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Phase 3b > CARDIOLOGY > Flashcards

CARDIOLOGY Flashcards

1
Q

what is the most common cause of mitral stenosis

A

rheumatic fever

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2
Q

Hypoglycaemia with impaired GCS

A

give IV Glucose if there is access- 100 ml of 20%

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3
Q

Management of hypoglycaemia

A

In patients with hypoglycaemia causing a low GCS, the BNF advises IV glucose administration if there is IV access. An alternative is IM glucagon - not IV glucagon. In this instance, the patient has IV access and so the STAT dose of IV glucose can easily be administered. If the GCS was not impaired, than proprietary products of quick-acting carbohydrate such as GlucoGel® can be given or alternatively the above-mentioned soft drinks.

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4
Q

What calcium channel blocker should never be prescribed with a beta blocker

A

verapamil - has rate limiting effects, so if prescribed with BB can cause complete heart block

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5
Q

first line management for angina

A

beta blocker or ccb
gtn
statin

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6
Q

what medication for angina do patients become tolerant to

A

nitrites

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7
Q

what is De Musset’s sign

A

head bobbing with aortic regurge

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8
Q

changes to NICE hypertension guidelines

A

lowering the threshold for treating stage 1 hypertension in patients < 80 years from 20% to 10%
angiotensin receptor blockers can be used instead of ACE-inhibitors where indicated
if a patient is already taking an ACE-inhibitor or angiotensin receptor blocker, then a calcium channel blocker OR a thiazide-like diuretic can be used. Previously only a calcium channel blocker was recommended

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9
Q

what ecg change can hypokalaemia cause

A

long qt

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10
Q

what are the acquired causes of long qt

A

Electrolyte imbalance: hypokalaemia, hypocalcaemia and hypomagnesaemia
Medications: in addition to those listed in the subject notes below: tramadol, metoclopramide and domperidone.
CNS lesions: subarachnoid haemorrhage and ischaemic stroke
Malnutrition
Hypothermia

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11
Q

drugs that cause long qt

A 
amiodarone, sotalol, class 1a antiarrhythmic drugs
tricyclic antidepressants, selective serotonin reuptake inhibitors (especially citalopram)
methadone
chloroquine
terfenadine**
erythromycin
haloperidol
ondanestron
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12
Q

First line anti hypertensive for diabetes pt

A

ACE inhibitor

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13
Q

Causes if aortic dissection

A 
Marfans 
HTN 
Bicuspid aortic valve 
Pregnancy 
Traumatic injury 
Atherosclerosis (calcium deposits in aorta)
High intensity weight lifting
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14
Q

Signs of aortic dissection on CXR

A

Widened mediastinum
Calcification of aorta
Double layer in aorta (calcification and then blood where dissection has occurred)
Covid

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15
Q

What does a small and large square represent time wise on an ecg

A

Small square = 0.04 s

Large square = 0.2 s

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16
Q

what length of time does the rhythm strip at the bottom of ecg show

A

10 s

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17
Q

how can you quickly calculate hr from ecg

A

300/ number of big squares

count the number of QRS across rhythm strip and x by 6 as it is 10s

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18
Q

what is a normal range for corrected QT for men and women

A 
men = 0.45
women = 0.47
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19
Q

what do the ecg waves represent - from p, qrs, t

A
  • P wave - atrial depolarisation
  • Q wave - septal left side first deflection
  • R wave - septal (early ventricular) depolarisation
  • S wave - circumference (late ventricular) depolarisation
  • T wave - ventricular repolarisation
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20
Q

how does a posterior infarct look om ecg

A

st depression in v1 and 2

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21
Q

method for reviewing an ecg

A 
rate 
rhythm 
axis (reaching inwards R, leaving L)
segments - st (character)
waves - p and t (bipid p waves, tall tented t waves) 
intervals - pr, qrs, qt (time)
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22
Q

what 10 rules should you check in an ecg

A

PR interval should be 120 - 200ms. 3-5 little squares
QRS should not be more than 120 ms, <3 small squares
QRS should be dominantly upright in leads I and II
QRS and T waves should have the same general direction in the same limb lead
All leads are negative in aVR.
The R wave must from V1 to at least V4; S wave must grow from V1 - V3, and disappear in V6
ST segment should start isoelectric, expect in V1 and V2 where it may be elevated
P waves should be upright in I, II and V2 - V6
There should be no q wave or small q wave, less than 0.04 in I, II, v2-v6
T wave must be upright in I, II, v2-v6.

