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Finals > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Which criteria is used to diagnose Rheumatic fever?

A

Modified Jones criteria

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2
Q

List the major criteria of Rheumatic fever

A 
Carditis
Cardiac murmur
SC nodule
Arthritis - migratory large joints 
Erythema marginatum - red geographical rash 
Chorea - Sydenham's, St vitus dance
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3
Q

List the minor criteria of Rheumatic fever

A

Fever
Raised CRP/ESR
Long PR interval
Arthralgia

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4
Q

Describe modified jones criteria for RF diagnosis

A

2 Major

1 major and 2 minor

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5
Q

What might ECG show in Rheumatic fever?

A

Increased PR interval

Heart block

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6
Q

What test is used in rheumatic fever?

A

Antistreptolysin O titres - tests for streptococcus

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7
Q

Describe the treatment of rheumatic fever?

A

Admit and bed rest
Aspirin PO PRN
Benzylpenicillin 1.2g IM stat
Commence oral penicillin 10 day course

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8
Q

What are some acute findings in rheumatic fever?

A

Chorea like movement
Conduction defects
Pericardial rub
Prolonged PR interval on ECG

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9
Q

What ECG sign is classic of pericarditis?

A

Saddle shaped ST elevation

Shallow T wave inversion may also be noted

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10
Q

What is the treatment of acute pericarditis?

A

NSAIDs

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11
Q

Describe the features of pericardial effusion on CXR

A

Enlarged heart in the absence of pulmonary vasculature congestion

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12
Q

Describe how pericardiocentesis is conducted

A

Needle inserted SC in midline aiming to the left shoulder

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13
Q

Describe the murmur in aortic stenosis

A

Ejection systolic murmur, high pitched, radiating to the carotids
Slow rising pulse
Narrow pulse pressure

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14
Q

Describe the features of the mitral regurgitation murmur

A

Pansystolic murmur
High pitched whistling murmur
Radiates to the axilla

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15
Q

What is the most common aortic valve pathology in those <60yo?

A

Bicuspid aortic valve

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16
Q

Describe the features of ventricular septal defect post MI

A

New systolic murmur

Shock

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17
Q

Describe the management of ventricular septal defect post MI

A 
Analgesia PRN
Urgent transfer to cardiothoracic unit
Coronary angiography
Intra-aortic balloon pump 
Positive pressure ventilation 
Swann-ganz pulmonary artery catheter
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18
Q

Describe the ECG changed of SVT

A

Regular rhythm
Absent P waves
Narrow complex tachycardia

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19
Q

How can you treat SVT?

A

Valsalva
Carotid sinus massage
Administration of IV adenosine

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20
Q

How does adenosine work?

A

Slowing conduction in the AV node

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21
Q

Give some examples of Valsalva manoeuvre

A

Sticking fingers down throat
Pressing hard on eyeballs
Dipping face in cold water

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22
Q

Describe how the Valsalva manoeuvres work

A

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

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23
Q

What investigations are important in wolff Parkinson white?

A

Thyroid function

Echocardiography

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24
Q

What abnormality is associated with wolff Parkinson white?

A

Epstein’s anomaly - offset tricuspid valve

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25
Q

What is the management of acute STEMI?

A 
Morphine
Oxygen 
Nitrates
Aspirin 300mg 
PCI
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26
Q

Describe the management of acute pulmonary oedema with cardiogenic shock

A

CPAP

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27
Q

What medications are patients discharged on post MI

A 
Aspirin 75mg OD
Atorvastatin 80 mg OD 
Ramipril 5mg ON
Bisoprolol 2.5mg OD
Clopidogrel 75mg OD
28
Q

Describe the two types of aortic dissection

A

Type A - ascending aorta, false lumen visible - require surgery
Type B - descending aorta

29
Q

Describe the treatment of type A aortic dissection

A

Oxygen and analgesia
IV antihypertensive (sodium nitroprusside and beta blocker)
Aortic root replacement/repair/stent

30
Q

Describe the treatment of type B aortic dissection

A

Blood pressure control

No surgery

31
Q

What investigations should be done in aortic dissection?

