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Cardiology Flashcards

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1
Q

What is the normal axis of the QRS complex?

Which leads to these numbers represent?

A

-30 -> +90
-30 = aVL
+90 = aVF

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2
Q

What is the dominant pacemaker of the heart? Rate?

What other pacemaker cells exist? Rate?

A

SA Node: 60-100

AV Node: 40-60
Ventricular cells 40-60

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3
Q

ECG: ST elevation in leads I, aVL, V5, V6
Which view of the heart?
Which coronary artery?

A

Lateral view

Circumflex

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4
Q

ECG: ST elevation in leads II, III, aVF
Which view of the heart?
Which coronary artery?

A

Inferior

Right coronary artery

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5
Q

ECG: ST elevation in leads V1, V2
Which view of the heart?
Which coronary artery?

A

Septal

Left Anterior Descending

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6
Q

ECG: ST elevation in leads V3, V4
Which view of the heart?
Which coronary artery?

A

Anterior

Right Coronary Artery

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7
Q

5 modifiable risk factors for IHD?

A 
Smoking
Diabetes
High cholesterol (LDL)
Obesity/sedentary lifestyle
Hypertension
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8
Q

3 non-modifiable risk factors for IHD?

A

Increasing age
Biological sex
Family history/genetics

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9
Q

What are the classic signs + symptoms of IHD?
Pain - radiation
Others?

A

Crushing, crescendo central chest pain. “squeezing, tight” - may radiate to neck, jaw, left shoulder, arm

Pallor, dyspnea, diaphoresis, , nausea/vomiting, anxiety

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10
Q

ECG investigations & biochemical markers for the 4 main IHD
What are the main markers?

A

1: ECG
Normal in SA
ST depression, Inverted T-waves in UA & NSTEMI

ST elevation & pathological Q waves in STEMI

2: Biochemical markers
Normal in SA and UA
Raised in NSTEMI
Raised in STEMI

Troponin I, Troponin T, Creatine Kinase myocardial band (CK-MB)

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11
Q

What other investigations can you do for IHD? (other than ECG and markers) (4)

A

Echocardiography - can show damage

CT angiography - good NPV, exlcuding disease

Exercise tolerance test - use drugs now

Invasive angiogram - can tell you FFR (fractional flow reserve)

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12
Q

Two types of revascularisation.

Adv and Dis of each

A

Percutaneous Coronary Intervention (PCI/stents)
Less invasive, convenient
Risk of restenosis

Coronary Artery Bypass Graft (CABG)
Good prognosis
Very invasive, long recovery

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13
Q

What is prinzmetals angina?
ECG?
Can lead to….
2 important management points?

A

Coronary Artery Vasospasm

Will cause ST-segment elevation: full occlusion

Can lead to arrhythmias

Calcium-channel blockers + avoid smoking

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14
Q

Significant difference between ACS symptoms and SA?

A

Stable angina: relieved by GTN spray and rest

ACS: not relieved easily

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15
Q

Initial managment of unstable IHD?

A 
Call an ambulance
M: morphine
O: oxygen
A: aspirin
N: nitrates
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16
Q

What is a silent heart attack?

Who is it more common in?

A

An MI with little or minimal symptoms

Women and diabetics

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17
Q

5 potential complications of an MI?

A
  1. Heart failure
  2. Rupture of ventricle or septum
  3. Mitral regurgitation
  4. Arrhythmias - eg, heart blocks
  5. Pericarditis
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18
Q

GUIDELINE TREATMENT OF ANGINA:
3 immediate actions
Next steps
Still intolerant?

A

Platelet therapy: Aspirin, Clopidogrel, Ticagrelor
Statins: Atorva or Simva
GTN spray

First line: BB or CCB
Switch, Combine

Still intolerant?
Long-acting nitrate or revascularisation

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19
Q 
ACEi:
Stands for?
Used in?
2 examples?
Side effects?
Less effective in...
Not used in...  (2)
A

Angiotensin Converting Enzyme inhibitor

Hypertension, Heart Failure, Diabetic Nephropathy

Ramipril & Enalapril

Dry cough
Hypotension, rash, allergy, renal failure

Afro-Caribbean

AKI & pregnancy

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20
Q 
ARB:
Stands for?
Used in?
3 examples?
Contraindicated in...?
A

Angiotensin II receptor blocker

Hypertension, Heart failure, Diabetic Nephropathy

Candesartan, Valsartan, Losartan

Not used in pregnancy

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21
Q 
CCBs:
Used in?
Stands for?
Which type of channels?
Used in?
Examples: 2 categories
Side effects?
A

