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AKT > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Which ECG leads refer to a Lateral MI?

A

I, aVL, V5, V6

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2
Q

Which ECG leads refer to an Anterior MI?

A

V3, V4

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3
Q

Which ECG leads refer to a septal MI?

A

V1, V2

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4
Q

Which ECG leads refer to an inferior MI?

A

II, III, aVF

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5
Q

Which coronary arteries supply the anterior, lateral, septal and inferior parts of the heart?

A

Anterior: LAD
Lateral: Circumflex
Septal: LAD anterior 2/3 , RCA posterior 1/3
Inferior: RCA

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6
Q

Troponin results are used to diagnose an?

A

NSTEMI

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7
Q

Is Troponin needed to diagnose a STEMI?

A

No, based on presentation and ECG

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8
Q

GRACE score?

A

GRACE score gives a 6-month probability of death after having an NSTEMI.

3% or less is considered low risk
Above 3% is considered medium to high risk

Patients at medium or high risk are considered for early angiography with PCI (within 72 hours).

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9
Q

What is Dressler’s syndrome?

A

Dressler’s syndrome is also called post-myocardial infarction syndrome. It usually occurs around 2 – 3 weeks after an acute myocardial infarction. It is caused by a localised immune response that results in inflammation of the pericardium.

It presents with pleuritic chest pain, and a pericardial rub on auscultation.

Management is with NSAIDs (e.g., aspirin or ibuprofen) and, in more severe cases, steroids (e.g., prednisolone).

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10
Q

Diagnosis of Dressler’s syndrome

A

A diagnosis can be made with an ECG (global ST elevation and T wave inversion), echocardiogram (pericardial effusion) and raised inflammatory markers (CRP and ESR).

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11
Q

Four main differentials of a narrow complex tachycardia

A

Sinus tachycardia (treatment focuses on the underlying cause)

Supraventricular tachycardia SVT (treated with vagal manoeuvres and adenosine)

Atrial fibrillation (treated with rate control or rhythm control)

Atrial flutter (treated with rate control or rhythm control, similar to atrial fibrillation)

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12
Q

The resuscitation guidelines break down broad complex tachycardia into

A

Ventricular tachycardia or unclear cause (treated with IV amiodarone)

Polymorphic ventricular tachycardia, such as torsades de pointes (treated with IV magnesium)

Atrial fibrillation with bundle branch block (treated as AF)

Supraventricular tachycardia with bundle branch block (treated as SVT)

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13
Q

Narrow complex tachycardia vs broad complex tachycardia

A

QRS>3 small squares = broad <3 small squares = narrow

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14
Q

What is atrial flutter?

A

Atrial flutter is caused by a re-entrant rhythm in either atrium.

The electrical signal re-circulates in a self-perpetuating loop due to an extra electrical pathway in the atria.

The signal goes round and round the atrium without interruption. The atrial rate is usually around 300 beats per minute.

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15
Q

What is atrial flutter?

A

Atrial flutter is caused by a re-entrant rhythm in either atrium.

The electrical signal re-circulates in a self-perpetuating loop due to an extra electrical pathway in the atria.

The signal goes round and round the atrium without interruption. The atrial rate is usually around 300 beats per minute.

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16
Q

Relative ventricular rates in atrial flutter

A

The signal does not usually enter the ventricles on every lap due to the long refractory period of the atrioventricular node.

This often results in two atrial contractions for every one ventricular contraction (2:1 conduction), giving a ventricular rate of 150 beats per minute.

There may be 3:1, 4:1 or variable conduction ratios.

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17
Q

Atrial flutter ECG appearance

A

Atrial flutter gives a sawtooth appearance on the ECG, with repeated P wave occurring at around 300 per minute, with a narrow complex tachycardia.

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18
Q

Prolonged QT leads to an ECG showing

A

Torsades De Pointes

Afterdepolarisations spread throughout the ventricles, causing a contraction before proper repolarisation.

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19
Q

Causes of prolonged QT

A

Long QT syndrome (an inherited condition)

Medications, such as antipsychotics, citalopram, flecainide, sotalol, amiodarone and macrolide antibiotics

Electrolyte imbalances, such as hypokalaemia, hypomagnesaemia and hypocalcaemia

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20
Q

On an ECG, first-degree heart block presents as

A

A PR interval greater than 0.2 seconds (5 small or 1 big square).

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21
Q

Mobitz type 1 (Wenckebach phenomenon)

A

Is where the conduction through the atrioventricular node takes progressively longer until it finally fails, after which it resets, and the cycle restarts.

On an ECG, there is an increasing PR interval until a P wave is not followed by a QRS complex. The PR interval then returns to normal, and the cycle repeats itself.

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22
Q

Mobitz type 2

A

Intermittent failure of conduction through the atrioventricular node, with an absence of QRS complexes following P waves. There is usually a set ratio of P waves to QRS complexes, for example, three P waves for each QRS complex (3:1 block). The PR interval remains normal. There is a risk of asystole with Mobitz type 2.

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23
Q

RBBB +left anterior or posterior hemiblock (left axis deviation) + 1st-degree heart block =

A

Trifasicular block

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24
Q

Hypertrophic cardiomyopathy is inherited in a ___ fashion

A

AD

25
Q

Cardiac tamponade on ECG

A

Electrical alternans

Consecutive, normally-conducted QRS complexes that alternate in height, due to the heart swinging back and forth in a fluid-filled pericardium.

