Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardioresp > Cardio > Flashcards

Cardio Flashcards

1
Q

Why is hyperkalaemia so dangerous

A

VF + cardiac arrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the signs and symptoms of hyperkalaemia

A
  • fast irregular pulse
  • chest pain
  • weakness
  • palpitations
  • light headedness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Give three hallmark signs of hyperkalaemia

A

1) small p wave
2) wide qrs
3) tall tented t waves
4) slurred ST segment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What ecg appearance is present in patients with severe hyperkalaemia

A

Sine wave pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

List some possible causes of hyperkalaemia being an artefact finding

A
  • haemolysis e.g. Rapid blood transfusion
  • contamination with edta (hence do FBC after u+e)
  • thrombocythaemia
  • delayed analysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

List the 4 steps of management for hyperkalaemia, with doses

A

1) ecg
2) 10ml 10% calcium gluconate
3) insulin e.g. 10 U rapidly acting insulin + glucose e.g. 50ml
4) nebulised salbutamol 2.5mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What do you do if you’ve tried everything and hyperkalaemia >7mmol/L persists

A

Consider dialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the steps you take to manage a patient with stemi

A

1) 12 lead ecg
2) high flow O2
3) 300mg Aspirin
4) 5-10mg morphine + 10mg metroclopramide
5) GTN - 2 puffs or 1 tablet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the definitive treatment for stemi

A

Primary PCI within 120mins from when you can give thrombolysis and within 12hours of symptom onset
Otherwise fibrinolysis with streptokinase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do you manage an nstemi

A

1) ECG
2) high flow O2
3) 300mg Aspirin +/- 300mg clopidogrel
4) 5-10mg morphine + 10mg metroclopramide
5) heparin e.g. Dalteparin 120U/Kg/12hours sc
6) iv nitrate if pain continues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the definitive treatment for nstemi

A

Urgent angio,
If high risk: infusion of gpiib/iiia inhibitors e.g. Tirofiban
If low risk and no further pain: discharge if 12hr troponin is negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is stage1 in the New York classification of hf

A

heart disease present but no undue dyspnoea from ordinary activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is stage2 of the New York classification of hf

A

Comfortable at rest, but symptoms on ordinary activities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is stage 3 New York classification of hf

A

Less than ordinary activities cause dyspnoea, which is limiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is stage 4 of the New York classification of hf

A

Dyspnoea at rest, all activity causes discomfort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How do you manage broad complex tachycardia with no pulse

A

ARREST CALL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do you manage a patient with broad complex tachycardia, with adverse signs present

A

1) sedate
2) synchronised do of 200>300>360J monophasic
3) AMIODARONE 300mg iv over 20-60 mins
4) correct K+ and Mg2+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What other drugs or management would you consider if normal cardio version techniques don’t work

A
  • lidocaine
  • flecainide
  • procainamide
  • overdrive pacing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

If a patient is in broad complex tachycardia, with no adverse signs and regular rhythm, how would you manage them

A

AMIODARONE 300mg iv over 20-60mins or 50mg LIDOCAINE over 2 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

If a patient with broad complex tachycardia, with no adverse signs and irregular rhythm present to you, how would you manage them?

A

Refer, Synchronised do shock 200>300>360J monophasic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the first sign you check for in a patient with broad complex tachycardia

A

Pulse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the two non shockable rhythms

A

1) asystole

2) pulse less electrical activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the 2 shockable rhythms

A

1) VF

2) pulseless VT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do you treat narrow complex tachycardia with an irregular rhythm

A

As AF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the first steps in managing narrow complex tachycardia

A

Continuous ecg and Vaal manoeuvres

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How do you treat regular rhythm narrow complex tachycardia even before you assess adverse signs

A

ADENOSINE 6mg bolus injection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How do you treat narrow complex tachycardia with regular rhythm and adverse signs present

A

1) sedate
2) give synchronised cardioversion 100>200>300J
3) AMIODARONE 300mg iv over 20-60mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

If a patient has narrow complex tachycardia, with regular rhythm and no adverse signs, how do you treat them

A 
Try any of
Esmolol
Digoxin
Amiodarone
Verapamil
Overdrive pacing if not AF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the level of k+ which makes hyperkalaemia and emergency

A

Over 6.5 mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Which condition often causes radio-radio delay

A

Aortic dissection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Which condition often causes radio femoral delay

A

Coarctation of the aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What does the first heart sound correspond with

A

Closure of the atrioventricular valves (mitral and tricuspid valves)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What does the second heart sound correspond with

A

Closure of the aortic and pulmonary valves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Between which heart sounds is systole

A

Between s1 and s2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Between which heart sounds is diastole

A

Between s2 and s1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Give some causes of a bounding pulse

A

Volume overload, co2 retention (e.g. COPD), pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Give a cause of regularly irregular rhythms

A

Atrial or ventricular ectopics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Give cause of irregularly irregular heart beat

A

AF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How should you investigate possible AF on auscultation during examination of the patient

A

Listen to apex with Steth while feeling pulse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Which pulse should you feel for while listening to the first heart sound

A

Carotids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What quick systems review questions would you ask for in a patient you are taking a cardiovascular history from

A

Bowels ok?

Any problems with waterworks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is the pahtophysiological cause of third heart sounds

A

Stiff or dilated ventricle suddenly reaches its elastic limit and decelerates the incoming rush of blood during diastole, hence causes an extra heart sound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What ages is it normal to have a third heart sound

A

Under 30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

List the causes of third heart sounds

A

1) heart failure
2) mi
3) cardiomyopathy
4) hypertension (pressure overload)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

When do you hear a systolic and when do you hear a diastolic murmur

A 
Systolic = between first and second heart sound
Diastolic = between second and next first heart sound
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the pathophysiology of fourth heart sounds

A

Atrial contraction into a non compliant of hypertrophied ventricle causes fourth heart sound as the atria is struggling to puch blood into the ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Give some causes of fourth heart sound

A 
Ventricular hypertrophy
Hypertension
Mi
Heart failure
Hypertension 
(Always abnormal)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What causes a heave on palpating over the murmur

A

LV hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is a thrill

A

A palpable murmur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Which murmurs are heard best on inspiration and which are heard best on expiration

A

On Inspiration - rIght sided

On Expiration - lEft sided

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What are grades 1, 2, and 3 of intensity of heart murmurs

A

1- very faint
2- soft
3- heard easily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What are grades 4, 5, and 6 of intensity of heart murmurs

A

4- loud with palpable thrill
5- very loud, with thrill, may be heard with Steth partly off chest
6- very loud, with thrill, may be heard with Steth entirely off chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What are the causes of mitral stenosis

A

Rheumatic fever

Old age and calcification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What are the consequences of mitral stenosis that lead to right heart failure

A

High LA pressure > pulmonary venous hypertension
> pulmonary arterial hypertension > RV hyper trophy
> tricuspid regurgitation > RHF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Which valve abnormality may result as a consequence of mitral stenosis

A

Tricuspid regurg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What are some of the signs which may be associated with mitral stenosis

A

AF on pulse
Malar flush
Tapping apex beat due to palpable 1st heart sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What may be heard on auscultation of a patient with mitral stenosis

A

Loud s1
Opening snap
Rumbling mid diastolic murmur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is the best way to hear mitral stenosis

A

With bell of the stethoscope held lightly at apex with patient lying on their left side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What are some of the CXR signs in mitral stenosis

