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Finals > Cardio > Flashcards

Cardio Flashcards

1
Q

How to calculate rate in ECG

A

300/number of squares (R-R)

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2
Q

how long should p-wave be

A

120-200ms

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3
Q

what does prolonged PR interval indicate

A

AV block

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4
Q

what does shortened PR interval indicate?
eg?
what other feature do you seen on ecg?

A

accessory pathway

eg WPW –> delta wave (slurred QRS upstroke)

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5
Q

QRS normal length?

A

80-120ms

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6
Q

where is the j-point?

A

where S wave meets ST segment

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7
Q

when is ST elevation significant?

A

> 1mm in >2 limb leads

> 2mm in >2 chest leads

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8
Q

what is t-wave?

A

ventricular repolarisation

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9
Q

when is a t-wave tall?

A

> 5mm in limb AND >10mm in chest

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10
Q

what does tall t-wave indicate

A

hyperacute STEMI

hyperkalaemia

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11
Q

which leads is inverted t-wave normal

A

V1

III

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12
Q

inverted t waves assos with?

A

ischaemia
PE
BBB

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13
Q

what is sinus brady?

A

<60bpm

every p-wave followed by QRS

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14
Q

physiological causes of sinus brady?

pathological causes?

A

Physiological: athletes, young

pathological: acute MI, drugs, hypothyroid, hypothermia, sick sinus, raised ICP

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15
Q

when do you treat bradycardia

A

<40bpm / symptomatic

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16
Q

mx of symptomatic brady

A

IV atropine

temp pacing wire

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17
Q

what is sick sinus syndrome?

causes?

A

result of SAN dysfunction - impaired ability to generate impulse

idiopathic fibrosis of node; ischaemia; digoxin

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18
Q

causes of AV block

A

MI
SLE
myocarditis
degeneration of His-Purkinje

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19
Q

define 1st degree heart block?

A

PR > 0.2s
PR interval constant
every P followed by QRS

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20
Q

define 2nd degree heart block?

A

intermittent failure of conduction from A to V
some P not followed by QRS

Mobitz I = failure at AVN - PR is progressively increased until QRS missed

Mobitz II = intermittent failure of P wave conduction. PR is constant + prolonged. Dropped QRS 2:1 / £:1

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21
Q

define 3rd degree heart block?

A

complete failure of conduction between atria and ventricles

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22
Q

cause of 3rd degree heart block?

A

myocardial fibrosis

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23
Q

causes of RBBB

A 
Rheumatic heart disease
RVH
IHD
myocarditis 
cardiomyopathy
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24
Q

ECG changes of RBBB

A

MarroW

QRS > 0.12s (broad)

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25
Q

causes of LBBB

A

CAD
HTN
dilated cardiomyopathy
anterior infarction

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26
Q

ECG changes of LBBB

A

WilliaM

QRS > 0.12s (broad)

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27
Q

ix in brady

A

ECG
electrolytes
TFT

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28
Q

mx of brady

A

treat cause
stop negative chronotropes
IV atropine 0.5mg

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29
Q

sinus tachy pres

A

angina like sx -> chest pain, faintness, sob

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30
Q

define sinus tachy?

A

HR > 100bpm

every P followed by QRS

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31
Q

causes of sinus tachy?

A

physiological: exertion, anxiety, pain

Pathological: fever, anaemia, hypovolaemia

Endocrine: thyrotoxicosis, phaeochromocytoma

Pharma: adrenaline, alcohol, caffeine, salbutamol

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32
Q

ix in sinus tachy?

A

ECG, cardiac enzymes, FBC, TFT

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33
Q

mx of acute sinus tachy

A

vagal manoeuvres: carotid massage, valsalva, cold water

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34
Q

mx of chronic sinus tachy

A

BB / CCB (diltiazem, verapamil)

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35
Q

egs of SVTs?

A

AF / flutter
sinus tachy
AV re-entry tachy

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36
Q

Mx of WPW?

A

vagal manoeuvres +/- adenosine

pharma: flecainide / sotalol
surgery: radiofrequency ablation is curative

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37
Q

mx of narrow SVT? (if BP<90, chest pain, HF, HR>200)

A

DC cardioversion with general anaesthetic

+/- IV amiodarone

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38
Q

mx of AF?

A

Rate: 1. BB/CCB 2. Dual therapy (NOT VERAPAMIL + BB)

Rhythm: if <48h -> DC cardioversion
if >48h -> Warfarin for 3w before cardioversion

Anticoag

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39
Q

Pharmacological cardioversion?

