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Medicine - Year 3 COPY > Medicine - Cardiology > Flashcards

Medicine - Cardiology Flashcards

1
Q 
Atrial Fibrillation
Pathophysiology:
Causes:
ECG changes:
Symptoms:
Signs:
Investigations:
Management:
Complications:
A

Pathophysiology: Multiple atrial foci firing at once

Causes: Myocardial infarction, Hypertension, Pericarditis, Congenital Heart Defects, Alcohol, Thyrotoxicosis, Electrolyte Imbalance

ECG changes: Loss of P waves, Irregularly Irregular

Symptoms: Breathlessness, Syncope, Palpitations, Reduced Exercise Tolerance

Signs: Irregular heart rate, Tachycardia

Investigations: 24-hour Holter monitor, CHADS-VASC, HAS BLED

Management: Haemodynamically unstable: Emergency Cardioversion
Rate: B-blocker (Atenolol), Ca channel blocker (Diltiazem), Digoxin
Rhythm: Amiodarone + Flecainide - chemical cardioversion
Clotting agents

Complications: Stroke and thromboembolism, HF, Cardiomyopathy

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2
Q

What are the indications for DC Cardioversion in AF? Contraindications?

A

Indications: Haemodynamically unstable (High HR, low BP)
Stable, but not recovering with medical treatment
Contraindications: Structural heart defects

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3
Q

Recall CHADS VASC

A 
Congestive Heart Failure - 1
Hypertension - 1
Age - 2 - > 75
Diabetes - 1
Stroke/VTE - 2

Vascular history eg. MI/Peripheral artery disease - 1
Age - 1 - 65-74
Sex category - Female - 1

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4
Q 
Murmur (Valvular Heart Disease):
Signs of Aortic Stenosis:
Signs of Mitral Regurgitation:
Signs of Aortic Regurgitation:
Signs of Mitral Stenosis:
A

AS: Syncope (exertional), SOB, Ejection Systolic Murmur, Radiation to Carotids
MR: Pansystolic Murmur, Non-pitting Peripheral Oedema, Radiates to Axilla, SOB
AR: Quinke’s sign, Diastolic Murmurs, Bounding Pulse
MS: Malar Flush, Diastolic Murmurs, Raised JVP

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5
Q

Name 5 causes of Murmurs:

A 
Rheumatic fever
Congenital
Hypertension
Endocarditis
MI
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6
Q 
Aortic Stenosis
Pathophysiology:
Causes:
Symptoms:
Signs:
Investigations:
Management:
Complications:
A

Pathophysiology: Aortic Valve stenosed (!) - leads to right sided pump issues

Causes: Rheumatic fever, MI, Endocarditis, Hypertension

Symptoms: SAD - Syncope, Angina (chest pain), Dyspnoea, particularly if lying flat

Signs: Cyanosis, SOB, Carotid bruit

Investigations: Echocardiogram, ECG for hypertrophy

Management: TAVI (transcatheter aortic valve implantation through femoral artery), Anticoagulants

Complications: Heart failure, Haemolytic anaemia, Stroke

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7
Q 
Endocarditis
Pathophysiology:
Causes:
Symptoms:
Signs:
Risk factors:
Investigations:
Management:
A

Pathophysiology: Infection of the endocardium (inner lining) and valve(s) of the heart - most commonly mitral, then aortic valves

Causes: Staph aureus - most common, Staph epidermidis (replacement valves), Strep viridans (IVDU)

Symptoms: Fever (spiking), fatigue, weight loss

Signs: Osler’s nodes (painful, large), splinter haemorrhages (under nails), Janeway lesions (small, painless), clubbing of the fingers

Risk factors: IVDU, Valve replacement therapy, immunocompromise

Investigations: Blood cultures x2 done when temperature spikes, Echocardiogram, Eye test - Roth spot on retina

Management: Vancomycin or Gentamicin

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8
Q 
ECGs:
Signs for:
- AF
- Atrial flutter
- Hyperkalaemia
- Anterior STEMI
- Inferior STEMI
- Pericarditis
- WPW
- VF
- RBBB
- LBBB
- Bifascicular Block
- Trifascicular Block
- PE
- Right Axis Deviation
- Left Axis Deviation
- 1st degree HB
- 2nd degree, MT1
- 2nd degree, MT2
A
  • AF - loss of p waves, irregularly irregular
  • Atrial flutter - sawtooth baseline, regular
  • Hyperkalaemia - loss of p waves, tented T waves
  • Anterior STEMI - ST elevation in V3-V4
  • Inferior STEMI - ST elevation in Leads 2, 3, AVL
  • Pericarditis - PR depression, saddle ST elevation
  • WPW - delta wave
  • VF - polymorphic ventricular tachy
  • RBBB - V1, V2, RSR pattern
  • LBBB - V5, V6, M wave
  • Bifascicular Block - RBBB, LAD
  • Trifascicular Block - RBBB, LAD, 1st degree HB
  • PE - tachycardia, S1Q3T3, RBBB, RV strain, RAD
  • Right Axis Deviation - 1 and 3 pointing at eachother
  • Left Axis Deviation - 1 and 3 pointing away
  • 1st degree HB - >5 squares PR interval
  • 2nd degree, MT1 - gradually increasing PR and then drop
  • 3rd degree, MT2 - constant PR and then drop
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9
Q 
Hypertension
Pathophysiology:
Causes:
Signs:
Investigations:
Management:
Complications:
A

Pathophysiology: High BP

Causes: Hyperthyroidism, Pre-eclampsia, Renal Artery Stenosis, OSA, Conn’s tumour

Signs: Haematuria, SOB, High BP

Investigations: Ambulatory Blood Pressure Monitoring (ABPM) or HBPM. Do same day assessment of organ function and eyes if >180.

