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Yr 6 PACES knowledge COPY RJ Challenger > 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

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25
Causes of aortic regurgitation
Bicuspid aortic valve Rheumatic valve disease Autoimmune - ank spond, RhA CTD - marfan's, ehlers danlos Acute: IE, type A aortic dissection
26
sign of LV strain on ECG?
lateral lead T wave inversion
27
Key investigation that must be undertaken prior to valve replacement surgery
Cardiac catheterisation to assess coronary arteries
28
Atrial fibrillation: 1st episode + symptomatic but stable + unknown duration
-Treat as late (\>48 hours) If onset unknown **-Rate control** **Beta blocker** - eg **Bisoprolol**, or **Calcium Channel Blocker** - eg **Diltiazem** (Rate-limiting non-dihydropyridine) **-Anticoagulation**: **heparin** + warfarin **-Rhythm control** 3 weeks later (amiodarone or DC Cardioversion)
29
atrial fibrillation: 1st episode + symptomatic + L atrial thrombus found
**Rate control** Beta blocker eg **Bisoprolol**, or rate limiting, non-DHP Calcium channel blocker eg **Diltiazem** Anticoagulation (heparin + warfarin) -Rhythm control 3 weeks later (DCCV or amiodarone)
30
Atrial fibrillation: 1st episode + asymptomatic
Chadsvasc is 0-1: observe for 24 hours (most resolve spontaneously ) Chadsvasc is \>=2: anticoagulate + observe for 24 hours
31
Pacemaker spikes: how to differentiate between atrial and ventricular pacing?
Atrial: spike before p wave Ventricular: spike before QRS
32
Ventricular pacing: what does the ECG look like?
pacing spike before QRS Left ventricular pacing --\> QRS morphology similar to RBBB
33
Pacemakers: what are the indications for a) atrial lead only b) ventricular lead only c) both atrial and ventricular leads
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
ICD - what is it for?
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
Indication for cardiac resynchronisation therapy
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
What is cardiac resynchronisation therapy
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
Classification of heart block
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
Causes of heart block
Coronary heart disease (ACS or chronic) Drugs: beta blocker, adenosine, CCBs,
39
which electrolytes may be responsible for heart block
Potassium Calcium
40
Management of v symptomatic second degree type II heart block
Stop AVN blocking drugs (B-blockers, CCBs) + Temporary pacing (both mobitz type II and 3rd degree heart block are treated this way)
41
In what scenario can you merely observe heart block?
if Asymptomatic and either 1st degree or 2nd degree type I
42
Young person - faints a lot ECG shows long QT. Next steps?
HUGE risk of VT + VF Ix: Serum K, Mg, Ca (low levels can cause it) Echo 24 hour ECG Mx: beta blockers + ICD
43
When is shock given in DCCV?
During QRS
44
Cardiac tamponade - causes
Post MI Post cardiac intervention Pericarditis Malignancy Trauma
45
Becks traid of cardiac tamponade
Raised JVP Low BP Muffled HS
46
Mx of cardiac tamponade
Pericardiocentesis (echo guidance)
47
Dukes Criteria for IE
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
Classification of atrial fibrillation
First episode Paroxysmal - \<7 days Persistent - \>7 days Permanent - often \>1 year, refractory to treatment
49
Causes of Afib
Heart: MI, IHD, mitral valve path, HTN Hyperthyroidism EtOH pneumonia
50
Complications of AFIb
Embolism: stroke, TIA HF: reduced CO Further remodelling
51
HASBLED - what is it? what score is considered high ris
Bleeding risk - 3+ is high risk HTN, renal disease, liver disease, stroke history, bleeding history, wild INR, elderly, EtOH
52
Afib pharm rhythm control: which agents are used? and in which situs is one preferred?
Flecainide or amiodarone Amiodarone in structural heart disease
53
Mx of broad complex tachycardia w no adverse signs
IV amiodarone 300mg over 20-60 mins then 900mg over 24 hours
54
Mx of tachycardia w shock/syncope/MI/HF
DC shock! + IV amiodarone 300mg over 10-20 mins + repeat shock
55
Mx of SVT
vagal manœuvres IV adenosine 6mg bolus, then 12mg then 12mg
56
Ddx for SVT
atrial fibrillation atrial flutter AVNRT AVRT
57
Stage 2 HTN clinic? home?
Clinic: \>160/100 Home: \>150/95
58
Diagnosis of rheumatic fever - what are the criteria?
Modified Jones criteria Major: carditis, arthritis, sydenams chorea, erythema marginatum, subcut nodules Minor: fever, raised ESR/CRP, long PR interval, arthralgia
59
Management of rheumatic fever
Admit + bed rest until inflame markers resolve - IM benpen stat - 10 day penicillin - Aspirin as needed AND secondary Abx prophylaxis
60
What are the Rule outs for the cardiovascular station?
Acute Cornary Syndrome/ Myocardial infarction Acute heart failure
61
New onset atrial fibrillation and pt are haemodynamically unstable. How would you manage?
Emergency electrical cardioversion Consider amiodarone (Rate control) Long term anticoagulation: Refer to CHADVASC Score

Yr 6 PACES knowledge COPY RJ Challenger (16 decks)

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