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Year 4 part 2 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

At what stage in the cardiac cycle do the coronary arteries fill with blood

A

Diastole

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2
Q

What is Sterling’s law of the heart / Frank-starling

A

The greater the stretch of the heart muscles = the greater the force pumped from the heart

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3
Q

Where is a collapsing/water hammer pulse heard

A

Aortic regurgitation

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4
Q

Define pulses alternans

A

A mix of weak and strong pulses

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5
Q

Define Pulsus bigeminus

A

A premature ectopic beat following the normal beat

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6
Q

Define Pulsus Bisferiens

A

a Double pulse

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7
Q

In what condition is Pulsus bisferiens heard in

A

Hypertrophic cardiomyopathy and mixed aortic valve disease

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8
Q

What causes S1 sound

A

Mitral and tricuspid valve closure

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9
Q

What causes S2 sound

A

Aortic and pulmonary valve closure

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10
Q

What causes an S3 sound

A

HF

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11
Q

What causes an S4 soundd

A

Gallop rhythm when the walls harden

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12
Q

Carotid sinus syndrome vs Vasovagal syndrome

A

CSS affects elderly vs Young people

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13
Q

Define First degree Heart Block

A

PR INterval >0.22 seconds

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14
Q

Define Mobitz Type I block

A

Progressive PR interval prolongation til a p wave is skipped

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15
Q

Define Mobitz type II Hear block (HB 2)

A

All PR intervals are the same but the p wave skips randomly

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16
Q

Define a complete heart block

A

Ventricular rhythm is sustained but electrical impulses fail to reach to the ventricles at all.

So they both beat at different rhythms to each other

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17
Q

What artery is most commonly affected in MIs

A

Right coronary artery occlusion

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18
Q

What parts of an ECG indicate inferior wall MIs (right coronary artery occlusion)

A

STEMIs in II, III and aVF

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19
Q

What condition can cause heart block

A

Lyme Disease

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20
Q

What medications can cause heart block

A

beta blockers
CCBs
Adenosine
Amiodarone
Digoxin

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21
Q

What heart block is seen in Lyme Disease

A

Third degree AV block

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22
Q

Normal QRS complex size

A

3 boxes - 120 ms

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23
Q

Affects of bundle branch blocks on QRS complexes

A

Widen them (as delayed time)

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24
Q

What does the pneumonic WiLLiaM MaRRoW show us

A

LBBB = W in V1, M in V6

RBBB = M in V1, W in V6

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25
Q

Causes of RBBB

A

Right Ventricular Hypertrophy
RHF
PE

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26
Q

What is characteristic of LBBB in V1 leads

A

Sloping S waves (google)

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27
Q

Causes of LBBB

A

Hypertension
Ischaemia (MIs)

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28
Q

What is the most common complication of cardiac surgery

A

AF (appears 4 days after surgery)

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29
Q

HR in AF

A

300-600 BPM

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30
Q

Define Paroxysmal AF

A

Stops after 7 days

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31
Q

Define Persistent AF

A

> 7 Days

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32
Q

Define permanent

A

Continuous with no recovery

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33
Q

First Line investigation of AF

A

ECG

Second Line: 24-hour ECG

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34
Q

Purpose of rate control

A

Bring back rate to 90 BPM

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35
Q

First line rate control medication

A

Atenolol or CCB

Second Line: Digoxin

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36
Q

Role of Rhythm control

A

Brinsg back erratic heart to normal regular rhythm

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37
Q

Intervention for rhythm controlling AF

A

Cardioversion (IV Adenosine)

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38
Q

In what people is Cardioversion indicated in

A
  • Recent AF
  • <65
  • Successful treatment of underlying AF cause
  • NO other heart abnormality
  • Acute HF made worse by AF
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39
Q

Complications of AF

A

Dilated Cardiomyopathy and strokes

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40
Q

What should be done if CHA3Ds@ vast score >2

A

Offer DOAC

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41
Q

If a DOAC is contraindicated for CHA2d2vasc, what should be given

A

Vit K antagonist

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42
Q

When are DOACs often contraindicated for use in AF

A

<65 with no other risk factors (just sex)

