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Year 6 Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What are the causes of aortic stenosis?

A 
age related calcification (most common >65)
bicuspid aortic valve (most common <65)
rheumatic heart disease
Williams syndrome (supravalvular AS)
HOCM (subvalvular AS)
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2
Q

What does an AS murmur sound like and where is it heard?

A

ESM
right 2nd ICS
loudest on expiration
radiates to the carotids

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3
Q

what does the pulse feel like in AS?

A

slow rising, narrow pulse pressure (<30 mmHg)

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4
Q

what are the S/S of severe AS?

A

SAD
syncope
angina
dyspnoea

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5
Q

What are some differentials of AS?

A

aortic sclerosis
hOCM
MR
PS/TR

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6
Q

What signs would be picked up with severe AS?

A

Absent S2, S4
narrow PP
LVF (decompensation)

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7
Q

What investigations would you do for AS?

A

ECG (LCH, arrhythmia)
Bloods (FBC, U&E, BNP, lipids, glucose)
Blood culture
CXR (calcified valves, LVH, pul oedema)
Echo +/-doppler (assess severity, cause and LV function)
Coronary angiography - often done prior to surgery as cardiovascular disease may co-exist.

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8
Q

What would be seen on echo in severe AS?

A

Valve area <1cm^2
Pressure gradient >40 mmHg
Jet velocity >4m/s

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9
Q

What is the management of AS?

A

MDT - cardiologist, GP, SNP, cardiothoracic surgeon, dietician, OT/physio
RF modification
Regular f/u

Surgical:

  1. open replacement (biological or artificial valve)
  2. TAVI
  3. balloon valvuloplasty
  4. sutureless AV replacement
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10
Q

What are the types of artificial valve?

A
  1. Starr-Edwards (ball in cage)

2. Tilting disc/bileaflet

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11
Q

What do you hear in AR?

A

early diastolic murmur
loudest at left lower sternal edge 3rd ICS (Erbs point)
loudest sitting up on expiration

+/- mid diastolic murmur (austin flint of regurgitant jet causing MS)

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12
Q

What peripheral signs may be seen in AR?

A

AORTIC MAN
Beckers sign (retinal artery pulsation)
Mueller signs (systolic pulsations of uvula)
De Musset’s sign (nodding head)
Corrigan’s sign (carotid pulsation)
Quincke’s sign (pulsatile nail bed)
Traube’s sign (pistol-shot femoral pulses)
Duroziez’s sign (femoral artery compression)

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13
Q

What signs of AR may be identified in the pulse?

A 
Corrigan's pulse (water hammer pulse)
Wide PP (180/45)
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14
Q

What are the signs of severe AR?

A

Collapsing pulse
Wide PP
LVF

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15
Q

What are some causes of AR?

A

Acute:
Infective endocarditis
Aortic dissection (standard type A)
syphilis

Chronic:
bicuspid aortic valve
RHD
autoimmune (anklyosing spondylitis, RhA, SLE)
CTD (Ehler's danlos, Marfarns)
HTN
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16
Q

What are the investigations for AR?

A

ECG (LVH, LV strain - lateral lead TWI)
Bloods (FBC, U&E, NT-proBNP, lipids, glucose, ESR, HLA-B27, ANA)
CXR (cardiomegaly, LVH, pulmonary oedema)
Echo +/- doppler
Coronary angiography

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17
Q

what would be seen on echo/doppler in severe AR?

A

Jet width >65% outflow tract
regurgitant jet volume
premature closing of mitral valve

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18
Q

what is the management of AR?

A

General:
MDT
RF modification
Regular F/U

Medical:
reduce after load -> ACEi, BB, diuretics

Surgical:
valve replacement before LV dilatation and dysfunction

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19
Q

what are indications for surgical management of AR?

A 
NYHA >2
LV dysfunction:
- pulse pressure >100 mmHg
- ECG changes (TWI in lateral leads)
- LV enlargement on CXR or EF <50%
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20
Q

What are the peripheral signs of MS?

