High Yield points in Cardiology - Medicoshare

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14 Dec

High Yield Points in Cardiology

  1. Stopping smoking has greatest benefit in reducing cardiovascular risk factors.
  2. 3 vessel disease or 2 vessel disease in diabetes needs 1 or 2 vessel disease needs stent placement.
  3. Antihypertensive for a diabetic patient with proteinuria => ACEIs / ARBs.
  4. Beck triad for cardiac tamponade => Hypotension, distant heart sounds, and JVD.
  5. Drugs that slow heart rate => β-blockers, calcium channel blockers, digoxin, and amiodarone.
  6. Hypercholesterolemia treatment that leads to flushing and pruritus =>
  7. Treatment for atrial fibrillation and atrial flutter: If hemodynamically unstable, cardiovert. If stable or chronic, rate control with CCBs or β
  8. Treatment for ventricular fibrillation: Immediate defibrillation.
  9. Dressler syndrome: Autoimmune reaction with fever, pericarditis, and ↑ ESR occurring 2–4 weeks post-MI. Treatment with analgesics and steroids.
  10. IV drug use with JVD & a holosystolic murmur at the left sternal border: Treat existing heart failure, & replace tricuspid valve.
  11. Diagnostic test for HOCM: Echocardiogram (showing a thickened left ventricular wall & outflow obstruction).
  12. Pulsus paradoxus: Decrease in systolic BP of > 10 mm Hg with inspiration. It is seen in cardiac tamponade.
  13. Eight surgically correctable causes of hypertension: Renal artery stenosis, coarctation of the aorta, pheochromocytoma, Conn syndrome, Cushing syndrome, unilateral renal parenchymal disease, hyperthyroidism, hyperparathyroidism.
  14. MR angiography is the investigation of choice for renal artery stenosis.
  15. Evaluation of a pulsatile abdominal mass and bruit: Abdominal ultrasound and CT
  16. Indications for surgical correction of abdominal aortic aneurysm: size > 5 cm, rapidly enlarging, symptomatic, or ruptured.
  17. 50-year-old man with stable angina can exercise to 85% of maximum predicted heart rate, appropriate diagnostic test => Exercise stress treadmill with ECG.
  18. 65-year-old woman with left bundle branch block and severe osteoarthritis has unstable angina, appropriate diagnostic test = Pharmacologic stress test (eg, Dobutamine echocardiogram).
  19. Signs of active ischemia (Angina) during stress testing = ST-segment changes on ECG, or ↓
  20. Young patient with angina at rest and ST-segment elevation with normal cardiac enzymes = Prinzmetal angina.
  21. Diagnostic test for pulmonary embolism: CT pulmonary angiogram.
  22. Young patient with family history of sudden death collapses and dies while exercising. Probable diagnosis => Hypertrophic cardiomyopathy.
  23. Endocarditis prophylaxis regimens:
    • Oral surgery—amoxicillin for certain situations.
    • GI or GU procedures— endocarditis prophylaxis not recommended.
  24. Virchow triad: Stasis, hypercoagulability, endothelial damage.
  25. Most common cause of hypertension in young women =>
  26. Most common cause of hypertension in young men => Excessive Ethyl alcohol.
  27. Water bottle–shaped heart pericardial effusion: Look for pulsus paradoxus.
  28. Swan Ganz catheter does not measure cardiac output
  29. Reversal of shunt in PDA causes cyanosis in lower limbs.
  30. Most common cause of death in infective endocarditis is
  31. Oliguric lung fields / absent lung markings + RV dilation on echocardiography => think of pulmonary stenosis.
  32. Rapid replacement of IV potassium results in cardiac arrest in diastole because potassium is involved in repolarization.
  33. Most accurate way of determining the ejection fraction is MUGA scan.
  34. Diagnostic feature of coarctation of aorta is absent femoral pulses.
  35. Pulmonary capillary wedge pressure is approximation of pressure in left atrium.
  36. Dyspnea is the most common presentation in mitral stenosis. It is due to pulmonary congestion.
  37. Syncope is the most common presentation in aortic stenosis.
  38. Palpitations are most common presentation of atrial fibrillation.
  39. Young man, sport injury, presenting with clinical features of heart failure => Fat embolism. Treat with oxygen, IV fluids, and CPAP.
