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Icm > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What are the Sokolow Lyon criteria for left ventricular hypertrophy

A

The amplitude of R wave in V5 or 6 and the S wave in V1 or 2 is greater than 35

Or

R wave in avl is > 11

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2
Q

What is the normal axis for left ventricular deporalrisation

A

-30 to +90

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3
Q

What are the different types of shock

A 
Cardiogenic
Hypovolaemic
Septic 
Neurogenic 
Anaphylactic
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4
Q

How does digoxin work

A

It inhibits sodium potassium ATPase resulting in the exchange for calcium for potassium.
This increased concentration of calcium in the myocytes increase contractility
Prolongs the conduction of AV node

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5
Q

What adverse reactions can occur due to the use of digoxin specific antibody fragments

A 
Allergy
Hypokalaemia
Rebound toxicity
Heart failure
Arrhythmia
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6
Q

What are the causes of J waves

A 
Hypothermia
Hypercalcaemia
SAH
VF
Brugada 
Normal variant 
Brain injury
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7
Q

If someone is hypothemic what changes are made to the als guidance

A

No adrenaline / drug until >30
30-35 double the normal drug intervals
For VF 3X shock then no more until >30

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8
Q

What is the significance of a high or low scvO2 and what is normal

A

Normal oxygen extraction is 25–30% corresponding to a ScvO2 >65%
Less that <65% is impaired tissue oxygenation

>80% 
cytotoxic dysoxia- cyanide
Increase cardiac output - sepsis 
Av shunting - vasodilator a 
Reduced oxygen demand- hypothermia
left to right shunt
blood transfusion
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9
Q

What is the oxygen flux equation.

A

O2 flux = (cardiac output x (Haemoglobin concentration x SpO2 x 1.34) + (PaO2 x 0.003)) – VO2

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10
Q

Why is there a difference between scv02 and svo2 values

A

ScvO2 < SvO2

because it contains predominantly SVC blood from the upper body — blood from the upper body has a higher oxygen extraction ratio, and thus a lower SO2 than IVC blood — of major organs at rest, the brain has high oxygen extraction ratio and the kidneys have the lowest

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11
Q

What are the determinants of venous oxygen saturations

A

Arterial oxygen sats
Oxygen consumption
Cardiac output
Hb concentration

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12
Q

Where is a central venous oxygen sats measured

A

ScvO2

Superior vena cava

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13
Q

Where are mixed venous sats measured

A

Pulmonary artery

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14
Q

What ecg changes are typical of rv hypertrophy

A

Right axis deviation
Prominent R wave in V1
T wave inversion
Dominant S wave V5-6

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15
Q

How does cor pulmonary cause peripheral oedema

A

Chronic hypoxia causes sympathetic stimulation which leads to renin release and fluid retention

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16
Q

What echo features are seen in chronic and acute cor pulmonale

A

RV hypertrophy is chronic
Higher systolic pressures and TR
Dilated RV suggests acute or late chronic

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17
Q

What are the benefits of LTOT in cor pulmonale

A

Prevent progression to failure of rv therefore prolonging life expectancy and qol

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18
Q

What are the effect of mechanical ventilation on the right ventricle

A

Increased preload via increase in intrathoracic pressure which reduces venous return

Increased right ventricular afterload

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19
Q

Why are pulmonary vasodilators used with caution in cor pulmonale with copd

A

Reversal of hypoxic pulmonary vasoconstriction worsen hypoxaemia

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20
Q

What is the value of pro BNP in itu

A

Negative predictive value of a negative test and ruling our HF

But a high level is not diagnostic

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21
Q

What possible routes can you deliver temporary pacing

A

Transcutaneous
Transvenous
Epicardial
Oesophageal

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22
Q

Describe transvenous pacing

A

Consent
Monitoring
Right IJ or subclavian access
Fluoroscopic or X-ray guidance to insert wire
Insert into Apex of right ventricle
Connect to pacing box
Establish pacing threshold , capture threshold and set pacing program
Secure wire to skin and cover with a dressing
Post procedure ecg with CXR

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23
Q

Complications associated with temporary transvenous pacing wire

A

During insertion - arterial puncture, pneumothorax, air embolus, bleeding
Arrhythmia, cardiac perf, tamponade

During use- displacement, venous thrombosis, infection, tamponade

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24
Q

Beck’s triad

A

Low BP
Distended neck veins
Quiet muffled heart sounds

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25
Q

How to drain pericardial tamponade

A

Consent
Position patient - semi erect left lateral
Sterile field
Needle + 50mls syringe
Local anaesthetic left costal margin to xiphisternum
Orient needle 15-30 degrees to abdominal wall
Aim at left shoulder
Feel for a pop
If using lead monitoring - ST elevation
Withdraw needle and aspirate

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26
Q

What causes burugada syndrome

A

Brugada syndrome is due to a mutation in the cardiac sodium channel gene. This is often referred to as a sodium channelopathy.

