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med > cardio > Flashcards

cardio Flashcards

1
Q

What ECG findings suggest brugada syndrome?

A

Elevated J point

Coved/saddleback ST elevation

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2
Q

Whats are patients with brugada syndrome at risk of?

A

Going into VF/ sudden cardiac death

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3
Q

What is the only available tx for brugada syndrome?

A

ICD

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4
Q

Which artery is affected in an inferior stemi?

A

Posterior descending artery

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5
Q

What should you assume a broad complex tachycardia to always be in exams?

A

VT

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6
Q

What drug do you give if VT with no adverse signs?

A

Amiodarone

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7
Q

Define the classes of antiarrythmic drugs and give examples?

A

I - sodium channel blockers (fleicanide)
II - Beta blockers (bisoprolol)
III - prolong action potential (amiodarone)
IV - CCBs (verapamil, diltiazem)

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8
Q

What are the three presenting features of typical angina?

A

1) Constricting heavy discomfort in chest, jaw, neck, arms
2) Sx brought on by exertion
3) Relieved within 5 mins by rest/GTN

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9
Q

Which two patient groups are at risk of silent MI?

A

Elderly

Diabetics

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10
Q

Mx for angina

A

1) low dose aspirin
2) statin
3) GTN spray
4) beta blocker and/or amlodipine (diltiazem on own)
5) long acting nitrate

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11
Q

What test is now first line for diagnosing angina? (in patients lower than 90% probability)

A

CT coronary angiography

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12
Q

Give two examples of non-invasive functional testing for diagnosing angina?

A

Stress myocardial perfusion scintigraphy
Stress echo
Cardiac MRI stress test
Exercise ECG testing

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13
Q

Which nerve innervates the pericardium?

A

Phrenic nerve

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14
Q

What are the roles of the pericardium?

A

Fixes heart
Prevents overfilling
Lubrication
Protection from infection

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15
Q

What does left anterior hemiblock look like on an ECG?

A

L axis deviation

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16
Q

What does bifascicular block look like on ECG?

A

RBBB and left axis deviation

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17
Q

What does trifascicular block look like on ECG?

A

Bifascicular block and 1st degree heart block

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18
Q

What is a normal cardiac axis?

A

-30-90 degrees

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19
Q

How do you calculate rate from an ECG?

A

300 divided by no. of large squares

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20
Q

Whats a normal PR interval?

A

120-200ms (3-5 small squares)

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21
Q

What signs on an ECG suggest WPW?

A

Short PR interval
Delta wave
Widened QRS

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22
Q

What could tall T waves be a sign of?

A

Hyperacute STEMI

hyperkalaemia

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23
Q

What type of drug is atropine?

A

Muscarinic receptor antagonist

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24
Q

Define 1st degree heart block

A

PR constant but greater than 0.2s

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25
Q

Define Mobitz type one heart block (2nd degree)

A

PR prolonged until QRS dropped

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26
Q

Define Mobitz type 2 heart block (2nd degree)

A

Dropped QRS random

PR is constant and prolonged

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27
Q

Which Mobitz type carries greatest risk of progression to complete heart block?

A

Mobitz 2 (need pacing if bradycardic)

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28
Q

How is third degree heart block managed?

A

Admission to hospital and pacing

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29
Q

What is the most likely cause of sudden onset palps and chest pain in a young woman. ECG shows SVT. Previous ECG had no abnormalities.

A

AVNRT

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30
Q

How is AVNRT managed long term?

A

Beta blockers

Ablation of accessory pathway

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31
Q

What is the accessory pathway called in WPW?

A

Bundle of kent

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32
Q

What must be fulfilled before you can consider an AF patient for cardioversion?

A

Onset < 48h or already anticoagulated for 3 weeks

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33
Q

How is SVT managed?

A

Vagal manoeuvres

Adenosine

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34
Q

What are the three types of AF?

A

Paroxysmal (stops within 7 days)
Persistent (>7 days)
Permanent (over 1 yr)

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35
Q

What are the classic causes of AF?

A

Alcohol intoxication
Thyrotoxicosis
Rheumatic heart disease

HTN
Heart failure

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36
Q

Which drugs can be used for rate control in AF?

