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Year 4 PassMed Incorrect Qs > Cardio 3 > Flashcards

Cardio 3 Flashcards

1
Q

anti-coags and their antidote

Dabigatran-

A

Dabigatran- Idarucizumab

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2
Q

post-MI what suggests a left ventricular aneurysm?

A

pulmonary oedema- bibasal crackles.
S3 heart sound suggests the left ventricle is larger than normal (as S3 represents the sloshing of blood into a large ventricle during diastole)
S4 heart sound suggest that the left ventricle is stiffer than normal (as S4 represents the forceful atrial push of blood against a hard ventricular wall)

left ventricular aneurysm will cause persistent ST elevation in V1-6 on an ECG. This is because the fibrosis and dead tissue is not able to properly move as expected.

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3
Q

Wellen’s syndrome ECG

A

shows deeply inverted T-waves in leads V2-V3 (which may extend to V1-V6) with no or minimal ST-elevation and preserved R wave progression.

biphasic or deep T wave inversion in V2-3
minimal ST elevation
no Q waves
high-grade stenosis in the left anterior descending coronary artery.

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4
Q

Kussmaul’s sign constrictive pericarditis

A

JVP will rise on inspiration;

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5
Q

NSTEMI (managed conservatively) antiplatelet choice

A

aspirin, plus either:
ticagrelor, if not high bleeding risk
clopidogrel, if high bleeding risk

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6
Q

What does a pacemaker look like on ECG?

A
  • A long straight line vertical going over all the leads, it precedes the QRS complex
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7
Q

peri-arrest management bradycardia + haem unstable
1
2 can repeat step 1. up until…
3
4

A
  1. Atropine Atropine (500mcg IV)
  2. Can repeat up to a max of 3mg
  3. Trans-cutaneous pacing
  4. Isoprenalne/ adrenaline infusion titrated to response
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8
Q

Clinically how can you differentiate Rheumatic fever from IE?

Rhemuatic (4)

A

Rheumatic fever:
- Recent sore throat
- rash (annular macules)
- Arthritis
- Murmur
(usually strep! think sore throat!)

IE
- Obvs fever and new murmur but more likley to be IV drug user/ staph infection from skin
- Rashes are less common, Skin changes are more nail changes splinter haemorrhages, roth spots, osler nodes and janeway lesions

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9
Q

What do these meand and condition

Soft S1 (2 condition)

Absent S2 (1 condition)

Loud P2

S3 ( 1 condition but normal if…)

S4 (3 condition)

A

Soft S1- prolonged PR, severe mitral stenosis or mitral regurgitation

Absent S2- severe aortic stenosis

Loud P2- early sign of pulmonary hypertension (right sided HF)

S3 - Rapid ventricular filling- LV failure. Normal if < 30yo

S4- atrial contraction against a stiff ventricle- hypertrophic obstructive cardiomyopathy and hypertension, aortic stenosis

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10
Q

What should you do If patients treated with PCI for MI are experiencing pain or haemodynamic instability post PCI (hours after)

A

urgent coronary artery bypass graft (CABG) is recommended

because PCI has failed

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11
Q

Post MI complications what is the STEM that gives it away

Pericarditis (3)

Dresslers (when, 4 key signs, treatment)

Left ventricle Aneurysm (ECG, risk of…, treatment)

Left ventricular free wall rupture (when, TRIAD! treatment)

VSD (when, 2 features, echo to differentiate between it and…, management)

Acute mitral regurg (what territory MI increased likelihood and why, 2 presentations, murmur, treatment 2)

A

Pericarditis-
- in first 48 hours is common
- pain worse on lying flat, better leaning forward
-may auscultate muffled heart sounds if effusion, echo to confirm

Dresslers (autoimmune ttack myocardium)
- 2-6 weeks after MI
- fever, pleuritic pain, pericardial effusion and increase ESR
- treat with NSAIDs

Left ventricle Aneurysm
- persistent ST elevation and left ventricular failure.
- Thrombus may form within the aneurysm increasing the risk of stroke
- Patients are therefore anticoagulated.

Left ventricular free wall rupture
- 1-2 weeks post-mi
- acute HF secondary to cardiac tamponde (muffled heart sounds, raised JVP, pulses paradoxicus- BP drop when breathing in)
- Urgent pericardiocentesis and thoracotomy

VSD
- first week
- heart failure associated with a pan-systolic murmur.
Acute mitral regurg
- Echo to rule out acute mitral regurg which presents similarly
- Urgent surgical correction is needed.

Acute mitral regurgitation
- More common with infero-posterior infarction and may be due to ischaemia or rupture of the papillary muscle
- Acute hypotension and pulmonary oedema
- early-to-mid systolic murmur
- treated with vasodilator therapy but often require emergency surgical repair.

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12
Q

What drug can cause cool peripheries?

A

Propranolol

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13
Q

Which betablocker can cause long QT syndrome?

A

Sotalol

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14
Q

Aortic stenosis common causes
< 65yo think-
> 65yo think -

A

younger patients < 65 years: bicuspid aortic valve
older patients > 65 years: calcification

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15
Q

What are the indications for treating stage 1 essential HTN?