  40. VT 2ndry to digoxin toxicity: Give phenytoin 250mg IV over 5 min, or lidocaine.
  41. Stent thrombosis occurs 2 days post angioplasty, treat with IV abciximab, heparin, and aspirin then do urgent angioplasty.
  42. Pericarditis: chest pain worse on lying down, ST elevation in ECG, raised inflammatory markers & CK, Rx. NSAID. PR depression in lead II & V6 = specific ECG feature.
  43. Indication to temporary Trans venous pacing post MI: Mobitz type 2, Mobitz type 1 or sinus bradycardia not responding to atropine, asystole, and Trifascicular block.
  44. Carotid sinus hypersensitivity: patients present with collapse. Treat with Dual chamber pacemaker.
  45. Endocarditis following colonic resection may be caused by Bacillus fragilis.
  46. Aortic dissection: is associated with inferior wall MI.
    • Type-A (proximal): require surgery.
    • Type B (distal): conservative management, control BP with labetalol.
  47. ACE inhibitors are contraindicated in aortic stenosis as they may precipitate heart failure.
  48. Polymorphic VT: if patient is stable treat with IV magnesium, & overriding pacing. If patient is unstable treat with DC cardioversion.
  49. Dentistry in warfarinised patients: check INR 72 hours before procedure, proceed if INR is less than 4.0
  50. B-type natriuretic peptide is mainly secreted by the ventricular myocardium
  51. Patients with very poor dental hygiene – cause of endocarditis => Viridans streptococci e.g. Streptococcus sanguinis
  52. Primary percutaneous coronary intervention is the gold-standard treatment for ST-elevation myocardial infarction
  53. Prosthetic heart valves – antithrombotic therapy:
    • Bioprosthetic: aspirin
    • Mechanical: warfarin + aspirin
  54. Endothelin receptor antagonists decrease pulmonary vascular resistance in patients with primary pulmonary hypertension
  55. IV magnesium sulfate is used to treat torsades de pointes.
  56. J-waves in ECG are associated with
  57. HOCM is the most common cause of sudden cardiac death in the young
  58. Prosthetic valve endocarditis caused by staphylococci → Give Flucoloxacillin + rifampicin + low-dose gentamicin.
  59. When treating angina, if there is a poor response to the first-line drug (e.g. a beta-blocker), the dose should be titrated up before adding another drug.
  60. Infective endocarditis – indications for surgery:
    • Severe valvular incompetence
    • Aortic abscess (often indicated by a lengthening PR interval)
    • Infections resistant to antibiotics/fungal infections
    • Cardiac failure refractory to standard medical treatment
    • Recurrent emboli after antibiotic therapy.
  61. Gallop rhythm (S3) is an early sign of LVF
  62. Young man with AF, no TIA or risk factors, no treatment is now preferred to aspirin.
  63. Ischemic changes in leads V1-V4 – left anterior descending.
  64. With Magnesium sulphate therapy, Monitor => reflexes + respiratory rate.
  65. A single episode of paroxysmal atrial fibrillation, even if provoked, should still prompt consideration of anticoagulation
  66. A prolonged PR interval in ECG => aortic root abscess.
  67. Hypocalcemia is associated with QT interval prolongation; Hypercalcemia is associated with QT interval shortening
  68. Infective endocarditis – streptococcal infection carries a good prognosis
  69. Nitrates should be avoided in the likely diagnosis of right ventricular myocardial infarct because they cause reduced preload
