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Phase 3B > Cardiology 1 > Flashcards

Cardiology 1 Flashcards

1
Q

What is a channelopathy?

A

A genetic disorder in which the electrical activity of the heart is abnormal, but the heart is structurally normal.

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2
Q

When do symptoms first appear in channelopathies?

A

30-40 years

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3
Q

What is the cause of Brugada syndrome, a type of channelopathy?

A

Cardiac sodium channelopathy (SCN5A gene)

Autosomal dominant inheritance but can be a new mutation.

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4
Q

How does Brugada syndrome cause arrhythmias?

A

Abnormally slow conduction in the heart - decreased flow of Na+ ions changes the AP, slowing conduction.
“Short circuits” form, causing wavebreak and causing re-entry (U-turns).

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5
Q

What are the symptoms of channelopathies?

A 
May be asymptomatic
Syncope
Sudden cardiac death
Palpitations
Chest pain
Breathlessness or dizziness
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6
Q

How is syncope caused by a channelopathy?

A

Brief arrhythmias revert to a normal rhythm spontaneously OR vasovagal syncope.

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7
Q

In Brugada syndrome, when do arrhythmias occur?

A

At rest
Following a heavy meal
Fever/alcohol
When vagus nerve is activated

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8
Q

How is Brugada syndrome diagnosed?

A

Genetic testing
ECG with or without flecainide (provocation test):
Brugada sign: coved ST segment elevation >2mm in >1 of V1-V3 followed by a negative T wave

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9
Q

What must Brugada sign be associated with to diagnose channelopathies?

A

One of:

  • Documented VF or polymorphic VT
  • FH of SCD<45 years
  • FH of similar ECG
  • Syncope
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10
Q

Which arrhythmias may be caused by a Brugada syndrome?

A

Ventricular fibrillation
Polymorphic ventricular tachycardia
AV nodal re-entrant tachycardia
Sinus node dysfunction

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11
Q

As part of the treatment of Brugada syndrome, what triggers must be avoided?

A 
Fever
Alcohol and drugs
Dehydration
Tricyclics, anaesthetics, sodium channel blockers (flecainide)
CCBs
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12
Q

What is the main treatment of Brugada Syndrome?

A

Implantable cardiac defibrillator

If not appropriate - quinidine

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13
Q

What is a normal QT interval?

A

<440ms (two large squares)

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14
Q

What are the risks of prolonged QT syndrome?

A

Delayed repolarization of the heart following a heart beat increases the risk of toursades des pointes episodes

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15
Q

What are the congenital causes of LQTS?

A

Cardiac ion channel mutation:
Jervell and Lange Nielson syndrome
Romano-Ward syndrome

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16
Q

What are the acquired causes of LQTS?

A 
Low Ca/K/Mg
Drugs: amiodarone, TCAs, SSRIs
MI
3rd degree heart block
Fasting and bradycardia
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17
Q

What are the subtypes of LQTS?

A

Potassium channel: risk of SCD when patient is startled or awoken suddenly
Sodium channel: risk of SCD when patient is sleeping

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18
Q

What are the symptoms of LQTS?

A

Syncope and palpitations as a result of polymorphic VT

Nausea, pallor, dyspnoea, chest pain

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19
Q

What is seen on the ECG in LQTS?

A

QTc>440m/s
Toursades des points
Degeneration into sustained VT or VF

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20
Q

What is the treatment of congenital LQTS?

A

Propanolol (unless bradycardic)
Pacing
ICD

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21
Q

Why is propranolol contra-indicated in acquired LQTS?

A

Bradycardia can precipitate toursades.

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22
Q

What is the treatment of toursades des pointes?

A

IV magnesium sulphate
Temporary atrial pacing to increase HR and reduce QT
Correct predisposing factor e.g. QT prolonging drug
IV isoprenaline

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23
Q

Define cardiomyopathy.

A

Myocardial disorder in which the heart muscle in structurally and functionally abnormal without coronary artery disease, hypertension, valvular, or congenital heart diseases.

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24
Q

How can cardiomyopathies present?

A

Heart failure
Arrhythmias
SCD
Thromboembolism

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25
Q

What is the most common form of cardiomyopathy?

