Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

medicine can be fun > Cardio > Flashcards

Cardio Flashcards

1
Q

what percentage of strokes are ischaemic

A

85%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

acronym for stroke symptoms

A

FAST
- facial drooping
- arm weakness
- slurred speech

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what arteries does an anterior circulation infarct involve in a stroke

A

anterior and middle cerebral arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

features of a stroke of the anterior cerebral artery

A
  • contralateral lower limb weakness
  • behavioural changes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

features of a stroke of the middle cerebral artery

A
  • contralateral upper limb weakness
  • contralateral sensory loss
  • aphasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the 2 types of aphasia

A
  1. Wernicke’s: can speak but not comprehend
  2. Broca’s: can comprehend but not speak
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

features of a stroke of the posterior cerebral artery

A
  • contralateral homonymous hemianopia with macular sparing
  • visual agnosia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

features of a stroke affecting the cerebellum

A

ipsilateral DANISH
- dysdiadochokinesia
- ataxia
- nystagmus
- intention tremor
- slurred speech
- hypotonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

first line investigation for a stroke

A

non-contrast CT to exclude haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how to manage acute ischaemic stroke once bleeding excluded

A

< 4.5 hours since symptoms:
- thrombolysis (alteplase) + aspirin 300mg
- add thrombectomy if anterior circulation confirmed by CT angio

> 4.5 hours
- oral aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

secondary prevention of ischaemic stroke

A
  • aspirin 75mg for 2 weeks then lifelong clopidogrel
  • warfarin in AF patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how to manage a haemorrhagic stroke

A

reverse anticoagulation and refer to neurosurgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

QRISK indication for a statin

A

> 10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the difference between syncope and loss of consciousness

A
  • loss of consciousness can either be syncopal or non-syncopal
  • syncope is loss of consciousness due to cerebral hypoperfusion
  • non syncopal causes include epilepsy, hypoglycaemia, head trauma, alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how do you classify syncope

A
  • based on its causes
    1. reflex
    2. cardiac
    3. orthostatic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are two causes of reflex syncope

A
  • vasovagal syncope: fear
  • situational syncope: when straining
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are two causes of cardiac syncope

A
  • arrhythmias: heart block
  • outflow obstruction: AS, HOCM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are two causes of orthostatic syncope

A
  • drugs: ACEi, beta blockers, CCB
  • autonomic instabilty: Parkinson’s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are 3 triggers for vasovagal syncope

A
  • fear
  • pain
  • standing too long
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the pathophysiology of vasovagal syncope

A

excessive vagal discharge causes bradycardia and hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

how does loss of consciousness in vasovagal syncope present

A
  • Before: lightheaded, sweating, nausea
  • During: lasts seconds
  • After: fast recovery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What investigations would you do for loss of consciousness

A

Bedside:
- ECG for arrhythmias
- BM for hypoglycaemia
Bloods:
- FBC for anaemia
- U&Es for electrolyte abnormalities
Imaging:
- consider echo for cardiac causes
- consider CT head for trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

3 ways to manage a patient with vasovagal syncope

A
  • advice to avoid triggers
  • advise physical techniques
  • advise electrolyte rich sports drinks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

