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Medical Finals 2020 > Cardiology > Flashcards

Cardiology Flashcards

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USMLE® Step 1 flashcards
1
Q

What drug is contraindicated when on a beta blocker?

A

Verapamil and Diltiazem

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2
Q

What is your drug of choice for fast AF in a patient with heart failure?

A

Digoxin

Drug of choice when there is a reduced ejection fraction, ideally PO.

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3
Q

When is cardioversion indicated for fast AF?

A

Onset >48 hours or haemodynamic compromise

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4
Q

What are some contraindications of warfarin?

A
  • Haemorrhagic stroke
  • Clinically significant bleeding
  • Pregnancy
  • Renal or liver impairment
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5
Q

What affect do NSAIDs have on warfarin?

A

Increases the risk of bleeding

Other drugs that affect it: fluconazole and amiodarone

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6
Q

What drug may exacerbate long QT syndrome?

A

Sotalol

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7
Q

How do you treat long QT syndrome?

A
  • Avoid QT-prolonging drugs (amiodarone, sotalol, TCA, SSRI, haloperidol, ondansetron, erythromycin, methadone, chloroquine)
  • Beta-blockers
  • implantable cardioverter defibrillators
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8
Q

What may cause long QT syndrome?

A

Congenital deformities
Electrolyte - low calcium, potassium and magnesium
Drugs - (amiodarone, sotalol, TCA, SSRI, haloperidol, ondansetron, erythromycin, methadone, chloroquine),

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9
Q

What are the four classic ECG changes in hyperkalaemia?

A

Peaked T-waves
Small or indiscernible P-waves
Wide QRS
Prolonged PR Interval (when

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10
Q

On ECG what areas of the heart correspond to which leads?

A

Anterior - V2-4
Lateral - V5-6
Inferior - avF, I and II
Septal - avR, V1

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11
Q

What is the difference between Mobitz Type 1 and 2?

A

Second Degree Heart Block
Type 1 - PR prolongation and QRS drop
Type 2 - PR constant, QRS drop

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12
Q

What is the maximum that the AVN conducts to?

A

The AV node cannot conduct above 200bpm.

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13
Q

What are the two methods of calculating HR on an ECG?

A
  • Large squares between QRS complexes, divided into 300

- over 10 seconds, record number of R-waves and multiple by 6

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14
Q

What is a normal QRS duration?

PR Interval?

A

QRS: 0.06-0.10s
PR:0.12-0.2s

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15
Q

What is the normal range of the QRS axis?

A

-30 degrees to +90 degrees

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16
Q

What are the ECG changes associated with Wolff-Parkinson White?

A

Short PR interval

Wide QRS with slurred upstroke ‘delta wave’

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17
Q

What are the main ECG findings of hypercalcaemia?

A

Shortening of the QT interval.

Occurs secondary to malignancy

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18
Q

What arteries supply the different parts of the heart?

A 
Anterior - LAD, V1-4
Inferior - right coronary, II, III, avF
Anterolateral - LAD, LC, V4-6, I, aVL
Lateral - left circumflex, I, aVL, V4, V5, V6
Posterior - LC, RC, V1-2
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19
Q

What is a normal PR interval?

A

0.12-0.2 (3 small squares to 5)

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20
Q

What are the different types of heart block?

A

1st degree - increased PR interval, no dropped QRS
2nd degree - Mobitz 1 - PR gradually prolongs and then QRS drops
2nd degree - Mobitz 2 - fixed PR, but drops QRS every few beats
3rd degree - complete - no association between P-waves and QRS

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21
Q

What is Brugada syndrome?

A

An arrythmia associated with a problem with the calcium/sodium channels.
ST elevation in V1-3, wide QRS, incomplete RBBB

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22
Q

What is a saw-tooth ECG indicative of?

A

Atrial Flutter

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23
Q

What ischaemic features may be seen on ECG?

A

T-wave flattening or inversion
ST-depression or elevation
Q-waves

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24
Q

What ECG finding is associated with hypothermia?

A

A J-waves (osbourne wave)

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25
Q

What does S1Q3T3 refer to and what is the most common ECG finding for this condition?

A

PE - most common is sinus tachy

Deep s-wave in lead 1, q-wave in lead III, inverted T-wave in lead 3

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26
Q

What long-term ECG changes signify previous ischaemia?

