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XUAN MSRA > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is Beck’s triad for cardiac tamponade and when is thi seen clinically?

A

1) Hypotension
2) Raised JVP
3) Muffled heart sounds

Seen in cardiac tamponade

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2
Q

What is the most important cause of ventricular tachycardia?

A

Hypokalaemia

Followed by hypomagnesaemia
NOTE: severe hyperkalaemia can also cause in certain circumstances e.g. in patients with structural heart disease

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3
Q

What are the shockable rhythms? And their drug management?

A

1) Ventricular fibrillation
2) Pulsess VT

Management: Amiodaraone 300mg (or lidocaine), after 3 shocks

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4
Q

What are the non-shockable rhythms?

A

1) Asystole
2) PEA

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5
Q

When do you give adrenaline in cardiac arrest? Also what dose

A

Non-shockale- ASAP
Shockable- after 3rd shock
Repeat adrenaline every 3-5mins
Adrenaline 1mg

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6
Q

What are the reversible causes of cardiac arrest?

A

Hs:
Hypoxia
Hypovolaemia
Hypothermia
Hyperkalaemia, hypokalaemia, hypoglycaemia, hypocalcaemia, acidaemi and other metabolic disorders

Ts:
Thrombosis
Tension pneumothorax
Tamponade (cardiac)
Toxins

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7
Q

What is the drug management of angina?

A

1st line: beta-blocker or rate-limiting calcium channel blocker (e.g. verapamil or diltiazem)
2nd line: both (if used in combo with BB use elongating CCP e.g. amlodipine, MR nifedipine)
3rd line: long-acting nitrate, ivabradine, nicorandil, ranolazine (and refer for PCI/CABG)

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8
Q

What are the ECG changes caused by hypokalaemia?

A

1) U waves
2) small or absent t waves
3) Prolonged PR interval
4) St depression
5) long QT interval

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9
Q

What ECG changes do you expect with pericarditis?

A

Often global/widespread changes
1)’saddle-shaped ST elevation”
2) PR depression (most specific for pericarditis)

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10
Q

Side effects of GTN spray

A

Hypotension
Tachycardia
Headache

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11
Q

Characterise aortic regurgitation murmur?

A

Early diastolic

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12
Q

Characterise mitral regurgitation murmur?

A

Pansystolic

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13
Q

What are the complications of MI?

A

1) Cardiac arrest (VF- most common cause
2) Cardiogenic shock
3) Chronic heart failure
4) Tachyarrhythmia- e.g. VF
5) AV block after Inferior MI
6) Pericarditis- normally in first 48hrs
7) Dressler’s syndrome- 2-6 weeks later (fever, pleuritic pain, pericardial effusion and raised ESR)
8) Left ventricular aneurysm (persistent ST elevation LVF)
9) Left ventricular free wall rupture
10) Ventricular septal defect
11) Acute mitral regurgitation- acute hypotension and flash pulmonary oedema

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14
Q

Characterise aortic stenosis

A

Ejection systolic murmur

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15
Q

Causes of RBBB

A

1) normal variant - more common with increasing age
2) right ventricular hypertrophy
3) chronically increased right ventricular pressure - e.g. cor pulmonale
4) pulmonary embolism
5) myocardial infarction
6) atrial septal defect (ostium secundum)
7) cardiomyopathy or myocarditis

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16
Q

Chronic heart failure management

A

1st line: ACEi and Beta-blocker
2nd: Aldosterone antagonist e.g. spironolactone or eplerenone
3rd line: Ivabradine, sacubitril-valsartan, hydralazine in combo with nitrate, digoxin and cardiac resynchronisation

17
Q

Management of hypertension in patients with T2 diabetes?

A

ACE inhibitor or an angiotensin receptor blocker regardless of age

18
Q

Characterise mitral stenosis murmur

A

mid-late diastolic murmur

19
Q

Management of angina if there is co-existent AF and chronic heart failure?

A

Digoxin

20
Q

Pharmacological cardioversion for AF

A

1) flecainide or amiodarone if there is no evidence of structural or ischaemic heart disease or
2) amiodarone if there is evidence of structural heart disease.’