how to manage a patient with syncope due to HOCM, Brugada

A

implant a cardioverter-defebrillator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
sign of HOCM on auscultation
ejection systolic murmur
26
three steps to managing orthostatic syncope
i) educate and advice salt and hydration ii) discontinue drugs iii) fludrocortisone
27
how to manage syncope due to complete heart block
i) atropine ii) transvenous pacing
28
triad of causes for VTE
Virchow's triad: 1. stasis 2. injury 3. coagulability
29
acronym to remember risk factors for PE
CT sil vous plait: - C: cancer, chemo - T: trauma, travelling - S: surgery, smoking, stasis - V: virchow's, varicose veins - P: pill, pregnancy, previous DVT, polycythaemia
30
four symptoms for PE
1. pleuritic chest pain 2. SOB 3. haemoptysis 4. collapse
31
three signs of PE
1. tachycardia 2. tachypnoea 3. hypoxia
32
what are the PERC criteria
- used when very low probability of PE just to be sure - PE excluded when they're all negative
33
what are two initial investigations for PE
- CXR - ECG
34
CXR findings for PE
- most commonly normal - Westermark's sign
35
ECG findings for PE
- usually sinus tachycardia - RBBB, RAD - rarely S1Q3T3 - S wave in lead I - Q wave & inverted T wave in lead III
36
how do you score PE to decide how to investigate it
Well's score - more than 4 do a CTPA - 4 or less do a D-dimer
37
when is a CTPA unsuitable and what is the alternative
- renal impairment (CKD) - do a V/Q scan
38
what do you do if a CTPA is negative in PE
do a leg US for DVT
39
what do you do if the D-dimer is elevated in PE and what if it's normal
- elevated: CTPA - normal: alternative diagnosis
40
what do you do if there is a delay in CTPA in PE
give them apixaban in the meantime
41
how do you treat PE
- unstable: thrombolysis with alteplase - stable: DOAC aka apixaban unless severe renal impairment then LMWH
42
how long do you treat a PE for
- provoked PE: 3 months - unprovoked PE: 6 months
43
how do you manage recurrent PEs
IVC filter
44
what is VTE prophylaxis in hospital patients
- TED stockings - LMWH
45
which breast cancer drug increases the risk of VTE
tamoxifen
46
what will an ABG in PE show
respiratory alkalosis
47
what is aortic dissection
tear in the tunica intima forms a false lumen
48
what is the epidemiology and risk factors for aortic dissection
- men over 50 - hypertension - smoking - connective tissue disorders (Marfan's)
49
how do you classify aortic dissection and which type is the most common
- Type A: involves ascending aorta - IA: both - IIA: ascending only - Type B: does not involve ascending - IIIa: above diaphragm - IIIb: above and below - most common is type A
50
typical symptom of aortic dissection
sudden severe tearing chest pain that radiates to the back
51
three signs of aortic dissection
1. weak/absent pulses 2. blood pressure difference between arms 3. aortic regurgitation murmur (Type A)
52
three artery-specific symptoms of aortic dissection
- angina (coronary arteries) - hemiparesis (spinal arteries) - syncope (subclavian artery)
53
how to investigate suspected aortic dissection
- CXR: widened mediastinum - stable: CT angio false lumen (diagnostic) - unstable: TOE
54
how to manage aortic dissection and what is the target blood pressure
- Type A: surgery (aortic root replacement) + morphine + labetalol - Type B: bed rest + morphine + IV labetalol - labetalol controls blood pressure to a target of 100-120
55
what are the three types of peripheral arterial disease
1. intermittent claudication 2. critical limb ischaemia 3. acute limb ischaemia
56
what are 5 risk factors for peripheral arterial disease
- age >40 - smoking - diabetes - hypertension - hyperlipidaemia
57
what is the presentation of acute limb ischaemia
6 Ps - pale - pain - paraesthesia - perishingly cold - pulseless - paralysis
58
what are the symptoms of intermittent claudication
- calf pain on exertion - worse going up the hill
59
what are the symptoms of critical limb ischaemia
- calf pain at rest - relieved by hanging legs off the bed
60
what are two signs of peripheral vascular disease
- hair loss - absent pulses
61
how do you test for peripheral vascular disease on examination
- Buerger's test - angle less than 20 degrees is severe ischaemia
62
what is leriche syndrome
- erectile dysfunction - buttock claudication - absent pulses
63