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23
Q

signs of ischemia on ecg

A

ST depression, t wave inversion

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24
Q

signs of hyper acute MI

A

Tall (giant) T waves

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25
Q

what do bifid p waves show (p mitrale)

A

left atrial enlargement

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26
Q

what do tall p waves show (p pulmonale)

A

right atrial enlargement

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27
Q

what does a short PR interval indicate

A

WPW - accessory pathway

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28
Q

what does a long PR interval indicate

A

1st degree heart block

29
Q

how deep is a pathological q wave

A

> 2 mm

30
Q

How can you look for BBB, how can you work out which side it is on

A

Look in precordial leads (chest leads)
Look at V1 - the defection will tell you if its L or R
Look if it is widened
If it is widened and has a positive deflection in V1 = RBBB bc the later RV depolarisation (via current from LV) is moving towards V1 electrode = positive
If it is widened and has a negative deflection in V1 = LBBB bc the later LV depolarisation is moving away from V1 electrode

31
Q

How can an MI show on an ecg

A

Giant T waves
ST elevation
LBBB
ST depression - anteroseptal leads (V1-4) - posterior

32
Q

How can an MI show on an ecg

A

Giant T waves
ST elevation
LBBB
ST depression - anteroseptal leads (V1-4) - posterior (also possibly ?posterior infarct with inferior ST depression)

33
Q

What are the causes of BBB

A
  1. Ventricular strain - PE, RHF, COPD (RBBB), Valve disease (AS - LBBB)
  2. Vascular - Ischemia/ infarct - MI - LBBB
34
Q

What BBB is most commonly associated with an MI

A

LBBB

35
Q

What is a hemi block on ecg

A

When the QRS is not widened

36
Q

What is a bifasicular block, and causes

A

When 2 of the 3 conducting pathways are blocked
LBBB is always bifasicular
RBBB plus anterior or posterior hemiblock is a bifasicular block

37
Q

How can you tell right and left ventricular hypertrophy on ecg

A

R - look in R leads V1, V2 - S+R >10

L - look in L leads V5, V6 - S+R >45

38
Q

What is a delta wave

A

J-like sloping where Q wave should be

Sign of aberrant pathway

39
Q

What is an epsilon wave

A

Wave that shows R ventricular dysplasia/ cardiomyopathy

40
Q

What is an osborne or ‘J wave’

A

Sign of hypothermia

41
Q

PE ECG trace

A

s1, q3, t3

42
Q

What is brugada syndrome
What are symptoms
What are changes on ecg

A

Genetic disorder affecting sodium channels
Can cause arrhythmias at rest and during sleep
Symptoms - syncope/ blackouts
ECG changes 3 types:
type 1 - ST elevation V1 - sharks tail
type 2 - saddle v2,3
type 3 - saddle v2,3

43
Q

How does hypertrophic cardiomyopathy look on ecg

A

LVH changes (large R waves) plus T wave inversion and st segment depression

44
Q

List some ecg findings with coronary artery disease

A 
Pathological (>2mm) Q waves
ST depression 
T wave inversion and peaking 
BBB
AV block
45
Q

what is the definition of st elevation on ecg

A

ST elevation >1 mm in 2 limb leads next to each other

ST elevation >2mm in 2 precordium leads next to each other

46
Q

Explain the temporal ecg changes that occur with myocardial ischemia

A

J segment depression (where S meets isoelectric line)
ST depression
ST elevation
U wave inversion

