PassMedicine Flashcards
(145 cards)
1
Q
what is the main molecule type responsible for carrying cholesterol into the intima
A
LDL
2
Q
which cells phagocytoses LDL to form foam cells
A
macrophages
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
4
Q
what are the modifiable risk factors of IHD
A
1 smoking 2 DM 3 HTN 4 high cholesterol 5 obesity
5
Q
which leads are associated with the anterior myocardium
A
V1-V4
6
Q
what vessel is associated with the anterior myocardium
A
left anterior descending
7
Q
what leads are associated with inferior myocardium
A
II, II, aVF
8
Q
what vessel is associated with inferior myocardium
A
right coronary
9
Q
what leads are associated with lateral myocardium
A
I, V5-V6
10
Q
what vessel is associated with lateral myocardium
A
left circumflex
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
12
Q
what are the indications for a thiazide-diuretic in HTN
A
1 poorly controlled HTN, already taking an ACE inhibitor and CCB
13
Q
what is the first line HTN therapy for >55yrs or afrocarribean
A
CCBs
14
Q
def of HTN
A
> 140/90mmHg on 3 separate occasions
15
Q
what are the two types of HTN
A
1 primary/idiopathic (90%)
2 secondary
16
Q
when does HTN cause symptoms and what are these symptoms
A
> 200/120mmHg
headaches
visual disturbances
seizures
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
18
Q
ACE inhibitors
A
inhibits conversion of angiotensin I to angiotensin
first line in <55yrs
SEs: cough
19
Q
CCBs
A
blocks voltage gated calcium channels relaxing SM and force of myocardial contraction
first line in >55yrs or afrocarribbeans
20
Q
thiazide diuretics
A
inhibits sodium absorption at beginning of distal convoluted tubule
21
Q
ARBs
A
blocks effects of angiotensin II at the AT1 receptor
often used in development of chronic cough with ACE inhibitor use
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
23
Q
def of persistant AF
A
AF is not self-limiting
24
Q
def of permanent AF
A
AF cannot be cardioverted
25
how is rate controlled in AF
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
26
what scoring system is used to determine stroke risk with AF
CHADSVASC score
0 - no treatment
1 -males: offer anticoagulation, females: no treatment as score of 1 is due to gender
>2 - anticoagulate
27
features of the CHADSVASC score
```
CCF (1)
HTN (1)
Age: >75 (2), 64-75 (1)
Diabetes (1)
S (prior) Stroke/TIA (2)
VAscular disease (1)
Sex (female) (1)
```
28
what is characteristic of mitral stenosis
low volume pulse
29
what are the indications for beta blocker use
```
1 cardiovascular
-arrythmias
-angina
-post MI
-HF
-HTN
2 thyrotoxicosis
3 migraine prophylaxis
4 anxiety
```
30
what is the drug of choice for AF for rate-control
beta-blockers
31
what are the SEs of beta-blockers
bronchospasm
| cold peripheries
32
what are the contraindications of beta blockers
asthma
33
what type of drugs are furosemide and bumetanide
loop diuretics
34
how do loop diuretics work
inhibit Na/K/CL cotransporter in the thick asending limb of the loop of henle
reduces absorption of NaCl
35
indications for loop diuretics
HF (acute - IV, chronic - oral)
| resisitent HTN
36
A patient develops acute heart failure 5 days after a myocardial infarction. A new pan-systolic murmur is noted on examination
ventricular septal defect
37
what is the most common immediate complication of MI
cardiac arrest
| due to patients developing VF
38
why could MI cause cardiogenic shock
large area of the ventricular myocardium is damaged
dysfunction
ejection fraction is reduced
cardiogenic shock becomes chronic HF
39
what sort of MI causes AV block to be more common
inferior MIs
40
what can present within the first 48h post MI and within months post MI
```
pericarditis
dresslers syndrome (autoimmune reaction against antigenic proteins as myocardium recovers)
```
41
what are the rarer complications of MI
LV aneurysm
LV free wall rupture
ventricular septal defect
acute mitral regurgitation
42
how do patients with LV free wall rupture present
1-2wks post MI
| acute HF secondary to cardiac tamponade
43
what is the triad of features associated with cardiac tamponade
raised JVP
pulsus paradoxus
diminished HSs
44
how do patients with ventricular septal defect present
1wk post MI
rupture of interventricular septum
pan-systolic murmur
45
how do patients with acute mitral regurg present
infero-posterior MI