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27
Q

What can unmask brugada

A

Fever, ischaemia, drugs (ca channel, sodium channel, beta blockers, cocaine, alcohol) hypokalaemia, hypothermia, dc cardioversion.

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28
Q

What should accompany the brugada ecg changes

A

This ECG abnormality must be associated with one of the following clinical criteria to make the diagnosis:

Documented ventricular fibrillation (VF) or polymorphic ventricular tachycardia (VT).
Family history of sudden cardiac death at <45 years old .
Coved-type ECGs in family members.
Inducibility of VT with programmed electrical stimulation .
Syncope.
Nocturnal agonal respiration.

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29
Q

What are the brugada ecg changes in T1

A

Coved ST segment elevation >2mm in >1 of V1-V3 followed by a negative T wave.

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30
Q

What are the ecg changes in brugada type 2

A

Brugada Type 2 has >2mm of saddleback shaped ST elevation.

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31
Q

Treatment strategies for cocaine induced hypertension

A

Benzodiazepines
Nitrates
Phentolamine

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32
Q

What drugs should be avoided and why in cocaine toxicity

A

Beta blockers

Can result in unopposed alpha adrenergic stimulation which will worsen coronary artery vasospasm and hypertension

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33
Q

What drugs used to be treat haemodynamically stable VT

A

Amiodarone
Flecanide
Lignocaine
Propafenone

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34
Q

Ecg changes in severe hypokalaemia

A 
U waves
Flat t 
Twi 
Prlonged PR
St depression
Long tall p waves
Arrhythmia
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35
Q

How is atrial ablation performed for AF

A

The pulmonary vein is a later via pfo or through the wall of the arterias

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36
Q

ecg characteristics of pericarditis

A

Diffuse concave ste
st depression in avr and V1
R wave depression

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37
Q

Clinical features of pericarditis

A

Chest pain on inspiration
Pericardial rub
Pericardial effusion

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38
Q

What drugs are used to treat PAH

A

Phosphodiesterase 5 inhibitors (block degradation of cGMP)
Endothelin receptor antagonists (inhibits binding of endothelin) Bosentan
Progaglandins (cAMP relaxation of Sm)
Inhaled nitric oxide
Calcium channel blocker

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39
Q

What do the pacemaker codes stand for ?

A

1: paced chamber
2: sensed chamber
3: response to sensing- inhibited or triggered
4: rate modulation in response to physiological demand (simple or none)
5: anti tachy function- pace, shock, dual

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40
Q

Temporary pacing wire pacemaker code

A

Vvi (demand pacing)
Or
Voo (fixed a synchronous pacing)

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41
Q

What is the definition of alcohol missuse

A

14 units per week

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42
Q

What are the different types of cardiomyopathy

A 
Dilated
Restrictive
Hypoterophic
Arrythmogenic right ventricular 
Unclassified
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43
Q

Define dilated cardiomyopathy

A

Left ventricular dilation and left systolic dysfunction in absense of pressure or volume overload, or ischaemia

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44
Q

Define restrictive cardiomyopathy

A

Non dilated right or left ventricule with diastolic dysfunction

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45
Q

Causes restrictive cardiomyopathy

A

Amyloid
Sarcoidosis
Haemochromatosis
Radiotherapy

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46
Q

Causes of dilated cardiomyopathy

A 
GPA
Sarcoidosis
Amyloid
Lupus 
PAN
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47
Q

Define hypertrophic cardiomyopathy

A

Asymmetrical septal hypertrophy resulting in outflow obstruction of the left ventricle

48
Q

Causes of hypertrophic cardiomyopathy

A

Autosomal dominant HOCM

Or genetic mutation.

