Cardio Flashcards
1
Q
‘global speckled’ pattern on ECHO
A
Cardiac amyloidosis
2
Q
Psuedoinfarction pattern on ECG appears as
A
Low-voltage complexes with poor R wave progression
3
Q
Pseudoinfarction pattern on ECG associated with
A
Cardiac amyloidosis
4
Q
Normal PR interval
A
120 - 200 ms
5
Q
Anteroseptal - ECG changes
A
V1 - V4
6
Q
Inferior - ECG changes
A
II, III, aVF
7
Q
Anterolateral - ECG changes
A
V4-V6, I, aVL
8
Q
Lateral - ECG changes
A
I, aVL +/- V5-V6
9
Q
Posterior - ECG changes
A
Tall R waves V1-V2
10
Q
Coronary artery affected: Anteroseptal changes
A
Left anterior descending
11
Q
Coronary artery affected: Inferior changes
A
Right coronary
12
Q
Coronary artery affected: Anterolateral changes
A
Left anterior descending,
or,
Left circumflex
13
Q
Coronary artery affected: Lateral changes
A
Left circumflex
14
Q
Coronary artery affected: Posterior changes
A
Usually left circumflex, also right coronary
15
Q
Long QT1
A
Adrenergic surge due to physical activity
16
Q
Long QT2
A
Adrenergic surge due to intense emotion
17
Q
Long QT3
A
Death during sleep
18
Q
Kussmaul’s sign looks like
A
JVP rises during inspiration
19
Q
Kussmails sign associated with
A
Constrictive pericarditis
20
Q
Definition of pulmonary arterial hypertension
A
Resting mean pulmonary artery pressure is >= 25 mmHg
21
Q
Wellen’s syndrome - appearance on ECG
A
Deeply inverted/biphasic T waves in V2 - V3
22
Q
Wellen’s syndrome - suggests
A
Critical LAD stenosis
23
Q
Aortic stenosis - Criteria for aortic valve surgery
A
Symptomatic
Valvular gradient > 40 mmHg and features of LV systolic dysfunction
24
Q
Dabigatran MOA
A
Inhibits thrombin
25
Dabigatran reversal agent
Idarucizumab
26
Blood pressure target - patient with hypertension without other comorbidity
< 140/90 mmHg
27
Blood pressure target - patient with diabetes and end organ damage
< 130/80 mmHg
28
Normal QRS duration
< 120 ms
29
INR > 8.0 with No bleeding
Oral Vitamin K 1-5 mg
Repeat dose vitamin K if INR still too high after 24hr
Restart warfarin when INR < 5
30
ECG findings associated with ostium primum
RBBB + LAD, prolonged PR
31
ECG findings associated with ostium secundum
RBBB + RAD
32
Heart failure - 1st-line management for all patients
ACEi + beta-blocker
| start one, then add other
33
Heart failure - 2nd-line
```
Aldosterone antagonist
(spironolactine/eplerenone)
```
34
Heart failure - 3rd-line options
Ivabradine
Sacubitril-valsartan
Digoxin
Hydralazine with nitrate
Cardiac resynchroniziiton therpy
35
Heart failure management -- criteria for ivabridine
Sinus rhythm >75 bpm +
| LVEF <35%
36
Heart failure management - criteria for sacubitril-valsartan
LVEF <35%
37
Heart failure management - indication for digoxin
Coexistant AF
38
Heart failure management - indication for hydralazine with nitrate
Afro-Caribbean patient
39
Heart failure management - indication for cardiac resynchronization therapy
Widened QRS complex >130ms
40
Infective endocarditis- empiric treatment for prosthetic valve
Vancomycin + rifampicin + low-dose gentamicin
41
Infective endocarditis- empiric treatment for native valve
Amoxicillin + consider low-dose gentamicin
42
Infective endocarditis- empiric treatment for native valve (Penicillin allergy)
Vancomycin + low-dose gentamicin
43
Mitral regurgitatiion with new AF - management?
