Cardiology

Front 1

Life-threatening causes of chest pain

Back 1

Acute ACS
Acute PE
Aortic dissection
Oesophageal rupture
Pneumothorax

Front 2

Anterior leads

Back 2

V2-V5

Front 3

Lateral leads

Back 3

V5, V6, aVL

Front 4

Inferior leads

Back 4

II, III, aVF

Front 5

Immediate treatment for STEMI

Back 5

Morphine 5-10mg IV;
Oxygen;
GTN - sublingual;
Aspirin 300mg PO + clopidogrel 300mg PO (or ticagrelor 180mg PO)

Front 6

Early complications of MI

Back 6

Mechanical - Papillary muscle rupture, ventricular-septal rupture, free wall rupture

Arrhythmias - brady / tachy
Cardiogenic shock
Left / right ventricular failure

Front 7

Late complications of MI

Back 7

Pericarditis
LV aneurysm

Front 8

Medical management for NSTEMI

Back 8

Pain control
Anti-thrombotic - fondaparinux/LMWH
Anti-platelet - aspirin + ticagrelor (rather than clopidorgrel)

Front 9

Discharge meds after ACS

Back 9

aspirin 75mg/d
statin
a beta-blocker
an ACE-I
ticagrelor (for 1 year)
GTN spray

Front 10

NICE treatment pathway for hypertension step 1

Back 10

Under 55 years: ACEi or ARB
Over 55 years or Afro-Caribbean: Calcium-channel blocker (amlodipine, nifedipine)

Front 11

adverse effects of thiazides

Back 11

Excessive diuresis
Hypokalaemia
Diabetes
Impotence
Gout

Front 12

Adverse effects of ACEi

Back 12

cough
Hyperkalaemia
renal failure
Angioedema

Front 13

adverse effects of beta-blockers

Back 13

Cold extremities, paraesthesia, numbness at peripheries (more common if peripheral vascular disease)
Sleep disturbances or nightmares
Fatigue
Sexual dysfunction (impotence and loss of libido)
Masking of hypoglycaemia
Increased risk of diabetes mellitus Bronchospasm - avoid β-blockers in asthma, use cautiously in COPD

Front 14

Risk factor modification for stable angina

Back 14

lifestyle modification
Statin
low dose aspirin - 75mg
ACEi

Front 15

Symptom control for stable angina

Back 15

GTN, calcium channel blocker, β-blocker, long-acting nitrate (isosorbide mononitrate), consider cardiac revascularisation if uncontrolled

Front 16

4 causes of LV failure

Back 16

Ischaemic heart disease (70%)
Hypertension
Idiopathic dilated cardiomyopathy
Valve disease (10%)

Front 17

causes of right heart failure

Back 17

chronic LV failure

chronic lung disease

recurrent PE

Atrial septal defect

Front 18

Common findings of heart failure on CXR

Back 18

Front 19

New York Heart Association (NYHA) Functional Classification of heart disease

Back 19

I No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnoea
II Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnoea
III Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnoea.
IV Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases.

Front 20

4 drugs for symptomatic management of heart failure

Back 20

Furosemide
ACE inhibitor / AR blocker
β-blockers
Spironolactone

Front 21

Drugs to avoid in heart failure

Back 21

Calcium channel blockers
alpha blockers
NSAIDS

Front 22

Symptoms of AF

Back 22

Fast, irregular palpitations
Breathlessness
Loss of good health
Syncope (rarely)

Front 23

Causes of AF

Back 23

Ischaemic heart disease
Heart failure
hypertension

Mitral valve disease
Thyrotoxicosis
Alcohol

Front 24

Basic management of AF

Back 24

Rate control
Rhythm control

Anticoagulation

Front 25

Rate control drugs for AF

Back 25

Beta-blocker - metoprolol
Calcium-channel blockers - verapamil / diltiazem
Digoxin
If refractory, try combination of beta-blocker + digoxin or calcium channel blocker + digoxin

