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Cardiology Flashcards

1
Q

STEMI management

A

M - morphine 5-10mg IV + antiemetic - metacloperamide 10mg
O - O2 aim for highest possible start at 15l if unwell
N - GTN 2 puffs/sublingual
A - aspirin 300mg
C - clopidogrel 300mg

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2
Q

STEMI Investigations

A

12 lead ECG
Bloods: U+Es, troponin, glucose, cholesterol, FBC
CXR

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3
Q

Shock management

A

ABC - high flow O2
Raise feet
IV access - 2 wide bore cannula
Fast crystalloid infusion
Catheterise, central line if needed
Ix: FBC, U+E, ABG, cross match, cultures, ECG, CXR
careful not to fluid overload in cardiogenic shock

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4
Q

SVT:

Management

A
  1. Vagal manoeuvres (breath holding, carotid massage)
  2. IV adenosine (or verapamil for asthmatics)
    Or DC cardiovert if haemodynamically unstable
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5
Q

Torasades de points

A

VT with varying axis
Crazy ECG
Caused by high QT interval, from anti arrhythmics, hypokalaemia
Tx: IV mag sulphate

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6
Q

VT:

Management

A
  1. Amiodarone 5mg

2. DC cardiovert

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7
Q

Left-sided Heart Failure:

Causes and features

A

Sx: dyspnoea, poor exercise, fatigue, PND, nocturnal cough, pink frothy sputum, cadriac wheeze, muscle wasting, cold peripheries

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8
Q

Right-sided Heart Failure:

Causes and features

A

Causes:
- pulmonary stenosis, lung disease

Sx: peripheral edema, ascites, anorexia, facial engorgement

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9
Q

Leads:

II, III, avF

A

Inferior

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10
Q

Leads:

I, aVL, V5, V6

A

Lateral

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11
Q

Leads:

V3, V4

A

Anterior

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12
Q

Leads:

V1, V2

A

Septal

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13
Q

First degree heart block

A

> 200ms (5 small squares) P-R interval

If really marked p wave gets lost in previous ST

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14
Q

Second degree mobitz type 1

A

Wenkelback phenomenon, gets progressively longer then drops the beat

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15
Q

Second degree block, mobitz type II

A

2:1 or 3:1 ratio

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16
Q

Third degree heart block

A

No relation between atrial and ventricular activity

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17
Q

Wolff Parkinson White

A

Congenital accessory pathway between a and v
Short PR interval but wide QRS complex due to slurred upstroke delta wave
Present like SVT
Treat with ablation

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18
Q

Multi focal atrial tachycardia

A

Most commonly COPD
Irregularly irregular with loads of p waves
Treat - correct hypoxia/hypercapnia, verapamil or beta blocker if HR remains high

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19
Q

Cardiac tamponadep

A

Accumulation of pericardial fluid raises intra-pericardial pressure➡️ poor ventricular filling ➡️ poor cardiac output

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20
Q

Cardiac tamponade:

Causes

A 
Pericarditis
Aortic dissection
Haemodialysis
Warfarin
Cardiac biopsy
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21
Q

Cardiac tamponade:

Signs

A 
⬆️pulse
⬇️BP
Pulsus paradoxus
⬆️JVP (rises on inspiration, no Y)
Muffled heart sounds
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22
Q

Beck triad

A

For diagnosis of cardiac tamponade

Falling BP, rising JVP, small quiet heart

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23
Q

Cardiac tamponade:

Tx

A

Referral for urgent drainage

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24
Q

Slow rise pulse:

Sign of

A

Aortic stenosis

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25
Q

Pulsus paradoxus:

Causes

A

Severe asthma

Asthma Tamponade

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26
Q

Slow-rising pulse:

Causes

A

Aortic stenosis

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27
Q

Collapsing pulse:

Causes

A

Aortic regurg
PDA
Hyperkinetic state

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28
Q

Pulsus alternans:

Cause

A

Severe LVF

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29
Q

Jerky pulse:

Cause

A

HOCM

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30
Q

ST elevation:

Causes

A 
MI
Pericarditis
LVA
Prinzmetals angina
(Hyperkalaemia)
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31
Q

Aortic dissection:

Signs and symptoms

A 
Severe tearing chest pain, radiates to back
Unequal BP in arms
Widened mediastinum
Hemi/paraplegia
Anuria
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32
Q

