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4th year passmed > Cardio > Flashcards

Cardio Flashcards

1
Q

which part of an ECG shows the anteroseptal territory of the heart? What supplies it?

A

V1-V4
LAD

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2
Q

which part of an ECG shows the inferior territory of the heart? What supplies it?

A

II, III, aVF
R coronary

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3
Q

which part of an ECG shows the anterolateral territory of the heart? What supplies it?

A

V1-V6, I and aVL
LAD

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4
Q

ECG changes seen in a posterior MI?

what supplies the posterior territories?

A

V1-V3

horizontal ST depression

tall broad R waves

upright T waves

dominant R waves in V2

left circumflex and right coronary

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5
Q

which part of an ECG shows the lateral territory of the heart? What supplies it?

A

I, aVL +/- V5 and V6
Left cirucmflex

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6
Q

normal QRS and PR interval

A

QRS = 70-120ms (<3 small squares)

PR Interval = 120-200ms (3-5 small squares)

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7
Q

long QTc syndrome causes

A

loss of functioning K+ channels

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8
Q

long QTc syndrome

A

from the start of the QRS to the end of T
>12 in women, >11 in men

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9
Q

hypokalaemia ECG findings

A

small, absent or inverted T waves
prolonged PR interval
ST depression
long QTC
U waves

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10
Q

VF/VT Mx

A

deliver 1 shock immediately

if witnessed on cardiac monitoring: give up to 3 initial shocks

deliver CPR for 2 mins before shocking again

after 3 shocks give 1mg adrenaline and 300mg amiodarone

  • repeat 1mg adrenaline every 3-5 mins

after 5 shocks give 150mg amiodarone

if amiodarone is not available give lidocaine

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11
Q

PEA and Asystole Mx

A

1mg adrenaline ASAP

continuous CPR

repeat adrenaline 1mg every 3-5mins

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12
Q

supraventricular tachycardia Mx

A

adenosine

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13
Q

bradycardia Mx

A

only requires treatment when haemodynamically unstable

  1. IV atropine 500mcg -> can be given up to 3mg
  2. transcutaneous pacing
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14
Q

adenosine side effects

A

flushing

chest pain

abdominal discomfort

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15
Q

amiodarone monitoring

A

prior to treatment: TFTs, LFTs, U&Es, CXR

every 6 months: TFTs, LFTs

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16
Q

haemodynamically unstable AF (hypotension or HF present) management

A

DC cardioversion

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17
Q

stable AF (<48 hours) management

A

rate control
- bisoprolol or metoprolol
- verapamil or diltiazem

rhythm control
- DC cardioversion
- start heparin beforehand

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18
Q

stable AF presenting (>48 hours) management

A

rate control
- bisoprolol or metoprolol
- verapamil or diltiazem

elective DC cardioversion
- anticoagulated for at least 3 weeks

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19
Q

if medical treatment fails and catheter ablation is required, do you still need to anticoagualte?

A

yes if they were already being anticoagulated! stroke risk does not change

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20
Q

alternative to anticoagulating for 3 weeks before cardioversion?

A

transoesophageal echo to exclude clots

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21
Q

which patients presenting >48 hours after AF begins will we offer elective DC cardioversion to?

A

<65s who are symptomatic or for whom this is the first presentation of AF
>65s or those with a history of IHD should be treated with rate control

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22
Q

features for rhythm control in AF

A

new onset

reversible cause

coexistent ♡ failure

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23
Q

features for urgent DC cardioversion in new onset AF

A

haemodynamic instability
- syncope
- acute pulmonary oedema
- MI or ischaemic chest pain
- systolic BP <90
- shock

♡ failure
- pulmonary oedema
- raised JVP

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24
Q

which drug is always contraindicated in VT?

A

verapamil

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25
Q

aortic regurgitation - associated connective tissue/inflammatory conditions

A

marfan’s syndrome

Ehler-Danlos syndrome

RA

SLE

ankylosing spondylitis

+ inferior MI = ascending aortic dissection

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26
Q

INR management

A

INR >8 with bleeding - IV Vit K

INR >8 no bleeding - Oral Vit K

INR 5-8 minor bleeding - IV Vit K

INR 5-8 no bleeding - withold 1 or 2 doses of warfarin

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27
Q

antibiotics which increase the INR

A

ciprofloxacin

clarithromycin

erythromycin

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28
Q

target INR in those with repeated PEs

A

3.5

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29
Q

how do we interperate Ferritin?