A 
FBCs 
U&Es
BP in both arms - SBP >20mmhg difference is significant 
ECG
CXR
32
Q

What is the inheritance pattern of marfans?

A

Autosomal dominant

33
Q

What is the inheritance pattern of hypertrophic cardiomyopathy?

A

Autosomal dominant

34
Q

Which drug should be given to those with DVT?

A

Apixaban

35
Q

Can warfarin be given in pregnancy?

A

No - crosses the placenta and anticoagulates the foetus predisposing to bleeds

36
Q

Which drug is preferential for anticoagulation in pregnancy?

A

Heparins

37
Q

What does the dose of LMWH depend on?

A

Weight and renal function of the patient

38
Q

Which valve abnormality is malar flush associated with?

A

Mitral stenosis

39
Q

How does mitral regurgitation present?

A 
Dyspnoea 
Fatigue 
Palpitations 
Hyperdynamic apex 
Pansystolic murmur radiating to the axilla
40
Q

What can cause pericarditis

A

MI - Dresslers syndrome
Coxsackie B infection, mumps, influenzas and varicella
RA and SLE

41
Q

Name some complications of pericarditis

A

Heart failure

Cardiac tamponade

42
Q

Name the causes of bradycardia

A 
Hypothermia
Hypothyroidism 
Aerobic training 
Legionnaires disease
MI
43
Q

Name some complications of infective endocarditis

A 
Complete heart block 
TIA
AKI
HF
Vertebral osteomyelitis
44
Q

Name some risk factors for infective endocarditis

A 
IVDU
Pneumonia
Colonic malignancy 
Prosthetic valve
Chronic cholecystitis 
Miscarriage
45
Q

Which is the most common valve affected by infective endocarditis in IVDU

A

Tricuspid

46
Q

In which leads is T wave inversion normal

A

Lead 3 and V1

47
Q

What is T wave inversion a sign of

A 
Ischaemia
Bundle branch block (V4-6 in LBBB and V1-3 in RBBB)
PE
General illness
Hypertrophic cardiomyopathy 
LVH
48
Q

What is a biphasic T wave a sign of

A

Ischaemia

Hypokalaemia

49
Q

What do flattened T waves represent

A

Ischaemia

Electrolyte imbalance

50
Q

What is a U wave

A

> 0.5mm deflection seen after the T wave

51
Q

Where are U waves present

A

Hypothermia

Secondary to antiarrhythmic drugs - digoxin, amiodarone, procainamide

52
Q

How do you calculate heart rate in a regular rhythm

A

300/No. large squares between each R wave

53
Q

How do you calculate heart rate in an irregular rhythm

A

Count the number of complexes on rhythm strip X 6

54
Q

What is a normal cardiac axis in terms of the angle

A

Between -30 to + 90

55
Q

Describe right axis deviation

A

Lead 3 has the most positive deflection and lead 1 is negative

56
Q

What is right axis deviation associated with

A

Right ventricular hypertrophy

57
Q

Describe a normal axis in terms of the leads

A

Lead 2 had the most positive deflection compared to leads 1 and 3

58
Q

Describe left axis deviation

A

Lead 1 has the most positive deflection and leads 2 and 3 are negative

59
Q

What is left axis deviation associated with

A

Conduction abnormalities

60
Q

What is the normal PR interval

A

3-5 small squares (120-200ms)

61
Q

What causes prolonged PR interval

A

Heart block

62
Q

Describe 1st degree heart block

A

PR interval has a fixed prolongation

63
Q

Describe 2nd degree heart block

A

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

64
Q

Describe third degree heart block

A

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

65
Q

Where do narrow complex escape rhythms originate

A

above the bifurcation of the bundle of his

66
Q

Where do broad complex escape rhythms originate

A

Below the bifurcation of the bundle of His

67
Q

What ECG features are present in Wolff parkinson white

A

Tachyarrhythmia
Delta wave
Shortened PR interval

Finals (18 decks)

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