Calcium Channel Blockers - dilate arteries/arterioles

IHD, HTN, arrhythmias

L-type calcium channels

Hypertension, IHD, arrhythmias

Amlodipine, -pines
Diltiazem, Verapamil

Side effects: flushing, headache, oedema
Bradycardia, AV block, constipation in diltiazem & verapamil

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22
Q 
BBs:
Used in?
Stands for?
Examples
What does selectivity mean in this context?
Side effects?
Contraindication!
A

Beta-adrenoreceptor blockers

IHD, heart failure, HTN, arrhythmias

Atenolol, Bisoprolol, Metoprolol, Propanolol

Selective (only beta-1) (A-> N)
Non-selective (beta-1 & beta-2) (O -> Z)

Fatigue, headache, sleep disturbance, bradycardia

Asthma (maybe COPD)

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23
Q

DIURETICS:
Used in?
3 types w/ examples
Side effects?

A

HTN + Heart Failure

Thiazides - bendroflumethiazide, hydrochlorothiazide

Loop diuretics - furosemide, bumetanide

Potassium-sparing diuretics - spironolactone, eplerenone (aldosterone antagonists), amloride

Hypovolaemia, Hypotension, Low K+/Na+/Mg2+/Ca2+, Gout

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24
Q 
NITRATES:
Used in?
Mechanism?
3 categories - w/ examples
Side effects?
A

IHD & Heart Failure

Arterial + Venous dilation (decrease preload + afterload)

Long-acting (isosorbide, nicorandil, ivabradine)
Short-acting (GTN spray)
GTN infusion