what is an investigation specific for peripheral vascular disease and how to interpret it
- ABPI - normal is around 1 - vascular disease is less than 0.9 - critical limb ischaemia is less than 0.5
64
when is ABPI not a reliable test for peripheral vascular disease
- diabetes - more than 1.3
65
which US is for acute limb ischaemia and which for intermittent claudication
o is before u so acute - acute: Doppler - intermittent: Duplex
66
what is the first line and diagnostic imaging for peripheral vascular disease
- first line: duplex US - diagnostic: MR angiogram
67
how to manage acute limb ischaemia
i) heparin + paracetamol + morphine ii) revascularisation iii) amputation
68
how to manage peripheral vascular disease
- quite smoking + statin + clopidogrel + exercise - revascularisation in critical limb ischaemia
69
what are the types of ischaemic heart disease
- stable angina - ACS (unstable angina, NSTEMI, STEMI)
70
five risk factors for ischaemic heart disease
- male - HTN - diabetes - smoking - hyperlipidaemia
71
what is stable angina
chest pain on exertion relieved by rest
72
how would you investigate stable angina
- ECG: normal - troponin: normal - bloods: lipid profile, FBC, HbA1c
73
what is the management for stable angina
- aspirin 75mg - statin - GTN - beta blocker or verapamil - 2nd line: beta blocker + amlodipine
74
what is unstable angina
chest pain at rest
75
what is the management for unstable angina/NSTEMI
i) MONA ii) if unstable then PCI iii) LMWH + GRACE score iv) long term prevention
76
what is the long term management in all patients with ACS
- aspirin 75mg - tricagrelor/clopidogrel - ACEi - statin - beta blocker
77
how do you interpret the GRACE score
- >3% take them for PCI - <3% give aspirin + tricagrelor
78
what do you give before and during a PCI
- before: prasugrel + aspirin - during: unfractionated heparin
79
what are the symptoms of ACS
- chest pain radiates to left arm and jaw - sweating, nausea, SOB - diabetics can have an atypical presentation (no chest pain)
80
what investigations would you do in ACS
- ECG - troponin: elevated - bloods for clotting, FBC, lipid profile
81
2 ECG features of an NSTEMI
- ST depression - T wave inversion
82
2 ECG features of a STEMI
- ST elevation - LBBB
83
what are the 4 areas of myocardial infarction and arteries supplying them
- anterior MI: V1 - V4 (LAD) - lateral MI: I, aVL, V5 - V6 (left circumflex) - inferior MI: II, III, aVF (right coronary) - posterior MI: ST depression in V1 - V3
84
how to manage an ACS
i) MONA ii) determine whether it's STEMI or NSTEMI iii) if STEMI then PCI within 2 hours within 12 hours of symptoms iv) if more than 2 hours then give alteplase + antithrombin
85
3 contraindications for fibrinolysis in a STEMI
- blood thinners - head trauma - more than 12 hours since symptoms
86
what do you do if fibrinolysis is unsuccessful in a STEMI
coronary angio with PCI
87
what are the complications of an MI
DARTH VADER - death - arrhythmias (V-fib, V-tach, heart block) - rupture (tamponade) - tamponade - heart failure - valve problems (MR) - aneurysm (persistent ST elevation) - dressler's (pericarditis fever) - embolism - recurrence
88
how do you investigate a DVT
- if Wells >2: doppler US then D dimer if negative US - if Wells <2: D-dimer then doppler US if high D-dimer
89
what causes arterial ulcers
- peripheral arterial disease - atherosclerosis
90
what causes venous ulcers
- valve incompetence - varicose veins, DVT
91
compare the appearance of venous vs arterial ulcer
- venous: shallow, dark, not well defined - arterial: pale, deep, well defined
92
compare the location of venous vs arterial ulcer
- venous are on medial malleolus - arterial are on toes, lateral feet
93
what two investigations do you want to do for all leg ulcers
- ABPI - duplex US
94
what are four signs of peripheral venous disease (venous ulcers)
- stasis eczema - atrophie blanche (shiny skin) - hemosiderin deposition (pigmentation) - lipodermatosclerosis (champagne bottle hardening)
95
how do you manage venous ulcers
- compression stockings - moisturise eczema
96
what are 2 important considerations before giving compression stockings in venous ulcers
- exclude PVD (contraindicated if ABPI <0.8) - exclude diabetic neuropathy
97
what is the epidemiology of acute pericarditis
young/middle aged males
98
what are 3 causes of acute pericarditis
- viral: Coxsackie B, TB - Dressler's syndrome: weeks post MI - idiopathic
