Cardiology Flashcards
what type of murmur is aortic regurgitation
early diastolic
what type of murmur is aortic stenosis
ejection systolic
what type of murmur is mitral regurgitation
pan systolic
what type of murmur is mitral stenosis
mid diastolic
most common cause of mitral stenosis
rheumatic fever
acute management of Atrial Fibrillation
immediate DC cardioversion
management of paroxysmal Atrial Fibrillation
dont require long term anti-arrythmic therapy
flecainide (pill in pocket)
electrical cardioversion
done in A fib.
patient needs to be anti coagulated (DOaC e.g. edoxaban)
or transesophageal echo to check for thrombus
pharmacological cardioversion
flecainide or amiodarone
still needs anticoagulation
treatments for persistent/permanent a fib
verapamil
carvedilol
digoxin
aortic dissection presentation and classification
tearing chest pain
Stanford type A = ascending aorta
type B = descending aortia
investigation + management of aortic dissection
CT aortogram/angiogram = diagnosis
ECG / echo to investigate
Type A = surgical (valve graft)
Type B = medical (labetalol to control arterial BP)
indications of amiodarone
arrhythmias, only used as last resort
what is brugada syndrome, affected population, Mx
inherited arrhythmia
causes sudden death in east asian males with structurally normal hearts
Implantable Cardioverter - Defibrillator
ECG for brugada syndrome
cove shaped ST segment with negative T wave
how to diagnose brugada syndrome
ECG (cove shaped ST segment with negative T wave)
+ family history / V fib / syncope
pathophysiology of Wolff-Parkinson White syndrome
accessory pathway opens between SA node and AV node, ventricles contract too early (accessory pathway doesn’t account for the normal delay)
supraventricular tachycardia
ECG findings for WPW
delta wave (slurred upstroke of the QRS)
Mx for stable and unstable patients with WPW
stable: vagal manoeuvres/meds (amiodarone)
unstable: immediate DC cardio version
definitive treatment for WPW
radiofrequency ablation of the accessory pathway
Wellen syndrome ECG
biphasic/negative T wave in leads V2 + V3
cause of wellen syndrome
stenosis of LAD, major risk for MI
meds for heart failure
ABAL
ACEi , beta blocker, aldosterone antagonist, loop diuretic
meds for heart failure
ABAL
ACEi , beta blocker, aldosterone antagonist, loop diuretic
irregular R R interval
a fib
what is cardiac resynchronisation therapy (CRT) used for
connects to the ventricles, allows them to contract properly. used in severe heart failure
what is cardioversion used for
reset to sinus rhythm
what is a permanent pacemaker used for
takes over entire electrical conduction
broad complex is defined as?
> 120ms
presentation of aortic stenosis
pulmonary edema
low volume pulse
low pulse pressure
slow rising carotid pulse
ejection systolic murmur and 4th heart sound
forceful apex beat
unheard A2 (aortic closure sound)
indications for embolectomy vs thrombolysis
embolectomy: remove an embolus (a blood clot originating from elsewhere and moving to this location)
thrombolysis: break down a clot that has formed there
non specific symptoms e.g. cough, fatigue, weight loss, hoarseness, night sweats
dockyard worker
malignant pleural mesotheliomaM
Mx of a Malignant pleural mesothelioma
combination therapy (chemo + radio)
management of peripheral arterial disease
- 12 week exercise program
- Stenting and angioplasty
- Bypass surgery
- Naftidrofuryl oxalate
Mx of acute arterial embolus
fogarty embolectomy
initial Mx of hyponatremia
fluid restriction
diagnosis of renal artery stenosis
MRI with gadolinium contrast of renal arteries
how does cardiac contraction occur
increase CAMP activates protein kinase A which stimulates calcium release
this acts on Calcium sensitive calcium channels to release even more calcium
binds to Troponin C
exposes the actin binding site
actin binds to myosin
CONTRACTION
cardiac output equation
heart rate x stroke volume
what is preload
degree of stretch applied to the cardiac muscle during filling (end of diastole and before systole)
what is afterload
force against which the heart has to overcome to contract
what are the two waveforms on JVP and what do they indicate?