GTN syncope and headaches

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25
4 types of cardiomyopathy | Which is most common? (number)
``` Hypertrophic Cardiomyopathy (HCM) Affects 1 in 500 ``` ``` Dilated Cardiomyopathy (DCM) - heart failure Affects 1 in 2500 ``` Arrhythmogenic Cardiomyopathy (ACM) Restrictive cardiomyopathy (RCM)
26
4 types of channelopathy? Which ones are more common? | Basic explanantion of each
``` LONG QT SYNDROME (common) - 3 subtypes BRUGADA SYNDROME (common) - sodium channel ``` SHORT QT SYNDROME (fast ventricular repolarisation) CVPT - catecholaminergic polymorphic ventricular tachycardia
27
Aortavascular syndromes Increased risk of..? Main one: 2 others linked
Aortic dissection or anuerysm MARFAN'S SYNDROME: tall, slender Loey's-Dietz syndrome Ehlers-Danlos syndrome
28
What are the causes of pericarditis? Name 4 out of 6 | Usually?
Usually idiopathic (80-90%) Virus - Coxsackle B, echovirus, HIV Dressler syndrome - couple weeks after an MI Uremic pericarditis Autoimmune, cancer, medications
29
Two negative outcomes from pericarditis? Which one depends on...
``` TAMPONADE PHYSIOLOGY (Pericardial effusion) or RESTRICTIVE PERICARDITIS (fibrosis) ``` Depends on whether there is time to adapt, tamponade if yes, restrictive if no
30
4 diagnostic factors of pericarditis
Saddle shaped ST elevation & PR depression Friction rub Sharp/stabbing chest pain Pericardial effusion: pulsos paradoxus
31
Treatment of pericarditis? First line Second line Third line
First: bed rest, oral NSAIDS Second: Colchicine (inhibits neutrophil migration) Third: drained or removed
32
Different stages of HTN? | At what stage is medication used?
Stage 1: 140-160 Stage 2: >160 Malignant: Over 180 Medication generally started at stage 2, unless risk factors present (eg, diabetes)
33
Two aetiologies of HTN | Proportion
Primary (>95% of cases) Secondary (<5% of case) eg, Renal, Endocrine, Pre-eclampsia, Aortic coarctation
34
Symptoms & signs of HTN? Usually? Always check...
Usually asymptomatic Possibly headaches, cardiovascular disease CHECK EYES AND KIDNEYS
35
What drugs to prescribe for HTN? Two pathways?
Under 55: 1: ACEi or ARB 2: + CCB 3: + Thiazide 4: Consider adding anything else Over 55 or Afro-Caribbean any age 1: CCB 2: + ACEi or ARB 3: + Thiazide 4: Consider adding anything else (alpha blockers, eg: doxazosin, centrally acting, eg: clonidine, methydopa)
36
Symptoms of pericarditis? 2 big 3 smaller
Chest pain - severe, sharp, pleuritic, rapid onset Dyspnoea Cough Hiccups - phrenic nerve irriated Skin rash
37
5 abnormal heart sounds? | When do they occur?
Ejection click: aortic stenosis (early sys) Non ejection click: mitral valve prolapse (later sys) Opening snap: mitral stenosis S3: volume overload, ventricular gallop, CHF S4: pressure overload, atrial gallop
38
Aortic stenosis: | When do symptoms occur? (What proportion of normal size)
Symptoms occur at 1/4th of normal Normal = 3-4cm2 So... about 1cm2
39
How does aortic stenosis present? 3 physical signs 3 main investigations?
Syncope, Angina, HF, Dyspnoea Weak, late pulse (tardus & parvus), S4 gallop Ejection-systolic murmur - diamond shape Echo, ECG, CXR
40
Management of aortic stenosis? 2 points
Dental hygience/care - IE prophylaxis | Valve replacement - increasingly TAVI
41
``` Mitral Regurgitation: 2 major causes? Big link with.... Presentation? Murmur? ```
IE and RF Mitral prolapse Exertional dyspnoea, palpitations, fatigue Holo/pansystolic flat murmur (NEC w/ prolapse)
42
AORTIC REGURG: Murmur? Other signs:
Decrescendo early diastolic murmur Collapsing pulse, wide pulse pressure (Corrigan's, De Musset's, Duroziez's, Austin flin, Traube's)
43
MITRAL STENOSIS: Murmur? Common with?
Rumbling mid-diastolic murmur Common with AF
44
What is Libman-Sacks Endocarditis? Association with? Key feature
Non-bacterial cause of endocarditis Association with SLE Vegetations on both sides of the mitral valve
45
``` Bacteria associated with IE: Most common? Note? IV drug abusers? On prosthetic valves Underlying colorectal carcinoma Negative blood cultures? ```
Strep viridans - low virulence, damaged valves Staph aureus - IV, infects normal tricuspid Staph epidermidis - prosthetic valves Strep bovis - colorectal carcinoma HACEK: Haemophilus, Actinobacillius, Cardiobacterium, Eikenella, Kingella
46
Clinical features of IE? | Diagnosis criteria? Name, points, system
Fever, Murmur Janeway lesions, Osler nodes, Roth spots, Splinter haemorrhages "modified Duke's" 2 major: +ve BC, ECHO 5 minor: fever, presdisposing factors, vascular problem, immune problem, equivocal blood cultures 2ma, 1+3, 5mi
47
Two types of Rheumatic Fever? What valve does it affect? Causitive organism
Acute or Chronic Mitral valve Strep. pyogenes - Group A beta-haemolytic streptococcus
48
``` Causes of AV heart blocks? (4) Treatment: 2 other points Bradycardia medications (3) ```
Ischaemic heart disease, cardiomyopathies, Lev's disese (conduction fibrosis), Myocarditis, Medications Treat underlying cause, consider pacemaker Medications: Atropine, Adrenaline, Dopamine
49
``` Explanation of: First degree HB: Mobitz 1: Mobitz 2: Third degree: ```
Prolonged PR interval longer than 200ms "going, going, gone" - PR interval gradually increases until no QRS is seen Random loss of QRS with stable PR interval Completely independent atria and ventricle contraction
50