99
what are the symptoms of acute pericarditis
- pleuritic chest pain relieved by leaning forwards
100
what is a sign of acute pericarditis
- pericardial friction rub on the left sternal edge on expiration
101
what does the ECG show in acute pericarditis
- global saddle-shaped ST elevation - PR depression
102
what is the diagnostic investigation for all patients with acute pericarditis
TTE
103
how do you manage acute pericarditis
- NSAIDs + colchicine - restrict exercise - pericardiectomy if recurrent
104
what is cardiac tamponade
- fluid in the pericardium increases pressure and restricts heart pumping
105
what are 3 causes of cardiac tamponade
- trauma - heart surgery - complication of acute pericarditis
106
what are the features of cardiac tamponade
- Beck's triad: hypotension, raised JVP, distant heart sounds - pulsus paradoxus - SOB
107
what do you see on an ECG in cardiac tamponade
electrical alternans (tall followed by short QRS)
108
what do you see in a chest x-ray for cardiac tamponade
globular heart
109
what is the diagnostic investigation for cardiac tamponade
TTE
110
how do you manage cardiac tamponade
urgent pericardiocentesis
111
what is constrictive pericarditis
thickened pericardium restricts heart pumping
112
what causes constrictive pericarditis
acute pericarditis complication (TB)
113
what are features of constrictive pericarditis
- RHF: ascites, oedema, raised JVP - Kussmaul's sign: raised JVP on inspiration - S3
114
what do you see on a CXR for constrictive pericarditis
calcification of the pericardium
115
what is the diagnostic investigation for constrictive pericarditis
echo: pericardial thickness distinguishes from restrictive cardiomyopathy
116
how do you manage constrictive pericarditis
pericardiectomy
117
what is the epidemiology of myocarditis
younger patients (acute chest pain in younger patients)
118
what are 4 causes of myocarditis
- viral: Coxsackie B - bacterial - autoimmune - Chagas disease
119
what are the symptoms of myocarditis
- young patient with acute chest pain - SOB - palpitations - flu like (fever)
120
what investigations would you do for myocarditis
- ECG: ST elevation, T inversion - high CK, high troponin - high CRP - high BNP - CXR & echo
121
how do you manage myocarditis
- supportive treatment - treat complications
122
what drug would you give in a case of myocarditis if they are unstable (acutely hypertensive)
nitroprusside (vasodilator)
123
what are three symptoms of HOCM
- syncope - sudden death in young athletes - exertional dyspnoea
124
what murmur, heart sound and ECG feature is seen in HOCM
- ejection systolic louder on Valsava, quite on squatting, no radiation - S4 - LVH
125
what are 3 causes of dilated cardiomyopathy
- alcohol - Coxsackie B myocarditis - pregnancy
126
what heart sound and CXR feature is seen in dilated cardiomyopathy
- S3 - balloon heart
127
what is the presentation of Takotsubo cardiomyopathy
- stress induced chest pain (broken heart syndrome)
128
what are causes of infective endocarditis
- Staph (most common, IVDUs, prosthetic valve) - Strep viridans (dental procedures)
129
what are signs of infective endocarditis
- FROM JANE - fever (rigours), Roth spots, Osler nodes, murmur, Janeway lesions, anaemia, nail haemorrhage, emboli - clubbing
130
what valve is affected in infective endocarditis
- usually mitral regurgitation - tricuspid in IVDUs
131
what are Duke's criteria for infective endocarditis and how many do you need for diagnosis
- 2 major or 1 major + 3 minor or 5 minor Major: - positive blood cultures 12hrs apart - positive echo valve vegetation - new murmur (regurgitation) - Coxiella Minor: - risk factors (IVDU) - fever - emboli - Osler/Roth - positive culture once
132
how do you manage a patient with infective endocarditis
i) A-E sepsis six ii) broad spectrum antibiotics after cultures - native: amoxicillin - prosthetic: vancomycin + rifampicin iii) antibiotics - strep: amoxicillin + gentamicin - staph: flucloxacillin - MRSA/allergy: vancomycin iv) consider valve surgery v) anticoagulate prosthetic valves
133
what are two causes of aortic stenosis
- older: calcification (most common) - younger: bicuspid valve
134
what are the symptoms of aortic stenosis
SAD - syncope - angina - dyspnoea
135
describe the murmur heard in aortic stenosis
- ejection systolic - radiates to the carotids - louder on expiration
136