A

Malar flush

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21
Q

what is the pulse like in MS?

A 
Often irregular (AF)
Can be normal
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22
Q

What signs can be found on the precordium in MS?

A

Apex: tapping (palpable S1), non displaced, left parasternal heave (RVH secondary to pul.HTN)
Sounds: loud S1, early diastolic opening snap +/- loud S2 if pul HTN

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23
Q

What does the murmur sound like in MS?

A

Mid diastolic murmur
loudest in left lateral at end expiration with bell
radiates to axilla
+/- Graham Steell murmur (EDM 2nd to PR)

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24
Q

What signs are seen in severe MS?

A

Malar flush, longer murmur, LVF

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25
Q

What are some causes of MS?

A

Rheumatic heart diseases
austin flint murmur
Rare: prosthetic valve, congenital

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26
Q

What are some differentials of MS?

A

AR
TS
PR

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27
Q

What are some signs of pulmonary hypertension?

A

malar flush
JVP with large V waves
right ventricular heave
loud s2 (p2)

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28
Q

What are some investigations for MS?

A

ECG (p mitrale, AF)
Bloods (FBC, U&E, NT-proBNP, lipids, glucose)
CXR (LA hypertrophy (splaying of carina), calcified mitral valve, pul oedema)
Echo +/- doppler
Coronary angiography

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29
Q

what would you see on echo/doppler in severe MS?

A

Valve orifice <1cm^2
Pressure gradient >10 mmHg
Pul. artery SBP >50 mmHg

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30
Q

What is the management of MS?

A

General:
MDT
RF modification
Regular F/U

Medical:
RhF prophylaxis (benzylpenicillin)
AF (Rate control + DOAC)
Diuretics (symptomatic relief)

Surgical:
1st: balloon valvuloplasty
valvotomy/commissurotomy (valve repair)
Valve replacement (if repair not poss)

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31
Q

What are the indications for surgery in MS?

A

Moderate severe MS (symptomatic or non-symptomatic)

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32
Q

When is balloon valvulplasty contraindicated?

A

left atrial appendage thrombus, calcified valve

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33
Q

what pulse signs can be seen in MR?

A

irregular/AF

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34
Q

what signs may be present on the precordium in MR?

A

Apex: displaced (ventricle pumps SV and regurgitant volume), parasternal heave (RVH)
Sounds: soft S1 +/- loud S2

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35
Q

What murmur is heard in mitral regurgitation?

A

pansystolic murmur
loudest in left lateral position at end expiration in apex
radiates to axilla

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36
Q

What are the signs of severe AF?

A

LVF, AF

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37
Q

What are some differentials of MR?

A

AS,
VSD,
TR
PS

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38
Q

What are some causes of MR?

A

Acute:
IE
IHD (MI) - papillary muscle rupture, chord tendinae rupture

Chronic:
mitral valve prolapse (2% population - mid systolic murmur)
RHD
calcification
CTD (marfan's, Ehlers danlos)
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39
Q

What signs are seen in papillary muscle rupture?

A

new systolic murmur (MR)
hypotension
pulmonary oedema

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40
Q

What are the investigations for MR?

A

ECG (P mitrale, AF, LVH)
Bloods (FBC, U&E, NT-proBNP, lipids, glucose
CXR (LA/LV hypertrophy, calcified mitral valve, pulmonary oedema)
Echo +/- doppler assessing severity, cusp calcification and LV function
coronary angiography

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41
Q

what is seen on echo in severe MR?

A

Jet width >0.6 cm
systolic pulmonary flow reversal
regurgitant volume >60 ml

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42
Q

What is the management of MR?

A

General: MDT
RF modification
regular FU

Medical: reduce afterload
AF (control rate + rhythm + anticoagulant)
Reduce after load (ACEI, BB (carvedilol), diuretics)

Surgical:
valve replacement
repair

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43
Q

What are the indications for surgery in MR?

A

Symptomatic

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44
Q

Prognosis of MR?

