Revision Flashcards
(125 cards)
1
Q
Medical Management of NSTEMI
A
Antiplatelets Anticoagulation Tirofiban Nitrates B-Blockers (Ca2+ if contraindicated) ACEI Statins
2
Q
Pericarditis and Dressler’s
A
ECHO
NSAIDs or steroids (severe)
3
Q
Signs of cardiac temponade
A
Low CO Pulsus paradoxus Raised JVP Muffled heart sounds Diagnose with ECHO and the pericardial aspiration
4
Q
LV aneurysm
A
Persistent ST elevation
5
Q
Wenckenbach’s phenomenon
A
Mobitz Type I heart block
6
Q
Post-MI AF/flutter
A
Treat with digoxin +/- B-Blocker
7
Q
In PVC or non-sustained VT
A
Avoid AADs
8
Q
Positive Electrode
A
Recording electrode (LA, LL)
9
Q
PE on ECG
A
S1 Q3 T3
Deep S waves
Pathological Q waves
T wave inversion
10
Q
Hypothermia on ECG
A
Bradycardic with J wave
11
Q
ECG changes in hyperkalaemia
A
Tall tented T waves
Later = decreased height of p waves, increased PR
Even later = widening of QRS, merging of QRS and t wave
12
Q
QT interval
A
0.36-0.44 seconds
13
Q
Manifestation of aldosteronism
A
Low K+
14
Q
Flushing and Palpitations
A
Phaechromocytoma
15
Q
Young female with high BP
A
Fibromuscular dysplasia affecting the renal arteries (will see a corkscrew effect)
16
Q
Anti-Anginal drug treatment
A
1st. B-Blocker OR Ca2+ blocker
2nd. B-Blocker + Ca2+ blocker
3rd.
Long acting nitrate
Ivabradine
Ranolazine
Nicorandil
17
Q
Side Effects of Ca2+ channel blockers
A
Dihydropyridines Calf swelling, gingival hypertrophy, reflex tachycardia Rate Limiting eg. verapamil, diltiazem Complete heart block
18
Q
Side Effects of Nicorandil
A
Blue vision
Mouth Ulcers
19
Q
Metabolic effect of B-Blockers
A
Hypoglycaemia (B2 adrenoceptors in liver)
20
Q
3 CVS effects of adrenaline
A
Positive ino/chronotrope- (B1)
Redistribution of blood flow to heart (A1)
Coronary artery dilation (B2)
21
Q
Determining axis of heart
A
Look at Lead I and aVF
- I up and aVF down = left axis deviation
- I down and aVF up = right axis deviation
22
Q
Criteria for diagnosing left ventricular hypertrophy
A
S wave depth in V1
Talles R wave height in V5/6 >35mm
23
Q
Digoxin Toxicity on ECG
A
Slows HR
Reverse tick on T wave
Shortened QT
Flattened, biphasic or inverted T waves
24
Q
Signs of constrictive pericarditis
A
Raised JVP JVP rises paradoxically with inspiration Quiet heart sounds Diastolic pericardial knock CXR - small heart and pericardial calcification
25
Acute endocarditis
Sepsis
Cardiac failure
(caused by organisms such as staph. aureus
26
What might aortic root abscess lead to ...
Prolongation of PR, then complete AV block
27
Antibiotic treatment of endocarditis if penicillin allergic
Vancomycin
28
Staph aureus (endocarditis)
Flucloxacillin
29
Prosthetic valve (endocarditis)
Vancomycin, Gentamicin, Rifampicin
30
MRSA (endocarditis)
Vancomycin, Gentamicin, Rifampicin
31
Strep. viridans (endocarditis)
Benzylpenicillin + Gentamicin
32
Enterococcus (endocarditis)
Amoxicillin/Vancomycin + Gentamicin
33
Staph. epidermis (endocarditis)
Gentamicin, Vancomycin, Rifampicin
34
Signs, Symptoms and Causes of Myocarditis
```
Signs = arrhythmia, cardiac failure
Symptoms = breathlessness, fever, chest pain, palpitations
Causes = enteroviruses e.g. echovirus, influenza A
Diagnosis = throat swab or stool swab
```
35
Brugada Syndrome
Polymorphic VT/VF preceded by AF in young person with a structurally normal heart
ST elevation + RBBB in V1-V3 which is intermittent and can be induced
Sodium channel mutation
36
Long QT syndrome
Polymorphic VT (TdP) triggered by adrenergic stimuli with long QT, syncope
37
Catecholaminergic polymorphic VT
Bidirectional/polymorphic VT triggered by stress or activity (normal resting ECG)
Treat: ICD, B-Blockers, Flecainide
38
Hypertrophic cardiomyopathic
Sarcomeric genes, thickened septum, obstruction to outflow, heart failure, angina, AF at young age
39
Treatment of hypertrophic cardiomyopathic
As for heart failure
| ICD (implantable cardioversion defibrillator)
40
Suspect dilated cardiomyopathy...
