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Year 5 Cardiology > PassMedicine > Flashcards

PassMedicine Flashcards

1
Q

what is the main molecule type responsible for carrying cholesterol into the intima

A

LDL

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2
Q

which cells phagocytoses LDL to form foam cells

A

macrophages

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3
Q

what are the two main problems with IHD

A

build up of fatty plaques in walls of coronary arteries
1 gradual narrowing leading to insufficient oxygen reaching myocardium causing ischaemia
2 sudden plaque rupture leading to occlusion of the coronary artery and MI

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4
Q

what are the modifiable risk factors of IHD

A 
1 smoking
2 DM
3 HTN
4 high cholesterol
5 obesity
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5
Q

which leads are associated with the anterior myocardium

A

V1-V4

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6
Q

what vessel is associated with the anterior myocardium

A

left anterior descending

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7
Q

what leads are associated with inferior myocardium

A

II, II, aVF

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8
Q

what vessel is associated with inferior myocardium

A

right coronary

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9
Q

what leads are associated with lateral myocardium

A

I, V5-V6

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10
Q

what vessel is associated with lateral myocardium

A

left circumflex

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11
Q

what are the indications for an ACE inhibitor in HTN

A

1 newly diagnosed and <55yrs caucasian

poorly controlled HTN and already taking a CCB

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12
Q

what are the indications for a thiazide-diuretic in HTN

A

1 poorly controlled HTN, already taking an ACE inhibitor and CCB

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13
Q

what is the first line HTN therapy for >55yrs or afrocarribean

A

CCBs

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14
Q

def of HTN

A

> 140/90mmHg on 3 separate occasions

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15
Q

what are the two types of HTN

A

1 primary/idiopathic (90%)

2 secondary

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16
Q

when does HTN cause symptoms and what are these symptoms

A

> 200/120mmHg

headaches
visual disturbances
seizures

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17
Q

investigations for HTN

A

1 fundoscopy: to check for hypertensive retinopathy
2 urine dipstick: to check for renal disease, as a cause or consequence of HTN
3 ECG: to check for LVH or IHD

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18
Q

ACE inhibitors

A

inhibits conversion of angiotensin I to angiotensin
first line in <55yrs
SEs: cough

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19
Q

CCBs

A

blocks voltage gated calcium channels relaxing SM and force of myocardial contraction
first line in >55yrs or afrocarribbeans

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20
Q

thiazide diuretics

A

inhibits sodium absorption at beginning of distal convoluted tubule

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21
Q

ARBs

A

blocks effects of angiotensin II at the AT1 receptor

often used in development of chronic cough with ACE inhibitor use

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22
Q

what is the management for hypertension when a ACE inhibitor, CCB, and thiazide diuretic are alread being used

A

K<4.5mmol/l add spironolactone

k> 4.5 add higher dose thiazide

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23
Q

def of persistant AF

A

AF is not self-limiting

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24
Q

def of permanent AF

A

AF cannot be cardioverted

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25
Q

how is rate controlled in AF

A

1 beta-blocker/rate-limiting CCB (diltiazem) is first line
2 if one drug fails to rate control, combination with any two of:
-betablocker
-diltiazem
-digoxin

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26
Q

what scoring system is used to determine stroke risk with AF

A

CHADSVASC score
0 - no treatment
1 -males: offer anticoagulation, females: no treatment as score of 1 is due to gender
>2 - anticoagulate

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27
Q

features of the CHADSVASC score

A 
CCF (1)
HTN (1)
Age: >75 (2), 64-75 (1)
Diabetes (1)
S (prior) Stroke/TIA (2)
VAscular disease (1)
Sex (female) (1)
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28
Q

what is characteristic of mitral stenosis

A

low volume pulse

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29
Q

what are the indications for beta blocker use

A 
1 cardiovascular
-arrythmias
-angina
-post MI
-HF
-HTN
2 thyrotoxicosis
3 migraine prophylaxis
4 anxiety
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30
Q

what is the drug of choice for AF for rate-control

A

beta-blockers

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31
Q

what are the SEs of beta-blockers

A

bronchospasm

cold peripheries

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32
Q

what are the contraindications of beta blockers

A

asthma

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33
Q

what type of drugs are furosemide and bumetanide

A

loop diuretics

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34
Q

how do loop diuretics work

A

inhibit Na/K/CL cotransporter in the thick asending limb of the loop of henle
reduces absorption of NaCl

