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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
What is the management of acute STEMI?
``` Morphine Oxygen Nitrates Aspirin 300mg PCI ```
26
Describe the management of acute pulmonary oedema with cardiogenic shock
CPAP
27
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 ```
28
Describe the two types of aortic dissection
Type A - ascending aorta, false lumen visible - require surgery Type B - descending aorta
29
Describe the treatment of type A aortic dissection
Oxygen and analgesia IV antihypertensive (sodium nitroprusside and beta blocker) Aortic root replacement/repair/stent
30
Describe the treatment of type B aortic dissection
Blood pressure control | No surgery
31
What investigations should be done in aortic dissection?
``` FBCs U&Es BP in both arms - SBP >20mmhg difference is significant ECG CXR ```
32
What is the inheritance pattern of marfans?
Autosomal dominant
33
What is the inheritance pattern of hypertrophic cardiomyopathy?
Autosomal dominant
34
Which drug should be given to those with DVT?
Apixaban
35
Can warfarin be given in pregnancy?
No - crosses the placenta and anticoagulates the foetus predisposing to bleeds
36
Which drug is preferential for anticoagulation in pregnancy?
Heparins
37
What does the dose of LMWH depend on?
Weight and renal function of the patient
38
Which valve abnormality is malar flush associated with?
Mitral stenosis
39
How does mitral regurgitation present?
``` Dyspnoea Fatigue Palpitations Hyperdynamic apex Pansystolic murmur radiating to the axilla ```
40
What can cause pericarditis
MI - Dresslers syndrome Coxsackie B infection, mumps, influenzas and varicella RA and SLE
41
Name some complications of pericarditis
Heart failure | Cardiac tamponade
42
Name the causes of bradycardia
``` Hypothermia Hypothyroidism Aerobic training Legionnaires disease MI ```
43
Name some complications of infective endocarditis
``` Complete heart block TIA AKI HF Vertebral osteomyelitis ```
44
Name some risk factors for infective endocarditis
``` IVDU Pneumonia Colonic malignancy Prosthetic valve Chronic cholecystitis Miscarriage ```
45
Which is the most common valve affected by infective endocarditis in IVDU
Tricuspid
46
In which leads is T wave inversion normal
Lead 3 and V1
47
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 ```
48
What is a biphasic T wave a sign of
Ischaemia | Hypokalaemia
49
What do flattened T waves represent
Ischaemia | Electrolyte imbalance
50
What is a U wave
>0.5mm deflection seen after the T wave
51
Where are U waves present
Hypothermia | Secondary to antiarrhythmic drugs - digoxin, amiodarone, procainamide
52
How do you calculate heart rate in a regular rhythm
300/No. large squares between each R wave
53
How do you calculate heart rate in an irregular rhythm
Count the number of complexes on rhythm strip X 6
54
What is a normal cardiac axis in terms of the angle
Between -30 to + 90
55
Describe right axis deviation
Lead 3 has the most positive deflection and lead 1 is negative
56
What is right axis deviation associated with
Right ventricular hypertrophy
57
Describe a normal axis in terms of the leads
Lead 2 had the most positive deflection compared to leads 1 and 3
58
Describe left axis deviation
Lead 1 has the most positive deflection and leads 2 and 3 are negative
59
What is left axis deviation associated with
Conduction abnormalities
60
What is the normal PR interval
3-5 small squares (120-200ms)
61
What causes prolonged PR interval
Heart block
62
Describe 1st degree heart block
PR interval has a fixed prolongation
63
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
64
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
65
Where do narrow complex escape rhythms originate
above the bifurcation of the bundle of his
66
Where do broad complex escape rhythms originate
Below the bifurcation of the bundle of His
67
What ECG features are present in Wolff parkinson white
Tachyarrhythmia Delta wave Shortened PR interval

Finals (18 decks)

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