cardiology Flashcards
causes of long QT syndrome
congenital
- Jervell-Lange-Nielsen syndrome
drugs
- amiodarone
- sotalol
- TCA
- SSRI
- methadone
- chloroquine
electrolytes
- low CA K MG
causes of right axis deviation
- right ventricular hypertrophy
- left posterior hemiblock
- lateral myocardial infarction
- chronic lung disease → cor pulmonale
- pulmonary embolism
- ostium secundum ASD
- Wolff-Parkinson-White syndrome* - left-sided accessory pathway
- normal in infant < 1 years old
- minor RAD in tall people
causes of left axis deviation
left anterior hemiblock
left bundle branch block
inferior myocardial infarction
Wolff-Parkinson-White syndrome* - right-sided accessory pathway
hyperkalaemia
congenital: ostium primum ASD, tricuspid atresia
minor LAD in obese people
contraindication to adenosine
asthma as it causes bronchoconstriction
mx of INR >8 with minor bleeding
Stop warfarin
Give intravenous vitamin K 1-3mg
Repeat dose of vitamin K if INR still too high after 24 hours
Restart warfarin when INR < 5.0
mx of INR >8 no bleeding
Stop warfarin
Give vitamin K 1-5mg by mouth, using the intravenous preparation orally
Repeat dose of vitamin K if INR still too high after 24 hours
Restart when INR < 5.0
mx of INR 5-8 minor bleeding
Stop warfarin
Give intravenous vitamin K 1-3mg
Restart when INR < 5.0
mx of INR 5-8 with no bleeding
withhold 1 -2 doses of warfarin
reduce subsequent maintenance dose
mx of major bleeding with a pt on warfarin
stop warfarin
Give intravenous vitamin K 5mg
Prothrombin complex concentrate - if not available then FFP
what is bifascicular block
the combination of RBBB with left anterior or posterior hemiblock
e.g. RBBB with left axis deviation
what is trifasciular block
features of bifascicular block as above + 1st-degree heart block
anteroseptal ECG changes in which leads and which artery is affected?
V1-4
LAD
inferior ECG changes in which leads and which artery is affected?
II, III, AVF
right coronary
anterolateral ECG changes in which leads and which artery is affected?
V1-6 I AVL
proximal LAD
lateral ECG changes in which leads and which artery is affected?
I, AVL, +/- V5-6
left circumflex
posterior ECG changes in which leads and which artery is affected?
V1-3
- reciprocal changes of STEMI ie horizontal ST depression
left circumflex and right coronary
digoxin ECG changes
short QT
arrhythmias
ECG changes hypokalaemia
U waves
small/absent T waves
prolonged PR
ST depression
long QT
In Hypokalaemia, U have no Pot and no T, but a long PR and a long QT
ECG changes hypothermia
bradycardia
J/osborne waves = small hump at end of QRS complex
first degree heart block
how to remember the difference between LBBB and RBBB
WiLLiaM MaRRoW
in LBBB there is a ‘W’ in V1 and a ‘M’ in V6
in RBBB there is a ‘M’ in V1 and a ‘W’ in V6
causes of LBBB
always pathological
- MI
- HYT
- AS
- cardiomyopathy
- rare = digoxin toxicity, idiopathic fibrosis
causes of prolonged PR interval
idiopathic
ischaemic heart disease
digoxin toxicity
hypokalaemia
rheumatic fever
aortic root pathology e.g. abscess secondary to endocarditis
Lyme disease
sarcoidosis
myotonic dystrophy
causes of short PR interval
WPW syndrome
causes of RBBB
normal variant - more common with increasing age
right ventricular hypertrophy
chronically increased right ventricular pressure - e.g. cor pulmonale
pulmonary embolism
myocardial infarction
atrial septal defect (ostium secundum)
cardiomyopathy or myocarditis
causes of inverted T waves
myocardial ischaemia
digoxin toxicity
subarachnoid haemorrhage
arrhythmogenic right ventricular cardiomyopathy
pulmonary embolism (‘S1Q3T3’)
Brugada syndrome
what is S1 heart sound
closure of mitral and tricuspid valves
what is S2 heart sounds
closure of aortic and pulmonary valves
what causes S3 heart sound
diastolic filling of ventricle
normal if <30
abnormal
- LV failure -> dilated cardiomyopathy
- constrictive pericarditis
- MR
what causes S4
AS
HOCM
HYT
caused by atrial contraction against stiff ventricle
mnemonic for heart sounds
My Two Apple Pies are Very Sweet
M - Mitral S1
T - Tricuspid S1
A - aortic S2
P - pulmonary S2
V - ventricular filling S3
S - stiff ventricle S4
what causes a loud vs quiet S1
loud = MS, short PR
quiet = MR
what condition causes:
- persistent ST elevation 4 weeks post MI
- bi-basal crackles
- s3 and s4 heart sounds
left ventricular aneurysm
what complication of MI causes an acute mitral regurgitation
infero-post MI causes ischaemia/rupture of papillary muscle
causes hypotension, MR, pul oedema
antiplatelets - TIA or ischaemic stroke
lifelong
1st = clopidogrel
2nd = aspirin and dipyridamole
antiplatelets - PCI
aspirin lifelong
prasugrel/clopidogrel 12 months
antiplatelets ACS (no PCI)
aspirin lifelong
ticagrelor 12 months
antiplatelets PAD
lifelong
1st = clopidogrel
2nd = aspirin
causes of acute pericarditis
coxsackie
TB
uraemia
post MI -> weeks = autoimmune Dresslers
radiotherapy
lung/breast cancer
trauma
RA/SLE
ECG changes pericarditis
saddle shapped ST elevation
PR depression
fx of pericarditis
pleuritic chest pain, relieved sitting forward
flu like symptoms
pericardial rub
ix pericarditis
ECG
TT echo
bloods -> inflamm and troponin
mx pericarditis
NSAIDS and colchicine
if triple therapy for HYT is ineffective and potassium <4.5 which drug should be added
spironolactone
if >4.5 add beta or alpha blocker
echo findings for atrial myxoma
pedunculated heterogeneous mass
most common primary cardiac tumour
which BP would require urgent further IX?
