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ACC > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What are the characteristic changes seen on an ecg with wolf-parkinson white?

A

short PR interval
wide QRS complexes with a slurred upstroke - ‘delta wave’
left axis deviation if right-sided accessory pathway*
right axis deviation if left-sided accessory pathway*

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2
Q

What does HASBLED stand for?

A 
HTN
Abnormal renal function OR liver function
Stroke
Bleed
Labile INR
Elderly >65
Drugs predisposing to bleeding OR alcohol
MAX 9 points
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3
Q

NB

A 
Differentiating between type A and type B**
type A (left-sided pathway): dominant R wave in V1
type B (right-sided pathway): no dominant R wave in V1
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4
Q

Name some associations with wolf-parkinson white?

A 
HOCM
mitral valve prolapse
Ebstein's anomaly
thyrotoxicosis
secundum ASD
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5
Q

Treatment of wolf-parkinson white?

A

definitive treatment: radiofrequency ablation of the accessory pathway
medical therapy: sotalol***, amiodarone, flecainide

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6
Q

What is ebsteins anomaly?

A

Remember lithium in pregnancy**
A congenital malformation of the heart that is characterized by apical displacement of the septal and posterior tricuspid valve leaflets, leading to atrialization of the right ventricle with a variable degree of malformation and displacement of the anterior leaflet.
Associated with WPW.

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7
Q

In a patient with paroxysmal AF, which two drugs can cardiovert him into sinus rhythm?

A

amiodarone + flecainide

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8
Q

Which two drugs should you not use together. hint: one calcium channel and one beta blocker.

A

Atenolol and verapamil. ( risk of complete heart block**)

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9
Q

What type of waves may you see in a patient with hypokalaemia?

A 
U waves
small or absent T waves (occasionally inversion)
prolong PR interval
ST depression
long QT
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10
Q

Name some conditions where a third heart sound is heard?

A
  • Caused by diastolic filling of the ventricle
  • considered normal if < 30 years old (may persist in women up to 50 years old)
  • Heard in left ventricular failure (e.g. dilated cardiomyopathy), constrictive pericarditis (called a pericardial knock) and
  • mitral regurgitation
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11
Q

Where is the tricuspid valve best heard?

A

Fourth intercostal space left sternal edge

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12
Q

Where is the aortic valve best heard?

A

2nd intercostal space, right sternal edge

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13
Q

Where is the mitral valve best heard?

A

Left fifth intercostal space, just medial to mid clavicular line

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14
Q

What is the acute management of SVT?

A

vagal manoeuvres: e.g. Valsalva manoeuvre
intravenous adenosine 6mg → 12mg → 12mg: contraindicated in asthmatics - verapamil is a preferable option
electrical cardioversion

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15
Q

Which beta blockers are licensed to treat HF?

A

bisoprolol, carvedilol, and nebivolol.

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16
Q

INTERACTION

A

amlopidine and simvastatin

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17
Q

If an ecg had a ‘saw tooth’ appearance, what are you thinking?

A

Atrial flutter

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18
Q

Inferior infarct, which artery?

A

Right coronary artery

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19
Q

How long after an MI can you drive?

A

4 weeks

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20
Q

Why do you give ace inhibitors long term after MI?

A

It stops remodelling of the heart after MI.

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21
Q

Hypokalaemia on an ECG…

A

In Hypokalaemia, U have no Pot and no T, but a long PR and a long QT
Submit answer

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22
Q

Features of a massive PE?

A

Hypotension, cardiac arrest. patients receive alteplase

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23
Q

Features of a submissive PE?

A

Hypoxia, cardiac echo/ecg show features of right sided heart strain. Troponin is also raised.

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24
Q

If someones had a non-massive PE, what scoring system do you then use?

A

PESI- pulmonary embolism score index.

<85 is LOW risk. consider ambulatory care. start LMWH and counsel about oral anticoagulation.

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25
Q

In which patients should you NOT prescribe a non-dihydropyridine?

A

Eg diltiazam and verapamil. These are contra-indicated in patients who are on beta-blockers because these are both cardiac depressants and they therefore potentiate the effects of beta-blockers.

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26
Q

What pulse is felt on a patient with a patent ductus arteriosus?

A

Bounding pulse

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27
Q

ECG changes with hypothermia….

A 
bradycardia
'J' wave - small hump at the end of the QRS complex
first degree heart block
long QT interval
atrial and ventricular arrhythmias
Submit answer
28
Q

Drugs which improve mortality in patients with heart failure?

A

ACE inhibitors
spironolactone
beta-blockers
hydralazine with nitrates

29
Q

What is dressler’s syndrome?

A

The underlying pathophysiology is thought to be an autoimmune reaction against antigenic proteins formed as the myocardium recovers. It is characterised by a combination of fever, pleuritic pain, pericardial effusion and a raised ESR. It is treated with NSAIDs.

30
Q

Left ventricular aneurysm following an MI

A

The ischaemic damage sustained may weaken the myocardium resulting in aneurysm formation. This is typically associated with persistent ST elevation and left ventricular failure. Thrombus may form within the aneurysm increasing the risk of stroke. Patients are therefore anticoagulated.

31
Q

Associations of co-orctation of the aorta?

A

Turner’s syndrome
bicuspid aortic valve
berry aneurysms
neurofibromatosis

32
Q

High blood pressure and low potassium, what you thinking?

