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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
AF: ECG findings
Absent P waves Irregularly irregular QRS
26
Atrial flutter: ECG findings
Atrial rate ~300/min usually with 2:1 block Sawtooth baseline
27
Atrial flutter: management
Beta blockers
28
Hyperkalaemia: ECG changes
Tented T waves Small P waves Broad QRS (progresses to sinusoidal appearance/VF)
29
Hyperkalaemia: management
Calcium gluconate IV insulin + dextrose (alt: salbutamol nebs) Fluids Elimination (calcium resonium or Lokelma)
30
Hypokalaemia: ECG changes
Small or absent T wave Prolonged PR U waves ST depression Progresses to SVT or AF
31
Hypokalaemia: management
Replace Mg IV replacement to a maximum of 10mmol/hr (20mmol/hr on ICU)
32
Hypocalcaemia: ECG changes
Long QT
33
Hypercalcaemia: ECG changes
Short QT
34
Hypothermia: ECG changes
Bradycardia J wave / Osborne Wave ('hump' at end of QRS) 1st deg heart block Long QT Arrhythmia
34
Hypothermia: ECG changes
Bradycardia J wave / Osborne Wave ('hump' at end of QRS) 1st deg heart block Long QT Arrhythmia
35
Hypothermia: management
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
Digoxin toxicity: ECG changes
Down-sloping ST depression Flattened or inverted T waves Short QT Arrhythmia
37
Digoxin toxicity: precipitating factors
hypokalaemia [common] old age renal failure MI electrolyte disturbance hypoalbuminaemia hypothyroidism hypothermia drugs (amiodarone, verapamil)
38
Digoxin toxicity: management
Digibind Correct arrhythmia and hypokalaemia
39
HFrEF: management
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
HFpEF: management
Address underling cause (e.g. valve repair, PCI) Prognostic management: SGLT2 inhibitor (flozins) Symptomatic management: Loop diuretic (furosemide) Thiazide diuretics (indapamide) MRA (spironalactone)
41
HFrEF: management in refractory cases
If LBBB present, biventricular pacing If no LBBB present, ICD
42
HF: causes
ischaemia HTN valve disease diagnosis of exclusion: dilation Hypertrophic picture = HFpEF/diastolic Dilatory picture = HFrEF/systolic
43
AF: causes
Sepsis Alcohol Thyrotoxicosis HTN Hypokalaemia, low Mg Heart disease: IHD, mitral valve disease, cardiomyopathy, pericarditis Lung disease: pneumonia, PE
44
HTN: management in patient <55yo or T2DM
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
HTN: management in patient >55yo or Afro-Caribbean
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
Pericarditis: management
Acute: NSAIDs Long-term: steroids, colchicine
47
Constrictive pericarditis: features
Similar to cardiac tamponade, except raised JVP features X+Y components. No pulsus paradoxus. Kussmaul's sign present. Pericardial calcification on CXR
48
Cardiac tamponade: features
Beck's Triad: - hypotension - raised JVP (absent Y descent) - muffled heart sounds Pulsus paradoxus
49
Constrictive pericarditis: management
urgent pericardiocentesis
50
Cardiac tampenade: management
urgent pericardiocentesis
51
Stable angina: management
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
aortic stenosis: causes
senile calcification (>65yo) bicuspid valve (<65yo) rheumatic fever HOCUM (subvalvular AS) coarctation (supravalcular AS)
53
mitral regurgitation: causes
post-MI prolapse (secondary to connective tissue disorder) LV dilatation infective endocarditis rheumatic fever
54
aortic regurgitation: causes
rheumatic fever calcific valve disease infective endocarditis connective tissue disorder aortic root disease: bicuspid valve, aortic dissection, syphillis
55
mitral stenosis: causes
rheumatic fever
56
aortic stenosis: examination findings
slow rising pulse narrow pulse pressure soft/absent S2 HF presence of these features is indicative of severe disease
57
aortic regurgitation: examination findings
collapsing pulse widened pulse pressure Quincke's sign (nailbed pulsatation) De Musset's sign (head bobbing)
58
mitral regurgitation: examination findings
pulmonary hypertension (dyspnoea, haemoptysis) soft/absent S1
59
mitral stenosis: examination findings
pulmonary hypertension (dyspnoea, haemoptysis) loud S1 malar flushing AF
60
aortic stenosis: management
young, low-risk = surgical AVR older, high-risk = TAVR (transcatheter) critical stenosis = balloon valvuloplasty
61
aortic regurgitation: management
medical management of AF (anticoagulate using warfarin) if symptomatic, balloon valvotomy or surgery
62
infective endocarditis: Duke's Criteria
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
infective endocarditis: risk factors
abnormal valve (e.g. rheumatic disease, congenital anomaly) prosthetic valve IVDU recent piercing or dentistry GI malignancy
64
infective endocarditis: most likely pathogen
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
infective endocarditis: management in a native valve
amoxicillin +/- gentamicin
66
infective endocarditis: management in a prosthetic valve
vancomycin + rifampicin + gentamicin
67
infective endocarditis: management in a MRSA or sepsis
vancomycin + gentamicin
68
infective endocarditis: management in a confirmed staphylococcal disease
flucloxacillin
69
infective endocarditis: indications for valve surgery
severe valvular incompetence aortic abscess (= PR prolongation) antibiotic resistant infection fungal infection heart failure recurrent embolic phenomena
70
infective endocarditis: non-infectious causes
Lupus ⇒ Libman-Sacks endocarditis Malignancy ⇒ marantic endocarditis (also seen in malnutrition) Carcinoid Also consider culture negative endocarditis (Bartonella)
71
rheumatic fever: presentation
2-5wk Hx GAS UTRI/pharyngitis Fever, malaise, anorexia Arthralgia SOB, chest pain, palpitations
72
rheumatic fever: investigations
ASOT Throat swab (group A streptococcus culture-positive or antigen-positive)
73
rheumatic fever: Duckett Jones Criteria
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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