A

IV amiodarone

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40
Q

Mx of atrial flutter

A

Rhythm: cardioversion

  • DC (if >48h ensure adequate anticoag)
  • IV amiodarone
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41
Q

mx of broad complex tachy?

if unstable?

A

ABCDE
monitor ECG, BP, sats

Cardioversion - DC shock / amiodarone

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42
Q

what do you need to consider long term for VT? why?

A

requires maintenance anti-arrhythmics (BB/CCB) or implantable defibrillator

usually due to damage

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43
Q

What does TdP look like on ECG?

A

like a sound wave

varied axis + amplitude QRS

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44
Q

what can happen to torsades if untreated?

A

–> VF

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45
Q

mx torsades?

A

IV MgSO4

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46
Q

what does VF look like on ECG

A

chaotic (varying amplitudes)

no identifiable P, QRS or T

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47
Q

mx of acute VF?

long term?

A

defibrillation

BB and ICB

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48
Q

ECG finding in PE

A

sinus tachycardia

+/- S1Q3T3

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49
Q

ECG of hypothermia

A

bradycardia

J-wave (late delta wave, positive deflection at j point)

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50
Q

when do you use amiodarone?

A

tachyarrhythmias (AF, AFlut, SVT) when other drugs or DC shock dont work

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51
Q

SEs of amoidarone

A

hypotension during IV infusion

Chronic -> pneumonitis, AV block, hepatitis, thyroid

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52
Q

when do you use adenosine?

A

first line diagnostic and therapeutic in SVT

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53
Q

SE of adnosine?

A

patient feels like they are going to die!

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54
Q

mech of adenosine

A

blocks SA + AV node - causes bradycardia and asystole –> feeling of doom

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55
Q

Indications for Digoxin

A

Reduce ventricular rate (AF, AFlut) - after CCB or BB

Severe heart failure - 3rd line

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56
Q

important to remember in digoxin

A

low therapeutic index

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57
Q

interactions with digoxin?

A

loop / thiazide like diuretics -> hypokalaemia

amiodarone, CCB, spironolactone -> increase plasma digoxin

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58
Q

monitoring for digoxin toxicity?

A

monitor sx / ventricular rate + ECG + renal dysfunction + hypokalaemia

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59
Q

target blood conc of digoxin

A

1 - 1.5 nmol/L

>2 suggests toxicity

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60
Q

CCBs indication

A

rate control in SVT

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61
Q

BBs indication

A

IHD to reduce angina
CHF to improve prognosis
AF to reduce rate and maintain sinus
SVT to restore sinus rhythm

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62
Q

SEs of BBs

A

fatigue, cold extremities, headache, impotence

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63
Q

when are BBs CI?

what can you use?

A

Asthma - B2 block causes bronchospasm

Can use B1 selective (atenolol, bisoprolol, metoprolol)

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64
Q

MR murmur

A

pansystolic

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65
Q

MS murmur

A

loud S1 + mid-diastolic murmur

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66
Q

how to differentiate between MR and TR

A

both pan systolic

TR does not radiate to axilla

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67
Q

PS murmur

interesting fact

A

crescendo-decrescendo ejection systolic murmur

disappears on inspiration

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68
Q

PR murmur

A

early diastolic

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69
Q

when are aortic murmurs best heard

A

holding breath

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70
Q

AS murmur

A

crescendo-decrescendo ejection systolic murmur

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71
Q

AR best heard?

A

early diastolic

best heard leaning forwards + holding breath (PR disappears on holding breath)

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72
Q

usual cause of AS

A

senile calcification

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73
Q

triad of sx in AS

A

chest pain
HF
syncope

74
Q

o/e AS

A

slow rising pulse
narrow pulse pressure
LVH-> apex thrill

75
Q

Confirm dx of AS?

A

Echo

76
Q

Mx of AS?

A

avoid heavy exertion, modify RFs for CAD

valve replacement

if not fit for surgery -> balloon valvluoplasty / TAVI

77
Q

comps of mechanical heart valves?

A

predispose to IE

small emboli

78
Q

how to prevent IE with new heart valves?

A

Abx prophylaxis

79
Q

target INR in valve replacement

A

anticoag

INR 2.5-3.5 for aortic

80
Q

causes of AR

A

bicuspid
rheumatic fever
IE
collagen [Marfans, E-D, Turners]

81
Q

pres of AR?