A

Hyperaldosteronism (conns). aldosterone causes sodium retention (high bp) and therefore potassium loss.

33
Q

If someone had heart block following an MI, which artery was the infarction likely to be in?

A

Right coronary artery

34
Q

Inferior infarction?

A

right coronary

35
Q

Myocardial ischaemia on ECG?

A

Hyper acute T waves, ST elevation, then t wave inversion, then pathological q waves.

36
Q

Phaeochromocytoma test?

A

24 hour urine metanephrines

37
Q

What type of pulse pressure is seen in aortic stenosis?

A

Narrow pulse pressure

38
Q

Aortic regurgitation pulse pressure?

A

Wide

39
Q

How does amiordarone work?

A

It works by blocking potassium channels which inhibits repolarisation and thus prolongs the action potential.

40
Q

What tests must you do before you start someone on amiodarone?

A

Chest X-ray due to the risk of pulmonary fibrosis with amiordarone/ pneumonitis. TFT, LFT and U&Es (TFT and LFT must be repeated every 6 months).
(causes bradycardia)

41
Q

NB

A

Atrioventricular block is more common following inferior myocardial infarctions.

42
Q

An early-to-mid systolic murmur

A

Mitral regurg

43
Q

Tx for Dressler’s?

A

NSAIDS

44
Q

Left ventricular free wall rupture..

A

This is seen in around 3% of MIs and occurs around 1-2 weeks afterwards. Patients present with acute heart failure secondary to cardiac tamponade (raised JVP, pulsus paradoxus, diminished heart sounds). Urgent pericardiocentesis and thoracotomy are required.

45
Q

Hyperkalaemia on ecg?

A

Tall tented t waves

46
Q

What treatment do you give for Polymorphic VT (e.g. Torsade de pointes)?

A

IV magnesium

47
Q

Pericarditis on ECG?

A

Widespread ‘saddle-shaped’ ST elevation

PR depression: most specific ECG marker for pericarditis

48
Q

BNP

A

Increased BNP levels (>400) are not on their own diagnostic of heart failure, and may be elevated as a result of left ventricular hypertrophy, myocardial ischaemia, atrial fibrillation, pulmonary hypertension, hypoxia, pulmonary embolism, right ventricular strain, chronic obstructive pulmonary disease, liver failure, sepsis, diabetes, and renal impairment. In addition, levels tend to be higher in women, and in people older than 70.

49
Q

When should you not measure BNP when a patient presents with signs of HF?

A

If they have already had a previous MI.

50
Q

When may the levels of BNP be falsely low in a patient with heart failure?

A

If they take aldosterone antagonists, ACE inhibitors, angiotensin-II receptor antagonists, beta-blockers and diuretics can all falsely lower BNP levels, as can obesity.

51
Q

How do you manage prolonged QT syndrome?

A

Avoid drugs which prolong the QT interval and other precipitants if appropriate (e.g. Strenuous exercise)
Beta-blockers***
implantable cardioverter defibrillators in high risk cases

52
Q

What type of medication is dosuepilin?

A

TCA

53
Q

What are the side effects of TCA overdose?

A

Anti-cholinergic side effects, seizures, arrhythmias, metabolic acidosis and coma.

54
Q

What ECG changes are seen in TCA overdose?

A

Prolonged QT, sinus tachycardia and widening of QRS.

55
Q

How do flecanide and quinidine work?

A

They both prolong QT interval.

56
Q

How should glycaemic control be achieved in acute coronary syndromes?

A

It is recommended using a dose-adjusted insulin infusion with regular monitoring of blood glucose levels to glucose below 11.0 mmol/l
Intensive insulin therapy (an intravenous infusion of insulin and glucose with or without potassium, sometimes referred to as ‘DIGAMI’) regimes are not recommended routinely. Stop metformin and gliclazide

57
Q

Which anti-hypertensive is ALWAYS first line for patients with diabetes?

A

ACE-inhibitor, doesn’t matter what age!!

58
Q

Mechanical valves, target INR?

A

aortic: 3.0
mitral: 3.5

59
Q

DVLA advice post MI?

A

Cannot drive for 4 weeks.

60
Q

In heart failure, if symptoms persist what should you consider?

A

Cardiac resynchronisation therapy or digoxin* should be considered. An alternative supported by NICE in 2012 is ivabradine. The criteria for ivabradine include that the patient is already on suitable therapy (ACE-inhibitor, beta-blocker + aldosterone antagonist), has a heart rate > 75/min and a left ventricular fraction < 35%

61
Q

In a patient with AF who has asthma, what medication should be given to control their rate?

A

Calcium channel like diltiazam.

62
Q

What type of pulse is felt on a kid with a patent ductus arteriosus?

A

Large volume bounding pulse. Also wide pulse pressure (like in aortic regurg).

63
Q

Tx for stable angina?

A

Beta-blocker or calcium channel or both.

64
Q

Step 4 of HTN management?

A

If K <4.5 add spironalactone and if K >4.5 add higher dose thiazide like treatment.

65
Q

What is a holter monitor?

A

A Holter monitor is a battery-operated portable device that measures and tape records your heart’s activity (ECG) continuously for 24 to 48 hours or longer depending on the type of monitoring used.

ACC (8 decks)

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