A wave - R atrial contraction
V wave = R atrial venous filling
what heart failure drugs improve morbidity and mortality
ACE inhibitors and beta blockers
what heart failure drugs improve mortality only
mineralocorticoid receptor antagonists (spironolactone)
ivabradine
hydralazine + nitrate
causes of constrictive pericarditis
TB
mediastinal irradiation
cardiac surgery
signs of constrictive pericarditis
pericardial knock in early diastole (ventricle cannot fill effectively)
kussmauls sign (paradoxical rise in JVP upon inspiration)
what criteria is used to diagnose rheumatic fever
Jones major and minor
evidence of strep A infection in past week AND 2 major OR 1 major 2 minor
major jones criteria
JONES
polyarthritis
carditis
subcut nodules
erythema migratum
sydenham chorea
minor jones criteria
CRPPPF
raised CRP
Previous rheumatic fever
polyarthralgia
fever >38
Mx of acute rheumatic fever
bed rest
1mg benzyl penicillin or 10 days PO phenoxymethylpencillin
high dose aspirin
ACEIs and corticosteroids for caridtis
complications of acute rheumatic fever
mitral stenosis
infective endocarditis
where is best to hear mitral stenosis
apex beat
hypokalaemia ECG changes
small T waves
ST depression
U waves
hyperkalemia ECG changes
tall tented T waves
broad QRS
absent P waves
hyperkalemia management
30ml of 10% calcium gluconate
mitral valve prolapse findings (x2)
mid systolic click
late systolic murmur
mitral stenosis findings (x1)
mid diastolic murmur over apex
what coronary artery commonly causes inferior MI
right coronary artery
what coronary artery commonly causes anteroseptal MI (what leads)
left anterior descending
V1-4
what vein is the best to measure JVP and why
right internal jugular vein
it has a straight continuation with the brachiocephalic and SVC
AVNRT + management
AV nodal reentrant tachycardia
Impulse re-enters the AV node
Mx:
1) vagal maneuvres
2) 6mg adenosine
3) 12 mg adenosine
4) 12mg adenosine
clinic and ABPM target for >80
clinic 150/90
ABPM 145/85
clinic and ABPM target for <80
clinic 140/90
ABPM 135/85
indications for Ambulatory blood pressure monitoring
everyone in clinic with BP >140/90
nitrates are contraindicated in
aortic stenosis
when is digoxin used in AF Mx
when they do little exercise / bed bound
what meds are used for rate control
beta blocker
verapamil
diltiazem
digoxin
when is rate control indicated
fast ventricular rate
when is rhythm control indicated
reversible cause of AF
heart failure
acute AF
> 48 since AF onset
what to do, what is preferred
anticoagulation for 3 weeks
electrical cardioversion preferred
<48 hrs since AF onset
what to do, what is preferred
pharmacological cardioversion is preferred
amiodarone, flecainide
when is flecainide contraindicated and what is used instead
structural heart disease
amiodarone used instead
aortic dissection urgent management
limited fluid resus(permissive hypotension)
CT scan
refer to cardiothoracic surgeon
indications for CABG
more than 50% narrowing plus:
left ventricular dysfunction
triple vessel disease
angina persisting despite all steps of medical management
left main stem narrowing
diabetics
what are all the steps of medical management for angina
lifestyle changes
sublingual GTN to use for attacks
1. beta blocker
2. Add a dihydropyridine CCB e.g. amlodipine
3. long acting nitrate (isosorbide nitrate) / ivabradine
**aspirin and statin for prevention
symptoms of DVT and right side weakness
what is it
Ix
venous thrombosis becoming an arterial embolus due to patient foramen ovale or ASD
Ix: transoesophageal echo
6 absolute contraindications to thrombolysis
active internal bleeding or uncontrollable external bleeding
suspected aortic dissection
recent head trauma (< 2 weeks)
intracranial neoplasms
history of proven haemorrhagic stroke or cerebral infarction < 2 months earlier
uncontrolled high blood pressure (> 200/120 mmHg).
