1. BB or CCB 2. BB + CCB 3. Ivabradine OR Nicorandil OR Ranolazine OR long acting nitrate

Cardiology Flashcards by Miranda King

Stage I HTN
- Criteria
- Mangement

> 135/85
Treat if QRISK >20%

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Accelerated idioventricular rhythm

P waves not always associated with QRS
Wide QRS
50-100bpm

Often seen following reperfusion, if in this context needs no intervention

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What is sinus arrest?

No p waves for >3 seconds

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What is sick sinus syndrome?
Management of symptomatic bradycardia

Bradycardia + sinus arrest
Need AAIR pacemaker
(single lead, atrial sensing and pacing lead, not suitable if there is atrial fibrillation)

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Management of sustained slow AF in sick sinus syndrome

VVIR pacemaker

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Management of Angina

BB or CCB
BB + CCB
Ivabradine OR Nicorandil OR Ranolazine OR long acting nitrate

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Diarrhoea
New tricuspid regurgitation
- diagnosis
- pathological findings

= carcinoid syndrome
Endocardial plaques of the firbous tissue with often involve the tricuspid valve
- May then develop signs of RHF

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Management of ARVC

Sotalol
(superior to other BBs)

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Treatments licensed for rate control in heart failure

Ivabradine
Carvedilol
Nebivolol

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Skin sign seen in acute rheumatic fever

Erythema marginatum
= red circular lesions, sharp borders, faint central clearing

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ST Elevation
No reciprocal depression
Recent MI
- diagnosis?

Left ventricular aneurysm

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RV involvement of MI pathophysiology of presentation

Immediate management

V4 usually best lead to see in
Associated with inferior infarction, rare to happen alone
Poor contraction of RV results in peripheral oedema and right atrial dilation
Poor flow of blood into pulmonary artery
Reduced blood delivery to LV

Fluid resuscitation - want to increase the LV preload to improve hypotension

Then consider noradrenaline/dobutamine

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Suspected endocarditis
- lymphocytosis
- middle east
- culture negative

Consider brucellosis

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Features of constrictive pericarditis (5)

Right heart failure
Rapid x/y descent (kussmaul’s)
Septal shift on inspiration
Relative equalisation of diastolic pressures on cardiac catheterisation
Dip/plateau pattern

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Location ASD secundum vs primum

Secundum = mid septum
Primum = lower in septum

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ACS + already on anticoagulation

Usually triple therapy 4 weeks-6 months after
THEN
DAPT to complete 12/12 of treatment

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Prognostic benefit in heart failure (beyond 4 pillars)

In afro-caribbean - ISMN and hydralazine shown to have benefit

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Management of severe non-calcific MR

Percutaneous balloon mitral commissurotomy

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Medication not useful in cocaine overdose

Beta blockers
Get unopposed alpha stimulation, enhances vasospasm and raises BP

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Fabry’s Disease
- features (4)

Black-blue papules
MV prolapse
Stroke/TIA
Distal paraesthesia

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Type A WPW

Left sided pathway
Dominant R wave in V1

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Type B WPW
- target for ablation

Right sided pathway
Dominant S wave in V1
= right atria/ventricular area

Coronary artery vasospasm
- features

Intermittent STE
Occurs at rest
Normal coronary arteries

Management of Kawasaki Disease

Aspirin
IV immunoglobulin
(can add steroids in with high risk cases)

Defect on stress and rest MRI

Fixed defect = transmural defect

Indications for valve intervention in MR (3)

EF <60% LVES diameter >40 New AF

Contra-indications in sick sinus

Calcium channel blockers Ivabradine

CI for ranolazine

Liver dysfunction Severe renal dysfunction

SVT with aberrancy VS VT - what makes VT more likely?

Absence of LBBB/RBBB Extreme axis deviation Very broad complex Positive or negative concordance in the chest leads

Choice of heparin if angio < 24 hours

Unfractionated heparin

Successful ablation - decision RE anticoagulation

Need long term anticoagulation as per their CHADSVASC - usually lifelong anticoagulation

Cause of constrictive pericarditis

Post radiotherapy

Drug to avoid in cardiac amyloid

Digoxin - increased risk of toxicity in binding of digoxin to deposits

What is Wellen's syndrome?

Critical stenosis of LAD - needs immediate intervention

Coved ST elevation V1-V3 - diagnosis - diagnostic aid

Brugada syndrome = Na+ channelopathy - Flecainide worsens the ECG changes (Na+ channel opener)

When would you consider PCI in stable angina?

When ischaemia >10% of left ventricle (ESC guideline)

What can you do in worsening heart failure with polypharmacy?

Stop the alpha blocker - anecdotal evidence may improve symptoms

Refractory VT Not unstable - management?

IV lidocaine infusion

Claudication Smoker 20-40s ANA negative - diagnosis?

Thromboangitis obliterans Affects small-medium vessels with segmental inflammation

Inferior supply of the heart

Right coronary artery via the posterior descending artery - in 20% PDA comes via the left circumflex In this case of inferior STEMI, will see posterior and lateral changes as well (reflecting circ. supply)

Management of HOCM

1st = BB or CCB e.g. verapamil 2nd = disopyramide Acts as a negative inotrope, reduces the LVOT gradient 3rd = myomectomy/DDDR PM/ablation

Indications for AVR/root surgery

>50mm aortic root size - regardless of severity of aortic regurgitation

Contraindication to using atropine in bradycardia

Heart transplant - heart is denervated, does not respond to the vagal blockade

HTN - stage 1 vs stage 2

Stage 1 = >135 >145 if over 80 years old - don't treat Stage 2 = >150: treat regardless of age

Inverted P wave in lead I

Lead misplacement Dextrocardia

Signs of dextrocardia on an ECG

Inverted P wave in lead I Right axis deviation Loss of R wave progression

Management of hypertriglyceridaemia

Fenofibrate

Valve area for intervention in mitral stenosis

<1cm2

CRT choice according to NYHA class

If class IV for CRT-P

LDL not to target + secondary prevention

PCSK9 inhibitor e.g. evolocumab

Indication for using entresto

Usually only when EF <35%

Necked appearance of pacemaker leads

Fractured lead

Severe MS - indications for balloon valvotomy

Severe MS (valve area <1.5) Favourable valve morphology Nil thrombus

Severe MS - indications for mitral valve replacement

Severe MS (<1.5) Not high risk for surgery Failed or not suitable for balloon treatment