Cardiovascular System Flashcards
(106 cards)
1
Q
What is the 1st line management of Ventricular Tachycardia?
A
1st line- Amiodarone
2
Q
What is the 1st line investigation for Brugada Syndrome?
A
1st line investigation- sodium challenge test
3
Q
What is the 1st line management of Brugada Syndrome?
A
Management:
1st line- ICD
4
Q
Long QT Syndrome:
a) What is the 1st line management?
b) What is the definitive management?
A
Long QT syndrome
1st line- beta blocker
definitive- ICD
5
Q
What are the main X2 types of HF, and what causes them?
A
Reduced Ejection Fraction HF- this is when the heart does not contractt forceful enough during systole
Preserved Ejection Fraction HF:
The left ventricle is too stiff, so less blood fills overall resulting in reduced ejection fraction
6
Q
What Classification system is used in HF?
A
NYHA classification
7
Q
What are the abbreviations used for the management of these conditions?
a) Asthma Attack
b) COPD exacerbation
c) NSTEMI
d) HF
A
a) O SHIT MAN
b) ISOAP
c) BATMAN
d) LMNOP
8
Q
What is the management of acute HF?
(*use abbreviation)
A
LMNOP
l-loop diuretic (furosemide)
m-morphine
n-nitrates
o-oxygen
-p-position (sit patient upwards, avoid lying on back)
acute HF- most commonly caused by decompensated chronic HF
9
Q
What is the acute management of Atrial Fibrillation?
b) what are the factors must be presebt
A
Acute:
1st line- DC Cardioversion +/- Amiodarone
Cardoversion can only be carried out if:
-arrythmia been present <48hrs
-patient is haemodynamically unstable
10
Q
What is the long term management of Atrial Fibrillation?
a) long term
b) anti-coagulation therapy
A
1st line- beta blocker
2nd line- CCB
Anti-coagulation therapy
1st line- DOAC
2nd line- LMWH
(*SAME AS DVT/PE)
11
Q
What is the management of Ventricular Tachycardia?
a) with pulse
b) pulseless
A
Acute:
1st line- IV Amiodarone
Pulseless Ventricular Tachycardia:
1st line- DC Cardioversion (shockable rhythm)
12
Q
What is the management of Supra-Ventricular Tachycardia? (SVT)
(*spa)
A
1st line- valsalva manouver
2nd line- carotid sinus massage (s-spa)
3rd line- IV adenosine 6mg bolus > 12mg> 18mg
alternative if asthmatic
verapamil
13
Q
What is the dosage of Adenosine in the management of SVT?
A
Dosage of Adenosine:
rd line- IV adenosine(6mg)- then 12 mg > 18mg
14
Q
What is the alternative to adenosine in SVT when a patient is asthmatic?
A
asthmatic- verapamil
15
Q
What is Malignant Hypertension?
A
acute rise in blood pressure defined as systolic >180 and diastolic >120
16
Q
Infective Endocarditis
a) what is the 1st line investigation
b) what is the 1st line imaging?
A
1st line test- x3 sets of blood cultures (against Dukes Criteria)
1st line imaging- echocardiogram
17
Q
What is GRACE score used for?
A
-determines short and long term risk in ACS
if >3% in an NSTEMI this indicates a coronary angiogram within 72hrs of admission
18
Q
What GRACE score (%) in an NSTEMI indicates a coronary angiogram must be performed?
A
if >3% in an NSTEMI this indicates a coronary angiogram within 72hrs of admission
19
Q
What is the management of an NSTEMI?
(*BATMAN)
A
BATMAN
- Base whether angiography should be carried out within 72hrs on the GRACE score is >3%
- Aspirin 300mg stat
- Ticagreor
- morphine
- anti-thrombin
- nitrates (GTN)
20
Q
A
21
Q
Where anatomically is a PCI carried out?
A
-radial access
22
Q
What is Dresslers Syndrome and what are its clinical features?
