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Phase 4 > Cardiology > Flashcards

Cardiology Flashcards

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1
Q

What are the causes of bradycardia?

A 
DIVISION 
Drugs 
- beta blockers 
- Digoxin
- Ca2+ blockers

Iscehmia

Vagal tone

Infection
- Infective endocarditis

Sick Sinus Syndrome

Infiltrative

  • sarcoidosis
  • Amyloid

O

  • Hypothyroidism
  • Hypokalemia

Neuro
- ICP

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2
Q

If a person is only started on rate control for AF, what else must the be prescribed?

A

Anti-coagulation

DOAC
or
Warfarin for valvular disease

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3
Q

What is the target HR in AF?

A

<90bpm

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4
Q

What are the complications of hypertension?

A

CANER

  • Cardio
  • Aorta
  • Neuro
  • Eyes
  • Renal
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5
Q

What clinical signs may you find of hypertension?

A 
Ventricular heave 
4th heart sound 
Abdominal bruits 
enlarged kidneys 
Radiofemoral delay
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6
Q

What is the management for Mitral stenosis?

A

Balloon Valvotomy

Anticoagulation
Beta blockers
Diuretics - to reduce pressure on atrium

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7
Q

What are the major causes of Dyslipidemia?

A

Predominantly hypercholesterolaemia
- primary: - Familial - loss of ApoB100

  • Secondary: Nephrotic syndrome And Hypothyroidism

Predominantly Triglyceridemia/ mixed:
- primary: - Lipoprotein Deficiency

  • Secondary: - Diabetes, central obesity
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8
Q

In a lipid profile, what is investigated?

A

Total cholesterol
HDL
LDL
Fasting triglycerides

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9
Q

What is the treatment for hyperlipidaemia?

A

Remove underlying causes

  • hypothyroidism
  • Diabetes

Lifestyle changes

1st: Atorvastatin
2nd: Ezetimibe
3rd: alirocumab

Hypertriglyceridemia:
1st: Fibrates

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10
Q

Which Valvular abnormality gets a TAVI?

A

Aortic Stenosis

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11
Q

What additional tests should be done into HTN?

A

Bloods:
• U&Es
- Assess renal damage
- Low K+ would also suggest primary aldosteronism

* Serum total cholesterol and HDL cholesterol
* TFTs   
* Serum glucose 
Orifices: 
	• Urinalysis 
	- Proteins 
	- Blood 
	- Glucose

ECG:

Consider secondary causes:

  • Cortisol
  • metadrenalines
  • renal ultrasounds
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12
Q

Following a PCI, if a patient develops severe chest pain, what should be done?

A

There can be failure of the procedure.

CABG needs to be considered

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13
Q

What measuring device can be put in place to measure the filling pressures of the heart - which are useful for assessing the type of shock someone is in?

A

Pulmonary artery catheter

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14
Q

Name some differentials for a P.E:

A

Pneumothorax

Pneumonia

Unstable Angina

Asthma

Pericarditis

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15
Q

What are some potential findings of P.E on x-ray?

A

Wedge shaped opacity

Enlarged pulmonary artery

Pulmonary opacities

Pleural effusion

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16
Q

What is the ABG likely to show on a P.E?

A

Respiratory alkalosis

In massive P.Es you may get mixed metabolic acidosis due to hemodynamic collapse

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17
Q

What are the complications of mitral stenosis?

A

Pulmonary hypertension

AF

Dysphagia

laryngeal palsy

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18
Q

What are the symptoms of a mitral valve prolapse and what are some complications of it?

A

Sudden onset breathlessness
Atypical chest pain
Palpitation
Anxiety attack

Complications:

  • Mitral regurgitation
  • Arrhythmias
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19
Q

What are the causes to cardiogenic shock?

A

MI HEART

MI 
Hyperkalemia
Endocarditis 
Aortic dissection
Rhythm disturbance 
Tamponade
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20
Q

What are the signs of a cardiac tamponade?

A

Beck’s signs:

  • raised JVP - during inspiration
  • Muffled heart sounds
  • Low BP

Kussmaul’s breathing

Pulsus paradoxus

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21
Q

What additional investigation can be done in AF to rule out thrombosis formation?

A

Transesophageal echocardiogram

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22
Q

Why is spironolactone used in heart failure?

A

Has been showing to increase life expectancy

- 30% reduced mortality

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23
Q

What should be checked prior to starting someone on an ACE inhibitor?

