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Julia PCP2 > Cardiovascular > Flashcards

Flashcards in Cardiovascular Deck (81):
1

Name 8 risk factors for the development of IHD.

-Increasing age
-Family Hx
-Obesity
-Sedentary lifestyle
-Smoking
-Hypercholesterolaemia
-Hypertension
-Diabetes

2

What is the WHO definition of an AMI?

At least 2 of the following 3 features:
-Symptoms of myocardial ischaemia
-Elevation of cardiac markers (troponin or CK)
-Typical ECG pattern involving the development of Q waves, ST segment changes or T wave changes

3

What are the reperfusion options in AMI and how soon should they be implimented?

Options: percutaneous intervention or fibrinolysis
Should be performed within 90 minutes of symptom onset

4

When is fibrinolysis preferred over PCI for treatment of AMI?

-Early presentation
-Invasive strategy not an option
-There will be a delay to invasive option

5

What are the adjunctive therapies in AMI?

Oxygen, IV morphine, aspirin, IV heparin/clexane, IV GTN, additional antiplatelets if applicable

6

What are the benefits of starting a beta-blocker after AMI?

-Reduced rates of recurrent MI
-Reduced angina
-Reduced arrhythmias
-Improved LV function

7

What are contraindications to starting a beta blocker after AMI?

Hypotension, bradycardia, second- or third-degree heart block, severe asthma

8

In CCF following an AMI, what changes might you see on a chest X-ray?

Cardiomegaly, Kerley B lines, pleural effusions

9

What are cholesterol targets post-AMI?

Total cholesterol

10

What is the post-hospital management following a STEMI?

-Review at 1 month; then 6 monthly
-Repeat ECHO at 6 months
-Stress testing at 1 year
-Cholesterol profile, renal & liver function tests, CK, FBE 6 monthly
-Regular review of lifestyle changes
-Regular review of medication chart & compliance

11

What is the most common clinical presentation of a tachyarrhythmia?

Palpitations

12

What is the most common clinical presentation of a bradyarrhythmia?

Syncope/presyncope

13

Name 1 vital investigation in palpitations and 5 others you may consider.

1. ECG

Others: Holter monitor, Event recorder, Loop recorder, Echocardiogram, Electrophysiology study, Stress testing

14

What is the usual management of premature ventricular/atrial complexes in an otherwise healthy patient?

1. Reassurance
2. Cut down caffeine
3. Occasionally requires beta blockers or calcium channel blockers if very frequent & symptomatic

15

What is the usual management of AF?

1. Rule out precipitant (eg/ hyperthyroidism, infection)
2. Look for a cause (eg/ cardiomyopathy)
3. Decide whether to rate control or rhythm control
4. Evaluate the risk of stroke & how best to manage it (CHADS2)

16

Which 3 medications might be used in AF to maintain sinus rhythm (rhythm control)?

Sotalol, flecainide, amiodarone

17

Which 3 medications might be used to control rate in AF?

Beta blockers, calcium channel blockers, digoxin

18

What location does an ablation procedure target in AF?

Pulmonary veins (4)

19

A majority of SVTs involve which part of the cardiac conduction system?

AV node

20

What are 3 possible acute treatments of SVT?

1. Vagal manoeuvres
2. IV adenosine (induces transient AV block)
3. IV verapamil

21

What are the long-term options for treatment of SVT?

1. No treatment
2. Beta blockers or calcium channel blockers - 'pill in the pocket' approach
3. Catheter ablation (>95% success rate)

22

42 year-old male who has occasional palpitations - sudden onset, at rest, regular, last 5-10 minutes, resolve spontaneously & suddenly. Presents with a further episode of palpitations lasting >1 hour. What is the likely arrhythmia causing his palpitations?

Supra-ventricular tachycardia

23

What is the acute management for a patient presenting with VT?

If unstable -> DC cardioversion

If stable, can try amiodarone before DC cardioversion

Always investigate & treat the cause

24

What are the 'red flag' features of palpitations?

-Past history of cardiac disease
-Evidence of cardiac disease on baseline tests
-Family history of sudden cardiac death
-Severe symptoms
-High risk work environment
-High level sporting activities
-Before/during pregnancy

25

What is the definition of syncope?

