Cardiology — Flashcards
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Management for a term infant with clinically significant PDA is _____
The murmur heard with Coarctation of Aorta is an _____ heard best over the back
What is adminstered in management of coarctation of the aorta _____
Coactation of the Aorta gives rise to _____
Hint: ribs
Coarctation of the aorta causes _____, with reduced blood flow distal to the narrowing, leading to weak, delayed femoral pulses compared to radial pulses (radio-femoral delay)
The pulse in Patent Ductus Arteriosus is described as _____
What syndrome is associated with Coarctation of the Aorta _____
_____ can cause bronchiolitis to be more severe
Coarctation of the aorta causes circulatory collpase at _____ when the duct closes Leading to heart failure & absent femoral pulses
Preterm infants with haemodynamically significant PDA 1 week after birth give _____ to promote duct closure
Cardiology UK Medical PG Flashcards - Medical Study Cards
Master Cardiology with OnCourse flashcards. These spaced repetition flashcards are designed for medical students preparing for NEET PG, USMLE Step 1, USMLE Step 2, MBBS exams, and other medical licensing examinations.
Cardiology Flashcard Deck - 436 Cards
Flashcard 1: Management for a term infant with clinically significant PDA is _____
Answer: transcatheter PDA closure
Flashcard 2: The murmur heard with Coarctation of Aorta is an _____ heard best over the back
Answer: ejection systolic murmur
Flashcard 3: What is adminstered in management of coarctation of the aorta _____
Answer: Prostaglandin
Flashcard 4: Coactation of the Aorta gives rise to _____
Answer: Notching of the inferior border of the ribs
Flashcard 5: Coarctation of the aorta causes _____, with reduced blood flow distal to the narrowing, leading to weak, delayed femoral pulses compared to radial pulses (radio-femoral delay)
Answer: increased LV afterload → left ventricular hypertrophy
Flashcard 6: The pulse in Patent Ductus Arteriosus is described as _____
Answer: large voume, bounding, collapsing pulse
Flashcard 7: What syndrome is associated with Coarctation of the Aorta _____
Answer: Turner's Syndrome
Flashcard 8: _____ can cause bronchiolitis to be more severe
Answer: Congenital Heart Disease
Flashcard 9: Coarctation of the aorta causes circulatory collpase at _____ when the duct closes Leading to heart failure & absent femoral pulses
Answer: 2 days of age
Flashcard 10: Preterm infants with haemodynamically significant PDA 1 week after birth give _____ to promote duct closure
Answer: Ibuprofen/Indomethacin
Flashcard 11: Coarctation of the Aorta is associated with having a _____
Answer: bicuspid aortic valve
Flashcard 12: Coarctation of Aorta is usually at the insertion of the _____
Answer: ligamentum arteriosum
Flashcard 13: _____ should NOT be used in VT
Answer: Verapamil
Flashcard 14: If adding a 4th drug in hypertension managment first check for: _____
Answer: confirm elevated clinic BP with ABPM or HBPM Assess for postural hypotension Discuss Adherence
Flashcard 15: ECG findings for HOCM include: _____ ST segment and T-wave abnormalities, T-wave inversion deep Q waves
Answer: Left Ventricular Hypertrophy
Flashcard 16: Growth failure, tachycardia and tachypnoea in the context of weak femoral pulses - _____
Answer: coarctation of aorta
Flashcard 17: Contraindications for statins include: _____ macrolides (e.g. erythromycin, clarithromycin)
Answer: pregnancy
Flashcard 18: What is the definitive managment of Coarctation of Aorta? _____
Answer: surgery
Flashcard 19: _____ are administered to neonates in coarctation of aorta whilst awaiting surgery
Answer: IV prostaglandins
Flashcard 20: A low salt diet is recommended in hypertension, aiming for less than _____ ideally 3g/day
Answer: 6g/day
Flashcard 21: Coarctation of the Aorta describes a congential deformity which causes narrowing of the _____
Answer: descending aorta
Flashcard 22: Is Risk of Falls or Old age sufficient reasoning to withhold anticoagulation in AF _____
Answer: No
Flashcard 23: The Right Side of the heart has an oxyen saturation of around _____
Answer: 70%
Flashcard 24: The Left Side of the Heart has oxygen saturation levels of _____
Answer: 98-100%
Flashcard 25: Ostium Primum can present with _____ on ECG
Answer: RBBB with LAD, prolonged PR interval
Flashcard 26: A _____ occurs when a ventricular complex results from simultaneous activation of the ventricles by two impulses
Answer: fusion beat
Flashcard 27: The Side-Effects of Beta-Blockers Include; _____
Answer: FACES F-Fatigue A - Avoid in Asthmatics (Bronchospam) C - Cold Peripheries E - Erectile Dysfunction S - Sleep Distrubances
Flashcard 28: BNP is a hormone produced by the _____ in response to strain
Answer: left ventricular myocardium
Flashcard 29: Dihydropyridines are indicated in conditons such as: _____
Answer: Hypertension Angina Raynaud's
Flashcard 30: In Atrial Flutter radiofrequency ablation of the _____ is curative for most patients
Answer: tricuspid valve ithmus
Flashcard 31: Atrial Flutter waves may be visible following _____ or adenosine
Answer: carotid sinus massage
Flashcard 32: Atrial Myxomas can present with _____ murmur also known as tumour plop
Answer: mid-diastolic
Flashcard 33: What general measures can be used to manage Brugada Syndrome: _____
Answer: Treat fever promptly Avoid excessive alcohol
Flashcard 34: Propanolol is _____ therefore crosses the blood-brain barrier
Answer: lipid-soluble
Flashcard 35: Arrhythmogenic Right Ventricular Cardiomyopathy is a form of inheritied cardiovascular disease which many present with _____
Answer: syncope or sudden cardiac death
Flashcard 36: The Indications of Beta-Blockers include: _____
Answer: angina post-MI Heart Failure Arrhythmias (rate control) AF Hypertension Thyrotoxicosis Migraine Prophylaxis Anxiety
Flashcard 37: PDA with Eisenmenger's causes mixed oxygenated blood in the _____
Answer: Aorta
Flashcard 38: Side Effects of Verapamil include: _____
Answer: Heart Failure Constipation Hypotension Bradycardia Flushing
Flashcard 39: Eisenmenger's syndrome is a complication of uncorrected congenital heart defects when the left-to-right shunt reverses to a _____
Answer: right-to-left shunt
Flashcard 40: What are the causes of Aortic Stenosis: 5 _____
Answer: Degenerative Calcification Bicuspid Aortic Valve Williams Syndrome Post-Rheumatic Disease HOCM
Flashcard 41: The Contraindications of Beta-Blockers include: _____
Answer: Uncontrolled Heart Failure Asthma Sick Sinus Syndrome Verapamil use: may precipitate severe bradycardia
Flashcard 42: Aortic Regurgitation (AR) is the leaking of the aortic valve of the heart that causes blood _____
Answer: to flow in the reverse direction during ventricular diastole
Flashcard 43: In Aortic Stenosis the calcified, immobile valve leaflets close less abruptly causing a _____
Answer: soft or absent S2
Flashcard 44: Buerger's Disease is strongly associated with _____
Answer: smoking
Flashcard 45: 2nd Degree Mobitz Type 1 Heart Block is _____
Answer: progressive prolongation of the PR interval until a dropped beat occurs
Flashcard 46: Atrial Myxomas most commonly attach to the _____
Answer: fossa ovalis
Flashcard 47: What would cause an Acute presentation of AR due to disease of the valve: _____
Answer: Infective Endocarditis
Flashcard 48: Diltiazem is _____ than verapamil but caution should be taken when patients have heart failure or are taking beta-blockers