A

Normal sized heart with enlarged left atrium

The signs of pulmonary oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What are some of the ecg changes of a patient with mitral stenosis

A

1) AF
2) bifid p waves if sr
3) rvh causes right axis deviation and tall r waves in leads v1 and v2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What are the causes of mitral regurgitation

A

1) prolapsing mitral valve
2) rheumatic mitral regurg
3) papillary muscle rupture
4) cardiomyopathy of any sort
5) connective tissue disorders e.g. Marfans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

List some of the connective tissue disorders that may lead to mitral regurg

A

Marfans syndrome
Ehlers Danlos
Osteogenesis imperfecta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What are some of the signs that may be found in a patient with mitral regurg

A

Malar flush
Displaced apex beat
Palpable thrill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What may be heard on auscultation of a patient with mitral regurg

A

Pansystolic murmur radiating to axilla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What may a CXR of a patient with mitral regurg show

A

Left atrial and left ventricular enlargement - cardiomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Which chamber is likely to be affected by disease in a patient with bifid p waves on ecg

A

LA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What may be seen on ecg of a patient with mitral regurgitation

A

Bifid p wave

Left ventricular hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What are some of the causes of aortic stenosis

A

Bicuspid aortic valve
Age related calcification
Rheumatic fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What are some of the symptoms of aortic stenosis

A

Exercise induced syncope - Angina and dyspnoea develop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is found on the pulse of patients with aortic stenosis

A

Slow rising
Low volume
Narrow pulse pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is felt on palpation of the apex region with aortic stenosis

A

Forceful apex beat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What is heard on auscultation of a patient with aortic stenosis

A

Ejection systolic murmur radiating to the carotids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Where else should you listen with the diaphragm of the Steth in a patient with aortic stenosis

A

The carotids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What do you listen for with the bell of the Steth in the carotid area

A

Bruits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What may be seen on the CXR of a patient with aortic stenosis

A

Relatively small heart with a prominent, dilated ascending aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Why do you get a dilated ascending aorta in patients with aortic stenosis

A

Post stenosis dilatation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What may be seen on ECG of a patient with aortic stenosis

A

LVH

LV strain pattern - depressed St segments and t wave inversion I leads directed towards left ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

How is aortic regurgitation best heard on auscultation

A

Sit the patient forward with their breath held in expiration

Listen at left eternal edge in the fourth intercostal space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What is the typical murmur of a patient with aortic regurgitation

A

High pitched early diastolic murmur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What are the causes of aortic regurg

A 
Rheumatic fever
Bicuspid valve
Infective endocarditis 
Marfans 
Tertiary syphillis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Give two infective causes of aortic regurgitation

A

Syphillis

Infective endocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What is the typical pulse sign in patients with aortic regurg

A

Collapsing

Wide pulse pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What is the difference in pulse pressure between aortic regurg and aortic stenosis

A

Aortic stenosis has a narrow pulse pressure

Aortic regurg has a wide pulse pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What is quincke’s sign in aortic regurg?

A

Capillary pulsation in nail beds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What is de mussels sign in aortic regurg

A

Head nodding with each heart beat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What aid the pistol shot femorals sign in aortic regurg

A

Sharp bang heard on auscultation over femoral arteries in time with each heartbeat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What may be seen on an ecg of a patient with aortic regurg

A

LVH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What is p. mitrale on an ecg, and what is it an indication of

A

Bifid p wave

LA abnormality e.g. Dilatation, hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What is p. pulmonale on ECG and what is it an indication of

A

Peaked p waves >2.5mm

An indication of Right atrium enlargement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What is the pathophysiological cause of fourth heart sounds

A

Atrial contraction into a non compliant or hypertrophied ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Why are right heart murmurs heard best on inspiration

A

Inspiration increases venous blood return to the right side of the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

When are left sided murmurs heard loudest

A

On expiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What is a grade 1 and 2 murmur

A

1) very faint

2) soft

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What is grade 3 and 4 murmur

A

3) heard easily

4) loud, with palpable thrill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What is grade 5 and 6 murmur

A

5) very loud, with thrill, may be heard with Steth partly off chest
6) very loud, with thrill, may be heard with Steth entirely off chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

On an ecg, what is he normal PR interval

A

3-5 small sq (0.12-0.2 secs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What is the normal QRS interval length

A

2-3 small sq

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What is the normal ST segment length

A

2-3 small sq (0.08-0.12s)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

How do you calculate heart rate from a regular rhythm strip

A

300 divided by number of big squares between R-R interval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

How do you calculate heart rate in a ecg rhythm strip which is irregular rhythm

A

Count number of qrs complexes in a 19 second rhythm strip and multiply by 6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What defines sindus rhythm

A

Each qrs preceded by p wave, with normal rhythm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What does atrial flutter look like on ecg

A

Sawtooth p waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

At what rate do atria and ventricles contract in atrial flutter

A

Atria contact at 300 bpm but eb tricked do not conduct that many atrial ap’s so the ventricular date is often around 150 bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

How do you calculate the rate of block in atrial flutter, considering the atrial rate is usually 300 bpm and the ventricles don’t contract at the same rate

A

Ventricular rate 150 = 2:1 conduction
Rate 100 = 3:1 conduction
Rate 75 = 4:1 conduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

What does ventricular tachycardia look like on ecg

A

Fast 120-180 bpm, broad complexes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What is the cardiac axis

A

The direction of spread of depolarisation through the ventricles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

How do you work out the heart axis looking at an ecg

A

Find the isoelectric lead (or most isoelectric lead). The axis is perpendicular to that
Compare the leads to lead II, III, AVL and AVR in terms of which ones show negative and positive deflections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What angles does the normal axis lie between

A

-30 to +90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

At which angles does left axis deviation lie

A

Less than -30 deg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

At which angles does right axis deviation lie

A

At over +90 deg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Is the lead I is greatly positive and lead II and AVF are negative, what axis deviation is it likely to be

A

Left axis deviation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

If lead AVF/III is greatly positive and lead I is negative, what axis derivation is it likely to be

A

Right axis deviation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

What does left atrium enlargement show in ecg

A

P mitrale - bifid p waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

What does right atrial enlargement show on ECG

A

Tall p waves (p pulmonale)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Over how many squares is considered a prolonged p wave

A

> 3 small squares

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

How many square’s height is considered tall p waves

A

Over 3 small squares height

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

List the degrees of heart block

A
  • first deg
  • second deg - mob its I (wenkebach) and Mobitz 2
  • third deg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

What is first degree heart block

A

PR interval prolonged by constant amount

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

What is Mobitz type 1 (wenckebach) heart block

A

Progressive lengthening of PR interval until one qrs complex is dropped

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

What is mobitz type II second degree heart block

A

Intermittent failure of AVN to conduct atrial depolarisation to the ventricles
May be fixed 2:1 , 3:1 etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

What is third degree heart block

A

No relationship between the p waves and qrs complexes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

What is the usual HR in patients with third degree heart block

A

30-50bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

What is consistently firing off in third degree heart block

A

P waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

What does increased qrs height indicate

A

Left or right ventricular hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

What does increased qrs width indicate

A

Left or tight bundle branch block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

What ecg features indicate left ventricle hypertrophy

A

S wave in V1+ R wave in V5 or V6 together over 35mm (3.5 large ecg squares)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

What are the ecg features of right ventricular hypertrophy

A

R wave tall in right ventricular leads (>5mm) + RAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

