Cardiology Flashcards
1
Q
Acute MI
Subendocardial (partial) infarct, 20-40 min
A
NON-STEMI
2
Q
Acute MI
Transmural (whole wall thickness(, 3-6 hours
A
STEMI
3
Q
relieved by rest or medications
A
Stable Angina
4
Q
doesn’t respond to rest/medications
A
Unstable Angina
5
Q
irreversible death of heart tissue
A
Acute MI
6
Q
is chest pain due to ischaemia but still the heart tissue is alive
A
Angina
7
Q
Presentation of Acute MI
A
central or epigastric chest pain radiating to the arms, shoulders, neck or jaw
Pain is substernal pressure, squeezing, aching =, burning or even sharp pain
Radiation to the left arm or neck is common
Chest pain is associated with diaphoresis, nausea, vomiting, dyspnea, fatigue and or palpitations
Could be painless in DM (autonomnic Neuropathy) - SILENT MI
8
Q
What are the investigation for Acute MI
A
Troponin
increase within 3-12 hrs peaks at 24-48 hrs and return to baseline 5-14 days
CKMB
return to baseline after 48-72 hrs, specificity and sensitivity are not as high - useful to detect reinfarction (10%)
9
Q
cardiac enzymes aren’t raised in
A
Unstable Angina
10
Q
What is the management of Acute attack
A
MONA
Morphine IV (to relieve the pain)
Oxygen (if there is hypoxia, pulmonary edema or continuing myocardial ischemia), if O2 saturation is <94%
Nitrates (GTN sublingual / IV) to treat angina
Aspirin 300 mg
- should be given before arrival to the hospital
- Clopidogrel should also be given
Heparin or LMWH should also be considered. (ENOXAPRIN SODIUM)
11
Q
What is the management of Pulmonary Edema
A
MONA but replace A with Fureosemide
MONF
12
Q
What are the complications of MI?
A
Ventricular Aneurysm
Dresslers Sydnrome
LBBB
13
Q
4-6 wks post MI
Persistent ST elevation with left ventricular failure
In CXR, there is cardiomegaly with an abnormal bulge at the left heart border.
Thrombus formation
ECHO - Paradoxical movement of the wall
A
Ventricular Aneurysm
14
Q
second autoimmune form of pericarditis that occur post MI
1 week several months post MI
A
Dressler’s Syndromeq
15
Q
What are the features of Dressler’s Syndrome
A
fever’
pleuritic pain
pericardial and pleural effusion
16
Q
WILLIAM
LBBB
A
QRS in V1 - Looks like W
QRS in V6 - Looks like M
17
Q
wide QRS + negative V1
A
LBBB
18
Q
wide QRS + positive V1
A
RBBB
19
Q
MarroW
RBBB
A
V1- looks like M
V6 - looks like M
20
Q
0-24 hrs
A
Arrhythmias
Cardiogenic Shock
21
Q
1-3 days
A
Pericarditis
22
Q
3-14 days
A
Myocardial Rupture
23
Q
after 2 weeks
A
Heart Failure
24
Q
What is the first line of management of CHF
A
ACE Inhibitor and Beta Blocker
Eg Carvedilol
25
Angina in CHF, treatment?
Beta Blocker
26
DM or signs of fluid overload, ejection fraction <40% in CHF
ACE Inhibitor
27
What is the second line of management in CHF?
Spironolactone
28
Heart Failure + Atrial Fibrillation
Digoxin
29
Management of STEMI
if patient presents with symptoms onset within 12 hours and PCI can be done within 120 minutes then withhold fibrinolysis
Perform PCI
Percutaneous Coronary Intervention
30
Management of STEMI
If PCI is not available and cannot be delivered within 120 minutes
Thrombolysis (alteplase or Streptokinase) - can only be done within 12 hours of symptom onset
31
Post myocardial infarction management / management of NSTEMI or unstable angina
Dual antiplatelet therapy: Aspirin + Clopidogrel (Pavix)
Beta blockers
ACE inhibitor
Statin (atrovastatin 80mg)
32
Chest pain is described as sharp, stabbing, central chest pain.
