Cardiology Flashcards
1
Q
Causes for prolonged QT interval
(DRUGS)
A
- Amiodarone, sotalol, class 1a antiarrhythmic - –drugs
- Tricyclic antidepressants, selective serotonin reuptake inhibitors (especially citalopram)
- Methadone
- Chloroquine
- Terfenadine**
- Erythromycin
- Haloperidol / Risperidone
- Ondansetron
2
Q
Causes for prolonged QT interval
(CONGENITAL)
A
- Jervell-Lange-Nielsen syndrome (includes deafness and is due to an abnormal potassium channel)
- Romano-Ward syndrome (no deafness
3
Q
Causes for prolonged QT interval
(METABOLIC)
A
- Electrolyte: hypocalcaemia, hypokalaemia, hypomagnesaemia
- Acute myocardial infarction
- Myocarditis
- Hypothermia
- Subarachnoid haemorrhage
4
Q
Clinical Signs Severe AS
A
- Soft second heart sound
- Valvular gradient >40 mmhg
5
Q
S3
A
- caused by diastolic filling of the ventricle
- considered normal if < 30 years old (may persist in women up to 50 years old)
- LVF (e.g. dilated cardiomyopathy), constrictive pericarditis (called a pericardial knock) and MR
6
Q
S4
A
- may be heard in aortic stenosis, HOCM, hypertension
- caused by atrial contraction against a stiff ventricle
- therefore coincides with the P wave on ECG
in HOCM a double apical impulse may be felt as a result of a palpable S4
7
Q
Anti-Coagulants and its Antidotes
A
- Heparin - Protamine Sulphate
- Warfarin - Phytomenadione
- Dabigatran - Idarucizumab
- Apixaban, Rivaroxaban - Andexanet alfa
8
Q
Features suggesting VT rather than SVT with aberrant conduction
A
- AV dissociation
- Fusion or capture beats
- Positive QRS concordance in chest leads
- Marked left axis deviation
- History of IHD
- Lack of response to adenosine or carotid sinus massage
- QRS > 160 ms
9
Q
First-line drug for Angina pectoris
A
- B-Blocker (Bisoprolol)
- Rate limiting CCB (Verapamil, Diltiazem)
* Don’t prescribe B-Blocker with CCB (risk of AV block)
10
Q
Prominent V waves on JVP
A
Tricuspid Regurgitation
11
Q
JVP waves in A.Fib
A
- Absent A waves
- Absent X descent
12
Q
Conditions having ‘Prominent X descent’ in JVP
A
- Cardiac Tamponade
- Constrictive Pericarditis
13
Q
Most accurate method to determine LVEF
A
MUGA (Multi Gated Acquisition) Scan
14
Q
Early Diastolic Murmur
A
- Aortic Regurgitation
- Graham-Steel murmur (PR)
15
Q
Murmur of ASD
A
Systolic Ejection Murmur
16
Q
Ejection Systolic Murmur
(Louder on Expiration)
A
- AS
- HOCM
17
Q
Ejection systolic murmur
(Louder on Inspiration)
A
- Pulmonary Stenosis
- ASD
18
Q
Holosystolic
A
- TR (Louder on inspiration)
- MR
- VSD
19
Q
Late Systolic Murmur
A
- Coarctation of Aorta
- MVP
20
Q
Mid-Late Diastolic murmur
A
- MS
- Austin flint murmur (severe AR)
21
Q
Coarctation of Aorta - Associations
A
Associations
- Turner’s syndrome
- bicuspid aortic valve
- berry aneurysms
- neurofibromatosis
22
Q
Causes for Aortic regurgitation
A
- Valve disorders (bicuspid AV, Aortic dissection)
- Spondyloarthropathies (AS)
- Aortic root disease (RHD, IE, Calcific Valve disease, Connective tissue disorder)
23
Q
William Syndrome
A
Supra-valvular Aortic Stenosis
24
Q
Bisferiens Pulse
A
- HOCM
- Severe AR
25
Pulsus Paradoxus
- Cardiac tamponade
- Severe Asthma
26
Pulsus alternans
Left Ventricular Failure
27
What is Dipyridamole?
- phosphodiesterase inhibitor used with Aspirin for secondary prevention following TIA if clopidogrel is not tolerated
28
Cannon Waves on JVP
Regular Cannon
-V.Tach (1:1 Ventricular-Atrial conduction)
- AVNRT
Irregular cannon
- Complete heart Block
29
Quincke's Sign
- Nail bed Pulsations in AR
30
S2 sound
- Loud?
- Fixed spilt?
- Reverse split?
- Widely spilt?
- Soft?
- Loud - SHTN
- Fixed split - ASD
- Reverse Split - LBBB/sev. AS/WPW B/PDA/ RV Pacing
- Widely split - RBBB/Deep inspiration/PS/ MR
- Soft - AS
31
ECG changes in Brugada syndrome (SCN5A)
- Autosomal Dominant
- ST elevation and negative T waves in V1-3
- Partial RBBB
- ECG changes more pronounced after administration of Flecainide or ajmaline
32
Factors that increases BNP
- Left ventricular hypertrophy
- Ischaemia
- Tachycardia
- Right ventricular overload
- Hypoxaemia (including pulmonary embolism)
- GFR < 60 ml/min
- Sepsis
- COPD
- Diabetes
- Age > 70
- Liver cirrhosis
33
Factors that decreases BNP
- Obesity
- Diuretics
- ACE inhibitors
- Beta-blockers
- Angiotensin 2 receptor blockers
- Aldosterone antagonists
34
Indications for stopping Exercise Tolerance Test
- exhaustion / patient request
- 'severe', 'limiting' chest pain
- > 3mm ST depression
- > 2mm ST elevation.Stop if rapid ST elevation and pain
- systolic blood pressure > 230 mmHg
- systolic blood pressure falling > 20 mmHg
- attainment of maximum predicted heart rate
- heart rate falling > 20% of starting rate
arrhythmia develops
35
M/C cause of native valve Endocarditis
Streptococcus Viridians
36
Leading cause of Infective Endocarditis
Staph. Aureus
37
M/C cause of Prosthetic valve Endocarditis
Staph. Epidermidis
<2 months Post valve replacement
38
what is Moxonidine
Centrally acting Anti-Hypertensive
Stimulates Imidazoline receptors > Reduced sympathetic outflow > decreases PVR
39
Initial Blind Therapy for Infective Endocarditis
Native valve
- amoxicillin, consider adding low-dose gentamicin
If penicillin allergic, MRSA or severe sepsis
- vancomycin + low-dose gentamicin
If prosthetic valve
- vancomycin + rifampicin + low-dose gentamicin
40
DOC for Prosthetic valve endocarditis caused by staphylococci
- Flucloxacillin + rifampicin + low-dose gentamicin
- If penicillin allergic or MRSA
vancomycin + rifampicin + low-dose gentamicin
41
DOC for Native valve endocarditis caused by staphylococci
- Flucloxacillin
- If penicillin allergic or MRSA
vancomycin + rifampicin
42
DOC for Endocarditis caused by fully-sensitive streptococci (e.g. viridans)
- Benzylpenicillin
- If penicillin allergic
vancomycin + low-dose gentamicin
43
DOC for Endocarditis caused by less sensitive streptococci
- Benzylpenicillin + low-dose gentamicin
- If penicillin allergic
vancomycin + low-dose gentamicin
44
Indications for surgery in IE
- Severe valvular incompetence
- Aortic abscess (often indicated by a lengthening PR interval)
- Infections resistant to antibiotics/fungal infections
- Cardiac failure refractory to standard medical treatment
- Recurrent emboli after antibiotic therapy