A

Dilated cardiomyopathy

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26
Q

What is the hallmark of dilated cardiomyopathy?

A

Left or both ventricles are dilated with impaired systolic function

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27
Q

What are the causes of dilated cardiomyopathy?

A

Idiopathic
Familial
Alcoholic

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28
Q

What is hypertrophic cardiomyopathy?

A

Left or right sided hypertrophy leading to LV outflow obstruction

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29
Q

What is affected in restrictive cardiomyopathy?

A

Diastolic filling

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30
Q

What is the pathophysiology of arrhythmogenic right ventricular cardiomyopathy?

A

Fatty and fibrous replacement of ventricular myocardium

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31
Q

Prolonged isometric training may result in athlete’s heart which may have features of…

A

Hypertrophic cardiomyopathy

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32
Q

What is seen on CXR in cardiomyopathy?

A

Cardiomegaly

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33
Q

What is seen on ECG in cardiomyopathy?

A

T wave inversion
ST changes
LVHT

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34
Q

What investigation differentiates between the different types of cardiomyopathy?

A

Transthoracic echo

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35
Q

What are the aims of treatment in cardiomyopathy?

A

Symptomatic
Treat heart failure
Prevent thromboembolism

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36
Q

What is the treatment of cardiomyopathies?

A

BB
Verapamil
ICD
Cardiac Tx

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37
Q

What are the indications for amiodarone in cardiomyopathy?

A

Massive LVHT
Family history SCD
Unexplained syncope
VT

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38
Q

What is infective endocarditis?

A

Infection of the endocardium, cardiac valves, intrathoracic vessels and prostheses.

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39
Q

What are the effects of infective endocarditis?

A

Valvular insufficiency

Systemic emboli

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40
Q

What are the two factors required for development of infective endocarditis?

A

Bacteraemia

Abnormal cardiac endothelium

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41
Q

Name three risk factors that cause bacteraemia and therefore infective endocarditis.

A

Poor dental hygiene - s.viridans
IV drug use - s.aureus
Cardiac surgery - s.epidermis

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42
Q

Name some causes of abnormal cardiac endothelium.

A

Valvular disease including replacement
Structural heart disease
Hypertrophic CMY

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43
Q

What are the most common organisms in infective endocarditis?

A

S.aureus

S.viridans

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44
Q

What are the symptoms of infective endocarditis?

A

Fever
New/changing murmur
CCF
Pleuritic or back pain

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45
Q

Name some immunological phenomena of infective endocarditis.

A

Splinter haemorrhages
Roth’s spots
Glomerulonephritis
Embolic stroke

46
Q

Name 6 signs of infective endocarditis.

A 
Petechiae
Splinter and subungal haemorrhages
Osler's nodes
Roth's spots
Janeway lesions
Splenomegaly
47
Q

What are the appropriate investigations for infective endocarditis?

A

3 sets of blood cultures prior to starting treatment

ECG, CXR, TTE

48
Q

What is the diagnostic criteria for infective endocarditis?

A

Modified Duke criteria

Major: +ve culture, evidence of endocardial involvement

Minor: predisposition, fever, vascular/immunological phenomena, echo findings

49
Q

What is the choice empirical antibiotic for infective endocarditis whilst awaiting blood culture results?

A

Amoxicillin and gentamycin

50
Q

What is the typical cause of pericarditis?

A

80% postviral or idiopathic

51
Q

What is the function of the pericardium?

A

Protects cardiac efficiency by limiting dilation, maintaining ventricular compliance.
Aids atrial filling and is a barrier against infection
Reduces external friction

52
Q

Name three other causes of pericarditis.

A

SLE
Sarcoidosis
Primary/metastatic neoplasms

53
Q

Describe the pain of pericarditis.

A

Sharp pain in the substernal/precordial region, which can radiate to the neck or shoulders.
Inspiration, swallowing, coughing, and lying flat exacerbates pain; sitting up or leaning forward relieves pain.

54
Q

What are the other symptoms of pericarditis?

A

Fever
Chills
Non-productive cough
Signs include tachycardia, tachypnoea.