How do you determine right bbb from left bbb

A

Compare lead V1 with V6
Lbbb: W in V1 and M in V6
Rbbb: M in V1 and W in V6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

List some causes of St segment elevation

A

Acute mi

Pericarditis (widespread)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

How do you define St depression

A

> 1 mm in 2 consecutive limb leads OR

> 2 mm in 2 consecutive chest leads

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

What are the ecg changes seen over time with stemi

A
  • within hours : St elevation
  • within days : St elevation and t wave inversion, pathological q waves
  • within weeks : St flattening, t wave inversion and pathological q waves persist
  • months : pathological q waves persist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

Which leads are affected in septal infarct

A

v1 and v2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

Which leads are affected in anterior infarct

A

V3 and 4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

Which leads are affected in lateral infarct

A

V5 and 6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

Which leads are affected in high lateral infarct

A

I, AVL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

Which leads are affected by inferior infarct

A

II, III, AVF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

What ECG changes are seen in PE

A

S1, Q3, T3

Large S wave in lead 1
Q wave inversion in lead 3
T wave inversion in lead 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

List some other precipitates of angina expect for exercise

A

Emotion, cold weather, heavy meals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

Which special investigations may be tried in patients with angina pectoris

A
  • exercise stress ecg
  • coronary angiography
  • cardiac ct
  • stress echo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

Which angina patients should be considered for referral

A
  • diagnostic uncertainty
  • new angina of sudden onset
  • recurrent angina e.g. Past mi/cabg
  • angina uncontrolled by drugs
  • unstable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

What is Percutaneous Transluminal Coronary Angioplasty

A

balloon dilatation of stenotic vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

List the steps for management of angina pectoris

A
  • modify lifestyle risk factors
  • aspirin
  • Beta blockers
  • nitrates
  • long acting calcium antagonists
  • potassium channel activator
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

What is the mechanism of action of nicorandil

A

Potassium channel activator - promotes K+ efflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

When is cabg performed

A 
Left mainstem disease
Multi vessel disease
Multiple severe stenosis 
Those unsuitable for angioplasty or failed angioplasty
Refractory angina
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

How is the procedure of cabg performed

A

Angiography
Heart stopped and blood pumped artificially by a machine outside the body
Patients own saphenous vein / internal mammary artery used as graft

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

What is aortic dissection

A

Blood splits the aortic media

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

How does aortic dissection present

A

Sudden tearing chest pain +/- radiation to the back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

What is the typical sign of aortic dissection found on examination

A

Radio radial delay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

As a result of aortic dissection, branches of the aorta may occlude, what can then result

A
  • Hemiplegia (carotid)
  • unequal arm pulses or bp
  • paraplegia (anterior spinal artery)
  • Anuria (renal arteries)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

What is the difference between type a and b aortic dissection

A

A - ascending aorta involved

B - ascending aorta not involved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

Which type of aortic dissection requires urgent surgical review more than the other - a or b

A

A (involves aortic arch)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

What is the definition for heart failure

A

CO is inadequate for body’s requirements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

List the main causes of heart failure

A

Ischaemic heart failure
Non ischaemic dilated cardiomyopathy
Hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

List the congenital heart diseases that can lead to heart failure

A

Asd, vsd

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

List some pericardial diseases that can lead to heart failure

A

Constrictive pericarditis, pericardial effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

List some causes of RHF

A

Pulmonary hypertension, PE, RV infarct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

List the pathophysiological changes in heart failure

A

Ventricular dilatation, myocyte hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

What are the systemic blood pressure changes in the pathophysiology of heart failure

A
  • sympathetic stimulation
  • peripheral vasoconstriction
  • salt and water retention
    Leads to increased ANP secretion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

What is starlings law

A

The greater the volume of blood entering the heart during diastole, the greater the volume of blood ejected from the LV during systolic contraction (stroke volume)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

What is the ejection fraction

A

Fraction of blood pumped out of the ventricles with each heart beat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

How is ejection fraction measured

A

ECHO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

What is the difference between systolic and diastolic heart failure

A

Systolic - inability of ventricle to contract therefore reduced ejection fraction
Diastolic - inability of ventricle to relax and fill normally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

List some chases of systolic heart failure

A

IHD, cardiomyopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

List some causes of diastolic heart failure

A

Constrictive pericarditis, tamponade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

What are the early compensatory mechanisms for marinating cardiac output in heart failure

A

Venous pressure increased, preload increased, therefore end diastolic volume increased
Coupled with sinus tachycardia
Reduced ejection fraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

What are the late compensatory mechanisms for marinating co in mod-severe heart failure

A

Co can only be maintained by massive increases in venous pressure, which leads to dyspnoea, hepatomegaly, ascites, dependent oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

Can CO be maintained in severe heart failure

A

No, it is decreased even at rest despite increased venous pressure and sinus tachy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

What are the main causes of left heart failure

A
  • IHD
  • non ischaemic dilated cardiomyopathy
  • hypertension
  • mitral/aortic valve disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

List the main symptoms of left heart failure

A

Fatigue, exertional dyspnoea, orthopnoea, PND, pink frothy sputum, poor exercise tolerance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

What are the physical signs on doing a cardiovascular examination of left heart failure

A

Displaced apex beat, gallop rhythm on auscultation (3rd heart sound), mitral regurgitation, crackles at lung bases, dependent pitting oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

How do ANP and BNP act on the kidneys

A

Increase GFR, and decrease renal sodium absorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

What investigations should be carried out, except for blood tests, in heart failure

A

CXR, echocardiogram

ECG may indicate cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

Which molecule should be tested for in blood tests of patients with heart failure

A

B type natriuretic peptide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

What is class 1 and 2 NYHA heart fissure classification

A

1 - no limitation to physical activity

2 - slight limitation to physical activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

What is stage 3 and 4 of NYHA classification of HF

A

3- marked limitation on physical activity

4- symptoms at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

List the causes of right heart failure

A
  • chronic lung disease (cor pulmonale)
  • PE or pulmonary hypertension
  • tricuspid/pulmonary valve disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

What how can asd/vsd cause right heart failure

A

Left to right shunts, putting more pressure on the right side of the heart which is not adapted to such high pressures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

List some of the symptoms of RHF

A

Fatigue, dyspnoea, anorexia, nausea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

List some of the physical signs on examination of a patient with right heart failure

A
  • increased jugular venous pressure
  • cardiomegaly
  • hepatic enlargement
  • ascites
  • dependent pitting oedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

List some of the general management steps in heart failure

A

Low level exercise, low salt diet, stop smoking, education, vaccination
As well as treating the cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

List the steps of a management in heart failure

A

1) diuretics
2) ace inhibitor
3) beta blockers
4) spironolactone (aldosterone antagonist)
5) inotropic agents e,g, digoxin
6) nitrates
7) anticoagulation

182
Q

What are the first, second and third line diuretics used in heart failure

A

Step 1- furosemide
Step 2- change to bumetanide
Step 3- add a thiazide

183
Q

List a thiazide diuretic that is commonly used in heart failure

A

Metolazone

184
Q

If a patient on ace inhibitors for heart failure gets a dry cough side effect, which drug class can be sued instead

A

Angiotensin receptor blockers

185
Q

How does dobutamide work

A

It is an inotrope - acts as a beta 1 agonist, acting as a sympatheticomimetic

186
Q

When is digoxin considered in the treatment of hf

A

Patients who have severe hf in spite of therapy with vasodilators, beta blokes and diuretics

