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Maud- Phase 3b > Cardio > Flashcards

Cardio Flashcards

1
Q

Give 2 shockable cardiac arrest rhyhms

A

Ventricular tachycardia

Ventricular fibrilation

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2
Q

Give 2 non-shockable caridac arrest rhthms

A

Asystole

Pulseless electrical activity

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3
Q

Unstable tachycardia patient- treatment options?

A

consider 3 synchronised shocks

consider amiodarone infusion

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4
Q

Give 3 examples of narrow complex tachycardias in a stable patient?

A

Atrial Fibrilation
Atrial Flutter
SVT

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5
Q

Give 2 examples of broad complex tachycardias in a stable patient?

A

Ventricular tachycardia

SVT with bundle branch block

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6
Q

Atrial flutter causes a narrow or broad QRS complex tachycardia?

A

Atrial flutter= Narrow complex tachycardia

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7
Q

What is the pathophysiology behind atrial flutter?

A

Re-entrant rhythm

Extra electrical pathway causing self-perpetuating electrical signal loop

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8
Q

ECG shows “Saw Tooth Appearance”- likely diagnosis and management?

A

Atrial Flutter

Rate/rhythm control- BB / Cardioversion
Tx underlying cause e.g HTN / Thyrotoxicosis
Anti-coagulate if CHA2DS2VASc high risk
Radio-frequency ablation

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9
Q

What is the most definitive treatment of Atrial Flutter?

A

Radio-frequency ablation

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10
Q

Potential causes/ associations with atrial flutter

A

Ischaemic heart disease
Hypertension
Thyrotoxicosis

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11
Q

Three types of AF

A

Paroxysmal <48hrs
Persistent > 7 days
Permanent (cannot restore to normal)

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12
Q

Which is the commonest arrhythmia

A

AF (10% over 80yos)

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13
Q

What is the pathophysiology of AF?

A

single re-entrant circuit or ectopic foci

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14
Q

What clinical picture may indicate AF?

A

Palpitations, SOB, fatigue
Increased HR, Decreased BP,
Irregularly irregular pulse

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15
Q

Patient has absent P waves and an irregularly irregular RR interval on ECG. Likely diagnosis? They are stable, how would you acutely manage this patient?

A

Rhythm- electrical/chemical cardioversion

Rate- BB/CCB/Digoxin

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16
Q

Derek is an 82 year old gentleman with a history of AF. What is the long term management plan for derek?

A

Rhythm control- amiodarone
Rate control- BB/CCB/Digoxin
Anti-coagulation if CHA2DS2VASc high risk
Consider catheter ablation

17
Q

What is the definitive management of AF?

A

Catheter ablation

18
Q

Patient presents to A&E with SOB, palpitations and an irregularly irregular pulse. It is uncertain from the history how long the patient has been like this. Your colleague is about to cardiovert the patient, what should you do?

A

Warn them that if it has been >48hrs since onset they may have clot formation in atria, cardioversion will dislodge this and cause stroke.

Perform transthoracic/transoesophageal echo or anti-coagulate for 4 weeks before cardioverting

19
Q

What are the causes of AF?

A 
PIRATES 
Pulmonary= PE , COPD, Lung CA
Ischaemia= IHD, MI, HTN, HF 
Rheumatic valve disease 
Alcohol 
Thyrotoxicosis 
Electrolytes (low K+/Mg2+)
Sugar (DM) / Sepsis
20
Q

patient has stable angina, what should you prescribe them?

A

Bisoprolol (lower rate)
Aspirin or Clopidogrel (give single antiplatelet in stable angina)
Statin (lower cholesterol)
GTN spray (reliever)

21
Q

What is metaclopromide? When might you give it?

A

anti-emetic

ACS, when giving morphine (prevent sickness from morphine)

22
Q

What is the purpose and what are the components of CHA2DS2-VASc Score?

A

Risk of stroke in patients with AF

Congestive heart failure 
Hypertension 
Age (>65, >75)
Diabetes 
Stroke/TIA/VTE hx (2)
Vascular disease hx e.g. MI, PAD
Sex (female)
23
Q

Mangement of ventricular tachycardia

A

DC cardioversion

24
Q

Name 3 cardio drugs which can increase serum potassium

A

ACEi
BB
Spironolactone

25
Q 
Describe the coronary arteries involved in....
Anterior MI 
Inferior MI 
Posterior MI 
Lateral MI
A 
Anterior= LAD 
Inferior= Right coronary 
Posterior= Circumflex / Right coronary 
Lateral= circumflex / diagonal branch LAD
26
Q

CPAP is given to patients in LVF, how does CPAP help these patients?

A

Improves oxygenation by recruiting lung units, improved V/Q mismatch
Improves lung compliance, decreases work of breathing therefore decreases myocardial demand

Increased intrathoracic pressure decreases venous return (preload), this decreases LV systolic pressure and therefore decreased afterload

27
Q

What are the 3 diagnostic features of stable angina?

Number of features needed for stable angina? for atypical angina? for non-cardiac/anginal pain?

A

1) Chest pain/dicomfort
2) Exacerbated by exercise / emotion / big meals
3) Relieved by rest / GTN

All 3= stable angina
Any 2/3= atypical angina
=1= non-anginal pain

28
Q

Gary, a 62 year old male, suffered a heart attack 3 days ago. On cardiovascular examination you auscultate a loud pansystolic murmur at the base of the left sternal edge. What has occured and what other sign might you elicit in your CV exam?

A

Ventricular Septal Defect (post-MI complication)

Other sign= check for ankle oedema

29
Q

Patients with suspected MI presents to A&E, a number of investigations are ordered including a troponin. When should the troponin levels be re-tested?

A

12 hours after symptoms started (more reliable result at 12 hours than initial)

30
Q

What cardiovascular presentation would warrant a carotid sinus massage/table tilt test? Describe the test, what equipment is needed and what constitutes a positive result?

A

Vasovagal syncope

Massage one carotid sinus then the other for ~5 seconds
First with patient lying flat then on table 30 degrees up

Need beat to beat BP measurement, need continuous ECG and print strip
Positive test if systolic BP drops >50mmHg with symptoms or asystole >5 seconds

31
Q

Atrio-ventricular nodal reentrant tachycardia is a common arrhythmia in what patient group?

A

young women (~5%)

32
Q

What are the 3 Ps indicative of uncomplicated syncope e.g vasovagal?

A

Posture/prolonged standing
Provoked
Prodromal sx

Maud- Phase 3b (14 decks)

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