Cardiology Flashcards
CHA2DS2-VASc score
Congestive heart failure - 1 Hypertension - 1 Age 65-74 years - 1, ≥75 years - 2 Diabetes mellitus - 1 Stroke/TIA/TE - 2 Vascular disease (prior MI, PAD, or aortic plaque) - 1 Sex category (ie. Female) - 1
Oral anticoagulant if score ≥2
When is warfarin preferred over NOAC for anticoagulation in AF?
- Patient already stable on warfarin.
- CrCl less than 30
- Prosthetic heart valves
- Rheumatic heart disease
- Mitral stenosis
- Enzyme inducing antiepileptic eg. Phenytoin
- HIV infection on protease inhibitor
Pulsus paradoxus
Drop in BP more than 10mmHg with inspiration.
eg. severe asthma, cardiac tamponade
Kussmaul’s sign
Elevation of JVP on inspiration due to poor RV filling.
eg. constrictive pericarditis, cardiac tamponade
Pansystolic murmur
Mitral regurgitation
Tricuspid regurgitation
Ventricular septal defect
Aortopulmonary shunts
Mid-systolic murmur
Aortic stenosis
Pulmonary stenosis
Hypertrophic cardiomyopathy
Pulmonary flow murmur of ASD
Late systolic murmur
Mitral valve prolapse
Papillary muscle dysfunction (eg. HOCM)
Early diastolic murmur
Aortic regurgitation
Pulmonary regurgitation
Mid-diastolic murmur
Mitral stenosis Tricuspid stenosis Atrial myxoma Austin Flint murmur of AR Carey Coombs murmur of acute rheumatic fever
Murmur accentuation
Left sided accentuates with expiration.
Right sided accentuates with inspiration.
Duke treadmill score (in exercise stress testing)
Exercise time (on Bruce protocol in minutes) - (5 x max ST deviation in mm) - (4 x exercise angina, 0=none, 1=non-limiting, 2=limiting)
Low risk ≥5 (99% 4 year survival)
Moderate risk -10 to 4 (90% 4 year survival)
High risk ≤-11 (65% 4 year survival)
Brugada criteria - differentiate VT from SVT
Concordance
RS interval (over 100msec)
AV dissociation
QRS morphology criiteria
Brugada criteria - QRS morphology RBBB pattern
Monophasic R
Biphasic qR in V1
rS complex in V6
Brugada criteria - QRS morphology LBBB pattern
Broad R wave ≥40msec
Notched S wave downstroke
QRS ≥60msec in V1/V2
Q or QS wave in V6
Most common symptoms of myocarditis
Dyspnoea - 72%
Chest pain - 32%
Arrhytmias - 18%
Most common acquired valvular disease
Aortic stenosis
Long QT - definition
QT interval - measured from onset QRS to termination of T wave
Men - more than 470 msec abnormal
Women - more than 480 msec abnormal
ECG findings - pulmonary embolism
Sinus tachycardia Non-specific ST & T-wave changes (70%) S1Q3T3 pattern RV strain New incomplete RBBB
Most common cause of large U waves
Hypokalaemia (typical)
Bradycardia
Antiarrhythmic drugs (class 1A and 3)
Intracranial haemorrhage
Exercise stress ECG - most predictive finding for multivessel or left main coronary artery disease
ST segment elevation in aVR
Hypertrophic cardiomyopathy (HOCM) - echocardiogram diagnosis
LV thickness more than 15mm
Septal to free wall ratio 1.3 to 1.5
Atrial flutter - circuit origin
Tricuspid annulus
Idiopathic ventricular tachycardia - circuit origin
Right ventricular outflow tract
Atrial fibrillation - circuit origin
Pulmonary veins
Atrioventricular nodal reentrant tachycardia (AVNRT) - circuit origin
Dual AV node pathways
posterior slow pathway - target for ablation
Atrioventricular reentrant tachycardia (AVRT) - circuit origin
Accessory pathway (from AV ring/groove or septum)
Beta blockers - non-selective (beta 1 and beta 2)
Propranolol
Sotalol
Carvedilol (alpha 1 as well)
Beta blockers - beta 1 selective
Metoprolol
Atenolol
Most common cause aortic stenosis
Calcification aortic valve - age 70+
Bicuspid aortic valve - age 40-50
