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2A - Stuff i just cannot remember > Cardio > Flashcards

Cardio Flashcards

1
Q

MI ECG Changes

A

ST depression
ST Elevation

T-wave inversion
Abnormal Q wave

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2
Q

QT prolongation indicates…

A

Medication SE.

Amiodarone, antibiotics

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3
Q

Wide QRS indicates…

A

Bundle Branch Block

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4
Q

Dual Antiplatelet Therapy

A

Aspirin + PY12 inhibitor

ticagrelor, clopidogrel, prasugrel

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5
Q

ACS Management

A

1) GTN
2) O2
3) Analgesia
4) Dual Antiplatelet Therapy
5) PCI/ thrombolysis

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6
Q

Anti-hypertensives
1L - caucasian?
1L - Afro-Carib?

2L

3L

A

1L: Caucasian: ACEi
(ramipril)

1L: Afro-Carib: CCB
(Amlodipine)

2L: ARB
(Losartan)

3L: Thiazide-diuretic

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7
Q

Cor Pulmonale is ___ heart failure and presents with __

A

Right sided heart failure

Shortness of breath

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8
Q

What is a common cause of stroke?

A

Atrial Fibrillation

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9
Q

What would infective endocarditis present with?

A 
Fever 
New murmur 
Janeway lesion 
Osler's nodes
Splinter haemorrhages
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10
Q

How does Left Bundle Branch Block present?

A

Usually asymptomatic

ECG: WiLLiaM (V1, V6)

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11
Q

How does Right Bundle Branch Block present?

A

ECG: MaRRoW (V1, V6)

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12
Q

Heart failure classic triad

A

SOB, fatigue, ankle oedema.

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13
Q

Management of Acute Heart Failure

A

IV Furosemide + Diamorphine + Antihypertensive (GT, diuretic) or Antihypotensive (vasocative DA)

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14
Q

Management of Chronic Heart Failure

A

ACEi - Ramipril/ ARB - Valsartan + BB + Diuretic - Furosemide

2L Hydralazine/ nitrate/ Digoxin (with AF)

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15
Q

A high BNP level indicates…

A

Congestive heart failure

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16
Q

How is hypertension classified?

A

1) >135/85 ABPM
2) >150/95 ABPM
3) >180 S or >110 D

Malignant = >180/120 + end-organ damage

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17
Q

How is hypertension managed

A

ACEi/ ARB or CCB - Nifedipine (if >55/ Afro-Carib)

ACEi +/- CCB +/- Thiazide-like diuretic - Indapamide/ Spironolactone if K<4.5

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18
Q

How is pregnancy-induced HTN managed?

A

IV Magnesium Sulphate + Labetalol/ Hydralazine/ Methyldopa

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19
Q

What is Sodium Nitroprusside used for?

A

Lowering vv high BP

  • encephalopathy
  • Aortic dissection
  • Pulmonary oedema
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20
Q

What is Labetalol used for?

A

= a BB - 1L for lowering BP in pregnancy

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21
Q

Cannon A-waves, HR <40bom, syncope indicates…

A

AV Block

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22
Q

What is seen on the ECG of a first-degree AV Block?

A

Prolonged PR interval >0.2s

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23
Q

ECG shows a PR interval progressively lengthening until P-wave is not conducted.

What SnS will this pt present with?

A

= Mobitz I (Wenckebach) 2nd degree AV block

Light head, dizzy, syncope

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24
Q

ECG shows a constant PR interval, with a dropped QRS.

What SnS will this pt present with?

A

= Mobitz II 2nd Degree AB block

SOB, postural hypotension, angina.

Requires permanent pacemaker.

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25
Q

Why is Mobitz II irreversible?

A

Failure of conduction through His-purkinje system, which is resistant to AV blocking agents

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26
Q

ECG shows P-waves completely independent of QRS.

How is this pt treated?