Front 26

Rhythm control for AF

Back 26

Acute (<48 hours) - DC cardioversion

Chronic (>48 hours) - 3 weeks warfarin then DC cardioversion

Persistent AF: amiodarone, sotalol or ablation

Front 27

CHAADSVAS score for stroke risk

Back 27

Score of 1 → consider anticoagulation
Score >3 → anticoagulation essential

Front 28

Options for anticoagulation in AF

Back 28

heparin + warfarin or apixaban

Front 29

Types of narrow complex tachycardia (SVT)

Back 29

Sinus tachycardia

Sinusnode re-entry (rare)

atrial flutter

atrial tachycardia

atrial fibrillation

AVNRT

AVRT - WPW

Front 30

causes of broad complex tachycardia

Back 30

Ventricular tachycardia (VT) - 80% [95% if ACS]

SVT with BBB
SVT with WPW

Front 31

management of SVT

Back 31

Carotid sinus massage
Vagal manoeuvres
Adenosine 6mg rapid IV bolusm if unsuccessful give 12mg, if unsuccessful give further 12mg
Verapamil

Front 32

what does adenosine do?

Back 32

blocks the AVN
half life 15 secs
If tachycardia resolves after adenosine, tachycardia was SVT, dependent on AVN & requires no further management
Adenosine will reveal atrial flutter but won't terminate it

Front 33

medical management of stable VT

Back 33

IV amiodarone 300mg over 20-60 mins via a central line

then IV amiodarone 900mg over 24 hours

Front 34

causes of complete heart block

Back 34

idiopathic fibrosis (most common)
ischaemic heart disease

Infective endocarditis

amyloidosis, sarcoidosis

Front 35

1st degree heart block on ECG

Back 35

prolonged PR interval

Front 36

Mobitz type 1 (Wenckebach) on ECG

Back 36

progressive prolongation of the PR interval on consecutive beats followed by a blocked P wave (i.e., a 'dropped' QRS complex). After the dropped QRS complex, the PR interval resets and the cycle repeats

Front 37

Mobitz type 2 on ECG

Back 37

intermittently non-conducted P waves not preceded by PR prolongation. There is usually a fixed number of non-conducted P waves for every successfully conducted QRS complex,and this ratio is often specified in describing Mobitz II blocks e.g. 2:1

Front 38

3rd degree heart block on ECG

Back 38

no association between p waves and QRS

Front 39

Which types of heart block require active management?

Back 39

Mobitz II and 3rd degree
Manage with pacemaker

Front 40

Causes of LV outflowtract obstruction

Back 40

Sub-valvular e.g. hypertrophic cardiomyopathy (HCM)
Valvular - aortic stenosis
Supravalvular - William's syndrome

Front 41

Symptoms of aortic stenosis

Back 41

SAD:

Syncope

Angina

Dyspnoea

heart failure (usually after age 60)

Front 42

Signs of aortic stenosis

Back 42

Slow rising pulse with narrow pulse pressure
heaving non-displaced apex beat
LV heave
aortic thrill
ejection systolic murmur, radiates to carotids

Front 43

causes of aortic stenosis

Back 43

Senile calcication
bicuspid valve
William’s syndrome
rheumatic heart disease

Front 44

symptoms of mitral regurgitation

Back 44

Dyspnoea
fatigue
Palpitations

Front 45

Signs of mitral regurgitation

Back 45

AF
displaced, hyperdynamic apex
RV heave soft
split S2; loud P2 (pulmonary hypertension)
Pan-systolic murmur at apex radiating to axilla, loudest right to left

Front 46

Mechanisms of mitral regurgitation

Back 46

Annulus problem (annulus = fibrous ring surrounding the valve) - due to dilated LV or annular calcification (elderly)
Leaflet problem - failure of co-action - mitral valve prolapse
Sub-valvular apparatus problem i.e. papillary muscle dysfunction, chordae tendinae rupture
Combination

Front 47

symptoms of tricuspid regurgitation

Back 47

Fatigue
hepatic pain on exertion
Ascites
oedema and also dyspnoea and orthopnoea if the cause is LV dysfunction.