A

Beta blockers or CCB

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37
Q

Long term what scoring system is used to determine if a pt on rate control for AF needs anticoagulation

A

CHADS-VASC

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38
Q

What is used to assess the risk of bleeding when starting a patient on anticoagulation?

A

HASBLED

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39
Q

What factors contribute to poor warfarin control?

A 
Impaired cognitive function
Poor adherence to tx
Illness
Interacting medications
Diet
Alcohol consumption
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40
Q

What are the risk factors for atrial flutter?

A 
CAD
HTN
Hyperthyroid
Obesity
Alcohol
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41
Q

How long must you anticoagulated before you can cardiovert an AF or atrial flutter patient?

A

3 weeks

42
Q

What can prolong QT?

A

Drugs
Congenital
Electrolyte abnormality (hypohalaemia, hypomagnaesaemia)

43
Q

What ECG abnormality is seen in hypercalcaemia?

A

Decreased QT interval

44
Q

How do you manage torsades de pointes?

A

Congenital - beta blockers

Acquired - stop precipitant, correct hypokalaemia and give magnesium sulphate

45
Q

What are the side effects of chronic use of amiodarone?

A 
Sun sensitivity 
Pneumonitis
AV Block
grey discolouration
Hypothyroidism
optic neuropathy
46
Q

What sign on ECG indicates digoxin toxicity?

A

ST segment depression (reverse tick sign)

47
Q

Can you use verapamil with a beta blocker?

A

No - risk of severe bradycardia

48
Q

When are beta blockers CI?

A

Asthma

49
Q

How can you grade murmurs?

A

Levines scale

50
Q

What valve disorder does a loud S1 indicate?

A

Mitral stenosis

51
Q

What is an Austin flint murmur?

A

Rumbling diastolic murmur heard best at apex

Due to severe AR

52
Q

What signs on exam suggest aortic stenosis?

A

Slow rising pulse
Narrow pulse pressure
Apex thrill
Systolic murmur

53
Q

What criteria are used to dx rheumatic fever?

A

Jones criteria

54
Q

What forms the jones criteria for diagnosing rheumatic fever?

A 
Carditis
Arthritis
SC nodules
Erythema marginatum
Sydenhams chorea

+ evidence of recent strep infection e.g. positive ASOT or throat culture

55
Q

How do you ix for carditis in rheumatic fever?

A

Doppler USS

56
Q

Mx for rheumatic fever

A

Bed rest
IV benzylpenicillin
Aspirin

57
Q

Which organisms cause IE most commonly?

A

S.viridans

S.aureus (IVDU)

58
Q

What can be used to classify disability/functional limitation due to heart failure?

A

New York heart association classification

59
Q

Name a diagnostic criteria used for heart failure

A

Framingham criteria

60
Q

Ix for heart failure

A

ECG
BNP
Echocardiography
CXR

61
Q

CXR signs of HF

A 
Alveolar oedema
kerley B lines
Cardiomegaly
Dilated upper lobe vessels
pleural Effusion
62
Q

What should you monitor when putting a heart failure pt on diuretic therapy in the hospital?

A

Renal function
Weight
Urine output

63
Q

What is the acute mx of heart failure?

A

O2 and IV diuretics (+NIV)

64
Q

How is chronic heart failure managed?

A 
Lifestyle modification
Flu vaccine and pneumococcal vaccine
Inform DVLA
LOOP DIURETICS (e.g. furosemide)
ACE-I
BETA BLOCKERS 
(+digoxin)
65
Q

What is the main side effect of loop diuretics such as furosemide?

A

Hypokalaemia (therefore monitor U & Es)

Renal impairment

66
Q

Which drug might you switch to if furosemide is causing hypokalaemia?

A

Spironolactone

67
Q

What are the causes of secondary hyperlipidaemia?

A

nephrotic syndrome
Cushing’s syndrome
Hypothyroidism
cholestasis

68
Q

Who would you start treatment with a statin?

A

Known CVD
CKD
type 1 DM
Qrisk > 10%

69
Q

When are statins CI?