A

Low ferritin often indicated iron deficiency anaemia, high ferritin can be seen in inflammation, malignancy and liver disease

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30
Q

gallop rhythm (S3 heart sound) cause

A

early LV heart failure

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31
Q

how long should you anticoagulate after VTE or DVT when the patient has been pregnant within the last 3 months?

A

3 months

pregnancy is considered a provoking factor

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32
Q

drugs contraindicated in aortic stenosis

A

nitrates

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33
Q

most common cause of aortic stenosis

A

<65s = bicuspid aortic valve
>65s = calcification of the aorta

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34
Q

aortic valve replacement indications in aortic stenosis

A

stenosis is symptomatic or if the pressure gradient is >40mmHg

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35
Q

above what value is hyperkalaemia always considered bad enough for urgent treatment?

A

> 6.5

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36
Q

brugada syndrome

A

AD cause of sudden cardiac death.

ECG changes seen when giving flecainide = ST segment elevation in V1-V3 then negative T waves and a partial RBBB

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37
Q

brugada syndrome management

A

Implantable Cardioverter Defibrillator

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38
Q

hypertrophic obstructive cardiomyopathy (hocm)

A

AD cause of sudden cardiac death (the most common in young people)

ECG = Left ventricular hypertrophy (tall R waves in I, aVL and V4-V6, increased S wave depth in III, aVR and V1-V3 and Left axis deviation)

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39
Q

hocm symptoms

A

exertional dyspnoea and syncope.

ejection systolic murmur which is increased by the Valsalva manoeuvre and decreased by squatting

+/- a pansystolic murmur of mitral regurg

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40
Q

hocm associated with

A

fredreich’s ataxia

wolff-parkinson’s white syndrome

ventricular arrythmias = sudden death

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41
Q

fondaparinux moa

A

activates antithrombin III

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42
Q

aortic regurg causes

A

rheumatic fever

endocarditis

ascending aortic dissection

ankylo spondyl

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43
Q

aortic regurg symptoms

A

early diastolic murmur

collapsing pulse

wide pulse pressure

nail bed pulsation

head bobbing

heart failure symptoms

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44
Q

mitral regurg

A

acute: early-mid systolic

chronic: pansystolic

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45
Q

aortic stenosis

A

ejection systolic murmur

splitting of second ♡ sound

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46
Q

aortic stenosis Mx

A

only if symptomatic or valvular gradient > 40 mmHg

low/medium operative risk patients: surgical AVR

high operative risk patients: transcatheter AVR

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47
Q

tricuspid regurg murmur

A
  • high pitched pan-systolic murmur
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48
Q

mitral stenosis causes and Sx

A

rheumatic fever
- mitral facies
- AF
- haemoptysis
- pulmonary hypertension
- rumbling mid-late diastolic murmur best heard in expiration

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49
Q

non cardiac chest pain but ischaemic changes in ECG

A

CT coronary angiogram

50
Q

stable angina Ix

A

contrast enhanced CT angiography

51
Q

cardiac tamponade Sx

A

low BP
raised JVP (with absent Y descent) muffled heart sounds
pulsus paradoxus (a large drop in BP during inspiration)

52
Q

cardiac tamponade Ix and Mx

A

Ix = Echo
Mx = urgent pericardiocentesis

53
Q

cor pulmonale

A

right heart enlargement due to pulmonary pathology (of the lungs or vessels)

54
Q

angina Mx

A

A B C

angina =

  1. beta blocker
  2. ca channel blocker
  • monotherapy: non dihydropyridine
    (diltiazem, verapamil)
  • dual therapy: dihydropyridine
    (amlodipine, modified release nifedipine)
  1. nitrates: ivabradine, nicorandil, ranolazine
55
Q

beta blockers contraindications

A

rate limiting calcium channel blockers

  • verapamil
  • diltiazem

(VD = Very Dangerous)

56
Q

which of the 3rd line angina drugs is contraindicated by sildenafil usage?

A

Long Acting Nitrates

57
Q

which NSTEMI patients get a coronary angiography (and PCI if indicated) within 72 hours?

A

GRACE score >3%

58
Q

STEMI management if PCI can be done in <120 mins?

A
  • PCI
  • prasugrel
  • during PCI give unfractionated heparin with glycoprotein IIb/IIIa inhibitor
59
Q

STEMI management if PCI can not be done in <120 mins?

A
  • fibrinolysis: alteplase or tenecteplase.
  • aspirin
  • ticagrelor
  • fondaparinux/LMWH
  • repeat ECG 60-90 mins after fibrinolysis

if MI persists consider for PCI

60
Q

When should you use GTN with caution in ACS?

