Cardio Flashcards
ECG findings anteroseptal MI? Which vessel supplies it?
ST elevation in the anterolateral leads V1-V4
Reciprocal changes (T wave inversion) in lead III and AVF
LAD
How does a post MI VSD present?
Shock
New pan-systolic murmur
How does papillary rupture post MI present?
Mitral regurgitation - early-to-mid systolic murmur
Cardiac failure
How do left ventricular aneurysms present?
persisting ST elevation on ECG
pain
arrhythmias
stroke
Mx of post MI VSD?
Inotropes
Balloon pump (counterpulsation inside aorta to augment blood pressure during diastole)
Percutaneous closure of defect
Consider PPV
Consider Swann Ganz pulmonary artery catheter
ECG findings anterolateral MI?
ST segment elevation leads V2, V3 and leads I and aVL
reciprocal ST segment depression in leads, II, III and aVF
What is the blood supply to the anterior/lateral wall?
LAD
What is the blood supply to the inferior wall? Where would you see ecg changes?
RCA
II, III, AVF
What is the blood supply to the posterior/lateral wall? Where would you see ecg changes?
LCA, also some RCA
V1-3
There is an increased risk of developing hyperkalaemia when ramipril is used with which drugs?
potassium-sparing diuretics
aldosterone antagonists
ciclosporin
heparins
Which drugs are likely to increase the risk of myopathy when given with simvastatin?
CYP450 inhibitors e.g.: amiodarone ciclosporin erythromycin fibrates ketoconazole
Contraindications to treatment with β-blockers?
Bronchospasm Sick sinus syndrome Peripheral arterial disease Prinzmetal angina Heart block
Define Isolated systolic hypertension
systolic pressure ≥160 mmHg with a diastolic pressure <90 mmHg
MoA of thiazide diuretics?
Inhibits sodium and chloride reabsorption in the early distal tubule via the Na-Cl co-transporter
MoA of loop diuretics?
Inhibits the luminal Na-K-Cl co-transporter in the thick ascending limb of the loop of Henle
MoA of Amiloride?
inhibits ENaC (epilthelial sodium channels)
There is a doubling of risk of stroke for every how many mmHg in mean systolic blood pressure?
15mmHg
CIs of statins?
Active liver disease
Pregnancy
Breast feeding
Infectious causes of sinus bradycardia?
Legionnaire’s disease
Typhoid fever
Lyme disease
What medications can cause digoxin toxicity?
Macrolides Thiazide diuretics Loop diuretics CCBs Amiodarone
CIs to digoxin tx?
WPW
Heart block
HOCM
SEs of verapamil?
Flushing
Headache
CIs to verapamil tx?
Chronic HF
Beta blocker use
The New York Heart Association (NYHA) 4 classes of HF?
Class 1: No limitation of physical activities
Class 2: Slight limitation of physical activity in which ordinary physical activity leads to fatigue, palpitation, dyspnea, or anginal pain; the person is comfortable at rest
Class 3: Marked limitation of physical activity in which less-than-ordinary activity results in fatigue, palpitation, dyspnea, or anginal pain; the person is comfortable at rest
Class 4: Inability to carry on any physical activity without discomfort but also symptoms of heart failure or the anginal syndrome even at rest, with increased discomfort if any physical activity is undertaken
INR target in AF?
2-3
INR target in DVT/PE?
2-3
INR target in recurrent DVT/PE?
3-4
INR target mechanical heart valve?
2.5-3.5
Example of class I anti-arrhythmic and MOA?
Lidocaine
Membrane stabilising
Example of class II anti-arrhythmic and MOA?
Beta blockers
Example of class III anti-arrhythmic and MOA?
Amiodarone
Sotalol
act on both supraventricular and ventricular arrhythmias
Example of class IV anti-arrhythmic and MOA?
CCBs
CIs to amiodarone tx?
Sinus bradycardia
Sino-atrial heart block
What should you do if INR >8 and not bleeding?
Give Vit K (IV orally)
Stop warfarin until INR <5
ECG findings WPW? What is the accessory pathway called and what type of arrhythmia is it?
Short PR
Slurred upstroke (delta wave)
Broad QRS
Bundle of Kent - AVRT
Medical tx for WPW?
Sotalol
Flecainide/Procainamide
Amiodarone
Major Modified Jones Criteria for rheumatic fever?
carditis, cardiac murmur, subcutaneous nodule, arthritis (migratory large joints), erythema marginatum (red geographical rash), chorea (Sydenham’s, St Vitus dance)
Minor Modified Jones Criteria for rheumatic fever?
fever, raised ESR/CRP, long PR interval, arthralgia
Tx of acute rheumatic fever?
Benzylpenicillin 1.2mg IM stat
10 day course po penicillin V
NSAIDs
Long term secondary abx prevention can be needed for up to 10 years if mild murmur of lifelong if loud murmur
Mitral stenosis on auscultation?
Tapping apex (palpable and loud first HS) Low rumbling mid-diastolic murmur
What are two signs of mitral stenosis on ECG?
Bifid p waves (P mitrale)
No p waves
Major diagnostic criteria for infective endocarditis?
1+ positive blood culture (typical organism in 2 separate cultures or presistently positive blood cultures)
Positive echocardiogram findings of vegetation, abscess or abscess prosthetic valve
Minor diagnostic criteria for infective endocarditis?
predisposition (cardiac lesion, IV drug abuse);
fever over 38 °C;
vascular signs, e.g. mycotic emboli, Janeway lesions (painless palmar/plantar macules);
immunological signs e.g. Oslers nodes (painful swelling fingers/toes), positive RhF, glomerulonephritis
microbiological evidence not fitting major criteria
How is diagnosis made of infective endocarditis?
2 major, 1 major/3minor or >5 minor criteria
Why should NSAIDs not be prescribed with digoxin?
Digoxin is renally cleared so can become toxic if NSAIDs are prescribed and decrease renal clearance
ECG changes in digoxin toxicity?
Flattened, inverted, or biphasic T waves
Shortened QT interval (scooped)
Downsloping ST depression
Symptoms of digoxin toxicity?
nausea, vomiting, abdominal pain, headache, dizziness, confusion, delirium and vision disturbance (blurred or yellow vision)
Main ecg finding in hypercalcaemia?
Shortening of QT interval
What is coarctation of the aorta associated with?
Turner’s syndrome
bicuspid aortic valve
berry aneurysms
neurofibromatosis
Auscultation of coarctation of aorta?
mid systolic murmur, maximal over back
apical click from the aortic valve
Mx of AF if obvious reversible cause?
Rhythm control
What is the most appropriate first-line anti-anginal for stable angina in a patient with known heart failure, if there are no contraindications?
Bisoprolol
When to give 3 (stacked) shocks in cardiac arrest?
If a patient has a monitored and witnessed cardiac arrest in the catheter laboratory, coronary care unit, a critical care area or whilst monitored after cardiac surgery, and a manual defibrillator is rapidly available and shows VF/pVT
What to do regarding anti diabetic meds in ACS?
Stop oral agents and switch to sliding scale insulin