Lamin A/C mutation
First degree AV block
Neuromuscular symptoms
41
Arrhythmogenic RV cardiomyopathy
fibrofatty replacement of cardiomyocytes
| Family history of sudden cardiac death
42
Improving survival in transposition the great vessels
Balloon atrial septostomy to increase the size of the patent foramen ovale
43
Pre-ductal saturation
| Pos-ductal
Right Hand
| Left Foot
44
Mitral regurgitation (symptomatic with LVEF <30%)
ACEI
B-Blocker
Loop Diuretic
Intra-aortic ballon counterpulsation
45
CXR with straight left heart border
Mitral stenosis (increased pulmonary vasculature)
46
Murmur which results in very low diastolic blood pressure
Aortic regurgitation
47
Valve replacement in aortic regurgitation
not TAVI
48
Non-shockable rhythms
Asystole
| PEA (pulseless electrical activity)
49
Management of asystole
Cannot defibrillate, must use adrenaline
50
Temperature management if unconscious after ROSC (return of spontaneous circulation) post-arrest
32-36oC for 12-24 hours
51
Commonest cause of polymorphic VT
Ischaemia
52
Treatment of fast AF in heart failure
Digoxin
| DC shock
53
Key investigation in suspected heart failure
ECHO - indicates the cause, and if any LV dysfunction
54
Drugs to avoid in chronic heart failure
NSAIDs (cause fluid retention)
| Verapamil (negative inotrope)
55
Treatment of heart failure
```
B-Blockers, ACEIs
Diuretics (furosemide)
Spironolactone if still symptomatic
Digoxin
Ivabradine (if HR remains fast)
Vasodilators (important in black people with HF)
```
56
What can be used to diagnose heart failure/why?
Plasma BNP
| Reflects the myocyte stretch
57
Imaging in stroke
1. CT
| 2. MRI
58
Treatment of ischaemic stroke
Patient presents within 3-4.5 hours = 1. Ateplase 2. Aspirin after 24 hours
Patient presents after 4.5 hours = Aspirin
59
Secondary prevention of stroke
Aspirin + dipyridamole/clopidogrel
Statins
Anti-coagulants in AF
Anti-hypertensives
60
VTE and anti-coagulation
1. LMWH for 5 days/ until INR >2 for 24 hours
2. Warfarin for 3 months
3. Re-assess
Cancer patient: LMWH
Drug User: Rivaroxaban
61
Pre-test probability scoring systems in PE
Wells (>3 high risk) or Geneva (>10 is high risk)
62
Investigation in chronic venous disease
Duplex ultrasound
63
Management of claudication
1. Exercise (30-45 mins/week)
2. Symptom relief with cilostazol (PDE inhibitor)
3. CV drugs to reduce the CV risk
4. Revascularisation (angioplasty + stent, bypass)
64
Tension
(pressure x radius) / thickness
65
CABG is the main treatment
3 vessel disease
| Left main stem CA disease
66
Marked hypertension
190/95 in aortic dissection
67
Gold standard for investigating CHD
Angioplasty
68
Platelet granules
```
alpha = vWF, factor V. PDGF, fibrinogen, anti-heparin
dense = ADP, 5-HT
```
69
Spirinolactone only suitable if
K+ < 4.5 mmol/L
70
Higher dose thiazide therapy
Stage 4 hypertension if K+> 4.5 mmol/L
71
Hypertension in young fertile females
BCD
72
Stage 1 Hypertension
Clinic: 140/90
| Home/Ambulatory: 135/85
73
Stage 2 Hypertension
Clinic: 160/100
| Home/Ambulatory: 150/95
74
Severe Hypertension
Clinic: >180/>110
75
Phaeochromocytoma
Tumour of the adrenal medulla
76
Eruptive xanthomas
Due to abrupt rise in serum triglyceride = small red/yellow papules on buttox/thighs
77
Adverse effects of heparin and LMWH
Haemorrhage, Osteoporosis, Hypoaldosteronism, Hypersensitivity
78
Treatment of the adverse effects of LMWH
Protamine sulphate
79
LMWH
Inhibits Factor Xa
Subcutaneous
1st order kinetics
Renal excretion
80
Treatment of fibrinolytic-induced haemorrhage
Tranexamic Acid
81
Role of GP IIb IIIa
To bind fibrinogen resulting in soft plug formation
82
Activation of chylomicrons and VLDL
Transfer of apoCII from HDL
83
How does adenosine work?