49
Q

What is the definition. Of arrythmogenic right ventricular dysplasia

A

Fatty fibrous tissue replaces normal heart muscle which interrupts electrical conduction

50
Q

Causes of arrythmogenic right ventricular cardiomyopathy

A

Autosomal dominant genetic condition

51
Q

What is the definition of peripartum cardiomyopathy and what type of Cardiomyopathy is it

A

Idiopathic cardiomyopathy presenting with HEart failure and reduced Ejection fraction towards the end of or in the months following pregnancy - with no other cause found

Dilated cardiomyopathy

52
Q

What drugs cause dilated cardiomyopathy

A

Chemo - alkylating agent
Lithium
tCA
Respiradone

53
Q

What are the infective causes of dilated cardiomyopathy

A 
Enterovirus
Parvo b19
Adeno
Hsv
Hep c 
Flu a
HIV
Chagas
54
Q

Causative bacteria for IE in native valve

A

Staphylococcal
Streptococcal
Enterococcus

55
Q

What is in dukes criteria

A

Major

  • positive BC -2 separate samples or persistent pos
  • endo positive

Minor

  • risk factors
  • fever 38
  • emboli
  • immunological - GN oslers
  • positive culture

2 major
1 major + 3minor
5 minor

56
Q

Causes of prosthetic valve IE

A 
Early 
Staph aureus 
Coag neg staph 
Enterococcus 
Fungi

Late
Strep

57
Q

Adverse features of tachyarrythmias

A

Syncope
Shock
Mi
Heart failure

58
Q

Resus council definition of shock

A

BP <90
Poor peripheral perfusion.
Altered cognition

59
Q

Contraindications to adenosine

A 
Copd/ asthma 
Long QT
Heart failure 
2nd /3rd degree Hb
Hypotension
60
Q

What coronary artery is an anterior mi

A

Left anterior descending

61
Q

What coronary artery is an inferior mi

A

Right coronary artery

62
Q

What coronary artery is an lateral mi

A

Left circumflex

V4-6, avl

63
Q

What coronary artery is an posterior mi

A

Right coronary artery

64
Q

Mechanism of action of aspirin

A

Cox 1 inhibitor

65
Q

Mechanism of action of clopidogrel

A

ADP pathways inhibitor

66
Q

Mechanism of action of tirrofiban

A

Glycoprotein 2b 3a inhibitor

67
Q

What is the time frame for PCI for a stemi

What is the time frame for thrombolysis of a stemi

A

Within 12 hours of presentation for pci 90 min balooon to door. But within 2 hours of when thrombolysis could be given

For thrombolysis if no pci within 12 hours.

68
Q

What is Failure to pace

A

the pacing is not providing sufficient voltage output to depolarize myocardium

69
Q

Define Failure to capture

A

Failure to capture occurs when paced stimulus does not result in myocardial depolarisation

70
Q

what are the parameters of the pacemaker

A

Heart rate
Output - current delivered mA
Sensing - minimum voltage mV the pacing will regard as intrinsic electrical activity
AV delay- the maximum time the pacing will give to allow conduction

71
Q

Explain how to set up a pacemaker

A

Determine the intrinsic heart rhythm

Determine the capture threshold - the minimum output from pacing that results in cardiac activity. Increase the PM rate above the hr until a PM spike precedes every QRS. Increase the output to double the capture threshold

Determine the sensing threshold - minimum electrical activity the device accepts as intrinsic cardiac impulse. Sensitivity should be increased to the least sensitive therefore 50% of the measured.
If it is too sensitive it will sense non cardiac activity as intrinsic.

72
Q

State bazzets formula

A

QT interval / square root RR interval

73
Q

Drugs to avoid in torsades

A 
Class 1 
Class 3
tCA
Antibiotics - erythro
Propofol
74
Q

Ecg changes suggesting that a broad complex tachycardia is ventricular

A

Fusion beats
Capturer beats
No A V association
Prolonged QRS

75
Q

What is the definition of pre- excitation

A

An accessory pathway that connects atria with the ventricle

76
Q

Drugs avoided in af with pre- excitation

A

B blockers
Amiodarone
Digoxin
Adenosine

77
Q

Define wolf Parkinson white syndrome

A

Ecg evidence of an accessory pathway and symptomatic tachyarrythmias

78
Q

Define pulsus paradoxus

A

Decrease of 10mmhg in systolic BP during inspiration

79
Q

What is electrical alternans

A

Alternating QRS amplitude

80
Q

What is the BP control in dissection

A

MAp 60-75

Lowest tolerated

81
Q

What is the debakey system

A

Type 1 - ascending aorta - to aortic arch.

