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passmed ! > cardiology > Flashcards

cardiology Flashcards

1
Q

causes of long QT syndrome

A

congenital
- Jervell-Lange-Nielsen syndrome

drugs
- amiodarone
- sotalol
- TCA
- SSRI
- methadone
- chloroquine

electrolytes
- low CA K MG

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2
Q

causes of right axis deviation

A
  • 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
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3
Q

causes of left axis deviation

A

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

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4
Q

contraindication to adenosine

A

asthma as it causes bronchoconstriction

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5
Q

mx of INR >8 with minor bleeding

A

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

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6
Q

mx of INR >8 no bleeding

A

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

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7
Q

mx of INR 5-8 minor bleeding

A

Stop warfarin
Give intravenous vitamin K 1-3mg
Restart when INR < 5.0

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8
Q

mx of INR 5-8 with no bleeding

A

withhold 1 -2 doses of warfarin
reduce subsequent maintenance dose

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9
Q

mx of major bleeding with a pt on warfarin

A

stop warfarin
Give intravenous vitamin K 5mg
Prothrombin complex concentrate - if not available then FFP

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10
Q

what is bifascicular block

A

the combination of RBBB with left anterior or posterior hemiblock
e.g. RBBB with left axis deviation

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11
Q

what is trifasciular block

A

features of bifascicular block as above + 1st-degree heart block

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12
Q

anteroseptal ECG changes in which leads and which artery is affected?

A

V1-4

LAD

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13
Q

inferior ECG changes in which leads and which artery is affected?

A

II, III, AVF

right coronary

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14
Q

anterolateral ECG changes in which leads and which artery is affected?

A

V1-6 I AVL
proximal LAD

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15
Q

lateral ECG changes in which leads and which artery is affected?

A

I, AVL, +/- V5-6
left circumflex

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16
Q

posterior ECG changes in which leads and which artery is affected?

A

V1-3
- reciprocal changes of STEMI ie horizontal ST depression

left circumflex and right coronary

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17
Q

digoxin ECG changes

A

short QT
arrhythmias

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18
Q

ECG changes hypokalaemia

A

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

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19
Q

ECG changes hypothermia

A

bradycardia
J/osborne waves = small hump at end of QRS complex
first degree heart block

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20
Q

how to remember the difference between LBBB and RBBB

A

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

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21
Q

causes of LBBB

A

always pathological
- MI
- HYT
- AS
- cardiomyopathy
- rare = digoxin toxicity, idiopathic fibrosis

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22
Q

causes of prolonged PR interval

A

idiopathic
ischaemic heart disease
digoxin toxicity
hypokalaemia
rheumatic fever
aortic root pathology e.g. abscess secondary to endocarditis
Lyme disease
sarcoidosis
myotonic dystrophy

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23
Q

causes of short PR interval

A

WPW syndrome

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24
Q

causes of RBBB

A

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

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25
Q

causes of inverted T waves

A

myocardial ischaemia
digoxin toxicity
subarachnoid haemorrhage
arrhythmogenic right ventricular cardiomyopathy
pulmonary embolism (‘S1Q3T3’)
Brugada syndrome

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26
Q

what is S1 heart sound

A

closure of mitral and tricuspid valves

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27
Q

what is S2 heart sounds

A

closure of aortic and pulmonary valves

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28
Q

what causes S3 heart sound

A

diastolic filling of ventricle
normal if <30
abnormal
- LV failure -> dilated cardiomyopathy
- constrictive pericarditis
- MR

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29
Q

what causes S4

A

AS
HOCM
HYT
caused by atrial contraction against stiff ventricle

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30
Q

mnemonic for heart sounds

A

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

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31
Q

what causes a loud vs quiet S1

A

loud = MS, short PR
quiet = MR

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32
Q

what condition causes:
- persistent ST elevation 4 weeks post MI
- bi-basal crackles
- s3 and s4 heart sounds

A

left ventricular aneurysm

33
Q

what complication of MI causes an acute mitral regurgitation

A

infero-post MI causes ischaemia/rupture of papillary muscle

causes hypotension, MR, pul oedema

34
Q

antiplatelets - TIA or ischaemic stroke

A

lifelong
1st = clopidogrel
2nd = aspirin and dipyridamole

35
Q

antiplatelets - PCI

A

aspirin lifelong
prasugrel/clopidogrel 12 months

36
Q

antiplatelets ACS (no PCI)

A

aspirin lifelong
ticagrelor 12 months

37
Q

antiplatelets PAD

A

lifelong
1st = clopidogrel
2nd = aspirin

38
Q

causes of acute pericarditis

A

coxsackie
TB
uraemia
post MI -> weeks = autoimmune Dresslers
radiotherapy
lung/breast cancer
trauma
RA/SLE

