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Difficult Passmed- MLA > Cardio > Flashcards

Cardio Flashcards

1
Q

What type of MI is known to have AV block as a complication?

A

INferior - ST elevation in II, III, AVF

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2
Q

When to use rhythm control to treat AF

A

If coexistent HF, first onset AF or obvious reversible cause

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3
Q

Intracranial haemorrhage on warfarin - what to do

A

Stop warfarin, give 5mg Vitamin K IV and PT complex concentrate

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4
Q

Polymorphic ventricular tachycardia (broad complex)- torsades de pointes - mx

A

Mg sulphate

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5
Q

Pulseless electrical activity mx

A

Non shockable so give adrenaline then CPR

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6
Q

What is the QT interval on an ECG

A

Time between the start of the Q wave and end of T wave

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7
Q

Ivabradine S/E

A

visual effects - luminous phenomena
Headache
Bradycardia, heart block

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8
Q

Young adult with HTN, systolic murmur heard best over back and LVH - dx

A

Coarctation aorta

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9
Q

What foods to avoid in warfarin

A

Broccoli, spinach, kale , sprouts = high vt k

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10
Q

ALS VF/Pulseless VT VS Non shockable

A

VF/Pulseless VT = shockable (up to 3 if monitored) - 2 mins cpr. Amiodarone 300mcg after 3 shocks and adrenaline 1mg (every 3-5mins). If 5 shocks then amidoarone/lidocaine also

Non shockable = Adrenaline 1mg + repeat. If thrombolyti drugs then 60-90mins CPR. If hypothermia only 3 shocks before >30 degrees

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11
Q

HTN Mx

A
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12
Q

Mx SVT

A

Vagal manoeuvres then IV adenosine - not in asthmatics 6-12-12
If unsuccessful then consider atrial flitter and control rate (BB)

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13
Q

CHADS VASC2

A

0 - no tx
1 males - consider antocga
1 female - no
2+ offer
still give if paroxysmal and high score

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14
Q

Unstable tachycardia mx

A

Hypotension, pallor, syncope, myocardial ischaemia, HF
Up to 3 synchronised shocks + amiodarone infusion

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15
Q

Angina step up Mx

A

Aspirin + GTN +
BB/CCB (verapamil)
BB+ CCB/Amlodipine
Long acting nitrate

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16
Q

Ejection systolic - Louder on expiration = high pitch, slow rising pulse, narrow PP, radiates to carotid

Dx and Mx

A

Aortic stenosis

Asymp + valvular gradient <40 = observe.
-Symp or >40 then replace with surgery or if frail (transcatheter).
-In children- balloon valvuloplasty

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17
Q

Ejection systolic murmur

Louder expiration = increased with valsalva. Quieter on squat.

Dx and Mx

A

HOCM

Need ICD (sudden death risk)
Causes diastolic dysfunction (HF with preserved ejection fraction)
ECHO

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18
Q

Ejection systolic murmur fixed splitting S2. Embolisms can pass and cause strokes/

what murmur is this

A

ASD

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19
Q

Early diastolic murmur

high pitch, blowing, corrigans collapsing pulse, wide pulse pressure, Quinke’s sign (nailbed pulsation), De musset’s sign (head bobbing)

Type murmur, IX, TX

A

aortic regurgitation

ECHO
Medical Mx HF, surgery (symptomatic with severe or asymp with severe and lV systolic dysfunction)

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20
Q

Pansystolic murmur -blowing, ass with collagen disorders, high pitch whistle, louder expiration

WHta murmur and Mx

A

mitral regurgitation

Nitrates, diuretics, positive inotropes, intr aortic balloon pump
If HF, can consider ACEi
In severe - surgery

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21
Q

Pansystolic murmur = blowing, high pitch, louder inspiration
Pulsatile herpaotmegaly, left parasternal heave

type murmur

A

tricuspid regard

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22
Q

Mid to late diastolic murmur

low pitch rumbling, ass with Atrial fibrillation. Tapping apex beat

Dx, cause, mx

A

Mitral stenosis - low pitch rumbling, ass with Atrial fibrillation. Tapping apex beat
Rheumatic fever is the cause!!
Dyspnea, haemotpysis, loud S1, opening snap, low vol pulse, malar flush
Ass AF need anticoag
Asymp patients- monitored with reg ECHO
Symp - percutaneous mitrla balloon valvotomy, mitral valve surgery

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23
Q

Murmur:
Late systolic, decrease fem pulses, ass with turners, maximal over back (scapulae between), notching of inferior border of ribs

