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Z MD 2 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

how long do troponin levels stay elevated for

A

7-10days

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2
Q

3 ways you can try and rhythm control someone with AF

A

antiarrhythmic agents - sotalol, flecainide, amioderone

electrical cardioversion under anaesthetic

catheter ablation

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3
Q

why is pregnancy associated with varicose veins

A

pelvic mass

hormones dilate blood vessels

hyperdynamic circulation

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4
Q

4 main causes of heart failure with reduced EF

A

CAD

primary dilated cardiomyopathy

alcohol and thiamine def

HT

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5
Q

what is 1st degree heart block

A

when PR interval is >0.2s

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6
Q

treatment of tachy-brady syndrome

A

pacemaker then use blocking agents to control rapid heart rates (beta or calcium channel blockers)

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7
Q

common causes of VT

A

cardiac ischaemia

cardiomyopathy

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8
Q

explain the use of the score of the CHADS-VASC score

A

0 (male) or 1 (female) - no anticoagulant recommended

1 (male) - anticoagulant should be considered

2 - anticoagulant is recommended

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9
Q

acute treatment of MI

A

MONASH

M - morphine

O- oxygen

N - Nitrites

A - aspirin

SH - streptokinase/heparin

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10
Q

what things put the patient at risk of imminent asystole when they have 3rd degree conduction block

A

very slow rate pauses broad QRS

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11
Q

what is lipodermadosclerosis

A

chronic inflammation involving the skin and subcutaneous tissue that tends to scar down (calf swelling and skinny ankle from scar)

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12
Q

where is the common site of arterial ulcers

A

distal at toe tips or at pressure areas

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13
Q

which heart blocks indicate to put in a pacemaker

A

sinus node dysfunction

symptomatic 2nd or 3rd degree AV block

intermittent 3rd degree AV block

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14
Q

ECG pattern of WPW

A

delta waves and short PR interval

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15
Q

what is wrong with having WPW

A

can lead to rapid regular tachycardias

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16
Q

what ECG changes do you see in a NSTEMI

A

T wave changes ST depression or nothing

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17
Q

what can cause unilateral oedema

A

DVT

compression of large veins by tumour or lymph nodes

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18
Q

what is the difference between the length of time a patient has to take dual anti-platelet therapy for a bare metal stent vs a drug eluding stent

A

bare metal - 3 months

drug eluding - 1 year

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19
Q

what is the effect on the heart of mitral regurg

A

LV eccentric hypertrophy

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20
Q

treatment of superficial thrombophlebitis

A

low molecular weight heparin (clexane)

graduated compression stocking

aspirin

simple analgesia

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21
Q

main cause of SVT

A

re-entrant circuits within the heart (most common are AV nodal re-entry tachy)

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22
Q

what position do you put a patient in if you want to hear a aortic valve murmur better and a mitral valve murmur better

A

aortic - sitting forward and on full expiration

mitral - lateral left position

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23
Q

management of a patient with ST elevation

A

urgent angiogram/thrombolysis or PCI

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24
Q

what ECG pattern do you get with digoxin

A

AF with “reverse tick”

ST depression and T wave inversion in lateral leads

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25
Q

symptoms of aortic stenosis (only when severe)

A

SAD

S - Syncope

A - angina

D - dypnoea (on exertion)

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26
Q

which ECG leads are the inferior leads

A

II, III and aVF

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27
Q

explain murmur with mitral stenosis and what accentuates the murmur

A

diastolic low-pitched decrescendo murmur best heard at the cardiac apex

  • accentuated by left lateral position or exercise
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28
Q

explain murmur with HOC and what accentuates the murmur

A

crescendo-decrescendo systolic murmur best heard at left lower sternal border or apex

  • increased intensity during Valsalva
  • softer during squatting
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29
Q

what are the ECG changes associated with pericarditis

A

widespread ST elevation - saddle shaped

also see widespread PR depression except for in aVR where you get PR elevation

no reciprocal changes

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30
Q

what does a single wave JVP point towards

A

AF

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31
Q

what is Buerger’s angle

A

the angle at which the leg becomes white when elevating the leg (normal >90 degrees) (severe ischaemia)