Transient LOC that is self-limiting. Onset is relatively rapid, leads to a fall. Recovery is complete, rapid & spontaneous.

26

What are some indications for a PPM?

-Symptomatic sinus bradycardia
-Sinus pauses >2s (day) or 2.5s (night)
-Symptomatic 2nd or 3rd degree AV block
-Intermittent 3rd degree AV block

27

What is the usual management of sick sinus syndrome?

1. Insert PPM
2. Once PPM inserted, you can use AV nodal blocking agents to control tachycardias

28

What is a normal PR interval?

29

What does a bifid P wave suggest?

'P mitrale' - a sign of mitral stenosis

30

What does a peaked P wave suggest?

'P pulmonale' - a sign of lung disease

31

What is the Wenkebach phenomenon?

Progressive lengthening of the PR interval until a P wave is non-conducted (2nd degree heart block, Mobitz type I)

32

What is a normal QRS width?

33

What is a pathological Q wave?

A marker of electrical silence which implies established full thickness death of the myocardium (scar)
-must be >25% the height of the corresponding R wave
-must be present in more than 1 contiguous lead

34

What are some causes of left axis deviation?

Left anterior hemiblock, ischaemic heart disease, cardiomyopathy, hypertension, WPW syndrome

35

What are some causes of right axis deviation?

(normal in children & tall thin adults)
RV volume/pressure overload, COPD, PE, WPW syndrome

36

What are some causes of extreme right axis deviation?

Lead transposition, VT, emphysema, hyperkalaemia, paced rhythm

37

In which leads are the T waves normally inverted?

V1 (sometimes V2), III, aVR

38

What does a biphasic T wave represent?

Critical LAD stenosis

39

What does an inverted T wave represent?

Ischaemia

40

From where to where is the QT interval measured?

From the start of the QRS complex to the end of the T wave

41

What are the common causes of long QT?

Drugs (amiodarone, sotalol, azithromycin, amitriptyline, clozapine), electrolyte imbalance (hypokalaemia, hypomagnesaemia), MI

42

What does echocardiography show?

-Chamber size & function (EF)
-Wall thickness
-Cardiac structure
-Valve morphology
-Doppler -> flow velocities

43

What is rheumatic fever?

A type II hypersensitivity reaction to grp A beta haemolytic Strep

44

What are the clinical features of rheumatic fever?

-Fever
-Arthritis
-Rash (erythema marginatum)
-Subcutaneous nodules
-Murmur
-Sydenham's chorea

45

How is rheumatic fever diagnosed?

Based on Jones criteria

46

What is the management of rheumatic fever?

Antibiotics + NSAIDs

47

In mitral regurgitation, when should you aim to operate?

BEFORE symptoms - on echo criteria (symptoms coincide with severe disease with irreversible changes in the LV)

48

In aortic stenosis, when should you aim to operate?

When the stenosis becomes symptomatic - the LVH will regress after surgery

49

Which 2 valve pathologies can result in pulmonary hypertension?

Mitral regurgitation & mitral stenosis

50

What are the 3 causes of aortic stenosis?

-Congenital (AS 0.33% or bicuspid aortic valve 1-2%)
-Rheumatic fever
-Calcific - COMMON

51

What is the pathophysiology of aortic stenosis?

Aortic stenosis creates a much greater pressure gradient across the valve that the LV must push to overcome, leading to left ventricular hypertrophy

52

What are the 3 main symptoms of aortic stenosis?

SOB on exertion, chest pain on exertion, syncope (only appear when stenosis is severe)

53

What are some physical signs of aortic stenosis (besides the murmur)?

-Slow upstroke carotid pulse with a plateau
-Heaving apex beat
-Thrill over upper R sternal edge

54

What murmur might be heard in aortic stenosis?

Ejection systolic 'crescendo-decrescendo' murmur best heard over the upper R sternal edge (with radiation to the carotids)

55

What echocardiography criteria signify severe aortic stenosis?