21
Q

ECG changes for hypercalcaemia

A

Shortened QT

22
Q

When is PCI used?

A
  • should be offered if the presentation is within 12 hours of the onset of symptoms AND PCI can be delivered within 120 minutes of the time when fibrinolysis could have been given (i.e. consider fibrinolysis if there is a significant delay in being able to provide PCI)
23
Q

When is fibrinolysis used?

A

should be offered within 12 hours of the onset of symptoms if primary PCI cannot be delivered within 120 minutes of the time when fibrinolysis could have been given

24
Q

What is antiplatelet therapy for patients with STEMi prior to PCI?

A

‘dual antiplatelet therapy’, i.e. aspirin + another drug:
- if the patient is not taking an oral anticoagulant: prasugrel
- if taking an oral anticoagulant: clopidogrel

25
Q

What is antiplatelet therapy for patients with STEMi during PCI?

A

Radial access:
unfractionated heparin with bailout glycoprotein IIb/IIIa inhibitor (GPI)

Femoral access:
bivalirudin with bailout GPI

26
Q

What is drug therapy for patients with NSTEMi prior to PCI?

A

1) antithrombin treatment:
- fondaparinux should be offered to patients who are not at a high risk of bleeding and who are not having angiography immediately
- if immediate angiography is planned or a patients creatinine is > 265 µmol/L then unfractionated heparin should be given

2) DAPT i.e. aspirin + another drug:
- if the patient is not taking an oral anticoagulant: prasugrel or ticagelor
- if taking an oral anticoagulant: clopidogrel

For PCI unfractionated heparin should be given regardless of whether the patient has had fondaparinux or not

27
Q

What is the conservative management of NSTEMi/ unstable angina?

A

‘dual antiplatelet therapy’, i.e. aspirin + another drug)
if the patient is not at a high risk of bleeding: ticagrelor
if the patient is at a high risk of bleeding: clopidogrel

28
Q

What are the two types of aortic dissection?

A

1) type A - ascending aorta, 2/3 of cases
2) type B - descending aorta, distal to left subclavian origin, 1/3 of cases

29
Q

What are the investigations for aortic dissection?

A

For stable pts:
CT angiography of the chest, abdomen and pelvis- shows false lumen

For unstable pts:
Transoesophageal echocardiography (TOE)

CXR- shows widened mediastinum

30
Q

What is the management of aortic dissection?

A

Type A
-surgical management, but blood pressure should be controlled to a target systolic of 100-120 mmHg whilst awaiting intervention

Type B*
- conservative management
- bed rest
- reduce blood pressure IV labetalol to prevent progression

31
Q

What are the complications of aortic dissection?

A

Backward tear:
1) Aortic regurgitation/incompetence
2) MI (normally inferior due to RCA involvement)

Forward tear:
3) unequal arm pulses and BP
4) stroke
5) renal failure

32
Q

What vessel is affected by inferior MI and where are the expected ECG changes?

A

Right coronary artery

II, III and aVF

33
Q

What vessel is affected by posterior MI and where are the expected ECG changes?

A

left circumflex and right coronary artery

V1-V3

Reciprocal changes of STEMI are typically seen:
horizontal ST depression
tall, broad R waves
upright T waves
dominant R wave in V2

Posterior infarction is confirmed by ST elevation and Q waves in posterior leads (V7-9)

34
Q

What vessel is affected by anterior MI and what are the expected ECG changes?

A

Left anterior descending

Anterolateral:
V1-6, I, aVL

Anteroseptal:
V1-V4

35
Q

What vessel is affected by lateral MI and what are the expected ECG changes?

A

Left circumflex

I, aVL +/- V5-6

36
Q

What is Brugada syndrome and its management?

A

A form of inherited cardiovascular disease with may present with sudden cardiac death

Autosomal dominant

Management: implantable cardioverter-defibrillator

37
Q

What is the management of HOCM?

A

Amiodarone
Beta-blockers or verapamil for symptoms
Cardioverter defibrillator
Dual chamber pacemaker
Endocarditis prophylaxis*

38
Q

What drugs should you avoid in HOCM?

A

nitrates
ACE-inhibitors
inotropes

XUAN MSRA (20 decks)

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