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Year 5 Notes > Cardiology > Flashcards

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
Pulsus paradoxus: | Causes
Severe asthma | Asthma Tamponade
26
Slow-rising pulse: | Causes
Aortic stenosis
27
Collapsing pulse: | Causes
Aortic regurg PDA Hyperkinetic state
28
Pulsus alternans: | Cause
Severe LVF
29
Jerky pulse: | Cause
HOCM
30
ST elevation: | Causes
``` MI Pericarditis LVA Prinzmetals angina (Hyperkalaemia) ```
31
Aortic dissection: | Signs and symptoms
``` Severe tearing chest pain, radiates to back Unequal BP in arms Widened mediastinum Hemi/paraplegia Anuria ```
32
ASD: | Types
Patent foremen ovale | Ostium primum/secundum
33
ASD: | Examination findings
Ejection systolic murmur Split second heart sound (loudest over pulmonary area) Acyanotic Often asymptomatic
34
VSD: | Examination findings
Severe heart failure in infancy/asymptomatic Harsh pansystolic murmur at LSE Pulmonary HTN
35
Long QT syndrome: | Causes
Congenital Drug induced (amiodarone, TCAs) Electrolyte imbalance MI, SAH
36
CHADS2VASC
``` Congestive Heart Failure HTN >160 Age 65-74 Diabetes Stroke/TIA Vascular disease Age >75 Sex ``` Sex
37
Hypokalaemia: | ECG findings
T wave inversion and U wave (swooping curvy after qrs)
38
Dukes criteria
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
Infective endocarditis: | Signs and symptoms
``` Fever Roths spots Solders nodes Murmur Jane way lesions Anaemia Nail haemorrhage Emboli ```
40
Mitral stenosis: signs
Malar flush AF Tapping beat JVP raised (late)
41
Acute LVF: signs
``` Sinus tacky/ AF Hypotension Cardiomegaly 3rd 4th heart sounds Pleural effusions ```
42
Fourth heart sound
Always abnormal HF MI cardiomyopathy HTN
43
Third heart sound
Normal up to 30 ``` Or HF MI cardiomyo HTN valve regurg Constrictive pericarditis ```
44
Aortic regurg: | Causes
REALM ``` Rheumatic heart disease Endocarditis Ank spond/aortic dissection Luetic heart disease Marfans syndrome ```
45
Where does a left main stem MI show?
Large anterior V2-6 Very ill/die
46
Where does a left anterior descending MI show?
Anteroseptal | V2-4
47
Where does a left circumflex MI show?
Anterolateral | 1, aVL, V4-6
48
Where does a right coronary MI show?
Inferior 2,3, aVF Bradyarrythmias
49
Angina vs MI
Ang: Pain less severe Lasts
50
Complications of an MI
SPARED ``` Sudden death Pump failure Aneurysm or arrhythmia Re upturn of papillary muscle/septum Embolism Dressers syndrome ```
51
Features of pericardial pain
``` Sharp Worse on inspiration Central Radiates to shoulder not arm Worse lying flat Better leaning towards ```
52
Radiographic changes of acute LVF/heart failure
``` Cardiomegaly Bats wings Diffuse mottling Pleural effusions Fluid in fissures -kerly b lines ```
53
Acute LVF: | Treatment
``` High dose O2 Treat arrhythmias Diuretics Vasodilators Opiates ```
54
Hyperkalaemia: | Management
ECG +resus equipment ready IV calcium gluconate Glucose+insulin
55
Mechanical prosthetic valves
Noisy Ball+cage/bi leaflet Long term anticoag Not for child breathing age or elderly or risk of bleeding
56
Mechanical prosthetic valves: | Complications
``` Valve failure (from thrombosis or mechanical failure) Obstruction Subacute bacterial endocarditis Leak Haemolysis ```
57
Bioprosthetic valves
``` Quiet Don't need anticoag For child bearing or bleeders Fail suddenly with acute severe pulmonary edema and cardiogenic shock 10-15 years ```
58
NYHA Heart Failure Classifications
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
Infective endocarditis ABx prophylaxis
For high risk patients (previous IE, valve replacement, congenital heart disease) having high risk procedures (tooth extraction, gingival margin)
60
Infective endocarditis: | Ix
``` FBC (raised WCC) Raised ERC, CRP Urine dip - microscopic haematuria Blood cultures x3 TTE/TOE ```
61
Dukes criteria for IE
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
Posterior MI
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
Stage 1 HTN
>140/90 (ABPM 135/85) | Treat if
64
Stage 2 HTN
>160/100 (150/95)
65
Immediate ECG changes for MI
ST elevation | Peaked T waves
66
ECG changes MI
Inverted t waves | +- ST elevation
67
ECG changes MI few days
Pathological Q waves
68
What does persistent ST elevation post MI indicate?
Left ventricular aneurysm
69
ECG changes for Digoxin
ST depression Inverted t waves v5-6 +- arrhythmias, modal bradycardia
70
ECG change for ventricular hypertrophy
Dominant R waves
71
ECG causes of low voltage
COPD, hypothyroid, PE
72
Indications for an exercise ECG
Suspected IHD in known CAD (e.g previous MI) | Exercise induced arrhythmias
73
Angina Tx
``` Modify risk factors Aspirin Beta blocker Nitrates Long acting Ca2+ blockers K+ channel activators ```
74
HCOM
Autosomal dominant Young sudden collapse or death Jerky pulse Ejection systolic murmur (mitral and tricuspid regurg)
75
Reasons to treat stage 1 HTN
20%
76
HF Ix: | Echo vs BNP
Previous MI = echo
77
STEMI: | PCI/thrombolysis
LWMH + PCI = gold standard if available | If not thrombolysis +tPa and repeat ECG 30 mins for 50% ST reduction
78
Chest pain: | Management for different presentations/timings
72h = full assess + ECG + trop
79
AF+heart failure management
DC cardio vert
80
Aortic stenosis + ACEi
Risk of profound hypotension
81
Heart failure management: | First line
ACE + beta blocker
82
Heart failure management: | Second line
Aldosterone agonist/ARB/hydralazine + nitrate
83
Heart failure management: | Last line
Cardiac re sync/digoxin +diuretics if fluid overload
84
New LBBB +chest pain
Treat as MI, do PCI or thrombolysis
85
Canon a waves in JVP
VT
86
Giant v wave in JVP
Tricuspid regurg
87
Absent y descent and raised JVP
Cardiac tamponade
88
Which are the cyanotic congenital heart defects?
Tetralogy of fallout | Transposition of great arteries
89
TGA
Cyanotic Presents to 2-3 as cyanotic Abby Needs surgery Can have stenosis, esp pulmonary arteries, in later life
90
Tetralogy of Fallot
Pulmonary stenosis + RVH + VSD + over-riding aorta Presents as cyanotic at 2-3, generally unwel,, poor weight
91
ASD
Presents days - months Ejection systolic murmur loudest over pulmonary area P pulonale + big R waves + Rbbb
92
VSD
6-8 weeks Small ones close by themselves Large have risk of eisenmengers in adolescence
93
Coarctation of the aorta
Presents at roughly 3 weeks Poor feeding, lethargy, tachypnoea, heart failure Unequal pulses, lower body cyanosis Give prostaglandin injection
94
Complication of Kawasaki disease
Coronary artery aneurysm

Year 5 Notes (19 decks)

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