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UCPEX > Cardiology > Flashcards

Cardiology Flashcards

1
Q

3 Is, 4 Ps, DTU

Causes of pericarditis

A

Infectious - usually viral (80% are viral or idiopathic)(coxsackie, COVID), can be bacterial, fungal, TB (poorer prognosis)
Immunological - SLE, rheumatic fever, vasculitis
Idiopathic
Post MI (Dressler’s syndrome)
Post cardiac surgery
Post RTx
Paraneoplastic
Trauma
Drug induced (isoniazid, cyclosporin)
Uraemia

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2
Q

ECG changes in pericarditis

A

Widespread concave STE (esp inferior and precordial) with reciprocal STD in aVR and V1
Widespread PR depression with reciprocal PR elevation in aVR and V1
Sinus tachycardia
Spodick’s sign

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3
Q

Differences between ECG for BER and pericarditis

A

Pericarditis:
-STE widespread in limb and precordial leads (BER pre cordial only)
-no “fish-hook” J point pattern (best seen in V4 in BER)
-ST/T wave ratio >0.25 (BER <0.25)
-presence of PR depression
-normal T wave amplitude
-dynamic ECG changes that evolve over time

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4
Q

Differences between ECG for STEMI and pericarditis

A

STEMI has reciprocal changes (pericarditis reciprocal only in aVR and V1)
Only STEMI causes convex or horizontal STE
STEMI causes STE > in III than II
PR depression in multiple leads is more likely pericarditis

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5
Q

Diagnosis of pericarditis

A

At least two of:
Chest pain (retrosternal, sharp, pleuritic, can radiate to L shoulder, better with leaning forward)
Pleural rub
Pericardial effusion
ECG changes of widespread STE and PR depression (<60% of patients)

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6
Q

NZ Criteria for Rheumatic Fever

A

2 major OR 1 major and 2 minor OR several minor
AND
Evidence of recent GAS infection (2-3 weeks)

Major:
Carditis (echo/new murmur)
Chorea (can be standalone diagnostic)
Polyarthritis (or aseptic mono arthritis)
Erythema marginatum
Subcutaneous nodules

Minor:
Fever
Raised ESR/CRP
Polyarthralgia
Prolonged PR interval on ECG

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7
Q

What is the OR of acute rheumatic fever in Maori and Pasifika cf other ethnicities?

A

> 20x more likely in Maori
40x more likely in Pasifika

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8
Q

Describe some key features of HFpEF

A

-EF >50%, LV normal volume
-usually females, older adults
-LV wall is thickened/stiff
-poorer prognosis/less amenable to drugs

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9
Q

List some causes of high output cardiac failure

A

Thyrotoxicosis
Obesity
Pregnancy
Anaemia
Shunting
Vit B1 deficiency

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10
Q

Describe the NYHA levels of HF

A

Class I - no limitation
Class II - ordinary activity causes SOB
Class III - less than ordinary activity causes SOB
Class IV - SOBAR

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11
Q

Hx and exam in HF

A

Hx:
Cough
SOB
Wheeze
Collapse
Palpitations
Decreased exercise tolerance
Orthopnoea/PND
Chest pain
Lethargy

Exam:
Elevated JVP
Tachycardia
Tachypnoea
Sweaty/clammy
Hypoxia
Hepatomegaly
Gallop rhythm/abnormal rhythm
Crackles
Oedema
Cyanosis

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12
Q

Treatment for acute HF

A

Oxygen
SL nitrates
Diuretics
Morphine
B blocker
ACE inhibiter/ARB
Aspirin

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13
Q

Risk factors for HF

A

IHD
Arrythmia
Smoking
HTN
High cholesterol
Increased age
Male
FHx heart disease

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14
Q

Treatment for chronic HF

A

If overloaded start with frusemide, add thiazide if required
Start ACE-i/ARB
Start B-blocker once fluid overload settled
If insufficient add spironolactone
If insufficient add entresto
If insufficient refer cardiology
Add SGLT2 inhibitor if diabetic
Digoxin if AF + consider anticoagulation

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15
Q

High risk features of syncope

A

Age >65
ANY ECG changes (esp ST/T changes, any conduction abnormalities, any QT prolongation or shortening, delta waves, brugada syndrome, LVH, RVH, bradycardia, abnormal Q waves, arrhythmia)
Palpitations
Dyspnoea
HCT <30
Abdo pain/back pain
Headache
Chest pain
SOB
Occurred while supine or exercising
No prodrome
Heart failure/IHD/structural heart disease/new murmur
Hypotension
Evidence of haemorrhage (malena)
Male
FHx sudden cardiac death <50yo

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16
Q

Low risk features of syncope

A

Provoking factors eg emotional stress/pain medical procedure
Postural
Prodrome
Age <40
Triggered by micturation/cough/defecation
Triggered by nausea/vomiting
Only while standing

17
Q

ECG changes in STEMI

A

STE 1mm or greater in 2 or more limb leads
STE 2mm or greater in 2 or more precordial leads
STE 0.5mm or greater in posterior leads (if sig STD in V1-3) - always check for this in inferior or lateral STEMIs
New LBBB
Sgarbossa criteria