Refer for mitral valve replacement
44
Features of cholesterol embolism
- Eosinophilia
- Purpura
- Renal failure
- Livedo reticularis
45
Causes of LBBB
- IHD
- HTN
- Aortic stenosis
- Cardiomyopathy
46
Epsilon wave looks like
Small positive deflection at end of QRS complex
47
Infective endocarditis - treatment for prosthetic valve, caused by staphylococci
Flucloxacillin + rifampicin + low-dose gentamicin
48
Prolonged QTc in men
>440ms
49
Infective endocarditis - treatment for native valve, caused by staphylococci (PEN ALLERGIC)
Vancomycin + rifampicin
50
Acceptable increase in creatinine when starting AECi
Up to 30% increase
51
Infective endocarditis - treatment for prosthetic valve, caused by MRSA
Vancomycin + rifampicin + low-dose gentamicin
52
Secundum atrial septal defects occur where
Middle of atrial septum
53
Infective endocarditis - treatment if caused by fully-sensitive streptococci eg viridans (PEN ALLERGIC)
Vancomycin + low-dose gentamicin
54
Infective endocarditis - treatment if caused by less-sensitive streptococci (PEN ALLERGIC)
Vancomycin + low-dose gentamicin
55
Infective endocarditis - treatment if caused by less-sensitive streptococci
Benzylpenicillin + low-dose gentamicin
56
Causes of LBBB
- IHD
- HTN
- Aortic stenosis
- Cardiomyopathy
57
Culture-negative causes of infective endocarditis
```
Coxiella burnetii
Bartonella
Brucella
HACEK
Prior antibiotics
```
58
Which pre-excitation disorder shows ECG with a short PR interval, and normal QRS complex
Lown-Ganong-Levine syndrome
59
ECG findings in Wolff-Parkinson-White syndrome
Short PR interval, wide QRS complex with slurred upstroke (delta wave)
60
PMH contraindications to adenosine use in SVT
Asthma
Taking dipyridamole
61
ECG findings in dextrocardia
Inverted P wave in lead I
RAD
Loss of R wave progression
62
Patient with WPW in AF - which medication for cardioversion
Flecainide
63
Unifying diagnosis: Constrictive pericarditis + nephrotic syndrome + mononeuritis multiplex
Amyloidosis
64
Digoxin contraindication
Cardiac amyloidosis (digoxin binds to amyloid > toxicity)
65
1st line management of acute idiopathic/viral pericarditis
NSAID + colchicine
66
HACEK agents
```
Haemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella
```
67
Culture-negative causes of infective endocarditis
```
Coxiella burnetii
Bartonella
Brucella
HACEK
Prior antibiotics
```
68
Which pre-excitation disorder shows ECG with a short PR interval, and normal QRS complex
Lown-Ganong-Levine syndrome
69
Contraindication to adenosine use in SVT
Asthma
70
ECG findings in dextrocardia
Inverted P wave in lead I
RAD
Loss of R wave progression
71
Patient with WPW in AF - which medication for cardioversion
Flecainide
72
Unifying diagnosis: Constrictive pericarditis + nephrotic syndrome + mononeuritis multiplex
Amyloidosis
73
Digoxin contraindication
Cardiac amyloidosis (digoxin binds to amyloid > toxicity)
74
1st line management of acute idiopathic/viral pericarditis
NSAID + colchicine
75
ECG findings in dextrocardia
Small complexes in chest leads vs the limb leads
| Inverted complexes in I and aVL
76
ECG findings in Second-degree AV block type 1 (Mobitz I, Wenckebach)
Progressive prolongation of PR interval until a dropped beat occurs
77
ECG findings in Second-degree AV block type 2 (Mobitz II)
P waves are often not followed by a QRS complex.