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35
Q

indications for loop diuretics

A

HF (acute - IV, chronic - oral)

resisitent HTN

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36
Q

A patient develops acute heart failure 5 days after a myocardial infarction. A new pan-systolic murmur is noted on examination

A

ventricular septal defect

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37
Q

what is the most common immediate complication of MI

A

cardiac arrest

due to patients developing VF

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38
Q

why could MI cause cardiogenic shock

A

large area of the ventricular myocardium is damaged
dysfunction
ejection fraction is reduced

cardiogenic shock becomes chronic HF

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39
Q

what sort of MI causes AV block to be more common

A

inferior MIs

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40
Q

what can present within the first 48h post MI and within months post MI

A 
pericarditis
dresslers syndrome (autoimmune reaction against antigenic proteins as myocardium recovers)
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41
Q

what are the rarer complications of MI

A

LV aneurysm
LV free wall rupture
ventricular septal defect
acute mitral regurgitation

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42
Q

how do patients with LV free wall rupture present

A

1-2wks post MI

acute HF secondary to cardiac tamponade

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43
Q

what is the triad of features associated with cardiac tamponade

A

raised JVP
pulsus paradoxus
diminished HSs

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44
Q

how do patients with ventricular septal defect present

A

1wk post MI
rupture of interventricular septum
pan-systolic murmur

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45
Q

how do patients with acute mitral regurg present

A

infero-posterior MI

early-mid systolic murmur

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46
Q

what are the two main non-dihydropyridine CCBs

A

verapamil

diltiazem

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47
Q

what are the main dihydropyridine CCBs

A

nifedipine
amlodipine
felodipine

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48
Q

indications for verapamil

A

angina, HTN, arrythmias

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49
Q

indications for diltiazem

A

angina, HTN

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50
Q

indications for dihydropyridine CCBs

A

HTN, angina, raynauds

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51
Q

MOA of verapamil

A

strong negative inotrope

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52
Q

what should verapamil not be given with

A

beta blockers

will cause heart block

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53
Q

MOA of diltiazem

A

negative inotrope (weaker than verapamil)

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54
Q

MOA of dihydropyridines

A

affects peripheral vascular SM more than myocardial SM

does not worsen HF

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55
Q

SEs of non-dihydropyridines

A

HF

ankle swelling

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56
Q

SEs of dihydropyridines

A

headaches

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57
Q

MOA of ACE inhibitors

A

inhibits angiotensin I to angiotensin II

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58
Q

SEs of ACE inhibitors

A

cough (increased bradykinin levels)
hyperkalaemia
angioedema

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59
Q

what are ACE inhibitors used to treat

A

first line for <55yrs with HTN
HF
diabetic nephropathy

60
Q

what causes HS1

A

closure of mitral + tricuspid heart valves

61
Q

what causes HS2

A

closure of aortic + pulmonary heart valves

62
Q

when is HS1 quiet

A

mitral regurgitation (doesn’t close fully if mitral regurg

63
Q

when is HS1 loud

A

mitral stenosis

left-to-right shunts

64
Q

when is HS2 quiet

A

aortic stenosis

65
Q

what is HS3

A

diastolic filling of ventricle

66
Q

what conditions are HS3 associated with

A

LV failure
constrictive pericarditis
mitral regurgitation

67
Q

what causes HS4

A

aortic stenosis
HOCM
hypertension

caused by atrial contraction against a stiff ventricle

68
Q

what are features of mitral regurgitation

A

pan-systolic murmur
soft HS1
widely split HS2
3rd HS

69
Q

which coronary artery is associated with the anterior heart

A

left anterior descending

70
Q

which coronary artery is associated with the inferior heart

A

right coronary

71
Q

which coronary artery is associated with the lateral heart

A

left circumflex

72
Q

atrioventricular block is most common with what sort of MIs

A

inferior MIs

73
Q

which drugs cause precipitation of digoxin toxicity

A

amiodarone
loop diuretics
thiazides
beta blockers

74
Q

what is the most common cause of infective endocarditis

A

staph aureus

75
Q

what is streptococcus viridans associated with

A

poor dental hygeine

76
Q

what produces a ejection systolic murmur

A

aortic stenosis
pulmonary stenosis
HOCM
atrial septal defect

77
Q

what produces a pansystolic murmur

A

mitral or triscuspid regurg (high pitched + blowing in character)
VSD (harsh in character)