A

Asymptomatic ->10 years

Symptomatic - 25% mortality at 5 years

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45
Q

What are the immediate complications of MI?

A
  • cardiac arrest
  • cardiogenic shock
  • tachyarrhythmia (vf, vt)
  • bradyarrhythmia (av block)
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46
Q

What are the early complications of MI?

A

Pericarditis / Dresslers
Left ventricular free wall rupture
VSD and acute HF

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47
Q

What are the late complications of MI?

A

Chronic heart failure

Left ventricular aneurysm

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48
Q

What classification can be used for heart failure?

A

New York Heart Association Classification

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49
Q

What are the stages of the NYHA?

A

I - no limitation of acitivty
II - comfortable at rest, dyspnoea on ordinary activity
III - marked limitation of ordinary activity
IV - dyspnoea at rest

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50
Q

what is a normal ejection fraction?

A

45-60%

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51
Q

Which drugs are contraindicated in heart failure?

A 
thiozoladinediones
verapamil
NSAIDs (fluid retention)
Glucocorticoids (fluid retention)
Flecainide
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52
Q

What is the the management of heart failure

A

BASHeD up heart (BB, ACEi, spiro, hydralazine, digoxin)
1st line: ACEi + BB (reduced EF-carvedilol) or loop diuretic (preserved EF)
2nd line: spironolactone
3rd line (specialist); hydralazine + nitrate
ivabridine (EF <35%), HR >75
valsartan
digoxin
cardiac resynchronisation +/- ICD

Other:
offer annual influenza
one of pneumococcal vaccine

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53
Q

What are the s/s of angina

A

CP is sharp
CP precipitated by physical exertion
CP relieved by GTN within 5mins

Stable = 3/3
atypical = 2/3
non anginal = <1/3

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54
Q

What are the investigations for stable angina?

A
  1. CTCA -> calcium score
  2. non invasive functional imaging:
    - Stress echo
    - Contrast enhanced perfusion MR
    - MR for stress induced wall motion abnormalities
    - MPS SPECT
  3. coronary angiography
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55
Q

What does calcium score show?

A

Risk of MI/stroke at 10 years

percentiles(>75th = 15-20%)

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56
Q

What is the management of angina?

A

Conservative:
stop smoking
weight loss and exercise
healthy diet (fish, F+V, reduced sat fat)

Medical:

1st: GTN + BB or CCB (non-DHP e.g. verapamil/diltiazem)
2nd: GTN + BB + CCB (DHP)
3rd: long acting nitrate, ivabradine, nicorandil, ranolazine

Secondary prevention: 
aspirin 75 OD
atojvastation 
ACEi (if angina and DM)
antihypertensives
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57
Q

which CCBs should never be combined with beta blockers?

A

non-DHP CCBs:
verapamil
diltiazem

interacts with AV node conduction and may cause complete heart block

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58
Q

What are the contraindications to BB?

A

hypotension, bradycardia, asthma, HF

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59
Q

What are the contraindications to CCB?

A

hypotension, bradycardia, peripheral oedema

DHP>non-DHP for peripheral oedema

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60
Q

What are some causes of AF?

A 
IHD
rheumatic HD (MR, MS)
Hyperthyroid
infection
PE
cardiomyopathy
alcohol
bronchial cancer
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61
Q

what are the types of AF?

A 
acute (<48H)
Paroxysmal AF (<7d, recurs)
persistent AF (>7d, may recur even after cardioversion)
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62
Q

When should you rhythm control rather than rate control?

A

reversible af
Coexistent heart failure caused by AF
New onset AF

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63
Q

When should those with AF be anti coagulated and what with?

A

AF<48h - LMWH
AF >48h- apixaban …

… for 3w before cardioversion
…for 4w after cardioversion or lifelong depending on CHASVASc

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64
Q

What are the rate control strategies for AF?