187
Q

How do nitrates work positively to help with hf

A

Reduce preload and after load

188
Q

List the nitrate drugs that may be given in heart failure

A

Glyceryl trinitrate, isosorbide momonitrate

189
Q

What are the other non pharmacological treatments for hf

A

Revascularisation, biventricular pacemaker, defibrillator, cardiac transplant

190
Q

What is the difference between low input and high output heart failure

A

Low output - co reduced and fails to increase normally with exertion
High output - this is rare. Output is increased with increased needs, however with high output filature inability to increase CO in response is of faster onset than in the normal heart

191
Q

What are the Framingham criteria for

A

Diagnosis of CCF

192
Q

How many minor and major criteria are required in Framingham CCF criteria

A

2 major or

1 major and 2 minor

193
Q

List the major Framingham criteria

A

1) PND
2) crepts
3) s3 gallop
4) cardiomegaly
5) increased Central venous pressure
6) weight reduction in response to treatment
7) neck vein distension

194
Q

What are the minor criteria for framinghams CCF diagnostic criteria

A

1) bilateral ankle oedema
2) dyspnoea on exertion
3) tachy >120
4) reduction in vital capacity
5) nocturnal cough
6) hepatomegaly
7) pleural effusion

195
Q

List the CXR signs of hf

A

1) dilated prominent upper lobe vessels
2) alveolar oedema - bats wings sign
3) cardiomegaly
4) kerley b lines
5) pleural effusion

196
Q

Why does pleural a effusion occur with CCF

A

Increased pulmonary capillary pressure

197
Q

What is the pathophysiology of bats wings and kerley b lines in CCF chest Xray

A

Alveolar oedema - bats wings sign

Interstitial oedema - kerley b lines

198
Q

List the pathophysiological steps of atherosclerosis

A
  • triggered by injury
  • lipoproteins oxidised
  • taken up by macrophages and creates foam cells
  • release of cytokines
  • accumulation of fat and smooth muscle proliferation
  • plaque formation
199
Q

List the steps where atherosclerotic plaques becomes myocardial ischaemia

A
  • rupture of coronary artery plaque
  • platelet aggregation and adhesion
  • localised thrombus, vasoconstriction
  • myocardial ischaemia results
200
Q

What are the ECG criteria for diagnosing a stemi at j point

A
  • 0.2 mV or more increased in leads V1-V3

- 0.1 mV or more increased in any of the other leads

201
Q

How do you manage a stemi, after a-e assessment, iv access, and 12 lead ecg has been sorted

A
  • assess for risk factors e.g. Pulse, bp, jvp, murmurs
  • aspirin 300mg
  • morphine 5-10mg IV + metoclopramide 10mg
  • GTN sublingual 2 puffs
  • assess for PCI
202
Q

Within how many minutes should a PCI be performed in stemi

A

120 minutes of when thrombolysis could have been given and within 12 hours of symptom onset

203
Q

What is given to a patient who cannot have a PCI within 120 minutes with a stemi

A

Thrombolysis, e.g. Streptokinase, or more commonly reteplase

204
Q

How is an n-stemi treated?

A
  • admit to CCU
  • O2 - 2-4litres aiming for sats over 95%
  • morphine - 5-10mg plus metoclopramide 10mg
  • aspirin - 300mg +/- clopidogrel 300 mg
  • oral beta blocker
  • heparin
  • IV nitrate if pain continues
205
Q

If a patient with n-stemi is managed adequately and is low risk, with no further pain, and negative Troponin, how are they managed next

A

Discharge, if repeat troponin is negative over 12 hours. Treat medically and arrange further investigation.

206
Q

If a patient with n-stemi is treated adequately but is still high risk, has recurrent ischaemia, ST depression, or troponin is raised, how do you manage them next

A

Urgent angiogram, tirofiban plus clopidogrel. Optimise health with beta blocker, CCB, ACI, Nitrates, statins

207
Q

If there is still no improvement with n-stemi patients who are high risk, and have been treated adequately, what is the final step in their management

A

Angiography +/- PCI/CABG

208
Q

Which enzymes do you test for in the blood of a patient suspected with MI

A

CK, troponin I

209
Q

Which leads does ST elevation occur in in anteroceptal MIs

A

V1-4

210
Q

Which leads show ST elevation in a lateral stemi

A

V5-6

211
Q

Which leads show ST elevation in a high lateral STEMI

A

Lead I, AVL

212
Q

Which leads show ST elevation in an inferior STEMI

A

Leads II, III, AVF

213
Q

Which coronary artery is usually the cause of an inferior STEMI

A

RCA

214
Q

Which coronary artery is responsible for a STEMI in the anteroceptal region

A

LAD

215
Q

The circumflex artery becoming blocked can lead to which two areas becoming ischaemic hence causing a STEMI

A

Lateral and high lateral MI

216
Q

List the indications for thrombolysis in a STEMI

A

Less than 12 hours onset of pain plus any of the following:

217
Q

List the complications of STEMI

A
  • heart failure/ pericarditis
  • rupture of papillary muscles or septum
  • embolism
  • aneurysm/arrhythmias
  • Dressler’s syndrome
  • sudden death
218
Q

List the symptoms of Dressler’s syndrome

A

Low grade fever, pleuritic chest pain, pericarditis, pericardial effusion

219
Q

Which drugs are given to patient with STEMI after discharge

A 
Aspirin, clopidorgel
Acei
B blockers
Statin
Address modifiable risk factors/comorbidities
220
Q

How many months off work do you have to take after suffering a STEMI

A

1 month

221
Q

Who long do you have to abstain from driving after an STEMI

A

4 weeks

222
Q

How do you distinguish between NSTEMI and unstable angina

A

Troponin I - negative troponin in unstable angina

223
Q

What is flash pulmonary oedema

A

Rapid onset pulmonary oedema, most often precipitated by acute mi or mitral regurgitation, heart failure.

224
Q

How does acute LV failure present

A

Acute pulmonary oedema

With symptoms of breathlessness, frothy pink sputum, orthopnoea, collapse, arrest, cardiogenic shock

225
Q

List the signs of acute LV failure

A
  • distressed, pale and sweaty
  • tachycardia
  • fine crepts bilaterally
  • gallop rhythm 3rd heart sound
226
Q

What are the commonest causes of LVF

A

Myocardial ischaemia, hypertension, aortic stenosis, aortic incompetence, mitral incompetence

227
Q

How do you treat acute LVF, after a to e assessment

A 
100% O2 via non rebreathe mask
Morphine 5 mg iv + metoclopramide 10mg
Nitrate if high systolic bp
Furosemide 40-80 mg iv
CPAP
228
Q

List the narrow complex tachycardias

A

AF, atrial flutter, re entrant tachycardia, others e.g. Atrial tachycardia

229
Q

Lost the main crowd complex tachycardias

A

VT

SVT with BBB

230
Q

List the three main mechanisms of tachy arrhythmia production

A

1) accelerated automaticity
2) triggered activity e.g, myocardial damage
3) re entry

231
Q

How is regular SVT managed

A

-A-E, O2 and iv access
- Vagal manoeuvres
- Adenosine
Seek help
- Antiarrhythmiac
- DC cardioversion if haemodynamically unstable