Answer: less negatively inotropic
Flashcard 49: Myoglobin is not often used alone for diagnosis due to its lack of _____
Answer: specificity
Flashcard 50: The _____ increases the intesity of the early diastolic murmur in AR
Answer: handgrip manouvre
Flashcard 51: Raised BNP can be caused by heart failure and any cause of left ventricular dysfunction such as _____
Answer: myocardium ischaemia ot valvular disease
Flashcard 52: Aortic Stenosis may present with _____
Answer: syncope/presyncope (e.g. exertional dizziness)
Flashcard 53: The typical ECG abnormalities seen in AVRC are _____
Answer: T-wave inversion in V1-3
Flashcard 54: ARVC is generally regarded as the _____ after HOCM
Answer: second most common cause of sudden cardiac death in the young
Flashcard 55: Side Effects of Diltiazem include: _____
Answer: Hypotension Bradycardia Heart Failure Ankle Swelling
Flashcard 56: The effects of BNP include: _____
Answer: vasodilator diuretic and natriuretic supress both sympathetic tone and RAAS
Flashcard 57: ECG changes in Brugada Syndrome may be more apparent following administration of _____ - this is the investigation of choice in suspected cases
Answer: flecainide or ajmaline
Flashcard 58: Those with Atrial Flutter may be at higher risk of _____
Answer: strokes
Flashcard 59: Troponin I & T are _____ to heart muscle damage
Answer: very specific
Flashcard 60: The inheritence pattern of Arrhythmogenic Right Ventricular Cardiomyopathy is _____
Answer: autosomal dominant
Flashcard 61: ARVC can present with _____
Answer: palpitations, syncope, sudden cardiac death
Flashcard 62: _____ first-degree heart block is relatively common and does not need treatment
Answer: Asymptomatic
Flashcard 63: Severe Aortic Stenosis can cause _____
Answer: left ventricular hypertrophy or failure
Flashcard 64: Raised levels of BNP can also be seen due to reduced excretion in patients with _____
Answer: CKD
Flashcard 65: Other symptoms of Atrial Myxoma consist of _____
Answer: emboli and atrial fibrillation
Flashcard 66: In 3rd degree heart block there is _____
Answer: no association between the P waves and QRS complexes
Flashcard 67: Managment of Brugada Syndrome consists of avoiding drugs that may precipitate ventricular arrhythmias e.g. _____
Answer: flecanide lithium tricyclic antidepressants
Flashcard 68: What Imaging is useful in AVRC _____
Answer: echocardigram, MRI
Flashcard 69: Naxos Disease presents as a triad of _____
Answer: ARVC, Palmoplantar keratosis, and wooly hair
Flashcard 70: Atrial Myxomas can present with systemic features of _____
Answer: dyspnoea fatigue weight loss pyrexia of unkown origin clubbing
Flashcard 71: The managment of ARVC involves _____
Answer: Sotalol Catheter Ablation ICD
Flashcard 72: Ostium Secundum on ECG can show _____
Answer: RBBB with RAD
Flashcard 73: The most common ASD is _____
Answer: ostium secundum
Flashcard 74: An atrial rate of 300/min with a 2:1 AV node block, the ventricular rate will be _____
Answer: 150/min
Flashcard 75: A history of _____ is suggestive of VT rather than SVT
Answer: IHD
Flashcard 76: An additional heart sound in Aortic Stenosis is _____ caused by atrial contraction forcing blood into a stiff, non-compliant left ventricle
Answer: S4
Flashcard 77: Verapamil should not be given with _____ as may cause heart block
Answer: beta-blockers
Flashcard 78: A _____ happens when a single sinus impulse conducts through to the ventricles during VT before ventricular ectopic focus fires
Answer: capture beat
Flashcard 79: In about 50% of those with AVRC an _____ is found on ECG described as a terminal notch in the QRS complex
Answer: Epsilon Wave
Flashcard 80: 2nd Degree Mobitz Type 2 is when the _____
Answer: PR interval is constant but the P wave is often not followed by a QRS complex
Flashcard 81: What are the causes of Chronic presentation of AR due to aortic root disease: 5 _____
Answer: bicuspid aortic valve (affects both valves and aortic root) Spondylarthropathies (e.g. Anky Spond) Hypertension Syphilis Connective Tissue Disorders (Marfan's, Ehler-Danlos Syndrome
Flashcard 82: What are the causes of Chronic presentation of AR due to valve disease: 4 _____
Answer: Rheumatic Fever Calcified Valve Disease Connectie Tissue Diseases (RA, SLE) Bicuspid Aortic Valve
Flashcard 83: ASD with Eisenmenger's causes mixed deoxygenated blood in the _____
Answer: Left Atrium, Left Ventricle and Aorta
Flashcard 84: Atrial flutter is a form of _____ characterised by a succession of rapid atrial depolarisation wave
Answer: supraventricular tachycardia
Flashcard 85: Dihydropyridine CCBs can affect the _____ more than the myocardium and therefore do not result in worsening of heart failure but may therefore cause ankle swelling
Answer: peripheral vascular smooth muscle
Flashcard 86: In ARVC the Right Ventricular Myocardium is replaced by _____
Answer: fatty and fibrofatty tissue
Flashcard 87: Atrial Myxomas are more common in _____
Answer: females
Flashcard 88: Other ECG changes can be seen in Brugada Syndrome consist of _____
Answer: Partial Right Bundle Branch Block
Flashcard 89: Shorter acting dihydropyridines (e.g. nifedipine) cause peripheral vasodilation which may result in _____
Answer: reflex tachycardia
Flashcard 90: Verapamil is _____ which describes its effect of significantly reducing contractile strength
Answer: Highly negatively inotropic
Flashcard 91: 2nd Line Antiplatelet Therapy in Peripheral Artery Disease _____
Answer: Aspirin (lifelong)
Flashcard 92: CCBs aid in hypertension by _____ which relaxes vascular smooth muscle and relaxes force of myocardial contraction
Answer: blocking voltage-gated calcium channels
Flashcard 93: ACE Inhibitor Drug names end in _____
Answer: -pril
Flashcard 94: What is Adenosine most commonly used for _____
Answer: to terminate supraventricular tachycardias
Flashcard 95: What are Side-Effects of CCBs: _____ ankle swelling headache
Answer: flushing
Flashcard 96: ACE Inhibitors may also adversely cause first-dose _____
Answer: hypotension
Flashcard 97: 1st Line Antiplatelet therapy in TIA, Ischaemic Stroke & Peripheral Artery Disease _____
Answer: Clopidogrel (lifelong)
Flashcard 98: ACE Inhibitors decrease Angiotensin II levels which reduced blood pressure by _____ 2.Reduce stimulation for aldosterone release -> decrease in sodium and water retention by the kidneys
Answer: 1.causing vasodilation and reducing BP
Flashcard 99: What are the cautions and contraindications of ACE Inhibitors _____ renovascular disease aortic stenosis hereditary of idiopathic angioedema specialist advice before starting in patients with K+>= 5.0 mmol/L
Answer: preganancy & breastfeeding
Flashcard 100: 2nd line antiplatelet in ACS if aspirin contraindicated _____
Answer: clopidogrel (lifelong)
Flashcard 101: Adenosine causes transient _____ by acting as a agonist of the A1 receptor in the AV node
Answer: heart block in the AV node
Flashcard 102: ACE Inhbitors function by inhibiting the _____
Answer: conversion of Angiotensin I to Angiotensin II
Flashcard 103: What are the long-term adverse effects of Amiodarone Use: _____
Answer: B: Bradycardia P: Pulmonary fibrosis/pneumonitis L: Liver fibrosis/hepatitis A: Appearance changes (Slate-grey skin, Photosensitivity) N: Neuropathy (Peripheral neuropathy, myopathy) T: Thyroid dysfunction (Hypo- and Hyperthyroidism) G: Gray corneal deposits
Flashcard 104: What monitoring tests should be taken prior to amiodarone treatment _____