78
Q

what produces a late systolic murmur

A

mitral valve prolapse

coarctation of aorta

79
Q

what produces a early diastolic murmur

A 
aortic regurg (high pitched + blowing in character)
graham steel murmur (pulmonary regurg which is high pitched + blowing in character)
80
Q

what produces a mid-late diastolic murmur

A 
mitral stenosis (rumbling)
austin flint murmur (severe aortic regurg)
81
Q

what produces a continuous machine like murmur

A

patent ductus arteriosus

82
Q

what are features of LV aneurysm

A

persistant ST elevation after recent MI

no chest pain

83
Q

what are features of dresslers syndrome

A

presents 2-6wks post MI

pleuritic chest pain

84
Q

what is patent ductus arteriosus

A

connection between pulmonary trunk and descending aorta

congenital

85
Q

what are features of PDA

A

continuous ‘machinery’ murmur
WPP
collapsing pulse

86
Q

what leads are associated with the anteroseptal heart

A

V1-V4

87
Q

what vessels is associated with the anteroseptal heart

A

left anterior descending

88
Q

what leads are associated with the inferior heart

A

II, III, aVF

89
Q

what vessel is associated with the inferior heart

A

right coronary

90
Q

what leads are associated with the anterolateral heart

A

I, aVL, V4-6

91
Q

what vessel is associated with the anterolateral heart

A

left circumflex or left anterior descending

92
Q

what leads are associated with the lateral heart

A

I, aVL, V5-6

93
Q

what vessel is associated with the lateral heart

A

left circumflex

94
Q

what enhances and blocks the effects of adenosine

A

enhances - dipyridamole (anti-platelet)

blocks - theophyllines

95
Q

HS4 is associated with what common valvular problem

A

aortic stenosis

96
Q

what is a supravalvular cause of aortic stenosis

A

williams syndrome

97
Q

what is a subvalvular cause of aortic stenosis

A

HOCM

98
Q

what are two causes of collapsing pulse

A

aortic regurg

patent ductus arteriosus

99
Q

what are causes of loud S1

A

mitral stenosis

100
Q

what are causes of soft S1

A

mitral regurg

101
Q

HS3 is associated with what common valvular problem

A

mitral regurg

102
Q

what is MOA for statins

A

inhibit HMG-CoA reductase

103
Q

what is the risk of statins

A

hepatotoxicity

104
Q

what are features of aortic regurg

A

early diastolic murmur
collapsing pulse
WPP
austin flint murmur (in severe AR - mid-diastolic murmur)

105
Q

what are valvular causes of aortic regurg

A

infective endocarditis
rheumatic fever
bicuspid aortic valve

106
Q

what are aortic root causes of aortic regurg

A

aortic dissection
spondylarthropathies (e.g. ankylosing spondylitis)
HTN

107
Q

what is HOCM

A

hypertrophic obstructive cardiomyopathy
an autosomal dominant disorder
caused by defects in genes encoding contractile proteins

108
Q

what is the most common defect in HOCM

A

mutation in gene encoding Beta-myosin or Myosin binding protein C

109
Q

what are features of HOCM

A

dyspnoea
angina
syncope
ejection systolic murmur

110
Q

what is the most common cause of mitral stenosis

A

rheumatic fever

111
Q

what features/associations are common with mitral stenosis

A

mid-late diastolic murmur
loud S1 or opening snap
malar flush
AF

112
Q

what is associated with a fixed split S2

A

atrial septal defect

113
Q

persistant ST elevation following recent MI with no chest pain is likely to indicate what