ASD:

Types

A

Patent foremen ovale

Ostium primum/secundum

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33
Q

ASD:

Examination findings

A

Ejection systolic murmur
Split second heart sound (loudest over pulmonary area)
Acyanotic
Often asymptomatic

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34
Q

VSD:

Examination findings

A

Severe heart failure in infancy/asymptomatic
Harsh pansystolic murmur at LSE
Pulmonary HTN

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35
Q

Long QT syndrome:

Causes

A

Congenital
Drug induced (amiodarone, TCAs)
Electrolyte imbalance
MI, SAH

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36
Q

CHADS2VASC

A 
Congestive Heart Failure
HTN >160
Age 65-74
Diabetes
Stroke/TIA
Vascular disease
Age >75
Sex

Sex

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37
Q

Hypokalaemia:

ECG findings

A

T wave inversion and U wave (swooping curvy after qrs)

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38
Q

Dukes criteria

A

2 major/1 major 3 minor/ 5minor

Major:
Blood cultures
Serology
Molecular assay
Echo
New valve regurg
Minor:
Predisposing heart condition or IVDU
Fever>38
Vascular e.g Jane way, emboli
Immunological e.g solders nodes
39
Q

Infective endocarditis:

Signs and symptoms

A 
Fever
Roths spots
Solders nodes
Murmur
Jane way lesions
Anaemia
Nail haemorrhage
Emboli
40
Q

Mitral stenosis: signs

A

Malar flush
AF
Tapping beat
JVP raised (late)

41
Q

Acute LVF: signs

A 
Sinus tacky/ AF
Hypotension
Cardiomegaly
3rd 4th heart sounds 
Pleural effusions
42
Q

Fourth heart sound

A

Always abnormal

HF
MI
cardiomyopathy
HTN

43
Q

Third heart sound

A

Normal up to 30

Or HF
MI
cardiomyo 
HTN
valve regurg 
Constrictive pericarditis
44
Q

Aortic regurg:

Causes

A

REALM

Rheumatic heart disease
Endocarditis
Ank spond/aortic dissection
Luetic heart disease
Marfans syndrome
45
Q

Where does a left main stem MI show?

A

Large anterior
V2-6
Very ill/die

46
Q

Where does a left anterior descending MI show?

A

Anteroseptal

V2-4

47
Q

Where does a left circumflex MI show?

A

Anterolateral

1, aVL, V4-6

48
Q

Where does a right coronary MI show?

A

Inferior
2,3, aVF
Bradyarrythmias

49
Q

Angina vs MI

A

Ang:
Pain less severe
Lasts

50
Q

Complications of an MI

A

SPARED

Sudden death
Pump failure
Aneurysm or arrhythmia
Re upturn of papillary muscle/septum
Embolism
Dressers syndrome
51
Q

Features of pericardial pain

A 
Sharp
Worse on inspiration 
Central
Radiates to shoulder not arm
Worse lying flat
Better leaning towards
52
Q

Radiographic changes of acute LVF/heart failure

A 
Cardiomegaly 
Bats wings
Diffuse mottling 
Pleural effusions
Fluid in fissures -kerly b lines
53
Q

Acute LVF:

Treatment

A 
High dose O2
Treat arrhythmias
Diuretics
Vasodilators 
Opiates
54
Q

Hyperkalaemia:

Management

A

ECG +resus equipment ready
IV calcium gluconate
Glucose+insulin

55
Q

Mechanical prosthetic valves

A

Noisy
Ball+cage/bi leaflet
Long term anticoag
Not for child breathing age or elderly or risk of bleeding

56
Q

Mechanical prosthetic valves:

Complications

A 
Valve failure (from thrombosis or mechanical failure) 
Obstruction
Subacute bacterial endocarditis 
Leak
Haemolysis
57
Q

Bioprosthetic valves

A 
Quiet
Don't need anticoag
For child bearing or bleeders 
Fail suddenly with acute severe pulmonary edema and cardiogenic shock
10-15 years
58
Q

NYHA Heart Failure Classifications

A

1) none: no symptoms
2) mild: breathlessness or angina on normal exertion
3) moderate: marked breathless or angina short distances
4) severe: breathless at rest

