Cardiology Flashcards
Most Specific ECG Finding in Acute Pericarditis
PR Depression
2 main complications of PCI
- Restenosis (5-20%)
- Stent Thrombosis (1-2%)
Restenosis presenting complaint
Recurrence of Angina
Stent Thrombosis presenting complaint
Acute MI
What are Drug-eluting stents
Stent coated with paclitaxel or rapamycin which inhibit local tissue growth
Complications of Drug-eluting stents
Reduces restenosis rates, but stent thrombosis rates are increased
NICE Guidelines for Amiodarone
To be given 4 weeks prior to Electrical cardioversion if high risk of failure
AF onset less than 48 hours anticoagulation rule
patient should be heparinised
Cardioversion for AF onset less than 48 hours
- Electrical
- Pharmacological
AF onset more than 48 hours anticoagulation rule
3 week anticoagulation prior to cardioversion
Rheumatic Heart Disease Histological Finding
Aschoff Bodies
Most Common Complication Post MI
Ventricular fibrillation
Catecholaminergic Polymorphic Ventricular Tachycardia cause
Defect in the ryanodine receptor (RYR2)
Catecholaminergic Polymorphic Ventricular Tachycardia feature
Symptoms generally develop before the age of 20 years
Management of Catecholaminergic Polymorphic Ventricular Tachycardia
- Beta-blockers
- Implantable cardioverter-defibrillator (ICD)
Jervell and Lange-Nielsen syndrome C/F
- congenital long QT syndromes
- sensorineural deafness
Poor Prognosis in Infective Endocarditis
- Staphylococcus Infection
- Prosthetic Valve
- Culture Negative Endocarditis
- Low complement levels
Better Prognosis in Infective Endocarditis
- Streptococcal Infection
DEAR mnemonic for Adenosine
- Dipyridamole Enhances effect
- Aminophylline Reduces effect
- Lignocaine also Enhance
Causative organism for Infective endocarditis in Ca Colon
Streptococcus Gallolyticus
Causative organism for Culture Negative Infective endocarditis
Coxiella Burnetti
Most commonly affected valve in Infective endocarditis
Mitral Valve
Takayasu Arteritis C/F
- Absent Pulse
- Unequal Blood Pressure
- Intermittent Claudication
Drug of Choice for Prinzmetal Angina
Calcium Channel Blocker - Felodipine
Indications for stopping Exercise Tolerance Test
- > 3mm ST depression
- > 2mm ST elevation
- SBP >230
- SBP falling > 20
Arrhythmogenic right ventricular cardiomyopathy (ARVC) ECG Changes
- T Wave inversion in V1-V3
- Epsilon Wave
Naxos disease Triad
- ARVC
- Wolly Hair
- Palmoplantar keratoderma
ALS plan for witnessed cardiac arrest
3 shocks followed by Amiodarone
ALS plan for unwitnessed cardiac arrest
30:2 Compressions
Indications for Urgent DC Cardioversion in Tachycardia
- Shock
- Syncope
- Heart Failure
- MI
Hypertension Step 1 DOC for patients < 55-years-old or with diabetes mellitus
Angiotensin receptor blocker (ACE-i or ARB)
Hypertension Step 1 DOC for patients >= 55-years-old or of black African origin:
Calcium channel
blocker
Hypertension Step 2 treatment
if already taking an ACE-i or ARB add a Calcium channel blocker or a thiazide-like Diuretic
Hypertension Step 4 treatment
if potassium < 4.5 mmol/l add low-dose spironolactone
if potassium > 4.5 mmol/l add an alpha- or beta-blocker
Cardiac syndrome X definition
Patients have a normal ECG at rest and normal coronary arteries but develop ST depression on exercise stress testing.