A

SOBOE

non-specific sx of left heart failure [orthopnea, paroxysmal nocturnal dyspnoea]

82
Q

o/e AR

A

early diastolic murmur, not transmitted to carotids
collapsing water hammer pulse
wide pulse pressure

83
Q

CXR of AR?

A

signs of HF, volume overload

84
Q

normal size of mitral valve?

A

4-6cm2

85
Q

what sx does large left atrium cause?

A

hoarseness

dysphagia

86
Q

o/e of MS

A

malar flush, raised JVP, RVH
signs of RHF
late diastolic murmur, loud S1 w opening snap

87
Q

mx of MR?

A

surgery

88
Q

cause of rheumatic fever

A

Group A beta haemolytic streptococci (pyogenes)

89
Q

when does rheumatic fever occur?

what is affected?

A

2-4w post-strep pharyngitis / skin infection

joints, skin, heart, nervous system

90
Q

blood test providing evidence of strep infection?

A

antistreptolysin O titre

or DNase B titre

91
Q

What criteria to use for diagnosis of rheumatic fever?

A 
Jones criteria:
Required Criteria
	Evidence of antecedent Strep infection: ASO / Strep antibodies / Strep group A throat culture / Recent scarlet fever / anti-deoxyribonuclease B / anti-hyaluronidase
Major Diagnostic Criteria
	Carditis
	Polyarthritis
	Chorea
	Erythema marginatum
	Subcutaneous Nodules
Minor Diagnostic Criteria
	Fever
	Arthralgia
	Previous rheumatic fever or rheumatic heart disease
	Acute phase reactions: ESR / CRP / Leukocytosis
	Prolonged PR interval
92
Q

ix rheumatic fever?

A

throat culture, ASO rise during 1st month

ECG: PR, ST elevation
CXR: ?HF
FBC, ESR, CRP
Doppler echo

93
Q

mx of rheumatic fever?

how to eradicate strep?

treat HF?

for chorea?

A

enforce bed rest until inflam markers normal

Eradicate strep -> IV benzylpenicillin

Treat HF: diuretics, ACEi, digoxin

Suppress inflam: NSAIDs

Chorea: self-limiting. maybe haloperidol

94
Q

fever + new murmur = ?

A

endocarditis until proven otherwise

95
Q

IE RFs

A 
valve disease/replacement
congenital structural defect
previous IE
HOCM
IVDU
96
Q

pres of IE

A

fever + chills + poor appetite + wt loss

97
Q

signs of IE

A 
FROM JANE
Fever > 38 + tachy
Roth's spots 
Osler's nodes 
Murmur
Janeway lesions
Anaemia/arthritis
Nail haemorrhage
Emboli
98
Q

cause of IE?

which murmur is classic?

A

S. aureus

tricuspid murmur

99
Q

comps of IE

A

MI / pericarditis
glomerulonephritis
stroke

100
Q

ix in IE?

A 
FBC, ESR/CRP, RF
TTE
Blood cultures
CXR
ECG
101
Q

how long to give Abx for IE?

which for staph / strep? / MRSA

A

4 weeks
staph - fluclox
strep - benpen
MRSA - vanc

102
Q

ix for cardiomyopathy

A

Bloods: FBC, ESR, U+Es, LFT, cardiac enzymes, TFT
CXR
ECG
TTE
MRI; distinguish constrictive / restrictive

103
Q

features of HF on CXR?

A 
ABCDE
Alveolar oedema
B-lines; Kerley
Cardiomegaly
Dilated upper lobe vessels
Effusion; pleural
104
Q

cause of sudden cardiac death in young people?

A

hypertrophic cardiomyopathy

arrhythmia / LV outflow tract obstruction

105
Q

cause of myocarditis

A

coxsackie

106
Q

ix for myocarditis

A 
FBC
Viral serology 
**endomyocardial biopsy *
ECG
CXR
107
Q

Sx of HF

A

breathless, fatigue, ankle swelling

108
Q

signs of HF

A 
tachyc, tachyp
pulmonary rales
pleural effusion 
raised JVP 
peripheral oedema 
hepatomegaly
109
Q

difference between LHF/RHF in pres

A

RHF: peripheral oedema, ascites, facial engorgement, pulsing in neck (TR)

LHF: dyspnoea, fatigue, cold peripheries, muscles wasting, orthopnea, PND, noct cough - pink frothy sputum

110
Q

if prev MI and new HF what ix? and when?

A

2WW for specialist + doppler echo

111
Q

Ix for HF

A

BNP - if high -> 2WW for echo
ECG
bloods
CXR

112
Q

Acute mx of HF?

when stable?