55
Q

What is the pathognomonic sign of pericarditis?

A

Pericardial friction rub heard best in the midline and lower left parasternal edge, louder in inspiration

56
Q

Why does dyspnoea develop in pericarditis?

A

Cardiac tamponade

57
Q

What are the main ECG changes seen in pericarditis?

A

Saddle shaped ST elevation
T wave elevation which flattens and inverts as time goes by
PR segment depression

58
Q

What is seen on CXR in pericarditis?

A

Enlarged flask shaped cardiac silhouette

59
Q

What other investigations should be done in suspected pericarditis?

A

Echo
Blood cultures
Bloods for WCC, ESR, CRP, urea, cardiac enzymes, RF etc

60
Q

What is the treatment of pericarditis?

A

Rest and avoid physical activity
Naproxen 250mg 6-8hourly
Colchicine

61
Q

What is Beck’s triad of cardiac tamponade?

A

Hypotension, elevated systemic venous pressure, muffled heart sounds.

62
Q

Define hyperkalaemia.

A

Plasma potassium >5.5mmol/L

Severe>6.5mmol/L

63
Q

Give four causes of hyperkalaemia.

A

AKI/CKD
Tumour lysis syndrome
DKA
Spironalactone

64
Q

The symptoms of hyperkalaemia are non specific; what are the signs?

A

Bradycardia from heart block
Tachypnoea from respiratory muscle weakness
Flaccid paralysis
Depressed or absent tendon reflexes

65
Q

What is seen on ECG in hyperkalaemia?

A

Peaked T waves, wide QRS complex, prolonged PR interval, reduced P wave

66
Q

What is the cardiac protection aspect of hyperkalaemia treatment?

A

10ml 10% calcium gluconate

67
Q

How is hyperkalaemia managed after cardiac protection?

A

Insulin-glucose infusion, then nebulised salbutamol if necessary
Calcium resonium

68
Q

Define hypokalaemia.

A

Serum K<3.5mmol/L

Severe<2.5mmol/L

69
Q

Give four causes of hypokalaemia.

A

Persistent vomiting
Burns
Respiratory or metabolic alkalosis
Diuretic use

70
Q

what are the symptoms of hypokalaemia?

A

Generalised weakness and then paralysis
Constipation
Respiratory failure and ileus
Paraesthesiae and tetany

71
Q

What is seen on ECG in hypokalaemia?

A

Flat T waves, ST depression, prominent U waves

72
Q

What other investigations are important in hypokalaemia?

A

U&Es, ABG, urinalysis for K, Na, and osmolality

73
Q

What is the oral ambulatory treatment of mild hypokalaemia in primary care?

A

Perform an ECG
Treat any underlying cause
Dietary supplementation 40-120mmol/day

74
Q

What is the treatment of severe hypokalaemia?

A

PO potassium bicarbonate in lower risk patients

IV KCL in normal saline 10mmol/hour or less, until ECG abnormalities resolve

75
Q

Define hypocalcaemia.

A

Serum corrected calcium<2.1mmol/L

76
Q

What are the causes of hypocalcaemia?

A 
Hypoparathyroidism
Secondary hypoparathyroidism
Tumour lysis syndrome
Osteoblastic metastases
Acute pancreatitis
77
Q

How does hypocalcaemia present?

A

Paraesthesia of the fingers, toes, and mouth

Tetany, muscle cramps, and carpopedal spasm

78
Q

What are the main signs of hypocalcaemia?

A

Chvostek’s sign
Trousseau’s sign
Laryngospasm
Seizures

79
Q

What is seen on ECG in hypocalcaemia?

A

Arrhythmias and prolonged QT interval

80
Q

What blood tests are important in hypocalcaemia?

A

U&Es: exclude CKD
Amylase: exclude pancreatitis
CK: exclude rhabdomyolysis
Serum PTH, Mg, PO4, vit D

81
Q

What is the treatment of acute hypocalcaemia (symptomatic, or calcium <1.9mmol/L)?

A

Slow 10ml IV 10% calcium gluconate

Correct Mg prior if low

82
Q

Define hypercalcaemia?