Radiates to the shoulders and upper arm.
Chest pain may be pleuritic and is often relieved by sitting forwards
Worsened by inspiration, lying flat, cough, swallowing or movement of the trunk.
pericardial friction rub
nonproductive cough and dyspnea
Acute Pericarditis
33
Viral cause of AP
Cocksakie
34
Bacterial cause of AP
Tuberculosis
35
Causes fibrinous pericarditis
Uremia
36
2nd form of pericarditis on top of cardiac injury, post MI
Dressler's Syndrome
37
ECG findinjgs for AP
Saddle shaped ST elevation
PR segment depression
38
any cause of pericarditis but especially trauma
Cardiac Tamponade
39
What are the Beck's triad for Cardiac Tamponade?
Muffled heart sounds
Distended neck veins
Hypotension
40
Dyspnea and raised JVP
Pericardial Effusion
41
CXR shows enlarged globular heart
ECG shows low-voltage QRS Complexes and alternating
Pericardial Effusion
42
What is diagnostic tool for the Cardiac Tamponade?
ECHO
43
What is the treatment for Acute Pericarditis?
NSAIDs
44
What is the management for Cardiac Tamponade?
Urgent Pericardiocentesis
45
It is a life threatening condition in which a pericardial effusion has developed so rapidly or has become so large that it compresses the heart
Cardiac Tamponade
46
Fever + new murmur
Infective endocarditis
47
What is the causative organism for the infective endocarditis
Staph aureus
48
What are the risk factors for Infective endocarditis?
Valve replacement
Recreational drug
Dentistry interventions
49
fevers, rigors, malaise , new murmur (Commonly MR), some patients may present with CHF
Infective Endocarditis
50
What is the surgical treatment for IF
Valve Replacement
51
What are the medications for IF?
Flucloxacillin
Benzylpenicillin
Gentamicin (Vancomycin with prosthetic valve)
52
What are the major criteria of IF?
Positive blood culture
Positive Echo = abscess formation, new valvular regurgitation
53
Minor Criteria of IF
FIVE PM
Fever,
Immunological Phenomena (AGN, Osler's node, Roth spots)
Vascular phenomena: Major emboli, splinter hemorrhage, Janeway lesions
Echo
Predisposition: IV drug user
Microbiological
54
hemorrhage under the nails
Splinter hemorrhage
55
painless macules
Janeway Lesions
56
small painful tender
Osler's nodes
57
red retinal spots with pale white center
Roth Spots
58
fever, rigor, malaise, MR (new murmur), CHF
IF presentation
59
What are the systolic Murmurs?
AS, MR, TR, VSD
60
What are the diastolic murmurs?
AR MS
61
Ejection Systolic
AS
PS
62
Pansystolic
MR, TR, VSD
63
Early diastolic
AR
PR
64
Mid-late diastolic
MS
65
Lesions above the level of the nipple
Ejection Systlolic
66
Lesions below the level of the nipple
Pansystolic
67
Left sided murmurs louder with
Expiration
68
Right sided murmur louder with
Inspiration
69
pAN-sYSTOLIC
MR
70
Diastolic Rumble
TS
71
found in 2nd intercostal space to the right of the sternum
AS
AR
72
Found at the apex
MS
MR
73
Found at the 2nd intercostal space to the left of the sternum
PS
PR
74
Found at the lower right sternal edge
TS
TR
75
Symptom of CHF
MR
76
Fluttering discomfort of the neck
TS
77
Symptom of the Right sided failure
TR
78
palpitations, fast heart rate, dyspnea
Atrial Fibrillation
79
patient in stem will describe it as a fluttering feeling in the chest
Atrial flutter
80
Regular and fast
Stem will mention a period of ongoing lightheadedness, palpitations and chest pain
Ventricular Tachycardia
81
Physiological situations, such as exercise or situations of stress or anger
History of infection
Sinus Tachycardia
82
lengthening of the PR interval
Type I AV block
83
progressive prolongation of PR interval until a missed QRS complex
Mobitz 1: Type 2 AV block
84
Normal PR interval with occasional missed QRS complexes
Mobitz 2: Type 2 AV block
85
no relation of P waves and QRS complexes
Type 3 AV block
86
Delta wave in ECG
Wolff-Parkinson White Syndrome
87
more than 3 consecutive PVCs, HR 100-250 bpm
less filling -> low CO -> hypotension and HF
Loss of atrial Click -> P wave may be present or absent (if present, it has no relation tot he QRS complex)
Ventricular Tachycardia
88
HR > 100 bpm in a healthy individual due to exercise and stress
SInus Tachycardia
89
a single beat starts from the ventricles
Premature ventricular contaction
90
Wide QRS + regular
VT
91
Wide QRS + irregular
V-fib
92
Narrow QRS + regular
SVT
93
Narrow QRS + irregular
A-Fib
94
With Pulse, hemodynamically stable, the tx are?
