Cardiology workbook Flashcards

1
Q

What is the ECG diagnosis

A

Inferior STEMI, RCA

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2
Q

Immediate management of STEMI patient before cardiologist arrives and after

A

Before: MONA IV
Morphine, O2 if sats <94%, nitrates, Aspirin 300mg loading and anti nausea (ondansetron), secure IV access
A-E assessment

After: transfer to cath lab

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3
Q

What long term medications should be prescribed following MI, prior to hospital discharge, to improve outcomes

A

ATABS
Aspirin 75mg OD for life, Ticagrelor (or prasugrel or clopidogrel), ACEi/ARB (LV remodelling), B blocker, Statin

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4
Q

Features of CXR suggestive of heart failure

A

Cardiomegaly, alveolar oedema, perihilar shadowing

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5
Q

Why do patients with heart failure develop ankle oedema

A

Heart cannot pump effectively, blood backs up into veins, increased pressure pushes fluid out due to higher hydrostatic pressure,causes swelling

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6
Q

Treatment for acute presentation of heart failure vs chronic

A

Acute: loop diuretics, O2 or CPAP, nitrates

Long term: ACEi, B blocker, (aldosterone antagonist?)

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7
Q

What does this ECG show

A

A fib, irregularly irregular

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8
Q

Acute treatment for A fib

A

Cardio version (electrical or flecainide) + amiodarone

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9
Q

Example of indication for electrical DC cardioversion

A

Haemodynamic instability

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10
Q

3 commonest causes of A fib and investigation for that

A

Heart failure (e.g. post MI): ECG
Valvular disease: echo
Acute infection: FBC,CRP,blood cultures

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11
Q

What is WPW syndrome

A

Re entry loops

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12
Q

What drugs cannot be used in WPW

A

No rate control e.g. beta blockers, no adenosine, no CCB or digoxin

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13
Q

What drugs are used in long term treatment of permanent AF

A

Anticoagulation e.g warfarin/DOAC, rate control e.g. B blockers/CCB/digoxin, rhythm control e.g. cardioversion

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14
Q

What scoring systems are used to decide if a patient with AF should be taking long term anticoagulation

A

CHADSVASC and HAS-BLED

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15
Q

Clinical features of aortic stenosis

A

Slow rising pulse, narrow pulse pressure, heaving apex beat, ejection systolic 2nd ICS RHS heart murmur radiating to neck/carotids loudest on expiration, reduced or absent S2

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16
Q

What are common differentials for systolic murmur

A

Aortic stenosis!
Pulmonary stenosis, VSD, mitral regurgitation

17
Q

Investigations relevant for murmur diagnosis

A

Echo and ECG

18
Q

Common complications of severe aortic stenosis

A

Heart failure, stroke, blood clots

(Endocarditis, arrhythmia, haemolytic anaemia)

19
Q

Symptoms of severe aortic stenosis

A

Syncope, chest pain, breathlessness

20
Q

Management of aortic stenosis

A

Aortic valve replacement and anti coagulants

(TAVI via femoral artery more likely if elderly)

21
Q

Common causes of valvular heart disease

A

Congenital heart disease, rheumatic fever, cardiomyopathy, heart attack

22
Q

Clinical signs of aortic regurgitation

A

Diastolic murmur LHS sternal edge, collapsing pulse, head bobbing (De Musset’s sign)

23
Q

Clinical signs of mitral stenosis

A

Murmur (low pitched mid diastolic)
irregularly irregular pulse
Malar flush
Loud SI

24
Q

Clinical signs of mitral regurgitation

A

Holosytolic murmur (heard best at apex)
Radiation to axilla
Displaced apex beat

25
Q

Clinical signs in infective endocarditis

A

Pyrexia, tachycardia, heart murmur new and regurgitating, splinter haemorrhages, clubbing, Jane way lesions, emboli, sepsis

(History of tiredness)

26
Q

Common pathogens causing infective endocarditis

A

Viridans strep, Staph Aureus, enterococcal

27
Q

How is a definitive diagnosis of infective endocarditis made

A

Blood cultures and TOE (echocardiogram)

28
Q

What antibiotic therapy is indicated if infective endocarditis is expected

A

If strep/enterococci: Benzylpenicillin (vancomycin is penicillin allergic) and low dose gentamicin

If Staph: flucloxacillin and gentamicin

29
Q

Clinical signs for high BP

A

None
Hypertensive retinopathy
Enlarged palpable kidneys
Renal artery stenosis causing bruits
Moon face, abdominal purple striae
Radiofemoral delay
Coarctation

30
Q

Common secondary causes of high BP

A

Cushing’s syndrome, PCK disease, renal bruits, coarctation, radio-femoral delay, cocaine, oral contraceptive, pregnancy

31
Q

investigations for hypertension

A

Test for protein in urine and haematuria
Plasma glucose, electrolytes, creatinine, eGFR, serum total cholesterol and HDL
12 lead ECG
Fundoscopy
Echocardiography
Pregnancy test

32
Q

3 common drug classes used to treat hypertension and side effects

A

ACEi - dry cough headaches
ARB - dizziness, headaches, fatigue
CCB - ankle swelling, flushing, palpitations
Diuretic - dizziness, tiredness, headache, gout, ED, cramps

33
Q

Common complications of untreated hypertension

A

Heart attack, stroke, TIA, heart failure, kidney failure, dementia

34
Q

What is a feature of hypertensive retinopathy

A

Flame haemorrhages

35
Q
A