Cardiology Flashcards
What is the definition of paroxsysmal AF?
2 or more episodes that self terminate. Episodes lasting less than 7 days.
When is rhythm control of AF indicated?
If AF has a reversible cause
Heart failure primarily caused by AF
New onset AF
Atrial flutter whose condition is considered suitable for an ablation strategy to restore sinus rhythm.
Describe the 2 most common believed triggers for AF.
Ectopic foci - An area usually found in the atria close to the pulmonary veins that releases electrical stimuli outside the normal conduction pathways, causing the atria to fibrillate.
Re entry circuit - As a result of heart disease, hypertension and increasing age. Change to atrial morphology, atrial tissue conducts at different rates leads to an impulse that can re excite the heart, creating rapid abnormal activation.
Which risk score is used to assess the risk of stroke in patients with AF?
CHA2DS2 - VASc
Which score can be used to assess bleeding risk in patients when starting anticoagulants?
ORBIT
If DC cardioversion is used for rhythm control of AF what must be considered?
Either symptoms must have been 48 hours or less.
Or the patient must be anticoagulated due to the risk of a thrombus being pushed out of the atria when sinus rhythm is restored.
What drugs can be offered for rate control of AF?
Beta blockers
Or rate limiting CCB (Verapamil or diltiazem)
When should digoxin monotherapy be considered in AF?
The person does little physical exercise
Other rate limiting drugs are ruled out due to co morbidities or personal preference.
In what condition would you hear a systolic murmur and feel a double pulse when palpating the radial artery?
Mixed AV disease
What is a collapsing pulse indicative of?
Aortic regurg
Patent ductus arteriosus
What is bisferiens pulse?
A double pulse with 2 systolic peaks characteristic of mixed AV disease.
A slow rising pulse can indicate which valve disease?
Aortic stenosis
What is the definition of pulmonary arterial hypertension?
Resting mean pulmonary artery pressure of >20mmHg.
What are the 2 main causes of pulmonary hypertension?
Left sided heart failure
Chronic lung disease
What is the pathophysiology of left sided heart failure in pulmonary hypertension?
Left heart dysfuction, leads to a back up of blood in the pulmonary veins which deliver oxygenated blood to the heart. Leading to an increase in pressure.
What is the pathophysiology of lung disease causing pulmonary hypertension?
Damaged lung tissue means that the lungs are not able to deliver O2 to the blood as effectively. Therefore this leads to pulmonary arteriole constriction to the damaged areas of lung, diverting the blood flow to the healthy areas. However when a large proportion of the lung tissue is damaged this arteriole constriction leads to an increase in pulmonary arteriole pressure and therefore pulmonary hypertension.
What is the classic presenting feature of pulmonary hypertension?
Progressive exertional dyspnoea
What is the diagnostic test for pulmonary hypertension?
Right heart catheterisation to measure the pressure in the pulmonary arteries.
Unstable angina definition?
Ischaemic symptoms suggestive of ACS but NO rise in trops.
May or may not have ECG changes.
What are the 2 main complications of atherosclerosis?
Plaque forms a physical blockage in the lumen of the coronary artery.
Plaque may rupture potentially causing a complete occlusion of the coronary artery.
ECG changes in leads V1 - V4 indicate which artery affected?
LAD
Changed in leads II, III, and AVF indicate which artery affected>
Right coronary
Changes in I, V5 - V6 indicate which artery affected?
Left circumflex artery
Management of STEMI
MONA then:
Angiography with PCI if presenting within 12 hours of symptom onset.
Continue aspirin and another antiplatelet such as clopidogrel
Then ECHO after the event to assess left ventricular function