Where a QRS complex does follow, the PR interval is NORMAL
78
CHA2DS2-VASc
CCF - 1
HTN - 1
Age:
=>75 - 2
65-74 - 1
DM - 1
Stroke/TIA - 2
IHD/PAD - 1
Female - 1
79
Hypertension - 4th line medical management
(already taking A + C + D)
- K < 4.5 mmol/l
Add low-dose spironolactone
80
Hypertension - 4th line medical management
(already taking A + C + D)
- K > 4.5 mmol/l
Add alpha-blocker (doxazosin) or beta-blocker (nebivolol, carvedilol)
81
Beta-blockers in systemic sclerosis
May worsen Raynauds
82
Hypertension - 3rd line management, already taking ACEi + CCB
Thiazide-like diuretic (Indapamide)
83
Hypertension - 1st line management <55 years old and not AFC
ACEi/ARB
84
Hypertension - 1st line management any age, with T2DM, not AFC
ACEi/ARB
85
Hypertension - 1st line management >55 years old not T2DM
Calcium channel blocker (amlodipine)
86
Hypertension - 1st line management any age, AFC, not T2DM
Calcium channel blocker (amlodipine)
87
Hypertension - 2nd line management - already taking ACEi/ARB
Add:
CCB (amlodipine)
or
TLD (indapamide)
88
Hypertension - 2nd line management - already taking CCB
Add:
ACEi or ARB (ARB if AFC)
or
TLD (indapamide)
89
Hypertension - 3rd line management, already taking ACEi + TLD
Add CCB
90
Patient with AF, already on dual anti-platelet
Still needs formal anticoagulation (Warfarin/DOAC)
91
Which anti-coagulant for AF, in patient with CKD?
Rivaroxaban
| Reduced dose if GFR 15-50
92
Dabigatran in renal impairment
Not safe, high risk of bleeding
93
Cardiac monitor shows 'short runs of polymorphic VT'
Torsades de pointes
94
Management of Torsades de pointes
IV Magnesium sulphate
95
Causes of long QT (therefore increase risk of Torsades de pointes)
```
Amiodarone, sotalol
Erythromycin/clarithromycin
Low Ca, K, Mg
TCA/antipsychotics
Chloroquine
Fluconazole
```
96
Management of monomorphic VT - no adverse signs
Amiodarone/
Lidocaine/
Procainamide
97
Management of monomorphic VT - with adverse signs
DC cardioversion
98
ECG findings in Brugada syndrome
Coved ST elevation in >1 of V1-V3 followed by negative T wave
99
Diagnostic tool for Brugada
Fleicanide challenge
100
Management of Brugada syndrome
ICD
101
Long-term management of WPW
Radiofrequency ablation
102
Medical management of SVT in WPW
Sotalol, adenosine, fleicanide, amiodarone
103
CI to use of sotalol/adenosine in for SVT in WPW
Possible underlying AF
104
Which type of atrial septal defect is most common
Ostium secundum defect
105
ST elevation without reciprocal depression, shortly after myocardial infarction, suggests
Left ventricle aneurysm
106
Feature that suggests vascular claudication (over neurogenic claudication)
No relief from leaning forward/sitting down.
| Only relieved with rest
107
ABPI > 1.2
Calcified stiff arteries
| May be PAD or normal in old age
108
ABPI 1.0 - 1.2
Normal
109
ABPI 0.9 - 1.0
Acceptable
110
ABPI < 0.9
Likely PAD
111
ABPI < 0.5
Severe PAD - urgent referral
112
ABPI required for compression bandaging
>= 0.8
113
ECG features of trifascicular block
RBB + LAD/RAD + prolonged PR
114
Management of sick sinus syndrome with bradarrhythmia
Pacemaker (AAIR)
115
Inherited long QT and sensorineural hearing loss seen in
Jervell & Lange-Nielson syndrome
116
Congenital syndrome with long QT (no hearing loss)
Romano-Ward syndrome