> 180/120
what signs to look for if BP >180/120
retinal haemorrhage
papilloedema
new onset confusion
chest pain
HF signs
AKI
headache, palp, sweating
definitive mx for brugada syndrome
implantable cardioverter-defib
drugs used to prevent angina attacks
beta blocker or verapamil/diltazem
which CCB are rate limiting
diltiazem or verapamil
which beta blockers are cardioselective
aten or bisoprolol
1st line tx for reduced LVEF?
ACEi+ BB
CCB are contraindicated in HF as depress heart function and exacerbate symptoms
- except amlodipine
tamonade vs pericarditis
tamponade
- elevated JVP
- muffled heart sounds
- hypotension
- electrical alternans on ECG
- pericarditis can cause tamponade
what is pulsus paradoxus and what is it assoc with
drop in BP of >10mmHg during inspiration
assoc with tamponade
indications for temporary pacemakers
unstable/unresponsive to atropine bradycardia
post anterior MI with type 2 or complete heart block
trifascicular block prior to surgery
mackler triad for boerhaave syndrome
vomiting
thoracici pain
subcut emphysema
what fx are present in a proximal aortic dissection
aortic regurgitation and inferior MI
drug mx of angina
everyone: statin, aspirin, GTN reliever
1st line: BB or CCB
- if poor response at start, increase to max dose
if CCB monotherapy = verapamil or diltiazem
2nd line: combine BB and CCB
if in combo with BB = amlodipine
if cannot tolerate combo or waiting on PCI/CABG start
isosorbide nitrate -> asymmetric dosing
ivabradine
nicorandil
ranolazine
if a pt is started on ACEi and has significant renal dysfunction within short time of taking drug, what could be underlying diagnosis
bilateral renal A stenosis
likely cause of HYT in young pt
mx of aortic dissection
Type A: ASS
Surgery and Systolic Management of 100-120
Type B: BooBs
Bed rest and Beta Blockers IV labetalol
what ECG changes are assoc with PE
sinus tachy
S1Q3T3
- deep S waves in I
- pathological Q waves in III
- inverted T waves in III
where is furosemide site of action
ascending thick loop of henle
inheritance pattern of hypertrophic cardiomyopathy
autosomal dominant
contraindications to statins
macrolides -> clarithromycin as increases risk of rhabdomyolysis/myopathy causing kidney damage so check creatine kinase levels
pregnancy
what is the biggest RF for aortic dissection
hypertension
JVP rising on inhalation is a sign of which condition
contrictive pericarditis -> kussmaul’s sign
in tamponade, it is raised but doesn’t increase with inspiration
reversal for dabigatran
idarucizumab
ECG finding of HOCM
left ven hypertrophy = tall R waves in V4-6 and deep S waves in V1-3 that exceed 40mm
mx for native valve endocarditis
amox + gentamicin
mx for native valve endocarditis + severe sepsis/pen allergy/MRSA
vancomycin + gentamicin
mx for native valve endocarditis with RF for gram -ve infection
vancomycin + meropenem
mx prosthetic valve endocarditis
vancomycin, gentamicin + rifampacin
dose of atorovastatin for primary vs secondary prevention
80mg secondary, 20mg primary
when are thiazide-like diuretics contraindicated in the tx of HYT
if pt has gout as increase levels of serum uric acid
what is atypical anginal pain
NICE define anginal pain as the following:
1. constricting discomfort in the front of the chest, or in the neck, shoulders, jaw or arms
2. precipitated by physical exertion
3. relieved by rest or GTN in about 5 minutes
patients with all 3 features have typical angina
patients with 2 of the above features have atypical angina
patients with 1 or none of the above features have non-anginal chest pain
which valve disease is most commonly assoc with marfan syndrome
aortic regurg
mARfans
which ECG change is common with mitral stenosis and what does it represent?
P mitrale = left atrial hypertrophy/strain
in a pt with CKD and potassium >6, what should be done regarding their antiHYT
stop ACEI and switch to different agent
secondary casues of HYT
RECENT
Renal
Endocrine
Coarc of aorta
Estrogen
Neurological
Treatment
