Cardiology Flashcards
1
Q
bradycardia examples
A
sinus bradycardia
sick sinus (tachy-brady)
sinus arrest vasovagal
2
Q
sinus bradycardia causes
A
athletes
drug toxicity - beta blockers, calcium channel blockers, digoxin
3
Q
asymptomatic sinus bradycardia management
A
NIL
4
Q
symptomatic sinus bradycardia management
A
permanent pacemaker
5
Q
sinus bradycardia origin
A
SAN / atria
6
Q
first degree heart block ECG features
A
elongated PR interval
7
Q
1D HB management
A
check for drug toxicity (digoxin)
NIL management if asymptomatic
if symptomatic - prov cardiac monitoring
8
Q
Type I second degree heart block ECG features
A
longer, longer, longer, drop!
PR gradually elongating, then dropped QRS complex
9
Q
2D HB Type I causes
A
high vagal tone ie. young, fit, healthy
post inferior MI
10
Q
2D HB Type I management
A
NIL
11
Q
Type II second degree heart block ECG features
A
sudden failure of P wave to be conducted to ventricles
ie. randomly dropped QRS
12
Q
Type II 2D HB management
A
permanent pacing
13
Q
third degree heart block ECG features
A
no relationship between p waves and QRS complexes
can have broad complex escape (beneath AVN) or narrow complex escape (above AVN)
14
Q
third degree heart block causes
A
digoxin toxicity
post inferior STEMI
sev hyperkalaemia
15
Q
third degree heart block management
A
atropine IV
isoprenaline
calcium chloride IV (hyperkalaemia)
permanent pacing
16
Q
what is the most common cardiac arrhythmia encounter in clinical practice
A
AF
17
Q
AF presentation
A
not typically presenting with symptoms
BUT - will present as a complication of another condition eg.
haemodynamic instability (due tachy / brady)
ACS
CCF
cardioembolic stroke
18
Q
complications of AF
A
cardioembolic stroke
cardiac instability
death
19
Q
AF diagnosis
A
manual pulse checks
ECG
(SOB, palpitations, syncope/dizziness, CP, stroke, TIA)
? paroxysmal - cardiac monitoring (24 hour cardiac monitor)
20
Q
AF classifications
A
paroxysmal > persistent > permanent
21
Q
Echocardiogram indications
A
structural heart disease
consideration of rhythm control strategy (eg. cardioversion)
baseline needed for LT treatment
22
Q
AF management
A
- anticoagulation (stroke / systemic embolism prophylaxis) eg. apixaban
- Rate control
- Rhythm control
- CHAD2S2 VASC Score / HAS-BLED Score
23
Q
DOACS MOA
A
apixaban = inhibit factor Xa dabigatran = inhibit direct thrombin inhibitor
24
Q
DOACs excretion
A
kidney
monitor renal function yearly
25
DOAC benefit
less need for regular monitoring (INR)
lower rates of bleeding (vs warfarin)
better reduction in strokes
26
Rhythm control options
Haemodynamically unstable = electrical cardioversion
Haemodynamically stable =
+ SHD = IV amiodarone
+ no SHD = IV flecainide
27
Rate control options
beta blocker
| digoxin
28
supraventricular tachycardia pathophysiology
AVNRT (AVN reentry tachy)
| AVRT (atria-ventricular reentry tachy)
29
first line treatment SVT
vagal manoeuvres
- breath holding
- Valsalva manoeuvre
- carotid massage
30
vagal manoeuvre MOA
slow AVN conduction > interruption of reentrant circuit
31
carotid massage risks
stroke / emboli
- always ascultate for bruits
- mostly used in younger patients
32
second line / 1st line drug treatment SVT
IV adenosine OR IV verapamil / diltiazem
adenosine = rapid IV bolus 6 mg stat + long saline flush in antecubital fossa
(if unsuccessful 12 mg stat, 12mg stat)
33
adenosine SEs
chest discomfort
transient hypotension
flushing
34
adenosine contraindications
reversible airways disease
| significant bradycardia / tachycardias
35
adenosine MOA
reduces HR and conduction velocity @ AVN
36
atropine MOA
reduces vagal tone > ^ AVN conduction
37
synchronised cardioversion indication for SVT
```
SVT
+ hypotension
+ pulmonary oedema
+ chest pain and ischaemia
+ unstable
Nb. under GA / sedation
```
38
verapamil contraindications
pts on BXs
39
flecainide MOA
Na channel blocker
40
flecainide contraindications
MI - past or present
41
2nd line drug treatment for SVT
flecainide
amiodarone
sotalol
42
HTN Target low-mod risk
<140 mmHg systolic
43
HTN target DM / stroke / TIA / IHD / CKD
< 130/80
44
HTN target >80 years old
140-150 systolic
45
HTN diastolic target
<90
46
HTN + DM diastolic target
<85
47
HTN first line tx <55 y/o
ACEi / ARB
48
HTN first line >55 y/o OR black (of any age)
CCB
49
HTN second step management
ACEi / ARB + CCB
50
HTN third step management
ACEi / ARB
CCB
Thiazide diuretic
51
Resistant hypertension definition
HTN sustained after three medical interventions
52
