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Year 6 > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Causes of:
Aortic stenosis
Aortic regurgitation
Mitral regurgitation
Mitral stenosis

A

Aortic stenosis - rheumatic heart disease, bicuspid valve, calcification
Aortical regurgitation - rheumatic heart disease, bicuspid valve, connective tissue disorders
Mitral regurgitation - rheumatic heart disease, calcification, connective tissue disorders
Mitral stenosis - rheumatic heart disease

or

All - rheumatic heart disease
Systolic - calcification
Aortic - bicuspid valve
Regurgitation - connective tissue disorders

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2
Q

Murmur investigations

A

Bloods: BNP, lipids
Imaging: CXR (hypertrophy), echo

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3
Q

Murmur management

A

MDT for regular follow-up
QRISK to determine whether statins, etc. are needed
Transcatheter implant
Open valve replacement: artificial/biological

Regurgitations: reduce afterload with ACEi, BB, diuretics

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4
Q

Heart failure causes

A

Myocardial (coronary artery disease, HTN)
Valvular
Pericardial (constrictive)
Arrhythmias

Non-cardiac: high output (sepsis), volume overload (CKD, nephrotic syndrome)

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5
Q

New York Heart Association classification for heart failure

A

1 - no limitation
2 - dypnoea on activity
3 - marked limitation on activity
4 - dyspnoea at rest

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6
Q

Ejection fraction classification for heart failure

A

HFpEF: >= 50% (LV unable to relax)
HFrEF: <40% (LV unable to contract properly)

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7
Q

Chronic heart failure investigations

A

Bedside - ECG
Bloods - BNP: 400-2000 (echo within 6 weeks), >2000 (echo within 2 weeks)
CXR - alveolar oedema, Kerley B lines, cardiomegaly, upper lobe diversion, pleural effusion

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8
Q

Chronic heart failure management

A
  1. ACE inhibitor, ARB, or beta-blocker
  2. Spironolactone, SGLT-2 inhibitor (e.g. dapagliflozin) or entresto if HFrEF
  3. Hydralazine with nitrate

Influenza and pneumococcal vaccine

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9
Q

Hypertension stages

A

Stage 1 >140/90
Stage 2 >160/100
Severe >180 or/110

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10
Q

Hypertension investigations

A
  1. Ambulatory BP monitoring
  2. Home BP monitoring
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11
Q

Hypertension management (age <55, not Black, T2DM)

A
  1. ACEi / ARB
  2. Add CCB or thiazide-like diuretic
  3. Triple
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12
Q

Hypertension management (age >55 or Black)

A
  1. CCB
  2. Add ACEi/ARB or thiazide-like diuretic
  3. Triple
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13
Q

What to do if hypertension resistant to initial treatment

A

Confirm with ABPM/HBPM
Low dose spironolactone if potassium <4.5
Alpha-blocker or beta-blocker if potassium >4.5
Seek expert advice

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14
Q

Infective endocarditis most common valves

A

Mitral (50%)
Tricuspid (IVDU)

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15
Q

Infective endocarditis bacteria in acute, subacute, and prosthetics

A

Acute - Staph. aureus
Subacute - Strep. viridans
Prosthetics - Coag. neg staph

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16
Q

Dukes major criteria

A

Positive blood cultures
Echo findings/new valvular regurgitation

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17
Q

Patient had scarlet fever 3 weeks ago, pathology shows verrucae, Aschoff bodies, and Anitschkov myocytes. What is the diagnosis and management?