232
Q

How are narrow complex SVTs which are irregular managed

A

As per AF

  • b blocker iv or digoxin iv
  • AMIODARONE 300 mg iv
233
Q

How is narrow complex SVT with regular rhythm managed

A

Vagal manoeuvres
Adenosine 6mg iv, then further doses as per guidelines
Monitor ecg continuously

234
Q

List the causes of ventricular tachycardia

A
  • torsades de pointes
  • SVT with bbb
  • pre excited tachycardia
235
Q

What is pre excitement

A

When ventricles become depolarised too early, which leads to their partial premature contraction. Abnormal pathway leads to lack of normal AVN delay

236
Q

How are broad complex tachycardias managed if they show no adverse signs

A

Amiodarone/lidocaine
K+/Mg2+ if needed
Sedation and DC cardioversion

237
Q

How are broad complex tachycardias treated if they show adverse signs

A

Sedation, DC cardioversion, amiodarone/lidocaine

238
Q

Which diuretic classes cause hypokalaemia and which cause hyperkalaemia

A

Loop and thiazide diuretics - hypokalaemia

k+ sparing diuretics - hyperkalaemia

239
Q

What type of drug is metolazone

A

Thiazide like diuretic

240
Q

Which particular part of the LoH do loop diuretics affect

A

TAL

241
Q

What are the side effects of loop diuretics

A

Hypokalaemia, deafness (ototoxicity), hypovolaemia , and hypotension

242
Q

List some side effects of thiazide diruetics

A

Hypokalaemia, hyponatraemia, hyperuricaemia, hyperglycaemia

243
Q

List some contraindications to thiazide diuretics

A

Refractory hypokalaemia, hyponatraemia, hypercalcaemia, Addison’s disease,

244
Q

What is the mechanism of action of spironolactone

A

Aldosterone antagonist

245
Q

What is the mechanism of a iron of amiloride

A

Inhibits ENaC channels

246
Q

Which drugs are potassium sparing diuretics co used with

A

K+ losing diuretics e,g, furosemide

247
Q

What are the side effects of potassium sparing diuretics (spironolactone, amiloride)

A

Impotence, gynaecomastia, menstruated problems,

Hyperkalaemia, hyponatraemia

248
Q

Why can spironolactone cause menstruated problems, gynaecomastia etc.

A

Blocks mineralcocorticoid receptors, but also has effects on androgens

249
Q

What are the three main lipid lowering drug classes

A
  • statins
  • Fibrates
  • ezetimibe
250
Q

What are the two principal mechanism of action of statins

A

1) inhibit HMG-coA reductase, hence inhibiting liver cholesterol synthesis
2) increased absorption of Ldls from the bloodstream into the liver, dour to upregulation of ldl receptors

251
Q

List the side effects of statins

A

Myositis, rhabdomyolysis, altered LFTs, paraesthesia, GI effects

252
Q

What are the contraindications of statins

A

Acute liver disease, pregnancy, breast feeding

253
Q

Which particular lipids do Fibrates act to lower

A

Triglycerides MORE than LDL

254
Q

How does Ezetimibe work

A

Lowers cholesterol absorption in the intestine

255
Q

What would you suspect in a patient with freer and a new murmur

A

Endocarditis until proven otherwise

256
Q

What is infective endocarditis

A

Microbial infection of normal or prosthetic heart valves, the endothelial surface of the heart, or a congenital defect such as PDA

257
Q

What is the main causative organism for infective endocarditis

A

Streptococcus viridans

258
Q

Which patients are at risk of infective endocarditis caused by staphylococcus aureus

A

Those with Skin infections, abscesses, central lines, iv drug abusers

259
Q

List the steps in the pathophysiology of infective endocarditis

A

1) endothelial damage/damaged valve
2) platelets and fibrin deposited
3) bacteria is delivers bacteria to surface of heart
4) adherence and colonisation of bacteria
5) fibrin aggregates protect bacteria vegetation from host defence mechanisms

260
Q

List the consequences of infective endocarditis

A
  • disruption of valve cusps, commonly leading to mitral or aortic regurgitation
  • vegetations embolise
  • deposition of immune complexes
261
Q

Where can infective endocarditis vegetations embolise in the body

A

Cerebral, pulmonary, coronary, renal

Can cause abscesses/haematuria

262
Q

What are the immune vasculitis presentations of infective endocarditis

A
  • Roth spots
  • oslers nodes and janeway lesions
  • clubbing
  • splinter haemorrhages
  • glomerulonephritis
263
Q

What are the two major criteria in diagnosing infective endocarditis

A
  • positive blood culture for IE (2 separate +ve cultures, or persistently positive cultures)
  • evidence of endocardial involvement (+ve Echo, or new vascular regurg)
264
Q

What is TOE in cardiology

A

Trans oesophageal echo

265
Q

List the five minor criteria in diagnosing infective endocarditis

A

1) predisposition
2) fever >38 deg
3) vascular/immunological signs
4) positive blood culture not meeting major criteria
4) positive echo not meeting major criteria

266
Q

What combinations of major and minor criteria lead to a diagnosis of infective endocarditis

A
  • 2 major
  • 1 major + 3 minor
  • 5 minor
267
Q

How many cultures do you take in suspected infective endocarditis, and where from

A

3 different cultures form different places, at oeak temperature

268
Q

How is infective endocarditis managed

A

A to E
Refer to cardio and micro
Drugs depends on organism
Empirical treatment of benzylpenicillin and gentamicin, at least 4 weeks

269
Q

What is the empirical treatment. For infective endocarditis

A

Benzylpenicillin and gentamicin

270
Q

When should surgery be considered in infective endocarditis

A

Heart figure, valvular obstruction,mrepreatrd emboli, fungal endocarditis, abscess, unstable infective prosthetic valve

271
Q

Why is antibiotc prophylaxis no longer given to patients at risk of infective endocarditis who are undergoing procedures

A

It has shown little evidence of benefit in practice and must be weighed up with the negatives of adverse effects a DM antibiotic resistance

272
Q

Wha it’s the visceral layer of the pericardium made of

A

Mesothelial cells

273
Q

Where does pericardial fluid drain

A

Via the thoracic duct and right lymphatic duct into the right pleural space

274
Q

What are the signs and symptoms of acute pericarditis

A

Chest pain, pericardial friction rub, serial ecg changes

275
Q

What is the pathophysiology of pericarditis

A

Inflammation of pericardium;

Infiltration of polmorphonuclear leucocytes and pericardial vascularisation

276
Q

What are the possible consequences of pericarditis

A
  • constrictive pericarditis

- pericardial effusion

277
Q

Why can constrictive pericarditis occur in pericarditis

A

Exudates and adhesions encase the heart

278
Q

What may pericardial effusion lead to as it develops from pericarditis

A

Accumulation of pressure can lead to cardiac tamponade

279
Q

What is the most common cause of pericarditis

A

Virus - particularly Coxsackie virus

280
Q

Expect for viral causes, what are the other causes of pericarditis

A
  • TB
  • bacterial
  • cardiovascular disease e.g, mi, Dressler’s syndrome
  • neoplasm
  • renal failure
  • inflammatory/autoimmune
281
Q

How is bacterial pericarditis treated

A

Antibiotics for at least 4 weeks and drainage of pericardial fluid

282
Q

List some inflammatory conditions associated with pericarditis

A
  • rheumatoid arthritis
  • sarcoidosis
  • SLE
283
Q

List the main symptoms of pericarditis

A
  • pleurisy: sharp pain worse on inspiration
  • central chest pain, radiating to left shoulder
  • eased sitting forward
284
Q