A

Coarctation aorta

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24
Q

Continuous machine like murmur

A

PDA

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25
Q

Quiet S1 cause

A

Mitral regurgitation

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26
Q

Loud S1

A

Mitral stenosis

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27
Q

Loud S2 cause

A

HTN

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28
Q

AV blocks - types and mx

A
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29
Q

Mx for STEMI

A
30
Q

Mx NSTEMI

A
31
Q

V1-V4 leads: which artery

A

Anterior (septal) = V1-4 = LAD

32
Q

Which view of the heart and artery for II, III, AVF

A

Inferior
Right coronary artery
II,III,AVF

33
Q

Which view of the heart and artery for I, V5-6

A

Lateral
left circumflex

34
Q

Which view of heart and artery for v1-3

A

Posterior = V1-3 (tall broad R waves,upright T waves, horizontal ST depression on 12 lead. Usually left circumflex, alo righ coronary. Confirmed by ST elevation and Q waves in posterior leads V7-9

35
Q

MI CX - <48hr, 1-2 weeks, 2-6 weeks

A

Pericarditis (<48HR)
2-6 weeks = Dressler’s - fever, pleuritic pain, pericarditis (NSAIDs)
1-2 weeks = LV Free wall rupture - cardiac tamponade (muffled heart sounds, Increased JVP, pulsus paradoxus, electrical alternans on ECG)

36
Q

AAA: The 3 categories and when to re scan or refer

A

3-4.4cm = rescan 12m
4.5-5.4cm = every 3m
>5.5 = refer <2 weeks

37
Q

TIA - what medications afterwards

A

Clopidogrel life or 2. Aspirin + dipyridamole

38
Q

Warfarin rules and what to give:
INR >8 minor bleeding
INR >8 no bleeding
INR 5-8 minor bleeding
INR 5-8 no bleeding

A

Major bleeding - stop warfarin, IV VK, PT
INR >8 minor bleeding - stop warfarin, IV VK (+/- repeat 24hr), restart warfarin when INR <5
INR >8 no bleeding - stop warfarin, PO VK, restrat when INR<5
INR 5-8 minor bleeding - stop warfarin, IV VK, restrat when INR<5
INR 5-8 no bleeding - withhold ½ warfarin, reduce subsequent maintenance dose

39
Q

Posterior circulation symptoms like dizziness and vertigo duing exertion of an arm. There is subclavian artery steno-occlusive disease proximal to the origin of vertebral artery and associated with flow reversal in vertebral artery. Management - percutaneous transluminal angioplasty or a stent.

A

Subclavian steal syndrome

40
Q

Ix and mx in aortic dissection (severe sharp chest/back pain, maximal at onset, pulse def, aortic regurgitation)

A

Depending on arteries - angina, paraplegia,limb ischaemia
CXR - widened mediastinu.
CTA is best - false lumen. If unstable then Transoesophageal ECHO
TA = ascending = surg x but bP controlled 100-120 whilst waiting
TB = conservative, bed rest, reduce BP with iV labetolol to prevent progression

41
Q

Polymorphic ventricular tachycardia ass with long QT interval

WHta is this and Mx

A

Torsades de pointes
IV MGS04-

42
Q

ATLS - shockable vs not shockable

A

CPR 30:2 and attach defib/monitor
Assess rhythm

Shockable = VF/Pulseless VT = 1 shock then CPR (if witnessed and monitored then up to 3 shocks)
Adrenaline 1mg once chest compressions restarted after 3rd shock. Then repeat every 3-5mins
Amiodarone 300mg if VF/pulseless VT after 3 shocks
Further dose amiodaorne 150mg after 5 shocks. Alternative is lidocaine

Non shockable = PEA/ASystole = immediately resume CPR 2mins.
Adrenaline asap 1mg then repeat every 3-5mins

Thrombolytic drugs - if PE suspected and if given then CPR extended 60-90mins

43
Q

Angina Tx

A

Aspirin + statin + sublingual glyceryl trinitrate (tolerance so asymmetric dosing)
BB/CCB (verapamil or diltiazam)
BB + CCB (amlodipine or MR nifedipine as the CCB)
If on CCB and cant tolerate addition of other then consider long acting nitrate, ivabradine, nicorandil, ranolazine
Only add third drug if waiting assessment for PCI/CABG

44
Q

Causes dilated cardiomyopathies

A

Causes - alcohol, Coxsackie, wet beri beri, doxorubicin

45
Q

restive cardiomyopathy causes

A

Causes - amyloidosis, post-radiotherapy, Loeffler’s endocarditis

46
Q

Systolic vs diastolic dysfunction HF in relation to ejection fraction and causes

A

By ejection fraction:
Systolic dysfunction - Reduced ejection fraction - IHD, dilated cardiomyopathy, myocarditis, arrhythmias
Diastolic - Preserved EF - HOCM, restrictive cardiomyopathy, cardiac tamponade, constrictive pericarditis