A

1st line: beta blocker or rate limiting CCB (verapamil>diltiazem)
2nd line: digoxin + CCB or BB; mono therapy in asthmatic with HF
3rd line: amiodarone

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65
Q

What are the acute rhythm control strategies for AF?

A

Acute:

1st: DC cardioversion
2nd: pharmacological cardioversion: flecainide if young and no structural heart disease, amiodarone if structural heart disease

66
Q

what are the long term rhythm control strategies for AF?

A 
1ST: BB
Paroxysmal: pill in pocket (flecainide or sotalol/amiodarone if structural heart)
Ablation of AV node
Maze procedure
pacing
67
Q

what are the ix for HTN?

A

ABPM

Home blood pressure monitoring

68
Q

What are the S/S of severe HTN?

A 
retinal haemorrhage
papilloedema
confusion
AKI
chest pain 
ADMIT
69
Q

what is severe HTN?

A

> 180/110

70
Q

What are the Ix for severe HTN?

A

Bedside: ECG, urine dip

Bloods

71
Q

What are the stages of HTN?

A

1: Clinic BP >140/90 AND ABPM/home BP >135/85
2: Clinic BP >160/100 AND ABPM/home BP >150/95
Severe: Clinic SBP> 180 OR clinic DBP >110

72
Q

When do you treat HTN?

A

if <80yo + stage 1

STAGE 2 ++

73
Q

What is the preferred thiazide diuretic?

A

indapamide >bendroflumethiazide

74
Q

What are the side effects of ACEi

A

ACE
Angioedema
Cough
Elevated K

75
Q

What are the RF for IE?

A
  • previously normal valves -> mitral valve most common
  • RHD
  • IVDU -> TRICUSPID
  • prosthetic valves, congenital heart defects, recent piercings
76
Q

Which organisms may cause IE?

A

S.aureus (acute, IVDU)
S.epidermidis (CoNS; prosthetic valves)
S. viridian’s (sub-acute, developing world)
HACEK

77
Q

What are some non infective causes of IE?

A 
Libman-Sacks Endocarditis (SLE)
Marantic endocarditis (malignancy)
78
Q

What are some culture negative organisms that cause IE?

A 
HACEK (sub-acute presentation)
H.influenzae
Actinobacillus
Cardiobacterium
Eikenella corrodens
Kingella
79
Q

When is surgery indicated for IE?

A 
Severe valvular incompetence
aortic abscess (lengthening PR interval)
infections resistant to Abx
fungal infections
cardiac failure refractory to standard treatment
recurrent emboli after Abx
80
Q

How is IE diagnosed?

A

Dukes criteria
2 majors OR
1 major + 3 minors OR
5 minors

81
Q

What is the Duke’s criteria?

A

BE FEVEER
Major:
Bacteraiemia [2 cultures, 12 hours apart]
Echo [vegetation, new murmur, abscess, dehisced prosthetic valve]

Minor:
Fever [>38]
Echo findings
Vascular phenomenon: emboli (stroke, PE, splenomegaly), splinter haemorrhages, janeway lesions
Evidence of immunological involvement: oslers nodes, roth sports, glomerulonephritis, rheumatoid factor
Evidence of micobiological involvement: 1 culture +ve
RF: IVDU, heart condition

82
Q

What are the signs and symptoms of IE

A 
FROM JANE
Fever
Roth spots
Oslers nodes
Murmur

Janeway lesions
Anaemia
Nail haemorrhages
Emboli

83
Q

What is the management of IE

A

Blind therapy:
native valve:amoxicillin +/- low dose gentamicin
prosthetic: vancomycin + rifampicin + low dose gentamicin

Staph:

native: fluclox
prosthetic: fluclox+ rifampicin + gent

Strep:
fully sensitive: benpen
not fully sensitive: benpen + gent

84
Q

What causes rheumatic fever/heart disease?

A

Group A beta haemolytic strep (S.pyogenes/GAS)

Scarlet fever

85
Q

What are the S/S of rheumatic fever/hd?