Answer: TFT, LFT, U&E, CXR
Flashcard 105: What should all Stable Angina patients recieve in absence of any contraindications _____
Answer: aspirin and a statin
Flashcard 106: What is the adrenaline dosage used in cardiac arrest _____
Answer: 10ml 1:10,000 IV or 1ml of 1:1000 IV
Flashcard 107: Amiodarone can _____ as it is a p450 inhibitor
Answer: decrease metabolism of Warfarin
Flashcard 108: If CCBs are used as monotherapy in Angina Pectoris then a _____ such as verapamil or diltiazem should be used
Answer: rate-limiting one
Flashcard 109: Amiodarone has a _____ so this means loading doses are frequently used
Answer: very long half-life (20-100 days)
Flashcard 110: 1st line antiplatelet use in ACS (medically treated) is _____
Answer: Aspirin (lifelong) & ticagrelor (12 months)
Flashcard 111: Amiodarone should ideally be given into _____ as it can cause thrombophlebitis
Answer: central veins
Flashcard 112: Adrenaline can result in _____ due to accidental injection in peripheral vessels
Answer: digital ischaemia
Flashcard 113: If there is a poor response to initial treatment for Angina Pectoris then medication should be _____
Answer: increased to the maximum tolerated dose
Flashcard 114: What pneumonic can be used to remember Amiadorane long-term adverse effects: _____
Answer: B-PLANT G B: Bradycardia P: Pulmonary fibrosis/pneumonitis L: Liver fibrosis/hepatitis A: Appearance changes (Slate-grey skin, Photosensitivity) N: Neuropathy (Peripheral neuropathy, myopathy) T: Thyroid dysfunction (Hypo- and Hyperthyroidism) G: Gray corneal deposits
Flashcard 115: What situations are ARBs used? _____
Answer: When patients have not tolerated ACE Inhbitors
Flashcard 116: What are the associations with Aortic Dissection: 7 _____
Answer: Hypertension Trauma Bicuspid Aortic Valve Collagens: Marfan's, Ehlers-Danlos syndrome Turner's and Noonan's sydrome Pregnancy Syphilis
Flashcard 117: ACE Inhibitors are activated by phase 1 metabolism in the _____
Answer: liver
Flashcard 118: 1st Line antiplatelet therapy in PCI _____
Answer: Aspirin (lifelong) & prasugrel or ticagrelor (12 months)
Flashcard 119: Effects of Adenosine are enhanced by _____
Answer: dipyridamole (antiplatelet agent)
Flashcard 120: A build up of _____ levels can cause cough in ACE Inhibitors
Answer: bradykinin
Flashcard 121: The recommended adrenaline dose for Anaphylaxis is _____
Answer: 0.5ml 1:1000 IM
Flashcard 122: 2nd Line Antiplatelet Therapy in PCI if Aspirin contraindicated _____
Answer: clopidogrel (lifelong)
Flashcard 123: Thiazide Type Diuretics work in Hypertension by _____ at the beginning of the distal convoluted tubule
Answer: inhibiting sodium absoprtion
Flashcard 124: Asymmetric Dosing Schedule can help maintain a daily _____ when taking standard-release isosorbide mononitrate
Answer: nitrate-free interval of 10-14 hours
Flashcard 125: What are Side-effects of Thiazide Type Diuretics: _____ Hypokalaemia Dehydration
Answer: Hyponatraemia
Flashcard 126: What should be monitored every 6 months for patients taking Amiodarone _____
Answer: TFT, LFT every 6 months
Flashcard 127: What are ACE Inhibitors used to treat: _____
Answer: Hypertension Heart Failure Diabetic Nephropathy Secondary Prevention in ACS
Flashcard 128: Polymorphic Tachycardias means the QRS morphology _____
Answer: varies
Flashcard 129: ACE Inhbitors must be avoided in _____
Answer: pregnant women
Flashcard 130: ACE Inhibitors interact with _____ which can increase risk of hypotension
Answer: high-dose diuretics (furosemide >80mg a day)
Flashcard 131: The indications for Adrenaline are _____
Answer: Anaphylaxis and Cardiac Arrest
Flashcard 132: What is the management of accidental adrenaline injection that can result in digital ischaemia _____
Answer: phentolamine injection
Flashcard 133: Adrenaline acts on Beta-1 (β1) receptors to _____
Answer: increase heart rate, contractility and blood pressure
Flashcard 134: Effects of Adenosine are blocked by _____
Answer: theophyllines
Flashcard 135: What is first-line management in Angina Pectoralis _____
Answer: beta-blockers or CCBs
Flashcard 136: Only add a 3rd drug iin Angina Pectoris if patient is awaiting assessment for _____
Answer: PCI or CABG
Flashcard 137: Amiodarone is a class _____ antiarrythmic agent used in the treatment of atrial, nodal and ventricular tachycardias
Answer: III
Flashcard 138: How long should patients be anticoagulated before catheter ablation: _____
Answer: 4 weeks
Flashcard 139: Why is WFW classed as an atrioventricular re-entry tachycardia (AVRT): _____ which in turn bypasses the AV Node
Answer: The Bundle of Kent provides an extra electrical pathway connecting the atria and ventricles
Flashcard 140: The accessory pathway has a shorter _____ than the AV node
Answer: refractory period
Flashcard 141: Rate control accepts that _____ but slows the rate down to avoid negative effects on cardiac function
Answer: the pulse will be irregular
Flashcard 142: Why does a Right-sided Accessory Pathway cause Left-Axis Deviation? Because Early activation occurs in the _____ causing initial depolarisation to move from right to left
Answer: right ventricle
Flashcard 143: What are common side-effects of ACE Inhibitors: _____ Angiodema Hyperkalaemia
Answer: Cough
Flashcard 144: What medications increase the risk of falls, as they can cause psotural hypotension? 7
Answer: • Nitrates • Diuretics • Anticholinergic Medications • Antidepressants • Beta-blockers • L-Dopa • ACE inhibitors
Flashcard 145: Rate control should be offered as first-line for AF except in people: _____ 2. For whom a rhythm-control strategy would be more suitable based on clinical judgement
Answer: 1. With atrial flutter whose condition is suitable for an ablation strategy to restore sinus rhythm
Flashcard 146: What are the anti-arrythmic medications that are contraindicated in patients with WPW that develop AF? _____ CCBs Digoxin adenosine
Answer: beta-blockers
Flashcard 147: If a patient scores >1 in their CHA2DS2-VASc for catheter ablation, how long is anticoagulation recommended: _____
Answer: longterm anticoagulation
Flashcard 148: Mnemonic to remember the associations of Wolf-Parkinsons White Syndrome: _____
Answer: Wolf is THE MS
Flashcard 149: Which beta-blocker can be used for pharmacological cardioversion? _____
Answer: sotalol
Flashcard 150: Why does a Left-sided Accessory Pathway cause Right-Axis Deviation? Because Early actvation occurs in the _____ causing initial depolarisation to move from left to right producing a right axis deviation
Answer: left ventricle
Flashcard 151: Which conditions are associated with Wolf-Parkinsons White Syndrome: _____ HOCM Ebstein Anomaly Mitral Valve Prolapse Seccundum ASD
Answer: Thyrotoxicosis
Flashcard 152: Digoxin should only be considered for rate-control if the person does no or very little physical exervise because they are _____
Answer: less effetive at controlling the heart rate during exercise
Flashcard 153: Notable complications of catheter ablation: _____ stroke pulmonary vein stenosis
Answer: cardiac tamponade
Flashcard 154: Alongside Amiodarone what else can be used to maintain sinus rythm: _____ dronedarone
Answer: beta-blockers
Flashcard 155: If there is a high risk of cardioversion failure (e.g. Previous failure or AF reccurence) then what is recommended? _____
Answer: 4 weeks amiodarone or sotalol prior to electrical cardioversion
Flashcard 156: How are patients advised when prescribed GTN?