Type 2 - ascending aorta

Type 3- descending aorta (left subclavian)

82
Q

Define hypertension

A

Systolic >140
Or
Diastolic >90

83
Q

Define the grades of hypertension

A

Grade 1 : 140/90- 159/99
Grade 2: 160/100- 179/ 109
Grade 3 >180/110

84
Q

In malignant hypertension how quickly should the Bp be lowered

A

Diastolic to 100-105 over 2-6hours

No more the 25% reduction in MAP

85
Q

Treatment of avnrt

A

Vagaries manoeuvres
Adenosine
Beta blockers or ca channel blockers
Flecanide or amiodarone

86
Q

How do you manage an avrt

A

Vagal manoeuvres
Adenosine
Calcium channel blockade
DCCV

87
Q

Talk me through the myocardial action potential

A 
0 - depolarisation- sodium in
1- repolarisation - k out 
2- plateau - slow l type ca in 
3 - repolarisation- l type ca close
4- resting membrane - na/k atp - sodium in k out
88
Q

What is a Class 1 drug and where on the myocardial action potential dose it work

A

Sodium channel blockers

Reduces rate of 0 rise

89
Q

What is a Class 2 drug and where on the myocardial action potential dose it work

A

Beta blockers

Prolong phase 4

90
Q

What is a Class 3 drug and where on the myocardial action potential dose it work

A

K channel blockers (ami)

Prolong phase 3

91
Q

What is a Class 4 drug and where on the myocardial action potential dose it work

A

Ca channel blockers (verapamil)

Reduces av node activity phase 2

92
Q

What is lidco

A

Transpulmonary lithium dilution
Pulse power analysis
Measured changes in voltage to produce a lithium time curve

93
Q

What is picco

A

Thermistor tipped artline used to measure transpulmonary thermodilution
Pulse contour analysis
Assumes auc is proportional to SV

94
Q

What is functional warm ischaemia

A

Starts when systolic blood pressure falls to <50 or spo2 <70%

Liver 30
Panc 30
Lungs 60
Kidneys 120

95
Q

What is the Maastricht classification for donation after circulatory death

A

1 uncontrolled; dead on arrival
2 uncontrolled: unsuccessful resus
3 controlled: planned withdrawal
4 either ; cardiac arrest in brain death
5 uncontrolled: cardiac arrest in hospital inpatient

96
Q

Absolute contraindications to organ donation

A

Variety cjd

HIV disease

97
Q

What are the arteries that come off the aorta in order from the aortic valve

A

Brachiocephalic (right sc and right cc)
Left common carotid
Left subclavian

98
Q

Treatment for an MI

A

Low dose aspirin life long
Dapt for 1 yr
High dose statin

99
Q

Pacemaker naming

A
  1. Chamber paced
  2. Chamber sensed
  3. Response to sensing
  4. Programme
  5. Shock/ pace
100
Q

Indications for pacemaker

A

Bradycardia due to nodal dysfunction

Arrhythmia

Cardiovascular optimisation

Heart transplant / valve repair etc

101
Q

What is in an Ecmo circuit

A

Membrane oxygenator
Gas blender

Heat exchanger

Pump

Venous reservoir

102
Q

Contraindications to Ecmo

A 
Non reversible
Severe chronic Pul HTN 
Malignancy
Gvhd 
>120kgs
103
Q

What is in the Murray score

A 
0-4 
CXr quadrants
Compliance (80- 20)
Peep (5/ 8/11/14)
PF ratio. (40/ 30/ 23/ 13)
104
Q

What does compliance =

A

Tidal volume / plateau- peep

105
Q

Which muscle is most likely to rupture in the heart

A

Antrolateral muscles has dual blood supply

Posterior medial has posterior descending

106
Q

Timing of iabp

A

Inflate at the brining of diastole

  • mid point of t wave
  • dicrotic notch

Deflate onset of systole

  • start of QRS
  • upstroke of pressure waveform
107
Q

Indication for iabp

A 
Cardiogenic shock
Unstable refractory angina
High risk surgical patients 
Wean from c-p bypass
Septic cardiomyopathy
108
Q

Contraindications iabp

A 
AR
Abdominal or thoracic 
aortic aneurysm 
Pvd 
Aortic dissection
109
Q

Benefit of iabp

A 
Increase myocardial oxygen supply
Decrease myocardial oxygen demand
Increase cardiac output 
Increase coronary perfusion
Decrease SVR
110
Q

What are the two extra parameters that a picco monitors

A

Gedi - global end diastolic blood volume , indicator of pre load
Elwi - quantification of lung water - pulmonary oedema.

111
Q

What are the extra parameters measured in lidco

A

Do2 I

Oxygen delivery index- art oxygen pp * cardiac index * 10

112
Q

Grade of dissection of the aorta

A

1 internal
2 intramural
3 pseudoanurysm
4 rupture

113
Q

Most common site of aortic dissection

A

Proximal descending aorta at ligamnetum arteriosum

114
Q

Picco type of analysis

A

Pulse contour thermodilution

115
Q

Lidco analysis

A

Pulse power analysis using lithium

Icm (16 decks)

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