Cardiology Flashcards
(106 cards)
1
Q
Extrinsic causes of bradycardia
A
B blockers, hypothyroid, hypothermia
2
Q
Name an intrinsic cause of bradycardia
A
Ischaemia of SAN
Fibrosis of atrium
Sick sinus syndrome - failure of the SAN to depolarise.
3
Q
Causes of heart block
A
CAD, cardiomyopathy, fibrosis within the conducting tissue.
4
Q
What is first degree heart block? ECG sign?
A
delayed AV conduction, prolonged PR interval
5
Q
What is Mobitz type 1 heart block?
A
Progressive PR prolongation until it doesn’t conduct and absent QRS
6
Q
What is Mobitz type 2 heart block?
A
dropped QRS complex (no PR prolongation.)
7
Q
What is third degree heart block?
A
All atrial activity fails to conduct to the ventricles.
8
Q
Causes of wide QRS complex on ECG?
A
Bundle branch block
9
Q
What is the definition of tachycardia?
A
HR >100bpm
10
Q
Causes of BBB?
A
PE/IHD/ventricular hypertrophy/AV disease/fibrosis.
11
Q
Name some pathological causes of tachycardia?
A
fever, anaemia, thyrotoxicosis, PE, hypovolaemia.
12
Q
Name causes of narrow complex QRS complex?
A
AVRT/AVNRT/physiological tachycardia.
13
Q
What is AVNRT?
A
commonest SVT. Ring of conducting pathway in AVN.
14
Q
What is AVRT?
A
accessory pathway connecting atria and ventricles.
15
Q
Example of AVRT and ECG findings?
A
Wolff-Parkinson-White, delta waves before the QRS complex.
16
Q
Symptoms of an arrhythmia?
A
Palpitation, dizzy, SOB, central chest pain, syncope.
17
Q
Management of supraventricular tachycardias? unstable/stable and prevention
A
Unstable - Emergency conversion
Stable - Vagal stimulation, IV Adenosine
Prevention - radiofrequablation, B blocker
18
Q
What is the HR like in AF?
A
irregularly iregular
19
Q
AF ECG signs?
A
absent P waves
20
Q
How to manage an unstable AF patient?
A
heparinisation, DC shock, IV amiodarone
21
Q
Rate control in a stable AF patient?
A
1st line = B blocker (C/I in asthma patients?
2nd line = CCB/digoxin
22
Q
Rhythym control in stable AF patient?
A
B blocker e.g. Sotalol
others: amiodarone
23
Q
How to assess anticoagulation in AF patient?
A
CHADVASC2 - CHF, HTN, >75, 65-74, DM, TIA or stroke, VD, Female
24
Q
Anticoagulation choice in AF patient?
A
DOAC e.g Rivaroxaban/apixaban
25
What is ventricular fibrillation?
Rapid and irregular ventricular rhythm with no mechanical effect. No CO.
26
Name some causes of HF
IHD, arrhythmia, anaemia, hyperthyroid, obesity
27
What is the pathophysiology of HF?
read in notes
28
Symptoms of HF?
exertional SoB, orthopnia, paroxysmal nocturnal dyspnoea, fatigue
29
Ix for HF? what would they show?
CXR - enlarged heart
ECG - underlying cause
Bloods - FBC, LFT, BG, UE, TFT, BNP
ECHO
30
General HF management?
Educate, physical exercise, diet, pneumococcal and influenza vaccine
31
1st and 2nd line treatment for HF
1st line = ACEi + B blocker
2nd line = Aldosterone antagonist (Spironolactone)
3rd line = digoxin
32
Symptomatic Mx for HF?
pillows, furosemide
33
investigations for acute heart failure?
CXR, ECG, bloods, ECHO
34
signs of fluid overload?
hypertension, raised JVP, pulm oedema (breathless)
35
Management of acute heart failure?
High flow O2 and IV 50mg Furosemide
36
What causes myocardial ischaemia?
imbalance in supply/demand of myocardial muscle
37
Commonest cause of IHD? how does it cause it?
coronary artery disease - atheromatous plaques whcih narrow lumen of the artery.