Answer: • Take the GTN when the symptoms start • Take a second dose after 5 minutes if the symptoms remain • Call an ambulance if the symptoms remain 5 minutes after the second dose
Flashcard 157: What medications are used for secondary prevention in Stable Angina? (4)
Answer: • Aspirin (75mg Once Daily) • Atorvastatin (80mg Once Daily) • ACE inhibitor (if diabetes, hypertension, CKD or heart failure also present) • Already on a beta-blocker for symptomatic relief
Flashcard 158: Why is Sotalol contraindicated in WFW treatment with co-existent AF? Sotalol prolongs _____ which slows conduction through the AV node but not the accessory pathway This means more impulses during AF conduct down the accesory pathway rather than the AV node This allows for very fast ventricular rates which increase the risk of denegeration into ventricular fibrillation
Answer: AV node refractory period
Flashcard 159: How would you identify Right Axis Deviation on ECG and what would that indicate in WFW QRS complex is _____ and positive in Lead III This would indicate a Left-sided Accessory Pathway
Answer: negative in Lead I
Flashcard 160: How would you identify Left Axis Deviation on ECG and what would that indicate in WFW QRS complex is _____ and negative in Lead III This would indicate a Right-sided Accessory Pathway
Answer: positive in Lead I
Flashcard 161: Digoxin may have a role in rate-control if there is coexistent _____
Answer: heart failure
Flashcard 162: The aim of catheter ablation is to ablate the faulty electrical pathways that are resulting in AF This is typically due to aberrant electrical activity between the _____ and left atrium
Answer: pulmonary veins
Flashcard 163: What Cardiovascular Differentials could cause Falls? 4
Answer: • Arrhythmias • Orthostatic Hypotension • Bradycardia • Valvular Heart Disease
Flashcard 164: Rythm control trys to get the patient back into, and maintain, normal sinus rhythm. This is termed _____. Drugs pharmacological cardioversion and synchronised DC electrical shocks (electrical cardioversion) may be used for this purpose
Answer: cardioversion
Flashcard 165: NICE recommends the use of catheter ablation for those with AF who _____
Answer: have not responded to or wish to avoid, antiarrhythmic medication
Flashcard 166: What is the Immediate symptomatic relief for Angina?
Answer: • Sublingual Glyceryl Trinitrate (GTN) *GTN causes vasodilation, improving blood flow to the myocardium
Flashcard 167: If a patient scores 0 in their CHA2DS2-VASc for catheter ablation, how long is anticoagulation recommended: _____
Answer: 2 months anticoagulation
Flashcard 168: If the CHA2DS2-VASc score sugests no need for anticoagulation it is important to ensure a _____ has been done to exclude valvular heart disease
Answer: transthoracic echocardiogram
Flashcard 169: What cardiac medication has a risk of causing thrombophlebitis?
Answer: • Amiadarone
Flashcard 170: How do you measure the QT interval on ECG?
Answer: • Time between start of the Q wave and the end of the T wave
Flashcard 171: What antibiotic would interact with statins?
Answer: • Clarithromycin (macrolide)
Flashcard 172: What is the main mechanism of simvastatin?
Answer: • Decreases intrinsic cholesterol synthesis - reduces the rate at which the liver produces LDL cholesterol
Flashcard 173: What is atrial myxoma?
Answer: • Benign tumour commonly occuring in the left atrium
Flashcard 174: When is secondary statin prevention indicated?
Answer: • When they've had an event already, and need to prevent a second event from happening again
Flashcard 175: Patient develops acute heart failure 5 days after a MI, new pan-systolic murmur is noted, diagonsis?
Answer: • Ventricular Septal Defect
Flashcard 176: Adverse effects of Adenosine? 4
Answer: • Chest Pain • Bronchospasm • Transient flushing • Can enhance conduction down accessory pathways, resulting in increased ventricular rate (e.g. WPW syndrome)
Flashcard 177: What does atrial myxoma show on echocardiogram?
Answer: • Pedunculated hetergenous mass
Flashcard 178: Beta-Blockers should not be prescribed concurrently with:
Answer: • Verapamil *Can increase risk of complete heart block
Flashcard 179: Murmur heard with Coarctation of Aorta?
Answer: • systolic murmur
Flashcard 180: What hypertension medication is contraindicated in asthmatics?
Answer: • Beta-blocker
Flashcard 181: What thiazide-like diuretic is used in hypertension managment?
Answer: • Indapamide *Bendoflumethiazide is a thiazide diuretic
Flashcard 182: if an Angina patient is on monotherapy and cannot tolerate the addition of a calcium channel blocker or a beta-blocker then consider?
Answer: • Long-acting Nitrate (Isosorbide Mononitrate • Ivabradine • Nicorandil • Ranolazine
Flashcard 183: What can cause Sudden Heart Failure, raised JVP, Pulsus parodoxus after recent MI?
Answer: • Left Ventricular Free Wall Rupture *Leakage of blood into the pericardial sac, resulting in cardiac tamponade
Flashcard 184: What is Trifascicular Block?
Answer: • RBBB • Left - Axis Deviation • + 1st-Degree Heart Block
Flashcard 185: What is complete dissociation between P waves and QRS complexes a sign of?
Answer: • Complete Heart Block
Flashcard 186: What murmur is heard in Atrial Septal Defect?
Answer: • ejection systolic murmur louder on inspiration
Flashcard 187: What are the ECG changes seen with hypercalcaemia?
Answer: • Shortened QT interval
Flashcard 188: What is a classic "sawtooth" sign on ECG?
Answer: • Atrial flutter
Flashcard 189: What is the dose of atorvastatin for secondary prevention?
Answer: • 80mg = high-dose
Flashcard 190: Is a new LBBB ever normal?
Answer: No - always pathological
Flashcard 191: Why are beta-blockers contraindicated in asthma patients with atrial fibrillation?
Answer: They can precipitate bronchospasm
Flashcard 192: What medication can cause Torsades de Pointes?
Answer: • Macrolides (e.g. Erythromycin)
Flashcard 193: Which antiarrhythmic can cause a grey skin appearance?
Answer: Amiodarone
Flashcard 194: Is first-degree heart block in an athlete normal or pathological?
Answer: Normal variant – no treatment required
Flashcard 195: What are the ECG changes in hyperkalaemia?
Answer: • Peak or "tall-tented" T waves • Loss of P waves • Broad QRS complexes
Flashcard 196: Hyperkalaemia + ECG changes, what is initial mamangement?
Answer: • IV calcium gluconate *to stabilise the cardiac membrane
Flashcard 197: What ARBs are used for hypertension?
Answer: • Losartan • Candersartan
Flashcard 198: If Angina is not controlled with a Beta-Blocker, what needs to be added?
Answer: • A longer-acting dihydropyridine calcium channel blocker • (e.g. Amlodipine, modified-release nifedipine)
Flashcard 199: What are the ECG changes in First-degree Heart Block?
Answer: • Abnormally long PR interval >220ms • No dropped beats
Flashcard 200: What is the intervention of choice for severe mitral stenosis?
Answer: • Percutaneous mitral commussurotomy
Flashcard 201: What is used first-line to prevent angina attacks?
Answer: • Beta-blocker or Calcium Channel Blocker
Flashcard 202: Which anticoagulant is best for mechanical heart valves?