  70. Infective endocarditis causing congestive cardiac failure is an indication for emergency valve replacement surgery
  71. A beta-blocker or a calcium channel blocker is used first-line to prevent angina attacks
  72. Furosemide – inhibits the Na-K-Cl cotransporter in the thick ascending limb of the loop of Henle
  73. People with cardiac syndrome X have normal coronary angiograms despite ECG changes on exercise stress testing.
  74. Patients with recurrent venous thromboembolic disease may be considered for an inferior vena cava filter
  75. AV block can occur commonly following an inferior MI
  76. Aortic stenosis – S4 is a marker of severity
  77. Labetalol is first-line for pregnancy-induced hypertension
  78. Paradoxical embolus – PFO most common cause – do TOE
  79. Risk of falls alone is not sufficient reason to withhold anticoagulation
  80. DVLA advice post MI – cannot drive for 4 weeks
  81. Pulmonary arterial hypertension patients with negative response to vasodilator testing should be treated with prostacyclin analogues, endothelin receptor antagonists or phosphodiesterase inhibitors. Often combination therapy is required
  82. A potassium above 6mmol/L should prompt cessation of ACE inhibitors in a patient with CKD (once other agents that promote hyperkalemia have been stopped)
  83. Hypokalaemia – U waves on ECG
  84. Rate-limiting CCBs should be avoided in patients with AF + heart failure with reduced EF (HFrEF) due to their negative inotropic effects
  85. Dipyridamole is a non-specific phosphodiesterase inhibitor and decreases cellular uptake of adenosine
  86. The main ECG abnormality seen with hypercalcemia is shortening of the QT interval
  87. Beta-blockers e.g. bisoprolol should not be used with verapamil due to the risk of bradycardia, heart block, congestive heart failure
  88. HOCM – poor prognostic factor on echocardiography => septal wall thickness of > 3cm
  89. Second heart sound (S2)
    • Loud in
    • Soft in
    • Fixed split in
    • Reversed split in
  90. ALS – give adrenaline in non-shockable rhythm as soon as possible
  91. Patients with stable CVD who have AF are generally managed on an anticoagulant and the antiplatelets stopped
  92. In management of STEMI if primary PCI cannot be delivered within 120 minutes then thrombolysis should be given
  93. HOCM is usually due to a mutation in the gene encoding β-myosin heavy chain protein or myosin binding protein C
  94. Ticagrelor has a similar mechanism of action to clopidogrel – inhibits ADP binding to platelet receptors
  95. Atrial myxoma – commonest site = left atrium
  96. Patients with a suspected pulmonary embolism should be initially managed with low-molecular weight heparin
  97. Patients with VT should not be prescribed verapamil
  98. Contrast-enhanced CT coronary angiogram is the first line investigation for stable chest pain of suspected coronary artery disease etiology
  99. Aortic regurgitation – early diastolic murmur, high-pitched and ‘blowing’ in character
  100. Patients with SVT who are hemodynamically stable and who do not respond to vagal manoeuvre, next step => treat with adenosine.
  102. Atrioventricular dissociation suggests VT rather than SVT with aberrant conduction
  103. Bisferiens pulse is suggestive of mixed aortic valve disease
  104. Patients on warfarin undergoing emergency surgery – give four-factor prothrombin complex concentrate
  105. Aschoff bodies are granulomatous nodules found in rheumatic heart fever
  106. Streptococcus bovis endocarditis is associated with colorectal cancer
  107. Most common cause of endocarditis:
    • Staphylococcus aureus
    • Staphylococcus epidermidis if < 2 months post valve surgery
  108. Left parasternal heave is a feature of tricuspid regurgitation.
  109. Hypertension in diabetics – ACE-inhibitors are first-line regardless of age
  110. New onset AF is considered for electrical cardioversion if it presents within 48 hours of presentation
  111. Takotsubo cardiomyopathy is a differential for ST-elevation in someone with no obstructive coronary artery disease
  112. DVLA advice following angioplasty – cannot drive for 1 week
  113. PCI – patients with drug-eluting stents require a longer duration of clopidogrel therapy
  114. Pulsus alternans is seen in left ventricular failure
  115. Cocaine induced MI should be treated with PCI if available as cocaine causes vasospasm with platelets activation and acute arterial blockage.
  116. Massive PE + hypotension => thrombolysis.
  117. Major bleeding while using warfarin => stop warfarin, give intravenous vitamin K, and prothrombin complex concentrate
  118. Complete heart block following an inferior MI is NOT an indication for pacing, unlike with an anterior MI
  119. Pulmonary arterial hypertension patients with positive response to vasodilator testing should be treated with calcium channel blockers
  120. Pulmonary embolism and renal impairment → V/Q scan is the investigation of choice
  121. Takayasu’s arteritis is an obliterative arteritis affecting the aorta
  122. Palpitations should first be investigated with a Holter monitor after initial bloods/ECG
  123. Tricuspid valve endocarditis can cause tricuspid regurgitation, which may manifest with a new pan-systolic murmur, large V waves and features of pulmonary emboli.