Activates ACh sensitive K+ channels (GIRK) causing hyperpolarisation which supresses impulse conduction
84
Purkinje Fibre Cells
Larger than normal cardiac muscle cells
Glycogen but no T-tubules
Sparse actin and myosin filaments
Allow for inferior to superior conduction
85
Extracellular Fluid
3/4 interstitial
| 1/4 plasma
86
NFP
i.e
| Forces pulling water out - Forces drawing water in
87
Factors causing oedema
Decreased plasma osmotic pressure (low protein)
Increased capillary pressure
Lymphatic insufficiency
Changes in capillary permeability
88
Atrial Contraction
Occurs between the P wave and QRS complex
89
Isovolumetric Contraction
Tension rises around a closed volume, causing a steep increase in ventricular pressure
90
Consequences of hypovolaemic shock
```
Pulse rate increases
Resp rate increases
Blood pressure falls
Pulse pressure falls (esp. SBP)
Urine output decreases
Mental status deteriorates
```
91
Anatomical and Functional Assessment of the heart gold standard
Cardiac MRI
92
What valvular abnormality is aortic coarctation associated with?
Bicuspid aortic valve
93
Hypertrophic Cardiomypoathy Presentation
Young Patient
Arrhythmia
Family History of SCD
94
Opening snap
Mitral Stenosis
95
Ejection click
Congenital pulmonary of aortic stenosis
OR
Mechanical aortic valve
96
Mid-systolic click
Mitral valve prolapse
97
Causes of 3rd Heart Sound
LVF
Mitral regurgitation
Physiological in athletes/young children
98
4th Heart Sound
At apex with bell, due to atrial contraction causing rapid flow into a stiff ventricle
99
Decreased LV compliance
Myocardial ischaemia
Hypertension
Aortic Stenosis
(send for ECHO)
100
Appearance of tetralogy of Fallot on CXR
Boot shaped heart
101
Describe what the transverse pericardial sinus is and the surgical significance
'Space' posterior to the ascending aorta and pulmonary trunk
Used to identify and isolate the great vessels in cardiopulmonary bypass
102
What does AF in patients with Wolff-Parkinson-White Syndrome result in?
```
Ventricular Fibrillation (broader QRS)
Sudden Cardiac Death
```
103
Cause of Atrial Flutter
Macro-re-entrant circuit only in the right atrium
104
Treatment of Atrial Flutter (1st Line)
Ablation
105
Associations with early after depolarisations
Ca2+ overload: associated with catecholamines, digoxin and heart failure
106
What happens in complete heart block?
Purkinje Fibres become the ventricular pacemaker
| = slow firing and so bradycardia
107
Drugs used to treat SVT and mechanism
```
Adenosine = activates A1 receptors, open GIRK channels and hyperpolarising AVN to briefly supress conduction
Digoxin = slows conduction and prolongs refractory period (AVN, Bundle of His)
Verapamil = slows conduction and prolongs refractory period
```
108
Type IB ant-arrhythmic drug
Lignocaine
109
Uses of Lignocaine
Ventricular Arrhythmias following MI (largely affect ischaemic zones)
110
Type Ia Effect on AP
Lengthens the AP by decreasing AP upstroke gradient and prolonging repolarisation
111
Type Ib Effect on AP
Shortens repolarisation preventing premature beats
112
Type Ic Effect on AP
No effect on repolarisation/duration of AP, but depresses conduction
113
'Events' which may lead to the development of TdP
Hypokalaemia
Renal Impairment
Prolongation of AP
114
Why do ectopic beats lead to light headedness?
Transient change in arterial pressure
115
Where is renin released from?
Juxtaglomerular apparatus in the kidney (granular cells)
116
Stimulants of renin release
Renal artery hypotension
Stimulation of renal sympathetic nerves
Decreased sodium concentration in tubular fluid
117
What initially brings about changes in stroke volume?
Changes in the diastolic length of myocardial fibres
118
What is radial-radial delay a sign of?
Subclavian steal syndrome (stenosis/occlusion of the subclavian artery)
119
What is long term control of MAP achieved by?
Changes in blood volume
120
What is ANP released in response to ?
Atrial distension in hypovolaemic states
121
What does ANP cause?
Salt and water excretion
Vasodilation
Decreased renin release
122
Where are osmoreceptors located?
| What is their function?
Near the hypothalamus
| To recognise an increase in plasma osmolarity > trigger ADH release
123
Function of ADH
Regulate extracellular fluid volume and osmolarity
124
Function of RAAS
Long term regulation of MAP
125
Aldosterone
To regulate the total body Na+ and ECFV in the long term
