Cardio Flashcards by Charis Gibson

Mechanical valves target INR? Aortic and mitral

3.0: Aortic
3.5: Mitral

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Drugs for fibrinolysis for a STEMI?

Antithrombin and fibrinolysis drugs
Alteplase and fondaparinux

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Bronchiectass and dextrocardia is highly suggestive of what?

Kartagner’s syndrome

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AF + acute stroke (non-haemorrhagic) should have anticoagulation therapy when?

2 weeks after event, antiplatelet therapy given in intervening period

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Broad complex tachycardia + acute MI…what shouldn’t you give?

Verapamil
-Contraindicated as its a non-dihydropyridine CCB, which inhibits influx of extracellular Ca across myocardial membranes= inhibition of cardiac muscle contraction = dilation of main coronoary and systemic arteries

Basically:
Can precipitate marked haemodynamic deterioration, VF, and cardiac arrest

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What does a pCO2 >6.0 kPa indicate?

Near fatal asthma
If patient is tachypnoeic, CO2 should be low as CO2 lost in ventilation. If it is high or normal: person is tiring and beginning to hypoventilate

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Pr interval in 1st degree in Heart block?

> 200ms

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Emergency management of patients in major haemorrhage on warfarin

Stop warfarin
Give IV vit K
Prothrombin complex conc

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What does a GRACE score of more than 3 warrant?

Coronary angiography in NSTEMI

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Organism for infective endocarditis amongst IVDU?

Staph aureus

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Most common cause of mitral stenosis ?

Rheumatic fever

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Aortic regurgitation causes what type of murmur?

Early diastolic

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What is aortic regurg?

Leaking of aortic valve causing blood to flow in reverse direction during ventricular diastole

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Features of aortic regurg?

Collapsing pulse
Wide pulse pressure
Quincke’s sign (nailbed pulsation)
De Musset’s sign (head bobbing)
Mid-diastolic austin flint murmut

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What is De Musset’s sign?

Head bobbing

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What is Quincke’s sign?

Nailbed pulsation

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Common adverse SEs from thiazide diuretics?

Dehydration
Postural hypotension
Hypokalaemia
Hyponatraemia
Hypercalcaemia
Gout
Impaired glucose tolerance
Impotence

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Hypercalcaemia ECG change?

Short QT interval

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Common SEs of amiodarone?

Brady
Hyper/hypo-thyroid
Pulm fibrosis
Liver fibrosis
Jaundice
Taste change
Slate grey skin
Raised serum transaminase
Nausea
Constipation

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Angina management if patient has inadequate response to verapamil?

Add long acting nitrate (isomorbide monnitrate)

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When should you tell patients to take their statin?

At night

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Young male smoker, symptoms similar to limb ischaemia think what?

Buerger’s disease

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Patients with bradycardia and signs of shock require what?

500mcg of atropine (repeated to max 3mg)

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What are the normal degrees of heart block expected in athletes?

2nd degree heart block Mobitz type 1
First degree heart block
Junctional rhythm
Sinus bradycardia

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Bradycardia + signs of shock treatment?

IV Atropine

Mid-diastolic murmur at apex us what?

Mitral stenosis

Pan-systolic murmur loudest at left sternal edge of 4th ICS?

Tricuspid regurg

Radiation to carotids?

Aortic stenosis

Ejection systolic murmurs?

Aortic stenosis: Louder on expiration Pulmonary stenosis: Louder on inspiration

Pansystolic murmurs?

Mitral regurg Tricusp regurg: louder during inspiration

Early diastolic?

Aortic regug

Mid-late diastolic?

Mitral stenosis Austin-Flint

Which side of heart murmur is heard best on inspiration?

Right sided murmur RILE Right sided heard best on Inspiration Left sided heard best on expiration

1st line management of heart failure is ACEi and what? Then what would you add if they're still struggling?

Beta blocker -Spironolactone

High voltage QRS complex represent what?

LV hypertrophy

Inverted P wave in lead 1, Right axis deviation and loss of R wave progression?

Heart's apex located on right hand side of body

Causes of LAD?

Left anterior hemiblock LBBB I MI WPWS Hyperkalaemia

Causes of Right axis deviation?

RVHT Left posterior hemiblock Lateral MI Cor pulmonale PE WPWS (LHS)

Mechanical heart valves anti-coags?

Warfarin

Collapsing pulse, SOB, cardiac murmur...what you think it is? + what else might be present relating to the nails

Aortic regurg Quincke's sign

What is coarcation of aorta associated with

Bicuspid aortic valve

What type of murmurs in coarcation of aorta?

