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Medicine for Finals > Cardiology > Flashcards

Cardiology Flashcards

1
Q

STEMI: guidelines for PCI

A

PCI within 12hrs or within 120mins of when fibrinolysis could have been performed

Prasugrel (antiplatelet) and anticoagulation immediately

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2
Q

STEMI: management

A

BATMAN:
Bisoprolol
Aspirin
Ticagrelor (or clopidogrel)
Morphine
Anticoagulant (fondaparinaux)
Nitrite

PCI gold-standard
Thrombolysis second-line

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3
Q

NSTEMI: management

A

BATMAN:
Bisoprolol
Aspirin
Ticagrelor (or clopidogrel)
Morphine
Anticoagulant (fondaparinaux)
Nitrite

Calcuate GRACE score, if >3% then PCI within 72hrs

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4
Q

ACS: secondary prevention

A

DAPT
ACE inhibitor
Beta blocker
Statin
Lifestyle modification

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5
Q

ACS: transfusion and O2 guidelines

A

Transfuse for Hb <80g/L
O2 for SaO2 <90%

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6
Q

AF: rate control

A

First-line, aim HR ~90

  1. Bisoprolol
  2. Digoxin
  3. Amiodarone

Asthmatic? Amiodarone first-line.

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7
Q

AF: rhythm control

A

Preferred in younger patients who tolerate rate control poorly

  1. DCCV (within 48hrs onset OR wait 3-4wks)
  2. Flecainide
  3. Ablation
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8
Q

AF: anticoagulation

A

Calculate CHADS-VASc score, if >1 in males or >2 in females

  1. DOAC
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9
Q

AF: anticoagulation in stroke patients

A

CT Head to exclude intracranial haemorrhage

TIA = immediate anticoagulation (DOAC or warfarin)

Stroke = 2wks aspirin then commence anticoagulation (DOAC or warfarin)

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10
Q

Bradycardia: management

A
  1. Atropine 500mcg IV (repeat up to 6 times / maximum 3mg)
  2. Transcutaneous pacing
  3. Adrenaline IV
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11
Q

Bradycardia: risk factors for asystole

A

complete heart block
Mobitz type II block
broad QRS
recent asystole
ventricular pauses >3s

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12
Q

Bradycardia: management in individuals at high risk of asystole

A

Transvenous pacing

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13
Q

SVT: management

A
  1. Vagal manoeuvres
  2. Adenosine 6mg IV (repeat with 12mg at 2mins, 18mg at 4mins) into large vein
  3. DCCV
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14
Q

SVT: definitive management in a structurally abnormal heart (AVRT e.g. WPW)

A

Typically poorly responsive to adenosine

Catheter ablation of the accessory pathway is definitive management

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15
Q

VF: ECG findings

A

No discernible ECG morphology
Irregular rhythm and rate

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16
Q

VT: ECG findings

A

Constant, broad QRS complex. Rate >100. QRS >120ms.

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17
Q

Shockable ECG rhythms (VT and VF): management in a haemodynamically unstable patient

A
  1. CPR
  2. DCCV (up to 3 times)
  3. Amiodarone 300mg IV (via peripheral line, over 20-30mins)

Follow-up with amiodarone 900mg over the next 24hrs

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18
Q

Shockable ECG rhythms (VT and VF): management in a haemodynamically stable patient

A
  1. Correct electrolyte abnormalities
  2. Amiodarone 300mg IV (via central line)
  3. Sedation and DCCV

Follow-up with amiodarone 900mg over the next 24hrs

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19
Q

Shockable ECG rhythms (VT and VF): factors decreasing success of DCCV

A

Down-time without CPR
Acidosis
Hypoxaemia
Hypothermia
Toxins and drugs
Electrolyte disturbance

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20
Q

Torsades de pointes: ECG features

A

(a type of VT seen on background of long QT)

Constantly varying axis, alternating ‘points’

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21
Q

Torsades de pointes: management

A
  1. Stop QT-prolonging drugs
  2. Correct hypokalaemia
  3. Give MgSO4
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22
Q

Cardiac arrest (asystole or PEA): reversible causes

A

4Hs and 4Ts

Hypoxia
Hypothermia
Hypo or hyperkalaemia
Hypovolaemia

Tension pneumothorax
cardiac Tampenade
Toxins
Thrombosis (coronary or pulmonary)

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23
Q

Cardiac arrest (asystole or PEA): management

A
  1. CPR
  2. Adrenaline 1mg IV, repeat every 2nd CPR cycle (~4mins)