A

Renal function

  • not recommended in AKI
  • Renal stenosis contraindicated
  • if serum creatinine rises should be withheld

Electrolytes
- increases K+

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24
Q

What are the cardinal changes on ECG that are seen for a full thickness MI?

A

ST elevation in two continuous leads

  • Chest leads > 2mm (2 small boxes)
  • Limb leads >1mm (1 small box)

Q - waves

T Waves
Reciprocal are not cardinal

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25
In heart failure what are you looking for on ECHO?
Ejection fracture and peak velocity Valvular abnormalities Wall thickness Heart size
26
Other than medications, what treatments should be implemented into heart failure?
``` Low Salt intake Low restriction Rehabilitation exercise programs Low fat diet Weight loss Education ```
27
Why should IV drugs be used in severe hypotension?
Reduced absorption from SC or G.I or Rectal if low perfusion
28
What are the features of pericarditis?
Sharp Central Worse when leaning back
29
What are some causes of pericarditis?
Autoimmune Dressler's Infection Uraemia
30
With acute onset breathlessness in LV failure, what questions do you want to ask?
``` Is it made worse lying down? Normal level of exercise? Sputum? Syncope? Chest pain? ```
31
What will an ECG of aortic stenosis show on ECG?
Left ventricular hypertrophy Left axis deviation
32
What are the two types of electric shock delivered, and when is what given?
DC synchronised cardioversion - timed with QRS - for downslope of Q wave Defibrillation - given at any point through cardiac cycle. Cardioversion used when: - AF - Atrial flutter - VT WITH pulse but unstable Defibrillation - VF - VT WITHOUT a pulse
33
How long does Dressler's take to present?
Few weeks. - there will be fever as well If there is symptoms consistent with pericarditis following M.I within a few days it is simply pericarditis
34
How can you differentiate between JVP and carotid and what things will cause it to rise?
2 waves form Hepatojugular reflux Non- palpable pulse Heart failure Fluid overload Constrictive pericarditis Tamponade
35
What are the signs of Pericarditis?
Pleuritic central pain Worse on: - inspiration - Lying back - lean forward for relieve Pericardial friction rub Fever ECGs: - ST saddle shape - PR depression
36
Why do heart failure patients get worse symptoms at night?
1. Lying flat allows fluid to build up 2. Reduced respiratory effort due to sleep - allows saturations to change more drastically and more shallow breathes 3. Less adrenaline levels - less cardiac output - worse heart failure
37
Specifically what BNP is monitored for in heart failure? and what additional tests should be done?
N terminal Pro-B type natriuretic / NT proBNP ECG Echocardiogram
38
In heart failure, who should not get ACE inhibitors?
Valvular disease patients
39
What are the grades of a murmur?
Grade 1: Difficult to hear Grade 2: Quiet Grade 3: Easy to hear Grade 4: Easy to hear with palpable thrill Grade 5: Can hear it with stethoscope just touching Grade 6: Without stethoscope
40
Outwith CT angiogram what other investigations can be done into angina?
Stress echo Stress ECG Myocardial perfusion scans CT calcification
41
List some causes of non cardiac progressive breathlessness
``` Anemia COPD Lung cancer Interstitial lung disease Pleural effusion Sarcoidosis ```
42
In HTN, what does Left ventricular hypertrophy demonstrate?
End organ failure | - heart is struggling
43
What is the INR target for AF when anticoagulation with warfarin?
2-3
44
What can falsely lower BNPs?
Beta blockers ACE Aldosteronism antagonists Obesity
45
What are the shockable rhythms?
VT - which will be pulseless VF - which will also be pulseless
46
What are some causes of RBBB?
Can Be normal Pulmonary hypertension P.E M.I Cardiomyopathy Fibrosis Chagas disease
47
What are some causes of LBBB?
Aortic stenosis Hypertension M.I Severe coronary artery disease
48
When shocking someone, why is the shock delivered on the QRS?
It is an easily definable mark to be shocked on and ensure not shocking on T wave - which would cause VF
49
What is the management for long term VT?
Implantable cardiac defibrillator
50
What drugs can be used for rhythm control of AF?
Beta blockers Flecainide Sotalol - actually works by class III action - K+ Amiodarone
51
What are the different classifications of AF?
Acute - first presentation Paroxysmal - terminates within 7 days Persistent - requires cardioversion to stop Permanent - does not terminate. Requires rate control
52
What factors should be considered when thinking about cardioverting someone from AF?