Amiodarone
Lidocaine
Procainamide
All are antiarrhythmics
95
With Pulse, hemodynamically unstable, the tx is?
Immediate electrical cardioversion
96
Without pulse, next management?
Immediate electrical cardioversion (defib)
97
Manifested as an absolutely regular rhythm at a rate between 130-220 bpm
young patient with recurrent palpitations, normal/slightly low BP, regular HR and NO predisposition to heart disease
SVT
98
What is the acute management for SVT in hemodynamically stable patients?
1. Valsalva maneuver, carotid massage
2. Adenosine 6mg IV (if unsuccessful, add another 12mg IV - if still unsucessful give another 12)
3. Electrical Cardioversion (if given with Adenosine 3 doses (30mg) and with no improvement
99
What is the acute management for SVT in hemodynamically unstable patients?
DC cardioversion
100
What are the preventive measures for SVT?
BEta Blockers
Radio frequency ablation
101
This is caused by the premature discharge of a ventricular ectopic focus which produces an early and broad QRS complex
Skipped or Missed beats
benign unless there is an underlying disease that could lead to life-threatening arrhythmias
Ventricular ectopic
102
What are the causes of Ventricular ectopic?
IHD
Cardiomyopathy
Stress
Alcohol
Caffeine
Medication
COcaine
Amphetamines
Occus naturally
103
loss of consciousness
VF
104
Middle aged person with history of CHF
VT
105
Missed beats, dyspnea, dizziness and never sustained in 2H
Ectopic beats
106
decreased ejection fraction + damaged myocardium (e.g. thinning of the septal wall)
Dilated Cardiomyopathy
107
Most common arrhythmia that develop in patients with Dilated Cardiomyopathy
Atrial Fibrillation
108
due to the loss of the atrial contribution to Cardiac Output, AF can lead to this
Pulmonary Edema
109
History of Alcoholism followed by palpitations, dizziness, and syncope
Atrial Fib or Flutter
"Holiday Heart Syndrome"
110
Features of AF
Dyspnea
Palpitations
Syncope or dizziness
Chest discomfort or pain
Stroke or TIA
An irregularly irregular pulse
Absent P wave
111
rate of 220-350 bpm, A FLutter or A fib?
A flutter
112
rate of >350 bpm, A FLutter or A fib?
A fib
113
Atrial Activity: visible flutter waves, A FLutter or A fib?
Atrial Flutter
114
Atrial Activity: Fine fibrillatory waves
Atrial fibrillation
115
Ventricular activity:
Rate, regular
Constant RR interval
Atrial Flutter
116
Ventricular activity:
Rate, variable
No relation to atrial rate
Variable RR interval
Atrial fibrillation
117
saw tooth
Atrial Flutter
118
ragged
Atrial fibrillation
119
Atrial Fibrillation management, rate Control?
120
Atrial Fibrillation management, rhythm Control?
