Cardiology Flashcards
Check MS severity?
(1) Decrease A2 - OS interval,
(2) parasternal heave
(3) Soft S1
(4) Loud P2
HTN Enceph Rx
Na nitropruside/Labetalol
2nd line
Nicardipine/Diltiazem (IV CCB)
Drugs causing torsade-de-pointe ?
anti-Arrhythmic (Amiodarone, Flecainide, Quinidine)
anti-Biotic (macrolides)
anti-Cycotic (haloperidol)
anti-Convulsant (Cabamazepine)
anti-Depressant (TCA)
anti-Emetic (Onset)
anti-Fungal (Ketoconazole)
if AF evolve into Atrial Flutter
Medical Rx ?
Flecainide
Propafenone
(both Class IC)
High altitude pulmonary edema (HAPE)
medical Mx ?
high Conc Oxygen
Nifedepine
High altitude cerebral edema (HACE)
Medical Mx ?
Dexa
acute mountain sickness
prophylaxis ?
acclimatisation > acetazolamide
African-Caribbean
HTN Rx
CCB not effective.
Next step ?
Thiazide-like diuretic
C/I of PTMC ?
- Moderate to severe MR
- Left atrial thrombus
- heavily calcified MV
- concomitent coronary artery or other valve disease requiring surgery
ICD
reason to use ?
(rather Pacemaker)
Mx myotonic dystrophy
as some patients may have runs of tachyarrhythmia that require a shock to convert back to sinus rhythm.
Symptomatic Trifasicular block with moderate AS
Rx ?
PPM
(Not TAVI)
Suspected Chronic stable angina
Next best step in Dx?
CT angio
(Coro Angio - 3rd line)
Peripheral arterial dz
LDL Target ?
< 1.8
(if not high or very high CV risk then < 3)
CHADS2VASc
points ?
Hx of AF - evaluate stroke risk
CHF 1
HTN 1
Age > 75 2
DM 1
H/o Stroke/TIA 2
Vascular Dz 1
age 65 - 74 1
sex (female) 1
ACE-I
indications ?
*Mx:
HTN
*Prevent:
DM nephropathy
CHF
Prophylaxis of CV events
indications of PPM:
1) 3rd degree AV block
2) symptoamtic wenckebach
3) asymptomatic type2 second degree AV block
4) pauses > 3 sec
HOCM
Mx ?
Drugs C/I ?
*Beta-blockers
*ICD - Mx ventricular arrhythmia
*cardiac myomectomy when outflow gradient > 50 or not responding to beta blockers
C/I: Nitrate, caution with Diuretic
Colonic resection - Infective endocarditis. cause ?
bacteroides fragilis
S. bovis
Idiopathic long QT syn
(symptomatic/asymptomatic)
(N = 0.35 - 0.43 Sec)
1) atenolol 50mg OD
2) Dual chamber pacemaker - Rx long QT syn type3
3) ICD - very high risk patients with beta blockers
Pacemaker syn:
upgrade from VVIR to DDDR
Digoxin toxicity causing VT
Rx ?
digibind
(DC cardioversion less successful)
if BP > 100 - Lidocaine IV. other option phenytoin IV
VSR
Dx ?
Rx ?
5 - 10 days post-MI (rapid deterioration, pulm edema, hypoTN)
harsh pansystolic murmur at left sternal edge
if BP > 100 try vasodilator therapy
if unstable try IABP
PPH Pregnancy
Mx ?
Prevention ?
*anti-coagulation.
*oxygen
*pulmonary vasodilator therapy (prostacycline)
(Bosentan - teratogenic)
*avoid pregnancy but no OCPs
Brugada syn
Rx ?
ICD
PFO Dx ?
ASD Association ?
oxygen sat step-up in saturations b/w vena cava and RA.
ASD - migraine in some patients
Becker’s
Dx ?
Dystrophin gene defect
much milder weakness than Duchene & present in teen age.
pts present with heart failure s/t DCM rather proximal muscle weakness.
HOCM Dx ?
ECG findings ?
family H/O sudden cardiac death
lateral displaced Apex beat
ejection systolic murmur
ECG: RAD/LAD, RBBB, PR prolongation, non-specific T wave abnormalities in anterior leads
P mitrale
causes ?