What may be found on examination of a patient with pericarditis

A
  • tachycardia
  • tachypnoea
  • fever
  • pericardial friction rub
  • shins of RHF / high pitched loud s3
285
Q

Apart form the usual bloods, which other serology investigations should you do on a patient with suspected pericarditis

A
  • virology screen
  • blood cultures
  • antistreptolysin culture
  • rheumatoid factor
  • antinuclear antibodies
  • anti DNA antibodies
  • tuberculin testing and sputum test for acid fast bacilli
286
Q

What are the serial ecg changes in pericarditis

A

1) saddle shaped ST elevation
2) ST segment returns to normal a couple of days later
3) T wave inversion
4) ECG returns to pre pericarditis baseline weeks to months after onset

287
Q

How is pericarditis imaged

A

Echocardiography

Ct/mri

288
Q

What is the treatment of pericarditis

A
  • high dose PO aspirin and bed rest
  • corticosteroids sometimes used if disease does not subside rapidly
  • pericardial window/pericardiectomy
289
Q

What is the calculation for the ejection fraction

A

Stroke volume/end diastolic volume

290
Q

Define a pericardial effusion

A

Abnormal accumulation of fluid in the pericardial cavity

291
Q

Define cardiac tamponade

A

Pericardial effusion causing haemodynamically significant cardiac compression

292
Q

How does pericardial effusion affct venous return

A

Inhibits it

293
Q

How does cardiac tamponade affect blod flow int he heart and body

A

Reduces cardiac output hence results in hypotension and shock

294
Q

What are some of the acute causes of oericardial effusion

A
  • trauma
  • iatrogenic
  • aortic dissection
  • spontaneous bleed
  • cardiac rupture post mi
295
Q

What are the subacute causes of pericarditis

A
  • malignancy
  • idiopathic pericarditis
  • uraemia
  • infection
  • radiation
296
Q

What is Becks triad of signs in pericardial effusion

A
  • increased jvp
  • decreased blood pressure
  • muffled heart sounds
297
Q

The presentation of pericardial effusion depends on the speed at which fluids collects. Give some of the different presentations of the condition

A
  • cardiac arrest
  • hypotension
  • confusion
  • shock
  • sob, dysphagia, cough, hiccups if slowly developing
298
Q

What is kussmauls sign

A

Jvp is increased with inspiration

299
Q

What is pulsus paradoxus

A

Massive decrease in bp on inspiration

300
Q

What is pulsus paradoxus a sign of

A

Pericardial effusion

301
Q

How is pericardial effusion/tamponade managed

A

Emergency

  • a to e
  • iv access and fluids
  • ecg
  • bloods
  • senior help
  • pericardiocentesis +/- drain
302
Q

How is pericardiocentesis performed

A

Needle inserted in xiphisternum, USS guided. Ai, for tip of left scapula and aspirate continuously

303
Q

What do you do with pericardial fluid aspirated from pericardial effusion

A
  • send for micro and cytology
304
Q

List two af risk factor scores

A
  • CHADVASC

- HASBLED

305
Q

What is chadvasc used to predict

A

The risk of stroke in patients with AF, taking a variety of factors such as age, gender. And conditions such as DM into account

306
Q

What is HASBLED used as a predictor of

A

Assess 1 year risk of major bleeding in patients with AF, taking into account factors such as stroke, labeled inrs, abnormal liver and renal function etc.

307
Q

List a type 1A Antiarrhythmiac

A

Quinidine

308
Q

List a type 1B antidysrrhythmic

A

Lidocaine

309
Q

List a type 1C antidysrrhythmic

A

Flecainide

310
Q

List a class 2 antidysrrhythmic

A

B blocker e,g, bisoprolol

311
Q

List a class 3 antidysrrhythmic

A

K+ channel blocker e.g. amiodarone

312
Q

List a type 4 antidysrrhythmic

A

CCBs e.g. Diltiazem

313
Q

What are the effects of b blockers on the heart

A

Negatively chronological and inotropic

314
Q

List the side effects of beta blockers

A

Bradycardia, hypotension, cold peripheries. Bronchospasm,

315
Q

How does adenosine work

A

Causes transient heart block by inhibiting A1 therefore inhibiting Ca2+ influx and hence contraction

316
Q

Which antidysrrhythmic class can exacerbate Raynaud’s phenomenon

A

Class 2 - beta blockers

317
Q

What are the contraindications to beta blockers

A

Asthma, marked bradycardia, heart block

318
Q

List the two main types of CCBs

A
  • non dihydropyridines: verapamil, Diltiazem

- dihydropyridines: amlodipine, nifedipine

319
Q

How do CCBs work

A

Dilates peripheral arteries, reduces after load of heart, dilates coronary vessels (acts on coronary apvessels more than myocardium)

320
Q

List some of the side effects of verapamil and Diltiazem

A

COSNTIPATION, flushing, headache

321
Q

List some side effects of amlodipine

A

Palpitations, flushing. Headache, dizziness

322
Q

When are verapamil and Diltiazem contraindicated

A

Hf, 2nd and 3rd deg heart block, cardiogenic shock

323
Q

When are dihydropyridines such as amlodipines contraindicated

A

Unstable angina, significant AS

324
Q

What are dihydropyridines used to treat

A

HTN, prevention of angina

325
Q

What is verapamil used for

A

Fast AF, SVT, HTN

326
Q

What are the id citations for nitrates

A

Stable angina, unstable angina, acute hf, chronic hf

327
Q

What are the contraindications to nitrates

A

Hypotension conditions, hypovolaemia, cardiac tamponade, constrictive pericarditis

328
Q

What are some of the side effects of nitrates

A

Postural hypotension, throbbing headache, dizziness, tachy

329
Q

What positive benefits do ace inhibitors have for conditions of the heart

A
  • reversal of LV hypertrophy

- reversals of endothelial dysfunction

330
Q

What are some of the side effects of ace inhibitors

A

Renal impairment m chronic cough. Angio oedema, pancreatitis

331
Q

List some of the constrain cations to ace inhibitors

A

Hypersensitivity to ace I, renal artery stenosis, pregnancy

332
Q

What cod it one is digoxin used in

A

AF and atrial flutter with rapid ventricular response

333
Q

How does digoxin work

A

Slows down the conduction in the AVN, I crashing its refractory period, hence reducing the ventricular rate

334
Q

What arrhythmia is magnesium used to treat and how does it work

A

Torsades de pointes - shortens the QT interval

335
Q

What is prinzmetals angina

A

Angina at rest occurring due to vasospams of the coronary arteries

336
Q

Hey is prinzmetals angina treated

A

CCBs and nitrates. NOT b blockers

337
Q

List the different types of anti platelets

A

Aspirin, clopidogrel, dipyridamole, glycoprotein IIA/IIIB antagonists

338
Q

What is the mechanism of action of aspirin

A

Suppresses production of prostaglandins and thromboxane by irreversible inhibiting COX enzyme

339
Q

What does cox enzyme act to do

A

Convert arachidonic acid to prostaglandin

340
Q

What is the mechanism of action clopidogrel

A

Inhibits ADP-induced aggregation of platelets

341
Q

How does dipyridamole work

A

Phosphodiesterase inhibitor to block platelet aggregation In conjunction with aspirin