59
Q

Infective endocarditis ABx prophylaxis

A

For high risk patients (previous IE, valve replacement, congenital heart disease) having high risk procedures (tooth extraction, gingival margin)

60
Q

Infective endocarditis:

Ix

A 
FBC (raised WCC)
Raised ERC, CRP
Urine dip - microscopic haematuria
Blood cultures x3
TTE/TOE
61
Q

Dukes criteria for IE

A

Major criteria: x2 blood cultures, positive echo, new regurg
Minor: pre-disposing, fever, vascular lesions, single blood culture, immunological manifestation

2 major/ 1 major + 3 minor

62
Q

Posterior MI

A

Isolated posterior MI is rare
Left circumflex (or sometimes RCA or both)
Suspect if: tall R wave in V1, ST depression, upright T waves
Move leads round to back V7-9

63
Q

Stage 1 HTN

A

> 140/90 (ABPM 135/85)

Treat if

64
Q

Stage 2 HTN

A

> 160/100 (150/95)

65
Q

Immediate ECG changes for MI

A

ST elevation

Peaked T waves

66
Q

ECG changes MI

A

Inverted t waves

+- ST elevation

67
Q

ECG changes MI few days

A

Pathological Q waves

68
Q

What does persistent ST elevation post MI indicate?

A

Left ventricular aneurysm

69
Q

ECG changes for Digoxin

A

ST depression
Inverted t waves v5-6
+- arrhythmias, modal bradycardia

70
Q

ECG change for ventricular hypertrophy

A

Dominant R waves

71
Q

ECG causes of low voltage

A

COPD, hypothyroid, PE

72
Q

Indications for an exercise ECG

A

Suspected IHD in known CAD (e.g previous MI)

Exercise induced arrhythmias

73
Q

Angina Tx

A 
Modify risk factors
Aspirin
Beta blocker
Nitrates 
Long acting Ca2+ blockers
K+ channel activators
74
Q

HCOM

A

Autosomal dominant
Young sudden collapse or death
Jerky pulse
Ejection systolic murmur (mitral and tricuspid regurg)

75
Q

Reasons to treat stage 1 HTN

76
Q

HF Ix:

Echo vs BNP

A

Previous MI = echo

77
Q

STEMI:

PCI/thrombolysis

A

LWMH + PCI = gold standard if available

If not thrombolysis +tPa and repeat ECG 30 mins for 50% ST reduction

78
Q

Chest pain:

Management for different presentations/timings

A

72h = full assess + ECG + trop

79
Q

AF+heart failure management

A

DC cardio vert

80
Q

Aortic stenosis + ACEi

A

Risk of profound hypotension

81
Q

Heart failure management:

First line

A

ACE + beta blocker

82
Q

Heart failure management:

Second line

A

Aldosterone agonist/ARB/hydralazine + nitrate

83
Q

Heart failure management:

Last line

A

Cardiac re sync/digoxin

+diuretics if fluid overload

84
Q

New LBBB +chest pain

A

Treat as MI, do PCI or thrombolysis

85
Q

Canon a waves in JVP

86
Q

Giant v wave in JVP

A

Tricuspid regurg

87
Q

Absent y descent and raised JVP

A

Cardiac tamponade

88
Q

Which are the cyanotic congenital heart defects?

A

Tetralogy of fallout

Transposition of great arteries

89
Q

TGA

A

Cyanotic
Presents to 2-3 as cyanotic Abby
Needs surgery
Can have stenosis, esp pulmonary arteries, in later life

90
Q

Tetralogy of Fallot

A

Pulmonary stenosis + RVH + VSD + over-riding aorta

Presents as cyanotic at 2-3, generally unwel,, poor weight

91
Q

ASD

A

Presents days - months
Ejection systolic murmur loudest over pulmonary area

P pulonale + big R waves + Rbbb

92
Q

VSD

A

6-8 weeks
Small ones close by themselves
Large have risk of eisenmengers in adolescence

93
Q

Coarctation of the aorta

A

Presents at roughly 3 weeks
Poor feeding, lethargy, tachypnoea, heart failure
Unequal pulses, lower body cyanosis
Give prostaglandin injection

94
Q

Complication of Kawasaki disease

A

Coronary artery aneurysm

Year 5 Notes (19 decks)

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