Cardio Flashcards
Cannon A waves in JVP and broad QRS on ECG. Dx?
Sustained V tach
What is Tx for sustained V tach?
Cardioversion
Irregular QRS, long QT. Dx?
Torsades de Pointes
5+ consectutive beats in 30s. Dx?
Non sustained V tach
Which 2 rhytms are shockable?
Sustained V tach
V fib
What is the first step in MI Tx?
GTN or morphine
300mg aspirin in ambulance
L sternal edge, 2nd ICS. Inspiration loudest. Murmur?
Graham Steele
Constant machine murmur. Dx?
Patent ductus arteriosus
Low pitch, mid diastolic rumble at apex. Dx?
Austin flint murmur (aortic regurg)
Midsystolic click and late systolic murmur. Dx?
Barlow syndrome (mitral valve prolapse)
Inverted t waves and ST depression. Dx?
Ischaemic change
ST elevation, Q waves, raised troponin. Dx?
Infarct
What is the Tx for AF with unstable angina?
Warfarin, anti HTN, beta blocker and statin
What is the first sign O/E of aortic stenosis?
Bibasal creps
ST elevation in V1-4. Artery and MI type?
Left Anterior Descending –> Anterioseptal MI
ST elevation in V5-6. Artery and MI type?
Left circumflex artery –> Lateral MI
ST elevation in V1-6. Artery and MI type?
Left coronary artery –> Anterolateral
ST elevation in leads II, III and aVF. Artery and MI type?
Right coronary artery –> Inferior
Name the 5 wave forms of JVP
A, C, X descent, V, Y descent
What does A wave in JVP represent?
Atrial systole
What does C wave in JVP represent?
Closure of tricuspid valve
What does X descent in JVP represent?
Fall in atrial pressure in systole
What does V wave in JVP represent?
Atrium filling against closed tricuspid
What does Y descent in JVP represent?
Opening of tricuspid
Absent A waves in JVP. Dx?
Atrial fib
Raised JVP with normal waveform. Dx?
R heart failure / fluid overload
Large v waves in JVP. Dx?
Tricuspid regurgitation
Cannon A waves in JVP. Dx?
Complete heart block
Ventricular arrhythmias
Large A waves in JVP. Dx?
Pulmonary HTN
Pulmonary stenosis
List CXR features of heart failure
Alveolar oedema Kerly B Lines Cardiomegaly Upper lobe diversion Pleural effusions
What is the normal range of PR interval?
0.12 - 0.2s
What causes long PR?
First degree heart block
How long is PR in 1st DHB?
> 0.2s
What causes short PR?
Wolff Parkinson White
List clinical features of mitral stenosis
Malar flush
AF
Tapping apex beat
RV heave (2nd to Pulm HTN)
What is the mitral stenosis murmur?
Mid diastolic murmur (opening snap)
Syncope. Dyspnoea. Angina. Dx?
Aortic stenosis
What is the best drug to rapidly lower BP?
Sodium nitroprusside
What is phentolamine used for?
Phaeo causing HTN crisis
HTN. Radio-femoral delay. Mid systolic murmur at aortic area, radiating to back. Dx?
Coarctation of aorta
What 3 heart/lung problems are ventricular septal defects associated with?
Pulmonary HTN, Heart failure, shunt reversal
What heart problem are small ventricular septal defects associated with?
Endocarditis
What is the Ix of choice for ?PCKD ?
Urinary tract USS
What disease inheritance is PCKD?
Autosomal dominant
What is immediate Mx for ?ACS ?
IV LMWH
Beta blocker
No DVT risk factors. 3rd PE in 1 year. Initial Mx? Why?
Thrombophilia screen - suggests a thrombophilic trait
Thrombophilic trait. Mx?
Warfarin
Mid-diastolic murmur with opening snap. No other Sx. Dx?
Mitral stenosis
Ix for mitral stenosis?
Echo
Sudden severe chest pain after lifting heavy boxes. Radiates to shoulder blade. Dx?
Aortic dissection
What is Mx of aortic dissection?
Beta blockers
Surgery
Wide pulse pressure with collapsing pulse. Decrescendo diastolic murmur. Dx?
Aortic regurgitation
What is Mx of SVT?
IV adenosine
6 months of frequent chest pain in morning/night. No pain on exertion. Sinus rhythm, normal troponin, ST elevation in anterior leads. Dx?
Variant angina aka Prinzmetal’s angina
What is Mx for Prinzmetal’s angina?
Nitrates and CCB
19 y/o man. SoB on exertion +/- chest pain. Mid-systolic murmur on L sternal edge. L axis deviation on ECG. FH sudden death <50. Dx?
HOCM
What is Mx of HOCM?
Beta blockers
What is initial Ix of phaeo once high BP confirmed?
Urinary metanephrines over several 24hrs periods
What is Kussmaul’s sign?
Increased jugular distention on inspiration
What sign is consistent w constrictive pericarditis?
Kussmauls sign
Reduced heart sounds
Nausea, anorexia, yellow rings around lights. PMH heart failure. Dx?
Digoxin side effects
What drugs are given as part of post MI Mx?
Beta blocker
Aspirin
Statin
ACEi
How do you definitively diagnose infective endocarditis?
Blood culture
What causes bacterial infective endocarditis?
Strep viridans
What happens to prolapsed mitral valve in systole?
Flaps are pushed back into L atrium
What Tx is used for paroxysmal AF?
Flecanide
Patient has persistent HTN despite being on all the available medications. Next step?
Arrange for medication to be given under direct supervision