Cardiology 19/11

Question 1

Pulsus paradoxus

Answer 1

large drop in BP during inspiration in cardiac tamponade

Question 2

What is Dressler’s syndrome?

Answer 2

Autoimmune response by the body after an injury

Fever, pericarditis, pleuritic pain

2-3 weeks after

Question 3

Left ventricular free all rupture

Answer 3

3% of MIs occurs around 1-2 weeks
acute heart failure 2 to cardiac tamponade

Question 4

Bisoprolol as a beta blocker is contraindicated in asthmatics?

Answer 4

no Bisoprolol is cardioselective so okay

Question 5

Dihydropyridine CCBs MOA

Answer 5

act on vascular smooth muscle leading to vasodilation

no effect on conduction system

reduce BP by decreasing vascular resistance

Question 6

Cardioselective beta blockers
what does this mean?

Answer 6

act on beta 1 in heart

don’t cause vasoconstriction that beta 2 acting BB do

Question 7

axis deviation on an ECG

Answer 7

lead 1 and 3 pointing away is LAD

pointing towrds is RAD

Question 8

lead 1 is

Answer 8

0 degrees

Question 9

lead aVF is

Answer 9

90 degrees

Question 10

if lead 1 is + then?

if avf is +?

if normal axis is?

Answer 10

it’s between -90 to 90

0-180 degrees

0-90; Lead 1 and aVF ++

Question 11

ticagrelor > clopidogrel

Answer 11

true

Question 12

what ECG change is suggestive of cardiac tamponade?

Answer 12

electrical alternans

is a relatively specific but non-sensitive ECG sign of cardiac tamponade. Electrical alternans is characterised by beat to beat variation in QRS amplitude and morphology. This variability is due to the heart ‘swinging’ in the pericardial fluid

Question 13

When would you offer rhythm control as a first line?

Answer 13

coexistent HF
first onset Af
reversible cause

Question 14

acute pericarditis most specific ECG change?

Answer 14

PR depression

Question 15

prolonged QT interval is due to?

Answer 15

Hypokalaemia
Hypothermia

Question 16

S1Q3T3 pattern ECG

Answer 16

pulmonary embolism
sinus tachy

Question 17

poorly controlled HTN already on ACEi, CCB and thiazide like diuretic

what next

Answer 17

if >4.5mmol/L K+ then add alpha or beta blocker

<4.5 Spironolactone

Question 18

CCB - verapamil which is non hyrodropyrimidal

Answer 18

calcium-dependent conduction in the AV node

reduce contractility of the heart further

Question 19

torsades de pointes

Answer 19

polymorphic ventricular tachycardia

prolonged corrected QT interval

caused by macrolides : eryhtromycin

Question 20

Erythromycin causes change in QRS amplitude why?

Answer 20

inhibition if the delayed rectifier potassium channel

Question 21

warfarin drug interactions
inducers

Answer 21

phenytoin
carbamazepine

barbiturates
phenobarbitone

Rimampicin
st johns wort
chronic alcohol intake

Question 22

inhibitors of p450

Answer 22

Ciprofloxacin
macrolide
isoniazide
amiodarone
allopurinol
SSRIs
ritonavir
sodium valproate
acute alcohol intake

Question 23

why are CCB contraindicated in HF?

Answer 23

depress heart function further
exacerbate symptoms

negative ionotropic effects

Question 24

negative ionotropic effect means?

Answer 24

Negative inotropic agents reduce the influx or availability of calcium, leading to a weaker contraction

Question 25

after fibrinolysis for ACS what needs to happen 60-90 mins after?

Answer 25

ECG to see if ST segment elevation has decreased

Question 26

most common cause of death after an MI?

Answer 26

V fibrillation

Question 27

preferred sit for insertion of catheter for PCI?

Answer 27

Radial artery, > femoral

Question 28

complete heart block following MI?

Answer 28

right coronary artery lesion

supplies atrioventricular node

Question 29

which artery supplies atrioventricular node?

Answer 29

right coronary artery

Question 30

lateral or posterior MI

Answer 30

circumflex artery

Question 31

What is takayasu arteritis?

Answer 31

large vessel vasculitis occluding aorta

associated with aortic regurgitation
wide pulse pressure

Question 32

Bisferiens pulse

Answer 32

• mixed aortic valve disease
• double pulse
• caused by mixed aortic valve disease

Question 33

De musset

Answer 33

head bobbing is a clinical sign fo aortic regurgitation

Question 34

what is aortic regurgitation

Answer 34

leaking of aortic valve of the heart that cuases blood to flow in reverse direction during ventricular diastole

Question 35

Score system recommended to help with PE identify where to manage

Answer 35

The Pulmonary Embolism Severity Index (PESI) score is recommended by BTS guidelines to be used to help identify patients with a pulmonary embolism that can be managed as outpatients

Question 36

Rheumatic fever rash?

Answer 36

erythema marginatum

Question 37

what are Aschoff bodies

Answer 37

granulomatous nodules found in rheumatic fever

Question 38

Preference in angina symptom control between BB and CCB?

Answer 38

Diltiazem / verapamil

over Beta blocker

Question 39

Normal ECG variants

Answer 39

sinus brady
first degree heart block
mobitz type 1 wenckebach

Question 40

when are nitrates contraindicated in ACS Mx?

Answer 40

hypotension presence of

Question 41

what is first degree heart block?

Answer 41

when PR interval is longer than 0.2s

Question 42

Second degree heart block?

Answer 42

Progressive prolongation of PR interval until dropped beat occurs

Question 43

hypercalcaemia ECG changes

Answer 43

shortening of the QT interval

Question 44

2nd degree AV node block Mobitz type 1

Answer 44

Prolonged PR = AV node block
Increasing PR intervals

• non conducted p wave

Question 45

mx of bradycardia?

Answer 45

Atropine 500mcg IV
transcutaneous pacing
isoprenaline /adrenaline infusion

transvenous pacing

Question 46

what is a non shockable rhythm?

Answer 46

asystole/
pulseless-electrical activity (asystole/PEA)