18
Q

Fibrinolysis in STEMI

A

Tenecteplase:
<60kg = 30mg
60-69kg = 35mg
70-79kg = 40mg
80-89kg = 45mg
90kg+ = 50mg
Clexane 30mg IV (unless >75yo)
Clexane IM 1mg/kg (max 100mg) (unless >75yo then 0.75mg/kg, max 75mg)
Clopidogrel 300mg

19
Q

Contraindications to fibrinolysis in STEMI

A

Dementia
Uncontrolled HTN
Non-compressible bleeding
Head trauma/brain surgery <6/12
Cerebral AVM/neoplasm/aneurysm
Possible aortic dissection
Ischaemic stroke <1 year
Non-compressible vascular punctures <24 hours
GI bleeding <1 year
Other internal bleeding <1 year
CPR <3 weeks

20
Q

Infective Endocarditis diagnostic criteria

A

Dukes criteria:
Pathological Criteria:
+ve micro culture from vegetation or histology from vegetation indicating IE

OR

2 major OR
1 major, 3 minor OR
5 minor required

Major:
2x +ve BCs at least 12 hours apart (or 1x +ve coxiella burnetii culture)
New murmur/echo shows endocarditis

Minor
Vasc phenom eg Janeways lesions, emboli
Immunological phenom eg Oslers nodes/Roths spots/GMN
Predisposition eg IVDU/prev IE
Fever >38
Micro evidence not meeting major criteria

21
Q

Risk factors for IE

A

IVDU
Unrepaired cyanotic congenital heart disease
Immunosuppressed
Prosthetic valves
Rheumatic heart disease
Prev IE
Surgical repair congenital heart disease <6 months

22
Q

Bacterial causes of IE

A

Staph aureus
Coxiella burnetii
Strep viridans
GAS
Enterococcus
HACEK
-haemophilus
-aggregatibacter sp
-cardiobacterium hominis
-eikenella corrodes
-kingella sp
Strep gallolyticus/bovis

23
Q

Risk factors/causes myocarditis

A

Viral illness
Peripartum or postpartum
HIV
Autoimmune disease
Hypersensitivity reactions
Toxins

24
Q

ECG changes in myocarditis

A

QRS prolongation (poor prognosis)
ST/T diffuse elevation
AV block

25
Q

Features of myocarditis

A

Chest pain
Arrhythmia
Heart failure

26
Q

Posterior MI
-when to look
-how to identify

A

Look for posterior MI in inferior or lateral STEMI
ST depression in V1-3 suggests posterior MI
Other findings include:
-tall, broad dominant R waves in V2
-upright T waves
Obtain posterior leads to check for STE in V7-9
Posterior MI is confirmed by 0.5mm STE in posterior leads

27
Q

What is Wellen’s Syndrome?
What are the features and the significance?

A

Wellen’s syndrome is a clinical syndrome involving BOTH chest pain that has now resolved AND either biphasic or deeply inverted T waves in leads V2 and V3
Highly specific for critical stenosis of the LAD
Likely will progress to significant anterior MI in the coming days
DO NOT stress test a Wellen’s

28
Q

Features of the Marburg Score for chest pain?

A

Age (F >65, M >55)
Known CAD/CVD or PVD
Pain not reproducible with palpation
Patient assumes pain is cardiac
Pain worsened with exertion

29
Q

Aortic dissection
Definition

A

A life threatening condition in which the intimal layer of the aorta tears, separating the intima from the media, creating a false lumen

30
Q

Aortic dissection risk factors

A

Age
Hypertension
Smoking
Connective tissue disorder
Trauma
Iatrogenic (cardiac catheterisation)

31
Q

Aortic dissection prognosis

A

20% die pre-hospital
33% die pre- or peri-operatively

32
Q

Aortic dissection
Examination findings

A

May be nothing but look for:
Hypo or hypertension
Radial/radial or radial/femoral delay
Unequal pressures between arms
Diastolic murmur
Tachycardia
Abnormal pulse character
Abnormal neurological feature
Horner’s syndrome (rare but pathognomonic)
STEMI

33
Q

Symptoms of myocarditis

A

Chest pain (commonly pleuritic)
Palpitations
SOB
Collapse
Orthopnoea
Fatigue
Fever
Decreased exercise tolerance
Associated viral illness
Death

34
Q

Signs of myocarditis

A

Fever
Tachycardia
Hypotension progressing to cardiogenic shock
S3 gallop
Arrhythmia
Pericardial rub
Heart failure signs

35
Q

ECG changes in myocarditis

A

Frequently variable/absent/unpredicatble but can include
Sinus tach (most common)
Non-specific ST and T wave changes
QRS prolongation
AV block
Ventricular arrhythmias

36
Q

Risk and timeline of ARF post GAS

A

1-3% of untreated GAS will develop ARF in 2-3 weeks

37
Q

Risk factors for AF

A

Advanced age
European
Male
Hypertension
IHD
Hyperthyroidism
Obesity
Sleep apnoea
Alcohol excess
Valvular heart disease
Cardiomyopathy
Acute infection
Diabetes
Heart failure
Caffeine excess

38
Q

NYHA HF classes

A

I - no sx
II - ordinary exertion causes symptoms
III - less than ordinary exertion causes sx
IV - sx at rest

UCPEX (7 decks)

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