  124. Asymmetric septal hypertrophy and systolic anterior movement (SAM) of the anterior leaflet of mitral valve on echocardiogram or cardiac MR support the diagnosis of
  125. The recommended dose of adrenaline to give during advanced ALS is 1mg
  126. Bendroflumethiazide can worsen glucose tolerance
  127. PCI: stent thrombosis – withdrawal of antiplatelets is the biggest risk factor.
  128. Antibiotic prophylaxis to prevent infective endocarditis is not routinely recommended in the UK for dental and other procedures
  129. ACE-inhibitors should be avoided in patients with HOCM
  130. Renal dysfunction (eGFR <60) can cause a raised serum natriuretic peptides
  131. A stable patient presenting in AF with an obvious precipitating cause may revert to sinus rhythm without specific antiarrhythmic treatment
  132. Witnessed cardiac arrest while on a monitor => up to three successive shocks before CPR
  133. Ventricular tachycardia – verapamil is contraindicated
  134. Thiazide diuretics can cause hyponatremia, metabolic alkalosis, hypokalemia and hypocalciuria
  135. Percutaneous mitral commissurotomy is the intervention of choice for severe mitral stenosis.
  136. Ivabradine use may be associated with visual disturbances including phosphenes and green luminescence
  137. Myoglobin rises first following myocardial infarction
  138. Ischemic changes in leads I, aVL +/- V5-6 – left circumflex artery
  139. Mechanical valves – target INR:
    • Aortic: 3.0
    • Mitral: 3.5
  140. Unprovoked’ pulmonary embolisms are typically treated for 6 months
  141. INR > 8.0 (no bleeding) while using warfarin– stop warfarin, give oral vitamin K 1-5mg, repeat dose of vitamin K if INR high after 24 hours, restart when INR < 5.0.
  142. VF/pulseless VT should be treated with 1 shock as soon as identified.
  143. In the context of a tachyarrhythmia, a systolic BP < 90 mmHg → DC cardioversion.
  144. S1Q3T3 is a classic but uncommon ECG finding in PE.
  145. Pleuritic chest pain at <48hrs after MI ->
  146. RBBB +left anterior or posterior hemiblock + 1st-degree heart block = Trifascicular block.
  147. Bleeding on dabigatran => use idarucizumab to reverse.
  148. Myocarditis presents with ST elevation and acute pulmonary oedema in a young patient with a recent flu-like illness.
  149. Patients who’ve had a catheter ablation for atrial fibrillation still require long-term anticoagulation as per their CHA2DS2-VASc score.
  150. The most appropriate medication in patients with acute heart failure and a preserved ejection fraction who have signs of volume overload is addition/up-titration of a loop diuretic.
  151. Following elective DC cardioversion for AF, anticoagulation should be continued even if sinus rhythm is maintained
  152. New AF in mitral regurgitation => refer for mitral valve replacement
  153. Elderly male patients who present with pre-syncope/syncope and are on alpha-blockers as treatment for BPH should be assessed for orthostatic hypotension as a first step in evaluation.
  154. Complete heart block following an anterior MI suggests significant damage to the myocardium and will likely require pacing, in contrast to complete heart block following an inferior MI.
  155. Statins are the only lipid-regulating drugs that are used in secondary prevention of cardiovascular disease (with the exception of ezetimibe which is used in cases of primary hypercholesterolemia).
  156. Acute heart failure not responding to treatment => consider CPAP.
  157. In hypertensive urgency, treatment aims to lower blood pressure with the use of oral anti-hypertensive medication.
  158. Heyde syndrome is a triad of aortic stenosis, coagulopathy and GI bleeding.
  159. Electrical alternans is suggestive of cardiac tamponade.
  160. In coronary vasospasm (Prinzmetal’s angina, or variant angina), the ECG shows ST elevation that is very similar to an acute STEMI. However, unlike acute STEMI the ECG changes are transient, reversible with vasodilators and not associated with myocardial necrosis.
  161. First line management of acute pericarditis involves combination of NSAID and colchicine.
  162. Thiazide diuretics can cause hypercalcemia and hypocalciuria.
  163. ECG changes in Brugada syndrome are more apparent following the administration of flecainide or ajmaline – this is the investigation of choice in suspected cases.