6 relative contraindications to thrombolysis
pregnancy
peptic ulcer
INR >1.8
prolonged CPR
bleeding disorders
recent surgery
8 reversible causes of cardiac arrest
4Hs: hyper/hypokalaemia, hypothermia, hypoxia, hypovolemia
4Ts: thrombosis, tamponade, tension pneumo, toxins
why is adrenaline used in cardiac arrest
it causes systemic vasoconstriction (alpha effect)
increased cerebral and coronary perfusion pressure
5 waveforms on the central venous pressure graph and what they show
a: atrial contraction
c: tricuspid closes
x: ventricular contraction
v: atrial filling
y: tricuspid opening
regularly spaced QRS complexes
no P waves
tachycardic
atrioventricular nodal re-entrant tachycardia
how to check for PFO or ASD in adults
bubble echocardiography
some causes of acquired hyperlipidaemia
hypothyroidism
hypopituitarism
pregnancy
sedentary lifestyle
familial hyperchylomicronaemia
Ix and bloods
Apo C II deficiency
very high VLDL and chylomicrons
familial hypercholesterolaemia
Ix
inheritance
bloods
who to suspect in
reduced LDL receptors
Apo B 100 deficiency
autosomal dominant
high LDL
young IHD, strong family history
familial combined hyperlipidaemia
blood results x 2
assoc
no known gene
high VLDL
high Apolipoprotein B
assoc w metabolic syndrome
familial dysbetalipoproteinaemia
defect
bloods
defect in Apo E
high VLDL and chylomicrons
familial hypertriglyceridaemia
assoc
bloods
assoc with pancreatitis
high VLDL chylomicrons
moa statin
HMG Co-A reductase inhibitor
side effects statin
myositis
myalgia
hepatitis
score for clotting in a fib
Stroke prevention: calc CHADSVASC.
Cong HF; HTN; Age>75 (2px) ; Diabetics mell ; Stroke prev (2px) ; Vascular disease ; Age 65-74 (1px) ; Sex (female)
widespread ST elevation..
pericarditis
stable vs unstable angina
unstable is part of ACS. chest pain at rest or minimal exertion, getting worse and worse (less distance walked precipitates chest pain)
Stable: chest pain is predictable, after exertion
Both: No trop rise or ST elevation
what is curative in atrial flutter
cardio version is more useful that medication
radiofrequency ablation of the tricuspid isthmus is curative for most patients
which cardiac enzyme is the first to rise after MI
myoglobin
which cardiac enzyme can be used to see if there is a re-infarction
CK-MB
what is electrical alternans and what does it suggest
alternate beat variation in the QRS complex
assoc with cardiac tamponade/pericardial effusion
pulsus paradoxus and what does it suggest
massive drop in BP during inspiration
cardiac tamponade, COPD
echo findings in HOCM
Mitral regurg,
systolic anterior motion (SAM) of the anterior mitral valve
asymmetric septal hypertrophy
pathophis of HOCM
autosomal dominant
defect in gene encoding beta-myosin heavy chain
4 causes of dilated cardiomyopathy
wet beri beri (thiamine B1 deficiency)
alcohol
coxsackie B virus
doxorubicin
2 causes of restrictive cardiomyopathy
radiation
amyloidosis
infective endocarditis classification system
Duke
loud s1 opening snap is what ….
mitral stenosis
cardiac arrest: VF and pulseless VT management in a coronary care uni with cardiac monitoring
shock
shock
shock
amiodarone + adrenaline
what are the shockable and non shockable rhythms
shockable: V fib and pulseless v tach
non-shockable: asystole and pulseless electrical activity
torsades des pointes can turn into what
what symptom shows this
ventricular fibrillation
syncope
ideal dose of adrenaline in shockable rhythm
1mg
rSR’ pattern in V1-3 (‘M’ shaped QRS complex)
right bundle branch block
right bundle branch block and left axis deviation
bifascicular block
inheritance pattern of HOCM
autosomal dominant
infective endocarditis, indication for emergency valve replacement surgery
heart failure
what medication makes clopidogrel less effective
omeprazole
corrigans pulse
collapsing pulse - Aortic regurg
quinckes sign
nailbed pulsation - aortic regurt
narrow pulse pressure
aortic stenosis
aortic stenosis cause in <65 years old and >65 yearss
> 65 = calcification
<65 = bicuspid aortic valve
Mx of bradycardia 3 steps
- atropine
- transcutaneous pacing
- transvenous pacing
what is seen on CXR in aortic dissection
widened mediastinum
5 steps to manage HOCM
- beta blockers
- amiodaron
- ICD
- dual chamber pacemaker
- endocarditis prophylaxis
staph aureus
IE in IVDU
staph epidermis
IE in prosthetic valve
strep viridans
IE in developing countries or after dental procedure
tall R waves V1-2
posterior MI
finding of aortic dissection on CT angiogram
false lumen
best method of access for PCI
radial artery
pulmonary stenosis murmur + inspiration/expiration
ejection systolic murmur
louder on inspiration
v fib and v tach Mx in an unmonitored area
1 shock
what murmur is common in rheumatic fever
mistral regurg
aortic regurg
