cardio

Question 1

what is shockable Rhythm?

Answer 1

ventricular fibrillation / pulseless ventricular tachy

Vfib or pulseless VT

Question 2

what do you do for non-shockable rhythms

Answer 2

1mg adrenaline asap

repeat every 3-5mins

Question 3

Hs of cardiac arrest

Answer 3

hypothermia
hypovolaemia
hypoxia

hyper/hypo kalaemia, glycaemia,calcaemia, met disorders

Question 4

T’s of cardiac arrest?

Answer 4

Thrombosis
Tension pneumothorax
Tamponade
Toxins

Question 5

pleural rub on auscultation and chest pain relieved by sitting forward points to what diagnosis

what is the ECG finding for this condition?

Answer 5

pericarditis

saddle shaped ST elevation

PR depression - more common sign

Question 6

atrial flutter
what are the complications?

signs/symptoms?

Answer 6

blood clots > stroke, ischaemia of bowel [mesenteric ischaemia]

tachycardia: ventricles decompemnsate > HF

if atrial flutter rate is high enough can cause ventricular tachy> which can cause symptoms like dizziness, nausea, chest pain

Question 7

how do you manage atrial flutter?

Answer 7

rate control ; beta block, calcium channel blocker

anti-coagulate due to risk of clots

can do cardioversion to stop the reentrant

Question 8

how do you define atrial fibrillation?

Answer 8

the sinus node signal is used differently by different myocytes in the atria so that the contraction of atria is happening in a disorganised way

once in a while the signal is sent to AV node to contract ventricles so you have QRS contraction but it is at irregular rates and not always following a p wave

Question 9

Management of atrial flutter?

what do you first have to assess?

Answer 9

haemodynamic stability?

if yes then attempt rate control with a calcium channel blocker / beta blocker
also fluid resus can reverse if septic or dehydrated

second line is cardioversion

however is haemodynamic instability then attempt synchronised cardioversion first

Question 10

causes of atrial flutter?

Answer 10

pulmonary disease 
COPD
OSA
PE
Pulmonary htn

alcohol
sepsis
thyrotoxicosis
ihd

Question 11

what is the cycle of atrial flutter?

why is this not the cycle of the ventricles?

Answer 11

300bpm AVN has long refractory period

degree of block so 2:1, 3:1

Question 12

Ventricular rate which depends on the level of AV block:
 if 2:1
 3:1  
4:1
 5:1

Answer 12

300 : 150bpm

300: 100bpm
300: 75bpm
300: 60bpm

Question 13

what are signs of haemodynamic instability ?
what shows end organ hypoperfusion
brain hypoperfusion
MI?
HF ?

Answer 13

shock
syncope
chest pain
pulmonary oedema

Question 14

CHA2DS2 VASc what is the criteria

Answer 14

congestive heart failure 
htn
a2 75, a1 65-74
diabetes?
s2- stroke,tia,mi or thromboembolism 

vascular disease? IHD, peripheral arterial disease?

s- sex female

Question 15

CHA2DS2 VASc
what score is relevant?

if score of 4?

Answer 15

0- treatment

1- if male offer anticoagulant
if female don’t as the 1 is due to gender

> 2 offer anticoagulant

Question 16

CHA2DS2 VASc score is higher than 2 but anticoagulation is contraindicated?

why, what is the picture?

Answer 16

AF but with valvular disease is an ABSOLUTE CONTRAINDICATION

so a transthoracis echo has been done

Question 17

if worried about risk of bleed vs anticoagulation what scoring system?

Answer 17

orbit

Question 18

haemoglobin -2
AGE-1
bleeding Hx-2
GFR-1
treatment with antiplatelets -1

Answer 18

<130 M, <120 female
haematocrit <40%, 36%
age>74
GFR; renal impairment of <60mL/min/1.73m2

Question 19

orbit score
low
medium
high

Answer 19

low 0-2 : 2.4 bleeds per 100 pt
medium 3 : 4.7 bleeds per 100 pt
high >4 : 8.1 bleeds per 100 pt

Question 20

Mx of atrial fibrillation?
1st line
2nd line

Answer 20

DOACs apixaban, rivaroxaban

warfarin

Question 21

how is AF classified?

management of each?

