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
AL or ATTR amyloidosis - which one better prognosis?
ATTR amyloidosis
What do you see on echo of cardiac amyloidosis?
‘Apical sparing’ pattern, granular appearance
chronotropic effects what?
Inotropic effects what? affected by what?
Chronotropic = Heart rate
Inotropic = Contractility
Acidosis - reduces contractility
keith-wagner grade for hypertensive retinopathy?
Grade 1 = isolated narrowing of arterioles
Grade 2 = arterio-venous nicking
Grade 3 = Hypertensive retinal hemorrhage/exudates
Grade 4 = papilloedema ( blurred margin optic disc)
MS is severe when what is present?
Transmitral gradient > 1 0 mmHG
Mitral valve area < 1.5 cm2
Enlarge left atrium
pHTN
Dilated cardiomyopathy - what is seen on ECHO?
Regional wall abnormality but non-coronary distribution
Right coronary artery supplies what mainly?
SA node
AV node
Bundle of His
Left Anterior Descending Artery supplies what mainly?
Main and proximal Left bundle branch
What artery mainly supplies RBB?
LAD - septal perforators
