Cardiology Flashcards
Drugs than prolong QT
Antiarrhythmics (amiodarone, sotalol)
Antibiotics (erythromycin, clarithromycin, ciprofloxacin)
Psychiatric medications (SSRI, Tricyclics)
Electrolyte abnormalities that cause long QT
Hypocalcaemia, Hypomagnesaemia, Hypokalaemia
Management of torsades de pointes
IV Magnesium Sulphate
Features of severe aortic stenosis
Narrow pulse pressure
Slow rising pulse
Delayed ESM
Soft/absent S2
Fourth heart sound
Thrill
Left ventricular hypertrophy
Most common mutation seen in HOCM
Mutation in the gene encoding Beta myosin heavy chain proetin or myosin binding protein C
Does HOCM cause systolic or diastolic dysfunction
Diastolic dysfunction (Left ventricular hypertrophy causing decreased compliance therefore decreasing cardiac output
What do you see on a biopsy of HOCM?
Myofibrillar hypertrophy with chaotic fashion myoctes and fibrosis
ECG changes in HOCM
Left ventricular hypertrophy
Progressive T wave inversion
Deep Q waves
Which antibiotic can cause polymorphic VT?
Macrolides (eg azithromycin) due to prolongation of the QT interval
Diastolic murmur + Atrial fibrillation
Mitral stenosis.
Diastolic murmur loudest over the apex and accentuated with the patient in a left lateral position
Mitral stenosis
Diastolic murmur loudest over the aortic area
Aortic regurgitation
Pansystolic murmur loudest over the apex and radiating to the axilla
Mitral regurgitation
Systolic murmur over the tricuspid area
Tricuspid regurgitation
What are the components of the GRACE score?
Age
Heart rate
BP
Renal function
Cardiac arrest
ECG
Troponin
What does the GRACE score tell you?
Predicted 6 month mortality
What are the components of the CHADVASC score?
Congestive Heart failure - 1
Hypertension - 1
Age (over 75) - 2
Age (65 - 75) - 1
Diabetes 1
Stroke, or TIA 2
Vascular Disease - 1
Female sex - 1
Over what CHADVASC score do you need anticoagulation?
1 - Consider
2 - Offer
What scoring system is used to assess bleeding risk in AF and what does it contain?
ORBIT scoring system:
Haemaglobin less than 130 (male) or 120 (female) - 2
Age over 74 - 1
Bleeding history 2
Renal impairment eGFR less than 60 1
Treatment with anti platelets 1
Managment of VT with a pulse (stable patient)
Amiodarone
Second line - Lidocaine
What drug in contraindicated in VT with a pulse?
Verapamil
What valve is most commonly affected by endocarditis in drug users?
Tricuspid valve
Most common bacterial cause of endocarditis
Staph aureus
What is the strongest risk factor for getting endocarditis
Previous endocarditis
Which is the most common valve affected in endocarditis (NOT IVDU)
Mitral
What bacteria in endocarditis is associated with colorectal cancer?
Strep bovis - streptococcus gallolyticus
Persistent ST elevation and left ventricular failure after MI
Left ventricular aneurysm
Patient presents 2 weeks after MI with acute heart failure an cardiac tamponade
Left ventricular free wall rupture
Eary to mid diastolic murmy after posterior MI
Acute mitral regurgitaion (usually due to ischaemia or rupture of the papillary muscle
ECG features of hypokalaemia
U waves
Small or absent T waves (or inverted)
Long PR
ST depression
Long QT
What is the PESI score?
Pulmonary embolism severity score - can be used to identify patients with a PE than can be managed as Outpatients. Predicts 30 day mortality.
Includes age, sex, cancer, heart failure, lung disease, HR, BP, RR, Temp, Mental status and 02 sats
Very low or low risk - can be managed as OP
Factors that raise BNP
Heart failure
Myocardial ischaemia
Valvular disease
CKD
Factors which reduce BNP?
ACE inhibitors
ARBs
Diuretics
Echo findings in HOCM
Mitral regurgiation
Systolic anterior motion of the anterior mitral valve leaflet
Asymmetric hypertrophy
What are the features of coartation of the aorta in an adult?
Hypertension
Radio femoral delay
Mid sytolic murmur maximal over the back
Apical clicking from the aortic valve
Notching of the inferior border of the ribs
What is the most specific ECG change associated with pericarditis
PR depression
Describe the 2 types of aortic dissection (Stanford classification)
A: Ascending aorta
B: Descending aorta - distal to the left subclavian origin
Management of aortic dissection in the ascending aorta
Surgical managment (control BP in the meantime) Control to 100 - 120 systolic
Management of an aortic dissection in the descnding aorta
Conservative managment
Bed rest and BP control
Explain coronory angiography management of NSTEMI using GRACE score
Immediate - Unstable patient
Within 72 hours if GRACE score shows predicted mortality of over 3%
Early diastolic murmur high pitched and blowing in character
Aortic regurgiation
What are janeway lesions
Erythematous macular or nodular lesions caused by septic emboli
Non tender
What are osclers nodes
Painful erythematous lesions caused bu immune comples deposition
What are roth spots
Retimal haemorrhages seen in endocarditis
What is pulsas alterans and what does it indicate?
A strong and weak beat occurring alternately due to alternate rather than regular contraction of muscle fibres of the left ventricle
Caused by left ventricular failure
What is a collapsing pulse and what causes it?
A large bounding pulse that quickly dissapears. Best felt in the radial artery with the arm elevated. Seen in aortic regurgitation
What is bisifrens pulse and when is it seen
Rapid rising twice beting pulse where both waves are felt during systole. Seen in mixed aortic stenosis and incompetence
What is pulsus paradoxacus and what causes it
Alternate large and small amplitude beats and is found when taking BP. Seen in left ventricular failure
What is a plateau pulse and what causes it?
Low amplitude pulse and has a low size and fall. Seen in aortic stenosis
What is a 4th heart sound and what does it signify?
Causes by powerful atrial contraction filling and abnormally stiff ventricle. Causes include left ventricular hypertrophy and HOCM.
What is a 3rd heart sound and what does it signify?
Caused by turbulant blood flow when too much blood is pumped into the ventricle too quickly. Caused by heart failure
Describe the murmur associated with HOCM
Early peaking systolic murmur worse and valsalva and reduced on squatting
Describe the murmur associated with a VSD
Pansystolic murmur heard loudest at the left sternal edge
When does aortic aneurysm screening start
65th birthday for men
Describe the follow up after AAA screening
If AAA less than 3cm - discharge
If AAA between 3 - 4.4cm - Yearly screening
Between 4.5 - 5.4cm USS every 3 months
Above 5.5cm referred to a vascular surgeon
At what size does a AAA need to considered for surgery?
Over 5.5cm
What is the most common cardiovascular complication seen in marfan syndrome?
Aortic root dilatation.
Most common heart defect associated with downsyndrome?
AVSD
Do patients who have had a catheter ablation for Af still require anticoagulation
Yes. They require lifelong anticoagulation (Catheter ablation does not reduce the stroke risk)
What heart valve abnormailty is associated with polycystic kidney disease
Mitral valve prolapse
Treatment for HOCM?
Amiodarone
Beta blocker or verapamil
Cardiac defib
Dual chamber pacemaker
What drugs are contraindicated in patients with HOCM?
Nitrates
ACE inhibitors
Inotropes