Management: 1. Lifestyle 2. Only treat medically if QRISK>10%, diabetic, CKD, coronary disease 3. <55 or Diabetic - ACE, then Ca2+, then Thiazide-like diuretics (indapamide). > 55/Black and not diabetic - Ca2+, then indapamide, then ACE.

Complications: Heart failure, AF, MI, Stoke, Retinopathy (Flame Haemorrhages), Renal Failure

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10
Q

Name the ocular changes that occur in hypertension.

A

Copper and silver wiring
Flame haemorrhages, retinal oedema and Cotton wool spots
Papilloedema

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11
Q 
Heart Failure
Pathophysiology:
Causes:
Symptoms:
Signs:
Investigations:
Management:
Complications:
A

Pathophysiology: Drop in ventricular output leading to poor organ perfusion.

Causes: Coronary artery disease, Hypertension, AS, Pericarditis, Arrhythmias, Thyrotoxicosis and sepsis

Symptoms: SOB, PND, Orthopnoea, Dizziness/Syncope

Signs: Oedema, Tachycardia, Hypertension, Basal Pulmonary crackles, Liver congestion, Cardiomegaly

Investigations: BNP (care ACE), ECG, Echocardiogram, CXR (batwing + cardiomegaly + maybe pleural effusion)

Management:
Acute: Oxygen, Morphine, Loop diuretic IV (furosemide or add indapamide), GTN spray
Not responding: CPAP
Chronic: ACE (Ramipril) + B-blocker, (bisoprolol) add spironolactone if struggling, sleep study + lifestyle modification

Complications: AF, depression, cachexia, CKD

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12
Q 
Myocardial Infarction
Pathophysiology:
Risk factors:
Investigations:
Management:
Complications:
A

Pathophysiology: Coronary artery occlusion leading to ischaemia.

Risk factors: High cholesterol diet, Obesity, Smoking, Hypercholesterolaemia, Hypertension

Investigations: Troponin, but only changes after 4 hours, ECG

Management: ROMANCE immediately + PCI
Long-term: ACE + B-blocker (atenolol) + dual anti-platelet (aspirin + clopidogrel) + statin

Complications: Must tell DVLA and stop for 4 weeks, sudden pulmonary oedema, pericarditis leading to tamponade

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13
Q

Angina
Pathophysiology:
Investigations:
Management:

A

Pathophysiology: Partial Occlusion - stable if only during exercise, unstable if at rest.

Investigations: ECG + Troponin

Management: Nitrates + Aspirin + Statin + B-blocker

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14
Q 
Name the ECG leads for the corresponding and the artery supplied:
Anterior
Inferior
Septal
Lateral
A

Anterior - V3-V4 - Right coronary artery
Lateral - 1, V5, V6 - Circumflex artery
Inferior - 2,3,AVL - Right coronary artery
Septal - V1, V2 - LAD

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15
Q

Describe the management of VT/VF

A

Shockable

Start CPR, shock three times, give adrenaline 1mg 1:10000, give amiodarone, continue

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16
Q

Describe the management of PEA/Asystole

A

Non-shockable

Give 1mg 1:10000 adrenaline

17
Q

Hyperlipidaemia
Pathophysiology:
Causes:
Signs:
Management:
Describe the complications of prescribing statins (2)
What drug should statins not be given with?

A

Pathophysiology: High TAG/Cholesterol levels

Causes: Unhealthy diet, Alcohol excess, Familial Hypercholesterolaemia, CKD, Thiazides

Signs: Corneal Arcus, Tendinous Xanthoma, Xanthelasma

Management: Calculate QRISK2 - >10%, start on statins - lifetime risk of developing cardiovascular disease
Give atorvastatin or ezetimibe if this does not work

Complications: Myalgia, Liver impairment (must check LFTs at 3 months)

Contra: Clarithromycin (macrolides)

18
Q 
Pericarditis
Pathophysiology:
Causes:
Symptoms:
Signs:
ECG signs:
Investigations:
Management:
Complications:
What are the signs of constrictive pericarditis?
A

Pathophysiology: Inflammation of the pericardial sack, usually due to viral illness.

Causes: Viral illness/Renal disease

Symptoms: Sharp, retrosternal pleuritic pain

Signs: Worse pain on inspiration/ leaning forwards.

ECG signs: Saddle ST elevation, PR depression:

Investigations: ECG

Management: NSAIDs + colchicine

Complications:

Constrictive pericarditis: Peripheral oedema, increased JVP on inspiration (Kussmaul’s sign)

19
Q

Cardiac Tamponade
Triad of signs
What is the special sign for cardiac tamponade

A

Beck’s triad: Hypotension, distended neck veins, muffled heart sounds
Pulsus paradoxus - abnormally large drop in BP in inspiration

20
Q 
WPW
Pathophysiology
Symptoms
ECG sign
Treatment
A

Pathophysiology: Accessory pathway that bypasses the AV node

Symptoms: Tachycardia, Palpitations, SOB, Light-headedness, Syncope

ECG sign: Delta wave

Treatment: Accessory pathway ablation and amiodorone

Medicine - Year 3 COPY (6 decks)

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