Epsilon Wave
Terminal Notch in QRS Complex
Delta Wave
slurred upstroke in the QRS complex
Delta Wave Seen in
WPW Syndrome
Most common cause of Infective Endocarditis in prosthetic valve
Staphylococcus Epidermidis (if post surgery <2 months)
Most common cause of Infective Endocarditis in prosthetic valve in post surgery >2 months
Staphylococcus Aureus
Infective Endocarditis Blind Therapy for Native Valve
Amoxicillin + Low Dose Gentamycin
Infective Endocarditis Blind Therapy for Prosthetic Valve
Vancomycin + Rifampicin + Gentamycin
Glycemic Control Post MI in CCU
Stop OHA + Insulin Infusion
Management of Stable Torsades De Pointes
IV Magnesium
First Line Investigation for Pulmonary Embolism
CT Pulmonary Angiography
Golden Standard Investigation for Pulmonary Embolism
Pulmonary Angiography
Disadvantage of D-dimer for Pulmonary Embolism
High Sensitivity but Low Specificity
Investigation of Choice for Pulmonary Embolism in case of Renal Impairment
V/Q Scan
Giant ‘a’ Wave JVP seen in
- Tricuspid Stenosis
- Pulmonary Stenosis
Giant ‘v’ Wave JVP Seen in
Tricuspid Regurgitation
Canon ‘a’ wave JVP seen in
- Complete Heart Block
- Nodal Rhythm
First Line Angina Prophylaxis
Beta Blockers - Bisoprolol
Contraindication for Beta blocker use in Angina
Use of Calcium Channel Blocker use (Verapamil)
Angina in a patient with Verapamil Use DOC
Nicorandil
Conditions associated with Aortic Dissection
- Pregnancy
- Trauma
- Marfans Syndrome
- Turners Syndrome
- Noonans Syndrome
- Syphillis
Blood Finding in Cholesterol Emboli
Eosinophilia
Causes of Elevation of BNP
- Heart Failure
- Chronic Kidney Disease
- Sepsis
- COPD
- Cirrhosis
First Line Management of Hypertension in patient with Chronic Heart Failure
ACE Inhibitors -> Beta Blockers
Drug commonly prescribed to increase HDL Levels
Nicotinic Acid
Cause of Fixed Splitting of S2
Atrial Septal Defect
Cause of Wide Split S2
RBBB with Heart Failure
Cause of Loud S2
Hypertension
Cause of Soft S2
Aortic Stenosis
Aortic Stenosis marker of severity
Absent or Quiet S2
Target INR of Venous Thromboembolism
INR = 2.5
Target INR of Recurrent Venous Thromboembolism
INR = 3.5
Target INR of Atrial Fibrillation
INR = 2.5
Nicorandil MOA
Potassium Channel Activator
Aortic Stenosis Marker of Severity
S4
JVP Regular Cannon ‘a’ waves
Atrio Ventricular Nodal Re entry Tachycardia (AVNRT)
Investigation of choice for Pulmonary Artery Hypertension
Acute Vasodialator Testing
Endothelin Receptor Antagonist
Bosentan
Ambrisentan
Dentistry Procedure in Warfarinized patients
Check INR 72 hours before procedure and proceed if INR <4.0
HOCM Drugs to Avoid
NIA
Nitrates
Inotropes
ACE Inhibitors
HOCM Management
ABCDE
Amiodarone
Beta Blocker
Cardioverter Defibrillator
Dual Chamber Pacemaker
Endocarditis Prophylaxis
Ostium Secundum defect Features
ECG: RBBB with Right Axis Deviation
Ostium Primum defect Features
ECG: RBBB with Left Axis Deviation
Tri-Phalageal Thumb + Ostium Secundum
Holt–Oram syndrome
Clopidogrel Common Drug Interaction
Omeprazole (PPI)
Changes to Blood Pressure during Exercise
SBP Increases
DBP decreases
Malignant Hypertension Management
Oral Therapy: Atenolol
IV Therapy: Sodium Nitroprusside
ST depression seen in
Digoxin Use
Anterior Wall MI ECG Changes
ST elevation in V1 to V4
Lateral Wall MI ECG Changes
ST elevation inV5,V6 and avL
Inferior Wall MI ECG Changes
ST elevation in II, III, avF
ECG findings in Inferior MI with RV infarction
ST elevation in II, III, avF, V1
Posterior MI ECG Changes
ST depression in V1 and V2
Lateral Wall MI Artery
Left Circumflex artery
Cardiac Catheterization for Hyperthyroidism patient
Thyroid Radionucleotide Isotope Scan is done to identify between Graves Disease and Toxic Multinodular Goiter
Anti Hypertensives Safe in Pregnancy
- Labetalol
- Alpha Methyl Dopa
- Nifedipine
Diagnosis of Lumbar Pain following Pacemaker Insertion few weeks back
Infective Discitis
Acute Pulmonary Edema Initial Drug Therapy
IV Glyceryl Trinitrate
Antibiotics with QT prolongation
Macrolides and Quinolones
Relation of Alcohol and HDL Cholestrol
Alcohol Increases HDL Cholesterol
Definition of Long QT syndrome
QTc >450 mSec
Long QT Syndrome defective Ion Channel
Potassium Channel Alpha Sub-unit(LQT1, LQT2)
Most common congenital Long QT Syndrome
Potassium Channel Alpha Sub-unit (LQT1)
LQT1 mutation
Slow Delayed Rectifier Potassium Channel
LQT2 mutation
Rapid Delayed Rectifier Potassium Channel
Murmur worsening on Valsalva or Standing and Improves on Squatting