A

If the patient has a low BP

61
Q

athletes normal variant ECG changes

A

1st degree heart block

2nd degree (Mobitz type I)

sinus bradycardia

junctional rhythm

62
Q

commonest risk factor for aortic dissection?

A

hypertension

63
Q

aortic dissection Mx

A

ascending aorta
- weak pulse & aortic regurgitation
- control BP (IV labetalol) + surgery

descending aorta
- control BP (IV labetalol)

64
Q

acute pericarditis Sx

A

pleuritic chest pain
- worse on lying back
- relieved by sitting forward
- no productive cough
- dyspnoea and flu like Sx
- pericardial rub may be seen

65
Q

acute pericarditis Ix and Mx

A

ECG: saddle shaped ST elevation and PR depression.

troponin: mildly raised

transthoracic echo

Mx = NSAIDs and Colchicine

66
Q

how can we differentiate between cardiac tamponade and constrictive pericarditis?

A

cardiac tamponade: pulsus paradoxus (a large drop in BP on inspiration)

constrictive pericarditis: kussmaul’s sign (a rise in JVP on inspiration)

67
Q

myocarditis

A
  • new onset chest pain
  • dyspnoea
  • arrhythmias seen in previously well young people following a recent illness
68
Q

myocarditis Ix and Mx

A

Ix
- raised inflammatory markers
- cardiac enzymes
- BNP
- ECG: tachycardia, arrhythmias and ST elevation/T wave inversion

Mx
- treat cause

69
Q

can you get lung crackles/fever in PE?

A

yes

70
Q

how do you detect a re-infarction after MI?

A

CK-MB if it occurs in the first 4-10 days as troponin T can stay high for 10 days after insult

71
Q

how can sepsis affect troponin?

A

can cause an increase in troponin due to hypoxia of the tissues (as there is a supply and demand mismatch)

72
Q

left ventricular aneurysm

A

occurs 2 weeks after MI

mimics heart failure

persistent ST elevation

73
Q

ventricular septal defect

A

post mi acute ♡ failure

pansystolic mumur

74
Q

acute mitral regurg

A

post mi rupture of papillary muscles

widespread (early-mid) systolic murmur

hypotension

pulmonary oedema

75
Q

dressler’s syndrome

A

pericarditis occurring post MI

76
Q

should you worry about a new LBBB?

A

yes

always pathological and is suggestive of a STEMI

77
Q

if you get a complete heart block following an MI where can you localise the lesion to

A

right coronary artery lesion

78
Q

S3 and S4 heart sounds

A

S3: DCM (Dilated Cardiomyopathy)

S4: HOCM (Hypertrophic Obstructive Cardiomyopathy)

79
Q

what should you do with an AF patient who has a CHA2Ds2-VASc score indicating there is no need for anti-coagulation?

A

ECHO to exclude valvular heart disease

80
Q

valve abnormality associated with Marfan’s and Ehler’s Danlos

A

mitral valve regurgitation

81
Q

postural hypotension causes

A

DM and PD can cause it secondary to autonomic dysfunction
hypovolaemia, drug and alcohol

82
Q

what should you do if a CTPA is negative?

A

CTPA OR D-dimer is negative and Wells score =<4 stop anticoagulation treatment

CTPA is negative and Well’s Score >4 consider a proximal leg vein USS if you suspect DVT

83
Q

when is CTPA contraindicated and what should you do instead

A

renal impairment or allergy to the contrast media.

do a V/Q (Ventilation-Perfusion) scan

84
Q

What should you do in IE with congestive HF?

A

urgent valve replacement (will most likely be the tricuspid valve)

85
Q

IE Mx if the causative organism is unknown?

A

amoxicillin

86
Q

true or false, thiazide like diuretics can cause erectile dysfuncion?

A

true

87
Q

rheumatic fever Sx

A

CASES
- carditis
- arthritis
- subcutaneous nodules
- erythema marginatum
- sydenham’s chorea

88
Q

how often should you measure LFTs with statins?

A

pre-treatment

3 months

12 months

89
Q

when should you stop Beta blockers in acute HF?

A

HR <50

2nd or 3rd degree heart block

patient is shocked

90
Q

what should you consider if there is evidence that a peripheral clot (e.g. from a leg DVT) has travelled to the brain?

A

suspect a septal defect - most likely ASD

(OE: Ejection systolic murmur and a fixed splitting of S2)

91
Q

When is ejection fraction considered reduced?

A

<40%

92
Q

what should you do with the Wells score?

A

=<4 arrange a D-dimer
>4 do an immediate CTPA

93
Q

which antibiotics must you stop a statin to give?