A 
Laten interval of 2-6 weeks after pharyngeal infection:
PPE
Polyarthritis
Pericarditis
Erythema marginatum

Syndenhams chorea 2-6 months later

86
Q

How is rheumatic fever diagnosed?

A

JONES CRITERIA

  1. Evidence of GAS infection AND:
    - throat culture test +ve
    - rapid streptococcal antigen test +ve
    - high ISO titre
    - recent scarlet fever
  2. 2major criteria
  3. 1 major criteria + 2minors
87
Q

What are the major Jones criteria?

A 
CASES
Carditis
Arthritis
Subcutaneous nodules
Erythema marginatum
Syndenhams chorea
88
Q

What are the minor Jones criteria?

A 
FRAPP 
Fever
Raised ESR/CRP
Arthrlagia
Prolonged PR
Previous RF
89
Q

What investigations are done for RF?

A

Bedside: ECG
Bloods: FBC, ESR, ASOT
Imaging: echo

90
Q

What is the management of RF?

A

Acute:
Bed rest - until CRP normal for 2 weeks
Analgesia (NSAIDs,aspirin)
Phenoxymethylpenicillin (penicillin V QDS 10/7), AZITHRO if pen allergy

Other:
CCF, cardiomegaly, 3rd degree HB -> corticosteriods
Syndenhams chorea -> haloperidol, diazepam

Prophylaxis:
once monthly benpen iM OR
BD PO phenoxymethylpenicillin
+/- surgical valve repair

91
Q

Which valves are most affected by RF

A

Mitral valve (70%)
Aortic valve (40%)
Tricuspid (10%)
Pulmonic (2%)

92
Q

What are the causes of pericarditis?

A 
viral infections (coxsackie)
uraemia
post-MI, Dressler
Hypothyroid
TB
Trauma
CTD
Malignancy
93
Q

What are the signs and symptoms of pericarditis?

A 
Pleuritic CP
Pericardial rub
Tachypnoea, tachycardia
non productive cough 
Dyspnoea
Flu like symptoms
94
Q

What are the investigations for pericarditis?

A

ECG - widespread PR depression and saddle shaped ST elevation
TTE
troponin (may be raised)

95
Q

What is the management of pericarditis

A

treat the cause

1st line: NSAIDs and colchicine

96
Q

What are the cardiac causes of clubbing?

A

CIA
Cyanotic heart disease (TOF, TOGA)
Infective endocarditis
Atrial myxoma/LAME syndrome

97
Q

What is LAME syndrome?

A

Lentigines (spotty skin pigmentation),
Atrial myxoma
Endocrine (pituitary) tumours
Schwannomas

98
Q

What are the features of pulmonary hypertension?

A 
Raised JVP
Left parasternal heave
Ascites/peripheral oedema
Loud S2 +/- PSM of TR
Pulsatile hypertrophy
99
Q

What would cause a collapsing pulse?

A

AR
anaemia
thyrotoxicosis
pregnancy

100
Q

What would cause an absent radial pulse?

A

Trauma
coarctation
thromboembolic
takayasu arteritis

101
Q

What would cause an impalpable apex beat

A

COPD
Obesity
Pericardial effusion
Dextrocardia

102
Q

What would cause a loud S1?

A 
MS
high flow (anaemia, sepsis, thyrotoxic)
103
Q

What would cause a loud S2?

A

systemic HTN

pulmonary HTN

104
Q

What would cause an S3 heart sound?

A

Compliant ventricle
young, athletes, pregnancy
HF, AR, MR, TR, dilated cardiomyopathy

105
Q

What would cause an S4 heart sound?

A

LVH (AS, HTN)

Cardiomyopathy (HOCM, restrictive)

106
Q

what causes a split S1?

A

normal in 40-70% population

RBBB

107
Q

what causes a split S2?

