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Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Classical presentation of aortic stensosis

A

SAD
syncope (on exertion commonly)
Angina
Dyspnoea

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2
Q

ECG signs of aortic stenosis

A

LVH
P-Mitrale
AV block
Poor r wave progression

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3
Q

Signs of aortic stenosis

A

Ejection systolic murmur
Slow rising pulse - delayed through stiff ventricle
Narrow pulse pressure - reduced gap between systole/diastolic
Non-displaced but sustained/heaving apex
Aortic thrill

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4
Q

What constitutes severe aortic stenosis?

A

<1cm valve opening and symptoms

Valve gradient >40mmHg

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5
Q

Causes of aortic regurgitation

A 
Congenital - bocuspid valve 
Aortic root dilatation- Marian's, ehlers
Inflammatory- SLE, RA, rheumatic heart disease
Infective endocarditis 
Aortic dissection
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6
Q

Signs and symptoms aortic regurg

A

LVF symptoms, dyspnoea, orthopnoea
Signs - early diastolic murmur
Collapsing pulse - rapid increase then collapse
Wide pulse pressure

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7
Q

Symptoms of AF

A

Palpitations
SOB
Angina (rate associated ischaemia)
Syncope

Symptoms of complications - HF and stroke

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8
Q

ECG findings of AF

A

Irregularly irregular R waves
Absent P waves
HR > 100 = FAST AF

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9
Q

Management of AF

A

Rate control - B-blocker or rate limiting calcium channel blocker. Consider dioxin if sedentary

Rhythm control - for acute new-onset <48 hours
- electrical cardioversion ideally - anticoagulation before (heparin). If elective, anticoag for 3 weeks prior

Pharm. Electrocardioversion - flecainide if no structural damage, otherwise amiodarone

Anticogaulte (assess chadsvasc and hasbled) - DOACs ideally

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10
Q

Ecg findings of broad complex tachycardia

A

Usually 150-250 bpm
QRS > 120ms
Can be monomorphic or polymorphic

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11
Q

Torsades de pointes is a complication of what and how is it treated?

A

Long QT syndrome

Manage with IV magnesium sulphate

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12
Q

Management of VT

A

ABCDE
Cardiac arrest = arrest protocol
Pulseless VT and VF - non-synchronised DC cardiovert

Is a pulse:
Synchronised DC cardiovert - up to 3 if unstable
Followed by 300 mg IV amiodarone over 20 mins
Another shock
Followed by 900 mg over 24 hr

If stable - straight to amiodarone, correct electrolyte abnormalities

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13
Q

Example of suoraventricular tachycardias

A 
Sinus tachycardia 
Atrial tachycardia 
WPW
Avrt 
AVNRT
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14
Q

Typical SVT ECG

A

HR > 100 bpm
Narrow QRS
Weird P wave morphology (different depending on type of SVT)

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15
Q

Management of SVF

A

Slow AV node via - vagal maneuvers (valsalva or carotid sinus massage)
IV drugs - 1st line - adenosine, verapamil 2nd line, 3rd line - b blocker
Synchronised DC if haempdynamically unstable

Prevention- teach valsalva
If no-pre-extiement - verapamil
If pre excitement (WPW) - flecainide (if no structural damage, if so then admiodarone)

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16
Q

ECG signs of WPW

A

Delta wave
Short PR
Broad QRS (if with delta wave)

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17
Q

Management of WPW

A

Svt treatment
Control rate - b blocker
Accessory pathway ablation

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18
Q

First line medications for hypertension

A

<55 or T2DM - ACEi

>55 or afro-carribean - calcium channel blocker

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19
Q

Commonest type of cardiomyopathy

A

Dilated cardiomyopathy

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20
Q

Inheritance pattern for HCM

A

Autosomal dominant (50%)

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21
Q

Signs and symptoms of HCM

A 
SOB
Angina
Syncope 
Palpitations 
Asymptomatic 
Sudden cardiac death
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22
Q

ECG findings of HCM

A

Deep and narrow (dagger) Q waves
AF common complication
Non-specific ST segment and T wave abnormalities

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23
Q

Causes of bradycardia

A 
Sick sinus syndrome
Drugs- b-blocker, digoxin, amiodarone
Cushing's response - to raised ICP
Drugs to CNS - opioids 
Metabolic - hyperkalaemia, hypothermia, hypothyroidism 
Anorexia 
High level of fitness, pain
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24
Q

What is sick sinus syndrome, its causes

A 
Basically sinus node dysfunction 
Usually caused by sinus node fibrosis
Usually idiopathic
But can be secondary to cardiomyopathy, sarcoidosis, infiltrative disease (amyloidosis, sarcoidosis) 
Drugs - b-blockers, digoxin
25
Q

Management of severe bradycardia

A

ABCDE
Do ecg, correct electrolyte abnormalities or administer antidotes causing
IF ADVERSE SIGNS - ATROPINE 500mcg IV (unless transplanted hear. If unresponsive, can repeat every 3-5 mins
Consider - transcutaneous pacing, adrenaline

If a risk of asystole (recent asystole, AVN block mobitz 2 of complete heart block with broad QRS) - then will need specialist and possible transcutaneous pacing regardless of response to atropine or adverse signs

26
Q

What is 1st degree av block

A

Prolonged PR interval (>0.2s)

27
Q

Treatment for 1st degree heart block

A

No treatment needed

28
Q

What is the normal PR interval?

