cardiology Flashcards
ECG features of trifascicular block?
1st degree heart block AND RBBB AND LAFB or LPFB
LAFB: qR complex leads 1 and AVL, RS complex II, III, aVF, LAD
LPFB: rS complex leads 1 and AVL, qR complex leads II, III, aVF, RAD. NO RVH.
Indications for ICD in ischemic HFrEF as primary prevention
- LVEF ≤35% + NYHA II or III
- LVEF ≤30% + NYHA I*
- LVEF ≤40% + non-sustained VT assoc. with previous MI + inducible sustained VT/VF on EP*
Can be beneficial if syncopal episodes occurring suspected to be due to ventricular arrythmia
*Must be post acute phase of MI i.e. 40 days post MI AND >3/12 post revascularization + medical therapy
Indications for ICD in ischemic HFrEF as secondart prevention
Sustained VT/VF after reversible causes excl;uded (i.e. AMI, electrolyte disturbances, medication effects)
Lipid profile seen with diabetes and CKD
High triglycerides and LDL, low HDL
Lipid profile seen with alcohol excess
Isolated hypertriglyceridemia
Lipid profile seen with hypothyroidism
predominantly high LDL, sometimes high triglycerides
Rates of stroke post coronary angiography? Associated 30 day mortality?
1 in 100
30 day mortality = 20%
Normal ECG variants in young athletes?
RBBB Wenchebach phenomena (2nd degree heart block, mobitz 1 i.e. progressive PR prolongation) Dominant R wave in V1 LVH Bradycardia Junctional rhythm 1st degree heart block
Which antihypertensive should be avoided in aortic dissection?
Hydralazine
Mechanism of action/class of amiodarone
Which other drug is in this class?
Class 3 antiarrythmic - potassium channel blocker, acts on phase 3 of AP
Prolongs refractory period of atrial, nodal and ventricular myocardium by prolonging the the action potential
Decreases sinus node automaticity
Decreases rate of impulse conduction through the AV node
Other class 3 antiarrythmic - sotalol
Mehchanism of action/class of verapamil?
Class 4 antiarrhythmic acting on phase 2 of AP
Central (non-dihydropyridine) calcium channel blocker -
Prevents calcium from entering voltage sensitive areas of myocardium/vascular SM cells (via slow channels) during depolarization
Slows automatacity and conduction of AV node
Indications for surgery in type B aortic dissection
Recurrent chest pain Persistent severe HTN Aneurysm expansion Dissection propogation Expanding hematoma Rupture Occlusion of a major aorta branch leading to end organ ischemia
What is the murmur in acute aortic dissection? Which type of aortic dissection is it seen in?
Type A dissection
Decrescendo diastolic murmur, best heard over the right sternal edge and exentuated on expiration (left sided murmur)
What is the most common cause of aortic regurgitation?
Rheumatic heart disease (developing world)
Calcified aortic valve, bicuspid aortic valve, aortic root dilation (developed world)
Indications for pace maker
Symptomatic Sinus node dysfunction (SND)
Advanced 2nd degree block (Mobitz Type II) or intermittent 3rd degree block
Symptomatic Hypersensitive carotid sinus syndrome and neurocardiogenic syncope
Persistent inappropriate or symptomatic bradycardia not expected to resolve after cardiac transplantation
Sustained pause dependent VT with or without QT prolongation.
What are the effects of carvedilol?
Beta-1, Beta-2 and alpha-1 antagonist
Non selective HOWEVER has evidence in HFREF
What are the effects of metoprolol?
Selective beta 1 antagonist
What medications should be avoided in torsades?
Class IA agents + 1c (moderate + strong Na channel blockers)
- A: quinidine, procainamide, disopyramide),
- C: (eg,flecainide),
Class III agents potassium channel blockers ( eg, sotalol, amiodarone).
Contraindications to stress ECG (name 10)
LBBB
Severe HOCM
Severe AS
Recent AMI (3-4 days)
Unstable angina with recent rest pain or increased symptoms.
Untreated life threatening cardiac arrhythmia
Advanced AV block
Uncontrolled systemic HT (>220/120)
Acute systemic illness ie: PE, aortic dissection
Unable to perform test ie: gait disturbance,severe OA.
Which enzyme is required to convert clopidogrel to it’s active form?
CYP2C19
Higher rates of loss of function seen in chinese populations –> poor metabolizers
Choose prasugrel or ticagrelor isntead
Typical echo and MRI findings of cardiac amyloidosis
Echo: relative apical sparing of longitudinal strain
MRI: subendocardial late gadolinium enchancement (early); later transmural late gadolinium enhancement
Key investigation for diagnosing transthyretin cardiac amyloid (ATTR)
Bone scintigraphy
Effects of alpha 1 receptors
Peripheral vasoconstriction
Increased heart rate
Effects of beta 1 receptors
Poisitve chonotropy and inotropy
Effects of beta 2 receptors
Skeletal muscle relaxation
Bronchodilation
Mast cell stabilization
ECG findings of dextrocardia
R) axis deviation
Positive QRS in aVR
Lead I → inversion of all complexes
Absent R wave progression in chest leads, dominant S waves
ECG findings of ASD
R) axis deviation
“Incomplete” RBBB due to RVH
RV strain (TWI/ST depression V1-V4)
Characteristic R wave notching in inferior leads II, III, aVF (Crochetage sign)
ECG findings digoxin toxicity
Increased automaticity with slow ventricular response
I.e. AF with slow VR
Bidirectional VT
ECG findings sodium channel blockage
Wide QRS
Terminal R wave in AVR
RAD
ECG findings posterior infarct
V1-V3 changes → INVERTED ANTERIOR STEMI: ST depression (i.e. elevation), tall R waves (i.e. pathologic Q waves), upright T waves
Definition of low flow low gradient aortic stenosis
mean gradient <40 mmHg
valve area <1 cm2
LVEF <50%
SVi <35 mL/m2
What class of drugs are abciximab, tirofiban and eptifibatide?
When can they be use?
When should they not be used?
GIIb/GIIIa receptor inhbitors
Can be used in high risk patients pre PCI or for treating thrombotic complications among patients with ACS
Should not be used in combination with thrombolysis
3 beta blockers with proven effiacy in HFREF treatment
carvedilol, bisoprolol, metoprolol
carvedilol may have greatest survival benefit
Indications for emergency reperfusion in STEMI
Sx onset within 12hrs REGARDLESS of if sx have resolved at time of presentation
No advanced age, frailty and significant co-morbidities influencing overall survival
Sx onset >12hrs but ongoing chest pain –> should be considered for salvage PCI (fibrinolysis not recommended, bleeding+++ and lower benefit)
Metabolic syndrome criteria
Low HDL High triglycerides HTN Central obesity High fasting glucose (>5.6) or T2DM
Genes associated with familial hypercholesterolemia
LDLR
APOB (previously apoB100)
PCSK9
CXR findings of aortic coarctation
Notching of the posterior ⅓ of ribs 3-8
Indentation of the aortic wall - produces a “3” sign