26
Q

Beck’s triad

A

Cardiac tamponade

Muffled heart sounds, hypotension and raised jugular venous pressure

27
Q

In the context of a tachyarrhythmia, a systolic BP < 90 mmHg →

A

DC cardioversion

28
Q

Management for narrow-complex tachycardia without adverse signs

A

Vagal manoeuvres

Followed by Adenosine if vagal manoeuvres had failed in a non-asthmatic patient.

29
Q

The CHA2DS2-VASc Score

A

Calculates stroke risk for patients with atrial fibrillation

C congestive heart failure - 1 point
H hypertension - 1 point
A2 age >75 - 2 points
D diabetes - 1 point
S2 - past stroke - 2 points
V vascular disease -1 point
A age > 65 - 1 point
Sc Sex - 1 point for female

30
Q

Treatment for asymptomatic atrial fibrillation

A

Cardioversion

None

Anticoagulation should be considered for the following:
Men: CHA2DS2-VASC >= 1
Women CHA2DS2-VASC >= 2

31
Q

Notching of the inferior border of the ribs’. Which of the following conditions is likely to be responsible for this X-ray finding

A

Coarctation of the aorta

32
Q

Nicorandil side effect

A

Ulcerations along the entire gastrointestinal tract

33
Q

Young adult with hypertension, systolic murmur →

A

? coarctation of the aorta

34
Q

Coarctation of the aorta murmur

A

Ejection systolic which radiates to the scapulae

35
Q

What is more widely used secondary anti-platelet medication?

A

Clopidogrel was previously the second antiplatelet of choice. Now ticagrelor and prasugrel (also ADP-receptor inhibitors) are more widely used.

36
Q

Treatment after MI

A

Dual antiplatelet therapy (aspirin plus a second antiplatelet agent - ticagrelor)
ACE inhibitor
Beta-blocker
Statin

37
Q

What is used to treat toursades de pointes

A

IV magnesium sulfate

38
Q

The main ECG abnormality seen with hypercalcaemia is

A

Shortening of the QT interval

39
Q

First management in patients with suspected PE

A

The two-level Wells PE score should be calculated: if the score is >4 then PE is ‘likely’ and CTPA should be arranged; if it is ≤4 then PE is ‘unlikely’ so a D-dimer should be taken.

40
Q

What is Buerger’s disease (or thromboangiitis obliterans)?

A

A small and medium vessel vasculitis strongly associated with smoking. It causes Raynaud’s phenomenon (discolouration of extremities with cold exposure) and extremity ischemia leading to intermittent claudication (pain in legs which occurs during exercise and is relieved by rest).

41
Q

AF pulse

A

Irregularly irregular

42
Q

Aortic regurgitation causes

A

Valve disease (e.g. bicuspid aortic valve, aortic dissection, spondyloarthropathies (e.g. ankylosing spondylitis) and connective tissue disease) or due to aortic root disease (e.g. rheumatic fever, calcific valve disease, infective endocarditis and connective tissue diseases).

43
Q

Classical presentation of left ventricular free wall rupture

A

Sudden heart failure, raised JVP, pulsus parodoxus, recent MI

44
Q

What is left ventricular free wall rupture?

A

Left ventricular free wall rupture is caused by the infarction causing a weakening in the wall.

The rupture leads to bleeding into the pericardium, resulting in cardiac tamponade. Hence the examination signs are consistent with the triad noted in cardiac tamponade of any cause (raised JVP, pulses paradoxus and muffled/quiet heart sounds).

Patients often experience chest pain preceding symptoms of acute heart failure, such as breathlessness. This complication of an MI is associated with particularly high mortality (around 60%). It requires urgent pericardiocentesis and thoracotomy.

45
Q

Triad of cardiac tamponade

A

Raised JVP, pulses paradoxus and muffled/quiet heart sounds

46
Q

CCBs include

A

Amlodipine (Norvasc)
Diltiazem (Cardizem, Tiazac, others)
Felodipine.
Isradipine.
Nicardipine.
Nifedipine (Procardia)
Nisoldipine (Sular)
Verapamil (Calan SR, Verelan)

47
Q

First-line medication for hypertensive patients with type 2 diabetes - regardless of age

A

ACE inhibitor or ARB

48
Q

A GRACE score of __ warrants a coronary angiography within 72 hours of admission.

A

> 3%

49
Q

Hypertension management in Pt with chronic kidney disease who have a urinary ACR of >30 mg/mmol

A

Recommend the use of an ACE inhibitor or ARB. Not CCB

50
Q

If new BP >= 180/120 mmHg + retinal haemorrhage or papilloedema

A

Admit for specialist assessment

51
Q

Atrial fibrillation cardioversion drugs

A

Amiodarone + flecainide

52
Q

What is the first line investigation for stable chest pain of suspected coronary artery disease aetiology

A

Contrast-enhanced CT coronary angiogram

53
Q

Is first degree heart block ever normal?

A

Yes in a young fit athlete

54
Q

For patients of black African or African–Caribbean origin taking a calcium channel blocker for hypertension, if they require a second agent consider an ______ in preference to an _______

A

Angiotensin receptor blocker in preference to an ACE inhibitor

55
Q

What anti-arrhythmic causes chest pain

A

Adenosine may cause chest pain

56
Q

Antidote for or a prophylaxis against major bleeding in patients taking the anticoagulant dabigatran (Pradaxa).

A

Idarucizumab (Praxbind)

57
Q

Aortic dissection types and management

A

type A - ascending aorta - control BP (IV labetalol) + surgery
type B - descending aorta - control BP(IV labetalol)

58
Q

Sign of type A aortic dissection

A

Weak pulse and aortic regurg (early diastolic blowing) murmur
Louder when leans forward or breathes out

AKT (16 decks)

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