Cardiac

Question 1

Causes of 1st degree heart block

Answer 1

normal variant increased vagal tone inferior MI myocarditis hypokaelmia AV nodal blocking drugs: b blockers; ca channel blockers; digoxinl amiodarone

Question 2

Causes of long QT

Answer 2

Idiopathic Acquired including Drugs: antiarrhythmics (incl. amiodarone; sotalol); TCA; Antipsychotics (risperidone); antibiotics (macrolides); antifungals (traizoles); antihistamines MI Hypokalemia myocarditis cardiopmyopathy hypothermia

Question 3

Causes of mobitz type 2

Answer 3

Anterior MI Idiopathic fibrosis of conduction system cardiac surgery inflammatroy conditions (myocarditis, rheumatic fver) Autoimmunie (SLE, SS) Hyperkalemia Drugs: beta blockers, calcium channel blockers, digoxin, amiodarone

Question 4

Causes of mobitz type I

Answer 4

drugs: beta blcoekrs; ca channle blockers; digoxin increased vagal tone inferior MI myocardtitis Post cardiac sugery

Question 5

Causes of non-cardiogenic pulmonary oedema

Answer 5

ARDS high altitude plumonary eedema neurogenic pulmonary edema (narcotic OD; PE;Eclampsia; TRALI) in no-cardiogenic pulmonary oedema its factoris other than high pulmonary capillary pressure that are responsiblt for protein and fluid accumulation in alveoli

Question 6

Causes of VF

Answer 6

1. Structural Myocardial disease: infraction/ischemia; cardiomyopathy; HOCM; myocarditis; myocardial trauma 2. Metabolic/Electrlyte derangements: hypoxemia of any cause; hypo/hyper K; hypo Ca; hypo Mg; severe acidosis 3. Conduction abnormalities: prolonged WT; WPW and AF together; channelopathies 4. Drugs/Toxins; digoxin OD; TCA OD; 5. Environmental : electrocution; severe hypothermia

Question 7

Complications of ECMO

Answer 7

hemmorraghe; vascular damage; thromboembolism; infection; thrombocytopenia (HITS); VA ECMO - cardiac thrombus VA ECMO: inadeqaue upper body/coronary/ brain perfusion VA ECMO: pulm hemmorhage

Question 8

Complications of IABP

Answer 8

infection hemorhage vascular damage- arotic perforation thromboembolic phenomena renal failure failure to assist cardiac function balloon rupture

Question 9

Contraindicatins to ECMO

Answer 9

irresivble cardiac or respiratroy failure anticoagulation contra-indicated likley futility (MOF; GVHD; Age; prolonged CPR; advanced malignancy)

Question 10

Contraindications to IABP

Answer 10

significant Aoritc regurgitation Aortic aneurysm/ dissection significant PVD tortuous aorta uncontrolled sepsis uncontrolled bleeding

Question 11

Contraindications to thrombolysis in PE

Answer 11

intracrania neoplasm; intracranial surgery/trauma < 2mths; internal bleedgin last 6/12, Hx of hemmorhagic stroke, sever HTN; surgery last 10 days;bleeding diathesis; thrombocytopenia; non-hemm stroke last2/12;

Question 12

Diagnosis of infective endocarditis

Answer 12

2 major or 1 major +3 minor, or 5 minor criteria major criteria: positive BC for infective endocarditis with typical organisms positive echo for IE (oscialting mass on vlalve or adjacent structure; abscess; new dehiscence of prosthetic valve) New valvular regurg Minor crtiera: predisposition (heart condtion; IVDU); Fever>38; vascular phenomena (i.e.emboli); immunologic phenomena (glomerulonephritis; osler nodes; roths spots); microbiological evidence (BC positve not typical for IE); echo findings consitent with IE but does not meet major criteria

Question 13

ECG features of LVH

Answer 13

left axis deviation left atrial enlargement Swave in v1 + R wave in V5/V6 >35 mm

Question 14

ECg features of RVH

Answer 14

right axis deviation V1- dominant R wave V5/V6 dominant S wave

Question 15

Features of left atrial enlargement on ECG

Answer 15

bifid p wave in lead II (2 peaks) bipahsic p wave in V1

Question 16

Features of right atrial enlargement

Answer 16

peaked p wave in inferior leads (>2.5mm) andV1/V2 (>1.5mm)

Question 17

Indications for ECMO

Answer 17

VV ECMO: respiratroy failure PaO2/FiO2 <7.2 VA ECMO: refarctory cardiogenic shock ;cardiac arrest; failure to wean from bypass; bridge to cardiac transplant

Question 18

indications for surgery in infective endocarditis

Answer 18

hemodynamic instability abscess recurrent emoboli fungal or Qfever (coxiella burnetti)

Question 19

List investigations that help distinguish between cardiogenc and non-cardiogenic pulmonary edema

Answer 19

PCWP and CI- in cardiogenic pulmonary edema PCWP>18 mmH Serum BNP Echo PICo and EVLW (raised in both types) - can use pulmonary vascular permeability index to distinguish (raised in non cardiogenic; essentially te ratio of EVLW to Pulm blood voulme)

Question 20

List techniques/measurements available to assess the circulation status of a patient

Answer 20

Physical examiation- warm hands, UO, mentation Vital signs ABG- oxygenaion and lactate blood pressure repsonse to fluid challenge or leg raise Invasive monitoring: PICCO; LIDCO; FloTrac/Vigileo PAC Echocardiography -TTE; TOE Other methods: Impedance cardiography; gastric tonometry; trasncutatneous doppler

Question 21

mechanical strategies for supporting myocardial function

Answer 21

PEEP
IABP
Pacemaker
ECMO
VAD

Question 22

Potential indications for IABP

Answer 22

cardiogenic shock - although negative recent RCT intractable angina low CO post bypass (failure to wean post bypass) Cardiac surgery wth 2 of: left main>70%, LVEF<40%, unstable angina, reop bridge to heart transplant high risk PCI

Question 23

Prognosication following OOH arrest

Answer 23

Type of rhythm time to ROSC time to start CPR no sedation or NMBD required After 72 hours: GCS33 at 3 days) (EEG evidence of poor prognosis: burst surpresion; genealised seizures- less useful)

Question 24

Risks of cardioversion

Answer 24

failure need for sedation hypotension myocardial damage (usually transient) conduction abnormalities embolic phenomena burns damage to pacemaker

Question 25

Signs of severe Aoti stenosis

Answer 25

plateau pulse aortic thrill S4 splitting of S2 LVH- displaced apex beat LVF- late sign

Question 26

What is mobitz type 1

Answer 26

2nd degree heart block where PR interval lengthens and then drop every nth beat Treatment rarely needed

Question 27

What is mobitz type 2

Answer 27

2ns degree hear block where PR length is normla, but fail to conduct every nth PR interval Lesions is in bundle of His- always pathological