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*year 4 additions > Cardiac > Flashcards

Cardiac Flashcards

1
Q

ECG:
changes in hypothermia? (1)
digoxin? (1)

A
  • Frosty Jack ~ J waves

- reverse tick

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2
Q

Criteria:
Dukes? (2)
Fraser? (1)
Jones? (1)

A
  • infecitive endocarditis diagnosis
  • colorectal cancer (but a different criteria)
    interestingly colon cancer can –> IE!
  • contraception choice
  • Rheumatic fever risk after Strep infection
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3
Q 
QT prolongation:
how long should it be? (2)
why is it bad? (1)
causes? (6)
electrolytes? (3)
which drugs? (8)
what is torsade de pointes? (1)
A

<430ms in men, <450ms in females

  • can –> torsade de pointes/ VT
  • drugs
  • congenital
  • electrolyte abnormalities
  • acute MI
  • myocarditis
  • hypothermia
  • SAH
  • hypoCa2+, K+ or magnaesaemia
METHCATS
methadone
erythromycin
terfenadien
haloperidol
chkoroquine/citalopram
amiodarone
trycyclics
sotalol*
*the only B blocker that causes prolonged QT

TCA, SSRIs (particularly citalopram)

  • where QRS varies and twist around baseline
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4
Q

orthostatic hypotension:

diagnosis? (1)

A

drop in SBP of at least 20 mmHg and/or a drop in DBP of at least 10 mmHg after 3 minutes of standing

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5
Q

hypokalaemia:

ECG changes? (4)

A

In Hypokalaemia, U have no Pot and no T, but a long PR and a long QT

prominent U-waves, best seen in precordial leads
T waves have a ‘sine wave’ appearance
prolonged QTc > 600ms
borderline PR interval

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6
Q

Reasons for using statins? (3)

A
  • 10-year cardiovascular risk >= 10%
  • patients with type 2 diabetes mellitus should now be assessed using QRISK2 like other patients are, to determine whether they should be started on statins
  • patients with type 1 diabetes mellitus who were diagnosed more than 10 years ago OR are aged over 40 OR have established nephropathy
  • 20mg for primary prevention
  • 80mg for secondary prevention
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7
Q

Dresslers syndrome:

treatment? (1)

A

NSAIDS

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8
Q

When is prothrombin complex concentrate given? (1)
what does high INR mean? (1)
what to do in major bleed with someone on warfarin? (1)

A
  • reversal of warfarin
  • blood taking longer to clot than it should
  • prothrobin complex concentrate + vit K + stop warfarin
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9
Q 
ACS:
when should PCI be given? (1)
what to do if can't get PCI in time? (2)
what do you do for NSTEMIs? (1)
when do you not give glycerol trinitrate and oxygen? (1)
A

PCI if presents within 12 hours of onset AND PCI can be delivered within 120 minutes of the time when fibrinolysis could have been given

  • thrombolysis
  • repeat ECG in 90mins
  • if ECG shows STEMI still you can then go for PCI
  • NSTEMIs vary in severity –> risk assess with GRACE then if high risk send for PCI/thrombolysis, low risk just add ticegralor
  • if GRACE >3% PCI immediately if unstable or within 72 hours if stable.
  • if blood pressure allows a little drop and oxygen <94%
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10
Q

NSTEMIs:
how does initial management vary if going for PCI? (1)
why? (1)

A
  • if no immediate PCI= aspitin and fondaparinum
  • if immediate angiography= aspirin + unfractionated heparin
  • easy reversal with protamine sulfate
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11
Q

STEMI changes:

assessing for reciprocal changes? (1)

A

PAILS stands for P-posterior A-anterior I-inferior L-lateral S-septal.

ST elevations in these leads most commonly create reciprocal ST depressions in the corresponding leads of the next letter in the mnemonic.

remember the nature of STEMIs means 100% occlusion of the arteries, NSTEMIs are partial occlusion.

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12
Q

ECG:
how to measure QT? (1)
PR? (1)

A

Time between the start of the Q wave and the end of the T wave

time betwen start of Pand start of Q

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13
Q

Drugs that increase QT

A 
amiodarone, sotalol, class 1a antiarrhythmic drugs
tricyclic antidepressants, selective serotonin reuptake inhibitors (especially citalopram)
methadone
chloroquine
terfenadine**
erythromycin
haloperidol
ondanestron
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14
Q

AF post stroke:

when to start anticoagulant? (1)

A

2 weeks post event

if not post-stroke and you just find AF then start in hospital (depending on ABCD2) then refer to AF clinic as outpatient to review it but give briding anticoag.

