Cardiology Flashcards
Which criteria is used to diagnose Rheumatic fever?
Modified Jones criteria
List the major criteria of Rheumatic fever
Carditis Cardiac murmur SC nodule Arthritis - migratory large joints Erythema marginatum - red geographical rash Chorea - Sydenham's, St vitus dance
List the minor criteria of Rheumatic fever
Fever
Raised CRP/ESR
Long PR interval
Arthralgia
Describe modified jones criteria for RF diagnosis
2 Major
1 major and 2 minor
What might ECG show in Rheumatic fever?
Increased PR interval
Heart block
What test is used in rheumatic fever?
Antistreptolysin O titres - tests for streptococcus
Describe the treatment of rheumatic fever?
Admit and bed rest
Aspirin PO PRN
Benzylpenicillin 1.2g IM stat
Commence oral penicillin 10 day course
What are some acute findings in rheumatic fever?
Chorea like movement
Conduction defects
Pericardial rub
Prolonged PR interval on ECG
What ECG sign is classic of pericarditis?
Saddle shaped ST elevation
Shallow T wave inversion may also be noted
What is the treatment of acute pericarditis?
NSAIDs
Describe the features of pericardial effusion on CXR
Enlarged heart in the absence of pulmonary vasculature congestion
Describe how pericardiocentesis is conducted
Needle inserted SC in midline aiming to the left shoulder
Describe the murmur in aortic stenosis
Ejection systolic murmur, high pitched, radiating to the carotids
Slow rising pulse
Narrow pulse pressure
Describe the features of the mitral regurgitation murmur
Pansystolic murmur
High pitched whistling murmur
Radiates to the axilla
What is the most common aortic valve pathology in those <60yo?
Bicuspid aortic valve
Describe the features of ventricular septal defect post MI
New systolic murmur
Shock
Describe the management of ventricular septal defect post MI
Analgesia PRN Urgent transfer to cardiothoracic unit Coronary angiography Intra-aortic balloon pump Positive pressure ventilation Swann-ganz pulmonary artery catheter
Describe the ECG changed of SVT
Regular rhythm
Absent P waves
Narrow complex tachycardia
How can you treat SVT?
Valsalva
Carotid sinus massage
Administration of IV adenosine
How does adenosine work?
Slowing conduction in the AV node
Give some examples of Valsalva manoeuvre
Sticking fingers down throat
Pressing hard on eyeballs
Dipping face in cold water
Describe how the Valsalva manoeuvres work
Stimulates the vagus nerve causing AV nodal conduction slowing and may therefore terminate re-entrant arrhythmias using the AV node as part of the circuit
What investigations are important in wolff Parkinson white?
Thyroid function
Echocardiography
What abnormality is associated with wolff Parkinson white?
Epstein’s anomaly - offset tricuspid valve
What is the management of acute STEMI?
Morphine Oxygen Nitrates Aspirin 300mg PCI
Describe the management of acute pulmonary oedema with cardiogenic shock
CPAP
What medications are patients discharged on post MI
Aspirin 75mg OD Atorvastatin 80 mg OD Ramipril 5mg ON Bisoprolol 2.5mg OD Clopidogrel 75mg OD
Describe the two types of aortic dissection
Type A - ascending aorta, false lumen visible - require surgery
Type B - descending aorta
Describe the treatment of type A aortic dissection
Oxygen and analgesia
IV antihypertensive (sodium nitroprusside and beta blocker)
Aortic root replacement/repair/stent
Describe the treatment of type B aortic dissection
Blood pressure control
No surgery
What investigations should be done in aortic dissection?
FBCs U&Es BP in both arms - SBP >20mmhg difference is significant ECG CXR
What is the inheritance pattern of marfans?
Autosomal dominant
What is the inheritance pattern of hypertrophic cardiomyopathy?
Autosomal dominant
Which drug should be given to those with DVT?
Apixaban
Can warfarin be given in pregnancy?
No - crosses the placenta and anticoagulates the foetus predisposing to bleeds
Which drug is preferential for anticoagulation in pregnancy?
Heparins
What does the dose of LMWH depend on?
Weight and renal function of the patient
Which valve abnormality is malar flush associated with?
Mitral stenosis
How does mitral regurgitation present?
Dyspnoea Fatigue Palpitations Hyperdynamic apex Pansystolic murmur radiating to the axilla
What can cause pericarditis
MI - Dresslers syndrome
Coxsackie B infection, mumps, influenzas and varicella
RA and SLE
Name some complications of pericarditis
Heart failure
Cardiac tamponade
Name the causes of bradycardia
Hypothermia Hypothyroidism Aerobic training Legionnaires disease MI
Name some complications of infective endocarditis
Complete heart block TIA AKI HF Vertebral osteomyelitis
Name some risk factors for infective endocarditis
IVDU Pneumonia Colonic malignancy Prosthetic valve Chronic cholecystitis Miscarriage
Which is the most common valve affected by infective endocarditis in IVDU
Tricuspid
In which leads is T wave inversion normal
Lead 3 and V1
What is T wave inversion a sign of
Ischaemia Bundle branch block (V4-6 in LBBB and V1-3 in RBBB) PE General illness Hypertrophic cardiomyopathy LVH
What is a biphasic T wave a sign of
Ischaemia
Hypokalaemia
What do flattened T waves represent
Ischaemia
Electrolyte imbalance
What is a U wave
> 0.5mm deflection seen after the T wave
Where are U waves present
Hypothermia
Secondary to antiarrhythmic drugs - digoxin, amiodarone, procainamide
How do you calculate heart rate in a regular rhythm
300/No. large squares between each R wave
How do you calculate heart rate in an irregular rhythm
Count the number of complexes on rhythm strip X 6
What is a normal cardiac axis in terms of the angle
Between -30 to + 90
Describe right axis deviation
Lead 3 has the most positive deflection and lead 1 is negative
What is right axis deviation associated with
Right ventricular hypertrophy
Describe a normal axis in terms of the leads
Lead 2 had the most positive deflection compared to leads 1 and 3
Describe left axis deviation
Lead 1 has the most positive deflection and leads 2 and 3 are negative
What is left axis deviation associated with
Conduction abnormalities
What is the normal PR interval
3-5 small squares (120-200ms)
What causes prolonged PR interval
Heart block
Describe 1st degree heart block
PR interval has a fixed prolongation
Describe 2nd degree heart block
Mobitz Type 1 (wenckebach) - Progressive prolongation of the PR interval until a QRS is dropped, AV conduction resumes with the next beat and the
sequence is repeated
Mobitz Type 2 - Fixed prolongation of the PR interval with intermittently dropped QRS complexes due to a failure of conduction . The intermittent dropping of the QRS complex typically follows a repeating cycle of every 3rs (3:1block) or 4th (4:1 block) P wave
Describe third degree heart block
No electrical communication between the atria and ventricles due to complete failure of conduction
Presence of P waves and QRS complexes with no association with each other due to the atria and ventricles functioning independently
Where do narrow complex escape rhythms originate
above the bifurcation of the bundle of his
Where do broad complex escape rhythms originate
Below the bifurcation of the bundle of His
What ECG features are present in Wolff parkinson white
Tachyarrhythmia
Delta wave
Shortened PR interval