47
Q

LHF VS RHF symptoms

A

RHF = caused by increased RV afterload (Pulm HTN) or increased RV preload (tricuspid regurg)
Lvf = pulmonary oedema
RVF = peripheral oedema, raised JVP, hepatomegaly

48
Q

High output HF - what is this and what are the causes

A

High output HF:
Normal heart is unable to unable to pump enough blood to meet metabolic needs of body
Causes - Anaemia AV malformation, Pagets disease, pregnancy, thyrotoxicosis, thiamine def

49
Q

Features of Chronic Heart failure

A

Dyspnea, cough, orthopnea, paroxysmal nocturnal dyspnoea, wheeze, weight loss, bibasal crackles, signs RHF (raised JVP, ankle oedema, hepatomegaly)

50
Q

Management Chronic HF - first line medications

A
  1. ACEi + BB
  2. Aldosterone antagonist (monitor K+). SGLT-2 inhibitors used more in reduced ejection fraction.
  3. Specialist - ivabradie, sacubitril valsartan, digoxin, hydralazine in combo with nitrate, cardiac resynchronisation therapy
    Annual flu and one off pneumococcal
    NYHA 1 - no symp - NYHA IV - severe symp = rest pain
51
Q

Features of acute HF

A

Sudden onset or worsening of symptoms
Breathless, reduced exercise tolerance, oedema, fatigue
Cyanosis, tachy, elevated JVP, displaced apex beat, chest signs (bibasal crackles), S3 heart sound

52
Q

Ix in Acute HF

A

Bloods - anaemia. Abnormal electrolytes check
CXR - pulm venous congestion, interstitial oedema,c ardiomegaly
ECHO - if new onset or suspected change in function
BT NP

53
Q

Bones stones groan psychic moan
Shortened QT interval
HTN

electrolyte abnormality

A

Hypercalcaemia

54
Q

Organisms for infective endocarditis (most common)

A

Mostly mitral valve
Mostly staph aureus (esp in acute/IVDUs) - others include: strep viridans (dentl hygiene), staph epidermis (indwelling lines), strep bovis (CRC)

55
Q

management of postural hypotension - some medication options

A

Midodrine and fludrocortisone

56
Q

Perri arrest for bradycardia - mx

A

Need for Tx signs = shock, syncope, MI, HF
Atorpine 500mcg
Up to max 3mg atropgine, trascutaneous pacing, isoprenaline/adrenaline infusion titrated to respoinse

57
Q

Peri arrest tacky

A

Unstable is shock, syncope, MI, HF
Synchronised DC shock - up to 3

58
Q

raynauds with extremity ischaemia, male, smoker.

DX

A

Beurgers disease - thromboangiits obliterans

59
Q

Which angina drug can cause ulceration in GIT

A

Nicorandil

60
Q

first line anginal prophylaxis

A

BB

61
Q

What is brugada syndrome

A

inherited CVD which may present with udden cardiac death. Autosomal dominant. Partial RBBB, convex ST elevation, ECG changes more apparent after flecainide. ICD needed

62
Q

Mx rheumatic fever

A

IM Benzylpenicillin/oral penicillin V

63
Q

First line mx to pericarditis

A

ibuprofen and colchicine

64
Q

When to stop warfarin before surgery and what if you need to bridge it

A

5 day sbefore

If bridge it then o with LMWH until 3 days before

65
Q

Important interaction between statin and an ABx - which Abx and why

A

Can’t have statin and macrloife abx (clarithromycin) die to risk rhabdomyolysis

66
Q

Patient with AF and acute stroke (to hemorrhagic) - when to start anticoagulant tx and medication in between

A

Aspirin daily and start anticoagulant after 2 weeks

67
Q

Pedunculated heterogenous mass on ECHO

A

Atrial myxoma

68
Q

What is a non sensitive ECG sign of cardiac tamponade

A

Electrical alternans - beat to beat variation in QRS amplitude and morphology due to swinging in pericardial fluid.

69
Q

What WELLs score indicates a CTPA should be done

A

> 4

70
Q

If a pt with reduced ejection fraction HF still have symptoms despite being on ACE inhibitor, BB blocker then what medication to add

A

Spironolactone - mineralcorticodid receptor antagonist

71
Q

Target INR normally and when you suffer form recurrent pulmonary embolisms

A

Normally 2-3

Recurrent PEs = 3.5 (so may have to increase dose anticoags)

Difficult Passmed- MLA (26 decks)

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