121
It means sudden death, blood pressure drops immediately to zero so does the cardiac output
Ventricles are unable to contract in a synchronized manner -> immediate loss of the Cardiac Output
Ventricular fibrillation
rate is up to 500 bpm
122
What are the ECG findings of V FIb
Chaotic irregular deflections of varying amplitude
No identifiable P waves
Rate 150-500bpm
There is no specific pattern to the discharge
123
It is used to determine the most appropriate anticoagulation strategy for atrial Fibrillation
CHA2 DS2 VS
C - Congestive Heart Failure 1 pt
H - Hypertension 1 pt
A2 - Age > 75 yo 2 pts
- Age 65-74 yo 1 pt
D - Diabetes 1 pt
S2 - Prior Stroke or TIA 2pts
V - Vascular disease (sys/peri) 1 pt
S - Sex (female) 1 pt
124
<65 yo and no comorbidities =?
<65 yo and at least 1 comorbidity =?
<65 yo and no comorbidities = NO Warfarin
<65 yo and at least 1 comorbidity =Warfarin or DOAC (Direct anticoagulants)
DOAC:
Apixaban
Edoxaban
Riboroxaban
125
it may lead to intracranial hemorrhage and SAH - look out for headache
Warfarin
126
What are the benefits and disadvantages of DOAC over Warfarin?
127
syndrome of sudden onset focal neurological loss of presumed vascular origin lasting > 24H
Stroke
128
syndrome of sudden onset of focal neurological loss of oresumed vascular origin lasting <24H
TIA
129
Prevention of Stoke or TIA patient presented with AF
Warfarin or DOAC (stroke prophylaxis)
130
Prevention of Stoke or TIA, patient presented with disabling stroke and NO AF
defer anticoagulation tx for 14 days from the onset and start Aspirin 300mg for 2 weeks + Clopidogrel 75 mg lifelong
131
Prevention of Stoke or TIA, is internal carotid artery is stenosed >/- 50% in men, and >/- 70% in women
Carotid Endarterectomy
132
Prolonged PR interval > 0.2 secs
First Degree Heart Block
133
Mobitz Type 1 AV block (Wenckebach block/phenomenon)
-Progressive prolongation of the PT interval within intermittent dropped beat
Mobitz Type 11 AV Block
- sudden drop of QRS without prior PR changes
2nd Degree Heart block
134
P waves and QRS complexes have no relation to each other
3rd degree (complete heart block)
135
What is the management for the 1st degree and Mobitz 1
No treatment
Atropine could be given
136
What is the management for the Mobitz II and 3rd degree?
Permanent pacemakers
Atropine is CI
137
First Degree AV Block
138
Second degree AV block Mobitz II
139
Second degree AV block Mobitz I or Wenckebach
140
Third degree AV Block with Junctional Escape
141
What are the 7 Parameters for the ECG Interpretation?
142
Rules of thumb to determine Cardiac Axis deviation on ECG
143
Areas of Infarct and the Coronary Arteries involved
144
ECG Tracings
145
What is the most common valvular heart disease
Aortic Stenosis
146
MC cause of Aortic Stenosis usually in elderly patient
Degenerative Sclerocalcific changes to valves
147
MC cause of Aortic Stenosis in younger patients
Congenital Bicuspid Aortic Valve
148
This is a sign of AS which is best heard at the 2nd right intercostal space at the Right Sternal Border which radiates to the carotid arteries, louder with expiration (left-sided murmur)
Ejection Systolic Murmur
149
2nd most common heart valve disorder
It is due to ischemic papillary muscle dysfunction or partial rupture after MI (days)
Could be 2ry to rheumatic fever
Commonly associated with inferior MI than anterior, usually seen 2-10 days post MI and the patient is presented with Pulmonary edema
Mitral Regurgitation
150
Dyspnea
Orthopnea
Paroxysmal Nocturnal dyspnea
this is a sign for MR
Left Ventricular Failure
151
with severe MR, edema, and Ascites
Right-Sided Failure
152
Another sign for MR that can be heard at the 5th intercostal space Left Midclavicular line (apex) that radiates to the axilla
Soft S1 and S2 Pansystolic murmur
153
What is the diagnostic tool for MR?