Answer: • Warfarin
Flashcard 203: A patient on an ACEi develops a dry cough. What is the next step? _____
Answer: Switch them to an ARB
Flashcard 204: Normal left ventricular ejection fraction (LVEF) is _____-70%
Answer: 50
Flashcard 205: What is the difference between essential & secondary hypertension? _____
Answer: Secondary hypertension has an identifiable cause
Flashcard 206: What is the management for hypertension in < 40 years? _____
Answer: Consider specialist referral to exclude secondary causes
Flashcard 207: What is the pharmacotherapy management for heart failure with reduced ejection fraction (HFrEF)? _____
Answer: Fluid overload symptoms → loop diuretic e.g. furosemide Offer ACEi/ARB & beta blockers Offer adding MRA (spirinolactone) if still symptomatic
Flashcard 208: _____ is a clinical syndrome with ↓ reduced cardiac output and characterised by symptoms (dyspnoea, oedema, fatigue) & signs (↑ JVP, bibasal crackles, pitting oedema)
Answer: Chronic heart failure
Flashcard 209: Hypertension in patients under _____ years old should be considered for specialist referral to exclude secondary causes
Answer: 40
Flashcard 210: Heart failure is categorised into _____, mildly reduced, and preserved ejection fraction
Answer: reduced
Flashcard 211: Reducing _____ intake decreases ↓ blood pressure
Answer: caffeine
Flashcard 212: What is the functional classification of heart failure? _____
Answer: New York Heart Association (NYHA) class I-IV
Flashcard 213: What is the imaging modality of choice to confirm/diagnose chronic heart failure? _____
Answer: Transthoracic echocardiogram
Flashcard 214: What is the likely diagnosis in a young woman with recurrent headaches, significant hypertension, and a subauricular / carotid systolic bruit? _____
Answer: Fibromuscular dysplasia (FMD)
Flashcard 215: What antihypertensive is given to patients < 55? _____
Answer: ACEi or ARB
Flashcard 216: Vasovagal syncopes lasts seconds to minutes with _____ recovery
Answer: rapid
Flashcard 217: ECG for heart failure may show _____
Answer: LV hypertrophy
Flashcard 218: Patients needing a 4th antihypertensive: Blood K+ ≤ 4.5 mmol/l → add _____ Blood K+ > 4.5 mmol/l → add alpha-blocker or beta-blocker
Answer: low-dose spirinolactone
Flashcard 219: What antihypertensive is given to patients of Black African or African-Caribbean family origin (any age)? _____
Answer: CCB
Flashcard 220: Reducing _____ intake decreases ↓ blood pressure
Answer: salt
Flashcard 221: Spot diagnosis = _____
Answer: Left ventricular hypertrophy
Flashcard 222: Non-illicit drugs such as OCPs, corticosteroids, NSAIDS, & decongestants may cause secondary _____
Answer: hypertension
Flashcard 223: What criteria is used to identify left ventricular hypertrophy (LVH) on ECG? _____
Answer: Sokolow-Lyon criteria RV5 or RV6 + SV1 or SV2≥ 35 mm
Flashcard 224: Hypertensive patients who are on 2x antihypertensives and uncontrolled, what combination of antihypertensives should they be taking next? _____
Answer: ACEi/ARB + CCB + thiazide-like diuretic
Flashcard 225: What antihypertensive is given to patients ≥ 55? _____
Answer: CCB
Flashcard 226: Heart failure causes venous congestion leading to _____ & ascites on abdominal examination
Answer: hepatmegaly
Flashcard 227: NT-pro-BNP > _____ ng/L → Referral for specialist assessment & transthoracic echocardiogram within 6 weeks
Answer: 400
Flashcard 228: What is the likely diagnosis in a patient with refractory hypertension with upper-limb hypertension and a suprasternal murmur radiating through the back? _____
Answer: Coarctation of the aorta
Flashcard 229: The cardinal symptoms of heart failure are _____, dyspnoea, & oedema
Answer: fatigue
Flashcard 230: _____ hypertension (~10% of cases) has an identifiable cause
Answer: Secondary
Flashcard 231: What is the symptomatic pharmacotherapy for fluid overload in heart failure? _____
Answer: Loop diuretic e.g. furosemide
Flashcard 232: Chronic _____ leads to left ventricular hypertrophy and eventual heart failure
Answer: hypertension
Flashcard 233: Heart Failure: NYHA class I = _____ NYHA class II = symptoms on physical activity. Slight limitation NYHA class III = symptoms on less than ordinary activity. Moderate limitation NYHA class IV = symptoms on rest. Severe limitation
Answer: nil symptoms
Flashcard 234: How do you examine peripheral odema in heart failure? _____
Answer: First, gently palpate distally (e.g. ankle) for 5 seconds, then release. Observe an indentation, this is known as pitting oedema. Continue proximally and record the level at which the pitting oedema stops.
Flashcard 235: O/E of chronic heart failure is _____, S3 or S4 gallop, & jugular venous distension
Answer: bibasal coarse crackles
Flashcard 236: The most common underlying cause of chronic heart failure is _____
Answer: coronary artery disease
Flashcard 237: HF reduced ejection fraction: LVEF ≤ _____%
Answer: 40
Flashcard 238: What is the pharmacotherapy management for heart failure with mildly reduced ejection fraction (HFmrEF)? _____
Answer: Fluid overload symptoms → loop diuretic e.g. furosemide Consider ACEi/ARB & beta blockers Consider adding MRA (spirinolactone) if still symptomatic
Flashcard 239: Vasovagal syncopes are often preceded by _____; nausea, sweating, pallor & flushing
Answer: prodromal symptoms
Flashcard 240: What is the likely diagnosis with a 23 yrs old patient that experiences syncopal episodes provoked by strong emotion with nausea, sweating, & pallor prodrome? _____
Answer: Vasovagal syncope
Flashcard 241: Advise patients with vasovagal syncope to avoid _____, consume more water (2-3L), & consume more salt (6-9g)
Answer: triggers
Flashcard 242: HF preserved ejection fraction: LVEF ≥ _____%
Answer: 50
Flashcard 243: SGLT2 inhibitors are used in heart failure with _____
Answer: specialist advice
Flashcard 244: NT-pro-BNP > _____ ng/L → Urgent referral for specialist assessment & transthoracic echocardiogram within 2 weeks
Answer: 2,000
Flashcard 245: What is the pharmacotherapy management for heart failure with preserved ejection fraction (HFpEF)? _____
Answer: Fluid overload symptoms → loop diuretic e.g. furosemide
Flashcard 246: Hypertensive patients on ACEi/ARBs who are uncontrolled → _____
Answer: add CCB or thiazide-like diuretic
Flashcard 247: What is the only curative management of heart failure? _____
Answer: Heart transplant
Flashcard 248: Which heart failure drugs improve prognosis (↓ morbidity, mortality, & hospitilization rates)? _____
Answer: ACEi/ARB, beta blockers, MRA, SGLT2 inhibitors
Flashcard 249: HF mildly reduced ejection fraction: LVEF _____-49%
Answer: 41
Flashcard 250: _____ are used in the management of heart failure to terminate tachyarrhythmias promptly
Answer: Automated implantable cardioverter defibrillators (AICDs)
Flashcard 251: Patients with heart failure may complain of _____
Answer: nocturia
Flashcard 252: 5-year survival rate of heart failure is ~_____-60%
Answer: 50
Flashcard 253: Hypertensive patients on CCB who are uncontrolled → _____
Answer: add ACEi/ARB or thiazide-like diuretic
Flashcard 254: What initial investigation is done for chronic heart failure? _____
Answer: NT-pro-BNP; BNP is a ventricular myocyte hormone released in resposne to ↑ ventricular stretching promoting diuresis. NT-pro-BNP is from the cleavage of the prohormone proBNP.