47
Q

Explain the temporal ecg changes that occur with myocardial infarction (transmural)

A 
Peaked/ giant t waves (minutes)
ST segment elevation/ progression (mins - hours)
Loss of R wave (hours - days)
T wave inversion (days)
T wave normalisation (weeks to months)
48
Q

how many leads should a q wave be in

A

2 or more

49
Q

Infarct of which coronary artery can affect the SA and AV nodes

A

right coronary

50
Q

what are the different classes of antiarrhythmics

A

I - sodium blockers
II - beta blockers
III - K+ blockers
IV - calcium blockers

51
Q

pharmacological management of tachycardia in acute heart failure

A

never beta blockers

can use digoxin if need to - negative inotrope, positive chronotrope

52
Q

what should you never use in acute heart failure

A

beta blockers

53
Q

what should you consider when prescribing digoxin

A

kidney function

can overdose if have ckd as need dose adjustments

54
Q

what is the half life of amiodarone, what does this mean clinically

A

around 50 days

need high loading doses

55
Q

what is the effect of amioderone on the liver

A

it is an enzyme inhibitor so it can prevent other medicines from being metabolised
eg when prescribed with digoxin, digoxin dose must be halved

56
Q

what arrhythmia can amiodarone cause

A

long qt

should not be prescribed with other medicines that can cause long qt

57
Q

combination of which two cardio drugs can cause AV block

A

Beta blockers and verapamil

58
Q

what is the definition of sinus bradycardia

A

HR <60 bmp

59
Q

what drug can be given for sinus bradycardia

A

atropine

60
Q

what drugs can cause AV block

A

Beta-blockers
Rate limiting calcium-channel blockers (e.g. diltiazem, verapamil)
Digoxin

61
Q

List some of the causes of AV block

A 
Cardiomyopathy
Conduction system fibrosis
Connective tissue disease
Hypothyroidism
Ischaemic heart disease
Radiotherapy
Sarcoidosis
62
Q

explain first, second and third degree AV block

A

first = long PR interval (atria)
second = mobitz type 1 is when there is increasing PR interval then the QRS drops (AV node)
type 2 is when the QRS drops randomly - usually in a certain ration eg 3:1 (bundle of his)
third = no relationship between p and qrs (below AV node) - if QRS is narrow escape rhythm has come from just below AV node, if wide from further down in ventricles

63
Q

describe an approach to differentiate different tachyarrhythmias

A
  1. is the qrs regular, if irregular = AF
  2. is qrs narrow or broad - narrow above AV, wide below
  3. P wave morphology and P:R ratio
    P waves normal and P:R 1:1 = sinus tachycardia
    P waves abnormal and P:R 1:1 = focal atrial tachycardia
    no p waves = AVRT or AVNRT
    p wave rate >250 = flutter
    P:R 2:1 or greater = re-entrant tachy with AV block
64
Q

what drug management should you give to an unstable patient with a tachy arrhythmia

A

Intravenous adenosine (providing there is no contraindication) at a dose of 6 mg, then if no effect 12 mg, then if no effect a further 18 mg (maximum total dose of 36 mg). This should temporarily lead to AV blockade and so provide more information regarding the underlying rhythm (e.g. is there underlying AF?)

65
Q

what are the main drugs associated with long QT

A

Macrolide antibacterials (e.g. erythromycin), many antipsychotics and tricyclic antidepressants have all been associated with a prolonged QT. Baseline ECGs are often recommended.

66
Q

In which patients is flecanide contraindicated in

A

ischaemic heart disease or known structural cardiac abnormalities

67
Q

list some contraindications to cardioversion

A

Contraindications to anticoagulants
Structural heart disease
Permanent AF (usually more than 12 months)
A history of multiple failed attempts are/or relapses even with concomitant use of antiarrhythmics or non-pharmacological approaches
An ongoing but reversible cause of AF

68
Q

which cardiac drugs can induce AV block

A

antiarrhythmics

Phase 3b (13 decks)

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