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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
How to drain pericardial tamponade
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
26
What causes burugada syndrome
Brugada syndrome is due to a mutation in the cardiac sodium channel gene. This is often referred to as a sodium channelopathy.
27
What can unmask brugada
Fever, ischaemia, drugs (ca channel, sodium channel, beta blockers, cocaine, alcohol) hypokalaemia, hypothermia, dc cardioversion.
28
What should accompany the brugada ecg changes
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.
29
What are the brugada ecg changes in T1
Coved ST segment elevation >2mm in >1 of V1-V3 followed by a negative T wave.
30
What are the ecg changes in brugada type 2
Brugada Type 2 has >2mm of saddleback shaped ST elevation.
31
Treatment strategies for cocaine induced hypertension
Benzodiazepines Nitrates Phentolamine
32
What drugs should be avoided and why in cocaine toxicity
Beta blockers Can result in unopposed alpha adrenergic stimulation which will worsen coronary artery vasospasm and hypertension
33
What drugs used to be treat haemodynamically stable VT
Amiodarone Flecanide Lignocaine Propafenone
34
Ecg changes in severe hypokalaemia
``` U waves Flat t Twi Prlonged PR St depression Long tall p waves Arrhythmia ```
35
How is atrial ablation performed for AF
The pulmonary vein is a later via pfo or through the wall of the arterias
36
ecg characteristics of pericarditis
Diffuse concave ste st depression in avr and V1 R wave depression
37
Clinical features of pericarditis
Chest pain on inspiration Pericardial rub Pericardial effusion
38
What drugs are used to treat PAH
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
39
What do the pacemaker codes stand for ?
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
40
Temporary pacing wire pacemaker code
Vvi (demand pacing) Or Voo (fixed a synchronous pacing)
41
What is the definition of alcohol missuse
14 units per week
42
What are the different types of cardiomyopathy
``` Dilated Restrictive Hypoterophic Arrythmogenic right ventricular Unclassified ```
43
Define dilated cardiomyopathy
Left ventricular dilation and left systolic dysfunction in absense of pressure or volume overload, or ischaemia
44
Define restrictive cardiomyopathy
Non dilated right or left ventricule with diastolic dysfunction
45
Causes restrictive cardiomyopathy
Amyloid Sarcoidosis Haemochromatosis Radiotherapy
46
Causes of dilated cardiomyopathy
``` GPA Sarcoidosis Amyloid Lupus PAN ```
47
Define hypertrophic cardiomyopathy
Asymmetrical septal hypertrophy resulting in outflow obstruction of the left ventricle
48
Causes of hypertrophic cardiomyopathy
Autosomal dominant HOCM | Or genetic mutation.
49
What is the definition. Of arrythmogenic right ventricular dysplasia
Fatty fibrous tissue replaces normal heart muscle which interrupts electrical conduction
50
Causes of arrythmogenic right ventricular cardiomyopathy
Autosomal dominant genetic condition
51
What is the definition of peripartum cardiomyopathy and what type of Cardiomyopathy is it
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
What drugs cause dilated cardiomyopathy
Chemo - alkylating agent Lithium tCA Respiradone
53
What are the infective causes of dilated cardiomyopathy
``` Enterovirus Parvo b19 Adeno Hsv Hep c Flu a HIV Chagas ```
54
Causative bacteria for IE in native valve
Staphylococcal Streptococcal Enterococcus
55
What is in dukes criteria
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
Causes of prosthetic valve IE
``` Early Staph aureus Coag neg staph Enterococcus Fungi ``` Late Strep
57
Adverse features of tachyarrythmias
Syncope Shock Mi Heart failure
58
Resus council definition of shock
BP <90 Poor peripheral perfusion. Altered cognition
59
Contraindications to adenosine
``` Copd/ asthma Long QT Heart failure 2nd /3rd degree Hb Hypotension ```
60
What coronary artery is an anterior mi
Left anterior descending
61
What coronary artery is an inferior mi
Right coronary artery
62
What coronary artery is an lateral mi
Left circumflex | V4-6, avl
63
What coronary artery is an posterior mi
Right coronary artery
64
Mechanism of action of aspirin
Cox 1 inhibitor
65
Mechanism of action of clopidogrel
ADP pathways inhibitor
66
Mechanism of action of tirrofiban
Glycoprotein 2b 3a inhibitor
67
What is the time frame for PCI for a stemi | What is the time frame for thrombolysis of a stemi
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
What is Failure to pace
the pacing is not providing sufficient voltage output to depolarize myocardium
69
Define Failure to capture
Failure to capture occurs when paced stimulus does not result in myocardial depolarisation
70
what are the parameters of the pacemaker
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
Explain how to set up a pacemaker
