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Cardiovascular > Cardiac Shock + Myopathies > Flashcards

Cardiac Shock + Myopathies Flashcards

1
Q

What does a correctly functioning ventricular pacemaker show on ECG?

A

Pacing spike followed by widened and bizarre QRS

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2
Q

Management of cardiac shock

A

Nitrate
Diamorphine
NIV if in HF

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3
Q

Management of septic shock

A

O2
Culture, empirical abx
Vasopressors, inotropes

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4
Q

Management of hypovolaemic shock

A

Fluid replacement
Give blood
Inotropes if no response

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5
Q

What are the ECG findings for Wolff PW?

A

Delta wave

Narrow complex tachycardia

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6
Q

Causes of hypovolaemic shock

A 
Bleeding
Burns
GI losses
Pancreatitis
Sepsis
DM
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7
Q

S+S hypovolaemic shock

A

Thirst, cold/ clammy peripheries
Decreased cap refill
Reduced JVP

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8
Q

SIRS criteria

A 
2 or more:
Temp <36 or >38
HR >90
RR >20
WCC <4 or >12
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9
Q

What is sepsis vs septic shock?

A

Sepsis = SIRS secondary to infection

Septic shock = sepsis + hypotension

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10
Q

Cautions + CI with B blocker + what bloods need checking?

A

CI = asthma
Caution = COPD
Baseline U+E + BP = check 2 weeks after starting + every dose change

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11
Q

What is Eisenmenger’s syndrome?

A

When a left to right shunt becomes right to left due to increased pulmonary blood flow + RVH

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12
Q

Which are the right to left shunts?

A

Transposition of vessels

Tetralogy of Fallot

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13
Q

What are the left to right shunts?

A

ASD, PDA, VSD

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14
Q

What type of cardiomyopathy is seen in sudden death of young athletes?

A

Hypertrophic cardiomyopathy

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15
Q

Describe the histological changes seen after MI (in 24 hrs, first week, 3 weeks + months after)

A

First 24hrs: dark discolouration due to coagulative necrosis
First week: yellow pallor due to inflammation
1-3 weeks: granulation tissue is seen as red border around yellow pallor
Months after = white fibrosis tissue

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16
Q

What heart condition is Turners associated with?

A

Coarctation of the aorta

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17
Q

What is the main complication of the macrophage phase post MI, and when is this?

A

4-7 days post MI
Macrophages can cause cardiac rupture causing:
Cardiac tamponade/ shunt through ventricular wall/ mitral insufficiency (due to ruptured papillary muscles)

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18
Q

What are the signs of cardiac tamponade + what is the name given to these signs?

A

Hypotension
Muffled heart sounds
Increased jugular venous distension
^ called Beck’s triad

19
Q

What heart condition is associated with foetal alcohol syndrome?

A

VSD

20
Q

What heart condition is associated with congenital rubella?

A

PDA

21
Q

What heart condition is associated with maternal diabetes?

A

Transposition of great vessels

22
Q

What heart condition is associated with Downs?

A

ASD

23
Q

When can you get an acquired VSD? Describe the murmur this causes.

A

VSD following large left anterior descending artery infarct

Pansystolic murmur at lower sternal border + apex

24
Q

What is asterixis + what causes it?

A

CO2 flap - hands tremor when wrists extended

Due to hypercapnia, hepatic encephalopathy + uraemia

25
Q

What are the main cardiomyopathies?

A

Dilated, hypertrophic, restrictive, arrhythmogenic RV

26
Q

What are inotropic drugs + give examples?

A

Digoxin
Calcium
Drugs that increase force of contractions

27
Q

Describe the PDA murmur

A

PDA – continuous machinery murmur in systole + diastole, heard inferior to left clavicle

28
Q

Describe the pulmonary stenosis murmur

A

Ejection systolic murmur in 2nd IC space left side

29
Q

How do you treat PDA?

A

Cardiac catheter lab plugging

30
Q

When does rheumatic fever occur?

A

2-4 weeks after strep throat

31
Q

What is the difference between critical aortic stenosis + coarctation of the aorta?

A

Critical aortic stenosis = radial + brachial pulses are also hard to palpate (whereas coarctation, only femoral pulses are hard to palpate)

32
Q

What is dilated cardiomyopathy + what causes it?

A 
Unexplained dilation + impaired systolic function of ventricle(s) 
Causes:
Idiopathic 
Alcohol 
Genetic 
Uncontrolled tachycardia (AF)
Collagen disease (SLE etc)
Infectious 
NMD
33
Q

S+S of dilated cardiomyopathy

A

CHF
PE
Arrhythmias
Sudden death

34
Q

ECG changes for dilated cardiomyopathy

A

Variable ST-T abnormalities
Poor R wave progression
Conduction defects

35
Q

What investigations + results would you expect for dilated cardiomyopathy?

A

CXR = globular heart, signs of HF + pleural effusion
Echo = chamber enlargement
ECG
Bloods = CBC, U+E, BNP, trop, LFTs, TSH

36
Q

Management of dilated cardiomyopathy

A

Treat underlying disease
Anticoagulation with warfarin
Immunise against influenza S pneumoniae
Surgery

37
Q

What is hypertrophic cardiomyopathy + what are the causes?

A

Unexplained ventricular hypertrophy

Caused by genetic defect in cardiac sarcometric proteins - autosomal dominant

38
Q

S+S of hypertrophic cardiomyopathy

A 
Asymptomatic 
SOBOE
Angina 
Syncope 
CHF 
Spike + dome pattern in carotid pulse
39
Q

Murmur for hypertrophic cardiomyopathy

A

Paradoxically split S2, S4

Harsh systolic diamond shaped murmur at apex, enhanced by squat to standing/ Valsalva

40
Q

Investigations + results for hypertrophic cardiomyopathy

A

ECG - LVH, prominent Q waves in lead 1, aVL, V5 + V6
Tall R wave in V1
TTE + Echo - asymmetrical septal hypertrophy
Cardiac catheterisation

41
Q

Management of hypertrophic cardiomyopathy

A

Avoid competitive sports + factors which increase obstruction (eg volume depletion)
BB, disopyramide, verapamil, phenylephrine (if in cardiac shock)
Surgical myectomy
Septal ablation
High risk of sudden death = ICD
Screen 1st degree relatives

42
Q

What is restricted cardiomyopathy + what causes it?

A

Impaired ventricular filling with preserved systolic function in a non-dilated, non-hypertrophic ventricle
Causes:
Infiltrative = amyloidosis, sarcoidosis
Non-infiltrative = scleroderma, myocardial fibrosis
Endomyocardial (endocarditis, carcinoid syndrome)

43
Q

S+S of restricted cardiomyopathy

A

CHF with preserved LV function
Arrhythmias
Elevated JVP (Kussmaul’s sign)
PE

Cardiovascular (15 decks)

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