(6)

A
  1. < 80yo (if 80+ dont bother!)
  2. Q-RISK > 10%
  3. Diabetes
  4. established coronary vascular disease
  5. Renal disease
  6. End organ failure damage
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16
Q

What do you look out for wolf-park white ECG?

(3)

A
  1. sloped QRS (delta wave)
  2. Short PR interval
  3. non-specific ST-T changes
17
Q

non-shockable rhythm management

1.
2.
3.
4.

dont give…

A
  1. Commence CPR 30;2
  2. IV access if no interosseous give adrenaline 1mg - repeat every 3-5 mins
  3. 2 mins chest compress
  4. Repeat adrenaline at 3-5 mins

don’t give amiodarone in non-shockable!

18
Q

name drugs which can lower INR in someone on warfarin
7!!

cytochrome p450 inducers!

drug metabolised quicker so has less effect

A
  1. carbemazapine, pheytoin
  2. barbiturates: phenobarbitone
  3. rifampicin
  4. St John’s Wort (depression mild herbal)
  5. chronic alcohol intake
  6. griseofulvin
  7. smoking (affects CYP1A2, reason why smokers require more aminophylline)
19
Q

when starting ACEi it can cause a lucid drop in renal function but if too low can highlight what pathology?

A

significant renal impairment may occur if the patient has undiagnosed bilateral renal artery stenosis

20
Q

management of cardiac tamponade

non-metastatic cause

metastatic cause (which is what cancer)

A

Non met = urgent pericardiocentesis

Met
= Percutaneous balloon pericardiotomy

Melanoma most common
others- lung, breast, haematological cancers

21
Q

Acute HF management
1. first things first

3.

3.5- may have a role in…
main CI…

If severe hypotension this is trickyyyy….

  1. med
  2. med if 1. doesn’t work
  3. mechanical
A
  1. sit patient up!
  2. IV high dose furosamide or bumetanide (repeat CXR to see if improve)
  3. O2! target 94-98%
  • 3.5- vaodilators not routinely used but nitrates may have a role if concomitant myocardial ischaemia, severe hypertension or regurgitant aortic or mitral valve disease
    the major side-effect/contraindication is hypotension
  1. resp failure/ not improvement then CPAP

hypo

  1. inotropic agents
    e.g. dobutamine
    if - severe left ventricular dysfunction who have potentially reversible cardiogenic shock
  2. vasopressor agents
    e.g. norepinephrine
    - used if insufficient response to inotropes and evidence of end-organ hypoperfusion
  3. mechanical
    - intra-aortic balloon counterpulsation or ventricular assist devices
22
Q

ALS guidlines

Shockable rhythm =
1
2
3
4
5
6
7. If PE suspected

Non-Shock-able rhythm =
1
2
3

A

Shockable rhythm =
1. Start compressions 30;2 whilst waiting for defib
2. Shock once (stacked if witnessed in cardiac centre)
3. adrenaline 1mg after 3rd shock - repeat 1mg every 3-5mins
5. amioderone 300mg after 3rd shock (lidocaine as sub-situate)
6. repeat amioderone 150mg after 5th
7. PE suspected- give thrombolysis ad continue CPR for 60-90mins

Non-Shock-able rhythm =
1.Compressions 30:2
2. Give adrenaline 1mg asap
3. Re-check after 2 mins
4. Repeat adrenaline every 3-5 mins?

23
Q

Reversible causes for cardiac arrest 4H’s 4Ts

A

H- hypoxia
H- Hypothermia
H- Hyper K+, Hypo K+, Hypoglycaemia, acidaemia
H- Hypovolaemia

T- tension PTX
T- Thrombosis
T- Tamponade
T- Toxins

24
Q

Loop Diuretics Adverse Affects

A
  1. Hypo K+, Na+, Mg2+
  2. Ototoxicty
  3. HYPOCALCAEMIA
  4. Renal Immpair (stop in AKI)
  5. Gout
  6. Hypergycaemia
25
Q

Drug induced Ototoxicity

FAV Q&A
( + 2 more)

A

FAV. Q&A

F-furosamide
A- Aminoglycosides (gentamicin)
V- Vancomycin
Q- Quinolines
A- Aspirin

Also NSAIDs and cisplatin (chemo drugs)

26
Q

CI (2) for statins
1
2- other meds

Dosages
- Primary prevention =
increase the dose if…
- Secondary prevention =

A
  1. Preg
  2. macrolides (e.g. erythromycin, clarithromycin) are an important interaction. Statins should be stopped until patients complete the course

Dosages
- Primary prevention = 20mg
increase the dose if… non-HDL >= 40%
- Secondary prevention = 80mg

27
Q

What is

Pulses alternans
whats it seen in?

Kaussmauls sign
whats it seen in? (2*/6)

A

Pulses alternans- drop in BP on inspiration
- Cardiac tamponade

Kaussmauls sign- Rasied JVP on inpiration
- *Constrictive pericarditis
- *right-sided heart failure
- right-sided heart infarction
- tricuspid stenosis and massive pulmonary embolism.