Front 48

Signs of tricuspid regurgitation

Back 48

Giant v waves and prominent y descent in JVP
RV heave
Quiet pansystolic murmur, heard best at lower sternal edge in inspiration
pulsatile hepatomegaly
Jaundice
ascites

Front 49

causes of pericarditis

Back 49

1. virus (typically coxsackie)
2. bacteria
3. fungi
4. MI
5. drugs

Front 50

Clinical features of pericarditis

Back 50

Central chest pain worse on inspiration or lying at ± relief by sitting forward
pericardial friction rub
pericardial effusion / cardiac tamponade
fever

Front 51

pericarditis on ECG

Back 51

ECG classically shows widespread concave (saddle-shaped) ST segment elevation, but may be normal or non-specific (10%)

Front 52

immediate therapy for confirmed DVT

Back 52

Start LMWH, fondaparinux or UFH as soon as possible and continue it for at least 5 days or until the INR is ≥2 for >24 hours, whichever is longer

Front 53

maintenance therapy after DVT

Back 53

Offer warfarin to patients with confirmed proximal DVT within 24 hours of diagnosis and continue warfarin for 3 months. At 3 months, assess the risks and benefits of continuing warfarin treatment
If confirmed proximal DVT + active cancer, offer LMWH for 6 months

Front 54

Arterial disease on ABPI

Back 54

1.0-1.2 = normal
<0.89 indicates arterial disease

Front 55

features of critical ischaemia

Back 55

Rest pain - typically occurs when leg is horizontal in bed; patient sleeps with leg hanging out of bed
Ulceration / gangrene + absent pulses
ABPI < 0.5

Front 56

features of acute limb ischaemia

Back 56

Pain Pallor Pulselessness Paraesthesia Paralysis Perishingly cold

Front 57

indications for AAA surgery

Back 57

AAA of ≥ 5.5 cm should be repaired electively

Front 58

Signs of chronic venous insufficiency

Back 58

Oedema
Venous eczema
Haemosiderin deposits
Malleolar flare
Lipodermatosclerosis
atrophie blanche
Venous ulcers

Front 59

treatment for varicose veins

Back 59

foam sclerotherapy
endovenous ablation - radiofrequency or laser
surgical ablation - stripping

Front 60

Clinical features of carotid artery disease

Back 60

Amaurosis fugax
Stroke
TIA
Cerebral hypoperfusion

Front 61

Causes of hypertension

Back 61

1. Primary/Essential hypertension (95%) of

2. Secondary hypertension (5%)

A. Renal disease - intrinsic renal disease & renovascular disease

B. Endocrine disease - Cushing’s and Conn’s, phaeochromocytoma, acromegaly

C. Drugs: steroids, MAOI, OCP, NSAIDs

D. Others: Coarctation, pregnancy, sleep apnoea

Front 62

Indications for CABG on angiography

Back 62

Left main stem disease

Triple vessel disease

For unresolving unstable angina and NSTEMI, if PCI unsuccessful

Front 63

tests for monitoring amiodarone

Back 63

6 monthly TFTs and LFTs

Front 64

treatment for acute limb ischaemia

Back 64

1. Embolectomy

2. localised thrombolysis

3. Amputation

Front 65

Indications for Aortic valve replacement

Back 65

Severe aortic stenosis ( transvalvular gradient of>40mmHg)

Severe AS and LVEF <50%

Patients with AS undergoing other cardiacsurgery (e.g. CABG)

Symptomatic AS, especially if clear causeof angina, syncope and HF

Front 66

signs of aortic regurgitation

Back 66

wide pulse pressure, displaced, hyperdynamic apex beat, early diastolic murmur, collapsing pulse

Front 67

management of acute heart failure

Back 67

Sit patient up, high flow give O2

Get access, ECG, CXR, ABG, sats

IV 40-80mg furosemide - repeat at 30-60 mins

Consider slow IV morphine

IV isosorbide or glyceryl trinitrate, titrated to BP

Refer to seniors and ITU for IV inotropes or CPAP or invasive ventilation

Front 68

causes of acute limb ischaemia

Back 68

1. thrombosis formation (60%) - pre-existing peripheral artery disease, dehydration, hypotension, malignancy, polycythaemia, prothrombotic state

2. Embolism (30%) - AF, post MI, prosthetic valves, from aneurysms

3. Other (10%): aortic dissection, trauma, iatrogenic injury, thrombosed aneurysm, thrombosed graft, extreme cold