38
Irreversible RF for IHD
age, gender, family Hx
39
Reversible RF for IHD
hyperlipidaemia, smoking, HTx, DM, low veg diet, stress
40
Symptoms of stable angina?
central crushing chest pain (retrosternal) worse with exertion and relieved by rest.
41
Ix of angina?
ECG, stress ECG, ECHO, coronary antiography, clinical Hx
42
General risk Mx in angina patients?
lifestyle advice, aspirin 75mg OD, statin
43
Symptomatic Mx of angina?
sublingual GTN with symptoms, B blocker e.g. atenolol
44
2 surgeries for Angina
PCI, CABG
45
What causes ACS?
rupture of atheromatous fibrous plaque which causes formation of platelet rich clot within a coronary artery
46
Features of unstable angina?
worsening angina on minimal exertion, pain at rest - not relieved by nitrates. New onset HF/collapse.
47
DD of ACS?
aortic dissection/MSK pain/GORD
48
Ix of ACS?
FBC, creatinine, electrolytes, glucose, lipids, ECG (STEMI or NSTEMI), toponin and CK, cardiac monitor.
49
Management of acute ACS?
Morphine sulfate (for pain.)
Oxygen if <88%???
Nitrates
Aspirin (300mg then 75mg daily) +/- Clopidogrel
Metoclopromide for nausea?
50
What scoring systems for risk of ACS?
Grace
| TIMI
51
Featues of STEMI?
central chest pain occuring at rest. Sweating, breathless, N&V, pale/grey/sweaty
52
ECG signs of a STEMI?
ST segment elevation
| T wave flatteningt/inversion
53
Mx of a stemi?
MONA + Metoclopromide + immediate primary angioplasty
| Fibrinolytic agents - bolus IV streptokinase/alteplase
54
Complications of a stemi?
Arrhythmia, heart block, heart failure
55
What causes rheumatic fever?
Group A strep
56
Features of rheumatic fever?
fever, joint pain, heart murmer
57
Ix of rheumatic fever?
FBC, ESR, Ducket jones criteria, throat swab for strep
58
Mx of rheumatic fever?
high dose aspirin, penicillin
59
Causes of Mitral stenosis?
Rheumatic fever
60
what would you hear on auscultation of a pt with mitral stenosis?
mid diastolic rumbling murmer with loud first heart sound?
61
Ix for any valve pathology?
CXR, ECHO, ECG
62
How does mitral regurgitation cause pulm oedema?
back log into the LA and back into the lungs.
63
auscultation of mitral regurgitation?
pansystolic murmer + thrill
64
Cause of prolapsing valves?
Marfan syndrome.
65
Causes of aortic stenosis?
degeneration, calcification, rheumatic HD
66
Symptoms of Aortic stenosis? Why do you get these?
Obstructed LV exit - causes angina, exertional syncope, congestive HF
67
Auscultation of aortic stenosis?
harsh ejection systolic murmer
68
Signs of aortic regurgitation?
collapsing water hammer pulse
69
Symptoms of aortic regurgitation?
dyspnoea, orthopnea, LV failure (fatigue)
70
What criteria is used for infective endocarditis?
Dukes criteria
71
Causative organisms of infective endocarditis?
Strep.Pneumoniae, Staph.Aureus
72
Features of infective endocarditis?
fever, malaise, weight loss, anaemia, new onset HF, murmers, emboli
73
Ix of IE?
blood cultures, ECHO, CXR. ECG, FBC, ESR, Serum IGs
74
What is the definition of pulmonary HTN?
pressure in pulm arteries >25mmHG at rest (normally 10-14mmHG)
75
Causes of pulm HTN?
idiopathic, hereditary, inflammatory (SLE/RA)
76
Ix of pulm HTN? what would these show?
CXR - enlarged pulmonary arteries
ECG - RV hypertrophy
ECHO
77
Mx of pulm HTN?