A

T-wave inversion, ST depression

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27
Q

What leads would you expect to see ECG changes in an anterolateral STEMI? Which arteries are affected?

A

LAD – circumflex for lateral

V3-V4 – anterior, V5-6 – lateral

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28
Q

A fast HR and broad complex QRS indicates…?

A

Ventricular tachycardia

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29
Q

What are some potential causes of sinus tachycardia?

A
  • PE
  • salbutamol
  • anaemia
  • CO2 retention
  • anxiety
  • exercise
  • pregnancy
  • sepsis
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30
Q

What do you see on ECG in hypothermia?

A
  • J-wave
  • 1st degree HB
  • bradycardia
  • long QT interval
  • atrial and ventricular arrythmias
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31
Q

What is your pharmacological management for postural hypotension?

A

Fludricortisone

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32
Q

Give the name of some drugs that cause QTc prolongation

A

Antipsychotics (risperidone, haloperidol, clozapine), antidepressants (tricyclics), antiarrhythmics (sotalol, amiodarone, quinidine), fluconazole, azithromycin, clarithromycin, methadone

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33
Q

What are some non-cardiac causes of chest pain?

A

Respiratory - PE, pneumothorax, pneumonia
MSK - costochondritis

GI - GORD, peptic ulcer

Anxiety

Gallstones, pancreatitis

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34
Q

What are the five cardiac related symptoms to enquire about?

A

Chest pain, syncope, dyspnoea, oedema and palpitations

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35
Q

What is the scale used to quantify breathlessness?

A 
MRC Dyspnoea Scale
1 - not troubled
2 - on a hill
3 - stop
4 -stop frequently on flat
5 - interferes with ADL
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36
Q

What are some differentials of palpitations?

A

AF (hypo/hyperthyroidism)
Caffeine
MI
Anxiety

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37
Q

What organisms commonly cause bacterial endocarditis when in association with prosthetic valves?

A

Staph. epidermidis (coagulase negative staph)

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38
Q

Most common cause of bacterial endocarditis?

A

Strep viridins in non IVDU

Staph aureus in IVDU

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39
Q

How does the gram stain influence choice of initial antibiotic in infective endocarditis?

A

Gram +ve cocci - Penicillins (fluclox, penicillin), macrolides (erythromycin), glycopeptides (vancomycin, gent)
Gram -ve rods - cephalosporins, penicillins with anti-beta lactamase (co-amox, piperacillin-tazobactam), gent, meropenem

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40
Q

What are the 2 major criteria in the Modified Duke’s Criteria?

A

2 separate positive blood cultures

Endocardium involvement

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41
Q

How do you differentiate between VT and SVT?

A 
VT = broad QRS (>120ms)
SVT = narrow complex QRS (<120ms)
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42
Q

What is the Levine Scale?

A

Grading of how to describe heart murmurs

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43
Q

What are the associations with coarctation of the aorta?

A

Turner’s Syndrome, systolic murmur, non-cyanotic, radio-femoral delay

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44
Q

What is the acute management of VT?

A

Synchronised cardioversion.

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45
Q

What is the first and second line treatment for fast AF?

A

Beta Blocker

Digoxin or Diltiazep (CCB)

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46
Q

What are the clinical features associated with aortic regurgitation?

A

Early diastolic murmur, high-pitches, aortic area, radiating to 4th intercostal space, AF, LVF (pulmonary oedema), loudest on expiration,

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47
Q

What dose of adrenaline do you give in anaphylaxis in a child and adult respectively?

A

Child - 300mcg
Adult - 500mcg
Repeated every 5 minutes as necessary

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48
Q

What are two ectopic beats called?

A

Bigeminy

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49
Q

What is your management for VT?

A 
Acute defibrillation (if unstable)
Pharmacological - BB, amiodarone
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50
Q

What is Torsades De Pointes?

A

A form of VT with long QT intervals. Can develop into VF, result in haemodynamic compromise or death

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51
Q

Give five causes of AF?

A

PE, Ischaemia (MI), Alcohol, Thyrotoxicosis, Sepsis

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52
Q

What is your acute management drug of choice for AF?