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43
Q

What is the ORBIT bleeding risk score

A

For those on anti-coagulants with AF

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44
Q

What needs to be investigated before cardio version

A

ECHO

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45
Q

If cardio version fails, what should be done

A

Referral to cardiology

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46
Q

management of acute AF flare <48 hours

A

Offer Flecainide or amiodarone to those with no evidence of structural or IHDs

Alternatively offer only Amiodarone if there is evidence

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47
Q

Management of acute AF flare >48 hours onset

A

Delay cardio version + offer beta blockers

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48
Q

Flecainide vs Amiodarone

A

Flecainide = oral

Amiodarone = IV

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49
Q

Define Preload

A

Amount of blood returning to heart

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50
Q

Define Afterload

A

Peripheral resistance to ejected blood

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51
Q

Atrial Flutter vs AF

A

Flutter + regular Heart Rate, just super fast (250-300 BPM)

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52
Q

What causes Atrial Flutter

A

Electrical impulses circle around the Tricuspid valve and move back to the atria instead of all of the impulses going straight to the AV Node -> Ventricles.

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53
Q

Management of Atrial FLutter

A

Anticoagulation 3 weeks before and then cardio version

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54
Q

What is Bruggada syndrome

A

Idiopathic ventricular fibrillation than results in sudden death in South-east asian communities (caused by re-entrant loops)

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55
Q

Management of Prolongued QT intervals

A

Magnseium Sulphate

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56
Q

What are Class I drugs

A

Sodium-channel blockers

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57
Q

What are Class II drugs

A

Prevent the affects of catecholamines on the action potential of the heart

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58
Q

What are Class III drugs

A

Lengthen the action potential running through the heart

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59
Q

What are Class IV drugs

A

Reduce the amplitude of the action potential running through the heart

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60
Q

Name a Class I drug

A

Flecainide and Disopyramide

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61
Q

Name a Class II drug

A

Atenolol

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62
Q

Name a Class II drug

A

Amiodarone

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63
Q

IN what condition is catheter ablation first line

A

WPW syndrome

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64
Q

First line investigation of Heart Failure

A

NT-ProBNP levels

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65
Q

What should be done if NT-proBNP level >2,000

A

Urgent referral and ECHO within 2 weeks

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66
Q

Management of those with NT-proBNP levels 400-2,000

A

Referral to cardiology routinely (within 6 weeks) for ECHO

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67
Q

What are normal levels of NT-proBNP levels

A

<400

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68
Q

What else can elevate NT-proBNP levels

A

Tachycardia

eGFR <60

Age over 70

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69
Q

Why is an ECG important in investigating HF

A

If normal, HF unlikely

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70
Q

Staging of HF

A

NYHA:

1: No symptoms on ordinary physical activity
2: Slight limitation by symptoms
III: Less than ordinary activity leads to symptoms
IV: At rest

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71
Q

Medical treatment of Heart Failure

A

ABAL:

ACEI
Beta blocker
Aldosterone antagonist (spironolactone)
Loop Diuretic

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72
Q

Define primary prevention

A

Patients who have never had a VC disease in the past

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73
Q

Define Secondary prevention

A

Patient that have had angina, an MI, Tia or stroke in the PAST

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74
Q

What is used to determine if primary prevention is needed for CVD

A

QRISK 3

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75
Q

What is secondary prevention of CVD

A

AAAA

Aspirin
Atorvastatin 80mg
Atenolol
AceI

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76
Q

Define tertiary prevention

A

Treatment aimed at reducing the SEVERITY of disease (improve health outcomes)

while secondary is to stop progression of disease to something irreversible

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77
Q

What is given if QRISK3 is >10 %

A

Atorvastatin 20mg

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78
Q

Define Prinzmetal’s angina

A

Angina occurring without provocation (not on exertion)

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79
Q

Investigations for those with typical angina and disease risk of 10-29%

A

CT Angiography

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80
Q

Investigation of choice for those with angina and disease risk of 30-60%

A

Stress ECHO and SPECT

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81
Q

Investigation of choice for those with angina and disease risk fo 61-90%

A

Cardiac Catheterisation

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82
Q

Management of Stable angina

A

RAMP:

Refer to cardiology routinely if stable or urgently if unstable
Advise about diagnosis, management and when to call an ambulance
Medical treatment
Proceedural or surgical interventions