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15
Q

ECG:

how to tell difference between 3rd degree block and 2nd degree Mobits type I? (1)

A

since the P and QRS waves are completely unrelated this means the atria and ventricles each pace themselves:
• the p-p interval will always be the same
• the R-R interval will always be the same

i think complete AV block is most easily confused with Mobitz Type II - however Mobitz II:
• R-R interval will not be the same since there will be a dropped QRS complex somewhere!

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16
Q 
Pericarditis:
first line treatment? (1)
how to differentiate from ACS? (3)
ECG changes? (2)
investigations? (1)
A

NSAID and colchicine

  • pleuritic nature of the chest pain
  • fever
  • relieved sitting forwards

Idiopathic and viral causes make up the majority of cases of acute pericarditis. Therefore, antibiotics are not used first line. They may have a role where bacterial infection is suspected or proven.

  • ST elevation widespread (saddle shaped)
  • PR depression: most specific ECG marker for pericarditis
  • transthoracic echocardiography
17
Q

cardiac tamponade:
three main symptoms (Becks triad)? (3)
what does the ECG show? (1)

A

Beck’s triad: raised jugular venous pressure, hypotension and muffled heart sounds

  • electrical alternans
    (QRS range from short to tall as heart moves in the fluid)
18
Q

Why do you worry about giving anticoagulants with ischaemic strokes? (1)

A

–> haemorrhagic transformation

–> use aspirin for 2 weeks as acute management then switch to anticoag (DOAC) after
(you delay starting the anticoagulant for 2 weeks to avoid hemorrhage!)

19
Q

ACS:

what does vomitting indicate? (1)

A

suggests STEMI (total occlusion)

20
Q 
PE:
ECG changes? (3)
when do you use V/Q scan?  (3)
other causes of V/Q mismatch? (1)
when to do CXR? (1)
findings? (1)
how accurate is CTPA? (1)
A
  • sinus tachycardia ~50% MOST COMMON
  • S1Q3T3 occurs RARELY
  • RBBB and right axis deviation

if CXR normal and:

  • renal impairment
  • pregnancy
  • no significant symptomatic concurrent cardiopulmonary disease
  • old pulmonary embolisms, AV malformations, vasculitis, previous radiotherapy
  • CXR in ALL PATIENTS to exclude other pathology
  • typically normal in PE, findings include wedge-shaped opacification
  • CTPA: peripheral emboli affecting subsegmental arteries may be missed
21
Q

Side effects ACEi? (4)
when do you worry about toxicity? (1)
how is it protective to kidneys? (1)

A

A - Angioedema
C - Cough
E - Elevated potassium

i: 1st dose hypotension

  • in AKI/ if its given to someone with acute tubular necrosis
    normally nephroprotective as dilates efferent arteriole –> reduces pressure on kidneys
22
Q

Vaccinations:
who gets penumococcal 5 yearly?
influenza yearly?

A
  • Generally, only people with asplenia, splenic dysfunction or chronic kidney disease
23
Q 
Heart failure:
what vaccines to offer? (2)
when are BB and ACEi useless? (2)
what is 2nd line treatment? (1)
what to worry about with adding this? (1)
3rd line? (1)
A
  • yearly influenza
  • one off pneumococcal
  • ACE-inhibitors and beta-blockers have no effect on mortality in heart failure with preserved ejection fraction (only reduced EF)
  • 2nd=aldosterone antagonist (spirolactone)
  • hyperK+
  • 3rd= specialist- nitrate, digoxin and cardiac resynchronization therapy
24
Q

msot specific ECG marker for pericarditis? (1)

A

PR depression

25
Q

Digoxin:
why not given 1st line for AF? (1)
when to cardiovert in AF (3) and what to prescribe if you do? (1)

A

narrow therapeutic range and risk fo toxicity
(but good for heart failure and AF)

  • haemodynamically unstable
  • <48 hours
  • case-by-case reversible cause (but give heparin for 3 weeks before and 4 weeks after and check for TOE)
  • IV heparin

if a patient has had AF for >48 hours and is well, you schedule it as an elective procedure and anticoagulate them for 3 weeks before, and 4 weeks after. You can also do a TOE to look for clots before and you’d rate control until the elective cardioversion.

26
Q 
Bradycardia:
haemodynamic comprimise? (4)
risk of asystole? (4)
what to do 1st line? (1)
after that? (4)
A
  • shock, systole, MI, HF

complete heart block with broad complex QRS
recent asystole
Mobitz type II AV block
ventricular pause > 3 seconds

  • atropine 500mcg IV
  • if fails give up to 3mg,
  • transutaneous pacing
  • isoprenaline/ adrenaline infusion titrated to response
    Specialist help should be sought for consideration of transvenous pacing if there is no response to the above measures.
27
Q

Statins

monitoring? (1)

A

LFTs at baseline, 3 months and 12 months

inhibit the action of HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis.

*year 4 additions (12 decks)

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