Echo
154
ECG finding for MR
broad/bifid P wave (P mitrale) indicating enlarged Left atrium
155
Inheritable connective tissue disorder
Maybe associated with:
Marfan's, Ehlers Danlos S and Osteogenesis imperfecta
Most pxs are asymptomatic
Classic case - slim young female with low blood pressure
MVP
156
This is a sign for MVP, best heard at the 5th midclavicular line followed by a mid or late systolic murmur with finding accentuated in the standing position.
Mid-Systolic Click
MVP in a basketball team
Shoots from the middle court with great Suspense and with a Click
157
Tall, thin with long arms
Marfan's
158
Has loose joints
Ehlers Danlos
159
A heart condition that impedes left ventricular filling - increased BV in the left atrium - increased left atrial pressure -> blood is back to the lungs causing pulmonary congestion - 2ry pulm vasoconstriction - pulmonary hypertension - becomes harder for the Right Ventricular Failure
Mitral Stenosis
160
MS is commonly caused by
Rheumatic Fever
161
What are the signs of MS?
Pulmonary congestion and Edema - dyspnea, orthopnea, paroxysmal nocturnal dyspnea
Hepatomegaly, Ascites, peripheral edema
hemoptysis
Systemic Embolism
Physical signs: Atrial fibrillation, Malar flush, Pulmonary Rales
Loud S1
Mid-diastolic murmur with an opening click
162
ECG findings of MS
RV failure
AF
P mitrale - bifid P wave
thickening of MV leaflets
163
CXR findings of MS
Large left atrium - straightening of the left heart border
Pulmonary hypertension, including Kerley B lines and increased vascular markings
164
What are the causes of Aortic Regurgitation?
RF
Infective Endocarditis
Marfan's Syndrome
165
Sign of AR, best heard at the left sternal edge (Erb;s point)
Early diastolic murmur
166
Sign of Pulmonary Stenosis, best heart over the pulmonary area, radiates to the left shoulder at the infraclavicular region
Ejection Systolic Murmur
167
heart condition that is acyanotic congenital heart disease, Left to RIght Shunt
may present with severe heart failure in infancy, poor weight gain and frequent URTIs
Could remain asymptomatic and be detected incidentally in later life
Congenital
Acquired (post-MI)
VSD
168
Signs of VSD
169
persistence of a normal fetal connection between the aorta and the pulmonary artery
Very common in preterm babies and it also may close spontaenously.
Maybe asymptomatic or may cause apnea, bradycardia and increased oxygen requirements.
Patent Ductus Arteriosus
170
tx prevent closure of PDA
Prostaglandins
171
Drugs that close the duct
Indomethacin or Ibuprofen
172
bounding peripheral pulses
Continuous machinery murmur
Rough systolic murmur along the Left sternal border
PDA
173
What are the most common cyanotic heart conditions 5Ts?
Tetralogy of Fallot (TOF)
Transposition of the great arteries (TGA)
Tricuspid atresia
Truncus arteriosus
Total ANomalous Pulmonary Venous Connection (TAPVC)
174
MC cause of cyanotic congenital heart disease
typically presents at around 1-2 months, although may not be picked up until the baby is 6 months old
Tetralogy of Fallot (TOF)
175
What are the four characteristic features of TOF?
VSD
RIght Ventricular Hypertrophy
Pulmonary Stenosis - ejection systolic murmur
Overriding aorta
PROV-TOF
176
What are the other features of TOF?
Cyanosis
Causes a Right to Left Shunt
Ejection Systolic Murmur due to Pulmonary stenosis
A right-sided aortic arch is seen 25% of patients
CXR - "Boot-shaped" heart
ECG - RVH
177
What is the complication of TOF?
Pulmonary Regurgitation
(common after repair of pulmonary stenosis)
178
benign tumours, mostly int he Left atrium and tend to grow on the wall (septum)
symptoms occur due to obstruction of the Mitral Valve which result in syncope and heart failure
Atrial Myxoma
179
Features of Atrial Myxoma
180
Hypertension
181
Postural Hypotension
182
Ruptured Abdominal Aortic Aneursysm
183
Digoxin Toxicity
184
What is the management for Symptomatic bradycardia?