A

A beta-blocker, bisoprolol or metoprolol

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53
Q

What are patients usually on for chronic AF?

A

Beta blocker
Sometimes digoxin
Anticoagulation - rivaroxiban

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54
Q

What is Wolff-Parkinson White Syndrome?

A

Increased wiring around the AV node resulting in abnormal re-entry, HR200-300, short PR interval
Treat with adenosine and BB
Aberrant pathway that skips the AV nodes, bundle of kent is the muscle structure it pierces

Ablation is first line (radiofrequency, then chemical)

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55
Q

Give some causes of bradycardia?

A

Drugs -BB
Hypothermia, hypothyroidism
Sick sinus syndrome
Treat with PPM

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56
Q

How is acute Ventricular Fibrillation treated?

A

One shock followed by 2 minutes of CPR

If original rhythm known (VF/VT) give up to 3 shocks

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57
Q

Give three causes of postural hypotension?

A

Hypovolaemia
Autonomic dysfunction - diabetes, parkinson’s
Drugs - diuretics, antihypertensives

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58
Q

What can cause a long QT and why is this worrying?

A

Antipsychotics, Low K, Ca2+, Mg2+, acute MI

Can lead to VT and Torsades de Pointes

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59
Q

What is your acute management of an NSTEMI?

A

Aspirin 300mg
Nitrates or morphine if chest pain
Antithrombin (fondaparinux)
2nd platelet inhibitor (ticagrelor or prasugrel)

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60
Q

What is the site of action of bendroflumethiazine?

A

Proximal part of the distal convoluted tubule

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61
Q

What is symptomatic bradycardia treated with?

A

Atropine

If no improvement external pacing

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62
Q

A patient with uncrontrolled HTN is already on 10mg ramipril. What is the next step?

A

Add either a CCB or a diuretic

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63
Q

What is the PERC score?

A

PE rule-out critera
Includes aspects like Age>50, HR>100, SpO2 <95%, unilateral leg swelling, haemoptysis, recent surgery or trauma, previous PE/DVT, exogenous oestrogen

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64
Q

Give 4 differentials for a PE

A

Acute coronary syndrome
Pleuritic chest pain (pneumonia)
Anxiety
MSK

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65
Q

What clotting disorder increases your risk of PE/DVT?

A

Factor V Leiden

Thrombophilia

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66
Q

What is your acute management of a severe PE and what constitutes severe?

A

Thrombolysis

Haemodynamically unstable

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67
Q

How long do you treat a patient with warfarin post-PE and what is your target INR?

A

3 months for provoked, 6 months for unprovoked, aim INR 2-3

Treat with LMWH until INR >2

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68
Q

What are the different base pathologies for IHD?

A

Embolism, stenosis, occlusion, aneurysm, thrombosis

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69
Q

What are some precipitates of angina?

A

Exercise, cold weather, heavy metals, stress

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70
Q

What are your medical managements in an acute NSTEMI?

A 
Aspirin 300mg
Fondeparinux IV
Morphine
Nitroglycerin
Ticagrelor

Later - beta blocker, ACE-inhibitor, statin

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71
Q

What are some differentials for chest pain?

A 
Pericarditis
PE
Infection
GORD
MSK
Anxiety
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72
Q

What is your acute management for a STEMI

A

PCI

73
Q

What cardiac enzymes are used in investigation for chest pain?

A

Troponin T - repeated after 6 hours, peaks at 24 hours

CK-MB

74
Q

ST elevation in leads II, III and aVF and depression in leads V1-4 indicates a blockage in which artery?

A

Right Coronary Artery

75
Q

What complications occur over 24 hours post MI?

A

1-3 days - Pericarditis, VSD
3-14 days - myocardial rupture, cardiac tamponade
2 weeks - HF

Risks of cardiogenic shock, ischaemia mitral regurgitation, supraventricular arrythmias, heart block

76
Q

What are two acute complications of an MI?

A

Cardiogenic shock

Arrythmias

77
Q

What is hydralazine?

A

An antihypertensive that is used in pregnancy or severe hypertension.
Increases cyclic GMP causing smooth muscle relaxation
SE: tachycardia, palpitations, flushing, fluid retention

78
Q

What are some side effects of ACE inhibitors?