| early-mid systolic murmur
46
what are the two main non-dihydropyridine CCBs
verapamil
| diltiazem
47
what are the main dihydropyridine CCBs
nifedipine
amlodipine
felodipine
48
indications for verapamil
angina, HTN, arrythmias
49
indications for diltiazem
angina, HTN
50
indications for dihydropyridine CCBs
HTN, angina, raynauds
51
MOA of verapamil
strong negative inotrope
52
what should verapamil not be given with
beta blockers
| will cause heart block
53
MOA of diltiazem
negative inotrope (weaker than verapamil)
54
MOA of dihydropyridines
affects peripheral vascular SM more than myocardial SM
| does not worsen HF
55
SEs of non-dihydropyridines
HF
| ankle swelling
56
SEs of dihydropyridines
headaches
57
MOA of ACE inhibitors
inhibits angiotensin I to angiotensin II
58
SEs of ACE inhibitors
cough (increased bradykinin levels)
hyperkalaemia
angioedema
59
what are ACE inhibitors used to treat
first line for <55yrs with HTN
HF
diabetic nephropathy
60
what causes HS1
closure of mitral + tricuspid heart valves
61
what causes HS2
closure of aortic + pulmonary heart valves
62
when is HS1 quiet
mitral regurgitation (doesn't close fully if mitral regurg
63
when is HS1 loud
mitral stenosis
| left-to-right shunts
64
when is HS2 quiet
aortic stenosis
65
what is HS3
diastolic filling of ventricle
66
what conditions are HS3 associated with
LV failure
constrictive pericarditis
mitral regurgitation
67
what causes HS4
aortic stenosis
HOCM
hypertension
caused by atrial contraction against a stiff ventricle
68
what are features of mitral regurgitation
pan-systolic murmur
soft HS1
widely split HS2
3rd HS
69
which coronary artery is associated with the anterior heart
left anterior descending
70
which coronary artery is associated with the inferior heart
right coronary
71
which coronary artery is associated with the lateral heart
left circumflex
72
atrioventricular block is most common with what sort of MIs
inferior MIs
73
which drugs cause precipitation of digoxin toxicity
amiodarone
loop diuretics
thiazides
beta blockers
74
what is the most common cause of infective endocarditis
staph aureus
75
what is streptococcus viridans associated with
poor dental hygeine
76
what produces a ejection systolic murmur
aortic stenosis
pulmonary stenosis
HOCM
atrial septal defect
77
what produces a pansystolic murmur
mitral or triscuspid regurg (high pitched + blowing in character)
VSD (harsh in character)
78
what produces a late systolic murmur
mitral valve prolapse
| coarctation of aorta
79
what produces a early diastolic murmur
```
aortic regurg (high pitched + blowing in character)
graham steel murmur (pulmonary regurg which is high pitched + blowing in character)
```
80
what produces a mid-late diastolic murmur
```
mitral stenosis (rumbling)
austin flint murmur (severe aortic regurg)
```
81
what produces a continuous machine like murmur
patent ductus arteriosus
82
what are features of LV aneurysm
persistant ST elevation after recent MI
| no chest pain
83
what are features of dresslers syndrome
presents 2-6wks post MI
| pleuritic chest pain
84
what is patent ductus arteriosus
connection between pulmonary trunk and descending aorta
| congenital
85
what are features of PDA
continuous 'machinery' murmur
WPP
collapsing pulse
86
what leads are associated with the anteroseptal heart
V1-V4
87
what vessels is associated with the anteroseptal heart
left anterior descending
88
what leads are associated with the inferior heart
II, III, aVF
89
what vessel is associated with the inferior heart
right coronary
90
what leads are associated with the anterolateral heart
I, aVL, V4-6
91
what vessel is associated with the anterolateral heart
left circumflex or left anterior descending
92
what leads are associated with the lateral heart
I, aVL, V5-6
93
what vessel is associated with the lateral heart
left circumflex
94
what enhances and blocks the effects of adenosine
enhances - dipyridamole (anti-platelet)
| blocks - theophyllines
95
HS4 is associated with what common valvular problem
aortic stenosis
96
what is a supravalvular cause of aortic stenosis
williams syndrome
97
what is a subvalvular cause of aortic stenosis
HOCM
98
what are two causes of collapsing pulse
aortic regurg
| patent ductus arteriosus
99
what are causes of loud S1
mitral stenosis
100
what are causes of soft S1
mitral regurg
101