Flashcard 255: Recreational drugs such as cocaine & amphetamines may cause secondary _____
Answer: hypertension
Flashcard 256: Hypertension complications: Heart = _____ Brain = stroke, vascular dementia Kidney = CKD Eye = Hypertensive retinopathy Vascular = Peripheral vascular disease
Answer: coronary artery disease, heart failure
Flashcard 257: _____ is persistently raised arterial BP
Answer: Hypertension
Flashcard 258: Stage 2 hypertension clinic BP = ≥ _____ / 100 mmHg
Answer: 160
Flashcard 259: Patients with hypertension should be investigated with _____ for cardiac function & detect LVH
Answer: ECG
Flashcard 260: Which race is at higher risk of hypertension? _____
Answer: Black > white > then asians
Flashcard 261: Patients with hypertension should be investigated with _____ for hypertensive retinopathy
Answer: fundoscopy
Flashcard 262: Stage 2 hypertension ABPM/HBPM = ≥_____/95mmHg
Answer: 150
Flashcard 263: Stage _____ hypertension is systolic BP ≥ 180 or diastolic BP ≥ 120
Answer: 3
Flashcard 264: Hypertension is _____ unless severe
Answer: asymptomatic
Flashcard 265: Stage 1 hypertension clinic BP = ≥_____/90mmHg
Answer: 140
Flashcard 266: _____ hypertension is BP ≥180/120 -and- signs of retinal haemorrhage or papilloedema
Answer: Accelerated (malignant)
Flashcard 267: _____ is a class III antiarrhythmic drug that can cause hyper- and hypothyroidism
Answer: Amiodarone
Flashcard 268: What ECG abnormality may be found in patients with _____? Shortened QT interval
Answer: hypercalcaemia
Flashcard 269: The mainstay for primary prevention of hyperlipidaemia is _____
Answer: lifestyle advice
Flashcard 270: Untreated homozygous familial hypercholesterolaemia is associated with early death due to _____
Answer: CHD
Flashcard 271: Evidence of hyperlipidaemia may be visible on the eyelids in the form of _____, and in the eyes as corneal arcus
Answer: xanthelasma
Flashcard 272: If patients have a QRISK2 score of ≥_____%, they should be offered 20mg atorvastatin as first-line management
Answer: 10
Flashcard 273: _____ is caused by mutations in the gene encoding the LDL-receptor protein
Answer: Familial hypercholesterolaemia
Flashcard 274: If statins are contraindicated the alternative is _____
Answer: ezetimibe (10mg)
Flashcard 275: _____ is a genetic condition with an autosomal dominant pattern of inheritance where the liver is unable to remove excess LDL cholesterol effectively
Answer: Familial hypercholesterolaemia (FH)
Flashcard 276: Statins should be discontinued in women _____ before conception
Answer: 3 months
Flashcard 277: First-line management of familial hypercholesterolaemia is with _____
Answer: high dose statins (80mg atorvastatin)
Flashcard 278: _____ is known to be protective against CVD?
Answer: HDL
Flashcard 279: Low levels of _____ may be termed dyslipidaemia
Answer: HDL
Flashcard 280: Secondary prevention of hyperlipidaemia is offered to all adults with _____ in the form of high intensity statin (80mg atorvastatin)
Answer: CVD
Flashcard 281: What condition should be suspected in a patient with hypercholesterolaemia and a personal/family history of coronary heart disease before the age of 60? _____
Answer: Familial hypercholesterolaemia (FH)
Flashcard 282: Children of a parent affected by familial hypercholesterolaemia should be referred for _____ at the earliest opportunity
Answer: genetic testing
Flashcard 283: _____ monitoring is required for potassium infusions >20 mmol/hr
Answer: Cardiac
Flashcard 284: _____ is upper venous congestion from the obstruction of the superior vena cava
Answer: Superior vena cava obstruction
Flashcard 285: Examination of the JVP in patients with superior vena cava obstruction reveals a _____
Answer: bilateral non-pulsatile distension
Flashcard 286: Superior vena cava obstruction is characterised by impaired venous drainage of the _____, leading to oedema and distended superficial veins
Answer: head, neck and upper extremities
Flashcard 287: A carotid artery endarterectomy procedure is considered if symptomatic (e.g.TIA, stroke) and carotid stenosis > _____%
Answer: 50
Flashcard 288: The goal of statin therapy is to lower non-HDL cholesterol by more than _____%
Answer: 40
Flashcard 289: A pulmonary embolism risk factor is recent _____ & 6 weeks postpartum
Answer: pregnancy
Flashcard 290: On ECG the most common finding of pulmonary embolism is _____
Answer: sinus tachycardia
Flashcard 291: On ECG the classical finding of pulmonary embolism is _____
Answer: S1Q3T3
Flashcard 292: Which antiarrhythmic most commonly cause drug-induced pulmonary fibrosis? _____
Answer: Amiodarone
Flashcard 293: (chronic) cardiac tamponade classically has a "_____" appearance on CXR
Answer: watter-bottle
Flashcard 294: What is the initial investigation for Brugada syndrome? _____
Answer: ECG
Flashcard 295: What is the management of Brugada syndrome? _____
Answer: Implantable cardiac defibrillator (ICD)
Flashcard 296: What is the most worrisome complication of Brugada syndrome? _____
Answer: Sudden cardiac death
Flashcard 297: _____ syndrome is a genetic cardiac disorder that causes sudden cardiac death, most commonly caused by a SCN5A gene mutation which encodes for cardiac Na+ channel proteins
Answer: Brugada
Flashcard 298: _____ is the most common cause of cardiac tamponade
Answer: Pericarditis
Flashcard 299: Brugada syndrome is more prevalent in _____ descent with an estimated occurrence of ~1 in 2,000-5,000
Answer: Asian
Flashcard 300: Below is an ECG of a patient with _____
Answer: Wolff-Parkinson-White syndrome
Flashcard 301: Hypertrophic obstructive cardiomyopathy ejection systolic murmur _____ with squatting
Answer: decreases
Flashcard 302: Patients with hypertrophic obstructive cardiomyopathy most commonly present _____, but can develop dyspnoea, chest pain, palpitations, and syncope
Answer: asymptomatically
Flashcard 303: What is the management of hypertrophic obstructive cardiomyopathy? _____
Answer: Complex....