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83
Q

First line management of angina in patients

A

NOT surgical, medical first:

GTN - immediate relief

Long term:

Beta blocker or CCB

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84
Q

Second line management of stable angina (long term)

A

Switch to beta blocker and dihydropyridineor Nicorandil

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85
Q

When should PCI or CAB be considered for angina

A

After two lines of medications have failed to control symptoms

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86
Q

PCI vs CABG

A

<65 vs >65 years
Healthy vs Diabetes

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87
Q

Which is more effective PCi or CABG

A

More revascularisation sessions needed with PCI

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88
Q

Secondary prevention of angina

A

AAAA

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89
Q

Through which artery is PCI delivered

A

Femoral Artery

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90
Q

Where is the graft vein taken for CABG

A

Great saphenous vein

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91
Q

Where are CABG scars seen

A

Midline sternotomy

Great Saphenous veins

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92
Q

What does the right coronary artery supply

A

Right atrium
Right ventricle
Inferior left ventricle

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93
Q

What does the circumflex artery supply

A

Left atrium

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94
Q

What does the left anterior descending supply

A

LV and septum

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95
Q

What are troponin levels like in unstable angina

A

Normal

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96
Q

How often should troponin levels be repeated

A

If negative, they need repeating after 4 Horus

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97
Q

In which patients are silenT MIs common in

A

Diabetic patients

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98
Q

Signs of NSTEMI on ECG

A

ST depression
T wave inversion
Q waves

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99
Q

What else can cause troponin levels to increase

A

Sepsis
PE
CKD

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100
Q

What serum levels show prognosis of ACS

A

Troponin levels

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101
Q

Management of an acute STEMI

A

Primary PCI within 2 hours

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102
Q

If a primary PCI is contraindicated for STEMI treatment (>12 hours), what can be done

A

Thrombolysis

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103
Q

What thrombolysis is used in STEMI treatment

A

Streptokinase

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104
Q

Management of acute NSTEMI

A

BATMAN

Betablocker
Aspirin 300mg stat
Ticagrelor
Morphine
Anticoagulant (fondaparinux)
Nitrates

Oxygen only if sats decrease

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105
Q

What is a GRACE score

A

Assess risk of death from MI

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106
Q

Complications of MI

A

DREAD:

Death
Rupture of heart septum
Edema (HF)
Arrythmias
Dressler’s syndrome

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107
Q

What is Dressler’s syndrome

A

Pericarditis from immune response to MI

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108
Q

Signs of Dressler’ ssyndrome

A

Raised CRP and ESR with ST elevation

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109
Q

Management of Dressler’s syndrome

A

NSAIDs or steroids

Worst case: Pericardiocentesis as it might come with pericardial effusion

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110
Q

Secondary prevention of ACS

A

AAAAAA (6As)

Aspirin 75mg
Another antiplatelet (clopidogrel or Tica)
Atorvastatin 80mg
ACEI
Atenolol
Aldosterone antagonist

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111
Q

How to prevent post operative AF

A

Give Amiodarone or beta blocker

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112
Q

What is always first line for AF

A

Rate control

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113
Q

When is rate control not first line management for AF

A

When AF is new onset or has other causes

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114
Q

When should cardioversion (non pharmaceutical) therapy be offered

A

When AF has been ongoing for more than 48 hours

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115
Q

When is Radiofrequency ablation considered for AF

A

If drug treatment is unsuccessful

116
Q

What is rheumatic fever

A

Follows from strrep throat: strep pyogenes has M proteins which molecular mimics the porteins in the myocardium. Causes immune response against myocardium.

Type 2 hypersensitivity reaction

117
Q

What is the Jones’ criteria for rheumatic fever diagnosing

A
  1. Migratory polyarthritis
  2. Carditis
  3. Mitral regurgitation + Stenosis
  4. Sydenham’s chorea (rapid movement of face and arms)
  5. Erythema Marginatum
118
Q

Stenosis vs regurgitation

A

Stenosis: Prevents adequate outflow of blood

Regurgitation: Leaflets fuse and fail to close = unable to stop back flow of blood