Identify and correct reversible causes

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24
Q

SVT: ECG findings

A
  • HR > 100
  • QRS <120ms
  • P waves buried within or following QRS complexes
  • Inversion in leads II, III and aVF due to retrograde spread
  • Signs of structural abnormality (e.g. short PR with delta wave in WPW)
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25
Q

AF: ECG findings

A

Absent P waves
Irregularly irregular QRS

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26
Q

Atrial flutter: ECG findings

A

Atrial rate ~300/min usually with 2:1 block
Sawtooth baseline

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27
Q

Atrial flutter: management

A

Beta blockers

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28
Q

Hyperkalaemia: ECG changes

A

Tented T waves
Small P waves
Broad QRS (progresses to sinusoidal appearance/VF)

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29
Q

Hyperkalaemia: management

A

Calcium gluconate
IV insulin + dextrose
(alt: salbutamol nebs)
Fluids
Elimination (calcium resonium or Lokelma)

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30
Q

Hypokalaemia: ECG changes

A

Small or absent T wave
Prolonged PR
U waves
ST depression

Progresses to SVT or AF

31
Q

Hypokalaemia: management

A

Replace Mg
IV replacement to a maximum of 10mmol/hr (20mmol/hr on ICU)

32
Q

Hypocalcaemia: ECG changes

A

Long QT

33
Q

Hypercalcaemia: ECG changes

A

Short QT

34
Q

Hypothermia: ECG changes

A

Bradycardia
J wave / Osborne Wave (‘hump’ at end of QRS)
1st deg heart block
Long QT
Arrhythmia

34
Q

Hypothermia: ECG changes

A

Bradycardia
J wave / Osborne Wave (‘hump’ at end of QRS)
1st deg heart block
Long QT
Arrhythmia

35
Q

Hypothermia: management

A

Remove wet/cold clothings
Passive warming (blanked, bear huggers)
Consider warmed IV fluids

Rapid rewarming can cause peripheral vasodilation and shock in which case give CPR and avoid IV drugs

36
Q

Digoxin toxicity: ECG changes

A

Down-sloping ST depression
Flattened or inverted T waves
Short QT
Arrhythmia

37
Q

Digoxin toxicity: precipitating factors

A

hypokalaemia [common]

old age
renal failure
MI
electrolyte disturbance
hypoalbuminaemia
hypothyroidism
hypothermia
drugs (amiodarone, verapamil)

38
Q

Digoxin toxicity: management

A

Digibind
Correct arrhythmia and hypokalaemia

39
Q

HFrEF: management

A

Address underling cause (e.g. valve repair, PCI)

Prognostic management:

ACE inhibitor or A2RB
Beta blockers
SGLT2 inhibitor (flozins)
MRA (spironalactone) second-line if ongoing symptoms

40
Q

HFpEF: management

A

Address underling cause (e.g. valve repair, PCI)

Prognostic management: SGLT2 inhibitor (flozins)

Symptomatic management:

Loop diuretic (furosemide)
Thiazide diuretics (indapamide)
MRA (spironalactone)

41
Q

HFrEF: management in refractory cases

A

If LBBB present, biventricular pacing

If no LBBB present, ICD

42
Q

HF: causes

A

ischaemia
HTN
valve disease

diagnosis of exclusion: dilation

Hypertrophic picture = HFpEF/diastolic
Dilatory picture = HFrEF/systolic

43
Q

AF: causes

A

Sepsis
Alcohol
Thyrotoxicosis
HTN
Hypokalaemia, low Mg
Heart disease: IHD, mitral valve disease, cardiomyopathy, pericarditis
Lung disease: pneumonia, PE

44
Q

HTN: management in patient <55yo or T2DM

A
  1. ACE inhibitor or A2RB
  2. Add CCB or thiazide
  3. Add CCD and thiazide
  4. If spironolactone (K<4.5) or A/B blocker (K>4.5)
  5. Specialist review
45
Q

HTN: management in patient >55yo or Afro-Caribbean

A
  1. CCB
  2. Add ACEi/ARB or thiazide-like
  3. Add ACEi/ARB and thiazide-like
  4. If spironolactone (K<4.5) or A/B blocker (K>4.5)
  5. Specialist review
46
Q

Pericarditis: management

A

Acute: NSAIDs
Long-term: steroids, colchicine

47
Q

Constrictive pericarditis: features

A

Similar to cardiac tamponade, except raised JVP features X+Y components. No pulsus paradoxus. Kussmaul’s sign present. Pericardial calcification on CXR

48
Q

Cardiac tamponade: features

A

Beck’s Triad:
- hypotension
- raised JVP (absent Y descent)
- muffled heart sounds