Flashcard 304: Hypertrophic obstructive cardiomyopathy on echocardiogram shows _____
Answer: MR SAM ASH
Flashcard 305: What is the initial investigation for hypertrophic obstructive cardiomyopathy? _____
Answer: ECG
Flashcard 306: What is the likely cause of syncope in a young patient with occasional chest pain, dyspnea, and a crescendo-decrescendo systolic murmur along the left sternal border without carotid radiation? _____
Answer: Hypertrophic obstructive cardiomyopathy (HOCM)
Flashcard 307: Wolff-Parkinson-White Syndrome (WPW) presents with a _____ QRS complex, shortened PR interval, and characteristic delta wave on ECG
Answer: broad
Flashcard 308: Hypertrophic obstructive cardiomyopathy on ECG shows _____
Answer: left ventricular hypertrophy
Flashcard 309: What is the likely diagnosis in a young patient with palpitations, tachycardia, and the ECG below? _____
Answer: Wolff-Parkinson-White syndrome
Flashcard 310: Wolff Wolff-Parkinson White (WPW) syndrome: Type A: _____-sided accessory pathway, showing a dominant R wave in lead V1 Type B: right-sided accessory pathway, showing a non-dominant R wave in V1
Answer: left
Flashcard 311: What is the diagnostic investigation for hypertrophic obstructive cardiomyopathy? _____
Answer: Echocardiogram
Flashcard 312: Hypertrophic obstructive cardiomyopathy ejection systolic murmur _____ with Valsalva manoeuvre
Answer: increases
Flashcard 313: Hypertrophic obstructive cardiomyopathy presents with _____ on auscultation
Answer: ejection systolic murmur
Flashcard 314: _____ is characteristic for Wolff-Parkinson-White (WPW) on ECG
Answer: Delta wave
Flashcard 315: What is the definitive management of Wolff-Parkinson-White syndrome? _____
Answer: Catheter ablation
Flashcard 316: _____ is an autosommal dominant disorder characterised by left ventricular hypertrophy, impaired diastolic filling, & abnormalities of the mitral valve
Answer: Hypertrophic obstructive cardiomyopathy (HOCM)
Flashcard 317: In Wolff-Parkinson White (WPW) syndrome there is axis deviation _____ to the accessory pathway
Answer: contralateral
Flashcard 318: Hypertrophic obstructive cardiomyopathy can also present with _____
Answer: mitral valve regurgitation
Flashcard 319: Widened/slurred QRS (delta wave) and ↓ PR interval is suggestive of _____
Answer: Wolff-Parkinson-White syndrome
Flashcard 320: What is a major complication of hypertrophic obstructive cardiomyopathy? _____
Answer: Sudden death from ventricular arrhythmias
Flashcard 321: Wolff-Parkinson-White syndrome is due to an abnormally fast accessory conduction pathway from the atria to ventricle via the bundle of _____, which bypasses the slower AV node
Answer: Kent
Flashcard 322: Hypertrophic obstructive cardiomyopathy occurs in around 1 in _____
Answer: 500
Flashcard 323: What is the most common cause of sudden cardiac death in young people & athletes? _____
Answer: Hypertrophic obstructive cardiomyopathy
Flashcard 324: What is the recommended management for a hemodynamically stable Wolff-Parkinson-White syndrome patient with atrial fibrillation? _____ or amiodarone
Answer: Flecainide
Flashcard 325: Wolff-Parkinson-White syndrome may result in re-entry circuit, causing supraventricular _____
Answer: tachycardia
Flashcard 326: Hypertrophic obstructive cardiomyopathy causes _____ dysfunction
Answer: diastolic
Flashcard 327: _____ syndrome is a genetic disorder that allows abnormal conduction to occur in the heart, via an accessory pathway
Answer: Wolff-Parkinson-White (WPW)
Flashcard 328: Constrictive pericarditis may also occur after _____ surgery
Answer: open heart
Flashcard 329: CXR for myocarditis may show _____
Answer: cardiomegaly/heart failure
Flashcard 330: The main management for atrial fibrillation is _____ control
Answer: rate
Flashcard 331: Immediately before cardioversion for AF, the patient should be _____
Answer: heparinised
Flashcard 332: What is the second-line anticoagulation for atrial fibrillation? _____
Answer: Warfarin
Flashcard 333: What investigation can be done to differentiate between myocarditis & pericarditis? _____
Answer: Echocardiogram
Flashcard 334: Rate control for atrial fibrillation: 1st line = _____ 2nd line = rate limiting CCB (verapamil or diltiazem) 3rd line = digoxin if the patient does little/no exercise
Answer: beta blocker
Flashcard 335: What is the management of myocarditis? _____
Answer: Treat underlying cause + supportive
Flashcard 336: Bloods for myocarditis may show ↑ CRP, _____ cardiac enzymes (troponin), & ↑ BNP
Answer: ↑
Flashcard 337: What types of atrial fibrillation are given anticoagulation? _____
Answer: All groups even if they are not currently in AF
Flashcard 338: An ORBIT score of ≥ _____ means high risk of bleeding for AF patients on anticoagulation
Answer: 4
Flashcard 339: _____ is an inflammation of the myocardial layer of the heart
Answer: Myocarditis
Flashcard 340: What is the management for atrial fibrillation if rate control or rhythm control is not an option? _____
Answer: Catheter ablation
Flashcard 341: What is the best test for constrictive pericarditis? _____
Answer: CXR because it shows pericardial calcification
Flashcard 342: What is the diagnostic investigation for myocarditis? _____
Answer: Biopsy but this is very risky, so not often done Echocardiogram may be done to differentiate pericarditis vs myocarditis
Flashcard 343: Atrial fibrillation with _____ disease is an ABSOLUTE indication for anticoagulation
Answer: valvular heart
Flashcard 344: CHA2DS2-VASc Mnemonic: C_____ Hypertension A2 – Age >75 (Scores 2) Diabetes S2 – Stroke or TIA previously (Scores 2) Vascular disease Age 65-74 Sex (female)
Answer: ongestive heart failure
Flashcard 345: What is the pharmacological rhythm control of a patient with AF who has a structural heart disease? _____
Answer: Amiodarone
Flashcard 346: CHA2DS2-VASc score 0 = _____ 1 = consider anticoagulation (males only) 2 = offer anticoagulation
Answer: no anticoagulation
Flashcard 347: A 34 year-old patient presents with 2 weeks of fever and URTI. He is fatigued with chest pain and dyspnoea. On investigation there are ↑ troponins. What is the most likely diagnosis? _____
Answer: Myocarditis
Flashcard 348: Flecainide is contraindicated in _____
Answer: structural heart disease
Flashcard 349: _____ can cause QT prolongation, so an ECG must be performed before administering
Answer: Azithromycin
Flashcard 350: What is the management of constrictive pericarditis? _____
Answer: Diuretics; then Pericardiectomy
Flashcard 351: _____ sign is increased JVP on inspiration and present in constrictive pericarditis & restrictive cardiomyopathy
Answer: Kussmaul's
Flashcard 352: ECG for myocarditis may show _____ & T-wave inversion
Answer: ST-segment elevation
Flashcard 353: Rate control for _____ is done to slow down the heart rate & avoid impacts on cardiac function
Answer: atrial fibrillation
Flashcard 354: Myocarditis most commonly presents with _____ then chest pain with a recent history of viral illness
Answer: fatigue
Flashcard 355: Pharmacological rhythm control for atrial fibrillation: 1st line = _____ 2nd line = Flecainide (contraindicated in structural heart disease)
Answer: Amiodarone
Flashcard 356: _____ & hypertrophic cardiomyopathy are important differentials for acute chest pain in young, fit patients
Answer: Myocarditis
Flashcard 357: The prognosis of myocarditis is typically _____, but it can cause heart failure, sudden death from arrhythmia, and/or dilated cardiomyopathy
Answer: good
Flashcard 358: What are the initial investigations for myocarditis? _____
Answer: Bloods, ECG, & CXR
Flashcard 359: A patient presents complaining of dyspnoea. Physical exam reveals Kussmaul sign and a pericardial knock on heart auscultation. What is the most likely diagnosis? _____
Answer: Constrictive pericarditis
Flashcard 360: What is the first-line anticoagulation for atrial fibrillation? _____
Answer: DOACs (apixaban, dabigatran, rivoroxaban, & edoxaban)
Flashcard 361: Bleeding risk for atrial fibrillation is assessed with the _____ score when deciding risk vs benefits for anticoagulation
Answer: ORBIT
Flashcard 362: A patient with atrial fibrillation for ≥ _____ hours or uncertain should be treated with rate control
Answer: 48
Flashcard 363: The _____ criteria is used to determine anticoagulation for atrial fibrillation
Answer: CHA2DS2-VASc
Flashcard 364: In _____ atrial fibrillation there is continuous atrial fibrillation which cannot be cardioverted
Answer: permanent
Flashcard 365: _____ are contraindicated in pregnancy
