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Cardio Flashcards

1
Q

posterior MI ECG findings

which vessel

A

lead v1-3

Op of STEMI:

horizontal ST depression
Tall Broad R waves
upright T waves

dominent R wave in v2

Basically if st depression in leads V1-V4 = do 2 extra leads V&V9 bc something going on posterior

LCX or RCA

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2
Q

? PE investigation CKD or pregnant

A

V&Q scan

instead of CTPA

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3
Q

malignant hypertention

A

BP> 180/120

end organ damage

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4
Q

hypokal ECG

A

prolonged PR ( 1st degree Hb)
Prominent U waves

flateneed t wave and st depression

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5
Q

HOCM hart sound

A

s4

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6
Q

when to stop anticoag consider alternative diagnosis with PE

A

2-level PE Wells score </= 4

-ve d-dimer

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7
Q

NSTEMI scoring scale and Mx

A

GRACE SCORE

<3% = conservative management

> 3% = PCI in 72hrs

haem unstable = PCI now

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8
Q

Conservative management NSTEMI

A

aspirin fondaparinux ticagrelor

clopidgrel if high bleedinig risk (ie on anti coags)

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9
Q

pulmonary embolism abg

A

resp alkalosis

bc hypervent = low co2

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10
Q

criteria for infective endocarditis

A

duke criteria

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11
Q

risk of bleeding af and on anticoags

A

ORBIT score

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12
Q

PE with haemodynaic instability

A

thrombolysis

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13
Q

mitral stenosis

mc cause
path
sx
tx

A

rheumatic fever

(blood backflow in left atrium) heart failure sx and af bc atrial stretch
malar flush
haemoptysis

tx af w mitral stenosis = anticiag

ASx = monitor w echo every 6-12 mths
sx = baloon valvotomy or perc mitral commissurotomy

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14
Q

mitral stenosis sounds

A

mid diastolic rumble (best in exp)
at apex
loud s1
opening snap

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15
Q

pt w PE that can be managed as outpatients

A

PESI score

(pe severity index)

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16
Q

aortic regrug causes and presentation

A

infection - infective endocarditis, rheuamtic fever
infarction
aortic dissection
spondoarthrop
RA, SLE , marfans and ehler danlos

acute = cardiogenic shock
chronic = CHF and chest pain maybe

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17
Q

aortic regurg signs

A

early diastolic rumble (increase by handgrip)
collapsing pulse
wide pulse pressure

quincke
de mussets

severe = mid diastolic austin flint murmur

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18
Q

quinckes sign

A

nailbed pulsation in aortic regrug

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19
Q

de mussets sigm

A

head bobbing in aortic regurg

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20
Q

what is austin flint murmur

A

severe aortic regurg

due to partuial closure of anterior mitral valve cusps bc regurg stream

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21
Q

aortic stenosis sx

A

chestpain dysponea syncope (exertional dizziness)

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22
Q

aortic stenosis causes and tx

A

calcification

ie old pt w athersclerosis
process sped up if bicuspid valve = ypunger pt
williams syndrome (supravalv aotic sten)
post rheumatic disease
HOCM

Asx = monitor
Sx = valve replacement

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23
Q

aortic stenosis murmur

what if severe

A

ejection systolic
radiates to carotids
decreased by valsalva manouvre
crescendo descrescendo

severe =
soft absent s2
s4 sound
slow rising pulse
narrow pulse pressure

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24
Q

causes mitral regurg

A

Post MI/ ACS ( bc papillary muscles/chordea tendinae affected)
mitral valve proplapse
infective endo
rheumatic fever
congenital

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25
mitral regurg sx
often stays asx unless gets too bad = present w failure of Left vent, arythmia, or pul htn ie fatigue SOB oedema
26
mitral regrug murmir what if severe
pansystolic mumur hollow high pitched blowing sound apex and radiates to axilla widely split S2 if severe
27
medical mx acute mitral regurg
nirates duiretics inotropes intraaortic balloon pump if in heart failure maybe ace inhibitors n bb m spirinolactone severe = replacement
28
making murmurs worse/better
murmur louder bc more blood in the heart therefore valsalva = dec venous return = improve leg lift and squatting = increased venous return therefore worsens murm
29
hocm genes and path
autosomal dominant diastolic dyfxn left v hypertrophy -> decreased compliance -> decreased cardiac output
30
hcm presentation murmur
extertional sob young syncope post exercise sudden death bc vent arythmia ejection systolic murmur (made worse by vals and better by squatting)
31
hocm echo MR SAM ASH
MR SAM ASH mitrak regurg systolic antieror motion (of ant mitral valve leaflet) assymetic hypertophy
32
mitral valve prolapse causes features
usually idiopathuc ie congenital midsystolic click (occurs later if pt standing) late systolic murmur (longer if pt standing) basically similar murmur to mitral regurg but improves with blood in the heart
33
angina tx
bb or ccb first line if only ccb used = verpamil or diltazem if on monotherapy still sx and cannot tolerate either bb or ccb = long acting nitreate. nicorandil, ivabradine
34
hyperaldoesteronism presentation
hypertension hypokalaemia metabolic alkalosis
35
hyperaldost 1stline investigtiion how to differentiate btween 1 and 2ndry
aldoesterone renin ratio high = primary (in adrenals bc aldosterone being produced indepedant of renin) low ratio = secondary (inc aldos bc renin raised ie problem in axis )
36
primary hyperaldosterone ix
1st aldosterone renin ratio (high ald = primary) 2nd high resolution ct abdo (to see uni lat or bilat cause) if normal/inconc = AVS 3rd adrenal venous sampling (AVS) if aldos inc in both veins = bilateral cause
37
causes of primary hyperaldos
unilat adrenal adenoma bilateral adrenal hyperplasia
38
Post MI complication pericarditis
2-3 days bc post transmural MI
39
Post Mi complications Dressler’s syndrome
2-6weeks post MI autoimmune reactuion to proteins as myocardium recovers fever pleuritic pain pericardial effusion raised ESR Tx - nsaids
40
after 5 days complications of post MI
RUPTURE ie free wall = sx cardiac tamponade VSD septal rupture = hf sx (pansystolic murm) papllary muscle damage = mitral regurg and hf sx (early to mid systolic murm)
41
poorly controlled htn already on acei, ccb, and thiazide
if k<4.5 = add spironolactone
42
ccb SE gums
gingival hyperplasia = gum bleed
43
x ray findings heart failure
ABCDE Alveolar oedema (bats wings) Kerly B lines (intersitioal oedema) Cardiomegaly Dilated prominent upper lobe vessels effusion (pleural)
44
ruptured AAA bloods
crossmatch blood 6 units
45
acute pericarditis 1st tx
nsaids and colchicine
46
fibronolysis given for ACS then what
repeat ecg after 60-90 mins if still st elevation = transfer for urgent PCI
47
ccb se
headache flushing ankle oedema
48
meseneteric ischaemia triad
cvd hight lacate sofy but tender abdo
49
unstable pe
thrombolysis ie alteplase
50
mesenteric ischaemia 1st ix
vbg - lactate CT
51
nifedipine SE
reflex tachycardia palpitations dizziness
52
bradycardia atropine CI
adrenaline infusion
53
mechanical valve target INR
aortic = 3 mitral = 3.5
54
AAA screening
all men aged 65 offered single abdo USS
55
infective endocarditis indications for surgery
severe valv incompetence aortic abscess infxn reistant to abx or fungal infections cardiac failure refractory to standard medical therapy recurrent emboli after abx therpay
56
isolated hemisensory loss stroke
lacunar infarct
57
lacunar infarct
unilateral weakness and or senrsory face arm and leg or all 3 pure sensory stroke ataxic hemiparesis dysarthria/clumsy hand syndrome
58
mx primary hyperaldoesterone
adrenal adenoma = laproscoopic adrenalenctomy bilat adrenocortical hyperplasia = spironolactone
59
what does opening snap mean in mitral stenosis
leaflets still have some mobilty
60
new LBBB on ecg
wide QRS in precordial leads normal shape but negative QRS in V1 mostly positive w slow upstroke R wave peak in lateral leads
61
anticoag post catheter ablation for AF
so still need anticoag base on chadvasc score 0 = 2mths anticoag 1+ = long term anticoag
62
