Cardiology Flashcards
First and second line management of stable angina?
- Bisoprolol/Verapamil
- Bisoprolol + nifedipine
Nicorandil: 1. Mechanism of action, 2. Major associate adverse reaction?
- Potassium channel activator
- GI ulceration
Nicorandil: 1. Mechanism of action, 2. Major associate adverse reaction?
- Potassium channel activator
- GI ulceration
- What is printzmetal angina?
- notes on medical Rx?
- coronary artery spasm causing chest pain at rest
- BB CI, use dihydropyridines
persistent ST depression and LVF post-MI is indicative of what?
LV aneurysm
Two post-MI complications more common in inferior MIs?
complete heart block (no pacing needed), acute MV regurgitaiton
3 groups of drugs that should be avoided in HF?
- -ve inotropes e.g. verapamil
- drugs causing fluid retention e.g. steroids
- class 1 antiarrhymics e.g. flecanides
acute medical Rx of SVT, should valsalva manoeuvre is unsuccessful
IV bolus of adenosine, 6/12/18mg (to increase if unsuccessful)
How should amiodarone be commenced and why
At a loading dose due to long half-life
6 main adverse reactions of amiodarone?
- thyroid dysfunction
- lung fibrosis
- liver fibrosis
- prolonged QT
- peripheral neuropathy
- photosensitivity
What is type 2 amiodarone-induced thyrotoxicosis and how should it be treated?
a destructive thyroiditis that requires cessation + steroids
5 features of digoxin toxicity?
- bradycardia/AV block
- yellow tinged vision
- confusion
- GI upsets
- gynaecosmatia
3 ECG features of digoxin toxicity?
- down sloping ST depression (reverse tick)
- short QT
- T wave inversion
1st-3rd line Rx for life-threatening bradycardia?
- atropine 500mcg up to 3mg
- isoprenaline/adrenaline infusion
- transcutaneous pacing
cannon a wave in seen in…?
AV dissociation e.g. VT, CHB, junctional rhythm
What specific organisms matches with the following descriptions regarding infective endocarditis?
1. Most common overall
2. Most common within 2m of prosthetic valve replacement surgery
3. Poor dental hygiene
4. Negative blood culture
5. Associated with colorectal cancer
- S. Aureus
- S. Epidermis (Coagulase -ve)
- Viridans Streptococcus
- Coxiella burnetii, Bartonella, Brucella, HACEK group
- Strep bovis esp gallolyticus
Abx regime for the following scenarios of IE?
1. Empirical
2. Prosthetic valve associated
3. Prosthetic and pen allergic
4. Staphylococcal
5. Streptococcal
6. Enterococcal/HACEK
- Amoxicillin +/- gentamicin
- Flucloxacillin + gentamicin + rifampicin
- Vancomycin + gentamicin + rifampicin
- Flucloxacillin
- Benzylpenicillin
- Amoxicillin + gentamicin
HOCM mutation and inheritance pattern?
β-myosin heavy chain protein or myosin-binding protein C, autosomal dominant
6 Poor prognostic factors/risk factors for sudden cardiac death in HOCM and their relevance for ICD?
- FH of sudden cardiac death
- Non sustained VT on 24/48h ECG
- Septal wall thickness
- Resting LVOT gradient > 30mmHg
- Fall in SBP during exercise by > 25mmHg
- Hx of syncope
> 2 indicate ICD
Summary of management for HOCM?
A - Amiodarone
B - Beta-blocker/verapamil
C - ICD
D - dual chamber pacemaker
E - endocarditis prophylaxis
Drugs to avoid in HOCM?
- ACE-I/ARB
- Nitrates
- Dihydropyridines
- +ve inotropes
Arrhythmogenic right ventricular cardiomyopathy mutation and inheritance pattern?
Desmosome, autosomal dominant
What is the hallmark pathological feature of AVRC?
RV myocardium replaced by fibromyalgia-fatty tissue
Key ECG changes in ARVC?
- T wave inversion in V1-3
- Epsilon wave
- PVC/VT of LBBB morphology
ECG changes in Brugada syndrome?
convex (down-sloping) ST elevation in V1-3 with T wave inversion
Brugada syndrome mutation and inheritance pattern?
SCN5A gene for myocardium sodium channel, autosomal dominant
What drug can be given to help diagnose Brugada syndrome?
Flecanide to accentuate ECG changes
Key pathological feature of Ebstein’s anomaly?
cogenital low insertion of tricuspid valve
Common congenital heart defect associated with Ebstein’s anomaly
Patent foramen ovale, atrial septal defect
Key clinical and JVP features in Ebstein’s anomaly?
Tricuspid regurgitation, large a wave
3 Key ECG changes in WPW?
- delta waves (slurred initiation of QRS)
- short PR interval
- prolonged QRS