what is the pulse like in aortic stenosis
- slow-rising - narrow pulse pressure
137
what heart sounds can be heard in aortic stenosis
- soft S2 - S4
138
what can be seen on the ECG in aortic stenosis
- wide QRS with LBBB - LVH with left axis deviation
139
what is the diagnostic investigation for aortic stenosis
echo
140
how do you manage aortic stenosis
- asymptomatic: observe - low risk patients: aortic valve replacement - high risk patients: TAVI - percutaneous valvuloplasty if unsuitable for replacement
141
what are causes of aortic regurgitation
- valve problems (IE acutely, rheumatic fever chronic most common) - aorta problems (aortic dissection acutely, Marfan's & ankylosing spondylitis chronic)
142
what are 4 signs of aortic regurgitation
- collapsing pulse - wide pulse pressure - early diastolic murmur - displaced apex beat
143
what is an Austin Flint murmur
severe aortic regurgitation
144
how do you investigate aortic regurgitation
- ECG: LVH, LAD - CXR: cardiomegaly - Echo: diagnostic
145
how do you manage aortic regurgitation
i) inotropes (increase contractility) ii) aortic valve replacement iii) anticoagulate prosthetic valve
146
what causes mitral stenosis
rheumatic fever in females
147
what are the signs and symptoms of mitral stenosis
Symptoms: - fatigue, dyspnoea - palpitations Signs: - mid diastolic murmur - loud S1 - opening snap
148
how do you investigate mitral stenosis
- ECG: AF, p-mitrale (bifid), RVH, RAD - CXR: pulmonary congestion - echo: diagnostic
149
how do you manage mitral stenosis
i) manage AF with beta blocker ii) manage congestion with furosemide iii) penicillin for rheumatic fever iv) percutaneous balloon valvotomy
150
what are causes of mitral regurgitation
primary issues with the valve: - IE, rheumatic fever - Marfan's (chordae rupture) secondary functional issues: - left ventricle dilatation
151
what are the signs and symptoms of mitral regurgitation
Symptoms: - asymptomatic, SOB, palpitations Signs: - pansystolic murmur - displaced apex beat if LV dilatation
152
how do you investigate mitral regurgitation
- ECG: AF, p-mitrale - CXR: cardiomegaly & pulmonary oedema (LHF LV dilatation) - echo: diagnostic
153
how do you manage mitral regurgitation
- medical support (nitrates, inotropes, diuretics) - manage heart failure, AF - surgery to repair if severe
154
what do you hear in mitral valve prolapse
mid-systolic click
155
what is mitral valve prolapse and its associations
floppy mitral valve associated with connective tissue disorders (Marfan's)
156
what are two causes of tricuspid regurgitation
- valve vegetations due to IE in IVDUs - RV dilatation due to pulmonary congestion in LHF
157
what are signs of tricuspid regurgitation
- raised JVP - ascites, hepatomegaly, oedema - pansystolic murmur on inspiration
158
how to investigate tricuspid regurgitation
- ECG for AF - CXR for cardiomegaly, pulmonary oedema - echo for diagnosis
159
how to manage tricuspid regurgitation
- treat the cause - treat heart failure and AF - valve replacement
160
what murmur do you hear in tricuspid stenosis
diastolic
161
what do you see on the ECG for right heart valve disease
- p-pulmonale (tall p waves) - RVH, RAD, RBBB
162
what murmur do you hear in pulmonary stenosis
ejection systolic
163
what murmur do you hear in pulmonary regurgitation
- diastolic - Graham Steel if associated with mitral stenosis
164
where is the most common site for AAAs
below the renal arteries
165
what is the epidemiology and risk factors for a AAA
- men >65 years - smoking - HTN - Marfan's
166
what are the symptoms of a ruptured AAA
- sudden severe back/abdo pain - syncope - shock
167
what are three signs of a AAA
- Grey Turner's sign - pulsatile non expansile mass - bruit
168
what is the screening protocol for AAAs
- single US for all males at 65 - rescan in 3 months if 4.5-5.4cm - rescan in 12 months if 3-4.4cm
169
how do you investigate a AAA
- abdominal US detects the aneurysm - contrast CT detects the rupture but only if stable - in unstable patients diagnosis is clinical
170
how do you manage a AAA
i) give blood, antibiotics, LMWH - keep systolic <100 ii) emergency surgery - EVAR if stable but risks endo-leak - open surgery if unstable
171
what are the criteria for operating an asymptomatic AAA
- >5.5cm - expanding at >1cm/year
172
what is characteristic about a TIA
- resolves within 24hrs - no structural ischaemic changes