A

= 3rd Degree heart block

IV atropine
Permanent pacemaker

Narrow QRS IN BoH. (QRS < 0.12)

Broad QRS BELOW BoH. (QRS >0.12s)

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27
Q

ECG shows saw-tooth F waves in II, III, aVF. They show heart and lung pathologies.

How is this pt treated?

A

= Atrial Flutter

LMW Heparin THEN electrical cardioversion

Catheter ablation, IV amiodarone, BB

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28
Q

ECG shows irregular irregular rhythm at 400bpm and no p-waves.

How is this pt treated?

A

= Atrial Fibrillation

Cardioversion: DC Shock + LMW heparin + antiarrhythmic

VR control - block AVN!
- CCB, BB, digoxin, amiodarone

CHA2DS2-VASc Score

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29
Q

Symptoms and signs of LEFT heart failure

A

Prolonged capillary refill time, S3 gallop, pulsus alternans

30
Q

Pansystolic murmur heard loudest at the apex on expiration

A

Mitral regurgitation

31
Q

Pansystolic murmur heard loudest at the apex on inspiration

A

Tricuspid regurgitation

32
Q

What is pulsus paradoxus indicative of?

A

Abnormally large decrease in Stroke Volume/ Systolic BP.

  • Constrictive pericarditis
  • Pericardial effusion
  • cardiac tamponade
33
Q

Pericarditis presentations

A

Water-bottle shaped enlarged cardiac silhouette.

Chest pain, worse lying flat, pericardial friction rub

34
Q

Pulmonary embolism presentations

A

Fleischner Sign - prominent central pulmonary artery

Short Hx of SOB, Pleuritic chest pain +/- haemoptysis

35
Q

Congestive Heart Failure presentations

A

Cardiomegaly, Cardiothoracic ratio >0.5

Alveolar oedema 
B-lines (Kerley)
Cardiomegaly
Diversion - upper lobe 
Effusions - pleural
Fluid in horizontal fissure
36
Q

If adequate medication is given to a pt with heart failure, yet their symptoms persist, what is the next step?

A

Cardiac resynchronisation (also for LBBB)

37
Q

Who is suitable for a Permanent Pacemaker?

A

Symptomatic bradycardia, Mobitz II 2nd degree Heart block

38
Q

Who is suitable for an Implantable Cardioverter-defibrillator?

A

Reasonable QoL + Poor LVEF <35%, despite medical management.

Also life-threatening arrhythmias - Ventricular Fibrillation, Ventricular tachycardia

39
Q

Who is suitable for Digoxin?

A

Pt with sinus rhythm + symptomatic HF despite medical tx (BB, ACE, diuretic)

40
Q

Who is suitable for Cardiac Resynchronisation Therapy (CRT)?

A

Symptomatic HF despites meds, LVEF <35%, prolonged QRS >130ms.

41
Q

Who is suitable for Ivabradine?

A

LVEF <35%, in sinus rhythm, resting HR >70bpm despite BB/ACEi/Spironolactone.

42
Q

A chest radiography showing consolidation suggests…

A

Infection!

43
Q

Cor pulmonale investigations

A

ECG: Right axis deviation, due to right ventricle hypertrophy, P pulmonale (tall p-wave)

Raised Hb due to 2o polycythaemia

CXR: right atrial enlargement, ABCDEF

44
Q

Systemic Hypertension is associated with which side heart failure?

A

Left Heart Failure

HTN > Excess afterload > LVF

45
Q

Basal respiratory crackles indicate…

A

Left Heart Failure

LV cannot pump blood from pulmonary circ to rest of body > backflow to lungs

46
Q

Gallop heart rhythm indicates..

A

Left Heart Failure

Atrial contractions against stiff ventricle

47
Q

Westermark’s sign indicates

A

Vessel collapse, seen in pulmonary embolism

48
Q

Silhouette sign

A

Loss of structural borders, seen in pneumonia

49
Q

Prescribe Furosemide + Ramipril to a pt with…

A

Heart Failure and PRESERVED ejection fraction (HFPEF) with signs of fluid overload

50
Q

Prescribe Spironolactone + Ramipril to a pt with…

A

Heart Failure and REDUCED ejection fraction (HFPEF)

51
Q

If a patient cannot tolerate spironolactone, what is the next step?