A

O2 + IV diuretics +/- NIV

when stable: BB + ACEi + spiro +/- digoxin
f/u in 2w

113
Q

mx of chronic HF?

A

lifestyle
annual vaccinations
manage comorbs

114
Q

how do statins work

A

HMG-CoA reductase inhibitors

115
Q

when to prescribe statins

A

QRISK2 > 10%
history of CVD
hypercholesterolaemia
>85yo

116
Q

SEs of statins

A

myalgia - stiff, weakness, cramps

117
Q

what to monitor with statins

A

LFTs

118
Q

secondary causes of HTN

A 
renal
endocrine
coarctation
pre-eclampsia
drugs
119
Q

signs of end organ damage in HTN

A 
encephalopathy - seizure, vomiting, nausea
dissection - delayed/weak femoral pulses
pulm oedema
nephropathy - proteinuria 
eclampsia
papilloedema 
retinopathy
120
Q

Mx of HTN

A 
1. <55 - ACEi/ARB
>55 - CCB
2. dual 
3. + indapamide
4. resistant + spiro
121
Q

SE of amlodipine

A

ankle swelling

122
Q

target BP

A

<140/90

123
Q 
Which leads and arteries? 
anterior leads? 
lateral leads? 
inferior leads?
septal leads?
A

anterior leads = V3/V4 - LAD
lateral leads = 1, V5, V6 - Cx
inferior leads = I, II, aVF - RCA
septal leads = V1, V2 - LAD

124
Q

what to do with all new angina?

A

refer to rapid access chest pain clinic for confirmation of Dx and severity assessment within 2w

125
Q

DDx angina

A 
MI - pain over 5 mins
Pericarditis - worse on inspiration, lying flat, swallowing
MSK - worse on mvmt
GORD
Pleuritic pain - sharp on inspiration
126
Q

Ix in angina

A 
ECG - ST flattening
FBC
FBG
Cholesterol
LFTs 
TFTs
127
Q

non-pharma mx of stable angina

A 
modify RFs (?aspirin/statin)
patient education
128
Q

pharma mx of stable angina

A

acute - GTN
1st BB / CCB
2nd combination
3rd + ivabradine

129
Q

what if angina not controlled by pharma

A

CABG / PCI

130
Q

Ix in ACS?

A

ECG
cardiac enzymes - troponin, CK
bloods
CXR

131
Q

mx for ACS

A

ABCDE
GTN + IV opioid with antiemetic
Antiplatelet - 300mg aspirin, ticagrelor
O2 if <94%

132
Q

mx of STEMI

A 
MONA
Morphine
Oxygen 
Nitrates
Aspirin

reperfusion - PCI (if within 120mins) / fibrinolysis

133
Q

drug used for fibrinolysis

A

alteplase

streptokinase

134
Q

Pharma post MI?

A 
ABSeeD
ACEi
BB
Statin 
Dual antiplatelet (aspiri+clopidogrel)
135
Q

driving post ACS?

A

4weeks off

136
Q

dresslers syndrome?

A

post-ACS
late pericarditis -> inflam reaction to necrotic tissue
occurs at 2-8weeks

137
Q

comps post MI?

A 
DEPARTS + fails 
Death, dresslers 
Electrical: tachyc/bradyc
Pericarditis, papillary muscle rupture
Aneurysm
Re-MI, rupture
Thrombus
Shock
VSD
Heart failure
138
Q

unresponsive cardiac arrest

A 
999
A+B
C - CPR 30:2
D - defibrillator: AED
2 mins of CPR between defib, after 3rd shock give adrenaline + amiodarone
139
Q

causes of pericarditis

A 
Viral: coxsackie, EBV
Rheum: SLE, sarcoid
Post-MI
Drugs: hydralazine
Other: uraemia
140
Q

what causes granulomatous pericarditis

A

TB, sarcoid, fungal, RA

141
Q

pericarditis
aggravating pain?
relieving pain?

A

aggravated by inspiration, cough, swallow, lying flat

relieved by sitting up/fwd

142
Q

o/e acute pericarditis

A

pericardial friction rub

tachypnoea, tachycardia, fever

143
Q

Beck’s triad in tamponade?

A

hypotension
elevated JVP
muffled heart sounds

144
Q

Ix in pericarditis?

A

ECG
CXR
bloods
Echo

145
Q

mx of stable pericarditis

A

rest + treat cause + NSAIDs +/- PPI

146
Q

when to admit pericarditis

A

if fever, tamponade, large effusion, fail to respond to NSAIDs

147
Q

pericarditis with falling BP, what should you suspect?

