3,7 mins
Table tilt test
Valsalva maneuver
24 hour blood pressure monitoring
100
Name non- pharmacological ways of reducing falls in orthostatic hypotension:
Stand slowly
Sit cross legged
Increase Salt intake
Referral to falls clinic
101
What is the medication that be used in orthostatic hypotension?
Fludrocortisone
102
What are the complications of untreated hypertension?
```
Stroke
Heart failure
M.I
PVD
Renal stenosis
Aortic dissection
Retinopathy
```
103
In coronary heart disease, what score can be done to assess the risk of an adverse advent?
QRISK 3
104
What symptoms may someone with coronary heart disease have and how is it managed?
```
Angina
Strokes
MI
PVD
Mesenteric ischemia
```
Primary:
- QRISK 10% > aspirin and atorvastatin
```
Secondary
- previous adverse event
Aspirin
80mg Atorvastatin
ACE
Beta blocker
```
105
What are some causes to pericarditis?
Recent viral infection
Dressler's syndrome
Uraemia
Autoimmune
- RA
- SLE
Radiotherapy
106
How is pericarditis managed?
NSAIDs
Steroids
Colchicine
severe:
- pericardial paracentesis
Life threatening:
- Pericardiectomy
107
What does a lipid profile include?
Total levels of cholesterol
Triglycerides
HDL
108
What is the management of hyperlipidaemia?
Lifestyle changes
Lowering of BMI
1st line: Atorvastatin
2nd line: Ezetimibe (cholesterol absorption inhibitor)
3rd line: Alirocumab (PCSK9 inhibitor - blocks LDL)
109
What are the main categories of dyslipidemia?`
Hypercholesterolaemia
Hypertriglyceridemia
Mixed hyperlipidaemia
110
What are some secondary causes to hypercholesterolaemia and hypertriglyceridemia?
Hypercholesterolemia:
- hypothyroidism
- pregnancy
- cholestatic liver disease
Hypertriglyceridemia:
- DM type 2
- Chronic renal disease
- abdominal obesity
- Excess alcohol
111
What are some clinical manifestations of hypercholesterolaemia?
Xanthelasma - around the eyes
Corneal arcus
Xanthomas
- achilles
- Knee
- Extensors
112
What are the clinical signs of hypertriglyceridemia?
Lipaemia retinalis
Lipaemic and blood
Eruptive Xanthomas
113
Signs and symptoms of AF?
Palpitations
Hypotension
Chest pain
Dizziness
Breathless
Evidence of a stroke
114
What are some symptoms of heart failure?
Breathless
fatigue
Paroxysmal nocturnal dyspnoea
Nocturnal cough
Wheeze
Cold peripheries
Congestion - if right sided
Poor exercise in tolerance
115
What investigations should be done into angina?
ECG
Exercise ECG
Angiography - CT Angiography or Transcatherter angiography - which allows for therapeutic intervention as well
116
What are the signs of Mitral regurgitation? and what is the definitive diagnosis?
Displaced - hyperdynamic apex beat
Pansystolic murmur heard at apex - radiates to axilla
Splitting of S2 due to pulmonary oedema
Tests:
- initially Transesophageal echo
- cardiac catheterisation to confirm diagnosis - measure pressures
117
What are the complications of mitral regurgitation?
Arrhythmias
Stroke
Sudden death syndrome
118
What are the signs of Mitral stenosis? and how is it diagnosed? and treated?
Usually presents with signs of pulmonary oedema
```
Mid-diastolic snap
Heard on apex - best in expiration
Malar flush on cheeks - low cardiac output
Low volume pulse
RV heave
```
Diagnosis:
- echocardiogram
Management:
- control AF - rate limiting
- Anticoagulation
- Balloon dilation
- valvular replacement
119
What are the classical presentational symptoms of aortic stenosis?
```
Chest pain
Exertional syncope
Heart failure
Dyspnoea
Dizziness
```
Signs:
- Ejection systolic murmur - crescendo decrescendo
- slow rising pulse
- narrow pulse pressure
- Heaving
- LBBB
- Complete AV block
- LVH strain
Management:
- valvular replacement
- TAVI
120
Name some signs seen with aortic regurgitation:
Externational dyspnoea
palpitation
Syncope
```
High pitched early diastolic murmur
Collapsing pulse
Wide pulse pressure
Hyperdynamic apex beat
Head nodding - Musset's sign
Pistol shot over the femorals
```
Cardiomegaly
pulmonary oedema
121
How is aortic regurgitation assessed?
How is it managed?
Diagnosed via echocardiogram with doppler
Assessed for severity using cardiac catheterization
```
Control hypertension - ACE
Echo every 6-12 months
Valvular replacement
- if severe
- enlarging
- Deterioration in LV functioning
```
122
What are features of pericarditis pain?
What are some clinical findings of pericarditis?
```
Direct retrosternal pain
Pain relieved by sitting forward
No Pain related to activity
Pain is worse on deep inspiration
Fever may also accompany
```
Pericardial Rub
ECG - ST elevation across all leads
QRS Alterna