Answer: ACE inhibitors & ARB
Flashcard 366: What is the management of asymptomatic mitral stenosis? _____
Answer: Active monitoring with regular echocardiogram
Flashcard 367: What investigations should be ordered for suspected mitral stenosis? _____
Answer: ECG, CXR, Echo
Flashcard 368: A 30 year old immigrant presents with dyspnea, haemoptysis, and palpitations. A mid-diastolic murmur is heard loudest at the apex. What is the likely valve affected? _____
Answer: Mitral stenosis
Flashcard 369: _____ is often quiet or absent in mitral regurgitation
Answer: S1
Flashcard 370: A CXR may show _____ in mitral stenosis
Answer: left atrial enlargement
Flashcard 371: The most common ischaemic cause of acute mitral regurgitation is _____
Answer: myocardial infarction
Flashcard 372: Atrial fibrillation may present with _____, dyspnoea, & chest pain
Answer: palpitations
Flashcard 373: Mitral stenosis commonly presents with _____ and rarely haemoptysis due to pulmonary HTN
Answer: exertional dyspnoea
Flashcard 374: Cardiovascular risks increase ↑ the risks of dementia, particularly _____ dementia
Answer: vascular
Flashcard 375: Atrial fibrillation typically beats at _____
Answer: 100-175 BPM
Flashcard 376: The main cause of mitral stenosis is _____
Answer: rheumatic fever
Flashcard 377: The most common sustained arrhythmia is _____
Answer: atrial fibrillation
Flashcard 378: The S1 in mitral stenosis is described as a _____
Answer: loud snap
Flashcard 379: _____ is an arrhythmia characterised by irregular, rapid atrial contractions from uncoordinated atrial activity
Answer: Atrial fibrillation (AF)
Flashcard 380: _____ atrial fibrillation is characterised by recurrent episodes which does NOT self-terminate & commonly lasts > 7 days
Answer: Persistent
Flashcard 381: Mitral stenosis presents with a _____ murmur best heard at the apex on expiration
Answer: mid-late diastolic
Flashcard 382: What is the diagnostic investigation for mitral regurgitation? _____
Answer: Echocardiography
Flashcard 383: The most common presentation of mitral stenosis is _____
Answer: exertional dyspnoea
Flashcard 384: What additional heart condition often develops in patients with mitral stenosis? _____
Answer: Atrial fibrillation
Flashcard 385: Aortic regurgitation is heard best on _____ and leaning forward
Answer: expiration
Flashcard 386: ECG with an _____ pulse and absent P waves is characteristic of atrial fibrillation
Answer: irregularly, irregular
Flashcard 387: Signs of right heart failure (e.g. haemoptysis, pulmonary hypertension) are more common in _____
Answer: mitral stenosis
Flashcard 388: An ECG may show _____ in mitral regurgitation
Answer: broad, notched P waves
Flashcard 389: Chronic mitral regurgitation presents with _____, dyspnoea and oedema
Answer: fatigue
Flashcard 390: Patients with mitral stenosis may develop _____ on their faces
Answer: malar flush
Flashcard 391: What is the diagnostic investigation for mitral stenosis? _____
Answer: Echocardiography
Flashcard 392: _____ atrial fibrillation is characterised by recurrent episodes that terminates spontaneously usually < 7 days
Answer: Paroxysmal
Flashcard 393: What is the major complication of atrial fibrillation? _____
Answer: Stroke & thromboembolism
Flashcard 394: Aortic stenosis is heard best on _____ and leaning forward
Answer: expiration
Flashcard 395: What is the pharmacological managment of heart failure in mitral regurgitation? _____
Answer: Diuretics, ACEi, BB
Flashcard 396: Atrial fibrillation is managed with 1. _____ or rhythm control 2. Stroke prevention (anticoagulation)
Answer: Rate
Flashcard 397: Management options for symptomatic mitral stenosis: _____ + balloon valvotomy or valve replacement
Answer: Diuretic
Flashcard 398: AF secondary to mitral stenosis is managed with _____ and corresponding rate control (BB)
Answer: warfarin
Flashcard 399: CXR of a patient with mitral regurgitation may show _____
Answer: cardiomegaly
Flashcard 400: Clinical signs of atrial fibrillation is an _____ pulse
Answer: irregularly, irregular
Flashcard 401: Cardiac output can be increased in patients with mitral regurgitation by giving _____ or insertion of an intra-aortic balloon pump
Answer: positive inotropes
Flashcard 402: Symptoms of mitral regurgitation are generally caused by _____ failure, pulmonary hypertension or arrhythmias
Answer: left ventricular
Flashcard 403: Auscultation of mitral regurgitation reveals a _____ murmur heard best at the apex.
Answer: pansystolic
Flashcard 404: The target INR for mitral stenosis is _____-3.5
Answer: 2.5
Flashcard 405: Auscultation of severe mitral regurgitation may reveal _____
Answer: a split S2
Flashcard 406: What is the management of symptomatic aortic stenosis? _____
Answer: Aortic valve replacement
Flashcard 407: The most common cause of aortic reguritation in the developed world is _____
Answer: bicuspid valve
Flashcard 408: What is the management of asymptomatic aortic stenosis? _____
Answer: Observe
Flashcard 409: What is the definitive management of aortic regurgitation? _____
Answer: Aortic valve replacement
Flashcard 410: Aortic regurgitation may present with a(n) collapsing pulse (Corrigan / bounding / Water-hammer pulse), pulsating nail bed (Quincke pulse), and head _____ when severe
Answer: bobbing
Flashcard 411: What is the diagnostic investigation for aortic stenosis? _____
Answer: Echocardiogram
Flashcard 412: What are the initial investigations for suspected aortic stenosis? _____
Answer: ECG & CXR
Flashcard 413: The pulse in aortic stenosis is _____
Answer: slow rising
Flashcard 414: Pulse pressure is _____ in patients with aortic stenosis
Answer: narrow
Flashcard 415: What is the biggest risk factor for aortic dissection? _____
Answer: Hypertension
Flashcard 416: Pulse pressure is _____ in aortic regurgitation
Answer: wide
Flashcard 417: Aortic regurgitation is caused by a damaged _____ or distortion/dilation of the aortic root/ascending aorta
Answer: aortic valve
Flashcard 418: What are the aortic root disease that cause aortic regurgitation? _____
Answer: Aortic aneurysm, aortic dissection, spondylarthropathies, hypertension, connective tissue syndromes
Flashcard 419: Apex displacement may occur in aortic stenosis if there is _____
Answer: left ventricular hypertrophy
Flashcard 420: What type of pulse is palpated in aortic regurgitation? _____
Answer: Collapsing pulse
Flashcard 421: What investigations should be ordered for aortic regurgitation? 1st Line: _____ Before surgery: invasive cardiac catheterisation
Answer: Echocardiography
Flashcard 422: The medical management of aortic regurgitation is targeted at reducing aortic root dilation by lowering _____ blood pressure using what medications? Lorsartan
Answer: systolic
Flashcard 423: A _____ non-displaced/displaced apex may be felt upon chest palpation in a patient with aortic stenosis
Answer: heaving
Flashcard 424: What murmur is heard upon auscultation in Aortic regurgitation? _____
Answer: Early diastolic murmur (left sternal edge)
Flashcard 425: Mid-diastolic (Austin-Flint) murmur is auscultated in _____
Answer: SEVERE Aortic regurgitation
Flashcard 426: De Musset's signs (head bobbing) is generally a result of which valvular defect? _____
Answer: Aortic regurgitation
Flashcard 427: What triad of symptoms is associated with aortic stenosis? _____
Answer: Heart failure, syncope, angina
Flashcard 428: The most common cause of aortic reguritation: Developing world = _____ Developed world = bicuspid valve
Answer: rheumatic fever
Flashcard 429: An _____ murmur heard loudest at the 2nd right ICS that radiates to the carotids is characteristic of Aortic Stenosis
Answer: ejection systolic
Flashcard 430: Quincke's signs (nailbed pulse) is observed in _____
Answer: aortic regurgitation
Flashcard 431: Marfan sydrome is associated with _____ & mitral vale prolapse
Answer: aortic regurgitation
Flashcard 432: Aortic stenosis loudest on _____
Answer: expiration
Flashcard 433: What are the main 2 causes of aortic stenosis: _____ = leading cause in older patients > 60 Bicuspid aortic valve = leading cause in younger patients < 60
Answer: Age-related degenerative calcification
Flashcard 434: Pulmonary stenosis loudest on _____
Answer: inspiration
Flashcard 435: Anticoagulation should be given _____ after AF even if reverted to normal sinus rhythm (depends on CHADS-VASC score too)
Answer: lifelong
Flashcard 436: What heart sound is classically seen in hypertrophic obstructive cardiomyopathy? _____
Answer: S4
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