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Year 3 - CR > Before exam > Flashcards

Before exam Flashcards

1
Q

name the drugs for heart failure

A
  • beta blockers
  • ACE/ARBs
  • spironolactone/ furosemide
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2
Q

Describe the macroscopic appearance of the MI - 0-12 hours

  • 12-24 hours
  • 24-72 hours
  • 3-10 days
  • weeks - months
A
  • 0-12 hours = no changes
  • 12-24 hours = pale with blotchy discolouration
  • 24-72 hours = soft, pale and yellow
  • 3-10 days = soft, yellow-brown with hyperaemic border
  • weeks - months = white fibrous scar
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3
Q

Describe the histology appearance of the MI

  • 0-12 hours
  • 12-24 hours
  • 24-72 hours
  • 3-10 days
  • weeks - months
A
  • 0-12 hours = No changes
  • 12-24 hours = bright eosinophilia of muscle fibres reflecting onset of coagulation necrosis; intracellular oedema
  • 24-72 hours = coagulative necrosis with loss of nuclei and striations, beginning of acute inflammatory response with heavy interstitial neutrophil infiltrate
  • 3-10 days = replacement of infarcted area by granulation tissue
  • weeks - months = collagenous scar tissue
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4
Q

What are the symptoms of right sided heart failure

A

Liver

  • pure liver congested - nutmeg
  • centrilobular necrossi and firbosis
  • portal vein pressure increase - splenomegaly, ascities, kidneys and brain hypoxia, peripheral oedema
  • biventricular - plus LVF
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5
Q

what are the causes of secondary hypertension

A

Renal

  • Chronic renal disease
  • glomerulonephritis
  • renal artery stenosis

Neurological

  • stress including surgery
  • psychogenic
  • raised intracranial pressure

Cardiovascular

  • coarctation of the aorta
  • systemic vasculitis
  • increased intravascular volume

Endocrine

  • cushings
  • conns
  • exogenous hormones
  • pheochromocytoma
  • acromegaly
  • thyroid disease
  • pregnancy
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6
Q

What can cause pulmonary hypertension

A
  • diseases of the lung parenchyma such as COPD, cystic fibrosis, diffuse interstitial fibrosis
  • diseases of the pulmonary vessels such as recurrent, PEs, primary PH, severe vasculiits
  • Disorders affecting chest movement such as kyphoscoliosis, neuromuscular disease
  • disorders causing arterial constriction such as hypoxaemia, chronic altitude sickness
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7
Q

How do you work out the QTc

A

QT/ square root of RR

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8
Q

what is the axis in left axis deviation and right axis deviation

A

Left axis deviation is when the axis is greater than -30

right axis deviation is when the axis is greater than +120

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9
Q

What can cause right axis deviation

A

– children and tall thin adults
– RVH
– chronic lung disease/ pulmonary embolus
– left posterior hemiblock
– atrial septal defect/ ventricular septal defect
– Wolff-Parkinson-White syndrome - left sided accessory pathway

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10
Q

What can cause left axis deviation

A

– LVH
– LBBB and left anterior hemiblock
– Q waves of inferior myocardial infarction
– Wolff-Parkinson-White syndrome - right sided accessory pathway

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11
Q

What causes P pulmonale

A
  • peaked P wave

- Right atrial hypertrophy (tall and thin)

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12
Q

What causes P mitrale

A
  • Bifid P wave

- Left atrial hypertrophy (M shape)

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13
Q

what is wolf parkinson white syndrome associated with

A
  • pre excitation through an accessory pathway
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14
Q

What does an ECG of wolf parkinsons white syndrome look like

A
  • Short P-R interval
  • delta wave
  • Wide QRS complex
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15
Q

what leads look at which part of the wall

  • inferior
  • anterior
  • lateral
A
  • inferior - II/III/aVF
  • anterior - V2-4
  • lateral - V5-6/I/aVL
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16
Q

Wellens syndrome

A

Antero-lateral T wave inversion

  • anterior NSTEMI pending troponin
  • LAD syndrome - LAD can involve the lateral wall as well as the anterior wall
  • this patient should be treated as an MI
  • Sign of an LAD lesion
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17
Q

What ECG changes happen in hypokalaemia

A
  • small T waves
  • Prominent U waves
  • Peaked P waves
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18
Q

What ECG changes happen in hyperkalemia

A
  • Tall Tented T waves
  • wide QRS complex
  • Absent P waves
  • Sine wave appearance
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19
Q

What ECG changes happen in hypercalcaemia

A
  • short QT interval
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20
Q

What ECG changes happen in hypocalcaemia

A
  • long QT interval

- small T waves

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21
Q

What can cause a prolonged QT interval

A
  • Congenital – Romano-Ward syndrome, Jervell and Lange-Nielsen syndrome
  • Cardiac – MI, ischaemia, mitral valve prolapse
  • HIV – direct effect of virus or protease inhibitors
  • Metabolic – hypokalaemia, hypomagnesaemia, hypocalcaemia, starvation, hypothyroidism, hypothermia
  • Toxic – organophosphates
  • Anti-arrhythmic drugs – quinidine, amiodarone, procainamide, sotalol
  • Antimicrobials – erythromycin, levofloxacin, pentamide, halofantrine
  • Antihistamines – terfenadine, astimazole
  • Motility drugs – domperidone
  • Psychoactive drugs – haloperidol, risperidone, TCAs, SSRIs
  • Connective disease disorders – Anto-RO/SSA Abs
  • Herbalism – Chinese folk remedies (arsenic), cocaine, quinine, artemisinins (antimalarials)
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22
Q

