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Yr 6 PACES knowledge > Cardio > Flashcards

Cardio Flashcards

1
Q

Top 4 causes of chronic heart failure

A

Coronary heart disease
Hypertension
Valvular disease
Myocarditis

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2
Q

4 chest signs in L ventricular failure

A

Displaced apex
S3
Bibasal creps
Wheeze

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3
Q

What is S3?

A

“Kentucky”

Seen in LV failure when there is rapid ventricular filling

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4
Q

3 conditions which cause heart failure by increasing metabolic demand?

A

Anaemia
Hyperthyroidism
Pregnancy

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5
Q

CXR features of heart failure

A 
Alveolar shadowing
Kerly B lines
Cardiomegaly
Upper lobe Diversion
Fluid in fissures
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6
Q

What on earth are Kerly B lines

A

Increased pressure in pulmonary circulation —> more fluid in peripheral interlobular septa

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7
Q

normal ejection fraction

A

approx 60%

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8
Q

Classification of HF severity?

A

NYHA classification

1) no sx
2) SOB on normal activity
3) Marked limitation of normal activity
4) SOB at rest

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9
Q

Which drugs are best avoided in Mx of HF?

A

CCBs

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10
Q

1st line Mx of chronic HF

A

ACEi/ARB + b-blocker + loop diuretic +/- spironolactone

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11
Q

Caution with spironolactone in Mx of chronic HF?

A

Risk of hypERkalemia, esp as all HF pts are on ACEi

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12
Q

What is S4

A

active ventricular filling, when atria contracts against a non-compliant ventricle.
ALWAYS pathological + a sign of diastolic failure.

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13
Q

causes of myocarditis

A

50% idiopathic

1) VIRAL: coxsackie, flu, HIV
2) bacterial: staph, strep
3) drugs: anti epileptics (phenytoin, carbamazepine)
4) Autoimmune: SLE

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14
Q

One form of cyanotic congenital heart disease

A 
Tetralogy of Fallot
Pulmonary stenosis
RV hypertrophy
VSD
Overriding aorta
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15
Q

Causes of a collapsing pulse

A

Aortic regurgitation

Or due to hyper dynamic circulation:
Hyperthyroidism, anaemia, pregnancy

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16
Q

completion of a cardiovascular exam

A 
Hx
Basic observations
Respiratory exam
Drug chart
12 lead ecg
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17
Q

Janeway lesions vs Oslers nodes

A

JLs: non-tender, flat, palmar surface,

ONs: tender, nodular, on knuckles

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18
Q

Scoring system for Dx of Infective Endocarditis

A

DUke’s criteria = 2 major/1 major + 3 minor/5minor
Major criteria:
+ve blood cultures w typical organism on 2 occasions
Echo: vegetations or new regurgitation

Minor criteria:
Fever, embolic features, IVDU, predisposing valve/cardiac prob

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19
Q

3 Risk factors for IE

A

valvular disease
IVDU
Prosthetic valve

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20
Q

Common causative organisms of infective endocarditis?

A

Acute: staph aureus (in all groups, but esp IVDU)
Subacute: strep viridian’s (esp in native valves w pre-existing damage)

Native valve = strep viridian’s
IVDU = staph aureus
Prosthetic valve = staph epidermis

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21
Q

What is acute rheumatic fever

A

Aggressive immunological response to Strep pyogenes

Commonly affects mitral valve
- carditis, arthritis, sydenam’s chorea, erythema marginatum, subcutaneous nodules

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22
Q

mx of acute rheumatic fever

A

Admit + bed rest + IM benpen stat + 10 days of oral penicillin

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23
Q

How does infective endocarditis develop from a pt w history of rheumatic fever

A

Rheumatic fever –> damaged (mitral) valve

Later in life, after years of bacteraemia there is colonisation of damaged valve + vegetation –> pyrexia

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24
Q

Complications of infective endocarditis

A

Haematuria!
Thromboses: bowel infarct, splenic infarct, TIA, AKI
Heart block
Heart failure

25
Q

Causes of aortic regurgitation

A

Bicuspid aortic valve
Rheumatic valve disease
Autoimmune - ank spond, RhA
CTD - marfan’s, ehlers danlos

Acute: IE, type A aortic dissection

26
Q

sign of LV strain on ECG?

A

lateral lead T wave inversion

27
Q

Key investigation that must be undertaken prior to valve replacement surgery

A

Cardiac catheterisation to assess coronary arteries

28
Q

Atrial fibrillation: 1st episode + symptomatic but stable + unknown duration

A

treat as >48 hours

Rate control (bb or CCB)
Anticoagulation: heparin + warfarin
Rhythm control 3 weeks later (amiodarone or DCCV)

29
Q

atrial fibrillation: 1st episode + symptomatic + L atrial thrombus found

A

Rate control
Anticoagulation (heparin + warfarin)
- Rhythm control 3 weeks later (DCCV or amiodarone)

30
Q

Atrial fibrillation: 1st episode + asymptomatic

A

Chadsvasc is 0-1: observe for 24 hours (most resolve spontaneously )

Chadsvasc is >=2: anticoagulate + observe for 24 hours

31
Q

Pacemaker spikes: how to differentiate between atrial and ventricular pacing?

