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MD4003 Clinical > Cardiac Pathologies (Remember ECGs and CXR) > Flashcards

Cardiac Pathologies (Remember ECGs and CXR) Flashcards

1
Q

Bradycardia (definition, causes and management)

A

Definition: HR of less than 60 beats per minute

Causes: SA/AV node disease, electrolyte abnormalities, hypothyroidism, BB and CCB drugs

Management: ECG and reversible causes treated, if showing adverse effects (shock, syncope, MI) then treat with atropine (increases firing rate of SA node)

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2
Q

What is the treatment of supraventricular tachycardias/narrow complex tachycardias?

A

if patient shows adverse signs (shock, ischaemia, MI etc) then synchronised DC cardioversion

if patient is haemodynamically stable then:

  • if regular: vagal manoevures
  • irregular (AF): BB (eg. bisoprolol), anticoagulation (LMWH), rhythm control (flecainide/amiodarone)
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3
Q

Aortic dissection (definition, risk factors, signs and symptoms, tests and management)

A

Definition: tear in the tunica intima of the aorta causing blood to flow between inner and outer walls of the vessel

Risk factors: hypertension, connective tissue disorder eg. Marfan’s Syndrome, valvular heart disease, cocaine/amphetamine use

Signs and symptoms: tearing chest pain which radiates to back, syncope, and depending on severity -organ ischaemia

Tests: CT angiogram

Management: surgical management

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4
Q

What are the symptoms of a heart murmur?

What test would you order after auscultating a murmur?

A
  • pulmonary congestion (crackles on auscultation, cough, etc)
  • dyspnoea/orthopnea/PND
  • sweating
  • pallor
  • you would order an echocardiogram and exercise testing
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5
Q

What causes a ‘water-hammer’ pulse and what kind of murmur is it?

A
  • aortic regurgitation

- diastolic murmur

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6
Q

What condition causes radiation to the carotid pulses and what kind of murmur is this?

A
  • aortic stenosis

- ejection systolic murmur

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7
Q

What is the symptoms and treatment of atrial flutter?

A

Symptoms: asymptomatic, palpitations, dizziness, chest pain

Management: if haemodynamically unstable then emergency direct current synchronised cardioversion. If stable, treat underlying cause if one (eg. sepsis), then rate control with BB/rate limiting CCB (eg. bisoprolol, verapamil/diltaziem), if fails then cardioversion

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8
Q

What are the symptoms and treatment of atrial fibrillation?

A

Symptoms: palpitations, chest pain, SOB and dizziness

Management: rate control (BB/rate-limiting CCB), rhythm control (eg. cardioversion or flecainide/amiodarone), antivoagulation (LMWH/DOAC eg. dabigatran/rivaroxaban)

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9
Q

What is the management of a broad complex tachycardia/ventricular fibrillation?

A
  • primary survey then CPR
  • administer defibrillation then resume compressions
  • administer 1mg adrenaline and 300mg amiodarone after 3rd shock
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10
Q

First degree heart block (definition and management)

A

Definition: prolonged conduction of electrical activity through AV node causing a P-R interval >200ms

Management: benign so no treatment unless you can treat underlying cause

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11
Q

Second degree heart block (definition and management)

A

Mobitz type I : progressive lengthening of P-R interval which results in a p-wave which does not conduct a QRS complex

Management: treat underlying cause and exclude precipitating drugs (eg. digoxin, BB)

Mobitz type II: constant PR intervals which intermittent non-conducted p-waves

Management: permanent pacemaker due to risk of complete heart block

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12
Q

Third degree heart block (definition and management)

A

Definition: complete AV dissociation (when atrial impulses fail to be conducted to the ventricles)

Management: permanent pacemaker

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13
Q

What tests would you order if heart failure was suspected?

A
  • ECG and BNP blood tests
  • if BNP blood tests are high then order an echo, Us and Es (renal function), LEFTs (hepatic congestion), CXR (alveolar oedema, kerley B lines and cardiomegaly)
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14
Q

Describe the steps of prescribing for hypertension

A

Step 1: ACEi (eg. ramipril, lisinopril)/ARB (eg. candesartan, valsartan) unless * >55 or African/Caribbean then calcium channel blocker (eg. amlodipine, nicardipine)

Step 2: add CCB unless * then add ACEi/ARB or thiazide diuretic (eg. indapamide, chlorothiazide)

Step 3: add thiazide diuretic

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15
Q

Infective endocarditis (signs, tests and treatment)

A

Signs: fever and new murmur, Janeway lesions (palms and soles - non tender), Osler nodes (finger pads and toes (tender)), roth spots, splinter haemorrhages

Tests: ECG (PR prolongation/complete block), CXR, FBC, Us and Es, LEFT, CRP, blood cultures and echocardiogram

Treatment: long term broad spectrum antibiotics

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16
Q

What is the management of pulseless electrical activity or asystole?

A
  • CPR
  • give 1mg adrenaline UV then every 3-5 mins during 2 min loops of CPR
  • SHOCK not indicated
17
Q

What are the 3 categories of acute coronary syndrome? Which tests would you order to distinguish between them?

A
  • unstable angina
  • STEMI (complete occlusion of a coronary artery)
  • NSTEMI (severe occlusion/stenosis of a coronary artery)

Tests: ECG and troponin bloods

  • unstable angina: cardiac chest pain + abnormal/normal ECG + normal troponin
  • NSTEMI: cardiac chest pain + abnormal ECG (not ST elevation) + raised troponin
  • STEMI: cardiac chest pain + persistent ST elevation/LBBB (no need for troponin)
18
Q

What is the management of STEMI and NSTEMI?

A

STEMI: aspirin + clopidogrel, GTN and morphine, some cases will get PCI

NSTEMI: aspirin + clopidogrel, GTN and morphine, then LMWH in preparation for angiogram

19
Q

Describe secondary prevention after an MI

A
  • aspirin and clopidogrel
  • BB (bisoprolol)
  • ACEi (ramipril)
  • statin (atorvastatin)
  • cardiac rehab
20
Q

Angina (definition, tests and management)

A

Definition: chest pain which can radiate to arm, jaw, neck, brought on by physical activity, and can be quickly alleviated by GTN spray

Tests: CT coronary angiography, myocardial perfusion SPECT, stress echo

Management: control risk factors of cardiovascular disease (eg. weight, hypertension, diabetes etc,), aspirin, GTN, statin, BB/rate-limiting calcium channel blocker. If fails then consider long-acting nitrates (eg. nicorandil, ivabradine)

CABG/PCI considered in severe cases with coronary stenosis/affecting a complex vessel

21
Q

What is systolic failure associated with?

A
  • pump failure (reduced ejection fracture, or weakened heart muscle)
  • LV failure
  • cardiomegaly
22
Q

What is diastolic heart failure associated with?

A
  • decrease in BV in lungs, stiffening of heart muscle which cannot relax properly
  • pulmonary congestion
  • normal/ slightly larger ventricle

MD4003 Clinical (13 decks)

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