Cardiology Flashcards
What ECG changes are seen in Brugada syndrome? (2)
1) Convex ST elevation >2mm in V1-V3, followed by a negative T wave
2) Partial RBBB
What medications will worsen the ECG changes seen in Brugada syndrome? (2)
1) Flecainide
2) Ajmaline
What percentage of patients with infective endocarditis have previously normal heart valves?
50%
What is the most commonly affected valve in infective endocarditis?
Mitral valve
What is the most commonly affected valve in infective endocarditis, in IVDU populations?
Tricuspid valve
What is the most common cause of infective endocarditis in the developed world?
Staph. aureus
What is the most common cause of infective endocarditis in the developing world?
Strep. viridans
In what cohort of patients is Strep. viridian most commonly isolated? (3)
1) Patients in the developing world
2) Patients with poor oral hygiene
3) Patients having recently undergone dental surgery
What bacteria in infective endocarditis is commonly associated with indwelling lines, or post-valvular surgery?
Coagulase-negative Staphylococci, including Staph. epidermis
What bacteria in infective endocarditis is commonly associated with colorectal malignancy?
Strep. bovis
What are some non-infective causes of endocarditis? (2)
1) SLE (Libra-Sacks Endocarditis)
2) Malignancy (Marantic endocarditis)
What are the indications for surgery in patients with infective endocarditis? (5)
1) Severe valvular incompetence
2) Aortic abscess
3) Treatment-resistant infections
4) Cardiac failure
5) Recurrent emboli post-ABx treatment
What changes on an ECG would be consistent with an aortic root abscess?
PR prolongation
What scoring system is used to diagnose infective endocarditis?
Modified Duke’s criteria
When can a positive diagnosis of infective endocarditis be made?
Modified Duke’s:
- Pathological criteria positive, OR
- 2 major criteria, OR
- 1 major and 3 minor criteria, OR
- 5 minor criteria
What cardiac complication is associated with Long QT Syndrome?
1) VT
2) Torsades de pointes
What drugs are implicated in the development of Long QT Syndrome? (10)
Think acronym
ASTHMATiC
Amiodarone
Sotalol/SSRIs
Haloperidol
Methadone/Metoclopramide/Macrolides
Antiarrhythmics class 1a
TCAs
Chloroquine
What genetic defects are seen that lead to Long QT Syndrome?
Defect in alpha-subunit of slow-delayed rectifier potassium channel
What genetic conditions are associated with Long QT Syndrome?
1) Jervelle-Lange-Mielsen (deaf)
2) Romero-Ward (non-deaf)
What electrolyte abnormalities are associated with Long QT Syndrome?
1) Hypocalcaemia
2) Hypokalaemia
3) Hypomagnesaemia
What types of Long QT Syndrome can manifest?
LQT 1 - Exertional syncope
LQT 2 - Emotional syncope
LQT 3 - Rest/nocturnal events
What drug should be avoided in the treatment of Long QT Syndrome?
Sotalol (may worsen QT duration)
What is the INR target for a patient with a mechanical aortic valve?
3.0
What is the INR target for a patient with a mechanical mitral valve?
3.5
What is the underlying cause of ventricular tachycardia?
1 or more ventricular ectopic foci
What are the two types of ventricular tachycardia?
1) Monomorphic (1 ectopic focus)
2) Polymorphic (>1 ectopic foci)
Torsades de Pointes is a subtype of what cardiac condition?
Ventricular tachycardia
What is the most common underlying cause for monomorphic ventricular tachycardia?
Myocardial infarction
What is the first-line treatment for a patient with monomorphic ventricular tachycardia, with no signs of severe symptoms?
Amiodarone 300mg IV over 10-60 minutes
What is the treatment for polymorphic ventricular tachycardia, with no signs of severe symptoms?
Magnesium 2g IV over 10 minutes
If drug therapy fails to resolve ventricular tachycardia, what are the next best management steps?
1) Electrophysiological studies (EPS)
2) ICD insertion (almost certain in those with LVSD)
What does NICE recommend for initial management of Angina Pectoris?
1) Aspirin/Statin as secondary prevention (provided not contraindicated)
2) Either a beta-blocker (e.g. Atenolol), or rate-limiting CCB in monotherapy (e.g. Verapamil/Diltiazem)
If prescribing both a beta-blocker and CCB for Angina Pectoris, what type of CCB should be used?
A longer-acting dihydropyridine CCB (Amlodipine, M/R Nifedipine)
What drug should not be co-prescribed in patients taking a beta-blocker?
Verapamil (increased risk of complete heart block)
If dual-therapy with beta-blockers and CCB are ineffective for treating Angina Pectoris, what drugs can be considered? (4)
1) Modified release Nitrates, OR
2) Ivabradine, OR
3) Nicorandil, OR
4) Ranolazine
Why do patients experience tolerance when taking nitrates?
Depletion of intracellular sulfhydryl groups, which are needed to convert nitrates into NO, which then induces vasodilation
In what conditions would you expect to see pulsus paradoxus? (2)
1) Severe asthma
2) Cardiac tamponade
What is the clinical characteristics of pulsus paradoxus?
> 10mmHg fall in BP during inspiration, leading to a faint/absent pulse on inspiration
In what condition would you expect to find a slow-rising pulse?
Aortic stenosis
In what condition would you expect to find a collapsing pulse? (6)
1) Patent ductus arteriosis
2) Anaemia
3) Thyrotoxicosis
4) Pyrexia
5) Exercise
6) Pregnancy
What is the characteristic finding of pulsus alternans?
A regular alternation in the force of the arterial pulse
In what conditions would you expect to find pulsus alternates?
Severe LVF
What is the characteristic finding of Bisferiens pulse?
2 distinct systolic peaks of a pulse
In what condition would you expect to find Bisferiens pulse?
Mixed aortic valve disease