A

Ramipril - dry cough, rash, anaphylactoid reaction - this is the main antihypertensive at risk of causing these

Other - hypotension, renal impairment, hyperkalaemia

79
Q

Do antihypertensives caused hyperkalaemia?

A

Yes

Potassium is normally excreted in the kidney but most antihypertensives work by retaining potassium

80
Q

Which CCBs are chronotropic?

A

Verapamil

Diltiazem

81
Q

What are dihydropyridines, their effect and common side effects?

A

A type of CCB (amlodipine, nifedipine), works by reducing systolic vascular resistance and arterial pressure
SE - flushing, headache, oedema

82
Q

What are some uses of propanolol?

A

Anxiety, migraine prophylaxis, thyrotoxisis, pheochomocytoma, AF

83
Q

What types of diuretics act on which part of the kidneys?

A

Thiazide - distal convoluted tubule (promote sodium and water loss)
Loop - loop of Henle (furosemide)
Potassium sparing/aldosterone agonists - spironolactone

84
Q

What are some side effects of diuretics?

A 
Hypovolaemia, hypotension
Low electrolytes (all except uric acid)
Erectile dysfunction
85
Q

What dose of aspirin is given and what are the indications for each?

A

300mg following a TIA (3 weeks) or STEMI

75mg secondary prevention post-stroke or MI

86
Q

What type of anti-platelet is clopidogrel and ticagrelor?

A

P2Y12 antagonist

87
Q

What are some contraindications to DOACs?

A

Increased risk of GI bleeds
Avoid in pregnancy
Avoid in low GFR
(Less risk of ICH than warfarin)

88
Q

How do you monitor LMWH?

A

Don’t require monitoring unless unfractionated heparin in which case monitor APTT

89
Q

How long is the half-life of warfarin and how can you counteract it?

A

36 hours
Vitamin K or Fresh Frozen Plasma
Beriplex (Factor VIII concentrate)

90
Q

A high-pitched, early diastolic murmur is heard, radiating to the left sternal edge. What can cause this?

A

Aortic regurgitation

91
Q

What kind of valve replacements exist and what are some pros and cons of each?

A

Mechanical - lasts longer but requires lifelong warfarin
Tissue/bioprosthetic - lasts about 10 years, but don’t require anticoagulation
Complications - bleeding, thrombosis, stroke, IE
TAVI - less invasive - trans-catheter valve replacement

92
Q

What causes rheumatic fever?

A

Beta-haemolytic strep (Lancefield Group A)

93
Q

What are the 5 major criteria of rheumatic fever?

A 
Carditis
Arhtritis
Subcut Nodules
Erythema Marginatum
Sydenham Chorea
94
Q

What is your management for rheumatic fever?

A

Benpen IV then Penicillin (or erythromycin if allergic)
Aspirin
Rest, analgesia

95
Q

What criteria is used to determine infective endocarditis and what are some criteria?

A

Duke’s Criteria
Major - positive blood cultures, endocardium involvement on ECHO
Minor - Fever, risk factors present, vascular/immunological signs

96
Q

What is the most likely cause of infective endocarditis in an IVDU?
In someone with native valve disease?

A

Staph aureus

Strep viridans

97
Q

A patient presents with acute, tearing chest pain - what are you differential and what are risk factors for theses?

A

AAA - aortic aneurysm - ruptured - can result in collapse, expansile pulsatile mass, pain can be lower epigastri region, manage with surgery or stent

Aortic dissection - tearing pain spreading to shoulder or sternum, unequal pulses in both arms, Marfans increases your risk

98
Q

What is a low grade fever and pansystolic murmur suggestive of?

A

Infective endocarditis

99
Q

What is a precipitant of ventricular tachycardia (broad QRS)?

A

Hypokalaemia

100
Q

How do you manage supra-ventricular tachycardia?

A

Vagal manoeuvres
Adenosine

(Atropine in bradycardia, amiodarone in VT)

101
Q

What medication is used in angina?

A

GTN
Beta-blocker
CCB (verapamil or diltiazem but not with a BB)
Start on aspirin + statin

102
Q

What is the feature of a ventricular septal defect?

A

Pansystolic murmur

Commonly associated with congenital chromosomal disorders (Down’s, Edward’s, Patau’s)

103
Q

How do you treat torsades de pointes?