What can cause AF

A
  • IHD
  • thyrotoxicosis
  • hypertension
  • obesity
  • CCF
  • alcohol
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23
Q

What is bifasciular block

A

LBBB+RBBB: manifests as an axis deviation

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24
Q

What is trifascicular block

A

bifasciular block + 1st degree Heart block

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25
Q

What does left ventricular hypertrophy look like

A

R-wave in V6 >25mm OR sum of S-wave in V1 and R-wave in V6 >35mm

26
Q

What does right ventricular hypertrophy look like

A

Dominant R-wave in V1, T-wave inversion in V1-V3 or V4, deep S-wave in V6, RAD

27
Q

How do you assess the patient with tachycardia and what do you do in unstable tachycardia

A
  • Monitor SpO2 and give oxygen if they are hypoxic
  • monitor ECG and BP and record 12 lead ECG
  • obtain IV access
  • identify and treat reversible causes

adverse features

  • shock
  • MI
  • heart failure
  • Syncope
  • if you have these adverse features then this means that the tachycardia is unstable
  • if the tachycardia is unstable you should administer a synchronised DC shock up to 3 times
28
Q

What are the adverse features of tachycardia

A
  • shock
  • MI
  • heart failure
  • Syncope
29
Q

What are the risk factors for stroke (CHADSVASC score) in AF

A
  • Congestive heart failure - 1 point
  • hypertension - 1 point
  • age 65-74 - 1 point, age 75 years of older - 2 points
  • diabetes mellitius - 1 point
  • previous stroke, transient ischaemic attack/thromboembolism - 2 points
  • vascular disease - 1 point
  • female - 1 point
30
Q

What is the difference between orthodromic and antidromic AVRT

A

Orthodromic AVRT

  • the ventricle is activated down the pukinje his pathway and then goes up the accessory pathway
  • Narrow QRS complex

Antidromic AVRT

  • the ventricles are activated by the accessory pathway therefore the right side of the ventricle is activated first, the pathway then goes back up the bundle of His
  • Broad QRS complex
31
Q

What happens if you have a narrow QRS complex and the rhythm is regular

A

Narrow QRS complex

  • rhythm is regular
  • vagal manoeuvres
  • adenosine 6mg rapid IV bolus - if no effect give 12mg if no effect give further 12 mg
  • monitor/record ECG continuously
  • check to see if sinus rhythm is achieved
  • if no seek expert help - could be a possible atrial flutter - control rate with something like a beta blocker
  • if yes
    probably re-entry paroxysmal SVT
  • record 12 lead ECG in sinus rhythm
  • if SVT recurs treat again and consider anti-arrhythmic prophylaxis
32
Q

What happens if you have a narrow QRS complex and the rhythm is irregular

A
  • have a narrow QRS complex
  • If the rhythm is irregular it is probable AF
  • control rate with a beta blocker or dilitiazem
  • if in heart failure consider digoxin or amiodarone
  • assess thromboembolic risk and consider anticoagulation
33
Q

What do you do if the broad QRS complex is regular

A

It is VT until proven otherwise
- amiodarone 300mg IV over 20-60 minutes then 900mg over 24 hours

If known to be SVT with bundle branch block
- treat as for regular narrow-complex tachycardia

34
Q

What do you do if the broad QRS complex is irregular

A

= seek expert help

  • AF with bundle branch block treat as for narrow complex
  • Pre-excited AF consider amiodarone
35
Q

If the bradycardia has no adverse features how do you treat

A

calculate if there is a risk of asystole

  • recent asystole
  • Mobitz II AV block
  • complete heart block with broad QRS complex
  • ventricular pause greater than 3 seconds

if no
- continue to observe

if yes 
Consider interim measures 
- Atropine 500mcg IV repeat to maximum of 3mg 
or 
- transcutaneous pacing 
or 
- isoprenaline 5mcgmin-1 IV 
- adrenaline 2-10mcgmin-1 IV 
- alternative drugs
  • Seek expert help - arrange transvenous pacing
36
Q

What happens if you have adverse features of bradycardia

A

adverse features

  • shock
  • syncope
  • myocardial ischaemia
  • heart failure

Yes

  • atropine 500 mcg IV
  • satisfactory response

Yes
calculate if there is a risk of asystole
- recent asystole
- Mobitz II AV block
- complete heart block with broad QRS complex
- ventricular pause greater than 3 seconds

no
- continue observation

if no satisfactory response to atropine 
Consider interim measures 
- Atropine 500mcg IV repeat to maximum of 3mg 
or 
- transcutaneous pacing 
or 
- isoprenaline 5mcgmin-1 IV 
- adrenaline 2-10mcgmin-1 IV 
- alternative drugs
  • Seek expert help - arrange transvenous pacing
37
Q