A
This is a type of pericarditis (same clinical features) that occurs 4-6 weeks post MI
-better leaning forward, saddle ST elevation on an ECG
23
Q
What is the main chamber effected in Chronic HF?
A
main chamber effected- left ventricle
24
Q
Heart Failure:
a) what is the 1st line investigation?
b) what is the preferred imaging option?
A
Heart failure investigations:
1st line- BNP
2nd line -echocardiogram
25
What is the mutation in Long QT syndrome?
-base change in an exon nonsense mutation forming a premature stop codon
26
What is the genetic mutation in sickle cell syndrome?
Genetic - point mutation in codon 6 of the β globin gene that substitutes glutamine to valine producing βS
27
Hypertrophic Cardiomyopathy?
a) What is the 1st line management
b) what is the definitive management
Hypertrophic cardiomyopathy
1st line- beta blockers
definitive- ICD
28
What function is mainly impaired in hypertrophic cardiomyopathy?
reduced diastolic function
29
What is Frank Sterling Law?
Frank Sterling Law:
* relationship between stroke volume and end diastolic volume
30
What does J waves indicate?
-eat JELLYBABIES when hypothermic
-hypothermia
31
What medications are known to reduce the mortality rates of HF?
(*must know! in MLA exam last year)
mneumonic- BAMS
beta blockers
ACEIS/ARBs
MRA- aldosterone antagonists
SGLT-2 inhibitor
32
What are the X4 main types of Syncope?
-reflex
-orthostatic hypotension
-carotid sinus reflex
-cardiac syncope
33
What is reflex syncope?
reflex- brief loss of consicousness due to a neurologically induced drop in blood pressure
34
What is Carotid Sinus Reflex?
activation of the baro-recpetors in the neck due to exertion of pressure- e.g tight collars or shaving
35
What is the main triad of symptoms in cor pulmonale?
pulmonary oedema
elevated JVP
hepatosplenomegaly- inc pressure on the hepatic vein
36
What vessel layer is damaged in:
- aortic dissection
- AAA
What vessel layer is damaged in:
- aortic dissection- tunica intima
- AAA- tunica media
37
what condition is associated with:
Different blood pressure measurements in each arm, and tearing chest pain radiating to the back is associated with?
Aortic Dissection
38
What are the X2 main types of aortic dissection and associated symptom?
b) what part of the aorta is damaged?
- Aortic Dissection type A (*More common- ascending aorta- common ascend in life- **chest pain**
- Aortic Dissection type B (*less common in descending aorta)- back pain
39
What is the 'diagnostic' investigation for Aortic Dissection?
Diagnostic Investigation = CT angiography (*false lumen is the positive finding)
40
What is the 1st line investigation for suspected AAA?
B) what is the gold standard diagnostic investigation?
(***same gold standard as aortic dissection)
a) US
b) gold standard diagnostic- CT Angiogram
41
What is **Boerhaaves Syndrome?**
- spontaneous rupture of the full layers of oesophagus due to repeated episodes of vomiting
- associated with alcoholics
- bloody vomiting
- more severe than mallory weiss tear, malory weiss is NOT Painful only superficial tea
42
What is the main area damaged in Boerhaaves Syndrome?
(*Must know- very painful full rupture)
* usually DISTAL aorta
43
What is the diagnostic investigation for boerhaaves Syndrome?
* Diagnostic Investigation > CT contrast Swallow (*as associated with vomiting and rupture of oesophagus)
44
What function is reduced in hypertrophic cardiomyopathy?
-diastolic function is reduces- reduced filling of blood in the heart
45
How long does medication need to be given for a PE?
a) unprovoked
b) provoked
a) unprovoked - 6 months
b) provoked (e.g plane, in hospital )- 3 months
46
Prosthetic heart valves/metallic - mechanical valves requires what anti-coagulation?
warfarin
47
What is the main antibiotic that causes Long QT Syndrome?
erythromycin
(*other meds- citalopram and haloperidol triggers it)
48
QRS complex (> 120 ms) means what leads should be looked at?
