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Fourth Year > Cardiology > Flashcards

Cardiology Flashcards

1
Q

An incidental finding of left bundle branch block requires further investigation - true or false?

A

False. No further investigation is required based upon ECG alone.

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2
Q

Heart rate is normally controlled by?

A

SA node.

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3
Q

If unable to determine if a broad QRS is of ventricular origin, how would you proceed?

A

Treat it as ventricular tachycardia.

- VT should be always be confirmed by 12 lead ECG if patient is not in cardiac arrest.

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4
Q

What causes aberrant conduction?

A

When length of cardiac cycle changes without compensatory change in length of the refractory period.

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5
Q

What is aberrant conduction?

A

Abnormal conduction of the supraventricular impulse to the ventricles.

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6
Q

Capture and fusion beats are almost always diagnostic of what and why?

A

Ventricular tachycardia - they are proof of independent rhythms in the atria and ventricles.

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7
Q

What is a capture beat?

A

Sinus node “captures” the ventricles to produce a narrow-complex beat.

(In the midst of AV dissociation, an atrial impulse arrives at the AV node when the node has just recovered from its refractory period. -
- Produces a QRS of normal duration.)

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8
Q

What is a fusion beat?

A

A sinus and ventricular beat coincide, fusing to form a complex of intermediate morphology.

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9
Q

The Bundle of His separates into which two bundle branches?

A

Left and right.

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10
Q

When should someone with left bundle branch block be thrombolysed?

A

If they are symptomatic of MI (also consider Cath lab as alternative to thrombolysis).

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11
Q

Left bundle branch block is best seen in which lead?

A

V6.

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12
Q

ECG findings suggestive of LBBB?

A
  • W shaped QRS in V1.
  • M shaped QRS in I, aVL, V5, V6.
  • QRS >0.12s.
  • Small R wave in V2, V3 (due to activation of paraseptal region)
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13
Q

Causes of left bundle branch block?

A

Heart disease e.g. IHD, MI, cardiomyopathy, hypertension.

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14
Q

Delta wave in V1 suggests which underlying pathology?

A

Wolff-Parkinson-White syndrome (type A).

(Type A - positive R wave in V1 as the accessory pathway is a left atrioventricular connection. - Type B - negative R wave in V1 as the accessory pathway causes a negative R wave in V1).

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15
Q

Wolff-Parkinson-White syndrome can cause which arrhythmia?

A

Supraventricular tachycardia.

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16
Q

What is the cause of Wolff-Parkinson-White syndrome?

A

Congenital accessory conduction pathway connecting atria and ventricles.

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17
Q

Why can high atrial rates be conducted to the ventricles in Wolff-Parkinson-White syndrome?

A

The accessory conduction pathway lacks the rate-lowering properties of the atrioventricular node.

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18
Q

Definitive management of Wolff-Parkinson-White syndrome?

A

Radiofrequency ablation - destruction of the abnormal electrical pathway.

19
Q

Causes of mitral stenosis?

A 
CRAP
- Congenital.
- Rheumatic.
AND
- Prosthetic valve.
20
Q

Signs of mitral stenosis?

A
  • Malar flush.
  • Atrial fibrillation, palpitations, thromboembolism, embolism.
  • Left or right heart failure.
  • Tapping, undisplaced apex beat.
  • Loud S1 with an opening snap and a rumbling mid-diastolic murmur.
  • Cachexia, cyanosis, COPD, bronchiectasis.
  • Haemoptysis, rupture of congested bronchioles, hoarse voice (LA enlargement).
  • Syncope.
21
Q

Name the murmur. Loud S1 with an opening snap and a rumbling mid-diastolic murmur heard best with the patient on their left side and in expiration.
A Graham Steell murmur can occasionally be found.

A

Mitral stenosis.

22
Q

Pulmonary stenosis is what type of murmur?

A

Ejection systolic.

23
Q

Ventricular septal defect causes what type of murmur?

A

Pan-systolic murmur.

24
Q

Mitral valve prolapse causes what type of murmur?

A

Mid-systolic click, followed by a late systolic murmur.

25
Q

Right bundle branch block causes what type of murmur?

A

Wide splitting of the second heart sound.

26
Q

Myocardial infarction symptoms?

A

CUBE

  • Central crushing chest pain >20min, radiating to left arm or jaw.
  • Upset stomach with nausea and vomiting.
  • Breathlessness.
  • Excessive sweating.
27
Q

Most likely cause of a Q wave myocardial infarction (i.e. elevated ST segments in consecutive leads and Q waves on ECG)?

A

Completely occlusive thrombus.

- ACS typically due to rupture of a vulnerable plaque

28
Q

Elevated JVP with large V-waves and a pan-systolic murmur at the left sternal edge?

A

Tricuspid regurgitation

29
Q

Features of tricuspid regurgitation?

A
  • Elevated JVP with large V-waves.
  • Pan-systolic murmur at left sternal edge.
  • Pulsatile hepatomegaly.
  • Left parasternal heave.
30
Q

Ejection systolic murmur that radiates to the neck.

A

Aortic stenosis.

31
Q

Pan-systolic murmurs?

A
  • Tricuspid regurgitation (left sternal edge).

- Mitral regurgitation (apex > axilla).

32
Q

Pan-systolic murmur at apex radiating to the axilla.

A

Mitral regurgitation.

33
Q

Mid-diastolic murmur heard best at left sternal border.

A

Tricuspid stenosis.

34
Q

Ejection systolic murmur in the 2nd left intercostal space.

A

Pulmonary stenosis.

35
Q

Mid-diastolic murmur at the apex.

A

Mitral stenosis.

36
Q

Severe mitral stenosis may cause secondary pulmonary hypertension and therefore lead to which murmur?

A

Tricuspid regurgitation.

37
Q

Turner syndrome is associated with which cardiac defect?

A
  • Coarctation of the aorta.
  • Aortic stenosis.
  • Bicuspid aortic valve.
  • Aortic dilatation and dissection.
38
Q

Marfan syndrome is associated with which cardiac defect?

A
  • Aortic root dilatation > aortic regurgitation.
  • Mitral valve prolapse.
  • Mitral regurgitation.
  • Risk of aortic dissection.
39
Q

Kartagener syndrome is associated with which cardiac defect?

A
  • Dextrocardia.

bronchiectasis + infertility

40
Q

Congenital rubella syndrome is associated with which cardiac defect?

A
  • Patent ductus arteriosus.
  • Atrial septal defect.
  • Pulmonary stenosis.
41
Q

Post Myocardial infarction, patients should refrain from sexual intercourse for how long?

A

4 weeks.

42
Q

Post Myocardial infarction, patients should refrain from driving a bus/ lorry for how long?

A

6 weeks.

Car - one week if successful angioplasty or four weeks if not.

43
Q

Post Myocardial infarction, patients should refrain from operating heavy machinery for how long?

A

4 weeks.

44
Q

Post Myocardial infarction, patients should refrain from vigorous exercise for how long?

A

4 weeks.

Fourth Year (28 decks)

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