28
Q

What do you see on ECG in hypothermia?
*1.
2
3
4

A

*1. J waves (Osborne waves) - small hump at the end of the QRS complex
2. first degree heart block
3. long QT interval
4. atrial and ventricular arrhythmias

29
Q

Hypothermia

  • Vasoconstriction occurs and 2 hormones are released

Mild =
mod or severe =

Risk Factors (4/6)

A
  • TSH
  • ACTH

Mild = 32-35
mod or severe = < 32

  1. Homeless
  2. Elderly/ extremes of age
  3. Hypothyroidism
  4. impaired mental status
  5. substance misuse
  6. GA
30
Q

Hypothermia

Investigations
Bedside
- Obs- Temp (probe where?)
-
-
Bloods
- FBC (2)
- Electrolyte
- ABG
-

A
  • rectal or thermistor probs
  • ECG: J waves, or acute ST elevation
  • BM- stress hormones are increased and the body czn have more peripheral resisitcne to insulin

Bloods
- FBC- Hb and haematocrit can increase
- WCC and Plt low as sequested in spleen
- K+ HYPO
- Coagulation
- ABG

CXR

31
Q

Hypothermia Management

Conservative/ Initial:
1
2
3
4. If don’t respond…

  • should be ready for… in severe cases
  • don’t use….
A

Initial
1. remove from cold + wet/cold clothing
2. warm by blankets
3. secure airway
4. If don’t respond to passive warming give warmed IV fluids or apply forced warm air

  • be ready for CPR
    IV drugs should be avoided as patient more likely to have drastic response to drugs
32
Q

What Anti-hypertensive is CI in patients with renovascular disease? (bilateral renal artery stenosis)

A

ACE inhibitors

causes the creatinine to increase dramatically as a result of angiotensin II constricting the efferent arteriole, subsequently leading to dilatation of the efferent arteriole and reduced filtration.

33
Q

Patients on warfarin undergoing surgery:

  • Emergency =
  • can wait 6 -8 hours =
A

emergency = four-factor prothrombin complex concentrate

6-8 hours= give 5 mg vitamin K IV

both occasions stop warfarin

34
Q

ECG seen in severe cardiac tamponade

A

Electrical alternans- alternation of QRS complex amplitude between beats.

35
Q

Differenciate these classic post MI complications

Left ventricular free wall rupture
- when?
- presents with

Ventricular septal defect
- when?
- presents with (2)
- do….

Acute mitral regurg
- when?
- MI where?
Presents (3)
need…

A

Left ventricular free wall rupture
- 1-2 weeks after
- presents with Cardiac tamponade: Muffled heart sounds, pulsus paradoxicus, raised JVP

Ventricular septal defect
- first week
- presents with pans-systolic mrumur and assoc. heart failure
- DO ECH TO RULE OUT ACUTE MITRAL REGURG!

Acute mitral regurg
- first week
presents with:
- Inferio-posterior infarction- therefore PAPILLARY muscle rupture
1. Acute hypotension
2. Pul oedema
3. early-to-mid systolic murmur
- need emergecny surgery

36
Q

Amyloidosis seen in patient s wtih mulptiple myeloma have what cardiomyopathy?

A

restrictive cardiomyopathy- Protein deposition in the myocardium

37
Q

Management of NSTEMI
- already given Asprinin loading dose, GTN, O2 if needed, +/- morphone etc..

If haem unstable:

If stable:
1.
2.
-
-
3. Further drugs for PCI
- everyone gets…
Antiplatelet:
- not taking anticoag =
- taking anti-coag =

  1. Conservtive STEMI Further anti-platelet =
    anti-platelet =
A

If haem unstable:
- Immediate coronary angio and PCI

If stable:

  1. Fondiparinux
  2. GRACE score:
    - > 3% high risk next 6 month mortality = coronary angio < 72hrs
    - < 3% consider coronary angio
  3. Further dru gs for PCI
    - everyone gets… unfractionated heparin
    Antiplatelet:
    - not taking anticoag = prasugrel or ticagrelor
    - taking anti-coag = clopidogrel
    • Clopidogrel if high bleed risk
      Tecagralor if not high bleed risk
38
Q

Common SE of thiazides
1. Electrolytes
2.
3
4
5
6

Rare SE of thiazides
1
2
3
4

A

Common
- Hyper GLUC, Glucose, Urea, Lactate, Ca2+
- Hypo Na+, K+, Mg2+
- Gout
- Impotence
- Postural hypotension
- Dehydration

Rare
1- pancreatitis
2- agranulocytosis
3- photosensitive rash
4- thrombocytopaenia

39
Q

In broad complex tachycardias, which classic cardio drug is CI and why?

A

verapamil
can precipitate marked haemodynamic deterioration, ventricular fibrillation (VF), and cardiac arrest.

Year 4 PassMed Incorrect Qs (37 decks)

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