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
State bazzets formula
QT interval / square root RR interval
73
Drugs to avoid in torsades
``` Class 1 Class 3 tCA Antibiotics - erythro Propofol ```
74
Ecg changes suggesting that a broad complex tachycardia is ventricular
Fusion beats Capturer beats No A V association Prolonged QRS
75
What is the definition of pre- excitation
An accessory pathway that connects atria with the ventricle
76
Drugs avoided in af with pre- excitation
B blockers Amiodarone Digoxin Adenosine
77
Define wolf Parkinson white syndrome
Ecg evidence of an accessory pathway and symptomatic tachyarrythmias
78
Define pulsus paradoxus
Decrease of 10mmhg in systolic BP during inspiration
79
What is electrical alternans
Alternating QRS amplitude
80
What is the BP control in dissection
MAp 60-75 | Lowest tolerated
81
What is the debakey system
Type 1 - ascending aorta - to aortic arch. Type 2 - ascending aorta Type 3- descending aorta (left subclavian)
82
Define hypertension
Systolic >140 Or Diastolic >90
83
Define the grades of hypertension
Grade 1 : 140/90- 159/99 Grade 2: 160/100- 179/ 109 Grade 3 >180/110
84
In malignant hypertension how quickly should the Bp be lowered
Diastolic to 100-105 over 2-6hours No more the 25% reduction in MAP
85
Treatment of avnrt
Vagaries manoeuvres Adenosine Beta blockers or ca channel blockers Flecanide or amiodarone
86
How do you manage an avrt
Vagal manoeuvres Adenosine Calcium channel blockade DCCV
87
Talk me through the myocardial action potential
``` 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
What is a Class 1 drug and where on the myocardial action potential dose it work
Sodium channel blockers Reduces rate of 0 rise
89
What is a Class 2 drug and where on the myocardial action potential dose it work
Beta blockers Prolong phase 4
90
What is a Class 3 drug and where on the myocardial action potential dose it work
K channel blockers (ami) Prolong phase 3
91
What is a Class 4 drug and where on the myocardial action potential dose it work
Ca channel blockers (verapamil) Reduces av node activity phase 2
92
What is lidco
Transpulmonary lithium dilution Pulse power analysis Measured changes in voltage to produce a lithium time curve
93
What is picco
Thermistor tipped artline used to measure transpulmonary thermodilution Pulse contour analysis Assumes auc is proportional to SV
94
What is functional warm ischaemia
Starts when systolic blood pressure falls to <50 or spo2 <70% Liver 30 Panc 30 Lungs 60 Kidneys 120
95
What is the Maastricht classification for donation after circulatory death
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
Absolute contraindications to organ donation
Variety cjd | HIV disease
97
What are the arteries that come off the aorta in order from the aortic valve
Brachiocephalic (right sc and right cc) Left common carotid Left subclavian
98
Treatment for an MI
Low dose aspirin life long Dapt for 1 yr High dose statin
99
Pacemaker naming
1. Chamber paced 2. Chamber sensed 3. Response to sensing 4. Programme 5. Shock/ pace
100
Indications for pacemaker
Bradycardia due to nodal dysfunction Arrhythmia Cardiovascular optimisation Heart transplant / valve repair etc
101
What is in an Ecmo circuit
Membrane oxygenator Gas blender Heat exchanger Pump Venous reservoir
102
Contraindications to Ecmo
``` Non reversible Severe chronic Pul HTN Malignancy Gvhd >120kgs ```
103
What is in the Murray score
``` 0-4 CXr quadrants Compliance (80- 20) Peep (5/ 8/11/14) PF ratio. (40/ 30/ 23/ 13) ```
104
What does compliance =
Tidal volume / plateau- peep
105
Which muscle is most likely to rupture in the heart
Antrolateral muscles has dual blood supply Posterior medial has posterior descending
106
Timing of iabp
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
Indication for iabp
``` Cardiogenic shock Unstable refractory angina High risk surgical patients Wean from c-p bypass Septic cardiomyopathy ```
108
Contraindications iabp
``` AR Abdominal or thoracic aortic aneurysm Pvd Aortic dissection ```
109
Benefit of iabp
``` Increase myocardial oxygen supply Decrease myocardial oxygen demand Increase cardiac output Increase coronary perfusion Decrease SVR ```
110
What are the two extra parameters that a picco monitors
Gedi - global end diastolic blood volume , indicator of pre load Elwi - quantification of lung water - pulmonary oedema.
111
What are the extra parameters measured in lidco
Do2 I Oxygen delivery index- art oxygen pp * cardiac index * 10
112
Grade of dissection of the aorta
1 internal 2 intramural 3 pseudoanurysm 4 rupture
113
Most common site of aortic dissection
Proximal descending aorta at ligamnetum arteriosum
114
Picco type of analysis
Pulse contour thermodilution
115
Lidco analysis
Pulse power analysis using lithium

Icm (16 decks)

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