Resistant HTN management
```
ACEi / ARB
CCB
Thiazide diuretic
Additional diuretic OR BB
Seek expert advice
```
53
Complications of Hypertensive emergencies
```
encephalopathy
LV failure
aortic dissection
unstable angina
renal failure
```
54
HTN emergencies management
sodium nitroprusside
labetaolol
GTN 1-10mg/hr
esmolol
55
Hypertensive urgency features
sev HTN > damage over a period of days
diastolic >130
retinal damages
56
phaeochromocytoma triad of symptoms
episodic headache
sweating
tachycardia
sustained / paroxysmal HTN
57
phaeochromocytoma diagnosis
urinaary / plasma metanephrines and catecholamines
| CT / MRI (adrenal tumors)
58
phaeochromocytoma management
(FIRST) alpha + beta blockers
| eg. phenoxybenzamine
59
Primary aldosteronism signs
HTN
low serum potassium
high / normal sodium
60
HF causes
```
IHD
HTN
Valvular HD (Rheumatic fever)
AF
Chronic lung disease
Cardiomyopathy
Chemo
HIV
```
61
assessment of LV function
echocardiogram
| cardiac MRI
62
medication for HF
```
diuretics (furosemide)
ACEi
ARBs (candesartan)
Angiotensin receptor-neprilysin inhibitor - ANRI (saubitril)
Beta blockers
```
63
Complex device therapy for HF options
CRT (cardiac resynchronisation pacemaker)
| implantable cardiac defibrillators (ICD)
64
CXR findings of HF
```
ABCDE
Alveolar oedema
(Kerley) B lines
Cardiomegaly
Dilated upper lobes
pleural Effusions
```
65
why do HF patients develop peripheral oedema?
^ capillary hydrostatic pressure
v plasma oncotic pressure
> ^ fluid from IV > IT space
66
regular narrow complex tachycardias treatment
vagal manouveres
| adenosine
67
adenosine contraindications
asthma
| verapamil indicated instead
68
irregular narrow complex tachycardia management
MOST LIKELY Dx = AF
anticoagulation: apixaban
<48 hrs px: rhythm control ie. flecainide
>48 hrs px: rate control ie. bisoprolol
69
most likely pathogen in infective endocarditis (no existing cardiac pathology)
staphylococcus aureus
70
most likely pathogen in infective endocarditis with existing cardiac pathology
streptococcus viridans
71
secondary prevention and symptom control of stable angina
GTN spray
bisoprolol 5mg
aspirin 75 mg
atorvostatin 80mg
72
rheumatic fever presentation
```
recent streptococcal infection
generalised rash
fever
arthritis
pancarditis / murmur (MS)
SC nodules
```
73
rheumatic fever management
eradication of group A beta haemolytic streptococcal infection =
STAT IV benzylpenicillin
10/7 phenoxymethylpenicillin
74
contraindications of digoxin
WPW (> VF)
75
WPW management
radiofrequency pathway ablation
amiodarone / sotalol (to prevent SVTs)
rare: open heart ablation
76
MS heart sounds
mid-diastolic rumbling + 'opening' snap
malar flush
AF
77
most common cause of MS
rheumatic valve disease
78
most common cause of AS
age related calcification
79
acute ischaemic stroke management
<4.5 hours presentation = alteplase (60mg IV)
80
aortic stenosis presentation
triad = angina, HF, syncope
| + v exercise tolerance / dyspnoea on exertion
81
aortic stenosis causes
age related
CKD
previous rheumatic fever
82
aortic stenosis auscultation
ejection systolic murmur
radiating to the carotid arteries
crescendo-decrescendo
best heard in aortic area = 2nd IC space on the RHS
83
aortic stenosis investigations
echocardiogram
| assesses severity of stenosis + competency of rest of heart
84
aortic stenosis management
TAVI (transcatheter aortic valvular implantation)
| via femoral artery
85
aortic stenosis indications for surgery
symptomatic
symptomatic / abnormal upon exercise test
left ventricular systolic dysfunction
abnormal at time of other surgery (CABG)
86
aortic regurgitation symptoms
can be asymptomatic for years
| decreased exercise tolerance / dyspnoea on exertion
87
aortic regurgitation causes
congenital abnormalities of the aorta (progressive aortic dilatation)
rheumatic disease
infective endocarditis
Marfan syndrome
88
aortic regurgitation pathophysiology
progressive LV dilatation
| HF
89
aortic regurgitation signs
early diastolic murmur
collapsing pulse
best heard in aortic area
DeMusset's sign (head bobbing)
90
aortic regurgitation investigations
echocardiogram
| assess severity + competency of rest of heart
91
aortic regurgitation management
ACEi - reduces after load + v LV dilatation
92
aortic regurgitation surgery indications
symptomatic
evidence of early LV systolic dysfunction
aortic root dilatation
93
mitral regurgitation management
diuretics
IF functional / ischaemic MR = ACEi
IF LV systolic dysfunction = ACEi + BXs (v sev.)