A

Serum calcium>2.5mmol/L

83
Q

What are the most common causes of hypercalcaemia?

A

Primary hyperparathyroidism
Ectopic PTH
Granulomatous conditions e.g. TB or sarcoid

84
Q

What are the main symptoms of hypercalcaemia?

A 
Polyuria and polydipsia
Dyspepsia
Depression
Constipation
Muscle weakness
Nausea and anorexia
Abdo pain and pancreatitis
Coma
Cardiac arrhythmias and shortened QT interval
85
Q

Which investigations are required in hypercalcaemia?

A

PTH
X-Ray
USS parathyroid
U&Es, LFTs for ALP

86
Q

What is the treatment of acute hypercalcaemia?

A

0.9% saline
IV pamidronate or IV zolendronic acid
Furosemide if fluid overload

87
Q

What is the treatment of symptomatic PTH-mediated hypercalcaemia?

A

Reduce dietary calcium

Partial parathyroidectomy

88
Q

What are the types of PE?

A

Thrombosis
Fat following long bone fracture
Amniotic fluid
Air

89
Q

What is Virchow’s triad?

A

Hypercoagulability
Reduced mobility
Blood vessel abnormalities

90
Q

Other than surgery, thrombotic disorders, and heart disease, give fourother risk factors for a PE.

A

Malignancy
Late pregnancy/puerperium
Myeloproliferative disorders
COCP/HRT

91
Q

How does a PE present?

A

Dyspnoea
Pleuritic/retrosternal chest pain
Cough and haemoptysis
Collapse/sudden death

92
Q

What are the signs of PE?

A

Tachypnoea, tachycardia, pyrexia, hypotension
Hypoxia
Raised JVP
Gallop rhythm, split S2, TR murmur

93
Q

How is PE diagnosed?

A

CTPA and raised D-Dimer

Two level PE Well’s score

94
Q

What is Hampton’s hump?

A

Wedge shaped area of pulmonary infarction seen on CXR

95
Q

What is seen on ABG in PE?

A

Reduced PaO2

Reduced PaCO2 due to hyperventilation or acidosis

96
Q

What is the management of PE?

A

ABCDE approach
100% oxygen, IV access
If haemodynamically unstable: IV alteplase
If not, then LMWH or fondaparinux

97
Q

What is the further management of patients who have had PE?

A

Warfarin or rivaroxaban 3 months and then assess risks and benefits of continuing

98
Q

What is the management of recurrent PE on anticoagulation?

A

Inferior vena cava filter

99
Q

What are the contraindications to LMWH or fondaparinux and what is the alternative?

A

eGFR<30ml
Bleeding risk

Unfractionated heparin

100
Q

What is aortic dissection?

A

Disruption of the medial layer of the wall of the aorta provoked by intramural bleeding, resulting in separation of the aortic wall layers and subsequent formation of a true lumen and a false lumen

101
Q

Give five causes of aortic dissection.

A 
Hypertension
Marfan's syndrome or EDS
Direct blunt chest trauma
Cocaine and amphetamines
Familial thoracic aortic aneurysm type 1 and 2
102
Q

What are the two classification systems for aortic dissection?

A

Stanford and Debakey

103
Q

What is the main symptom of aortic dissection?

A

Migratory tearing/sharp chest pain

104
Q

What can aortic dissection lead to?

A 
Cardiac tamponade
Haemothorax
Sudden death
Multiorgan failure
Cardiac failure from gross AR
105
Q

How is suspected aortic dissection investigated?

A

Distinguish from MI as thrombolysis will worsen the dissection
ECG normal or non specific ST changes
Echo

106
Q

How is aortic dissection managed?

A

IV access, analgesia, ICU
IV BB to reduce the force of ventricular contraction
Blood products
Stents or grafts

107
Q

What is seen on ECG in pulmonary embolism?

A

Sinus tachycardia

108
Q

What is seen on ECG in hypothermia?

A

J waves

109
Q

What is the treatment of acquired LQTS?

A

Correct predisposing factor
IV MgSO4
IV isoprenaline accelerates AV conduction and decreases QT interval

110
Q

How is streptococcal infection diagnosed?

A

High anti-streptolysin O titre

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