Cardiology 2 Flashcards
Most specific feature of VT on ECG?
AV dissociation on ECG
Commonest form of SVT?
AVNRT
Wide QRS complex mechanism?
QRS = QAT
- QRS going through another pathway in the BBB
- Anterograde bypass pathway - prolongs QRS
- Tachycardia of atrial origin - takes longer to engage Purkinje of his fibres
Narrow QRS complex mechanism?
RS
Re-entry circuit ( commonest cause)
Simultaneous firing down of Purkinje of his fibres down both bundle pathway
Long QT - prone to Sudden cardiac death when?
Treatment for Long QT?
QTc > 500 msecs
Primary prevention = B-blockers
Secondary prevention = ICD
Most likely cause of Sudden cardiac death in adulthood ( < 40 yrs old)
Treatment of that condition?
HOCM
HOCM
Primary prevention = B-blockers
Secondary prevention = ICD
*Special
Septal LV thickness = ETOH injection
Concentric = surgical myotomy
When suspecting Brugada - do what?
Flecainide challenge
-ECG will show down slopping ST + RBBB
What usually cause Rheumatic MS?
B-hemolytic streptococcal infection
Indications of MR replacement?
Symptomatic = EF > 30%
Asymptomatic = EF < 50% / new AF or pHTN/ CABGs
Indications of AR replacement?
Symptomatic
Asymptomatic = EF < 50% / Aortic root dilatation > 5.5 cm / 5 cm in Marfan
Indications of MS replacement?
Valve area < 1.5 cm + Rheumatic heart disease
New AF/ pHTN
Indications of AS replacement?
Symptomatic - but can’t have open heart surgery
Asymptomatic - Reduced EF
Indications of Mitral clip?
MR with Heart failure!
Indications of percutaneous mitral commisurotomy?
Left atrial thrombus
Severe MR
Contraindicated to surgery
Having what heart condition - not advisable to get pregnant?
pHTN > 35 mmHg = abortion
EF < 40%
Left obstructive valve defects - MS/AS = high mortality!
Surgical intervention for IE indications?
1.Severe MR/AR causing HR with pulmonary oedema
2.Fever and blood culture positive despite 7 days IV abx
3.Fungal infection
4.Extension of infection, abscess into perivalvular tissue +/- perforation
*
Abscess > 20 cm in right side
Abscess > 10 cm in left side
How strep pneumococcus causing sudden cardiac death/arrythmias?
Pneumolysin ( Choline-binding peptide A) - damage heart
Activate PAFR
Commonest cause of restrictive cardiomyopathy?
Amyloidosis - wild type, restriction leads to left sided HF
Commonest cause of Constrictive cardiomyopathy?
TB - constrictive leads to right sided HF
Elevated PVR ( > 3 Woods unit) means
fixed vascular disease! in setting of pulmonary hypertension
Vasoreactive definition in pulmonary hypertension?
reduction in mPAP after vasodilators by 10 mmHG = dihydropyridine CCB
Congenital bicuspid aortic - need to investigate for what condition?
- Coarctation of aorta
2. Shunts!
what’s common complication post Tetralogy of fallot repair?
Pulmonary regurgitation
in what condition when aortic root dilatation > 5cm - surgery indicated?
Marfan
Bicuspid AV