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32
Q

what does a tapping apex beat imply

A

mitral stenosis

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33
Q

what about the ECG points towards p pulmonale and p mitrale

A

pulmonale - increased p wave voltages (height)

mitrale - bifid and long p wave

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34
Q

in which patients is only fibrinolysis treatment of MI given

A

dont have PCI facilities when invasive strategies not an option patient has bleeding issues, eg. cerebral bleeds

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35
Q

what are the non cardiac causes of troponin rise

A

anaemia

pulmonary embolism

sepsis

chronic renal disease

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36
Q

what things are the most concerning if a patient has syncope

A

occurred during sitting/lying

occurred during exercise

injury

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37
Q

name some causes of extreme right axis deviation

A

lead transposition

VT

emphysema

hyperkalaemia

paced rhythm

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38
Q

what is the ECG effect of hyperkalaemia

A

tall, peaked T waves with widening of QRS

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39
Q

symptoms of AF

A
  • often asymptomatic
  • may present with: palpitations, racing heart, irregular pulse, fatigue, light-headedness, increased urination, weakness, dyspnoea, angina, hypotension and presyncope
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40
Q

complaints of varicose veins

A
  • cosmetic
  • itch
  • heaviness/aching
  • swelling
  • pigment changes
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41
Q

action of adenosine in AF

A

induces transient AV block

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42
Q

what xray sign points towards aortic dissection

A

widened mediastinum

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43
Q

what does a high JVP tell you

A

high RA pressure

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44
Q

acute Sx of HT

A

headache, blurred vision, dizziness, altered mental state, seizure

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45
Q

treatment for venous ulcers

A

elevation

compression

dressing changes

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46
Q

LBBB pattern on ECG

A

W in V1 (often not obvious)

M in V6

inverted T waves in V5-V6, I and aVL

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47
Q

what can you do with the patient if you hear a ejection systolic murmur and want to differentiate between HOCM and AS

A

HOCM - can get the patient to do a Valsalva manoeuvre and listen and left sternal edge

AS - full expiration and listen at the carotids for murmur

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48
Q

which type of type 2 conduction block requires immediate treatment

A

mobitz type 2

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49
Q

typical look of AF

A

irregular irregular rhythm no p waves

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50
Q

typical location of ischaemic ulcers

A

distal periphery over dorsum of foot or pretibia

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51
Q

what is the recommended drug combinations for treating HT in someone post MI

A

ACEI + BB

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52
Q

why do you get a patient to chew aspirin instead of swallow it in an acute presentation of MI

A

during stress –> splanchnic circulation shuts down –> absorption through stomach slows down. If you chew it is is absorbed straight away by the buccal mucosa

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53
Q

typical look for venous ulcers

A
  • large and irregular edge
  • shallow
  • moist granulating base
  • surrounded by zone of inflammation and stasis dermatitis
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54
Q

6 Ps of a threatened limb

A

pulseless

paraesthesia

paralysis

pallor

pain

poikliothermia - cold

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55
Q

symptoms and signs of pericarditis

A
  • central or left side
  • sharp, stabbing
  • worse on movement
  • worse on breathing
  • eased by leaning forward!
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56
Q

what are the complications of infective endocarditis

A

mycotic aneurysms

heart failure

embolic complications - stroke, peripheral embolus, splenic infarcts, abscess, pulmonary infarcts, abscess

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57
Q

what is the definition of pulsus paradoxus

A

more than 10 mmHg rise in systolic blood pressure with expiration

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58
Q

at what EDP do you start to get pulmonary or systemic congestion

A

>20-30mmHg

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59
Q

treatment of varicose veins

A
  • reassurance
  • compression stocking for relief of pain and swelling
  • injection sclerotherapy (if small)
  • surgery
  • endo-venous methods
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60
Q

what are the X ray findings with someone in acute cardiac failure

A

ABCDE

A - alveolar opacity

B - Kerley B lines

C - cardiomegaly

D - dilated apical blood vessels

E - effusions

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61
Q

first line thearpy for infective endocarditis

A

benzylpenicillin + flucloxacillin + gentamicin

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62
Q

treatment of torsade de pointe

A

treat as VF - DC cardioversion

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63
Q

ECG criteria of a pathological Q wave

A
  • >25% height of the corresponding R wave
  • >40ms width and >2mm depth
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64
Q

how is pericarditis diagnosed

A

clinical features:

  • typical chest pain
  • examination: pericardial friction rub, low grade fever, tachy
  • suggestive ECG changes
  • pericardial effusion
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65
Q

explain murmur with tricuspid stenosis

A

diastolic decrescendo murmur at the left lower sternal border

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66
Q

empirical drug treatment of HT

A

first choice: ACEI (or ARB) or CCB or low dose thiazide s

econd choice: ACEI + CCB or ACEI + thiazide

third choice: ACEI + CCB + thiazide

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67
Q

what is the most serious nerve injury that can happen with varicose vein surgery

A

common peroneal nerve = foot drop

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68
Q

two types of venous ultrasound

A

DVT study

incompetence study

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69
Q

management of narrow complex tachycardia

A

vagal manoeuvres

IV adenosine (warn patient)

IV verapamil

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70
Q

treatment of atrial flutter

A

pretty much the same as AF - easily amenable to ablation

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71
Q

What is the CHA2DS2-VASC score for and what does it stand for

A

to assess the risk of stroke in a patient with AF

C - congestive heart failure (1)

H - hypertension >140/90 or on medication (1)

A - age >75 (2)

D - diabetes mellitus (1)

S - previous stroke/TIA/thromboembolism (2)

V - vascular pathology (PAD, MI etc) (1)

A - age 65-74 (1)

SC - sex category (female) - (1)

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72
Q

symptoms and signs of pleuritic chest pain

A
  • sharp, stabbing
  • localised
  • worse on inspiration, coughing
  • may be worse on sitting up
  • not related to exertion
  • dyspnoea, cough, haemoptysis
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73
Q

pharmacological approach to CHF with reduced LVEF

A

diuretics - normalize volume

Start ACEI early

Beta blocks for chronic therapy (after initial stabilisation)

digoxin and nitrates for refractory Sx

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74
Q

what does an enlarged, distended and tender liver suggest

A

right heart failure

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75
Q

what causes stable angina

A

atheroscelrosis causing narrowing –> ischaemia of the myocardium due to increased myocardial oxygen requirements during physical or emotional stress

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76
Q

treatment of pericarditis

A

NSAIDs

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77
Q

which symptoms and sign points towards aortic dissection

A

pain radiating to the back

sudden onset

BP difference >20mmHg between arms

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78
Q

definition of metabolic syndrome

A

abdominal obesity + 2 or more of:

  • elevated TG
  • low HDL
  • hypertension
  • hyperglycaemia
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79
Q

explain murmur with tricuspid regurgitation and what accentuates the murmur

A

pan-systolic murmur at the left 4th costal cartilage with radiation to left upper sternal border

  • accentuated by inspiration
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80
Q

how do you diagnose STEMI

A

chest pain PLUS

  • 1mm ST elevation in II, III and aVF
  • 2mm in precordial leads
  • new LBBB (may be reciprocal ST depression in other leads)
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81
Q

RBBB pattern on ECG

A

M in V1

W in V6

inverted T waves in V2-3

slurred S wave in V6

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82
Q

what is the concern about long QT interval

A

can predispose to torsades de pointe

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83
Q

what does hameosiderin staining in the legs point to

A

chronic venous hypertension

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84
Q

what signs (if any) could you see on a normal ECG with a posterior infarct of the heart

A

V1-V3 ST depression

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85
Q

what are the class 1 indications for a pacemaker

A
  • sinus node dysfunction
  • symptomatic 2nd or 3rd degree AV block
  • intermittent 3rd degree AV block
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86
Q

what does a pulsatile liver indicate

A

Tricuspid regurgitation

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87
Q

what does a large v wave of JVP suggest

A

tricuspid regurgitation

88
Q

how does digoxin work

A

promotes the effects of vagal stimulation to the AV node

89
Q

what is the ECG effect of hypokalaemia

A

flattening of T waves, with U waves

90
Q

what does a palpable P2 imply

A

Pulmonary HT

91
Q

which ECG signs do you see with right axis deviation

A
  • R wave predominant in V1
  • lead I predominantly negative
  • lead III - predominantly positive
  • inverted T waves in right praecordial leads
  • deep S in V6 (peaked p waves may also occur in right atrial hypertrophy)
92
Q

associated symptoms of AMI

A

dyspnoea, syncope, diaphoresis, nausea, vomiting, palpitations

93
Q

what is the consequence of lipodermadosclerosis

A

prone to ulceration

94
Q

what is the recommended drug combinations for treating HT in someone in heart failure or post stroke