A

Clarithromycin or Erythromycin

94
Q

aortic dissection classification on examination

A

type A
- associated with aortic regurg
- in type A there is a false lumen in the ascending aorta

type B
- normal heart sounds
- in type B there is a false lumen in the descending aorta

95
Q

aortic dissection Mx

A

type A (ascending)
- IV labetalol and surgical repair

type B (descending)
- IV labetalol and supportive management

96
Q

describe erythema marginitum?

A

ring like rash found on the trunk, arms and legs associated with mitral stenosis due to Rheumatic fever

97
Q

pulmonary stenosis murmur

A
  • harsh mid-ejection systolic murmur
  • may be associated with carcinoid syndrome (Hedinger syndrome)
98
Q

when should you give oxygen in ACS?

A

sats <94%

99
Q

NSTEMI Mx

A
  • aspirin and ticagrelor
  • PCI planned (GRACE score >3%): unfractionated heparin
  • PCI not planned: fondaparinux
100
Q

How do thiazide like diuretics affect calcium?

A

They cause hypercalcaemia and hypocalciuria

101
Q

takayasu’s arteritis?

A

unequal upper limb BP

absent/weak peripheral pulses

limb claudication

aortic regurg (an early diastolic decrescendo murmur)

carotid bruits

malaise/headaches seen in females.

Ix = MR or CT angiography

Mx = steroids

102
Q

acute HF Ix

A

echocardiography

103
Q

HF in Afro-Caribbeans who have not responded to :

  • ACEis
  • Beta-blockers
  • K+ sparring diuretics
A

hydralazine and a nitrate

104
Q

HF in non-Afro-Caribbean patients who have not responded to

  • ACEi
  • beta blockers
  • K+ sparring diuretics
A

ivabradine

sacubitril

valsartan

digoxin

105
Q

HF in patients with a widened QRS who have not responded to

  • ACEi
  • beta blockers
  • K+ sparring diuretics
A

cardiac resynchronisation

106
Q

What should you do in acute HF if the patient is hypotensive and at risk of cardiogenic shock?

A

Speak to HDU ?inotropic support

107
Q

chronic HF Mx

A

1st line = ACEi and Beta blocker

2nd line = spironolactone

If there is reduced EF a SGLT-2 inhibitor can be used to reduce hospital admissions (providing there is not severe renal failure)

108
Q

HTN stages

A

stage 1
- clinic: >=140/90
- abpm: 135/85

stage 2:
- clinic: >= 160/100
- abpm >= 150/95

severe:
- systolic >=180
- diastolic >=120

109
Q

HTN specialist assessment admission criteria

A

new BP >180/120

+ any of new onset confusion, chest pain, symptoms of HF or AKI

110
Q

when should you treat stage 1 HTN (BP >= 140/90 clinic or 135/85 ABPM)?

A

if patient is under 80 and:

  • organ damage
  • CVD
  • renal disease
  • DM
  • QRISK >10%
111
Q

diuretics usage in HTN and HF

A

HTN = thiazide like diuretics

HF = K+ sparring diuretics

112
Q

the only CCB that can be used (e.g. to treat HTN) in HF patients?

A

amlodipine

113
Q

thiazide like diuretics

A

indapamide

114
Q

HTN in patients who have not responded to

  • ACEi/ARBs
  • CCBs
  • thiazide like diuretics
A

look at K

  • ABove 4.5 = Alpha/Beta blocker
  • beLOw 4.5 = spiroNOlactone
115
Q

Torsade’s de Points Mx

A

MgSO4

116
Q

Primary and Secondary prevention of CVD?

A

Primary = 20mg Atorvastatin
Secondary = 80mg Atorvastatin

117
Q

signs of RHF

A

raised JVP

ankle oedema

hepatomegaly

118
Q

acs poor prognostic factors

A

age

♡ failure

pvd

reduced systolic bp

killip class

raised: creatinine, cardiac markers

cardiac arrest

st depression

119
Q

loop diuretics

A

inhibits NaKCl cotransporter in thick ascending limb of the loop of Henle

reduces NaCl absorption

useful in ♡ failure

examples: furosemide, bumetanide

120
Q

HTN in patients who have not responded to

  • ACEi/ARBs
  • CCBs
  • thiazide sparring diuretics
A

look at K

  • ABove 4.5 = Alpha/Beta blocker
  • beLOw 4.5 = spiroNOlactone
121
Q

statins contraindications

A

erythromycin/ clarithromycin

122
Q

acute mitral regurg

A

post mi rupture of papillary muscles

widespread (early-mid) systolic murmur

hypotension

pulmonary oedema

4th year passmed (28 decks)

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