1. Atropine 0.5 mg IV
2. Dopamine
3. Epinephrine
Initial ABCD
185
Resuscitation guide for Cardiac Arrest
1. Call for help
2. Check for ABCD (if there is no signs of life - call the resuscitation team)
3. CPR - 30:2
4. Defibrillation
186
What are the drugs that should be avoided in CHF, IHD and CKD?
NSAIDS (heart failure worsens, it inhibits prostaglandins - vasoconstriction-less filtration-> lower urinary output -fluid accumulation)
Cox2 Inhibitors
187
What cardiac medication increases the risk of gout and is due to reduced clearance of uric acid?
Thiazide
188
What is the treatment for beta-blocker overdose?
Glucagon
189
What is the antidote for Warfarin?
Vitamin K
190
U wave
Hypokalemia
191
J wave
Hypothermia
192
A wave
Atrial Myxoma
193
Delta waves
Wolff Parkinson White Syndrome (WPW S)
194
Bifida/wide P wave
Left Atrial Enlargement
MR MS
195
P Mitrale (broader than 2 and a half small boxes)
Left atrial enlargement
196
P Pulmonale (taller than 2 and a half small boxes)
Right atrial enlargement
197
ECG showing irregular/equivocal (ambiguous) rhythm, next investigation?
ECHO
198
ECG showing regular rhythm, next investigation?
Holter ECG (24h ECG)
199
Patients who have experienced episodes of syncope during or shortly after exertion?
Exercise testing
200
Investigations for Aortic Dissection
Transesophageal Echo, CT, MRI
201
Alternating episodes of tachycardia, bradycardia, AF or Flutter
Sinus Sick Syndrome
202
Prolonged QT interval - Torsades de pointes
Syncope or sudden death
Exacerbated by exercise, stress, medications, and electrolyte imbalance
treated with MgSO4
Polymorphic ventricular tachycardia
203
What are the complications of MI?
Days - Rupture and Acute Pericarditis
weeks - Dressler's
Month (4-6 weeks) - Aneurysm
204
85% are right dominant
gives off the posterior descending artery (PDA), supplying the inferior wall, ventricular septum and the posteromedial papillary muscle
Right Coronary Artery
205
15% left dominant
Left Circumflex gives off the PDA
206
sudden collapse into consciousness due to heart block
Stokes Adam's attack
207
What are the investigations following syncope?
1. FInd witness - ask how the patient became unconscious, was there a seizure?
2. ECG - to look for arrhythmias
3. Blood glucose - to exclude hypoglycemia (LOC + sweating + improves with glucose administration)
208
Decreased ejection fraction + damaged myocardium (e.g. thinning of septal wall)
Dilated Cardiomyopathy
209
Autosomal Dominant
Total cholesterol >7.5 , LDL > 5
Family history of MI in a first degree relative < 60 or a 2nd degree relative <50
Familial Hypercholesterolemia
210
it is milder with total cholesterol of >6.5, Ldl>4
Polygenic Hypercholesterolemia
211
elevated LDL and triglyceride + decreased HDL
Mixed Dyslipidemia
212
Baseline assessment
TFTs, LFTs and U and E
every 6 months
213
Baseline assessment
CXR and ECG
every 12 months
214
Before using Amiodarone,
initial assessment
TFTs
215
Before using Lithium, initial assessment
Kidney Function tests, then TFTs
216
Anginal pain that last less than 30 mins and is precepted by physical exertion or stress
Anginal pain
217
Anginal pain that occurs when lying down
Decubitus Angina
218
Patent foramen ovale is diagnosed by
Transesophageal ECHO
219
commonly caused by compressing lung cancer or lymphoma
SVC obstruction
220
Shortness of breath is the MC symptom
facial and upper body edema
Facial plethora
venous distention of the face, upper body, dysphagia, syncope and headache
SVC Obstruction
221
What is the appropriate investigation for SVC Obstruction?
CT with Contrast
222
What is the management for SVC obstruction?
Steroids (dexamethasone) avoided in night as it disturbs dleep
