Cardiology Flashcards
Which drugs are used for rhythm control in AF?
Amiodarone, flecanide, sotolol
What drugs are used to treat hyperkalaemia?
Calcium gluconate
Insulin + dextrose
Risonium
Ventolin (nebulised)
Which drugs are used for rate control in AF?
Beta blockers, CCB or digoxin
What are the treatments for SVT?
Vagal manoeuvre (eg blow into syringe)
- -> Adenosine
- -> CCB eg verapamil
Rx for AMI?
MONA Morphine IV Oxygen if SpO2 less than 95% Nitrates Aspirin 300mg
What are some common causes of AF?
IS HIP AF
Infarction
Stress eg post surgery
Hypoxia
Infection
PE
Anaemia
Fluid and electrolyte imbalance
What are 3 causes of SVT?
Atrial flutter, junctional tachycardia or AF
What is the treatment for pericarditis?
NSAIDs
How does pericarditis appear on ECG?
Global ST elevation
Which drug regime should be used for hypertension in DM?
CCB + ACEi
What is the drug regime for HTN + heart failure?
Beta blocker + ACEi
What is the drug regime for HTN post AMI?
ACEi + beta blocker
How does digoxin work?
Increases vagal tone thus parasympathetic drive
What does CHADSVASC stand for?
How do you decide whether to anticoagulate or not?
CCF Hypertension Age older than 75 = 2 points DM Stroke previously = 2 points Vascular disease (PVD, aortic plaque, MI) Age 65-74 Sex (female = 1)
Anticoagulate if 2 points or more
If male: 1 point maybe coagulate
How is HASBLED calculated and what score indicates increased risk of bleeding?
Hypertension 160/90 or on treatment
Abnormal renal (1 point) or liver function (1 point)
Stroke
Bleeding (prior major bleeding or predisposition to bleeding)
Labile INRs
Elderly >65
Drugs (aspirin, anticoagulants 1 point) or alcohol (1)
If 3 or more, indicates greater risk of bleeding
What does a large v wave of JVP suggest?
Tricuspid regurgitation
What are the signs of tricuspid regurgitation?
Pulsatile liver Raised JVP (large V wave) Right ventricular heave Pansystolic murmur Jaundice Ascites
pharmacological approach to CHF with reduced LVEF
Beta blocks
ACEi
Diuretics
digoxin and nitrates for refractory Sx
signs of Aortic regurgitation
collapsing pulse
wide pulse pressure
early diastolic murmur
What CXR sign points towards aortic dissection?
Widened mediastinum
Treatment of acute pulmonary oedema?
LMNOP Lasix Morphine Nitrates O2 Positioning
What is 3rd degree heart block?
Complete dissociation of the QRS from the p wave
What is the concern about long QT interval?
Can predispose to torsades de pointe
What are the shockable rhythms?
VT and VF
What are the X ray findings with someone in acute cardiac failure?
ABCDE A - alveolar opacity B - Kerley B lines C - cardiomegaly D - dilated apical blood vessels E - effusions
Pharmacological treatment of hypertension
ACEi (or ARB)
2nd line: + CCB or thiazide
3rd line: + CCB and thiazide
How long do troponins stay elevated for post MI?
7-10 days
Treatment algorithm for hypertension
1 ACEi, CCB or thiazide diuretic
2 ACEi or ARB + CCB or thiazide
3 ACEi or ARB + CCB + thiazide diuretic
Treatment algorithm for dyslipidaemia
1 Statin
2 Statin + ezetemibe (decreases chol absorption in gut)
3 Statin + ezetemibe + fibrate
Treatment algorithm for heart failure
1 ACEi
2 ACEi + beta blocker
3 ACEi + beta blocker + spironalactone
Hhere is the pain of aortic dissection classically localised to?
Interscapular
How is the quality of the pain of aortic dissection classically described?
Tearing
Which cause of chest pain is classically relieved by leaning forward?
Pericarditis
What is a positive Levine sign and what does it suggest?
Patient clenches fist over sternum when describing chest pain. Suggests cardiac pain.
Which cause of chest pain is worse on inspiration?
Pleuritic chest pain
What is the classic defining feature of pleuritic pain?
Worse with inspiration
What are the RFs for PE?
Travel, OCP, malignancy, surgery, immobility, steroids, FHx of factor V leiden mutation
MIS LOTS
What is the treatment protocol for acute Mx of an AMI?