V1 and V6- bundle branch block
Right- MarroW
Left- William
49
Absent radial pulse in one arm indicates?
Takyasu
(*also has different blood pressure in each arm)
(*Aortic dissection also presents with different blood pressures in each arm)
50
How do you calculate CHA2DS2-VASc?
a) What do the scores mean and when should an anti-coagulant be started?
Risk factor Points
C Congestive heart failure 1
H Hypertension (or treated hypertension) 1
A2 Age >= 75 years 2
Age 65-74 years 1
D Diabetes 1
S2 Prior Stroke, TIA or thromboembolism 2
V Vascular disease (including ischaemic heart disease and peripheral arterial disease) 1
S Sex (female) 1
>2- male means anti-coagulate, if woman do not
>3- females and males- start anti-coagulant
51
Electrical alternans is associated with?
Cardiac Tamponade
52
What is the most common heart valve effected in infective endocarditis?
b) most common valve effected in iV drug users?
most common- mitral valve (m-most common)
IV drug user- tricuspid
53
What blood vessel is most likely to be effected in an MI?
right coronary artery
54
>55 years old or afro-carribean is given CCB
b) what is the add on treatment if hypertension is uncontrolled
C + A or C + D
(ACEI/ARB or diuretic added)
55
What is the management of Acute chest pain?
Acute Chest Pain: Management
1st line- GTN Spray (vasodilator) + 300mg aspirin
(*do not administer oxygen unless sats <94%)
56
What are the investigations (1st to 3rd line) required for stable chest pain?
(*common MLA question)
**Stable Chest Pain:**
1st line- CT Coronary Angiography
2nd line- non-invasive functional imaging (ETT, Stress echo)
3rd line- invasive coronary angiography
57
What scoring system is used to determine whether an individual should start a statin?
QRISK2 >10% i
58
What is the QRISK SCORE?
Screening called the QRISK2 score is used. This determines the 10 year risk of developing CVD.
**QRISK2 >10%** indicates initiation of primary preventative statin is needed. (20mg of atorvostatin OD)
59
What QRISK score indicates to start a statin?
>10%
60
In what cases should a QRisk Score not be implemented?
QRISK2 score should not be used in these cases:
- T1DM
- Patients with reduced kidney function
- patients with familial hyperlipidemia
61
What T1DM circumstances indicates primary prevention with a statin?
- NICE guidelines recommends that all T1DM should be considered for primary prevention of CVD- 20mg statin. If they have any of the following features;
1. >40 years old
2. Had diabetes >10 years
3. Established nepropathy
4. Other CVD risk factors present
(do NOT carry out a QRISK score in T1DM)
62
What is the cholesterol management for patients with CKD?
- all patients with CKD should be offered a statin
1st line (primary prevention)- 20mg atorvostatin
63
What statin and dose is required for primary and secondary prevention?
Primary Prevention- 20mg atorvostatin OD (preferred statin of choice)
Secondary Prevention- 80mg atorvostatin OD
(*OD- once daily)
64
What is Familial Hypercholesterolaemia?
This is an autosomal dominant condition. Where there is excessively high levels of LDL cholesterol, left untreated can cause CVD.
-Caused by mutations in the gene which codes for the LDL receptors (LDL bad cholesterol)
65
What is the management for Familial Hypercholesterolaemia?
Management:
1st line- high dose statins
(*statins should be discontinued 3 months before conception and should NEVER be taken during pregnancy)
66
What MUST be prescribed prior to PCI?
(*PLEASE learn this!)
- dual anti-platelet therapy should be commenced prior to PCI- aspirin + the following….