HS3 is associated with what common valvular problem
mitral regurg
102
what is MOA for statins
inhibit HMG-CoA reductase
103
what is the risk of statins
hepatotoxicity
104
what are features of aortic regurg
early diastolic murmur
collapsing pulse
WPP
austin flint murmur (in severe AR - mid-diastolic murmur)
105
what are valvular causes of aortic regurg
infective endocarditis
rheumatic fever
bicuspid aortic valve
106
what are aortic root causes of aortic regurg
aortic dissection
spondylarthropathies (e.g. ankylosing spondylitis)
HTN
107
what is HOCM
hypertrophic obstructive cardiomyopathy
an autosomal dominant disorder
caused by defects in genes encoding contractile proteins
108
what is the most common defect in HOCM
mutation in gene encoding Beta-myosin or Myosin binding protein C
109
what are features of HOCM
dyspnoea
angina
syncope
ejection systolic murmur
110
what is the most common cause of mitral stenosis
rheumatic fever
111
what features/associations are common with mitral stenosis
mid-late diastolic murmur
loud S1 or opening snap
malar flush
AF
112
what is associated with a fixed split S2
atrial septal defect
113
persistant ST elevation following recent MI with no chest pain is likely to indicate what
left ventricular aneurysm
114
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
mitral stenosis
115
what is a low volume pulse associated with
mitral stenosis
116
what is S4 associated with
aortic stenosis
117
what are is found in history of aortic stenosis
SAD
syncope
angina
dyspnoea
118
what are features of aortic stenosis
```
NPP
slow rising pulse
ESM
soft or absent S2
S4
```
119
what sort of murmur does an atrial septal defect produce
ESM
120
what are common SEs of loop diuretics
(all lows, with exception of glucose)
hypotension
hyponatraemia
hypokalaemia
121
hyperthyroidism is commonly caused by which drug
amiodarone
122
A 25-year-old man is investigated for recurrent syncope and dyspnoea. On examination he has an ejection systolic murmur
HOCM
| young patient, no angina, so not AS
123
a 70-year-old man presents with chest pain and dyspnoea. On examination he has an ejection systolic murmur which radiates to his carotids
AS
124
what would be found on an echo with HOCM
MR SAM ASH
1 mitral regurg
2 systolic anterior motion of the anterior mitral valve leaflet
3 asymmetric hypertrophy
125
infective endocarditis caused by s aureus is associated with
prosthetic valves after 2 months
patients with no PMH
IVDUs
126
infective endocarditis caused by streptococcus viridans is associated with
poor dental hygiene
127
what distinguishes cardiac tamponade and constrictive pericarditis
pulsus parodoxus is present in CT but not CP
| kussmauls sign is present in CP but not in CT
128
how can the JVP be used to distinguish cardiac tamponade and constrictive pericarditis
CT has absent y descent but X present
-TAMponade=TAMpaX
CP has X+Y present
129
a patient is noted to have a new early-to-mid systolic murmur 10 days after being admitted for a myocardial infarction
ischaemia of pailllary muscle
130
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
cardiac tamponade
131
what happens to the heart rate on exertion in complete heart block
no change
132
when is flecainide indicated in cardioversion of AF
in haemodynamically stable patients with no heart failure
133
```
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
```
WPW syndrome
134
```
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
```
WPW syndrome
135
what is the most appropriate initial treatment of VT
IV adenosine
136
which is more sensitive (TTE or TOE) for detecting heart valve vegetations
TOE
137
what sort of murmur does a VSD produce
pansystolic murmur
138
what sort of murmur does a ASD produce
ejection systolic murmur
139
what is the TIMI score
estimates mortality with unstable angina and NSTEMI
140
what are components of the TIMI score
```
>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
what are features of cardiogenic shock
reduced urine output
cold and clammy
inspiratory crackles at lung bases
raised JVP
142
what areas does the RCA supply
RA
RV
SA node
inferior LV
143
what is pulsus alternans
alternating strong and weak pulse
144
what condition is pulsus alternans associated with
LV impairment (poor prognosis)
145
what are signs of severe mitral regurgitation
kerley B lines
| upper lobe diversion