A

left ventricular aneurysm

114
Q

A 50-year-old woman with a history of rheumatic fever presents with dyspnoea. On examination she is found to be in atrial fibrillation, with a loud S1, split S2 and a diastolic murmur

A

mitral stenosis

115
Q

what is a low volume pulse associated with

A

mitral stenosis

116
Q

what is S4 associated with

A

aortic stenosis

117
Q

what are is found in history of aortic stenosis

A

SAD

syncope
angina
dyspnoea

118
Q

what are features of aortic stenosis

A 
NPP
slow rising pulse
ESM
soft or absent S2
S4
119
Q

what sort of murmur does an atrial septal defect produce

A

ESM

120
Q

what are common SEs of loop diuretics

A

(all lows, with exception of glucose)
hypotension
hyponatraemia
hypokalaemia

121
Q

hyperthyroidism is commonly caused by which drug

A

amiodarone

122
Q

A 25-year-old man is investigated for recurrent syncope and dyspnoea. On examination he has an ejection systolic murmur

A

HOCM

young patient, no angina, so not AS

123
Q

a 70-year-old man presents with chest pain and dyspnoea. On examination he has an ejection systolic murmur which radiates to his carotids

A

AS

124
Q

what would be found on an echo with HOCM

A

MR SAM ASH
1 mitral regurg
2 systolic anterior motion of the anterior mitral valve leaflet
3 asymmetric hypertrophy

125
Q

infective endocarditis caused by s aureus is associated with

A

prosthetic valves after 2 months
patients with no PMH
IVDUs

126
Q

infective endocarditis caused by streptococcus viridans is associated with

A

poor dental hygiene

127
Q

what distinguishes cardiac tamponade and constrictive pericarditis

A

pulsus parodoxus is present in CT but not CP

kussmauls sign is present in CP but not in CT

128
Q

how can the JVP be used to distinguish cardiac tamponade and constrictive pericarditis

A

CT has absent y descent but X present
-TAMponade=TAMpaX
CP has X+Y present

129
Q

a patient is noted to have a new early-to-mid systolic murmur 10 days after being admitted for a myocardial infarction

A

ischaemia of pailllary muscle

130
Q

A 60-year-old man with a history of lung cancer presents with dyspnoea. On examination he is tachycardic, hypotensive, has a raised JVP with an absent Y descent and has pulsus paradoxus

A

cardiac tamponade

131
Q

what happens to the heart rate on exertion in complete heart block

A

no change

132
Q

when is flecainide indicated in cardioversion of AF

A

in haemodynamically stable patients with no heart failure

133
Q 
which of the following conditions is not a cause of sudden cardiac death that is usually familial
HOCM
LQTS
brugada syndrome
arrhythmogenic RV cardiomyopathy
WPW syndrome
A

WPW syndrome

134
Q 
which of the following conditions is not a cause of sudden cardiac death that is usually familial
HOCM
LQTS
brugada syndrome
arrhythmogenic RV cardiomyopathy
WPW syndrome
A

WPW syndrome

135
Q

what is the most appropriate initial treatment of VT

A

IV adenosine

136
Q

which is more sensitive (TTE or TOE) for detecting heart valve vegetations

A

TOE

137
Q

what sort of murmur does a VSD produce

A

pansystolic murmur

138
Q

what sort of murmur does a ASD produce

A

ejection systolic murmur

139
Q

what is the TIMI score

A

estimates mortality with unstable angina and NSTEMI

140
Q

what are components of the TIMI score

A 
>65yrs
>3 CAD risk factors
known CAD (stenosis >50%)
aspirin in past week
angina (>2 episodes in 24hrs)
ST changes >0.5mm
positive cardiac markers
141
Q

what are features of cardiogenic shock

A

reduced urine output
cold and clammy
inspiratory crackles at lung bases
raised JVP

142
Q

what areas does the RCA supply

A

RA
RV
SA node
inferior LV

143
Q

what is pulsus alternans

A

alternating strong and weak pulse

144
Q

what condition is pulsus alternans associated with

A

LV impairment (poor prognosis)

145
Q

what are signs of severe mitral regurgitation

A

kerley B lines

upper lobe diversion

Year 5 Cardiology (42 decks)

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