MONASH
morphine, oxygen, nitrates, aspirin, statin, heparin
What is the treatment protocol for discharging someone who he just had an AMI?
SAAB
statin
ACEi
aspirin
beta blocker
If you hear a murmur, where else should you auscultate?
Carotids and axilla
Where will a murmur from aortic stenosis ‘radiate’ to on auscultation?
Carotid arteries
Which murmur will radiate to the carotid arteries?
Aortic stenosis
Where will a murmur from mitral regurgitation ‘radiate’ to on auscultation?
Axilla
What triad of signs is found in cardiac tamponade? (called Beck’s triad)
Muffled heart sounds
Hypotension
Increased JVP
What kind of LV hypertrophy occurs with mitral regurgitation?
Eccentric hypertrophy
What type of murmur does aortic stenosis cause?
Ejection systolic (or crescendo-decresendo)
Which valve event corresponds to S1?
Closure of AV valves (mitral and tricuspid)
Where does the murmur of aortic stenosis radiate to?
Carotid arteries
What kind of hypertrophy occurs with aortic stenosis?
Concentric hypertrophy
What type of murmur does aortic regurgitation cause?
Early diastolic
What happens to the apex beat in aortic stenosis?
It is heaving but not displaced
What type of murmur does mitral regurgitation cause?
Pansystolic
What is the best method to measure severity of aortic stenosis?
Echocardiography
What kind of hypertrophy occurs with aortic regurgitation?
Eccentric hypertrophy
If present, where will the thrill of aortic stenosis be felt?
Over upper right sternal edge
What is the most common cause of aortic stenosis in Australia>
Calcification
Rheumatic fever occurs after infection with which pathogen?
Strep pyogenes (Group A/ Beta haemolytic)
Inspiration causes murmurs from which side of the heart to sound louder?
Right
Expiration causes murmurs from which side of the heart to sound louder?
Left
What are the 6 signs of severe AS?
Pulmonary oedema Weak pulse/slow rising carotid pulse Narrow pulse pressure S4 Soft or absent S2 A2/P2 reversal
What is a typical EDV?
110 to 120ml (Guyton and Hall, 1996)
What effects does parasympathetic stimulation of the heart have?
Decrease HR
What effects does sympathetic stimulation of the heart have?
Increased heart rate and force of contraction
What is the molecular target of heparin?
Heparin enhances activity of antithrombin III, which inhibits factor Xa and thrombin
What is a typical ejection fraction?
60% (Guyton and Hall, 1996)
What are 4 distinguishing features of the phrenic nerve course?
1 Runs along scalenus anterior muscle
2 Passes between subclavian artery and vein
3 Passes anterior to lung root
4 Pierce diaphragm
Where does the parasympathetic nervous system innervate the heart?
SA node and AV node
At the level of which thoracic vertebrae does the heart sit?
T5-T8
Where is the sternal angle?
Horizontal line between manubriosternal joint and T4/T5
What is a typical SV?
70ml (Guyton and Hall, 1996)
What is the average heart mass of a healthy young adult?
160g
How do Ca2+ channel blockers improve arrhythmias?
Reduce heart rate and conduction through SA and AV node
Where does the sympathetic nervous system innervate the heart?
SA node, AV node and ventricles
What percentage of the blood is in the veins?
65%
What is the most lateral structure in the mediastinum?
Phrenic nerves
At what vertebral level does the aorta pass behind the diaphragm?
T12
What is a typical ESV?
40-50ml (Guyton and Hall, 1996)
At what vertebral level does the inferior vena cava pass through the diaphragm?
T8
Where does left anterior descending artery supply?
LAD supplies anterior surface and anterior 2/3 of interventricular septum
Where does circumflex artery supply?
lateral wall of LV
Where does posterior interventricular artery supply?
Inferior part of LV and posterior 1/3 of interventricular artery
How soon after an AMI must repurfusion be to be effective?
6 hours
Which artery most commonly supplies the atrio-
ventricular node?
Right coronary artery
Which bacteria classically causes subacute bacterial endocarditis?
Viridans strep
What is empirical Rx for infective endocarditis?
BFG = Big Friendly Giant
Benzylpenicillin
Flucloxacillin
Gentamicin
What are the two most important Ix for infective endocarditis?
ECHO and blood cultures
What type of murmur does infective endocarditis typically cause?
Regurgitant