  164. In patient with BBB and unexplained syncope but an ejection fraction >35% proceed with further testing (e.g. carotid sinus massage, electrophysiological studies) prior to initiation of management.
  165. Accelerated idioventricular rhythm is common and unconcerning following recent MI
  166. Digoxin administration is not recommended in cardiac amyloidosis owing to a higher risk of digoxin toxicity, as the drug binds avidly to amyloid fibrils.
  167. Multiple episodes of inappropriate shocks from an ICD can be both unpleasant and dangerous. Ultimately the device will need interrogated from a pacemaker technician, however the most immediate management should be to place a ring magnet over the ICD to prevent further inappropriate shocks.
  168. AV blocking drugs and vagal maneuvers are absolutely contraindicated in patients with AF and pre-excitation.
  169. AKI following angiography can be caused by contrast-induced nephropathy or cholesterol emboli.
  170. Ischemic changes in leads II, III, aVF – right coronary artery
  171. Hydrazine and nitrate should be considered for Afro-Caribbean patients with heart failure who are not responding to ACE-inhibitor, beta-blocker and aldosterone antagonist therapy.
  172. Cardiac magnetic resonance imaging has been shown to be very useful in diagnosing myocarditis by visualizing markers for inflammation of the myocardium.
  173. In patients with Mobitz type II AV block, or complete heart block, a DDD or DDDR pacemaker is indicated.
  174. Wellens’ syndrome is a pattern of deeply inverted or biphasic T waves in V2-3. It is highly specific for critical stenosis of the left anterior descending artery (LAD). It should be treated as a STEMI with urgent angiography and revascularization.
  175. In pre-excited AF don’t give anything that blocks conduction at AV node (including calcium channel blockers, adenosine or digoxin) as this can cause ventricular tachycardia.
  176. Cardiac MRI is the investigation of choice alongside echocardiography in order to identify the potential cause of cardiomyopathy.
  177. If a cardiac MIBI scan shows that the defect is present on both stress and rest, this is suggestive of a fixed defect such as myocardial necrosis and fibrosis secondary to infarction.
  178. ACE inhibitors offer prognostic benefit in chronic heart failure.
  179. Females with Turner’s syndrome have just one X chromosome. Therefore they have the same probability of being affected by an X linked recessive disease as males.
  180. Distinguishing between VT and SVT with BBB can be challenging. The presence of RBBB and RAD favors the diagnosis of SVT with BBB.
  181. Aortic stenosis – a soft S2 is a feature of severe disease.
  182. First degree heart block and Wenckebach phenomenon are normal variants in an athlete. They do not require intervention.
  183. In pure sinus node dysfunction without AF or evidence of AV block, an AAIR or DDDR pacemaker can be used. Most cardiologists would choose a DDDR pacemaker since many of these patients go on to develop AV block.
  184. IV vancomycin + rifampicin + low-dose gentamicin is the empirical treatment of choice in prosthetic valve endocarditis with penicillin allergy.
  185. Patients with ventricular ectopics can usually be managed by reassurance and lifestyle modifications. If pharmacological management is required, then beta blockers are first line.
  186. Posterior wall MI typically present on ECG with tall R waves V1-2.
  187. The presence of ST elevation without reciprocal depression following myocardial infarction is suggestive of a left ventricle aneurysm. Left ventricle aneurysms predispose to both ventricular arrhythmias and cardiac thrombo-embolisms.
  188. Twiddling refers to pacemaker dysfunction due to patients interfering with the wires.
  189. Delivery of the baby is the treatment of HELLP syndrome.
  190. Methadone is a common cause of QT prolongation.
  191. During a cardiology clinical examination, a sustained apical impulse is consistent with left ventricular hypertrophy, which can be verified on an ECG by identifying deep S waves in V1 and V2 and tall R-waves in V5 and V6.
  192. Peripheral edema is considered to be a common and annoying adverse effect of calcium channel blockers. Diuretics don’t relieve the edema caused by calcium channel blockers.
  193. Radiographic evidence of aortic disruption or dissection => Widened mediastinum (> 8 cm), loss of aortic knob, pleural cap, tracheal deviation to the right, depression of left main stem bronchus.
  194. Turner’s syndrome – most common cardiac defect is bicuspid aortic valve (more common than coarctation of the aorta).
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