O2, warfarin, diuretic, CCB (pulm vasodilators.)
78
Features of a PE?
breathless, pleuritic chest pain, haemoptysis, tachypnoec, shocked, pale, sweaty, tachycardic, death
79
Risk score for a PE? what does it look at?
WELLS Score - clinical signs of DVT, alternative diagnosis is less likely, HR > 100, recent immobilisation, previous DVT/PE, haemoptysis, malignancy (>4 = high suspicion of a PE.)
80
Management of a PE in a high risk patient?
High risk --> start DOAC/LMWH --> CTPA --> diagnosis
81
management of PE in a low risk patient?
low risk --> D Dimer / other IX --> positive --> CTPA
82
General Mx of a PE patient?
Give O2, thrombolysis if massive, morphine, IV fluids
83
What does a D dimer show? When is it not useful?
fibrinogen degradation products when the clot is dissolved - false positives in pregnancy/malignancy.
84
Name 2 cardiomyopathies
hypertrophic, dilated
85
Causes of acute pericarditis?
Viral (Coxasackie), MI, uraemia, malignancy
86
Features of acute pericarditis?
sharp retrosternal chest pain (relieved by leaning forwards), pain worse on inspriation and pericardial friction rub.
87
what does an ECG show in acute pericarditis?
Saddle shaped ST segment
88
mx of acute pericarditis
1st line = NSAIDS
2nd line = corticosteroids
pain relief, look at underlying cause
89
what is cardiac tamponade?
medical emergency. rapid accumulation of fluid restricting diastolic filling of the ventricles which reduces CO.
90
Features of pericardial effusion?
soft heart sounds, low BP, increased HR, raised JVP, kussmauls resp
91
Mx of cardiac tamponade?
pericardiocentesis
92
Causes of essential HTN?
genetics, low birth weight, obesity, increased alcohol and salt intake
93
secondary causes of hypertension?
pre-eclampsia, renal stenosis, Conns, phaemochromcytoma, coarction of aorta, COCP, NSAIDS
94
What histology is shown with hypertension?
fibrinoid necrosis of the vessel walls
95
name end organ damage that occurs due to hypertension?
Kidneys - haematuria, proteinuria, progressive CKD
Brain - oedema, haemorrhage
Retina - flame haemorrage, cotton wool spots, pappilodoema
CVS - acute HF, aortic dissection
96
What Ix do you do for HTN?
serum UE, urine stix, BG, lipids, ECG
97
non pharm Mx measures for HTN?
weight loss, low fat and salt diet, reduce alcohol, exercise, increase fruit and veg, stop smoking
98
pharm management of HTN patheway?
1st line = <55/T2DM - ACEi, Afro-Carib,>55 - CCB
2nd line (A+C) or (A+D)
3rd line = (A + C + D)
99
Examples of ACEi/their action/side effects
lisinopril/ramipril
they block the conversion of angiotensin 1 --> angiotensin 2 (vasoconstrictor.)
SE = cough/rash/hypotension
100
Example of ARB and how they work?
Losartan - blocks angiotensin 2 receptor - good in ACEi patients who cannot tolerate cough.
101
Example of CCB/how they work/side effects
Amlodipine/nifedipine
cause dilation of peripheral arterioles
SE = headache/flushing/periphera oedema
102
name the 2 different types of diuretic and an example
loop diuretic - furosemide
| thiazide - bendroflumethiazide
103
Definition of an aortic aneurysm?
vessel Diameter >3cm. Permanent localised dilation of an artery.
104
Features of abdo/thoracic aneurysms
ABDO - pulsating mass, epigastric or back pain
| THORACIC - back pain, dysphagia, cough
105
What occurs during dissection? Features?
tear in the intima, false lumen created. Abrupt onset severe tearing central chest pain which radiates to the back.
Neuro signs, absent pulses, unequal BP in arms!!
106
Ix of dissected anuerysm?
CXR - widened mediastinum.
| CT/ECHO/MRI