A

0.2 secs

29
Q

What is 2nd degree heart block?

A

Intermittent conduction of P waves to the ventricles

30
Q

What is Mobitz type 1 heart block

A

Progressive PR prolongation until a QRS drops (there isn’t one)

31
Q

What is mobitz type 2 heart block?

A

No progressive PR prolongation but intermittent failure to transmit to the ventricles (high risk of becoming 3rd degree)

32
Q

What is 3rd degree heart block and its management?

A

No association of P waves and QRS (no transmission of P waves to the ventricles with ventricular escape rhythm taking over)

Needs pacemaker

33
Q

Causes of acute pericarditis

A

Usually idiopathic or viral
Bacteria - TB
Fungi
Acute MI or post-MI (dresslers syndrome)
Drugs
Autoimmune (SLE, RA, sarcoidosis)
Other - uraemia, chest trauma, hypothyroidism, cancer

34
Q

Signs and symptoms of pericarditis

A

Chest pain - worse on lying down and inspiration, relieved by sitting forward
Pericardial friction rub
Fever

35
Q

ECG findings of pericarditis

A

Widespread saddle shaped ST elevation

36
Q

Management of acute pericarditis

A

NSAIDs
Analgesia
Oxygen if hypoxic
Add colchicine if viral or idiopathic - continue for 3 months as prevents recurrence

37
Q

What is cardiac tamponade and its signs and symptoms

A

Fluid in the pericardial sac that increases the pressure so much it prevents ventricular filling, reducing cardiac output

Beck’s triad - decreased BP, reduced heart sounds, raised JVP
Increased HR
Pulses paradoxes

38
Q

What is pulses paradoxus and what is it a sign of?

A

Reduced BP with inspiration

Sign of cardiac tamponade

39
Q

Causes of cardiac tamponade

A

Trauma
Aortix dissection
Medical procedure - carherisation, heart surgery
Pericardial effusion causes - cancer, infection

40
Q

Management of cardiac tamponade

A

Urgent pericardiocentesis

41
Q

What medication should never be given in VT?

A

Verapamil

42
Q

ECG findings of hypokalaemia

A 
U waves
Prolonged PR
Small or absent T waves
ST depression 
Long QT
43
Q

ECG signs of hyperkalaemia

A

Peaked or tall T waves
Loss of P waves
Broad QRS
Ventricular fibrillation

44
Q

What are the stockade rhythms?

A

Pulseless VT

VF

45
Q

What are U waves

A

Small deflection immediately following T wave

Sign of hypokalaemia

46
Q

Inheritance pattern of long QT syndrome

A

Autosomal dominant

47
Q

Causes of long QT syndrome

A 
Congenital 
Drugs - amiodarone 
Tricyclic antidepressants 
Erythromycin 
Electrolytes - htpokalaemia, hypomagnesia
Myocarditis
Acute MI
48
Q

Presentation of long QT

A

Syncope
Palpitations
SCD
Triggers - stress, exercise

49
Q

Management of long QT

A

Avoid triggers including drugs
B-blocker
ICD

50
Q

Aortic stenosis murmur

A

Ejection systolic

Narrow, tough valve - harder to get blood out during ventricular systole

51
Q

Mitral regurgitation mumur

A

Pansystolic murmur

Backflow of blood into the atria during ventricular systole
Therefore occurs throught systole

52
Q

Aortic regurg murmur

A

Early diastolic murmur

When ventricles relax during diastole, aortic valves are shut but leaky so blood flows back into the atria during diastole

53
Q

Mitral stenosis murmur

A

Low-pitched, mid-diastolic murmur

Blood flowing through mitral valve during diastole into the ventricles but is tough because of stenosis (later in diastole due to increased filling as atria contract)

54
Q

Pulmonary stenosis murmur

A

Ejection systolic

55
Q

Tricuspid regurgitation murmur

A

Pansystolic murmur

Return of blood when ventricles contract

56
Q

Tricuspid stenosis murmur

A

Mid diastolic murmur

57
Q

Important differentials of broad complex tachy

A

VT
SVT with altered conduction to ventricles (BBB or WPW)
E.g. Aflutter with BBB

58
Q

Drug treatments in chronic heart failure

A 
ACEi / ARB 
If not tolerated - hydralazone and nitrates
B-blocker 
Entresto 
Mineralocorticoid receptor antagonists

Diuretics- for symptomatic relief

Other - Digoxin
Entresto (never put ACEi with this as has ARB in)
Ivabradine
Dapagliflozin

Medicine (25 decks)

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