LA enlargement
MS, MR, HTN etc
P pulmonale
Causes ?
RA enlargement
PS
increase PA pressure
Giant a wave cause ?
congenital cardiac defects in Down syn ?
impaired RA emptying - associated with TS, PS
Down syn: ASD/TOF
VSD
Physical exam finding ?
systolic thrill along left sternal edge
machinery-like murmur over 3rd/4th ICS
ASD
Dx ?
associations ?
Dx = adult (20-28), 1/3 all adult congenital heart dz.
pt often present with Afib
Fixed splitting S2 (Ascultation) with mid-systolic murmur loudest in pulmonary area.
ECG - RBBB
………………..
association: Pulm HTN
Atrial arrhythmias
ICD indication ?
scar tissue (recent post-MI) related ventricular arrhythmia esp with LV dysfunction
*as we are not aware of LV status and ECG morphology, so CRT criteria can’t be commented.
ICD > Amiodarone (prognosis)
PPCM
during pregnancy
Rx ?
post-Pregnancy?
Rx: sodium restriction, diuretics, digoxin and after-load reducing agents
Anti-coagulation with heparin (thrombo-embolism risk reduction)
add beta-blockers only after volume status is optimise.
add ACE-i (post-pregnancy)
Non-sustained VT
Rx ?
causes ?
manage K+/Mg++ replacement
amiodarone/lignocaine - next option
causes: Sympathomimetics, TCA, digoxin, aminophylline, caffeine.
Iatrogenic AV fistula
Dx ?
Rx ?
CVP catheterization - fistula b/w IVC and iliac artery - increase Right sided pressure.
Rx - stent repair.
AV malformation - similar increase right sided pressure
IE post extensive trauma
cause ?
Rx ?
staph
Rx - flucloxacillin
(wrong answer - benzyl penicillin + Genta)
Chronic AR
Surgery indications ?
1) Asymptomatic with Resting EF < 50 with severe LV dilatation LVESD > 50
2) Symptomatic pts regardless of EF/LV dimension.
2 episodes of bradycardia with HR 30, P wave unrelated with QRS
symptoms coincide with ECG changes.
Dx ?
Rx ?
Symptomatic 3rd degree heart block
Rx: PPM
1st episode of Afib with Normal ECHO.
Plan for anti-coagulation ?
1st 24 hr safest time - cardioversion
1/3 pts back to afib within 1month
Anti-coagulation: initially LMWH with warfarin 1month.
if sinus rhythm at 1 month, stop all medications.
Digoxin use in ER ?
long half life (36-48hrs), high volume of distribution. need loading dose 250mcg IV
Rheumatic fever
Jones Criteria
Major Criteria (JONES)
J - Joint (migratory polyarthritis)
Carditis
N - Nodules on Skin (subcutaneous)
E - Erythema marginatum
S - Sydenham Chorea
……………………………………..
Minor Criteria
Arthralgia
Previous Rheumatic fever
Increase PR interval
Increase ESR/CRP
Increase Temp
Early repolarization
ECG ?
Sinus rhythm
2mm concave ST elevation in V2 - V5
J point notching
Peaked T waves
AFib
ECHO normal
Rx ?
Flecainide (1C Agent)
Dressler syn
Dx ?
Rx ?
1 - 6 weeks post-MI
fever, pleuritis, pericarditis
Rx - Aspirin and steroids
Idiopathic PPH
Dx ?
Rx ?
No identified cause of PPH
ECG Suggestive: RVH
Rx: CCB, anti-coagulation, nebulised prostacycline
Chronic pulmonary Embolic
risk factors for venous thromboembolism
s/s of DVT
RCA occlusion association with RA/RV ?
IWMI - RV MI, may cause acute TR due to RV dilatation.
Coarctation of Aorta
Dx ?
Associated with Turner syn
Continuous or late systolic murmur (loudest in thoracic spine) with radio-femoral delay.
Dx = ECHO alongwith MR angio would be appropriate radio invx.
CT angio useful adjunct to echo but not definitive Invx.
Invx: 4limbs BP, Echo, ECG, CXR (scalloping of posterior ribs)