How well the arrhythmia is tolerated Whether anticoagulation is required Whether spontaneous cardioversion is likely Whether cardioversion is likely to work
53
If AF >48 hours what is the anticoagulation times?
3 weeks before | 4 weeks afterwards
54
Who is typically considered for rhythm control in AF?
Younger patients Symptomatic patients Active patients Recurrent paroxysmal
55
How can the rate limiting effect in AF be assessed?
ECG holder | Exercise stress test
56
What maneuver can be done to expose F waves seen in atrial flutter?
Carotid massage or Adenosine
57
If a young person has RBBB and stroke what is the likely defect?
Patient Foramen ovale
58
A raised JVP during inspiration is called? and is associated with what?
Kussmaul sign Cardiac tamponade
59
What are the first signs on ECG of M.I?
Hyperacute T waves - the T waves will then flip afterwards - usually within 24 hours. Q waves begin usually after 24 hours and last for a long time
60
Why should statins be stopped during pregnancy?
Cholesterol is essential for the fetus
61
Whats the most common cause of death in M.I?
VF
62
What are some causes of Prolonged QT?
``` Hypokalaemia Hypomagnesaemia Hypocalaemia Macrolides Quinolones Amiroadone M.I ```
63
What is the presentation of mitral stenosis? and how should it be investigated?
``` AF Pulmonary hypertension - dyspnea - frothy bloody sputum Right heart failure ``` Investigations: - CXR - ECG - Echocardiogram
64
How can the murmur of mitral stenosis be described?
Splitting of the S2 with diastolic low rumble The 2nd S2 sound is actually the snapping opening of the mitral valve.
65
What is the most common cause of aortic stenosis?
Calcific Aortic Valvular Disease Bicuspid Aortic Valve Rheumatic fever
66
When analysing an echocardiogram for aortic stenosis, what things are you looking for?
Valvular calcification Left ventricular hypertrophy Peak velocity of outflow
67
What is pulsus alternans? and what does it signify?
It is where there is a strong contraction and then a weak contraction. - associated with severe myocardial failure. May seen on blood pressure monitoring changes as much as 50mmHg
68
What things may cause a soft S1 sound?
``` Mitral regurgitation Shock Heart Failure Obesity Emphysema ```
69
What murmur may be associated with aortic stenosis and what is it? and what can it be mistaken for and how is that resolved?
Gallavardin phenomenon - where there is a musical like radiation to the apex Often mistaken for Mitral regurgitation Can be differentiated because mitral regurgitation radiates to the axilla
70
What are the signs of aortic regurgitation?
``` Collapsing pulse Wide pulse pressure Capillary Pulsation Head nodding with each heart beat Pistol shot femoral ``` **high pitched over the left sternal edge 4th intercostal space
71
What murmur is associated with Aortic regurgitation?
Austin Flint murmur
72
How does aortic dissection present?
``` Sever pain radiating to the back Hypertension **differentiates from AAA Reduced pulses peripherally Different pulses on limbs Aortic regurgitation (present with type A) ```
73
What is the diagnostic investigation and what medical management for an aortic dissection?
CT angiogram of thorax and abdomen Maintain a low blood pressure - beta blocker - labetalol IV - GTN IV - Contact cardio-thoracic surgeons
74
What blood tests do you want for a suspected P.E?
``` FBC - infection? ABG D-dimers U&Es - for contrast use Coagulation screen ESR ```
75
Prevention of a P.E can be achieved via:
LMWH Enoxaparin Stockings Early mobilisation ERAS IVC filters
76
When should diabetics be started on hypertensive medication?
Home ambulatory >135/85
77
What are some of the complications of infective endocarditis?
Stroke Congestive heart failure P.E AKI - with nephritic syndrome Splenic infarction Septic arthritis
78
When is surgery indicated for Infective endocarditis?
Signs of heart failure Multiple septic emboli Abscess formation Obstruction of the valve Persistent positive cultures
79
What is the wanted antibiotics for prosthetic valve endocarditis?
``` Vancomycin + Gentamicin + Rifampin ```
80
How can you distinguish a pericardial rub from a pleuritic rub?
Ask the patient to hold their breath
81
When is a cardiac rupture most likely to occur following an M.I?
3-7 days - due to macrophage involvement of the removal of necrotic tissues **most common an anterior rupture due to LAD involvement
82
Why is there pain to the left arm during an MI?
T1 dermatomal distribution
83
Who receives eplerenone following an M.I?
Diabetic patients | Ejection fraction <40%

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