119
Q

Describe the pulse in aortic stenosis

A

Parvus and Tardus

120
Q

Symptoms of aortic stenosis

A

Syncope and Angina

121
Q

What is the main cause of mitral regurgitation

A

Mitral valve prolapse

122
Q

Causes of aortic regurgitation

A

Infective endocarditis
Biscuspid aortic valve -

123
Q

What manoevure can be done to check for mitral stenosis

A

Patient lying on left hand side

124
Q

What manoeuvre can be done for aortic regurgitation

A

Sit up, elad forward and breathe out

125
Q

What valve disease causes hypertrophy of the left atria and ventricle

A

Mitral and aortic stenosis

126
Q

What valvular disease causes left atrial and ventricular dilatation

A

Mitral and aortic regurgitation

127
Q

Symptoms of Mitral stenosis

A

Malar flush and AF

128
Q

Where can aortic stenosis murmurs raidate to

129
Q

What is parvus and tardus sound

A

Slow rising pulse and narrow pulse pressure

130
Q

Where is the austin-flnit murmur typically ehard in aortic regurgitation

A

Apex (early diastolic rumblinhg murmur)

131
Q

Symptoms of infective endocarditis

A

Clubbing
Murmurs
Janeway lesions
Osler nodes
Roth Spots in the eyes
SPlinter haemorrhages

132
Q

What are the main types of ASDs seen

A

Ostium Secondum defects

133
Q

Murmur heard in VSDs

A

Loud pansystolic murmur in the apex

134
Q

What genetic condition is associated with coarctatin of aorta

A

Turner Syndrome

135
Q

Symptoms o f coarctation of aorta

A

COld legs, claudication and headaches

Nose bleeds from hypertension

136
Q

When is balloon dilatation indicated for coarctation of aorta

A

If peak-peak gradient across coarctation >20 mmHg

137
Q

What is tetralogy of fallot

A

VSD
Overriding Aorta
RVH
Pulmonary stenosis

138
Q

Most common cause of myocarditis

A

Coxsackie infection

139
Q

Management of myocarditis

140
Q

In what conditions is uraemic pericarditis common

A

CKD patients

141
Q

Most ocmmon cause of viral pericarditis

A

Coxsackie B

142
Q

Management of recurring pericarditis

A

Colchicine

143
Q

What is the normal diameter of the aorta

144
Q

Under what anatomical level do AAAs typically arise from

A

Below Renal arteries

145
Q

WHat is a pseudoaneurysm

A

Blood leakage through the qaterial wall but not contained by the adventitia

146
Q

What is an AA

A

Dilation of all three arterial wall layers as elastic lamellae is degraded

147
Q

Risk Factors for AAA

A

Male sex
Age
Hyperlipidaemia

148
Q

Symptoms of an unruptured AAA

A

No symptoms

149
Q

Symptoms of a ruptured AAA

A

Hypotension and abdominal pain usually

150
Q

What examination can be done to check for an AAA

A

Supraumbilical palpation

151
Q

GOLD STANDARD investigation for AAA

A

CT Angiography

152
Q

Three criterions for AAA repairs

A

Symptomatic
Asymptomatic > 5,5. cm

OR

Asymptomatic, over 4cm and grown by more than 1 cm in a year

153
Q

Management of an AAA between 3 and 4.4cm

A

Annual USS

154
Q

Management of 4.5-5.5cm AAA

A

Three monthly USS

155
Q

Define Ejection Fraction

A

Percentage of the blood in the left ventricle which is pumped out with each heartbeat.

156
Q

How is Ejection Fraction measured

A

Transthoracic Echocardiography

157
Q

What Ejection Fraction indicates HF

158
Q

What is a normal ejection fraction

A

50 or more

159
Q

What drugs can cause HF

A

Beta blockers, CCBs, Digoxin

160
Q

What is Diastolic HF

A

Contraction is sufficient but not enough blood is returing to the ventricles

161
Q

What is the Ejection Fraction in Diastolic HF

162
Q

What level is increased in Diastolic HF

A

Increased End Diastolic Pressure

EDV is normal

163
Q

What causes diastolic HF

A

Ventricular Hypertrophy

164
Q

What causes Pulmonary Oedema in LHF

A

Activation of RAAS due to less blood flow to organs = more na+ absorption and oedema