A

Hydralazine/nitrate

52
Q

What is the first line management of decompensated heart failure, secondary to AF?

A

BETA BLOCKADE - IV Metoprolol

CI: COPD, severe asthma

53
Q

Acute Management of STEMI

A

MMONAT

Morphine 
Metoclopramide 
O2 if sat <94%
Nitrates (GTN)
Aspirin 300mg
Ticagrelor/ Clopidogrel300mg

PCI within 12hr onset

OR Fibrinolytic/thrombolysis - Alteplase/ Fondaparinux

54
Q

Acute Management of NSTEMI

A

MMONAC

Morphine 
Metoclopramide 
O2 if sat <94%
Nitrates (GTN)
Aspirin 300mg
Clopidogrel 300mg

48hr LMW Heparin

High GRACE risk:

PCI within 12hr onset

OR Fibrinolytic/thrombolysis - Fondaparinux

55
Q

Contraindications to thrombolysis:

A

AGAINST

Aortic dissection 
GI bleed 
Allergic reaction 
Iatrogenic 
Neuro disease
Severe HTN
Trauma/CPR
56
Q

When is Clopidogrel favoured over Ticagrelor in ACS acute management?

A

Pt >70 with an NSTEMI

57
Q

Pt presents with chest pain and fever. He had an MI 4 weeks ago. His ESR is raised.

Likely diagnosis? Treatment?

A

Dressler’s syndrome - post-ACS pericarditis

NSAIDs

58
Q

Pt is recovering from an MI. He presents with a NEW pan-systolic murmur along the left-sternal border. His JVP is raised and there is bipedal pitting oedema.

Likely diagnosis?

A

Acute heart failure, secondary to Intraventricular Septum Rupture*

*Complication of MI

59
Q

Pt is recovering from an MI. His JVP is raised and there is bipedal oedema. His heart sounds muffled, and you notice pulsus paradoxus.

Likely diagnosis?

A

Left ventricle free wall rupture

= HF + Cardiac tamponade

  • muffle heart sound
  • pulsus paradoxus
  • raised JVP
60
Q

Pt presents with central chest pain on exertion. He admits to recently snorting cocaine with friends.

Likely diagnosis?

A

Coronary Artery Vasospasm

61
Q

Continuous machine-like murmur

A

Patent ductus arteriosus

62
Q

Ejection systolic murmur

A

aortic stenosis, pulmonary stenosis, atrial septal defect, hypertrophic obstructive cardiomyopathy

63
Q

Early diastolic murmur

A

Aortic regurgitation, pulmonary regurgitation

64
Q

Pan-systolic murmur

A

Mitral regurgitation (can be a complication of MI)

Tricuspid regurgitation

65
Q

Mid-diastolic murmur

A

mitral stenosis

tricuspid stenosis

66
Q

45yr F has ST-Elevation + new LBBB. The pt has a stent inserted into her RIGHT coronary artery.

Which leads would have been affected on her ECG?

A

RCA > RA + RV

67
Q

Blood supply of the heart

A

RCA > RA + RV

R Marginal > RV + apex

LAD > RV + LV + Interventricular septum

L Circumflex > LA + LV

L Marginal ? LV

68
Q

ECG Leads affected in a high-lateral MI

A

Circumflex artery > LA + LV

Leads I, avL

69
Q

ECG Leads affected in a septal-MI

A

Proximal LAD > septum

  • V1, V2
70
Q

ECG Leads affected in an anterior-MI

A

LAD RV + LV + Interventricular septum

V3, V4

71
Q

ECG Leads affected in an inferior-MI

A

RCA > RA+ RV

II, III, aVF

2A - Stuff i just cannot remember (19 decks)

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