39
Q

ECG changes pericarditis

A

saddle shapped ST elevation
PR depression

40
Q

fx of pericarditis

A

pleuritic chest pain, relieved sitting forward
flu like symptoms
pericardial rub

41
Q

ix pericarditis

A

ECG
TT echo
bloods -> inflamm and troponin

42
Q

mx pericarditis

A

NSAIDS and colchicine

43
Q

if triple therapy for HYT is ineffective and potassium <4.5 which drug should be added

A

spironolactone

if >4.5 add beta or alpha blocker

44
Q

echo findings for atrial myxoma

A

pedunculated heterogeneous mass

most common primary cardiac tumour

45
Q

which BP would require urgent further IX?

A

> 180/120

46
Q

what signs to look for if BP >180/120

A

retinal haemorrhage
papilloedema
new onset confusion
chest pain
HF signs
AKI
headache, palp, sweating

47
Q

definitive mx for brugada syndrome

A

implantable cardioverter-defib

48
Q

drugs used to prevent angina attacks

A

beta blocker or verapamil/diltazem

49
Q

which CCB are rate limiting

A

diltiazem or verapamil

50
Q

which beta blockers are cardioselective

A

aten or bisoprolol

51
Q

1st line tx for reduced LVEF?

A

ACEi+ BB

CCB are contraindicated in HF as depress heart function and exacerbate symptoms
- except amlodipine

52
Q

tamonade vs pericarditis

A

tamponade
- elevated JVP
- muffled heart sounds
- hypotension
- electrical alternans on ECG
- pericarditis can cause tamponade

53
Q

what is pulsus paradoxus and what is it assoc with

A

drop in BP of >10mmHg during inspiration

assoc with tamponade

54
Q

indications for temporary pacemakers

A

unstable/unresponsive to atropine bradycardia

post anterior MI with type 2 or complete heart block

trifascicular block prior to surgery

55
Q

mackler triad for boerhaave syndrome

A

vomiting
thoracici pain
subcut emphysema

56
Q

what fx are present in a proximal aortic dissection

A

aortic regurgitation and inferior MI

57
Q

drug mx of angina

A

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

58
Q

if a pt is started on ACEi and has significant renal dysfunction within short time of taking drug, what could be underlying diagnosis

A

bilateral renal A stenosis

likely cause of HYT in young pt

59
Q

mx of aortic dissection

A

Type A: ASS
Surgery and Systolic Management of 100-120

Type B: BooBs
Bed rest and Beta Blockers IV labetalol

60
Q

what ECG changes are assoc with PE

A

sinus tachy

S1Q3T3
- deep S waves in I
- pathological Q waves in III
- inverted T waves in III

61
Q

where is furosemide site of action

A

ascending thick loop of henle

62
Q

inheritance pattern of hypertrophic cardiomyopathy

A

autosomal dominant

63
Q

contraindications to statins

A

macrolides -> clarithromycin as increases risk of rhabdomyolysis/myopathy causing kidney damage so check creatine kinase levels

pregnancy

64
Q

what is the biggest RF for aortic dissection

A

hypertension

65
Q

JVP rising on inhalation is a sign of which condition

A

contrictive pericarditis -> kussmaul’s sign

in tamponade, it is raised but doesn’t increase with inspiration

66
Q

reversal for dabigatran

A

idarucizumab

67
Q

ECG finding of HOCM

A

left ven hypertrophy = tall R waves in V4-6 and deep S waves in V1-3 that exceed 40mm

68
Q

mx for native valve endocarditis

A

amox + gentamicin

69
Q

mx for native valve endocarditis + severe sepsis/pen allergy/MRSA

A

vancomycin + gentamicin

70
Q

mx for native valve endocarditis with RF for gram -ve infection

A

vancomycin + meropenem

71
Q

mx prosthetic valve endocarditis

A

vancomycin, gentamicin + rifampacin

72
Q

dose of atorovastatin for primary vs secondary prevention

A

80mg secondary, 20mg primary

73
Q

when are thiazide-like diuretics contraindicated in the tx of HYT

A

if pt has gout as increase levels of serum uric acid

74
Q

what is atypical anginal pain

A

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

75
Q

which valve disease is most commonly assoc with marfan syndrome

A

aortic regurg

mARfans

76
Q

which ECG change is common with mitral stenosis and what does it represent?

A

P mitrale = left atrial hypertrophy/strain

77
Q

in a pt with CKD and potassium >6, what should be done regarding their antiHYT

A

stop ACEI and switch to different agent

78
Q
A

passmed ! (6 decks)

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