Systolic murmurs

Heart failure severity score?

NYHA

Sleep apnoea assessment score?

Epworth sleepiness scale

Prostate symptom and prognosis scores?

IPSS Gleason

Most specific marker on ECG for pericarditis?

PR depression

What CV drug interacts dodgily with erythro/clarithro?

Statins

When should ivabradine be considered in patients with heart failure?

Sinus rhythm >75/min LVEF <35% Not respondd to ACEi, BB, aldosterone antagonist

What drugs should all MI patients be offered?

Dual antiplatelet therapy (aspirin + tica/clopi B blocker ACEi Statin

What stage of life should you not take statins in?

Pregnancy

Mid-diastolic low-pitched rumbling murmur?

Mitral stenosis ESPESH if haemopytsis

How long is PR interval in WPWS?

<120ms

Hypercalcaemia ECG?

Short QT interval

Tall R waves V1-2...means what?

Posterior MI

Half-life of adenosine?

10 secs

Protocol if patient has INR 5-8 with no bleeding?

Withhold 2 doses of warfarin Reduce subsequent maintenance dose

AB of choice for native valve endocarditis?

Amoxicillin

Hypothermia ECG?

J waves

Acute circulatory collapse at 2 days of age?

Coarctation of aorta

1st line for regular broad complex tachy?

IV amiodarone

When should B-blockers be stopped in a patient with heart failure?

HR <50 2nd or 3rd degree AV block Shock

Offer what in a 'broad lifestyle' manner (Vom) to patients with HF?

Influenza vaccine annually

What can thiazides do in diabetics?

Worsen glucose tolerance

What electrolyte abnormality do you think of? -Small or absent T waves -Prolong PR interval -ST depression -Long QT -U waves

Hypokalaemia

What ECG finding can SA haemorrhage cause?

Torsades de pointes (Polymorphic ventricular tachy)

Adenosine can cause?

Chest pain

What do you give a warfarin ptnt about to undergo surgery?

4 factor PT complex concentrate 25-50 units/kg

Treatment for an NTEMI?

300mg of aspirin

Diastolic murmur + AF = ?

Mitral stenosis

Persistent ST elevation after MI is suggestive of?

LV aneurysm

What murmur is assoc with PCKD?

Mitral valve prolapse

If atropine fails in symptomatic bradycardia what do you do next?

External pacing

If warfarin patient minor bleeding (5-8) what do you want to do?

Stop warfarin IV Vit K 1-3mg Restart when INR <5

Prophylaxis of PE?

Rivaroxaban

Pulseless electrical activity shockable?

ECG sign suggestive of cardiac tamponade?

Electrical alternans

Single episode of AFib treatment?

Commence apixaban

What CV drug is CIed in VFib?

CCB : Verapamil

Acute mitral regurg secondary to MI indicates a rupture of what?

Papillary muscle

Persistent ST elevation in anterior leads after MI + Pulmonary oedema?

LV aneurysm

Most common cause of death following MI?

V Fib

Dilated cardiomyopathy can be cause by what lifestyle?

Chronic alcoholism

HT + diabetes?

ALWAYS ACEi or ARB regardless of age

Non-shockable rhythms?

Asystole PEA

What do you do if non-shockable?

1mg of IV adrenaline Then further adrenaline 1mg IV every 3-5 min

Nitrates are CIed in what kind of patient?

Hypotensive

Cardioversion of AF patient pre-op?

Anticoagulated + bisoprolol for 3 weeks then electrical cardioversion

II, III, avF artery affected?

Right coronary artery

Loud S2 signifies?

Pulmonary HT

Treatment of acute onset of AFib <48 hours?

Rate control initially Then if considered for long term rhythm control: delay cardioversion until maintained on therapeutic anti-coags for minimum 3 weeks

What is false lumen in ascending aorta suggestive of?

Aortic dissection

Marfan's murmur?

Mitral regurg

Eisenmenger's syndrome is what?

Reversal of a left to right shunt

Third heart sound is heard in what condition?

Dilated cardiomypathy

What class is amiodarone?

Class III

What can amiodarone cause?

Thrombophlebitis

SEs of GTN spray?

Hypotension Tachycardia Headache

What is CIed in Astenosis?

Nitrates

2nd line treatment for rate in AFib?

Digoxin

Aortic regug?

Pansystolic murmur

How many shocks in hypothermia ALS?

3 and then commence again when patient returns to 30 degrees

Test for all patients with sus heart failure?

B-type natriuretic peptide

<4 weeks post valve replacement likely infective endocarditis organism?

Staph epidermis