165
Q

Management of Type 1 heart block

166
Q

What is the most specific ECG finding in pericarditis

A

PR Depression and saddle-shaped ST elevation

167
Q

What is Takotsubo cardiomyopathy

A

Cardiomyopathy induced by stressful triggers

168
Q

At what GRACE score should a CT angiography be sued

169
Q

What valve is usually affected in infective endocarditis

A

Tricuspid valve

170
Q

At what Well’s score is a D-dimer the investigation of choice for a PE

171
Q

At what Well’s score is a CT pulmonarty angiography the invetsigation of choice for a PE

172
Q

Define stage 1 Hypertension

A

140/90 Clinic or HBPM 135/85

173
Q

Define stage 2 Hypertension

A

> 160/100 at clinic or HBPM/ABPM >150/95

174
Q

Define stage 3 Hypertension

A

BP > 180 at clinic or diastolic BP >110

175
Q

Management of Bradycardia

176
Q

Management of acute heart failure with hypotension

A

Give inotropes not fluid

177
Q

What factors contribute to dilated cardiomyopathy

A

Alcoholism
Haemochromatosis
Alcohol

178
Q

Management of acute pericarditis

A

NSAID + Colchicine

179
Q

Management of pulmonary oedema

A

IV Fruosemide

180
Q

Signs of Right sided Heart Failure

A

Raised JVP
Hepatomegaly
Ankle Oedema

181
Q

In what HF is bibasal crackles heard in

A

Left sided HF

182
Q

In what valve disease is a mid-late diastolic murmur heard?

A

Mitral stenosis

183
Q

In what valvular disease is an early diastolic murmur heard

A

Aortic Regurgitation

184
Q

What blood disorder can lead to heart failure

A

Severe Anaemia

185
Q

Symptoms of Takayasu’s arteritis

A

Weak pulses and claudication in a young woman

186
Q

Management of a Type A Aortic Dissection (ascending aorta)

A

IV Labetolol + Surgery

187
Q

Management of a Type B (descending) aortic dissection

A

Iv Labetolol

188
Q

When is prothrombin complex indicated in high INR issues

A

Only if INR > 8

If 5-8, just stop warfarin and give IV vit K

189
Q

What leads show left anterior descending

190
Q

What ECG leads show activity through the right coronary artery

191
Q

What ECG leads show actvity through LAD or left circumflex

A

V4-6, I, aVL

192
Q

What ECG showed a posterior wall MI

A

Changes in V1-3

Alongside Q waves

193
Q

What is the management of a tachyarrythmia (e.g., atrial flutter) in the presence of hypotension

A

DC cardioversion

194
Q

What ECG changes are seen in WPW syndrome

A

Short PR interval + delta waves

195
Q

What classification can be used to stage limb ischaemia

A

I - asymptomatic
II - Intermittent Claudication
III - Rest Pain
IV - Necrosis

196
Q

Signs of intermittent claudication

A

Calf pain on exertion, relieved at rest

197
Q

Investigation for Peripheral vascular disease

198
Q

What symptoms does an ABPI of 0.5-0.9 come with

A

Intermittent claudication

199
Q

WHat ABPI level is indicative of critical limb ischaemia

200
Q

Medical management of Peripheral vascular disease

A

Cilostazol (phosphodiesterase III inhibitor) = vasodilatation

Naftidrofuryl - vasodilator agent

201
Q

Surgical intervention for peripheral vascular disease

A

Percutaneous transluminal angioplasty

202
Q

What antibiotic can cause long QT syndrome

A

Erythromycin

203
Q

Management of narrow-complex tachycardia

A

Vagal manoeuvres

204
Q

Myocarditis vs Pericarditis on an ECG

A

Myocarditis = ST eleveation
Pericarditis = PR Depression + ST elevation

205
Q

Target INR for PE patients

206
Q

What is the mechanism of heparin

A

Activates antithrombin III

207
Q

Management of an INR 5-8

A

WIthold two doses of warfarin + reduce maintenance dose

208
Q

Management of an INR >8.0

A

Stop warfarin completely and give vit K

209
Q

What medication should be given for hypertension if ACEi are contraindicated (ie., renal impairment