-Gradient >50mm
-Aortic valve area

56

What are the treatment options for severe aortic stenosis?

-Open aortic valve replacement
-Transcatheter aortic valve implant (TAVI)

57

What are some cases of aortic regurgitation?

-Aortic leaflet damage (endocarditis, rheumatic fever)
-Aortic root dilation (Marfan's syndrome, aortic dissection, collagen vascular disorders, syphilis)

58

What are the symptoms of aortic regurgitation?

NONE - until LV decompensates & person develops heart failure (SOB)

59

What are some signs of aortic regurgitation (besides the murmur)?

-Collapsing pulse - fast up & down stroke
-Wide pulse pressure

60

What is the murmur heard in aortic regurgitation?

Early diastolic murmur, best heard at the upper left sternal edge

61

What is the management for aortic regurgitation?

-Echo every 6-12 months for severe AS
-Aortic valve replacement (when LV decompensates)

62

What are the causes of mitral regurgitation?

-Myxomatous degeneration
-Ruptured chordae tendinae
-Infective endocarditis
-Myocardial infarct (ruptured papillary muscle)
-Rheumatic fever
-Collagen vascular disease
-Cardiomyopathy

63

What are the symptoms of mitral regurgitation?

NONE - until the LV decompensates & symptoms of heart failure occur (SOB)

64

What is the murmur heard in mitral regurgitation?

Pansystolic murmur best heard over the apex beat during expiration

65

What is the management for mitral regurgitation?

-Follow-up echo 6-12 monthly for severe MR
-LV decompensation or pulmonary hypertension are triggers for valve replacement or repair

66

What is the commonest valve lesion caused by rheumatic fever?

Mitral stenosis

67

What is the major cause of mitral stenosis?

Rheumatic fever (esp. in women)

68

What are the symptoms of mitral stenosis?

SOB, oedema, pulmonary disease

69

What are some signs of mitral stenosis (besides the murmur)?

-Mitral facies (flushing)
-Tapping apex beat - correlates with loud S1

70

What murmur is heard with mitral stenosis?

-Rumbling diastolic murmur with opening 'snap'

71

What are the heart changes observed over time in mitral stenosis?

-Atrial dilatation
-Atrial fibrillation
-Thrombo-embolism
-Pulmonary congestion & oedema
-Pulmonary hypertension
-Right heart failure

72

What are the principles of management for mitral stenosis?

-Regular echo
-Anticoagulation if AF
-Treat AF
-Diuretics
-Mitral valve intervention

73

What are the interventions for mitral stenosis?

-Mitral valvotomy - open or closed
-Balloon valvuloplasty
-Mitral valve replacement

74

What are the features of cardiogenic syncope?

-No prodrome
-Complete & rapid recovery
-Sudden with acute onset
-May be exertion related

75

What are some features of a LOC that suggest epilepsy?

-Urine or faecal incontinence
-Auras
-Post-ictal phase

76

In an otherwise healthy individual, at what level should you treat blood pressure?

SBP >180mmHg
DBP >110mmHg
SBP >160mmHg and DBP

77

When the individual has associated risk factors, at what level should you treat high blood pressure?

SBP >140mmHg
DBP >90mmHg
Or high CV risk

78

What constitutes critical limb ischaemia?

-Ischaemic rest pain
-Ulcers
-Gangrene

79

What is the white cell trapping hypothesis of chronic venous insufficiency?

-WBCs are larger & less deformable than RBCs
-When perfusion pressure is reduced by venous hypertension, WBC plug capillaries & RBC build up behind
-WBC activation occurs
-Endothelial adhesion by WBC releases proteolytic enzymes & ROS causing endothelial & tissue damage

80

What is the fibrin cuff hypothesis of chronic venous disease?

-Increased venous pressure if directly transmitted to capillaries resulting in capillary elongation & increased endothelial permeability
-Larger molecules such as fibrinogen become deposited into tissues -> fibrin
-Accumulation of fibrin acts as a barrier to oxygen -> tissue hypoxia -> ulceration

81

What does the CEAP classification of venous disease encompass?

C = clinical
E = etiology
A = anatomy
P = pathophysiology