94
mitral regurgitation causes
```
Marfan's
familial association
rheumatic heart disease
IHD
infective endocarditis
collagen vascular disease
LV dilatation
```
95
mistral regurgitation auscultation
pan-systolic blowing murmur
radiates to auxilla
best heard over 5th ICD mid clavicular line
96
mitral regurgitation investigations
echocardiogram
97
mitral regurgitation surgery indications
symptomatic
| mild-mod LV dysfunction
98
mitral regurgitation surgery options
mitral valve replacement / repair
99
common valvular pathology associated with AF
mitral regurgitation
| O/E - decompensated HF, systolic murmur loudest at apex
100
cause of torsades de points
drugs: ondansetron / clarithromycin / methadone - > QT prolongation => polymorphic VT
101
leads for inferior changes
II III aVF
| RCA
102
leads for lateral changes
```
I aVL (high lateral - circumflex a.)
V5 V6 (low lateral)
```
103
leads for apex changes
V5 V6
| distal LAD, RCA, circumflex a.
104
leads for septal changes
V1 V2
| prox LAD a.
105
leads for anterior changes
V3 V4
| LAD a.
106
torsades de points management
IV magnesium sulfate = stable pt
| urgent DC cardio version = unstable pt
107
aortic regurgitation pulse characteristic
collapsing pulse
108
aortic coarctation clinical features
radial-femoral delay
hypERtension
differences in BP of upper and lower extremities
109
associated disease with streptococcus bovis IE
colorectal carcinoma
nb. s bovis is normal component of gut flora, therefore systemic presence may be sign of haematogenous spread due to gut wall breakdown
110
hyperkalaemia management
10ml of 10% calcium gluconate
IV fast acting insulin (10 units)
Iv dextrose 50% 50 ml
5-10 ml nebulised salbutamol
Nb. calcium resonium is LT management
111
hyperkalaemia management
10ml of 10% calcium gluconate
IV fast acting insulin (10 units)
Iv dextrose 50% 50 ml
5-10 ml nebulised salbutamol
Nb. calcium resonium is LT management
112
NSTEMI ECG changes
ST depression
T wave inversion
Q waves (late)
113
NSTEMI management
```
BATMAN
BXs
aspirin
ticagrelor
morphine
anticoagulants: LMWH (enoxaparin)
nitrates
```
Can consider PCI if high risk of mortality, schedule in 4 days
114
LT management for MI
```
Aspirin
Atorvastatin
Anti-platelet (consider clopidogrel) for 12 months
ACEi
Atenalol
Aldosterone antagonist
Lifestyle changes
```
115
Secondary complications of MI
```
DREAD
Death
Rupture of the papillary muscles
Emoblism / oEdema
Arrhythmias / aneurysms
Dresler's syndrome (post-ACS pericarditis presents within 2-3 weeks)
```
116
Dresler's syndrome diagnosis and management
Echo + ECG changes + infection changes
NSAIDs + steroids +/- pericardiocentesis
117
ECG changes in pericarditis
PR depression = most specific
| saddle shaped syndrome
118
cardiac tamponade symptoms
BECK'S TRIAD: hypotension, muffled heart sounds, raised JVP
119
cardiac tamponade management
pericardiocentesis
| IV fluids
120
management of acute heart failure and WHY
sit up - reduces preload
high flow oxygen - corrects hypoxia
IV furosemide - combats fluid overload
IV GTN - vasodilation: reduces preload and after load
121
chronic heart failure management
all HF = diuretic
HFpEF = lifestyle, treat underlying cause, cardiac rehabilitation programme
HFrEF = cardiac rehabilitation programme, ACEi + Bx
No improvement = swap ACEi for valsartan, add digoxin / nitrates / hydralazine (esp in black pts)
No improvement = CRT, ICD