A

Amlodipine

210
Q

Examination findings in constrictive pericarditis vs cardiac tamponade

A

Kussmaul sign is positive in constrictive pericarditis but negative in cardiac tamponade (a raised JVP that DOESN’T FALL on inspiration)

211
Q

Common cause of cardiac tamponade

A

Recent cardiac surgery

212
Q

What ECG leads are anteroseptal MIs seen in

213
Q

Wga t ECG changes show an MI in the anterolateral leads

A

V4-6, I, aVL

214
Q

What are adverse signs in a patient that means someone with AF must be given DC cardioversion as first line

A

Systolic pressure < 90mmHg
Signs of shock
Syncope
Ongoing MI
HF

215
Q

How many times can cardioversion be given

A

Up to three shocks -> then ask consultant

216
Q

First line management of narrow-complex tachycardia

A

Vagal maneuvres followed by IV adenosine

217
Q

What is a common cause of pulseless electrical activity

A

Tension pneumothorax

218
Q

What ECG change is seen in a PE

A

Sinus Tachycardia

219
Q

What does torsades de pointes look like on an ECG

A

Polymorphic ventricular tachycardia

220
Q

What neurological condition can cause torsades de pointes

221
Q

Treatment of HF refractory to ABAL

222
Q

Prophylactic management of Hypertrophic Cardiomyopathy

A

Amiodarone

223
Q

Admitting a patient for PCI vs coronary angiogram for Mis

A

PCI = unstable patient

Angiogra, = stable + Grace score >3%

224
Q

What drugs specifically are used in PCI and thrombolysis

A

Prasugrel + Unfractionated heparin + glycopreotein IIb/IIIa inhibitor

225
Q

What is seen in leads V1-3 for arrythmogenic right ventricular cardiomyopathy

A

T wave inversion s

226
Q

What ventricle hyperthrophs in hypertrophic obstructive cardiomyopathy

227
Q

What murmur is associated with marfan’s syndrome

A

Mitral regurgitation

228
Q

What dose of adrenaline is given for anaphylaxis

229
Q

Features of heart failure on an X-Ray

A

Alveolar oedema (bat’s wings)
Kerly B lines (interstitial Oedema)
Cardiomegaly
Dilaeted prominant upper lobe vessels
Pleural Effusions

ABCDE

230
Q

How long does it take for a cough to resolve in pneumonia

A

3-6 months

231
Q

Management of all cases of pneumonia at 6 weeks of clinical resolution

A

Repeat Chest-X ray to look for emphysema

232
Q

Managemnt of patients with COPD and pneumonia but no exacerbation

A

Give prednsiolone anyways

233
Q

Prevention of Peripheral Arterial Disease

A

Atorvastatin 80mg + Clopidogrel

234
Q

Surgical management of PAD

A

Endovasuclar revascularisation (trnsluminal angiplasty + stent) - if <10cm stenosis

Surgical revascularisation (surgical bypass with autologous vein) - if >10 cm stenosis

235
Q

Initial management of acute limb ischaemia

A

Paracetamol
Codeine
Iv Heparin
Vascular review

236
Q

Initial investigation of acute limb-theratening ischaemia

A

hand held arterial doppler THEN an ABI

237
Q

What is a normal ABPI

238
Q

Management of an ABPI <0.5

A

Urgent referral

239
Q

What indicates PAD on an ABPI

240
Q

Features of acute limb ischaemia

A

Pain
Pulseless
Pallor
Power loss
Paraesthesia
Perishing with cold

241
Q

Management of intermittent claudication

A

First LIne: Supervised excercise

Second Line: Unsupervised excercise

third Line: Referral for angioplasty

242
Q

Management of critical limb ischaemia

A

Urgent referal + paracetamol (pain ladder)

243
Q

Is there pain in a neuroptahic ulcer

244
Q

Acute vs critical limb isdhaemia

A

Critical: caused gradually
Acute: Acute

245
Q

In what patients is adenosine contraindicated in

A

Asthmatics (causes bronchspasm)

246
Q

What antiplatlet therapy sould be given in ACS

A

Aspirin (lifelong) + Ticagrelor (12 months)

247
Q

Second line management of ACS (antiplatelet therapy)