1. patient is not on an oral anti-coagulant- prasguel ‘perfect’
2. patient is taking an oral anti-coagulant- clopidogrel. (so aspirin + clopidogrel is the dual antiplatelet therapy etc)
67
What dual anti-platelet therapy is preferred prior to PCI:
a) patient not on anti-coagulation
b) patient IS on anti-coagulation
p-perfect
a) not on anti-coagulation- prasguel + aspirin
b) on anti-coagulation- clopidogrel + aspirin
68
What anti-thrombin drugs are used in fibrinolysis
- anti-thrombin drug must be given- alteplase, streptokinase etc
69
What time scale bust fibrinolysis be carried out within?
12 hours of onset of symptoms
70
What must be repeated after fibrinolysis has been carried out?
ECG should be repeated after 60-90 mins to see if any changes have made from the therapy (ST elevation reduces etc)
71
What are the complications of mycocardial infarctions?
(*mneumonic- DARTH VADER)
D-death
A-Arrythmia > cardiac death
R-Rupture of ventricular free wall
T-tamponade
H-HF
V-Valvular disease
A-Anyeurism (left ventricular)
D-Dressler's syndrome
E-Embolism
R-Reocurrence
72
What is the management of 1st degree heart block?
Management:
1st line- generally benign and does not need treating (common cause in young adults- athlete)
73
What are features of 1st degree heart block?
-prolonged PR interval
P waves and QRS waves both mostly present
74
What are the x2 types of 2nd degree heart block?
- Mobitz 1- Progressive lengthening of the PR interval, some P waves fail to conduct QRS (as blockage at AVN between atria and ventricles). greatest interval for PR duration usually after 2nd or 3rd QRS complex.
- Mobitz 2- PR interval is prolonged and constant. No pattern identified. G
75
What are features of 3rd degree heart block?
This occurs when the atrial impulses fail TOTALLY getting through the AVN. Cause severe bradyacrdia or asystole or cardiac arrest.
76
What is the management of 2nd degree heart block?
a) Mobitz 1
b) Mobitz 2
Mobitz 1
1st line- conservative, usually asymptomatic
Mobitz 2:
Definitive management- permanent pacemaker (*patients as risk of complete heart block and asystole)
77
What is the definitive management of Mobitz 2 heart block?
Mobitz 2:
Definitive management- permanent pacemaker (*patients as risk of complete heart block and asystole)
78
3rd degree heart block
a) what is the acute management and why!
b) what is the definitive management
**Acute Management:**
1st line- (bradycardia)- 500mcg IV atropine (repeat up to 3mg until response)
Definitive Management:
permanent pacemaker insertion (reduces risk of asystole and cardiac death)
79
What is the management of peri-anal disease in crowns
**Peri-Anal Disease:**
1st line- metronidazole
80
Crohn's disease: Management
a) maintaining remission
b) inducing remission
**Maintaining Remission:**
1st line- azothioprine or mercaptopurine
2nd line- methotrexate
**Inducing Remission:**
1st line- oral or IV steroids (oral prednislone or iV hydrocortisone based on severity)
2nd line- mesalazine
81
Ulcerative Colitis : Management
a) maintaining remission
b) inducing remission
**Ulcerative Colitis:**
**Maintaining Remission:**
1st line- rectal mesalazine
2nd line- oral mesalazine
**Inducing Remission:**
1st line- rectal mesalazine
2nd line- oral mesalazine
3rd line- oral prednislone
82
What valves are associated with heart sound S1
**(S1) Heart Sound: ( end of systole)**
(closure of the atrio-ventricular valves)
- Tricuspid
- Mitral
83
What causes heart sounds S1 and S2
The sounds are often referred to as ‘lub’ (S1) and ‘dub’ (S2). These heart sounds are formed from the closure of the atrio-ventricular and semi-lunar valves in the cardiac cycle.
84
What valves are associated with (s2)
**(S2) Heart Sound: (end of diastole)**
(caused by closure of the semi-lunar valves)
- Aortic
- Pulmonary
85
What does presence of an S3 heart sound indicate?
a) young adults and children
b) adults
- Young adults and children- normal
- Older Patients- Heart Failure
86
ejection systolic murmur radiating to the carotids is a buzzword for?
Aortic stenosis!