Pulsus paradoxus

49
Q

Constrictive pericarditis: management

A

urgent pericardiocentesis

50
Q

Cardiac tampenade: management

A

urgent pericardiocentesis

51
Q

Stable angina: management

A

Symptomatic control: GTN spray

Prophylactic management:
- Beta blockers
- CCB
- New anti-anginals (ranolazine or ivabradine)
- Isosorbate nitrate (rarely used)

PCI is definitive treatment

Aspirin and statin

52
Q

aortic stenosis: causes

A

senile calcification (>65yo)
bicuspid valve (<65yo)
rheumatic fever
HOCUM (subvalvular AS)
coarctation (supravalcular AS)

53
Q

mitral regurgitation: causes

A

post-MI
prolapse (secondary to connective tissue disorder)
LV dilatation
infective endocarditis
rheumatic fever

54
Q

aortic regurgitation: causes

A

rheumatic fever
calcific valve disease
infective endocarditis
connective tissue disorder
aortic root disease: bicuspid valve, aortic dissection, syphillis

55
Q

mitral stenosis: causes

A

rheumatic fever

56
Q

aortic stenosis: examination findings

A

slow rising pulse
narrow pulse pressure
soft/absent S2
HF

presence of these features is indicative of severe disease

57
Q

aortic regurgitation: examination findings

A

collapsing pulse
widened pulse pressure
Quincke’s sign (nailbed pulsatation)
De Musset’s sign (head bobbing)

58
Q

mitral regurgitation: examination findings

A

pulmonary hypertension (dyspnoea, haemoptysis)
soft/absent S1

59
Q

mitral stenosis: examination findings

A

pulmonary hypertension (dyspnoea, haemoptysis)
loud S1
malar flushing
AF

60
Q

aortic stenosis: management

A

young, low-risk = surgical AVR
older, high-risk = TAVR (transcatheter)
critical stenosis = balloon valvuloplasty

61
Q

aortic regurgitation: management

A

medical management of AF (anticoagulate using warfarin)

if symptomatic, balloon valvotomy or surgery

62
Q

infective endocarditis: Duke’s Criteria

A

Pathological criteria: diagnosed at autopsy or surgery

Major criteria (x2): 2x blood cultures showing IE-causing organisms; evidence of endocardial involvement (echo)

Minor criteria (x5 or x3 + 1 major): predisposing heart condition or drug use, microbiological criteria not meeting major criteria, fever >38, vascular phenomenon, immunological phenomenon

63
Q

infective endocarditis: risk factors

A

abnormal valve (e.g. rheumatic disease, congenital anomaly)
prosthetic valve
IVDU
recent piercing or dentistry
GI malignancy

64
Q

infective endocarditis: most likely pathogen

A

40% Strep Viridans
35% Staph Aureus (IVDU, tricuspid valve)
Staph Epidermidis (post-prosthetic valve surgery [<2mo])
Strep Bovis (colorectal cancer)
HACEK, Bartonella, Brucella (culture-negative endocarditis)

65
Q

infective endocarditis: management in a native valve

A

amoxicillin +/- gentamicin

66
Q

infective endocarditis: management in a prosthetic valve

A

vancomycin + rifampicin + gentamicin

67
Q

infective endocarditis: management in a MRSA or sepsis

A

vancomycin + gentamicin

68
Q

infective endocarditis: management in a confirmed staphylococcal disease

A

flucloxacillin

69
Q

infective endocarditis: indications for valve surgery

A

severe valvular incompetence
aortic abscess (= PR prolongation)
antibiotic resistant infection
fungal infection
heart failure
recurrent embolic phenomena

70
Q

infective endocarditis: non-infectious causes

A

Lupus ⇒ Libman-Sacks endocarditis
Malignancy ⇒ marantic endocarditis (also seen in malnutrition)
Carcinoid

Also consider culture negative endocarditis (Bartonella)

71
Q

rheumatic fever: presentation

A

2-5wk Hx GAS UTRI/pharyngitis
Fever, malaise, anorexia
Arthralgia
SOB, chest pain, palpitations

72
Q

rheumatic fever: investigations

A

ASOT
Throat swab (group A streptococcus culture-positive or antigen-positive)

73
Q

rheumatic fever: Duckett Jones Criteria

A

Major (2 required): arthritis, carditis, Sydenham’s chorea, nodules, erythema marginatum)

Minor (2 required + 1 major): fever, history of rheumatic fever, arthralgia, recent GAS infection, raised inflammatory markers, ECG changes (long PR and QT)

Medicine for Finals (10 decks)

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