cardiology Flashcards
ECG features of trifascicular block?
1st degree heart block
AND
RBBB
AND
LAFB or LPFB
LAFB: qR complex leads 1 and AVL, RS complex II, III, aVF, LAD
LPFB: rS complex leads 1 and AVL, qR complex leads II, III, aVF, RAD. NO RVH.
Indications for ICD in ischemic HFrEF as primary prevention
- LVEF ≤35% + NYHA II or III
- LVEF ≤30% + NYHA I*
- LVEF ≤40% + non-sustained VT assoc. with previous MI + inducible sustained VT/VF on EP*
Can be beneficial if syncopal episodes occurring suspected to be due to ventricular arrythmia
*Must be post acute phase of MI i.e. 40 days post MI AND >3/12 post revascularization + medical therapy
Indications for ICD in ischemic HFrEF as secondart prevention
Sustained VT/VF after reversible causes excl;uded (i.e. AMI, electrolyte disturbances, medication effects)
Lipid profile seen with diabetes and CKD
High triglycerides and LDL, low HDL
Lipid profile seen with alcohol excess
Isolated hypertriglyceridemia
Lipid profile seen with hypothyroidism
predominantly high LDL, sometimes high triglycerides
Rates of stroke post coronary angiography? Associated 30 day mortality?
1 in 100
30 day mortality = 20%
Normal ECG variants in young athletes?
RBBB
Wenchebach phenomena (2nd degree heart block, mobitz 1 i.e. progressive PR prolongation)
Dominant R wave in V1
LVH
Bradycardia
Junctional rhythm
1st degree heart block
Which antihypertensive should be avoided in aortic dissection?
Hydralazine
Mechanism of action/class of amiodarone
Which other drug is in this class?
Class 3 antiarrythmic - potassium channel blocker, acts on phase 3 of AP
Prolongs refractory period of atrial, nodal and ventricular myocardium by prolonging the the action potential
Decreases sinus node automaticity
Decreases rate of impulse conduction through the AV node
Other class 3 antiarrythmic - sotalol
Mehchanism of action/class of verapamil?
Class 4 antiarrhythmic acting on phase 2 of AP
Central (non-dihydropyridine) calcium channel blocker -
Prevents calcium from entering voltage sensitive areas of myocardium/vascular SM cells (via slow channels) during depolarization
Slows automatacity and conduction of AV node
Indications for surgery in type B aortic dissection
Recurrent chest pain
Persistent severe HTN
Aneurysm expansion
Dissection propogation
Expanding hematoma
Rupture
Occlusion of a major aorta branch leading to end organ ischemia
What is the murmur in acute aortic dissection? Which type of aortic dissection is it seen in?
Type A dissection
Decrescendo diastolic murmur, best heard over the right sternal edge and exentuated on expiration (left sided murmur)
What is the most common cause of aortic regurgitation?
Rheumatic heart disease (developing world)
Calcified aortic valve, bicuspid aortic valve, aortic root dilation (developed world)
Indications for pace maker
Symptomatic Sinus node dysfunction (SND)
Advanced 2nd degree block (Mobitz Type II) or intermittent 3rd degree block
Symptomatic Hypersensitive carotid sinus syndrome and neurocardiogenic syncope
Persistent inappropriate or symptomatic bradycardia not expected to resolve after cardiac transplantation
Sustained pause dependent VT with or without QT prolongation.
What are the effects of carvedilol?
Beta-1, Beta-2 and alpha-1 antagonist
Non selective HOWEVER has evidence in HFREF
What are the effects of metoprolol?
Selective beta 1 antagonist
What medications should be avoided in torsades?
Class IA agents + 1c (moderate + strong Na channel blockers)
- A: quinidine, procainamide, disopyramide),
- C: (eg,flecainide),
Class III agents potassium channel blockers ( eg, sotalol, amiodarone).