A

Magnesium sulfate

104
Q

How might a child with Eisenmenger’s syndrome present?

A

Right ventricular hypertrophy
Harsh, blowing pansystolic murmur
Blue tinge to lips, loss of nail fold angle

105
Q

What is a globular heart associated with?

A

Atrial septal defect

106
Q

How do you treat acute pulmonary oedema?

A

IV diuretics

107
Q

What are some adverse effects of thiazide diuretics?

A 
Dehydration
Postural hypotension
Hyponatraemia, hypokalaemia, hypercalcaemia
Gout
Impaired glucose tolerance
Impotence

Thrombocytopaenia
Agranulocytosis
Photo-sensitivity rash
Pancreatitis

108
Q

What do you do in a major bleed for patients on warfarin?

A

Stop warfarin
Give IV vit K 5mg
Give prothrombin complex concentrate IV

109
Q

What medications usually used for heart failure should be stopped during a patient’s respiratory illness?

A

If prescribe antibiotics stop statins (macrolide antibiotics), risk of rhabdomyolysis

110
Q

What is Takayasu’s arteritis and it’s typical features?

A

Absent radial pulse
Large vessel vasculitis - malaise, headache, unequal blood pressure in upper limbs, carotid bruit, intermittent claudication, aortic regurg

111
Q

What is Buerger’s disease and some common features of it?

A 
Smoking history
Male
Young age of onset
Upper limb involvement
Pain in hands and feet, getting progressively worse, pain worse at night and on walking
Ulcer
Absent foot and hand pulses
112
Q

What might suggest an MSK cause of chest pain over cardiac?

A

Pain worse on movement or palpation

113
Q

What features are typical in a history of aortic dissection?

A

Tearing chest pain
May have a aortic regurg murmur if it splits to the artery branches
Proximal lesions are treated surgically, B (distal) are managed non-operatively
CT angiography diagnosic, widened mediastinum on X-Ray

114
Q

What are some association for coarctation of the aorta?

A

Turner’s
Bicuspid aortic valve
Berry aneurysms
Neurofibromatosis

115
Q

What medications improved PROGNOSIS and not just symptoms in HF?

A

ACE-i
BB
Spironolactone
Hydralazine with nitrates

Diuretics - symptoms only

116
Q

What is the first and second line treatment for heart failure management?

A

ACE-i + BB
Aldosterone agonist (or ARB or hydralazine with nitrate)
If still symptomatic - cardiac resynchronisation therapy or digoxin

117
Q

What is your exception in the >55 rule to hypertension management?

A

Diabetics - don’t used CCB, give ACE-i

118
Q

What dose of hydrocortisone should be given in acute anaphylaxis?

A

100mg

119
Q

What dose of chlorphenamine should be given in acute anaphylaxis?

A

10mg

120
Q

What are some acute complications of an MI?

A

Mitral regurgitation (systolic murmur)

Left ventricular aneurysm, arrythmias

121
Q

In acute onset narrow complex tachycardia in a patient who is breathless with chest pain; what is your management?

A

Synchronised DC cardioversion

If signs of HF, shock or MI

122
Q

What is the difference between atropine, adenosine and amiodarone?

A

Atropine - used in bradycardia
Adenosine - used 2nd line SVT
Amiodarone - VT

123
Q

How might hypertrophic obstructive cardiomyopathy present?

A

Exertional dyspnoea, angina
Jerky pulse
Ejection systolic murmur

Left ventricular hypertrophy, decreased compliance, decreased cardiac output

124
Q

Give some advantages of using a DOAC over Warfarin?

A

Less risk of ICH, don’t have to check INR, faster-onset and faster offset
BUT High GI bleed risk, non-reversible

125
Q

What does CHADS2VASc stand for and what is it used for?

A 
Congestive Heart Failure
Hypertension
Age >75, 64-74
Diabetes
Stroke - scores 2
Vascular Disease
Sex female

Used to determine anticoagulation use in AF patients
Moderate or high - warfarin

126
Q

What does HASBLED stand for and what is it used for?

A 
Hypertension
Abnormal kidney or liver function
Stroke - haemorrhagic
Bleeding history
Labile INR
Elderly >65
Drugs

1-3 moderate risk
>3 don’t anticoagulate

127
Q

What are the different types of AF?