A

ACEI + thiazide

95
Q

clinical features of Rheumatic fever

A

fever

arthritis over large joints

rash - erythema marginatum

subcutaneous nodules over bones, tendons

murmur

sydenham’s chorea

96
Q

What is the HAS-BLED score used for and what does it stand for

A

to assess bleeding risk when considering putting patient on medication for AF

H - Hypertension (>160/90 or on Rx) (1)

A - Abnormal renal and liver function (1 point each)

S - Stroke (previous)

B - Bleeding (prior major bleeding) (1)

L - Labile INRs (1)

E - elderly (>65) (1)

D - drugs predisposing to bleeding or alcohol (>8) (1 point each)

97
Q

how do you distinguish between angina and a NSTEMI

A

NSTEMI - will show troponin rise ECG can show ST depression

98
Q

treatment of 1st degree heart block

A

in isolation - doesnt need treatment

99
Q

presentation of superficial thrombophlebitis

A

acutely localised tender ropey hard veins with localised erythema

100
Q

why can you get chest pain with AF

A

due to subendocardial ischaemia (due to reduced diastolic filling time and reduced oxygen supply to myocardium)

101
Q

explain murmur with pulmonary stenosis and what accentuates the murmur

A

crescendo-decrescendo murmur best heard at the left 2nd intercostal space with systolic ejection click

  • accentuated by inspiration
102
Q

what are the main types of complications after AMI

A

ischaemic

mechanical

arrhythmic

embolic

inflammatory

103
Q

is infectious pericarditis most commonly caused by viruses, bacteria or mycobacteria?

A

viruses

104
Q

normal EF

A

50%

105
Q

what ECG signs do you get in someone with a past MI

A

q waves

t wave inversion

sometimes persistent ST elevation

106
Q

difference between stable and unstable angina

A

stable - pain only comes on with exercise/stress and relieved by rest unstable - new onset pain or pain at rest, or pain at lower levels of exercise

107
Q

what are some peripheral signs of infective endocarditis

A

splinter haemorrhages

Osler’s nodes

Janeway lesions

108
Q

signs of Aortic regurgitation

A

collapsing pulse (Waterhammer pulse)

wide pulse pressure

early diastolic murmur

Corrigans pulsation (carotid)

fingernail capillary pulsation

LVH - displaced apex beat

109
Q

suspect infective endocarditis in which clinical presentation

A

new regurgitant murmur

embolic events of unknown origin

sepsis of unknown origin

fever

110
Q

which two conditions other than VT can prolong the QRS interval

A

hyperkalaemia

BBB

111
Q

what is a positive Beurger’s sign

A

dependent rubor when dropping the leg down below side of bed

112
Q

what causes Rheumatic heart disease

A

immune response to Strep pyogenes (group A beta haemolytic strep) - antibody cross-reactivity (type 2 HS)

113
Q

what causes the pigment changes with varicose veins

A

red cells leaking out of the blood vessels due to venous stasis –> into the tissues –> breakdown –> haemosiderin deposition

114
Q

major Duke criteria for infective endocarditis

A

positive blood cultures

evidence of IE on echo

115
Q

what causes atrial flutter

A

large re-entrant pathway in the atrium

116
Q

when should you think to test for adrenal causes of HT

A
  • unprovoked, unexplained hypokalaemia
  • diuretic induced hypokalaemia, resistent to correction
  • family Hx of aldosteronism
  • reistant HT
117
Q

what is superficial thrombophlebitis

A

thrombosis in the superficial veins

118
Q

where is the typical area for ulceration with varicose veins

A

in the gaiter area (lower half of the calf, typically on the medial aspect down towards the medial malleolus)

119
Q

Tx for STEMI vs NSTEMI

A

both get MONA

STEMI –> PCI or thrombolysis, 2nd antiplatelet agent and anticoagulate til PCI

NSTEMI –> thrombolysis is contraindicated! Load 2nd antiplatelet agent, anticoagulate and ?PCI in a few days