A 
deep inspiration (normal)
ASD, pul hon, ref, bbb
108
Q

What are the ways of categorising cardiomyopathy

A

Primary and secondary

Genetic, mixed, acquired and other

109
Q

What are the types of primary cardiomyopathy

A

Genetic:
HOCM
arrhythmogenic right ventricular dysplasia

Mixed:
Dilated
Restrictive

Acquired:
permpartum
takotsubocardiomyopathy

110
Q

What are some causes of secondary cardiomyopathy?

A 
mainly a response to systemic insult:
infective - coxsackie B, chagas
infiltrative - amyloidosis
storage - haemochromatosis
toxicity - doxorubicin, alcohol
inflammatory - sarcoidosis
endocrine - DM, thyrotoxicosis, acromegaly
NM - Friedrichs ataxia, Duchenne, mythic dystrophy
Autoimmune - SLE
111
Q

What are the echo findings in HOCM?

A
  1. MR

2. systolic anterior motion of the anterior mitral valve and asymmetric septal hypertrophy

112
Q

What are 4 causes of dilated cardiomyopathy?

A
  1. alcohol
  2. coxsackie B
  3. wet beri beri
  4. doxorubicin
113
Q

What are 3 causes of restrictive cardiomyopathy?

A
  1. amyloidosis
  2. post radiotherapy
  3. Loefflers endocarditis
114
Q

What is seen on ECG in arrhythmogenic right ventricular dysplasia?

A

ECG abnormalities V1-V3 (T wave inversion)

epsilon wave

115
Q

What is takotsubo cardiomyopathy?

A

stress induced cardiomyopathy
HF features
transient apical ballooning of myocardium
treatment is supportive

116
Q

What are the types of long QT?

A

1: associated with exertion syncope e.g. swimming
2: syncope following emotional stress, exerciser auditory syncope
3: occurs at night or at rest
sudden cardiac death

117
Q

What are some congenital causes of long QT?

A
  1. Jervell-Lange-Nielsen syndrome (deafness)

2. Romano-ward syndrome (no deafness)

118
Q

What are some drug causes of long QT?

A 
METH CATS
Methadone
Erythromycine
Terfenadine
Haloperidol
Clarithromycine/chloroquine
Amiodarone/azithromycone
TCAs
SSRIs (citalopram)
119
Q

What are some physiological causes of long QT?

A

HYPOcalcaemia
HYPOkalaemia
HYPOmagnesaemia

MI
Myocarditis
Hypothermia
SAH
Malnutrition
120
Q

what are some complications of long QT

A

VT -> death

torsades des pointes

121
Q

What is the management of Torsades des pointes?

A

IV magnesium sulfate
avoid drugs prolonging QT and other precipitants
ICD

122
Q

what is bifascicular block?

A

RBBB + LAD

123
Q

What is incomplete trifascicular block ?

A

bifascicular + 1st/2nd degree HB

124
Q

What is complete trifascicular block ?

A

bifascicular + 3rd degree HB

125
Q

What is the definition of orthostatic hypotension?

A

drop of 20/10 after standing 3 mins

321

126
Q

When is pulsus paradoxus seen?

A

severe asthma

cardiac tamponade

127
Q

When is pulsus alternates seen

A

LVF

128
Q

When is a slow rising pulse seen?

A

AS

129
Q

When is a bisferiens pulse seen?

A

mixed aortic valve disease

HOCM

130
Q

When is a jerky pulse seen?

A

HOCM

131
Q

What is the indication for unipolar pacemakers?

A

SA node pathology (AV node unimpaired)

132
Q

What is the indication for unipolar pacemakers?

A

synchronisation

133
Q

What is the indication for dual atrial site pacemakers?

A

paroxysmal af

one lead in SA node, one coronary sinus (both RA), one in RV

134
Q

What is the indication for biventricular pacemakers?

A

HF (last line)

135
Q

What is the indication for ICD?

A

Tachyarrhytmia

136
Q

How does pacemaker nomenclature work?

A 
letter 1:  chamber that is paced
letter 2: chamber that is sensed
letter 3: response to sensed event
letter 4: rate response features
letter 5: anti-tachycardia facilities
137
Q

How is HOCM inherited?