342
Q

List a glycoprotein IIA/IIIB inhibitor

A

Abciximab, tirofiban

343
Q

Is LMWH fully reversible with protamine

A

No

344
Q

Which factors does warfarin hip hint the production of

A

Vit k dependent - II, VII, IX, X

345
Q

How is warfarin overdose treated if INR is

A

Decrease/omit warfarin

346
Q

How is warfarin overdose treated if INR is 6-8

A

Stop warfarin and restart when INR is less than 5

347
Q

How is warfarin overdose treated if INR is > 8

A

If no bleeding stop warfarin and give 9.5-2.5 mg vitamin K if at risk of bleeding

348
Q

If a patient experiences a major bleed with warfarin od, how do you manage it

A 
Stop warfarin
Prove prothrombin complex concentrate (beriplex) which contains factors 2, 7, 9 and 10
Or FFP
Give 5mg vit k 
Get help/refer!!
349
Q

What is the difference in the mechanism of action of UFH and LMWH

A

Both affect factor Xa and activate ATIII but LMWH does NOT affect thrombin

350
Q

Give some contraindications of heparin

A

Uncontrolled bleeding, risk o fbleeding, peptic ulcer, recent de renal haemorrhage, endocarditis

351
Q

What are the ecg changes in posterior MI

A

Dominant R wave v1-v3, with ST depression and upright t waves

352
Q

Which other murmur is often associated with mitral stenosis and why

A

Tricuspid regurg - increased LA pressure caused by mitral stenosis leads to pulmonary venous, hence pulmonary arterial HTN. This causes RV hypertrophy and leads therefore to tricuspid regurg.

353
Q

What are the Sokolow-Lyon ecg criteria for LVH

A

S wave in v1 + r wave in v5 or v6 (whichever largest) >35mm (7 large squares) - there is LVH

354
Q

What are the ecg changes in posterior MI

A

v1-v3 show ST depression + tall (broad) QRS complexes

355
Q

Which murmur can be heard with ventricular septal defect on auscultation

A

Harsh Pansystolic murmur at left eternal edge

356
Q

Which type of deviation is seen on ecg of a patient with congenital septal a defects

A

Left axis deviation

357
Q

What are the 4 features of tetralogy of fallot

A

1) overriding aorta
2) vsd
3) rv hypertrophy
4) pulmonary stenosis

358
Q

What is grade 1 hypertensive retinopathy

A

Tortuous Arteries with thick shiny walls

359
Q

What is Grade 2 hypertensive retinopathy

A

Av nipping (narrowing where arteries cross veins)

360
Q

What is grade 3 hypertensive retinopathy

A

Flame haemorrhages and cotton wool spots

361
Q

What is grade 4 hypertensive retinopathy

A

Papilloedema

362
Q

What is the treatment for malignant hypertension

A

Iv nitroprusside

363
Q

What is the defintion of malignant hypertension

A

BP >220/120 mmHg

+ bilateral retinal haemorrhage + exudates +/- papilloedema

364
Q

What is the triad of symptoms you get in cardiac tamponade

A
  • reduced bp
  • raised jvp
  • muffled heart sounds
365
Q

What is kussmauls sung in cardiac tamponade

A

Raised jvp on inspiration

366
Q

Raised levels of which electrolyte can cause cardiac tamponade

A

Urea

367
Q

What are the major criteria for rheumatic fever

A
  • carditis
  • erythema marginatum
  • arthritis
  • subcut nodules
  • Sydenham’s chorea
368
Q

List some viruses which can cause acute pericarditis

A
  • Coxsackie
  • EBV
  • flu
  • HIV
  • varicella
  • mumps
369
Q

Give an example of iib/iiia antagonist

A

Tirofiban

370
Q

Which class of drug do you stop in patients post mi

A

CCB

371
Q

What are the four adverse signs looked for in patients with broad complex tachycardia

A

1) bp less than 90 mmHg
2) HR over 150 bpm
3) hf
4) chest pain

372
Q

List the steps folded in the sinoatrial node action potential

A

First there is slow Na+ influx, followed by rapid Ca2+ influx causing depol. There is then outfit of K+ causing hyperpolarisation

373
Q

Lost the steps in the cardiac action potential

A 
Phase 0 - NA+ in
Phase 1 - K+ out, Cl- out
Phase 2 - Ca2+ in, K+ out
Phase 3 - Ca2+ channels close and K+ out
Phase 4 - K+ in
374
Q

Go through how digoxin works on the heart

A

1) inhibits Na+ - K+ - ATPase which means more Na+ accumulates within cell of myocardium
2) increased Na+ levels means there is reversal of Na+ - Ca2+ exchanger, hence less Na+ will come into the cell and less Ca2+ will leave the cell
3) this causes increased Ca2+ levels in the myocardial cell, hence increased amounts available for contraction of myofibrils (actin and myosin) causing prolongation of the cardiac action potential

375
Q

Which condition are you thinking about when asking a young patient with suspected heart problems about family history of sudden death

A

Hypertrophic cardiomyopathy

376
Q

What are stokes Adams attacks

A

Transient arrhythmias causing reduced cardiac output and loss of consciousness

377
Q

What features are suggestive of epilepsy rather than a faint

A

Aura, attacks when lying down, identifiable trigger e.,g tv, altered breathing, urinary incontinence, tongue biting, post ictal drowsiness prolonged, confusion, amnesia

378
Q

What is carotid sinus syncope

A

Hypersensitive baroreceptors causing excessive reflex bradycardia with minimal stimulation e.g. Tight collar, or shaving

379
Q

Which category of bacteria cause rheumatic fever

A

Lance field group A, beta haemolytic streptococci

380
Q

List the major criteria for rheumatic fever

A

1) carditis
2) arthritis
3) subcut nodules
4) eryhtema marginatum
5) Sydenham’s chorea

381
Q

What is the definitive treatment for rheumatic fever

A

Benzylpenicillin/penicillin/erythromycin

382
Q

List the common secondary causes for hypertension

A
  • glomerular disease
  • renal artery stenosis
  • cocp
  • pregnancy
  • diabetes
  • cushings
  • phaeochromocytoma
  • Conns syndorme
383
Q

What are the broad categories of causes for pericarditis

A

1) infection
2) drugs
3) MI, Dressler’s
4) autoimmune

384
Q

What is the typical ecg chnage shown in acute pericarditis

A

Saddle shaped ST elevation

385
Q

How is acute pericarditis managed

A

Analgesia, treat cause, steroids/immunosuppressants if relapsing

386
Q

How is pericardial effusion managed

A 
Treat cause (all causes of acute pericarditis can cause pericardial effusion)
Pericardiocentesis
387
Q

What do you do with the fluid you aspirate from pericardiocentesis in a patient with pericardial effusion

A

Culture, cytology, ZN stain, TB culture

388
Q

List two signs of pericarditis on auscultation

A

1) muffled heart sounds

2) pericardial rub

389
Q

What is constrictive pericarditis

A

Heart encased in rigid pericardium, with unknown cause, but e,sew here in the world it is TB, or pericarditis of any cause

390
Q

What are the CXR changes seen in constrictive pericarditis

A

Small heart, pericardial calcification

391
Q

How is constrictive pericarditis managed

A

Surgical excision

392
Q

What is cardiac tamponade

A

Accumulation of pericardial fluid raises intra pericardial pressure, causing poor ventricular filling and reduced cardiac output