173
how long does a TIA attack usually last
few minutes, resolves within the hour
174
how do you investigate a TIA
- BM to exclude hypoglycaemia - same day specialist assessment + MRI - CT only if on anticoagulants to exclude bleeding (not recommended as it doesn't show ischaemic changes)
175
how do you manage a TIA
- aspirin 300mg STAT - lifelong clopidogrel + statin
176
what are features of an SVT on an ECG
- narrow QRS < 3 squares - regular - no p waves
177
what are 3 causes of an SVT
- heart surgery - alcohol - digoxin toxicity
178
how do you manage an SVT
- unstable: DC cardioversion - stable: i) valsalva manoeuvre, carotid massage ii) 6mg adenosine followed by 12, 12mg - verapamil if asthmatic
179
what is WPW syndrome
- accessory conduction pathway so the ventricles get excited quicker - younger patients
180
what do you see on an ECG for WPW syndrome
- delta waves (slurred upstroke QRS) - shorter PR - axis deviation
181
how to manage WPW syndrome
- SVT so Valsalva, adenosine - radiofrequency ablation of accessory pathway
182
what do you give in WPW patients with AF
flecainide
183
what are the features of atrial fibrillation on an ECG
- narrow QRS - irregular tachycardia - absent P-waves - squigly
184
what are 5 causes of atrial fibrillation
- IHD - heart failure - alcohol - hyperthyroidism - mitral stenosis
185
how do you manage a stable patient with AF
- beta blocker - if contraindicated then rhythm control: - <48 hours: LMWH + DC cardioversion - >48 hours: DOAC for 3 weeks then cardioversion OR exclude thrombus with TOE + cardioversion
186
when should you choose rhythm control instead of rate control in AF
- first episode of AF - reversible cause - heart failure
187
how do you decide whether an AF patient requires anticoagulation
- CHA2 DS2 VASc score - males anticoagulation if 1 - females anticoagulation if 2 - if score = 0 do a TTE to check - assess bleeding risk using ORBIT
188
what is the CHA2 DS2 VASc score
- congestive heart failure - hypertension - age > 75 = 2 - diabetes - previous stroke = 2 - vascular disease - age > 65 - sex female
189
how do you manage any unstable patient with tachycardia
- DC cardioversion
190
what do you see on an ECG for atrial flutter
- regular - saw tooth pattern - narrow QRS
191
what are features of ventricular tachycardia on an ECG
- broad QRS > 3 squares - regular - fusion beats (normal beat between) - capture beats (normal QRS between abnormal)
192
how do you manage a stable patient with V-tach
i) amiodarone ii) DC cardioversion if it fails
193
what is torsades de pointes
polymorphic irregular V-tach with long QT (twisty)
194
what are causes of torsades de pointes
TIIMMES - toxin (clarithromycin) - inherited - ischaemia - myocarditis - mitral valve - electrolytes (hypokalaemia, low Mg) - SAH
195
how do you manage torsades de pointes
magnesium sulfate
196
what do you see on an ECG for ventricular fibrillation
- irregular - broad QRS - very messy
197
what is first degree heart block
- prolonged PR > 5 squares - sinus rhythm - no treatment required
198
what is Weckenbach heart block
- gradual PR prolongation until a beat drops - regular
199
what is Mobitz II heart block
- no PR prolongation - only some P waves are followed by QRS - regular ratio
200
what is complete heart block
- no association between Ps and QRS - irregular
201
how do you manage bradycardia
- do not treat if asymptomatic >40 i) IV atropine ii) temporary pacing
202
what causes cardiac arrest
- 4 Hs: hypoxia, hypovolaemia, hypokalaemia, hypothermia - 4 Ts: thromboembolism, tension pneumothorax, tamponade, toxins
203
what are shockable and non-shockable rhythms in cardiac arrest
Shockable: - V-fib - pulseless V-tach Non-shockable: - asystole - pulseless electrical activity
204
how do you manage a shockable rhythm in cardiac arrest
- CPR 30:2 STAT - cardioversion every 2 minutes - 1mg adrenaline after 2nd shock every 3-5 minutes - 300mg amiodarone after 3rd shock
205
how do you manage a non-shockable rhythm in cardiac arrest
- CPR 30:2 STAT - 1mg adrenaline every 3-5 minutes
206
what are causes of high output heart failure
NAP MEALS - nutrition (thiamine deficiency) - anaemia - pregnancy - malignancy - endo (thyrotoxicosis) - AV malformations - liver cirrhosis - sepsis
207
how do you classify low output heart failure
- left and right heart failure - left can be reduced (<40%) or preserved (>50%) ejection fraction