A

Paroxysmal - self-limiting, usually spontaneously terminates within 7 days, normally 48hrs)
Persistent - not self-limiting, lasts over a week
Permanent - lasts over 1 year

128
Q

What are some risk factors or causes of AF?

A 
Post-MI
Idiopathic
Age
Male
Co-morbidity
Hyperthyroidism
PIRATES
129
Q

What are some risk factors or causes of AF?

A 
Post-MI
Idiopathic
Age
Male
Co-morbidity
Hyperthyroidism
PIRATES
Pulmonary
Ischaemia
Rheumatic Heart
Alcohol
Thyrotoxicosis
Electrolytes
Sepsis
130
Q

If a patient is experiencing symptomatic AF what should be done?

A

Refer to DVLA

131
Q

What are symptoms a patient with AF might experience? (3)

A

Palpitations
Breathlessness
Chest pain or ‘discomfort’
Stroke or TIA may be first presentation

132
Q

What are shockable rhythms?

A

Pulseless VT

VF

133
Q

What does a thiazide diuretic act on?

A

Thiazide – competitively inhibits the Na K 2Cl cotransporter in the thick ascending limb of the loop of Henle

134
Q

What are some important questions to ask in heart failure?

A

Sleep flat? How far can you walk? Pink frothy sputum? Cough?

135
Q

What other cardiac enzymes exist?

A

AST, Lactate dehydrogenase, CK and CK-MB

136
Q

How does aspirin act?

A

Suppresses the production of prostaglandins and thromboxanes by irreversible inhibition of COX (cyclooxygenases)

137
Q

What are the reversible causes of a cardiac arrest?

A 
Hypoxia
Hypovolaemia
Hyperkalaemia
Hypothermia
Thrombosis
Tension Pneumothorax
Tamponade
Toxins
138
Q

What are some risks of an angiogram?

A

bleeding and infection, perforation or trauma to adjacent structures, risk of infection, failure to work, MI, allergy to contrast

139
Q

What else might cause a raised troponin?

A

Trop can be raised in myocarditis, pericarditis, trauma to the heart, endocarditis, PE, sepsis, aortic dissection, strenuous exercise

140
Q

What is a capture beat?

A

A normal beat within an arrythmia

141
Q

What do you see in a chest x-ray of a patient with heart failure?
What is your long-term management?

A 
Alveolar oedema
Kerley-B lines
Pleural effusion
Increased vasculature
Cardiomegaly

Stop smoking, cardiopulmonary rehab, ACEi, BB

142
Q

What signs would you see in a HF patient?

A 
S3 gallop
Hypotension - narrow pulse pressure
Wheeze/crackles
Raised JVP
Hepatomegaly
143
Q

What are indications for DC cardioversion?

A

<90 systolic BP
HR >150bpm
Dizziness, Chest pain, SOB

144
Q

Fibrinolysis should be offered to who…?

A

If primary PCI cannot be delivered within 120 minutes

Onset of symptoms >12 hours

145
Q

What does a double cardiac shadow on XR indicate?

A

Enlarged left atrium

146
Q

What is considered cardiomegaly on XR?

A

A cardiothoracic ratio of over 0.5. heart over half width of chest

147
Q

What are long-term consequences of untreated AS?

A

Sudden death, arrythmia such as AF or VT, left heart failure, angina, right heart failure

148
Q

What is diagnostic of orthostatic hypotension?

A

BP 110/90 mmHg after 3 minutes of standing

149
Q

How does Bendroflumethiazide work?

A

Thiazide diuretics work on the distal convoluted tubule by blocking the Na/Cl transporter causing water and sodium pretension

150
Q

What do you see in investigations for Hypertrophic obstructive cardiomyopathy?

A

Asymmetric septal hypertrophy and systolic anterior movement (SAM) of the anterior leaflet of the mitral valve
Asymmetric LV hypertrophy, signs on ECG

151
Q

What are some causes of pericarditis?

A 
Viral infection (adenovirus)
Bacterial infection (TB)
Recent MI
Chest trauma
Cancer
SLE
152
Q

What is heard in pericarditis?

A

Pericardial friction rub

153
Q

What is a common complication of pericarditis and signs you would see?