A

Clopidogrel

248
Q

First line prevention of AF post-stroke

A

Warfarin or DOAC/NOAC

should be commenced 2 weeks after a stroke

249
Q

Three ECG signs that may indicate ischaemia or previous MI

A

Pathological Q waves (mainly)
LBBB
T wave abnormalities

250
Q

How long after should response to treatment in angina be followed up

251
Q

What antiplatelet should be given for people with stable angina

A

75mg Aspirin daily

If someone’s had a storke: clopidogrel instead

252
Q

Can GTN sprays be taken alongside phosphodiesterase inhibitors

A

No - there should be at least 12 hours interval between taking the two medications

253
Q

If angina is present at rest, should someone be allowed to travel

A

No - unlrss inflight oxygen is available

254
Q

How often should someone with angina be reviewed

A

6 months to a year

255
Q

What is a Holter monitor

A

7 day ECG monitor if a 24 hour is not avilable

256
Q

Under what Oxygen sats should oxygen therapy be given

A

94% or less

257
Q

How do we manage oxygen therapy in acutely ill patients (non COPD)

A

Start at 15 L/min and then reduce

Unless hypercapnia is present

258
Q

Under what ALS situation is defibrillation contraindicated

A

Asystole or pulseless electrical actviity

259
Q

Management of Ventiruclar fibrillation or ventricular tachycardia

A

CPR with a 30:2 ratio

Give three shocks:

Then adrenaline 1 mg IV and Amiodarone 300mg IV

260
Q

Management of asystole

A

CPR

Then give 1mg Adrenaline IV

Then adrenaline every 3-5 minutes

261
Q

At what ABPI are compression stockings indicated

262
Q

What is the first line management of erectile dysfunction for non-invasive drug free managemen

A

Vaccuum eerectiond evices

263
Q

What is a pathological Q wave

A

> 1 square wide

264
Q

Where are pathological q waves seen

265
Q

What does a pathological q wave indicate

A

Previous MIs

266
Q

In what conditions are inverted t waves seen in

A

Ventricular hypertrophy
PEs
Hypertrophic cardiomyopathy

267
Q

Name three metabolic disturbances that can cause prolongued QT

A

Hypokalaemia
Hypomagnesaemia
Hypocalcaemia

268
Q

What leads show issues with the LAD

A

V1-V4 (inferior leads)

269
Q

What is diagnostic for dextrocardia in an ECG

A

Inverted p wave in lead I

270
Q

IN what CVcondition is raynauds commonly seen in

A

Buerger’s disease

271
Q

What investigation must be done before discharging a patient on AF

A

Arrange an ECHO cardiogram

272
Q

Investigation of choice in an aortic dissection

A

CT Angiography - shows a false lumen

Second line: Transoesophageal echocardiography

273
Q

Should statins be given during pregnancy

274
Q

What is the first line investigation for angina

A

CT angiogrpahy

275
Q

At what K+ level should ACE-inhibitors be stopped

A

> 6 mmol/L

276
Q

What part of the heart hypertrophs in Obstructive Cardiomyopathy

A

Septum of the LV

277
Q

What is seen on a Chest X-Ray for people with aortic dissections

A

Widened Mediastinum

False lumen typically only in CTs

278
Q

In what condition are kerley b lines found

A

Congestive cardiac failure

279
Q

What serum level is checked for re-infarctions in MIs

A

CK-MB

Troponin remains elevated for 10 days vs CK-MB which is 3 days. So more accurate in acute settings

280
Q

Management of AF if the episode has been ongoing for 48 hours

A

Anticoagulate for 3 weeks and DELAY cardioversion.

Check ECHO and the cardiovert

281
Q

After fibrinolysis is done for a STEMI, when should an ECG be repeated

A

Within 60-90 minutes, and then send for urgent PCI if this has not resolved.

282
Q

What is diagnostic for an aortic dissection

A

CT tomography angiography of the chest, abdomen and pelvis

NOT CT coronary angiography

283
Q

When should someone with high BP be referred to hospital

A

> 1280/120 or if phaeochromocytoma is suspected

284
Q

First line investigation of high blood pressure

A

Ambulatory Blood Pressure Monitoring

Second Line: HBPM

285
Q

Sounds heard in an atrial septal defect

A

Ejection-Systolic Murmur louder on inspiration + Fixed S2 split

Year 4 part 2 (10 decks)

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