Cardiology Flashcards
Prolonged QRS in the setting of monomorphic VT episode is an indicated for what type of pacing?
ICD with BIVENTRICULAR pacing
What is the normal vital sign response to exercise?
Increase in HR and BP
A patient gets angina during a stress test what is the next step
Stop test and order angiogram
NICE guidelines for daytime BP goals?
< 80 yrs : < 135/85
> 80 yrs : < 145/85
RCA myocardial infarction will produce an ECG with ST change in which leads
Inferior leads (II, III and aVF)
5 diseases associated with aortic dissection
SLE
Syphilis
Marfan’s
Ehlers Danlos
Turners
How to differentiate between a post MI VSD vs papillary muscle rupture
Measure the RA and PA O2 sats
Note: VSD and papillary rupture are difficult to distinguish clinically. The diagnosis is established by demonstration of a left to right shunt.
The presence of a VSD would be confirmed by detecting a step-up in the oxygen saturation between the RA and PA; if there is no step-up, the diagnosis is probably papillary muscle rupture.
In a patient who needs both a CABG and a CEA which should be done first?
CABG
Note: outcome of endarterectomy is significantly better in those patients who have significant coronary artery disease attended to beforehand
Digoxin is often used as an anti arrhythmic in WPW T/F
F
Beta blockers, digoxin, and calcium channel antagonists should be avoided as they may accelerate tachycardia and increase the risk of VT by driving conduction preferentially down the accessory pathway
Anti arhythmic of choice in WPW
Flecanide if structurally normal heart
Amiodarone if structurally abnormal
Patients with heart failure who are asymptomatic with a LBBB and QRS of more 150 ms should be considered for a CRT.T/F
T
In new onset a fib without haemodyanamic compromise and echo showing structurally normal heart what is the initial treatment of choice?
bolus of flecanide
NB: where there is no structural cardiac valve abnormality, which has been confirmed by echocardiography.
Patients with a predicted 10 year cardiovascular risk of more than __% should be considered for statin therapy
More than 10%
Which anti arrhythmic causes a shorted QT interval
Digoxin
The addition of digoxin in patients with symptomatic heart failure has been shown to result in an improvement in symptoms, whether they are in AF or not. T/F
T
Spironolactone at doses greater than ___ has no proven impact on mortality in patients with heart failure.
25 mg od
Clinical and ECG features of Pacemaker Syndrome? Tx?
AKA AV dyssynchronisation
Syncope, dizziness, hypotension and peripheral oedema (2ndary to HF).
ECG: Small P waves with dissociation from QRS complex
Tx: replace device with dual chamber device
In the setting of HF what increase in Cr/decease in EGFR is acceptable after staring an ACEi?
30% increase in the serum creatinine OR
25% reduction in the eGFR
is tolerable and should not lead to changes in dosing.
Note: ACE inhibitors should be stopped or dose adjusted if is there is a rise in the serum potassium level to greater than 6 mmol/l.
Wide pulse pressure (eg BP 160/45) is suggestive of what cardiac disease?
Aortic regurg
Note: early diastolic murmur
Tx of aortic dissection
Adequate analgesia and urgently reduce the blood pressure with intravenous antihypertensives: beta blockers first line, and then nitroprusside.
Then cardiothoracic surgeon referral
Aspirin + clopidogrel is the best DAPT post STEMI T/F
F
Note: aspirin 75 mg OD and ticagrelor 90 mg BD. In a subset of the Plato trial, ticagrelor was associated with a 13% relative reduction in cardiovascular events versus a conventional clopidogrel based regimen. This has driven use of ticagrelor in place of clopidogrel in major guidelines on anti-platelet therapy post STEMI.
For how long should a pt continue on DAPT after placement of a drug eluting stent post MI?
12 months
Which is likely to cause gynaecomastia: aspirin, lisinopril or furosemide?
Linsinopril
Note: Many drugs can cause gynaecomastia including inhibitors of testosterone synthesis( ketoconazole
metronidazole
cimetidine
etomidate, and
cisplatin.)
Oestrogens (digitalis, OCP)
Mechanism unknown:
isoniazid
diazepam
omeprazole
ca-channel blockers
ACE i
amiodarone
TCA
Efavirenz
busulphan
marijuana
heroin
spironolactone
Initial mgmt of cardiac device related infective endocarditis
Urgent extraction of the implanted device followed by prolonged antibiotic therapy
Note: Percutaneous extraction is recommended in most patients with cardiac devices even those with large (>10 mm) vegetations
After device extraction, reassessment of the need for reimplantation is recommended
Routine antibiotic prophylaxis is recommended before device implantation.
In treatment of SVT, what is a relative CI to adenosine? What should then be used second line?
Asthma
2nd line: verapamil
right sided failure, ascites and pericardial calcification on x ray suggest a diagnosis of _____
Constrictive pericarditis
Note: also may hear a pericardial ‘knock’ (might be described as an added diastolic sound)
In a patient with aortic stenosis, what will lead to an overestimation of the severity of the problem when assessed by echocardiography?
Large volumes of blood passing over the valve at high velocities, which occurs in aortic regurgitation.
In patients who cannot have a TTE (eg poor study due to obesity) what are other options to evaluate for heart failure?
Radionuclide angiography
Cardiac magnetic resonance imaging
TOE
Indications for valve replacement in AS
Gradient of 50 mmHg or more, or associated symptoms such as syncope, breathlessness and episodes of pulmonary oedema.
Pt underwent angioplasty and bare metal stent implantation for single vessel coronary artery disease five months before presenting with a 3 month hx of angina. Most likely cause?
In-stent re-stenosis due to neointimal proliferation
Note:Another ddx is Subacute stent thrombosis. But it would occur occurs acutely rather than over months, and typically presents with an acute MI.
An intra-aortic balloon pump is inserted under echocardiographic guidance.
At which point of the ECG should balloon inflation be timed?
Middle of the T wave
Note: aortic regurgitation is an CI
DC cardioversion is contraindicated in patients with pacemakers T/F
F
Note: It is not CI, although it is prudent to have the pacemaker function and settings rechecked after cardioversion
Medical mgmt of a symptomatic bradycardia in pt with heart transplant?
Slow infusion theophylline
Note: transplanted heart is denervated so not role for atropine
Where should internal jugular CVC lie?
In the lower superior vena cava
Note: If the catheter tip is above the carina on a post-procedure radiograph then it is generally accepted that the catheter lies outside the right atrium in the lower superior vena cava
Persistent ST segment elevation occurring 6 weeks after a known transmural myocardial infarction (usually an anterior MI)
LV aneurysm formation
Note: can mimic MI