A

Rheumatic fever / rheumatic heart disease

Bed rest until CRP normal for 2 weeks
NSAIDs
Phenoxymethylpenicillin
Corticosteroids if heart problems
Haloperidol or diazepam if Sydenham’s chorea

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18
Q

Rheumatic fever prophylaxis

A

IM benzathine pencillin (once a month)

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19
Q

Acute pericarditis investigations

A

Bedside - ECG (widespread ST elevation, PR depression)
Bloods - troponin (varies)
Imaging - TTE

20
Q

Acute pericarditis management

A

Treat cause (e.g. TB, malignancy, Dressler’s from MI)
NSAIDs + colchicine

21
Q

Pulmonary hypertension imaging

A

CXR (pruning, enlarged vessels)
Transthoracic doppler echo

Gold standard: right heart catheterisation

22
Q

WPW syndrome (AVRT) ECG finding

A

Short PR interval
Delta wave
Axis deviation dependent on side of accessory pathway

23
Q

WPW syndrome types (2x)

A

A: left-sided pathway, RAD, dominant R wave in V1
B: right-sided pathway, LAD

24
Q

WPW management (acute, general medical, definitive)

A

Acute
Stable - vagal manoeuvres -> adenosine
Unstable - Electrical cardioversion

Medical
Sotalol (avoid in AF)
Flecainide
Amiodarone

Definitive
Radiofrequency ablation of accessory pathway

25
Q

Anteroseptal ECG territories and coronary artery

A

V1-V4
Left anterior descending

26
Q

Inferior ECG territories and coronary artery

A

II, III, aVF
Right coronary

27
Q

Anterolateral ECG territories and coronary artery

A

V1-6, I, aVL
Left anterior descending

28
Q

Lateral ECG territories and coronary artery

A

I, aVL (, V5-6)

Left circumflex

29
Q

Posterior ECG territories and coronary artery

A

V1-3 (ST depression)
Confirmed with V7-9 showing ST elevation

Left circumflex and right coronary

30
Q

Left bundle branch block ECG features

A

W in V1
M in V6
Broad R wave

31
Q

Is a new LBBB pathological?

A

Yes, always

32
Q

Cause of LBBB and RBBB

A

LBBB - aortic stenosis, anterior MI, HTN, dilated cardiomyopathy
RBBB - right ventricular hypertrophy, PE

33
Q

RBBB ECG features

A

M in V1-V3
Slurred S wave in I, aVL, V5-6 (lateral)

34
Q

Left atrial enlargement on ECG

A

bifid P wave (p mitrale)

35
Q

First degree heart block on ECG and treatment

A

PR interval >0.2 seconds
Common and doesn’t need treatment

36
Q

Second degree Mobitz Type I on ECG, physiological cause, and treatment

A

Progressive prolongation of PR interval until dropped beat
Cause: AV cells fatigue
Treatment: Atropine

37
Q

Second degree Mobitz Type II on ECG, cause, and treatment

A

PR interval constant, not always followed by QRS
Cause: structural damage
Treatment: pacemaker

38
Q

Third degree (complete) heart block on ECG and treatment

A

No association between P and QRS
Treatment: pacemaker

39
Q

AVNRT on ECG

A

Narrow QRS
Tachycardia

40
Q

AVNRT (SVT) management

A

Vagal manoeuvres
Adenosine (6 -> 12 -> 18 -> electrical cardioversion)
Verapamil in asthmatics
Catheter ablation if medical not working

41
Q

Risk factor for ventricular tachycardia and its causes

A

Prolonged QT
Drugs: clarithromycin, erythromycin, metaclopramide, haloperidol
Electrolyte imbalance: hypokalaemia, hypocalcaemia
Hypothermia
MI

42
Q

Ventricular fibrillation and TdP ECG

A

VF: Squiggles and no complexes (may initially be normal then change)
TdP: Squiggles getting bigger and smaller

42
Q

Ventricular fibrillation and TdP ECG

A

VF: Squiggles and no complexes (may initially be normal then change)
TdP: Squiggles getting bigger and smaller

43
Q

Shockable cardiac arrest rhythms

A

Ventricular fibrillation (squiggles)
Pulseless ventricular tachycardia (broad jumping QRS)

44
Q

Non-shockable cardiac arrest rhythms

A

Asystole (flatline)
Pulseless electrical activity

45
Q

What type of heart problem is WPW?

A

AVRT
Axis deviation opposite to side of accessory pathway (RAD = left-accessory pathway, so I and III reaching)

46
Q

VT treatment

A

Haem stable: IV amiodarone (ideally central line)
Haem unstable: DC cardioversion
Don’t use verapamil in VT

Year 6 (19 decks)

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