208
what are causes of heart failure with reduced ejection fraction
- systolic dysfunction - dilated cardiomyopathy - IHD - arrhythmias - myocarditis
209
what are causes of heart failure with preserved ejection fraction
- diastolic dysfunction - tamponade - restrictive cardiomyopathy - HOCM
210
what are causes of right heart failure
- LHF, TR - lung: COPD, pulmonary HTN
211
how do you classify heart failure
NYHA classification using SOB - I: heart failure with no SOB - II: SOB during any activity - III: SOB limits small ADLs - IV: SOB at rest
212
what are signs and symptoms of left heart failure
- orthopnoea - SOB - PND - nocturnal cough with pink frothy sputum Signs: - fine bibasal crackles - S3 gallop (dilated LV) - displaced apex beat
213
what are signs and symptoms of right heart failure
- weight gain - anorexia - hepatomegaly & ascites - raised JVP - peripheral oedema - pansystolic murmur
214
how do you investigate heart failure
- bloods: high BNP, dilutional hyponatraemia, anaemia - CXR: A-E (alveolar oedema, B-lines, cardiomegaly, diverted upper lobe, effusion) - TTE: diagnostic calculates EF
215
how do you manage acute heart failure
- position them upright - oxygen if <94% - morphine with antiemetic if in a lot of pain - furosemide - GTN - if not responding put on CPAP
216
how do you manage chronic heart failure
i) ACEi + beta blocker ii) add spironolactone, SGLT2 inhibitor (gliflozins) iii) digoxin for symptoms, hydralazine if black iv) ICD v) LVAD, transplant, palliative
217
what is pulmonary hypertension
vasoconstriction of pulmonary vasculature increases pulmonary arterial pressure and can result in RHF
218
what are causes of pulmonary HTN
- LHF - lung pathology (COPD) - mitral stenosis - PE
219
what are 3 features of pulmonary HTN
- progressive SOB - Graham Steel murmur of pulmonary regurgitation with mitral stenosis - signs of RHF
220
how do you investigate pulmonary HTN
- ECG: RBBB, p-pulmonale - CXR: pulmonary artery dilatation - TTE, right heart catheterisation
221
how do you manage pulmonary HTN
amlodipine + anticoagulate + exercise
222
what are the stages of hypertension
- I: >140/90 - II: >160/100 - III: >180/110 - malignant: >200/120
223
what are symptoms of malignant hypertension based on systems
- renal: haematuria, proteinuria - cardio: palpitations, SOB, S4, angina - neuro: headache, blurred vision, retinopathy
224
what are the stages of hypertensive retinopathy
- I: silver wiring - II: AV nipping - III: flame haemorrhage - IV: papilloedema
225
how do you investigate hypertension
- average of 3 clinic readings - ABPM > 135/85 - calculate QRISK - exclude secondary causes
226
what are secondary causes of hypertension
Endo - Cushings, Conns, phaeo, acromegaly Renal - GN, RAS, CKD, PCKD (young, LVH) Other - pre-eclampsia, OCP, aorta coarctation
227
how do you manage acute malignant hypertension
IV labetalol
228
how do you manage essential hypertension
i) monotherapy with: - ACEi if <55 or diabetic (ARB if black) - CCB if >55 or black ii) combination therapy up to three (add thiazide) iii) assess potassium - if >4.5 then beta/alpha blocker - if <4.5 then spironolactone
229
what are side effects and contraindications of ACEi and what is an alternative
- cough, hyperkalaemia - give ARB if cough - both contraindicated in pregnancy, RAS
230
what are side effects of calcium channel blockers
- bradycardia, flushing - ankle oedema in amlodipine (peripheral vessels)
231
what are side effects of thiazides
- postural hypotension - gout - hypercalcaemia, hyperglycaemia - hyponatraemia, hypokalaemia - erectile dysfunction
232
what are electrolyte abnormalities of loop diuretics
- hypokalaemia - hyponatraemia - hypocalcaemia
233
what are side effects and contraindications for statins
- myopathy - liver disease - contraindicated in erythromycin, pregnancy
234
what are contraindications for beta blockers
- asthma (bronchospasm) - verapamil
235
what is a side effect of adenosine
- chest pain - bronchospasm so not in asthmatics (verapamil instead)
236
what are side effects of amiodarone
- lung fibrosis - hepatitis - thyroid issues - potentiates warfarin
237
when do you use different antiplatelets
- ACS: aspirin + tricagrelor - PCI: aspirin + tricagrelor/presugrel - stroke/TIA: clopidogrel - PVD: clopidogrel

medicine can be fun (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions