Cardio

Question 1

Ectopic then qrs then etcopic etc etc

Answer 1

Bigeminy

Question 2

Ventricular vs atrial ectopics

Answer 2

Ventricular are wider

Question 3

How can we determine axis deviation?

Answer 3

Look at lead one and lead 3, if they are leaving each other then they are left axis deviation. If they are returning to each other then they are right axis deviation

Question 4

Saw tooth p wave means what?

Answer 4

Atrial flutter

Question 5

Bifid p wave means what

Answer 5

Left atrial enlargement eg mitral regurgitation.

Question 6

Tall p waves means what?

Answer 6

P pulmonale

Question 7

What is William marrow?

Answer 7

William w looking v 1, m shaped v6 = left bundle branch block

Marrow m looking 1, W looking 6 = right bundle branch block

Question 8

U ain’t got no pot, no T but a long or and a long qt

Answer 8

Means what

For low pot, = no T, long pr and long qt

Question 9

Ssri, mthadone and antiemetics shave what in common?

Answer 9

Prolonged QT

Question 10

What are the ranges of long qt and when is the risk of torsards de points?

Answer 10

Over 440ms men, over 460ms women

Risk of tdp over 500ms

Question 11

High heart rate and high qt what do we need to do?

Answer 11

Double check qt interval manually

Question 12

Tourards du point treatment

Answer 12

IV mg

Question 13

What are the variations of T wave shapes and meaning?

Question 14

What are the different types of mi?

Answer 14

There are 6
1 = spontaneous
2 = imbalance supply and demand
3 = spontaneous eg collapse

Question 15

Do you give adenosine to asthmatics or copd?

Answer 15

NO!!!

Give verapamil

Question 16

What condition can cause a short pr interval and delta waves?

Answer 16

Wolf Parkinson white

Question 17

Prolonged qrs - is it likely to be lad stemi if there was elevation?

Answer 17

No! All needs to be checked: likely bundle branch block

Question 18

Pr interval time
Qrs time

Answer 18

Pr 0.12-0.2
Qrs under 0.12

Question 19

Big box ECG time

Answer 19

0.2s

Small box is 0.04

Question 20

Between qrs:
- more than 5 big boxes
-less than 3 big boxes

Answer 20

Tachycardia
Bradycardic

Question 21

How to calc hr

Answer 21

Total number qrs x 6

Or between qrs big box / 300

Question 22

Nstemi signs

Answer 22

There may be:
T wave inversion
Pathological q waves
There may be no changes but

RAISED TROPONIN

Question 23

Neurons in resting state: where are potassium and sodium? Relative negative action potentials

Answer 23

Resting state = more Na outside
More k inside

More Na over all and more positively charged particles outside cell as opposed to inside the cell. (Inside cell is more negative)
-70 at rest, -55 to potentiate the action potemtial and open sodium channels

Question 24

Heart failure drugs

Answer 24

Ace
BBlocker
Potassium sparing diuretics (mra) eg eplerenone
Sglt2 dapaglaflozin 10mg

Loop diuretics are PURELY symptomatic

Question 25

Side effects of ACEi

Answer 25

Cough Hyperkalaemia —- aki

Question 26

When do you give arb in heart failure?

Answer 26

If intolerant of ace

Question 27

Why don’t we give ace and arb?

Answer 27

Can push potassium up way up

Question 28

Digoxin therapeutic range

Answer 28

0.4-1 Cleared by kidney.

Question 29

What is the management of HFpEF

Answer 29

Dapaglaflozin Treatment of aetiology Loop diuretics

Question 30

Metolozone use

Answer 30

Extreme diureisis

Question 31

Sglt 2 side effects

Answer 31

Euglycaemic dKA Thrush UTI s

Question 32

How do sglt2i work

Answer 32

Increase glucose concentration in urine Can therefore cause diuretics via osmosis

Question 33

What are the sick day rules

Answer 33

Ace I Arbs NSAIDs Diuretics (all classes) furosemide/spiromolactone Metformin STOP these drugs for 24-48h or until feeling better

Question 34

Furosimide - consider what?

Answer 34

Mobility - will need to pee in the next hour So should be taken in the morning or when they can pee

Question 36

How can you calculate creatinine clearance

Answer 36

Md calc.

Question 37

Contraindications for heart failure heart drugs

Answer 37

Rate limiting Ccbs eg nifedipine NSAIDs are cautionary - not good - hypertensive drive, can increase blood pressure. Also not good for the kidneys. Diclofenac - can cause sudden cardiac death in people with heart failure

Question 38

Thyroxine half life

Answer 38

7 days So if there is stroke patient on it then you don’t need to panic if they can’t swallow for a couple of days

Question 39

Why would you want to give iv iron? (Ferric derisomaltose)

Answer 39

To improve symptoms quickly Higher than average anaphylaxis risk - needs observation for an hour after or so

Question 42

heart failure definition

Answer 42

structurla or functional abnormality that causes a fialing within the heart to meet the metabolic ability of the heart at rest or exercise

Question 43

WHen are naturitic peptides released. UNder what level is cardiac failure

Answer 43

Dilation due to volume loading Over 400 fairly likely Over 2000 almost certainly - urgent echo

Question 44

How to rule out heart failure

Answer 44

Normal ecg (abnormla in 98%) BNP Also - should do a chest x ray to rule out lung malignency

Question 45

hfpef often seen in who and why?

Answer 45

Obsese people with lots of fat around the heart - cytokines cause stiffening of the heart muscle

Question 46

How do most people with Cardiac Failure early stages die?

Answer 46

Ventricular arrhythmia and sudden death