Cardiology Flashcards
What are the classic ECG findings in hypothermia?
J waves
(also bradycardia, long QT)
R coronary artery
- Supply
- What happens if occluded
- RA, RV, nodes (in 90% of people)
- Proximal occlusion = complete heart block, Distal occlusion = first degree heart block/Wenckebech. Complete heart block in this instance develops progressively (initially first degree then second then complete)/resolves in 5-7d and causes asymptomatic brady. If it does not resolve it causes symptomatic brady.
Branches of L coronary artery and what they supply
- L anterior descending supplies anterior L side of heart
- Circumflex artery supplies outer side and back of the heart, occlusion causes lateral MI
Angina: what classifies as typical/atypical/non-anginal?
- Constricting sensation arm/chest/neck
- Precipitation by exertion
- Symptoms relieved in 5m by GTN
3 = typical
2 = atypical
0/1 = non-anginal
Treatment for IE with streptococcus viridans
Gent 3mg/kg + benzylpenicillin
ECG findings 1st degree heart block
PR >200ms
ECG findings 2nd degree heart block (mobitz 1)
Gradually increasing PR interval then dropped QRS
ECG findings 2nd degree heart block (mobitz 2)
PR interval stays the same and prolonged but also dropped QRS
ECG findings complete heart block
No association between P wave and QRS
How does complete heart block present clinically?
Syncope
Heart failure
How does clinical examination present in complete heart block?
Cannon a waves, wide pulse pressure, variable S1 intensity
Indications for a temporary pace maker
- Trifasicular block prior to surgery
- Symptomatic/unstable brady not responding to atropine
- ANTERIOR MI resulting in Mobitz 2 or complete heart block
Permanent pacemaker indications (6)
- Complete heart block
- Mobitz 2
- Heart block following MI
- Trifasicular block if syncope/other cardiac Sx/complete heart block
- Sick sinus syndrome
- Drug resistant tachy
What are 4 types of cardiomyopathy
- Hypertrophic cardiomyopathy (HOCM)
- Dilated cardiomyopathy
- Restrictive cardiomyopathy
- Takutsubo cardiomyopathy
What are the gene mutations in HOCM
B myosin heavy chain and myosin binding protein C
Autosomal dominant
HOCM features on examination
Ejection systolic murmur
Jerky pulse
Large A waves
S4
Management HOCM
A: amiodarone (NOT ACE/ARB)
B: beta blocker
C: Cardiac pacemaker
D: dual chamber pacemaker
E: (infective) endocarditis prophylaxis
ECG changes in HOCM
Progressive TWI
Deep Q waves
LAD
LVH
ECHO in HOCM
LV hypertrophy with no dilation
Mitral Regurg
Systolic anterior motion of anterior valve leaflet
Asymmetrical hypertrophy
What type of dysfunction is caused by dilated cardiomyopathy and why?
Dilation of all 4 chambers of the heart causing systolic dysfunction
Causes of dilated cardiomyopathy
Alcohol
Pregnancy
myocarditis
Duchenne
Doxorubicin
What type of dysfunction is caused by restrictive cardiomyopathy and why?
Diastolic dysfunction due to reduced ventricular compliance
ECG findings in restrictive cardiomyopathy
Low voltage
BBB
Causes of restrictive cardiomyopathy
Amyloidosis
Sarcoid
Scleroderma
Haemochromatosis