A

Cardiac tamponade

Raised JVP, tachy, low BP (resistant to fluid therapy)

154
Q

What are indications for urgent synchronised DC shocks?

A

Syncope, MI, Heart failure, shock (hypotension, pallor, sweating, cold extremities)

155
Q

What does acute coronary syndrome refer to?

A
  • STEMI
  • NSTEMI
  • Unstable angina
156
Q

What are some non-modifiable risk factors for acute coronary syndrome?

A
  • increasing age
  • male gender
  • family history of premature heart disease
157
Q

What are some modifiable risk factors in cardiovascular disease?

A
  • smoking
  • diabetes
  • hypertension
  • obesity
  • physical inactivity
158
Q

What are some non-athersclerotic causes of ACS?

A
  • vasculitits
  • cocaine (causes coronary spasms)
  • congenital cardiac abnormalities
  • CHD
159
Q

Who might present atypically with a heart attack or unstable angina?

A
  • diabetics
  • women

Abdominal discomfort
Jaw pain
Altered mental state in the elderly

160
Q

A patient presents with chest pain. There is suspected cardiac involvement - what investigations should be done?

A
  • 12 lead ECG
  • troponin (6hr and 12hr post onset of chest pain)
  • blood glucose
  • ECHO
  • CXR
  • Coronary angiography
161
Q

What are two causes for an irregular heartbeat?

A
  • AF

- Ventricular ectopics

162
Q

What conditions are associated with AF?

A
  • hyperthyroidism
  • alcohol and caffeine
  • MI
  • sleep apnoea
  • valvular disease
163
Q

How can you classify AF?

A
  • Acute: episode within previous 48 hours
  • Paroxysmal AF: self limiting AF lasting <7 days
  • Recurrent AF: 2+ episodes
  • Persistent AF: >7day duration
  • Permanent AF: fails to terminate following cardioversion, relapses within 24 hours
164
Q

What are some complications of AF?

A
  • stroke, TIA, VTE

- heart failure

165
Q

What is 3rd degree heart block?

A

Complete dissociation between the atria and the ventricles with no communication between them

166
Q

What are some potential causes of 3rd degree heart block?

A
  • ischaemia or infarction
  • fibrosis or sclerosis of the conducting fibres
  • heart surgery
  • cardiomyopathy
167
Q

What are some typical signs of heart failure?

A
  • tachycardia
  • tachypnoea
  • rales (crackles)
  • pleural effusion
  • raised JVP
  • peripheral oedema
  • hepatomegaly
168
Q

What leads cover the area of the heart provided for by the circumflex artery?

A

I, aVl, V4, V5, V6

169
Q

What leads indicate a right coronary artery infarction? What should you avoid giving in these patients and what do you give instead?

A

Infarction of right ventricle = inferior = II, III, aVf

GTN spray causes dilation of the inferior heart vessels, worsening the ischaemia, give fluids instead

170
Q

Out of atropine and amiodarone - which do you give for what?

A

Atropine - used in bradycardia to increase HR

Amiodarone - used for VT

171
Q

If a patient presents with an ECG rate 150 regular, what is it until further investigation?

A

Atrial flutter 2:1 block

if occurring at 100bpm then it is 3:1 block

172
Q

Why does atrial flutter often present at 150bpm?

A

The AVN cannot conduct above 150bpm

173
Q

Where do you measure PR- interval from?

A

Start of the P-wave to the end of the R-wave, it should be 3-5 small squares

174
Q

What is your secondary prevention for a STEMI?

A

Aspirin
Clopidogrel
Statin

175
Q

Can p-waves be present in AF?

A

They may be present, but usually not

176
Q

What is a typical presentation of angina?

A
  • increased SOB
  • heaviness in the left arm
  • increased pressure sensation on the chest
  • do treadmill test (cardiac stress test) to confirm
177
Q

An ECG sign for pericarditis is…?

A
  • global saddle-shaped ST-elevation
178
Q

What is a possible drug cause of VT?

A

Antipsychotic overdose e.g. tricyclics (give sodium bicarbonate)

Management of VT: pulseless - unsynchronised shock, pulse = synchronised shock

179
Q

What is your target blood pressure for patients under 80?

A

<140/90mmHg

Medical Finals 2020 (25 decks)

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