How do you treat a STEMI

A
  • Aspirin and ticagrelor (P2Y12 receptor antagonists)
  • GpIIb/IIIa inhibitor
  • unfractionated/LMWH
  • PPCI
38
Q

What is the criteria for reperfusion therapy

A
  1. Typical clinical symptoms of MI
  2. ECG criteria - either of the following
    - ST elevation>1mm in 2 or more adjacent limb leads or >2mm in 2 or more adjacent chest leads
    - LBBB
    - posterior changes: deep ST depression and tall R-waves in V1-V3
39
Q

When do you not thrombolyse

A
  • ST depression alone
  • T wave inversion alone
  • Normal ECG
40
Q

Name the absolute contraindications to thrombolysis

A
  • previous intracranial haemorrhage
  • ischameic stroke < 6 months
  • c cerebral malignancy or arteriovenous malformations
  • recent major trauma/surgery/head injury less than 3 weeks ago
  • GI bleeding less than 1 month ago
  • known bleeding disorder
  • aortic dissection
  • non-compressible punctures < 24 hours e.g. liver biopsy, lumbar puncture
41
Q

How does heart failure keep getting worse

A

Heart failure

  • this causes decreased stroke volume and cardiac output
  • this causes a neurohormonal response
  • this leads activation of sympathetic system and renin angiotensin aldosterone system is activated
  • this causes vasoconstriction, increased sympathetic tone, angiotensin II, endothelins, impaired nitric oxide release, sodium and fluid retention, increased vasopressin and aldosterone
  • this causes further stress on the ventricular wall and dilatation leading to worsening of ventricular function
  • this leads to further heart failure
42
Q

Name the classes for the New York Heart association classification (NYHA) for heart failure

A

Class One
- no symptoms

Class II
- symptoms on exertion e.g. cant walk very far

Class III
- symptoms of minimal exertion e.g. cant walk around the house without getting breathless

Class IV
- symptoms at rest

43
Q

What are the causes of high output heart failure

A
  • anaemia
  • pregnancy
  • hyperthyroidism
  • pagers disease
  • beriberi
44
Q

what are the signs of mitral regurgitation

A
  • AF
  • displaced hyperdyanmic apex
  • pan systolic murmur at apex radiating to axilla
  • soft s1, split s2, loud p2

the larger the left ventricle the more severe

45
Q

What would an ECG finding find in aortic stenosis

A
  • Left ventricular strain pattern due to pressure overload = depressed ST segments, T wave inversion in leads orientated to the left ventricle (I, AVL, V5 and V6)
  • usually sinus rhythm is present but ventricular arrhythmias may be recorded
46
Q

What are the signs of aortic regurgitation

A
  • Collapsing pulse
  • wide pulse pressure
  • hydrodynamic apex beat
  • high pitched early diastolic murmur
  • quick carotid filling up
47
Q

What type of murmur is tricuspid regurgitation

A
  • pan systolic murmur
48
Q

What type of murmur is pulmonary stenosis

A

ejection click systolic murmur

49
Q

What type is murmur is tricuspid stenosis

A

rumbling mid-diastolic murmur

50
Q

What are the signs of infective endocarditis

A
  • Septic signs = fever, riggers, night sweats, malaise, weight loss, anaemia, splenomegaly, clubbing
  • any new murmur
  • vegetation on valves
  • vasculitis
  • glomerulonephritis
  • splinter haemorrhages
51
Q

What causes an pan systolic murmur

A

Tricuspid regurgitation
Mitral regurgitation
Ventricular septal defect

52
Q

What causes an systolic ejection

A

Pregnancy- turblence
Pulmonary stenosis
Aortic stenosis
Aortic coarction

53
Q

What are the three stages of hypertension

A

Stage 1
- 140/90 and ABPM 135/85

Stage 2
- 160/100 and ABPM 150/95

Stage 3
- Systolic> 180 or diastolic >110

54
Q

What is the definition of malignant hypertension

A
  • BP > 180/110 AND signs of papilloedema or retinal haemorrages
55
Q

What blood pressure drugs can be used in pregnancy

A
  • Labetolol
  • Methyl Dopa
  • Nifedipine
56
Q

What can cause diffuse alveolar damage (ARDS; Shock lung)

A
  • shock
  • trauma
  • sepsis
  • viral infection
  • noxious gases
  • radiation
57
Q

What are the types of emphysema

A
  • centriacinar
  • panacinar
  • paraseptal
  • irregular
58
Q

define centriacinar emphysema

A
  • central/proximal parts of respiratory bronchioles are affected
  • distal spared
  • seen in smokers
59
Q

Define panacinar emphysema

A
  • uniform dilatation of acini from respiratory bronchiole to alveoli, seen in alpha-1-anti trypsin deficiency
60
Q

Define paraseptal emphysema

A
  • peripheral along lung margins
  • occurs adjacent to scarring, collapse or fibrosis
  • predisposes to spontaneous pneumothorax in young adults
61
Q

define irregular emphysema

A
  • irregular involvement of acini seen with scarring

Year 3 - CR (44 decks)

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