Cardiology Flashcards
What ABPI would you expect in arterial disease?
<0.8
Define first degree heart block
PR interval >0.2s
What is the difference between Mobitz type 1 and type 2 heart block?
T1 - progressive prolongation of PR interval
T2 - Intermittent failure of conduction of atrial impulse without progressive prolongation of PR interval
What is a Baker’s cyst?
Popliteal cyst is the result of accumulation of joint synovial fluid outside the knee joint - in the interval between the semimembranosus and the medial gastrocnemius.
What is a normal PR?
0.12-0.2s or 3-5 small squares
How do we determine right axis deviation?
The QRS complex is negative in lead I
How do we determine L axis deviation?
The QRS complex is negative in II and aVF
When do we give oxygen in MI?
If sats <94% or if pulmonary oedema
When can you return to sexual intercourse after an MI?
1/12
When can you return to work after an MI?
2/12
What are the non-shockable rhythms?
PEA and asystole
How does aortic dissection in the aortic arch and the descending aorta differ in presentation?
Aortic arch = pain in the neck or jaw
Descending aorta = pain in the intrascapular area
What is the first-line anti-anginal medication?
BB or CCB to reduce the sx of stable angina
What is stage 1 htn?
Clinic BP reading of 140/90 to 159/99
ABPM 135/85 to 149/94
What is stage 2 htn?
Clinic BP reading of >=160/100 to 180/120
ABPM average over 150/95
What is stage 3 htn?
Clinic BP of >= 180/120
What is a provoked DVT?
Associated with a transient risk factor such as significant immobility, surgery, trauma, pregnancy or puerperium. Unprovoked have no identifiable risk factor or one which cannot easily be removed e.g. active ca or thrombophilia
What is pulsus paradoxus?
An exaggeration of the normal inspiratory decrease of systemic BP (>12mmHg or 9%)
Where do you see pulsus paradoxus?
Constrictive pericarditis
Severe obstructive pulmonary disease
Restrictive cardiomyopathy
PE
Rapid and laboured breathing
Right ventricular infarction with shock
How does pericarditis present?
To do
What is Beck’s triad?
Increased JVP, hypotension and muffled heart sounds = cardiac tamponade
How do we treat ? cardiac tamponade
Pericardiocentesis when clinically unstable
When do we use dipyramidole?
Indicated for secondary prevention of stroke (not associated with AF) and TIAs (either alone or with aspirin). Can also be used as an adjunct to oral anticoagulation for prophylaxis of VTE associated w/ prosthetic heart valves
What is the most common cause of rhabdomyolysis?
Fall w/ long lie
What are the ECG changes in hyperkalaemia?
Prolonged PR
Broad, bizarre QRS complexes
Peaked T waves
What is pulsus paradoxus?
An exaggeration (>12mmHg or 9%) of the normal inspiratory decrease in systolic blood pressure. Seen in cardiac tamponade
What is Kussmaul sign?
Paradoxical increase in venous distension and pressure during inspiration. Seen in cardiac tamponade
What is Ewart sign or Pins sign
Seen in pts with large pleural effusions & is described as an area of dullness, with bronchial breath sounds and bronchophony below the angle of the left scapula. Seen in tamponade
How do we treat cardiac tamponade?
Pericardiocentesis
How do we manage those on warfarin with AF?
Considering switching patients from warfarin to a DOAC at the next review
What is seen on ECG in hypercalcaemia?
Reduced QT interval
What is seen on ECG in hypocalcaemia
Prolonged QT interval
What is the most common cause of pericarditis?
Viral infection
What is lone AF?
AF in younger adults (<60y.o.) with no clinical history or echocardiographic evidence of cardiovascular disease/pulmonary conditions
What is paroxysmal AF?
Episodes lasting longer than 30s but less than 7/7 that are self-terminating and recurrent
How do we manage acute HF?
Sit pt upright and give 100% O2 unless CO2 retainer
Furosemide IV
Consider small amounts opioids if pain
GTN IV BP permitting
Consider CPAP if poor response
What do we administer directly after thrombolysis of MI?
Heparin
What are femoral pseudoaneurysms?
Haematomas that result from a leaking hole in an artery - complication of cardiac catheterisation
Present with pulsatile mass, femoral bruit and compromised distal pulses
How does AAA present?
Constant and gnawing epigastric pain
Pain radiating to lower back and both groins
Palpable pulsatile mass just left of the midline of the umbilicus
What is Tietze’s syndrome?
Like costochondritis but with swelling of the costal cartilages
How does the pain in pericarditis change on movement?
Worsens on lying down, improves on sitting forward
What do you see on ECG in PE?
Sinus tachy
Right axis deviation
RBBB
Rarely S1QIIITIII
How does digoxin toxicity impact eyesight?
Objects may appear green or yellow
How does digoxin toxicity present on ECG?
Reverse tick sign - ST depression and inverted T waves in V5-6
How may hypokalaemia present?
Muscle weakness and cramps
What is the most common cause of IE?
S aureus
What ECG change do you see in hypothermia?
J waves
When do we offer ABPM?
If clinic BP between 140/90 and 180/120
When does Dressler’s syndrome usually present?
1-6wks post MI
Pericarditis
How do we manage htn in an under 40y.o. with no evidence of disease?
Refer to investigate secondary cause of htn
What is Vincent’s angina?
Vincent’s angina is a bacterial infection that causes inflammation of the tonsils and pharynx, and is also known as trench mouth
How does oesophageal spasm present?
Painful contractions in the esophagus that can feel like sudden chest pain. These contractions can also cause difficulty swallowing or regurgitation.
When do we favour warfarin over apixaban?
If eGFR <30ml/min, significant liver dysfunction or weight greater than 120kg
What is streptokinase?
Thrombolytic agent derived from streptococcal bacteria
What is the ORBIT score used for?
Risk of major bleeding with anticoagulation in pts with AF
What is first-line in stable angina?
BB or CCB
How does hypokalaemia present?
Fatigue, muscle cramps, spasms and polyuria
How does digoxin toxicity present?
Yellow-green distortion
Reverse tick sign on ECG
Which ECG change is characteristic of hypothermia?
J waves
What does nicotinic acid do?
lowers both cholesterol and triglyceride concentrations by inhibiting synthesis & it also increases HDL-cholesterol.
Give a common SE of nicotinic acid
Vasodilation - flushing