A

AD

138
Q

What conditions are associated with HOCM?

A

WPW

Friedrich’s ataxia

139
Q

What is seen on HOCM biopsy?

A

myofibrillar hypertrophy with chaotic and disorganised fashion myocytes and fibrosis

140
Q

What are the symptoms and signs of HOCM?

A
  • asymptomatic
  • sudden death (commonly due to VF/ventricular arrhythmias)
  • AF, VF (sudden death), VT (collapse)
  • exertional: dyspnoea, angina, syncope due to LVH and functional aortic stenosis
141
Q

What is seen on examination of HOCM

A 
jerky pulse
large a waves
double apex beat
ESM (increased with valsalva)
PSM of mitral regurgitation
142
Q

What is seen on echo of HOCM?

A

MR SAM ASH
MR
Systolic anterior motion (SAM) of mitral valve leaflet
Asymmetric hypertrophy

143
Q

What is seen on HOCM ECG?

A

LVH - tall voltages
Non specific ST/T wave abnormalities (t wave inversion may be seen)
Deep Q wves

occasionally WPW delta wave, p mitrale, AF

144
Q

What is the management HOCM?

A 
abcde
Amiodarone
Beta blockers/verapamil for symptoms
Carioverter defibrillator
Dual chamber pacemaker
Endocarditis prophylaxis

avoid nitrates, ACEi, inotropes

145
Q

What is the most specific ECG marker for pericarditis?

A

PR depression

146
Q

What is the most common congenital heart defect found in adulthood?

A

ASD

147
Q

What are the features of ASD

A

ejection systolic murmur, fixed splitting of S2

embolism may pass from venous system to left side of heart causing a stroke

148
Q

What are the features of osmium primum?

A

present earlier than ostium secundum defects
associated with abnormal AV valves
ECG: RBBB with LAD, prolonged PR interval

149
Q

What are the features of osmium secundum?

A

associated with Holt-Oram syndrome (tri-phalangeal thumbs)
ECG: RBBB with RAD
70% ASDs

150
Q

ECG findings hyperkalaemia?

A 
Peaked or 'tall-tented' T waves (occurs first)
Loss of P waves
Broad QRS complexes
Sinusoidal wave pattern
Ventricular fibrillation
151
Q

what condition is associated with bisferiens pulse?

A

HOCM

double pulse’ - two systolic peaks
mixed aortic valve disease

152
Q

Risk factors for asystole in bradycardia?

A 
(? needs transvenous pacing)
complete heart block with broad complex QRS
recent asystole
Mobitz type II AV block
ventricular pause > 3 seconds
153
Q

Warfarin management of major bleeding?

A

Stop warfarin
Give intravenous vitamin K 5mg
Prothrombin complex concentrate - if not available then FFP*

154
Q

Mx warfarin INR > 8 and minor bleeding?

A

Stop warfarin
Give intravenous vitamin K 1-3mg
Repeat dose of vitamin K if INR still too high after 24 hours
Restart warfarin when INR < 5.0

155
Q

Mx warfarin INR >8, no bleeding?

A

Stop warfarin
Give vitamin K 1-5mg by mouth, using the intravenous preparation orally
Repeat dose of vitamin K if INR still too high after 24 hours
Restart when INR < 5.0

156
Q

Mx warfarin INR 5-8 and minor bleeding?

A

Stop warfarin
Give intravenous vitamin K 1-3mg
Restart when INR < 5.0

157
Q

Mx warfarin INR 5-8 and no bleeding?

A

Withhold 1 or 2 doses of warfarin

Reduce subsequent maintenance dose

158
Q

What is seen on ECG with hyper and hypocalcaemia?

A

hyper - shortened QTc

hypo - longer Qtc

159
Q

what do fusion and capture beats on ECG suggest?

A

VT

160
Q

what can be given to reverse bleeding on dabigatran?

A

idarucizumab

Year 6 Medicine (18 decks)

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