A

Pregnancy

Cholestasis

70
Q

When should you discontinue statins?

A

If liver enzymes greater than 3 times the upper limit of normal range

71
Q

What blood tests should you do before starting a patient on a statin?

A

Lipid profile
LFTs
CK

72
Q

What drug can be given if a patient cannot tolerate a statin?

A

ezetimibe

73
Q

What Ix would you do in hypertension for evidence of end organ damage?

A

Urine dipstick
U & Es
12 lead ECG
Fundoscopy

74
Q

What Ix would you do in htn for a secondary cause?

A 
U &amp; Es (low K+ in Conns)
Ca (increased in hyperparathyroidism)
renal US (renal artery stenosis)
24h urine for metanephrines (phaeochromocytoma)
urinary free cortisol (cushings)
MRI aorta (coaractation)
75
Q

What drugs is a patient discharged on post ACS?

A

Aspirin lifelong
Clopidogrel 12 months
Beta blocker (12months/ lifelong if LV dysfunction)
ACE-I
statin
spironolactone if evidence of heart failure

76
Q

How long are you not allowed to drive post ACS?

A

1 month (technically 1 week if successful PCI)

77
Q

What triad is associated with cardiac tamponade?

A

Becks triad:
Falling BP
Rising JVP
Muffled heart sounds

78
Q

What ECG changes are seen in cardiac tamponade?

A

Low voltage QRS +- electrical alternans (alternating QRS amplitude)

79
Q

Diagnostic Ix for cardiac tamponade

A

echo

80
Q

Tx for cardiac tamponade

A

pericardiocentesis

81
Q

What classification is used for PAD?

A

Fontaine classification

82
Q

What is buergers disease?

A

Pattern of thrombophlebitis and ischaemia seen in young heavy smokers

83
Q

Mx for PAD?

A

Clopidogrel
Supervised exercise
Naftidofuryl (if sx don’t improve with exercise)

84
Q

sx of aortic dissection

A 
SUDDEN tearing chest pain
neurological deficit
Acute limb ischaemia
paraplegia
angina
85
Q

Hyperkalaemia ECG changes

A

Tall, peaked T waves
P wave flattens
Wide QRS

86
Q

Hypokalaemia ECG changes

A

Small T waves
Prolonged PR
Depressed ST
Prominent U waves

87
Q

What condition should you suspect in a hypertensive, hypokalaemic pt not taking diuretics?

A

Conn’s syndrome

88
Q

How does hypomagnesaemia px on an ECG?

A

Prolonged QTc

89
Q

Generally what length of QT is concerning

A

> 0.5s (about 12 squares)

90
Q

Comps of MI

A 
Cardiac arrest
Shock
LV failure
Arrythmia
Pericarditis
Systemic embolism
Cardiac tamponade
MR 
VSD
91
Q

What is the first test you undertake on a suspected angina pt?

A

Calculate their pre-test probability

92
Q

How does aspirin act?

A

COX inhibitor

Decreases THROMBOXANE and prostaglandin synthesis

93
Q

How does clopidogrel act?

A

P2Y12 inhibitor

94
Q

What are side effects of ACE-I?

A

Cough
Hypotension
Acute renal failure
Hyperkalaemia

95
Q

What are the side effects of CCBs?

A

Flushing
Headache
Oedema
Palps

96
Q

How do thiazide diuretics act?

A

Inhibit sodium-chloride transporter in distal tubule

97
Q

What side effects are associated with nitrates?

A

Headache

Syncope

98
Q

Which viruses most commonly cause pericarditis?

A

coxsackievirus

echovirus

99
Q

What are the features of tetralogy of Fallot?

A

1) VSD
2) Pulmonary stenosis
3) RV hypertrophy
4) Overriding aorta

100
Q

What is the gold standard Ix for IE?

A

TOE

101
Q

What is P mitrale and what is it a sign of?

A

Notched P waves

Classically a sign of left atrial enlargement due to mitral stenosis

102
Q

What is P pulmonale a sign of?

A

Peaked P wave
Due to PULMONARY HTN
(e.g. from chronic lung disease (cor pulmonale) or congenital heart disease or primary pulmonary htn)

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