risk factors for asystole in bradycardia ie needs transvenous pacing
complete heart block w broad qrs complexes recent asystole mobitz type II av block ventricular pause> 3 seconds
63
CCB constipation which one most likely
verapamil
64
acute limb ischaemie intial mx
abc IV opiods IV UFH vascular review
65
acute limb ischaemia def mx
intra arterial thrombolysis surgical embolectomy angioplasty bypass surg amputation is irrevesible
66
MC cause infective endocarditis
Staph aureus staph epidermidis if <2mths post valve surgery
67
symptomatic aortic stenosis tx
surgical AVR for low/med risk op pts transcatheter AV for high risk
68
driving post MI
4 weeks dont tell dvla
69
useful cardiac enzyme to look for reinfarction
ck-mb returns to normal after 2-3 days
70
complications after coronary anggiography
bleeding infection allergy to contrast mi stroke
71
angina triggers
cold weather amotionie anger/excitement vivid dreams lying down
72
blood tests and why for pt w angina
fbc - anaemia tft - thyrotox blood glucose - d u&e if considering acei
73
how does aspirin work
Cox inhib prevents thromboxine production inhibits platelets aggregation
74
what is an aneurysm
abnormal dilation of vessal wall >150% of orgininal diameter due to weakness in vessel wall
75
true aneurysm
dilatation of vessel involving all 3 layers of vessel
76
false aneurysm,
collection of blood in a dilatation only secured by adventitia (outermost layer) due to damage to other two layers
77
aneurysm screening <3cm
no further action
78
AAA screening dilation found
3-4.4cm = rescan every 12 mths 4.5-5.4 = rescan every 3mths
79
AAA screening found aneur >5.5cm
refer 2 weks for vascular surgery for repair either EVAR (Eelective endovasc repair) or open surgery if unsuitable
80
causes AAA and RF
marfans/ehlers atheromatous degeneration smoking fhx dm htn male inc age hyperlipidemia
81
reasons why EVAR for aaa may be prefered over open surg
comorbidties = open surgery too much risk morphology of AAA = evar suitable position of renal arteries
82
-ve of EVAR for aaa repaire
long term follow up needed not suitable for every aneurysm high reintervention rate (endo leak)
83
ruptured aaa ix if stable
abdo ct with contrast
84
Trash foot
cholesterol embolism atheromatous debris shed during vasc surgery, lodges in distal vessel = local ischaemia mottled skin and darekened segments on toes
85
4 layers of vessel
endothelium/intima tunica media tunica externa serosa/adventitia
86
capture beat
normal qrs complex inbetween broad VT complexes
87
VT or VF shockable ?
VF yes VT yes if no palpable pulse
88
VT mx
oxygen adrenaline amiodarone lidocaine
89
vt vs vf
vt more regular and uniform than vf
90
severity of HF
NYHA
91
acute left heart failure path and sx
LV cant pump blood out to SVS, back log= pulmonary oedema= acute SOB, reduce sats, worse lying down. T1RF. unwell, cough pink frothy sputum, wheeze cough raised RR, tachyC, 3rd HS, bibasal crackles, hypotension. RSHF?
92
right heart failure sx
peripheral oedema, facial engorgement and distension o f the abdomen. raised jvp hepatomegaly
93
how does furesimide work
competitively inhibits na/k/cl cotransporter in thick ascending loop of henle removes osmotic water gradient for water to reabsorb
94
reverse tick pattern on ecg
down sloping st depression t wave inversion/flat short qt bc DIGOXIN
95
ACEi side effects
cough first drop hypotension angioedeema hyperkalemia renal impairement
96
hypertensive retinopathy classification
Keith-Wagener
97
signs of hypertensive retinopathy
silver wiring AV nipping flame haemorrhages cotton wool exudates flame and blot haemorhages (may collect around mac = macular star) papilloedema
98
complications of essential hypertension
HF IHD CKD Stroke PVD hypertensive retinopathy
99
causes of AF
pneumonia MI PE HF hyperthyroid alocohol excess endocarditis
100
af ecg
ireggular qrs absent p wave
101
AF cardioversion
medcal = amiodarine flecanide electrical DC cardioversion ablation
102
complications of AF
stroke tia HF systemic emboli falls
103
why check urine sample in infective endocarditis
microscopic haematuria bc immune complex glomerulonephritis septic emboli renal cortical necrosis
104
infective endocarditis eyes
roth spots on retina white centered haemorrhages
105
infecttive endo ix
3 blood cultures 3 seperate times 3 sep places echo cxr ecg urine dip
106
infective endo RF
prev episode IDVU prosthestic valves rheumatic valve disease congen heart defects ie PDA VSD recent piercings
107

finals (28 decks)

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