120
Q

typical look of ischaemic ulcers

A
  • punch out edges
  • base shows poorly developed gray granulation tissue
  • surrounding skin is pale or mottled with no signs of inflammation
  • little bleeding when debrided
121
Q

risk factors for PE

A

travel

OCP

malignancy

surgery

long periods of immobility

steroids

family history of coagulopathy

factor 5 leiden deficiency

122
Q

4 causes of oedema

A

increased venous pressure

decreased osmotic pressure

blocked lymphatics

increased capillary permeability

123
Q

which 6 things can precipitate heart failure

A

anaemia

thyroid problems

infection

arrhythmia

non-compliance ischaemia

124
Q

symptoms of venous insufficiency

A

leg ache, heaviness, fatigue at the end of the day leg elevation helps

125
Q

what can cause non-pitting oedema

A

hypothyroidism

lymphoedema

126
Q

definition of AMI

A

requires 2 out of the 3:

  • symptoms of MI
  • elevation of cardiac markers (troponin or CK)
  • typical ECG pattern
127
Q

what is the Adson’s test

A

elevation, abduction and external rotation of the left and and turning head to opposite side - causes disappearance of the radial pulse

128
Q

if AF is slow (50-60) what does it point to

A

significant conduction problems

129
Q

normal atrial flutter “rate”

A

300bpm

130
Q

examination findings in someone with coarctation of the aorta

A

high BP in upper body and low BP in lower body

radio-femoral delay

absent femoral pulses

loud systolic murmur heard over back

131
Q

other causes of ST segment changes other than MI/ischaemia

A

pericarditis

LV hypertrophy with “strain” pattern

Drugs

132
Q

which type of murmur will inspiration make louder

A

pulmonary and tricuspid (right sided murmurs)

133
Q

treatment for vasovagal syncope

A

increase fluid intake (>2L/day)

avoid predisposing factors

dynamic manoeuvres

increase salt intake

134
Q

what is the cut off points for abdominal obesity

A

europoids:

  • M: >94cm
  • F: >80cm

south asia and chinese

  • M: >90cm
  • F: >80cm
135
Q

what is a “significant” drop in BP with standing

A

>20mmHg

136
Q

management of aortic regurgitation

A

echo every 6-12 months for severe AR

  • when echo indicates early LV decompensation –> operation for valve replacement/repair
137
Q

in which leads are inverted t waves normal

A

avR, V1 (sometimes V-12), III

138
Q

what does a double impulse apex beat imply

A

hypertrophic obstructive cardiomyopathy (HOCM)

139
Q

treatment of pericarditis

A

pain relief - NSAIDs, steroids, opiods

colchicine if recurrent episodes

treatment of underlying condiiton

140
Q

route of short saphenous vein

A

lateral dorsal venous arch –> posterior calf –> popliteal vein

141
Q

examination findings for atrial flutter

A
  • regular pulse/heart sounds
  • often tachycardia
  • higher degree of conduction block at the AV node
142
Q

signs of Mitral regurg

A

pansystolic murmur radiating to the axilla

louder on full expiration

143
Q

what does a parasternal heave imply

A

RV volume enlargement

144
Q

2 main superficial veins of the eleg

A

great saphenous vein

short saphenous vein

145
Q

what is the advantage of CK levels over troponin

A

levels fall quickly - so can pick up subsequent MI after initial one (unlike troponins which will still be elevated)

146
Q

explain what the precordial leads look at

A

V1, V2 = anterior RV

V3, V4 = anterior septum

V5, V6 = anterior LV

147
Q

in which subset of people is rheumatic fever common in

A

children aged 6-15 years

148
Q

complications of aortic dissection

A

vascular - stroke, tamponade, dissection of coronaries (STEMI)

149
Q

what is 3rd degree heart block

A

where there is complete dissociation of the QRS from the p wave

150
Q

a pathological Q wave is a marker of

A

established full thickness death of myocardium (needs to be in more than 1 adjacent lead)

151
Q

cause of S3

A

turbulence during early filling of the ventricle

152
Q

what is the most effective drug treatment for HT in people with diabetes or lipid abnormalities

