Cardiology Flashcards
What does ST elevation in II, III & aVF signify?
Inferior STEMI - RCA
What does ST elevation in V1-4 signify?
Anteroseptal STEMI - LAD
What does ST elevation in V4,5 & aVL signify?
Anterolateral STEMI - LAD or circumflex
What does ST elevation in I & aVL signify?
Lateral STEMI - circumflex
What does ST elevation in V7-9 signify?
Posterior STEMI - circumflex
What are some causes of a prolonged QT?
Congential, anti-psychotics, amiodarone, hypokalaemia, erythromycin
What are the ECG signs of hyperkalaemia?
Low flat P waves, broad QRS, slurs into ST, tall tented T waves
What is angina and what are the symptoms?
Symptomatic, reversible myocardial ischaemia
- Constricting/heavy discomfort to chest/arms/jaw
- Brought on by exertion
- Relieved within 5 mins by rest or GTN
What is decubitus angina?
Precipitated by lying flat
What is prinzmetal angina?
Caused by coronary artery spasm
Amphetamines, cocaine, hypomagnesia
What tests should be done for angina?
ECG
FBC, U&Es, TFTs, lipids, HbA1c
Exercise tolerance test
What is the management of angina?
Stop smoking, diet, exercise, HTN & lipid control
75mg aspirin daily
GTN
B blocker
What is the acute treatment for STEMI?
O2 if needed 300mg aspirin 180mg ticagrelor Morphine + anti-emetic PCI
What is the chronic treatment following a STEMI?
75mg aspirin + clopidogrel + PPI for 12 months Anticoagulation till discharge B blocker High dose statin ACEi
What are the rules for driving following an MI?
1 week after successful angioplasty
4 weeks after ACS without angioplasty
What are some complications of MI?
Cardiac arrest, cardiogenic shock, left ventricular failure, arrhythmias, pericarditis, tamponade, mitral regurgitation, Dressler’s syndrome, left ventricular aneurysm
What are the signs of cardiac tamponade?
Decreased cardiac output - pulsus paradoxes, muffled heart sounds
Kussmaul’s sign - JVP rises during inspiration
What is Dressler’s syndrome?
Recurrent pericarditis, pleural effusion, fever, anaemia, raised ESR
What are the signs of a left ventricular aneurysm?
LVF, angina, recurrent VT, persistent ST elevation
What tests should be done for an arrhythmia?
FBC, U&E, glucose, calcium, magnesium, TFTs
ECG
Echo
What are the indications for D/C cardioversion rhythm control in arrhythmias?
Shock, chest pain, heart failure, syncope
What are some causes of atrial fibrillation?
Heart failure, HTN, IHD, PE, mitral valve disease, hyperthyroidism, alcohol, electrolyte imbalances
What is WPW syndrome and what are the ECG findings?
Congenital accessory conduction pathway between atria and ventricles
Short PR, wide QRS, ST changes
What is heart failure?
Cardiac output is inadequate for the body’s requirements
What are some causes of systolic heart failure?
IHD, MI, cardiomyopathy
What are some causes of diastolic heart failure?
Ventricular hypertrophy, constrictive pericarditis, tamponade, restrictive cardiomyopathy, obesity
What is the classification of heart failure?
I - no dyspnoea from ordinary activity
II - comfortable at rest
III - less than ordinary activity causes dyspnoea
IV - dyspnoea at rest
What are the CXR features of heart failure?
Alveolar oedema, Kerley B lines, cardiomegaly, dilated upper lobe veins, pleural effusions
What is malignant hypertension?
Rapid rise in BP leading to vascular damage
Severe HTN + bilateral retinal haemorrhages + exudates
What are some causes of secondary hypertension?
Renal disease e.g. glomerulonephritis
Endocrine - Cushing’s, Conn’s, acromegaly
Pregnancy, COCP, cocaine
What are the stages of hypertensive retinopathy?
- Tortuous arteries, thick shiny walls
- AV nipping
- Flame haemorrhages & cotton wool spots
- Papilloedema
What is the treatment for hypertension?
Over 55 or black - Ca channel blocker
Under 55 - ACEi
What are some causes of mitral regurgitation?
Calcification, rheumatic fever, IE, CTD, mitral valve proplapse
What are the signs and symptoms of mitral regurgitation?
Dyspnoea, fatigue, palpitations
AF, hyperdynamic apex, displaced apex
Pansystolic murmur at apex, radiates to axilla
What are the signs and symptoms of mitral stenosis?
Dyspnoea, haemoptysis, chronic bronchitis
Fatigue, palpitations, chest pain
Malar flush, low volume pulse, tapping apex, RV heave
Mid-diastolic murmur
What are the causes of aortic stenosis?
Senile calcification, bicuspid valve, rheumatic fever
What are the symptoms of aortic stenosis?
- Angina
- Syncope
- Heart failure
What are the signs of aortic stenosis?
Slow rising pulse, narrow pulse pressure
LV heave, aortic thrill
Ejection systolic murmur - left sternal edge to carotids
What are the symptoms and signs of aortic regurgitation?
Dyspnoea, orthopnoea, PND, syncope
Collapsing pulse, wide pulse pressure, hyperdynamic apex
De-musset’s, Corrigan’s, Quincke’s
Early diastolic murmur
What are the causes of pulmonary stenosis?
Usually congenital - Tuner’s, Noonan’s, William’s, TOF, rubella
What are the risk factors for infective endocarditis?
Skin breaches, renal failure, immunosuppression, DM, IVDU
What are the signs and symptoms of IE?
Fever, rigors, night sweats, malaise
New/changing murmur, vegetations
Vasculitis, microscopic haematuria, Roth spots
Osler nodes, Janeway lesions, splinter haemorrhages
What are the Duke’s major criteria for IE?
Blood culture - 2x typical organism, persistently positive
Echo - vegetation, abscess
What are the causes of pericarditis?
Bacteria - TB, lyme disease
Viruses - EBV, CMV
Autoimmune - SLE, RA, vasculitis
Drugs - chemo
What are the symptoms and ECG signs of pericarditis?
Central chest pain worst on inspiration and lying flat
Relieved by sitting forwards
Saddle shaped ST elevation, PR depression
How is cardiac tamponade diagnosed?
Beck's triad: 1. Falling BP 2. Rising JVP 3. Muffled heart sounds Echo diagnostic