HOCM Murmur
Murmur Worsening on Squatting
- Aortic Stenosis
- VSD
Paradoxical Embolus with Normal Cardiovascular Examination Findings
Patent Foramen Ovale
DOC for WPW + Broad Complex Irregular Tachycardia
Procainamide
Common ECG finding in Congenital Myotonic Dystrophy
PR Prolongation
DOC for Reducing ventricular rate in AF
Digoxin
Heart Condition which is an absolute contraindication to pregnancy
Primary Pulmonary Hypertension
Tricuspid Stenosis + Pulmonary Embolus + Benign tumor of breast
Right Atrial Myxoma
MI with 1 hour history of Chest Pain
Percutaneous Coronary Intervention
MI with less than 12 hour history of Chest Pain
IV Thrombolysis followed by PCI
Features of Complete heart block
- Irregular Canon ‘a’ waves
- High Volume Pulse
- Systolic Murmur
Most common valve injured in Precordial Stab
Pulmonary Valve
HOCM Most common cause
Sarcomere Protein Gene Mutation
Investigation of choice for HOCM
Transthoracic Echo
Pulsus Alternans seen in
Acute Left Ventricular Heart Failure
Electrical Alternans seen in
Pericardial Effusion
Indications for Urgent Surgery in Infective Endocarditis
- Increasing PR interval
- Heart Failure
- Septal Perforation
Hypertensive Emergency with End Organ Damage Blood Pressure Decrease Protocol
Decrease in MAP by 15-25%
X-ray shows Calcification around heart borders + Low Voltage QRS
Constrictive Pericarditis
Management of Small Pulmonary Embolism
Rivaroxaban 15 mg for 21 days Followed by maintenance dose
Management of Large Pulmonary Embolism
- Thrombolytic Therapy
- Mechanical Intervention
NSTEMI Management
2 Antiplatelet + Heparin + Beta Blocker
Conditions where ductus arteriosus is kept open
Any Cyanotic Heart Disease
1. Tricuspid Atresia
2. TOF
3. TAPVC
4. TGA
Biventricular Hypertrophy + Murmur
VSD
First Cardiac Enzyme to Increase after Myocardial Necrosis
Glycogen Phosphorylase BB
Precordial Pulsations + Wheezing + Flushing + Loose Stools
Carcinoid Heart Disease
Indication for Thrombolysis post fluid bolus in PE
SBP of 80 mmHg
Medication NOT Associated with Torsades De Pointes
Verapamil
Which Cholesterol is associated with CAD
LDL- Cholesterol
Initial Shock Joules for Monophasic
360 J
Initial Shock Joules for Biphasic
150-200 J
AF long term Anticoagulation DOC
Rivaroxaban
Anti Hypertensive of Choice in patients with Lithium
CCB - Amlodipine (ACE/ARB are C/I)
Heart Condition in which BNP is not elevated
Unstable Angina
Chemotherapy drug associated with Dilated Cardiomegaly
Doxorubicin
Cardiac Enzyme to be elevated after DC Cardioversion
Creatinine Kinase
Features in ECG for Diagnosing VT
- RS duration of >100 ms
- Ventriculoatrial Dissociation in any of 12 leads
- Absence of RS Complexes
Poor Prognosis in HOCM
Septal wall thickness >3 CM
Drug Contraindicated in WPW
Verapamil (increases conduction via accessory system)
ECG Hypothermia Characteristic
J wave
Antiarrythmic with Highest Risk of Torsades de pointes
Sotalol
Antihypertensive contraindicated in myasthenia gravis
Beta Blockers
DVT Management in pregnancy
LMW Heparin throught pregnancy
Drug Causing Allergic Myocarditis
Co-Trimoxazole
Unilateral Swelling of eyelid + Travel to South America
Trypanosomiasis (Chagas Disease)
Main Indication of Inserting Pacemaker
Mobitz Type II block
Heart Failure + AF Drug of Choice
Digoxin
Multifocal Atrial Tachycardia in Pulmonary Artery Hypertension DOC
Verapamil
Time of Highest Risk of DVT in Pregnancy
First 6 weeks after delivery
Atrial fibrillation persist despite Multiple Drugs
Radiofrequency pulmonary vein isolation with ablation
Ankylosing Spondylitis associated heart murmur
Aortic Regurgitation murmur
CVS complication of Co-trimoxazole
Allergic Myocarditis
Second Trimester Diastolic BP Change
A 10mmMHg Drop in Diastolic due to reduction in PVR
Most important cell that drives atherosclerotic plaques
Macrophages
Reason for reduction of digoxin dose in older patients
Decreased renal clearance
ECG Shows complete heart block what is clinical feature
Variable S1
Tolerance to Nitric Oxide is due to
Reactive Oxygen Species
MR Carotid Angiography shows String of bead appearance
Fibromuscular Dysplasia
MR Carotid Angiography shows String of bead appearance
Fibromuscular Dysplasia
Most significant side effect of celecoxib
Can worsen heart failure
The fastest conduction velocities in the heart
Purkinje Fibers
Which molecule does troponin T bind to?
Tropomyosin
Which molecule does troponin I bind to?
Actin