87
Give murmurs and heart conditions associated with:
a) pan-systolic
b) ejection systolic
- Pan-Systolic- mitral or tricuspid regurgutation or VSD
- Ejection Systolic- Aortic Stenosis, Pulmonary stenosis, hyperrophic cardiomyopathy
88
What are the x2 groupings of systolic murmurs?
pan systolic and ejection systolic
89
Advanced Life Support:
a) How many shocks are given in a cardiac arrest in community
b) How many shocks are given where a cardiac arrest happens in hospital with a monitor?
a) X1 shock, return to 30:2 ratio CPR
b) up to x3 shocks can be given followed by CPR
90
What is the 1st line immediate management in hospital of malignant hypertension?
IV labetalol
91
How can you differentiate between pericarditis and myocarditis?
elevated inflammatory markers, cardiac enzymes and BNP
92
What are common Post-MI complications and buzzword symptoms?
(*MUST KNOW_)
Dresslers syndrome- 4-6 weeks, presents like pericarditis
Left Ventricular Anyeurism- bi-basal crackles and persistant ST elevation
Ventricular Septall Defect- acute HF and pan-systolic murmur
93
What is 'sparkling appearance' on Myocardial wall associated with?
amyloidosis
94
What is the management of heart murmurs?
a) asymptomatic
b) symptomatic
c) symptomatic and high risk
Asymptomatic- watch and wait
Symptomatic:
low risk- aortic valve replacement
higher surgical risk- transcatheter aortic valve replacement
95
What is the 1st and 2nd line management of hypotension?
(*previous MLA question)
1st line- IV fluids
2nd line- IV noradrenaline
96
'early diastolic murmur with decreasing intensity over the tricuspid area'
(**previous MLA Question!- memorise)
aortic regurgitation
(marfans syndrome- inc risk of aortic regurgitation)
97
OSCE CARDIO QUESTION:
Examiner asks
'How do you differentiate between the JVP and carotids/other pulses of the neck?'
(*need to know extra marks)
-palpate radial artery at same time as carotid
-hepatojugular reflex
-JVP is biphasic
-move bed flat
98
What are the X2 main causes of high JVP >4cm
(extra OSCE marks)
-tricuspid regurgitation
-Right sided HF
Right side- rest body
Left sided- lung symptoms
99
What is the most common cause of aortic stenosis?
-most common cause- calcification/cacium degeneration
100
What grade of heart murmur is indicated if 'thrills' are present on examination?
(*buzzword osce exams)
Grade 4 murmur
101
Pulses plateau
Slow Rising Pulse
Hypotension
Associated with which heart murmur?
aortic stenosis- most common cause is calcification of the valve
102
What is pulse pressure?
The difference between systolic and diastolic blood pressure
103
State the buzzword features for the main X4 heart murmurs?
a) aortic stenosis
b) Aortic Regurgitation
c) Mitral Stenosis
(*if I struggle with murmurs at least know this!)
MUST KNOW
-Aortic Stenosis (most common)
-pan-systolic murmur radiates to the carotids
-Aortic Regurgitation-’high pitched early diastolic murmur over the tricuspid area’, associated with marfans syndrome**
-Mitral stenosis- pan-systolic murmur
104
DC Cardioversion:
a) What anti-coagulation is required for immediate cardioversion
b) What anti-coagulation is required for an arranged/elective DC Cardioversion
immediate DC Cardioversion- patient must be heparinised prior
elective DC Cardioversion- anti-coagulation should be given at least 3 weeks prior
105
What are the main heart murmurs associated with the following buzzword features:
a) ejection systolic murmur radiating to the carotids
b) pan-systolic
c) early diastolic, heart louder over the tricuspid area
d) assoicated with an elevated JVP
a) aortic stenosis
b) mitral or tricuspid regurgitation
c) aortic regurgitation
d) tricuspid regurg- high JVP
106
What is the main heart murmur associated with rheumatic fever?
mitral regurgitation