Answer 21

first time - self limiting

paroxysmal - recurrent but terminate spontaneously

persistent - lasting >7 days

permanent - clinically decided with pt - this we need to manage / treat w rate control and anticoagulant

Question 22

irregularly irregular pulse

Answer 22

A fibrillation

Question 23

when would you try to rhythm control Afib?

Answer 23

first time, HF coexistant and obvious cause

Question 24

drugs to rhythm control?

if coexisting heart failure?

Answer 24

amiodrone
dronedrone post cardioversion

catheter ablation

Question 25

when is the greater risk of thromboembolic / stroke in Afib pts?

Answer 25

just when you try to restore sinus rhythm via cardioversion as if a thrombus was formed or a clot then it would be flung out into arterial system

anticoagulate properly 4 weeks before attempting

or symptoms and AF lasting less than 48hours

Question 26

if very healthy young patient with no PMHx gets atrial fibrillation first time whats should you do?

Answer 26

flecainide + amiodarone

Question 27

irregularly irregular pulse
single waveform JVP
hyperthyroid features / alcohol/ sepsis 
HF signs 
>100bpm ventricular rate

Answer 27

atrial fibrillation

Question 28

The ECG showed no discernible p waves and irregularly irregular rhythm. Otherwise, the heart rate was approximately 70 beats per minute, the QRS complexes were not broadened, and the QT interval were within normal limits. No saw-tooth baseline was seen.

Answer 28

atrial fibrillation

Question 29

murmurs

‘mid systolic click followed by a late systolic murmur’

apical region

what causes this murmur?
what is this murmur called?

Answer 29

mitral prolapse

mitral regurgitation

Question 30

JVP raised
soboe
cough
low pitched diastolic murmur

what is the most likely cause of this?

Answer 30

mitral stenosis

rheumatic fever > rheumatic heart disease

Question 31

opening snap rumbling mid
diastolic murmur

irregularly irregular pulse

Answer 31

mitral stenosis

atrial fibrillation

Question 32

what is rheumatic fever caused by?

Answer 32

inflammatory disease group A streptococci

strep throat

causes valve to thicken calcify and contract = stenosis

Question 33

why is mitral stenosis associated with _____ ___ and a ____ pulse

Answer 33

a fibrillation and irregularly irregular pulse

as there is an increased atrial pressure due to inability fo blood to leave stenosed left ventricle

Question 34

what conditions predispose to mitral valve prolapse?

Answer 34

ehlers danlos
marfans
osteogenesis imperfecta
turner syndrome

Question 35

crescendo descendo murmur
ejection systolic

what valvular disease
what is the most common cause and where does it radiate to?

why is the nature of the murmur as such?

Answer 35

aortic stenosis
bicuspid valve congenital

carotids

why?
because when the pressure builds the initial LV pressure has to be so high to push open stenotic aortic valve so crescendo then as volume of blood / pressure decreases turbulance goes down so descendo murmur

Question 36

early diastolic descendo murmur heard at left sternal border

most common cause?

Answer 36

aortic regurgitation

idiopathic most common

then after aortic dissection
aneurysm
syphilis

Question 37

microangiopathic hemolytic anaemia is associated with which valvular disease?

Answer 37

aortic stenosis
RBC get damaged as pushed past stenosed valve

schistocytes on blood film
haemoglobinuria

Question 38

heart block

second degree MObitz type 1

Answer 38

wenkebach - progressive elongation of PR interval until dropped beat

Question 39

second degree heart block mobitz type 2

Answer 39

PR constant but p wave is not associated with qrs

Question 40

first degree heart block

Answer 40

PR >0.2 seconds

Question 41

third degree heart block

Answer 41

no association between p wave and qrs

Question 42

cardiac causes of a raised JVP

Answer 42

right sided heart failure
tricupsid regurg
constrictive pericarditis

Question 43

what does a positive hepatojugular result tell you?

what conditionS?

Answer 43

right ventricle is unable to accomodate the increased venous return

if it was normal it could increase it’s stroke volume

constrictive pericarditis
r ventricular failure
le
cardiomyopathy