Causes of bundle branch blocks? Significance of MaRRoW and WiLLiaM Treatment? - congenital and acquired
Fibrosis due to acute causes (MI, myocarditis) or chronic causes (HTN, CAD, cardiomyopathies) Shape of V1 and V6 in an ECG Congenital: doesn't require Acquired: pacemaker
51
Key finding of a PE ECG?
S1Q3T3 Large S waves in lead 1 Large Q waves in lead 3 Inverted T waves in lead 3
52
What is WOLFF-PARKINSON-WHITE SYNDROME? Name of tract? Main ECG finding?
Congenital abnormality which can result in SVT due to an AV accessory tract Bundle of Kent Delta waves
53
``` Atrial fibrillation: ECG finding - 2 points What does CHA2DS2-VASc score test for? Symptoms (4) 4 possible treatment points ```
Irregularly irregular, no p-wave Stroke risk for patients with AF Symptoms: palpitations, SOB, fatigue, chest pain Treat underlying cause - alcohol, thyroid, HTN, valve disease Rate control - BBs, CCBs, Digoxin Restore normal rate - amiodarone Anticoagulants - wafarin or DOACs
54
Atrial flutter: ECG finding - 2 points Symptoms
Narrow QRS, sawtooth flutter waves | Syncope, SOB, chest pain, dizziness, nausea
55
What is the ECG finding in focal atrial tachycardia?
Multiple different p wave forms
56
SVT vs VT: Where do beats originate from in each? Which is broad vs narrow complexes? SVT examples
SVT: from AV node VT: from ventricles SVT: narrow VT: broad SVT: A FIB, A FLUTTER, ACCESSORY PATHWAY, FOCAL ATRIAL TACHYCARDIA, AVNRT
57
What is a healthy ejection fraction?
65%-75%
58
2 different classifications of heart failure?
Acute HF vs Chronic HF ``` Systolic HF (failure of ventricle to eject blood - HFREF) Diastolic HF (failure of the ventricle to relax and fill - HFNEF) ```
59
What is main cause of heart failure? Percentage? | 3 other big causes
IHD (70%) Other: HTN, valvular heart disease, cardiomyopathy
60
What are 4 main symptoms of HF? What are 4 main signs of HF? Name of classification system?
Dyspnoea on exertion or rest, paroxysmal nocturnal dysponea, peripheral oedema, chest pain Tachycardia, displaced apex beat (LV hypertrophy), raised JVP, 3rd heart sound (ventricular gallop) New York Heart Assoication: I to IV
61
``` Investigations in HF: What is the key chemical to measure and range to refer? Other: ECG finding? Echo finding? CXR finding? ```
NT-proBNP (400-2000) ECG: no specific, but rarely normal Echo: will show systolic and diastolic function CXR: cardiomegaly, pulmonary congestion
62
What is intermittent claudication a form of? | Describe it
Form of peripheral arterial disease | Cramping in legs due poor circulation
63
What are the symptoms and signs of acute limb ischaemia? | If it becomes critical/chronic what else can become present?
6Ps Pain, pale, paralysis, paraesthesia, perishing, pulseness Rest pain, ulceration, gangrene
64
3 diagnostic points for peripheral arterial disease in legs
Auscultation of legs (bruit) Doppler ultrasound Ankle-brachial index: BP is compared
65
What size does an AAA have to be? Symptoms? Risk factors?
>3cm or more than 50% Usually asymptomatic until rupture - severe pain when ruptured Male, caucasian, advanced age, smoking, HTN, family history, connective tissue disorders
66
Diagnosis of AAA? (2) | Management? (3)
Ultrasound, CT | Monitoring - Ultrasounds, BP management, surgery
67
What is an aortic dissection? | Two types:
Tearing and widening of the tunica intima, blood flows in, layer seperation and false lumen Type A: ascending aorta (+/- arch) Type B: not ascending aorta (descending +/- arch)
68
What are the causes (3) and risk factors (3) of an aortic dissection?
C: Chronic HTN, Blood vessel coarctation, connective tissue (Marfan's, Ehlers-Danlos) RF: Pregnancy, Vasculitis, Family history
69
Signs + symptoms of an aortic dissection: Acute? Chronic?
Acute: sudden, intense, tearing pain radiating to the back Chronic: decreased peripheral pulses, diastolic decrescendo murmur from aortic regurg
70
Diagnosis of an AA? | Treatment of AA? Is it different in type A and type B?
ECG: rule out CXR, Echo, CT A: surgical repair B: lower heart rate, lower BP, pain management, surgical repair
71
What is shock? 5 main types - skin will be... Distributive shock includes...
``` "reduced blood perfusion from whole body circulatory failure" HYPOVOLAEMIC - cold CARDIOGENIC - cold NEUROGENIC - warm, dry SEPTIC - warm ANAPHYLATIC - warm ``` Distributive: neurogenic, septic, anaphylatic
72
4 parts of ToF 2 big symptoms 2 big treatments
VSD, pulmonary stenosis, hypertrophy of RV, overriding aorta Cyanosis, squatting Blalock-Taussig shunt (aortic branch to pulmonary artery to increase pulmonary flow) Complete repair
73
VSD: Two types? Murmur? Normal shunt? What is Eisenmenger's?
Small (restrictive) - incidental, normally close by age 10 (loud pan-systolic murmur) Large (non-restrictive) - heart failure, ventricular dilation, pulmonary HTN (quieter murmur) Normal L->R Eisenmenger's reversal of shunt due to pulmonary damage and HTN
74
ASD: 2-3 times more common in... Often not found until... 3 types?
Women Adulthood • Sinus venous defects: superior septum • Ostium secundum: mid-septum • Ostium primum: AV septal, lower part (AVSD - associated with Down's syndrome, malformed single AV valve)
75
Other than ASD, VSD, ToF, name 4 more congenital structural heart defects
Coarctation of the aorta Patent ductus arteriosus Bicuspid aortic valve Transposition of the great vessels

Phase 2a (9 decks)

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