A

ACEI + CCB

153
Q

what is Mobitz II heart block

A

intermittently block P waves

154
Q

how can you tell there is LVH on ECG

A
  • sum of S waves in V1/V2 and R in V5 or V6 > 35mm
  • R in aVL >11mm
155
Q

consequences of varicose veins

A

ulceration

lipodermadosclerosis

superficial thrombophlebitis

bleeding

156
Q

AF is associated with increased risk of…

A

embolic stroke

157
Q

which valvular diseases cause volume loads and which cause pressure loads

A

volume - aortic and mitral regurg

pressure - aortic and mitral stenosis

158
Q

main mechanical complications of AMI

A
  • heart failure
  • cardiogenic shock
  • mitral valve dysfunction
  • aneurysms
  • cardiac rupture
159
Q

what are the signs of venous insufficiency

A

haemosiderin deposits

venous eczema

venous ulceration and healed scars

lipodermatosclerosis

varicosities

brawny oedema - skin look tight and thick

160
Q

what is WPW

A

where there is an accessory pathway that bypasses the AV node leading to earlier excitation of the ventricle

161
Q

normal SV

A

70ml

162
Q

common community drugs that can elevate blood pressure

A

NSAIDs

OCP

oral decongenstants

163
Q

what is Mobitz type 1 /Wenckbach heart block

A

when there is progressive lengthening of the PR interval until there is no QRS complex and then cycle restarts

164
Q

tests for heart failure

A

ECG

Chest xray

transthoracic echo

BNP

165
Q

heart failure Sx

A

SOB - on exertion,

orthopnoea,

PND

peripheral oedema

ascites

fatigue

cachexia

166
Q

treatment of heart failure with preserved LVEF

A

no proven therapies

  • treat underlying conditions
  • diuretics for Sx
167
Q

what is the ECG sign of cardiac tamponade

A

electrical alternans - small voltage then large voltage alternating

168
Q

treatment of acute heart failure

A

LMNOP

Lasix (frusemide)

morphine

nitrates

oxygen

positioning (done in reverse order)

169
Q

what tests are useful to assess valvular disease

A

TTE

trans-oesophageal echo - particularly good at assessing posterior structures

coronary angiogram/right heart catheter

170
Q

symptoms of abdominal aorta and iliac arterial vascular disease

A

pain in buttocks, legs and impotence

171
Q

When do you start anti-HT Rx straight away (without further confirmatory tests)?

A

evidence of:

  • end organ damage
  • associated conditions (CV disease, diabetes, renal disease)
  • High CV risk
  • Grade 3 HT
  • isolated systolic HT
172
Q

complications of surgery for varicose veins and how to prevent

A

DVT - give clexane for 24 hours

infection - give prophylactic AB

nerve injury

recurrent varicose veins

173
Q

explain the look of venous ulcers

A

in the “gaiter area” tend to bleed especially if traumatised dark haemosiderin staining

174
Q

explain the look of ischaemic ulcers (arterial insufficiency)

A

punched out, well defined borders little erythema unless infected located in toes

175
Q

normal PR interval

A

less than 0.2 s

176
Q

when should you suspect phaeochromocytoma

A

markedly variable BP

paroxysmal symptoms

177
Q

cause of S4

A

turbulence during atrial contraction caused by stiff ventricle

178
Q

minor criteria for Duke’s criteria of infective endocarditis

A

predisposing conditions (abnormal heart valve, IVDU etc)

fever

vascular phenomenon

immunological phenomenon

positive blood culture but not meeting major criteria

179
Q

name some causes of right axis deviation

A
  • normal in children and tall thin adults
  • RV volume/pressure overload (ASD, VSD, pulm embolus, RV hypertrophy)
  • lung pathology
  • WPW
  • dextrocardia
180
Q

what else can you do to treat AF if pharmacological Tx not working

A

DC cardioversion

ablation

181
Q

explain murmur and pulse with patent ductus arteriosus

A

continuous murmur radiating to the back with collapsing pulse

182
Q

what examination signs will you get with aortic stenosis

A

plateau pulse of carotids

heaving apex beat

thrill over upper R sternal edge

crescendo-decrescendo murmur heard loudest in full expiration at the RUSE and radiating to the carotids

183
Q

signs of mitral stenosis

A

in severe:

  • mitral facies
  • tapping apex beat
  • loud S1
  • diastolic rumbling murmur
184
Q

what does a JVP that rises with inspiration point towards

A

constrictive pericarditis (Kussmaul’s sign)

185
Q

pharmacological treatment for rate or rhythm control for AF

A

rate - beta blockers, CCB, digoxin

rhythm - amiodarone, flecainide

186
Q

mneumonia for infective endocarditis

A

FROM JANE

F - fever

R - Roth’s spots

O - Osler’s nodes

M - murmur

J - Janeway lesions

A - Anaemia

N - nail bed haemorrhages

E - Emboli

187
Q

are pharmacological or lifestyle changes more effective in preventing diabetes

A

LIFESTYLE

188
Q

which leads are left looking

A

I, II, avL

189
Q

associated JVP with tricuspid stenosis

A

dominant a wave with slow y descent of JVP

190
Q

associated clinical signs of tricuspid regurgitation

A

dominant v wave of JVP

pulsatile liver

191
Q

in which lead is a Q wave normal

A

III

192
Q

what is the “strain” pattern with LVH

A

ST segment depression with T wave inversion in V5-6 and 1 and avL

193
Q

you do the hepatojugular reflex and the JVP stays elevated… what does this suggest

A

heart failure

194
Q

what do you think of if you find elevated creatinine in someone taking ACEI

A

bilateral renal stenosis

195
Q

what are the cardiac, vascular and respiratory causes of chest pain

A

cardiac - AMI, unstable angina, percarditis

vascular - aortic dissection

respiratory - PE, pneumonia, pneumothorax, pleurisy

196
Q

signs of arterial insufficiency

A

atrophic muscle, skin (shiny, dry, red) punched out ulcers/gangrene

197
Q

management of rheumatic fever

A

ABs

NSAIDs long term

AB prophylaxis

198
Q

what is the average rate of depolarisation of the AV node (not depolarised by the SA node)

A

50-60bpm

199
Q

treatment for bleeding varicose veis

A

ELEVATION then pressure bandage compression stocking

200
Q

what ECG pattern do you get with pericarditis

A

ST elevation in all precordial leads and Lead 1 also can get PR depression

201
Q

what is the difference between primary and secondary varicose veins

A

primary = affecting superficial veins or perforators in the absence of deep incompetence

secondary = associated with deep venous incompetence from recanalization of previous DVT. Or venous obstruction

202
Q

typical location of neuropathic ulcerrs

A

pressure points or calluses

203
Q

what should you do if you hear a murmur in the aortic area

A

sit the patient forward and get the patient to expire and hold their breath

  • listen at the left sternal edge (aortic regurg) and then aortic area (aortic stenosis)
204
Q

end organ damage caused by hypertension

A

stroke, intracerebral haemorrhage LVH, CHF, CAD Renal failure, proteinuria peripheral vascular disease, retinopathy

205
Q

what is the effect on the heart of mitral stenosis

A

LA enlargement

206
Q

when do you use dobutamine stress echo

A

in patients who cannot exercise

207
Q

what is the echo sign of cardiac tamponade

A

ventricular interdependence

208
Q

treatment of VT

A

DC reversion in unconscious

can try amiodarone as a bolus if conscious

209
Q

you cannot perform a stress ECG on a patient with which ECG signs

A

LBBB

WPW

paced rhythm - less reliable with LVH, digitalis effect

210
Q

clinical signs of HOCM

A

diffuse, foceful apex beat

Ejection systolic murmur best heard at the left sternal edge/apex that increases with the Valsalva manoeuvre

211
Q

management of mitral regurg

A

echo every 6-12 months if severe surgery for replacement/repair when:

  • echo shows decompensation of LV
  • pulmonary hypertension
212
Q

causes of secondary hypertension

A

renal artery stenosis

adrenal - Cushings, hyperaldosteronism phaeochromocytoma

coarctation of the aorta

sleep apnoea

213
Q

what does a diffuse and hyperkinetic apex beat suggest

A

volume overloaded heart

214
Q

management of aortic stenosis

A

mild-moderate with no symptoms = observe

severe AS + symptoms = replace valve

215
Q

do not use a CV risk calculator in patients with:

A

existing CVD

strong family history of premature cardiovascular disease

patients with renal disease (should be treated)

Z MD 2 (15 decks)

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