A

Atrial: spike before p wave
Ventricular: spike before QRS

32
Q

Ventricular pacing: what does the ECG look like?

A

pacing spike before QRS

Left ventricular pacing –> QRS morphology similar to RBBB

33
Q

Pacemakers: what are the indications for a) atrial lead only b) ventricular lead only c) both atrial and ventricular leads

A

a) atrial lead only: SAN disease in young patients w GOOD AVN conduction
b) ventricular lead only: permanent AFib
c) A+V leads: every one else, esp elderly who are at risk of AV block

34
Q

ICD - what is it for?

A

Prophylaxis for patients at risk of VT or VF

  • primary prevention in pts of previous arrest/sustained VT
  • secondary prevention for HOCM, long QT, congenital heart disease etc
35
Q

Indication for cardiac resynchronisation therapy

A

LV dysfunction + broad QRS (i.e. BBB)

In BBB, the impulse travels along intact branch first, before transmitting to the other side –> dysynchronous contraction

36
Q

What is cardiac resynchronisation therapy

A

3 leads: in R atrium, R ventricle, L ventricle

Allows synchronised ventricular contraction in response to atrial contraction (the lead in RA detects organised atrial contraction)

37
Q

Classification of heart block

A

1st degree: prolonged PR
2nd degree type 1: e.g. 3:1
2nd degree type 2: gradually increasing PR until QRS is dropped
3rd degree: no relationship between p wave + QRS

38
Q

Causes of heart block

A

Coronary heart disease (ACS or chronic)

Drugs: beta blocker, adenosine, CCBs,

39
Q

which electrolytes may be responsible for heart block

A

Potassium

Calcium

40
Q

Management of v symptomatic second degree type II heart block

A

Stop AVN blocking drugs (B-blockers, CCBs)
+ Temporary pacing

(both mobitz type II and 3rd degree heart block are treated this way)

41
Q

In what scenario can you merely observe heart block?

A

if Asymptomatic and either 1st degree or 2nd degree type I

42
Q

Young person - faints a lot
ECG shows long QT.

Next steps?

A

HUGE risk of VT + VF

Ix: Serum K, Mg, Ca (low levels can cause it)
Echo
24 hour ECG

Mx: beta blockers + ICD

43
Q

When is shock given in DCCV?

A

During QRS

44
Q

Cardiac tamponade - causes

A 
Post MI
Post cardiac intervention
Pericarditis
Malignancy
Trauma
45
Q

Becks traid of cardiac tamponade

A

Raised JVP
Low BP
Muffled HS

46
Q

Mx of cardiac tamponade

A

Pericardiocentesis (echo guidance)

47
Q

Dukes Criteria for IE

A

2 major + 1 minor
1 major + 3 minor
5 minor

Major: Echo finding (new murmur)
+ve blood cultures w typical organisms

Minor:

  • Emboli: splinter haemorrhage, haematuria, Janeway lesions
  • Immuno: Oslers nodes, GNitis
  • Fever
  • Predisposing <3 condition or IVDU
  • +ve cultures of atypical
  • Echo w non major criteria
48
Q

Classification of atrial fibrillation

A

First episode
Paroxysmal - <7 days
Persistent - >7 days
Permanent - often >1 year, refractory to treatment

49
Q

Causes of Afib

A

Heart: MI, IHD, mitral valve path, HTN

Hyperthyroidism
EtOH
pneumonia

50
Q

Complications of AFIb

A

Embolism: stroke, TIA
HF: reduced CO
Further remodelling

51
Q

HASBLED - what is it? what score is considered high ris

A

Bleeding risk - 3+ is high risk

HTN, renal disease, liver disease, stroke history, bleeding history, wild INR, elderly, EtOH

52
Q

Afib pharm rhythm control: which agents are used? and in which situs is one preferred?

A

Flecainide or amiodarone

Amiodarone in structural heart disease

53
Q

Mx of broad complex tachycardia w no adverse signs

A

IV amiodarone 300mg over 20-60 mins

then 900mg over 24 hours

54
Q

Mx of tachycardia w shock/syncope/MI/HF

A

DC shock!

+ IV amiodarone 300mg over 10-20 mins + repeat shock

55
Q

Mx of SVT

A

vagal manœuvres

IV adenosine 6mg bolus, then 12mg then 12mg

56
Q

Ddx for SVT

A

atrial fibrillation
atrial flutter
AVNRT
AVRT

57
Q

Stage 2 HTN

clinic? home?

A

Clinic: >160/100
Home: >150/95

58
Q

Diagnosis of rheumatic fever - what are the criteria?

A

Modified Jones criteria

Major: carditis, arthritis, sydenams chorea, erythema marginatum, subcut nodules

Minor: fever, raised ESR/CRP, long PR interval, arthralgia

59
Q

Management of rheumatic fever

A

Admit + bed rest until inflame markers resolve

  • IM benpen stat
  • 10 day penicillin
  • Aspirin as needed

AND secondary Abx prophylaxis

Yr 6 PACES knowledge (14 decks)

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