A

cardiac tamponade

148
Q

Mx of cardiac tamponade?

A

immediate pericardiocentesis

O2 + inotrope + increase venous return

149
Q

mx of recurrent pericarditis

A

colchicine

150
Q

pres of peripheral arterial disease

A

intermittent claudication [cramping in calf/thigh/buttock on walking -> relieved by rest]

ischaemic rest pain

151
Q

o/e lower limb ischaemia

A

absent/reduced femoral pulses
trophic changes - pale, cold, hairless, skin change
ulcers
cap fill prolonged

152
Q

ddx of lower limb ischaemia

A

sciatica
spinal stenosis
DVT
entrapment

153
Q

ix in lower limb ischaemia

A 
BP 
FBC
ESR
renal function 
**ABPI**
154
Q

ABPI for mild/mod/severe PAD

A

normal = 1
mild <0.9
mod <0.8
severe <0.5 –> ischaemic rest pain

155
Q

Ps of acute limb ischaemia

A

pale, pulseless, pain, perishingly cold, paraesthesia, paralysis

156
Q

mx of acute lower limb ischaemia

A

requires re-vasc in 4-6h

157
Q

comps of PAD

A

acute limb ischaemia
infection
poor healing
gangrene

158
Q

general mx of PAD

A 
modify RFs
statin 
ACEi
antiplatelet
pain management
159
Q

aortic dissection?

A

intimal tear -> disruption of media -> layers separate and form a false lumen

160
Q

simple ix in aortic dissection

A

BP may be different in both arms

161
Q

what must you differentiate from aortic dissection? why?

A

differentiate from MI

thrombolysis is fatal in dissection

162
Q

imaging in aortic dissection

A

CXR - widened mediastinum
TTE
MRI

163
Q

comps of aortic dissection

A

rupture + multi-organ failure + cardiac tamponade + hypotension

164
Q

mx of aortic dissection

A

O2, morphine
ICU
IV labetalol + nitroprusside
Surgical repair

165
Q

ix AAA? what sign could indicate imminent rupture?

A

FBC, clotting, U+Es, LFT, crossmatch, ECG, CXR

USS for initial assessment

CT for more detail -> crescent sign indicates blood within thrombus

166
Q

mx of AAA

A

regular USS monitoring
lifestyle
Surgical repair if >5.5cm or rapid expansion

167
Q

Triad in AAA rupture

A

hypotension
pulsatile abdo mass
flank/back pain

168
Q

mx AAA rupture

A 
large bore IV access
group + crossmatch 
immediate theatre
graft repair 
(death is highly likely)
169
Q

organs at risk in sepsis?

A

kidney (acute tubular necrosis)
lungs (ARDS)
heart (MI)
brain (confusion, coma)

170
Q

ix in hypovolaemic shock?

A

Hb, U+Es, LFT, group + crossmach, ABG, UO

171
Q

Mx of hypovolaemic shock?

A

raise legs

ABCDE -> 2large bore cannulae, airway, high flow O2, fluid resus.

if haemorrhage -> give blood ASAP [O-ve]

172
Q

cause of cardiogenc shock

A

acute MI

173
Q

monitor in cardiogenic shock?

A

cardiac monitoring
BP - arterial line
venous pressuer
UO

174
Q

mx cardiogenic shock?

A 
ABCDE
fluids
O2
pain relief 
cardiac inotropes [dopamine or dobutamine]
Revascularisation
175
Q

mx of anaphylactic shock?

A

ABCDE
life flat
high flow O2 [+/- intubate]

IM adrenaline
IV fluids
IV chlorphenamine + hydrocortisone

Bronchodilators; salbutamol

176
Q

signs of septic shock?

A

HAT
Hypotension < 100mmHg
Altered mental state GCS<15
Tachypnoea >22

177
Q

mx of sepsis

A 
Blood cultures + septic screen 
Urine output
Fluid resus
Abx - taz
Lactate - ABG
Oxygen
178
Q

other ix in sepsis

A

FBC, U+Es, urinalysis, LFTs, glucose, clotting, CXR, AUSS

179
Q

comps of sepsis?

A

DIC, renal railure, cardioresp failure

180
Q

SEs of amiodarone

A

prolong QT

pseudohypothyroidism

181
Q

cause of ST elevation in all leads?

A

pericarditis

SAH

182
Q

mx of PE

A

Short term - LMWH

Long term - warfarin 3-6m

Finals (20 decks)

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