393
Q

List some causes of cardiac tamponade

A

1) any pericarditis
2) aortic dissection
3) haemodialysis
4) warfarin

394
Q

What is the typical triad of cardiac tamponade

A

Pulsus paradoxus, increased jvp and muffled heart sounds

395
Q

What is pulsus paradoxus

A

Abnormally large decreased in pulse rate during inspiration

396
Q

In which conditions is electrical alternans seen

A

Cardiac tamponade, severe pericardial effusion

397
Q

What is electrical alternans

A

Changing qrs complex amplitude between beats

398
Q

What should you suspect in fever + new onset murmur

A

Infective endocarditis

399
Q

What is the chief cause of infective endocarditis

A

Strep viridans

400
Q

Which conditions predispose to infective endocarditis of acute course

A

Dermatitis, iv injections, renal failure, DM

401
Q

What are the two types of clinical course for infective endocarditis

A

Acute (normal valves) and subacute (abnormal valves)

402
Q

What are the risk factors for subacute course of infective endocarditis ( ii of abnormal valves)

A

Valve disease, iv drug use, congenital defects of the heart e,,g vsd, coarctation, patent ductus arteriosus, prosthetic valves

403
Q

What is the empirical treatment for infective endocarditis

A

Benzylpenicillin + gentamicin

404
Q

List some of the causes of acute myocarditis

A
  • viral infection e.g, flu, mumps, rubella, HIV, Coxsackie, polio
  • bacterial TB, meningococcus,clostridium
  • spirochete e.g. Syphillis, Lyme
  • Protozoa e.g. Chagas
  • drugs
  • toxins
  • vasculitis
405
Q

What would you hear on auscultation of a patient with acute myositis

A

S4 gallop

406
Q

What are the changes in bloods in acute myocarditis

A

Troponin I and T positive

407
Q

What other things is dilated cardiomyopathy associated with

A

Alcohol, HTN, haemocromatosis, viral infection

408
Q

How may dilated cardiomyopathy present

A

Symptoms of rvf or arrhythmias

409
Q

What is heard on auscultation of a patient with dilated cardiomyopathy

A

S3 gallop

410
Q

Which blood test in particular would you do in a patient with dilated cardiomyopathy

A

Bnp

411
Q

What is the management for dilated cardiomyopathy

A

As per hf - diuretics, digoxin, acei, anticoag, biventricular pacing, implantable cardiverter defibrillation

412
Q

What is hypertrophic cardiomyopathy

A

Inherited condition where there is LV obstruction from septal hypertrophy

413
Q

What ecg changes may be found in patients with hypertrophic cardiomyopathy

A

LVH, arrhythmias associated

414
Q

What is the management for hypertrophic cardiomyopathy

A

B blockers, verapamil, AMIODARONE for associated arrhythmias

415
Q

List some cusses of restrictive cardiomyopathy

A

Sarcoidosis, amylodosis, scleroderma, endomyocardial fibrosis

416
Q

What is cardiac myxoma

A

A rare cardiac benign tumour

417
Q

What are the features of restrictive cardiomyopathy

A

Like those of constrictive pericarditis

418
Q

List the three types of AF

A
  • paroxysmal
  • persistent
  • permanent
419
Q

What is paroxysmal AF

A

AF that terminates SPONTANEOUSLY, usually within 48 hours

420
Q

What is persistent AF

A

AF that terminates with cardioversion (electrical or chemical) but does NOT resolve spontaneously

421
Q

What is permanent AF

A

AF that will not terminate spontaneously and is refractory to cardioversion

422
Q

Which beta blocker is used for rate control in AF

A

Metoprolol

423
Q

How is acute AF treated

A 
Emergency cardioversion (chemical or electrical depending on signs)
Then give vp rate control drugs e.g. CCBs and b blockers, digoxin, amiodarone
424
Q

Which drugs are given for rate control first line in AF

A

CCBs - verapamil, Diltiazem
B blocker - metoprolol
(NOT both CCB and b blocker at same time)
Then LMWH

425
Q

Which drugs are given for chemical cardioversion of AF

A

Amiodarone or flecainide (WITH CAUTION)

426
Q

What is chronic AF management

A

Rate (or rhythm) control, anticoag

Rate control - first line

427
Q

What are the first line drugs for chronic AF rate control

A

First line - b blocker (metoprolol) or CCB (verapamil, Diltiazem)

428
Q

What are the second line drugs for rate control in patients with AF

A

Digoxin or amiodarone

429
Q

Which combination of drugs do you NOT give in AF, unless advised by an EXPERT

A

CCBs and b blocker

430
Q

What is the management for patients with paroxysmal AF

A

“pill in pocket” - sorta lol or flecainide

+ anticoagulation

431
Q

What is the anticoagulation in acute AF

A

Heparinise; use warfarin if high risk of emboli

432
Q

What are the anticoagulation options for chronic AF

A

Warfarin
Dabigatran
Apixaban, rivaroxiban

NOT aspirin

433
Q

What is the CHADVASC score a measure of

A

Risk of stroke per year - increases as score increases

434
Q

What are the components of the CHADSVASC score

A 
CCF (1)
HTN (1)
Age >75 (2)
DM (1)
Stroke/Tia (2)
Vascular disease (1)
Age 65-74 (1)
Sex (F) (1)
435
Q

What is the CHADSVASC score out of and what score is needed to put. As patient on anticoagulation

A

Out of 9 max

Score of 2 or higher needed to treat with warfarin etc

436
Q

What does the HASBLED score assess risk of

A

1 year risk of major bleed in patients with AF

437
Q

What are the parts that make up the HASBLED score

A 
HTN (1) 
Abnormal liver/kidney function (2x1)
Stroke (1)
Bleeding (1) 
Labile INRs (1)
Elderly (>65 yo) (1) 
Drugs/alcohol (2x1)
438
Q

What is the HASBLED score out of, and what score is concerning

A

Out of 9

Score of 3 or more requires regular review as they are high risk of bleeding

439
Q

Ecg arrhythmia may wpw underlie

A

AF

440
Q

Which drugs should be avoided in wow sydnrome

A

Verapamil, Diltiazem and digoxin (as these affect the AVN)

441
Q

Which drug may be used in wpw syndrome

A

Flecainide

442
Q

Which drug may be given in patients with u resolving bradycardia

A

Atropine

443
Q

Which two places should you palmate if a patient has AF

A

Feel apex beat and radial pulse at same time

444
Q

What is the typical ecg appearance of atrial flutter

A

Sawtooth baseline +/- 2:1 av block depending on ventricular and atrial rates

445
Q

Which two things can you do to try and find the underlying rhythm in a patient with atrial flutter

A

Vagal manoeuvre e.g. Carotid sinus massage

Iv adenosine

446
Q

What is the treatment for asymptomatic bradycardia with rate over 40

A

No treatment

447
Q

What is treatment for bradycardia with rate under 40bpm or patient who is symptomatic

A

Atropine

448
Q

What wells score makes pe likely

A

4 or more, if below 4 do D dimer

449
Q

Which 2 factors would score 3 points on wells score

A
  • clinically suspected PE

- alternative diagnosis to PE less likely

450
Q

Which 3 factors would score 1.5 points in a wells score

A
  • bpm over 150
  • immobilisation
  • prev PE/DVT
451
Q

Which two factors would score 1 on a wells score

A
  • haemoptysis

- malignancy

452
Q

Symptoms of which emergency can b blockers mask

A

Hypoglycaemia

Cardioresp (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions