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rw fy1 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

S4 coincides with which part of the ECG

A

P wave

S4 is due to atrial contraction against a stiff, non-compliant ventricle

e.g. Aortic stenosis

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2
Q

GI bleeding + murmur

What murmur?

A

Aortic stenosis

Heyde’s syndrome = GI bleeding (colonic angiodysplasia) + Aortic stenosis

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3
Q

What coronary artery supplies posterior heart

A

posterior heart

Posterior interventricular artery (PIVA)

RCA (90%)

or LCx (10%)

Also supplies AVN

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4
Q

What coronary artery supplies SAN and AVN

A
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5
Q

What is coronary artery dominance

A

Coronary artery dominance = determined by which artery gives rise to posterior interventricular artery (PIVA)

  • Right Coronary Artery (90%) ==> Right dominance
  • LCx (10%) ==> Left dominance
  • Equal contribution ==> Equal dominance
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6
Q

What is the flow of coronary veins

A

All cardiac veins* meet at the coronary sinus –> empties into right atrium

*Except anterior cardiac veins which empty directly into the RA

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7
Q

What are the waves of the JVP

A
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8
Q

What causes the following JVP pathology

large a waves

Cannon a waves

Absent a wave

Prominent X descent

Giant V waves

Slow Y desscent

A
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9
Q

What is Kussmaul’s sign

What causes it

A

Kussmaul’s sign = paradoxical ↑ JVP during inspiration

Caused by Constrictive pericarditis

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10
Q

ACS

DVLA rules?

A

Acute coronary syndrome

  • If PCI –> 1 week off driving
  • If CABG or conservatively managed –> 4 weeks off driving
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11
Q

Wellens syndrome

What is it?

ECG findings?

A
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12
Q

Osborn wave

What is it?
What causes it?

A
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13
Q

Epsilon wave

What is it?

What causes it?

A
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14
Q

ECG changes in hyperkalaemia

A

hyperkalaemia

Peaked T waves

Loss of P waves

Prolonged PR interval

Bradycardia

Broad QRS –> BBB –> Sine wave –> VF –> Asysole

If bradycardia, blocks (AV block, BBB), bizarre QRS complexes –> think Hyperkalaemia

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15
Q

ECG changes in hypokalaemia

A

hypokalaemia

TWI

U waves

Prolonged PR interval

ST depression

Long QU interval

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16
Q

ECG changes in hypercalcaemia

A

hypercalcaemia

Shortening of QTc

Osborn waves / J waves

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17
Q

ECG changes in hypocalcaemia

A

hypocalcaemia

Prolonged QTc

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18
Q

ECG changes in hypomagnesaemia

A

hypomagnesaemia

Prolonged QTc

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19
Q

ECG changes in TCA overdose

Treatment

A

TCA overdose

Broad QRS complex

Dominant secondary R’ wave in aVR (M appearance in aVR)

Sinus tachycardia

Treatment –> IV Sodium Bicarbonate + Activated Charcoal

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20
Q

Digoxin toxicity

Sx

Tx

A

Digoxin toxicity

Abdominal pain

Yellow-hue vision

Haloes

Ventricular ectopics

Bradycardia

Tx: Digibind (Digoxin-specific antibody)

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21
Q

ECG changes in incomplete and complete tri-fascicular block

A
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22
Q

ECG changes in bifascicular block

A

ECG criteria for Bifascicular block:

  • RBBB
  • Either Right axis deviation or Left axis deviation
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23
Q

Prolonged QTc

  • Causes
  • Treatment
A

Tip: “Hypos, Anti(medication), MI and Congenital”

Tx: β blockers

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24
Q

Treatment of tachyarrhythmia

A
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25
Q

Prophylaxis for recurrent SVT

A

Prophylaxis for recurrent SVT

(1) β blockers
(1) Catheter ablation

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26
Q

Tx of atrial flutter

A

(1) Rate control, Anticoagulation, Rhythmn control
(2) Catheter ablation of cavotricuspid isthmus (curative)

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27
Q

What is Ebstein’s anomaly

What is it caused by

Presentation

Associations

A

Ebstein’s anomaly = congenital defect where tricuspid valve is found lower in the R ventricle –> large RA, small RV = “atrialisation of right ventricle”

Caused by Lithium exposure in utero (Bipolar MUM)

Features

  • Tricuspid regurgitation / Pansystolic murmur

Associations

  • PFO
  • ASD
  • WPW syndrome
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28
Q

Features of VT

A

Broad complex tachycardia

Capture beats

Fusion beats

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29
Q

Tx for VT

A
  • Pulseless VT
    • –> Cardiac Arrest
  • VT with pulse
    • Haemodynamically unstable
      • Synchronised DC cardioversion
    • Haemodynamically stable
      • IV Amiodarone
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30
Q

What is C/I in VT

A

Avoid CCBs (Verapamil) in VT

Blocking the AVN may trigger VF –> Cardiac arrest

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31
Q

Tx for Torsades de Pointes

A

IV Magnesium sulphate 1-2g

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32
Q

ECG: Convex / coved ST elevation in V1-V3 followed by TWI

Diagnosis? Cause?

How to make ECG signs more apparent

Treatment?

A

Brugada syndrome

Mutation in SCN5A gene

ECG changes more apparent post-flecainide or post-ajmaline administration

Tx: ICD

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33
Q

Cardiac MRI: fibrofatty tissue within the myocardium

Diagnosis? ECG?

Treatment?

Complications?

A

Arrhythmogenic right ventricular cardiomyopathy

Right ventricular myocardium is replaced by fatty and fibrofatty tissue

ECG: Epsilon wave, TWI V1-V3

Management: Treat arrhythias, Catheter ablation to prevent VT, ICD

Complications: 2nd most common cause of sudden cardiac death in the young (HCM is 1st)

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34
Q

Exercise or emotion-induced VT

Diagnosis?

Cause?

A

Catecholaminergic polymorphic ventricular tachycardia

Autosomal dominant mutation in RYR2

Onset < 20 years old

Exercise/Emotion –> VT

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35
Q

Bradyarrhythmias - tx

A

If adverse features –> IV Atropine 500 micrograms +/- Repeat +/- Transcutaneous pacing +/- IV Isoprenaline +/- IV Adrenaline

If no adverse features

  • If at risk of asystole (2nd/3rd AV block) –> See above
  • If low risk –> Observation
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36
Q

Tx of AV block

A
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37
Q

Coarctation of the Aorta (Adult)

Definition

Features

Association

CXR

A

Coarctation of the Aorta (Adult)

= Narrowing of the aorta distal to the L subclavian artery

Features

  • hypertension in the R arm
  • Ejection systolic murmur (similar to Aortic stenosis)
  • Radio-femoral delay
  • Radio-radial delay

CXR:‘Rib-notching’

38
Q

Tx of PDA

A

Closure of the PDA

(1) NSAIDs (Indomethacin)
(2) Surgical ligation

39
Q

Dilated cardiomyopathy

Causes

Features

Tx

A

Dilated cardiomyopathy

Causes: Idiopathic, Alcohol, post-viral myocarditis

Systolic dysfunction

Heart failure symptoms

AV valve regutation (MR/TR)

S3 mrumur

Treat Heart failure

40
Q

Causes of HOCM

A

Autosomal dominant (50%)

Mutation in β-myosin heavy chain protein (15-25%)

or myosin-binding protein C (15-25%)

41
Q

Features of HOCM

A

Bifid carotid pulse (jerky pulse)

Double apex beat

ESM (louder with valsalva, quieter with squating)

S4 murmur (palpable –> double apex beat)

42
Q

Echo features of HOCM

A

Echo features of HOCM

Tip: MR SAM ASH

(MR) Mitral regurgitation

(SAM) Systolic anterior motion of anterior mitral valve leaflet

(ASH) Asymmetrical hypertrophy of ventricles (disproportionate septal involvement)

Diastolic dysfunction

43
Q

Treatment of HOCM

A

Treatment of HOCM

Tip: ABCD

  • Amiodarone
  • β blockers
  • CCB
  • Defibrillator/ICD
44
Q

Drugs to avoid in HOCM

A

Tip: Avoid IAN in HOCM

  • Avoid Inotropes
  • Avoid ACEi
  • Avoid Nitrates
45
Q

Classification of severity of HF

A
46
Q

Where is BNP secreted from

What factors affect BNP

A

BNP is secreted by ventricular myocardium

47
Q

Drugs with mortality benefits in heart failure with ↓ EF

A

Drugs with mortality benefits in HF

  • ACE inhibitors
  • β blockers
  • EF < 35% –> Aldosterone antagonists (Spironolactone)
48
Q

Tx of HF

A

EF > 55%

  • +/- Loop diuretics (symptomatic)
  • +/- Aspirin
  • +/- Statin

EF < 55% (ABCD HI DI ICD)

  • (1) ACE inhibitor + B blocker + Spironolactone + SGLT-2 inhibitor
  • (2) +/- Hydralazine + Isosorbide dinitrate combination
  • (3) +/- Digoxin +/- Ivabradine
  • (4) +/- ICD or CRT (if LBBB)
  • (5) Heart transplant
49
Q

Causes of myocarditis

A

myocarditis

Trypanosomiasis (Chagas disease) = most common cause worldwide

HHV6

Coxsackie B

HIV

Post-streptococcal

50
Q

2 weeks ago, fever, cough, myalgia

now SOB with orthopnoea + chest pain

Diagnosis?

Treatment?

A

Myocarditis

Prednisolone

Treat underlying cause

51
Q

Triad of pericarditis

A

Chest pain

  • Pleuritic
  • Relieved by leaning forward, worse on flying flat

Pericardial frictional rub – “walking on snow”

Serial ECG changes

  • Global PR depression
    • PR depression is the most specific finding in acute pericarditis
  • Global ST elevation
52
Q

Features of constrictive pericarditis

A

Kussmaul’s sign = ↑ JVP with inspiration

Pulsus paradoxus = ↓ SBP during inspiration

53
Q

Beck’s triad

What is it?

Indicates?

A

Cardiac tamponade

  • Beck’s triad:
    • ↑ JVP
    • ↓ BP
    • Muffed heart sounds
54
Q

Troponin in myocarditis and pericarditis

A

DDx: Myocarditis (↑ Troponin) vs Pericarditis (normal Troponin)

55
Q

Tx for pericarditis

A

Treat underling cause

(1) NSAIDs + Colchicine
(2) Corticosteroids

+/- Periardiocentesiss

+/- IV ABx

56
Q

Cardiac tamponade vs Constrictive pericarditis

A
57
Q

Duke’s criteria

A

Tip: IF BER (Major, Minor)

  • Blood culture (2 cultures from 2 sites > 12 hours apart)
  • Echo
  • Regurgitation
  • Immunological / Vascular signs
  • Fever

Need 2 major or 1 major + 1 minor or 5 minor

58
Q

Causes of IE

A

Acute (days-weeks)

  • Staph aureus ==> Tricuspid valve
    • most common ause
  • Staph epidermidis
    • most common cause post-prosthetic valve surgery (up to 2 months)

Subacute (weeks-months)

  • Strep viridans (Strep mitis, Strep sanguinis) ==> Aortic + Mitral valve
    • Associated with Dental procedures
  • Strep bovis (Strep gallolyticus)
    • Associated with GI cancer
  • Culture negative
    • HACEK

Non-infective

  • SLE / Libman Sacks endocarditis
59
Q

Empirical ABx for IE

A

Native valve

  • (1) Amoxicillin + Gentamicin
  • (2) If penicillin allergy –> Vancomycin + Gentamicin

Prosthetic valve

  • (1) Vancomycin + Gentamicin + Rifampicin
60
Q

IE + prolonged PR interval on ECG

Diagnosis

A

Aortic root abscess

Due to pressure on AVN –> prolonged PR interval

61
Q

Sore throat 2 weeks ago

Fever

Polyarthritis

Chest pain

Rash on extensor surfaces

Diagnosis? Cause? Diagnostic criteria? Ix?

A

Rheumatic fever

Group A B-haemolytic streptococcus pyogenes

JONES criteria

  • Joints –> Polyarthritis
  • O –> Carditis
  • Nodules –> Subcutaneous nodules
  • Erythema marginatum - pink macules with central clearing
  • Sydenham’s chorea

Ix: ASOT / Throat culture

62
Q

Tx for rheumatic fever

Prophylaxis

A

(1) Aspirin +/- Corticosteroids

+/- Antibiotics (IV Benzylpenicillin)

+/- Valve replacement

Oral Pencillin V daily as prophylaxis until 18 years old

63
Q

Complications of rheumatic fever

A

Chronic rheumatic heart disease (30-50%)

ANY valve

Most commonly causes mitral stenosis

64
Q

Definition

Decubitus angina

Prinztmetal angina

Syndrome X

A
65
Q

Tx for cocaine related MI

A
  • ACS Treatment
  • + IV Benzodiazepine
  • AVOID β blockers
    • Β blockers may cause unopposed α1-mediated vasoconstriction –> worsen coronary spasm
66
Q

Tx for complete heart block secondary to MI

A

Complete heart block due to

  • Inferior MI (affecting RCA) –>Tx: Monitor and only Tx if adverse features
  • Anterior MI (affected LAD) –> Tx: Pacing
67
Q

MI + new murmur

Diagnosis?

A

Post-MI mitral regurgitation (15-30%)

Associated with infero-posterior infarction

Tx: Urgent surgical repair

68
Q

MI + persistent ST elevation with Q waves on ECG

No chest pain

Diagnosis?

A

Ventricular aneurysm

MI + persistent ST elevation with Q waves on ECG

69
Q

MI + cardiac tamponade

Diagnosis

A

L ventricular free wall rupture (3%)

  • Occurs 1-2 weeks post-MI
  • Cardiac tamponade (↑ JVP, pulsus paradoxus, diminished heart sounds)
  • Secondary acute heart failure
  • Tx: Urgent pericardiocentesis and Thoracotomy
70
Q

Ix for anginal chest pain

A

(1) CT coronary angiogram with contrast
(2) Non-invasive functional imaging (stress ECHO, stress cMRI)
(3) Invasive angiography

71
Q

Anti-anginal Tx

A
  • PRN sublingual GTN
  • (1A) B blocker or rate limiting CCB
    • B blocker (Atenolol)
    • Rate-limiting CCB (Verapamil)
  • (1B) Uptitrate dose or change class or combination
    • B blocker + non-rating limiting CCB (Amlodipine MR, Nifedipine MR)
  • (2)
    • Isosorbide mononitrate
    • Nicorandil
    • Ivabradine
    • Ranolazine
      • Does not affect BP
  • (3) PCI / CABG
72
Q

Causes of Loud S1

A

Mitral stenosis

73
Q

Soft S1

A

Mitral regurgitation

74
Q

Split S1

A

RBBB

75
Q

Variable intensity of S1

A

Complete heart block

76
Q

Loud S2

A

Hypertension (systemic or pulmonary)

77
Q

Soft S2

A

Aortic stenosis

78
Q

Split S2

A

Fixed split S2 –> ASD

Widely split S2 –> Deep inspiration or RBBB

79
Q

Reversed split S2

A

LBBB

80
Q

S3

What does it mean?

Causes?

A

DCM (S3 = DCM, 3 letters)

MR

Diastole –> blood hits overly compliant LV –> S3

81
Q

S4

What does it mean?

Causes?

What part of ECG does it correlate with?

A

HOCM

(S4 –> HCOM, 4 letters)

atrial systole (P wave) –> blood hits non-compliant ventricle

Coincides with P wave

82
Q

Tx for aortic regurgitation

Indications?

A

Aortic valve replacement

if symptomatic

or asymptomatic + LVEF < 50%

83
Q

Tx for Aortic stenosis

Indications

A

Aortic valve replacement

  • Symptomatic AND pressure gradient > 40-50 mmHg
  • Asymptomatic AND LVEF < 50%

If unfit for surgery –> Transcatheter AV implantation (TAVI)

or Balloon aortic valvuloplasty (BAV)

84
Q

Target INR for mechanical aortic and mitral valves

A

Aortic metallic valve –> INR 3.0 (2.5 - 3.5)

Mitral metallic valve –> INR 3.5 (3.0 - 4.0)

Mitral –> higher INR due to slower flow

85
Q

Tx for mitral regurgitation

A

Mirtal valve repair with annuloplasty ring

Mitral valve replacement

If unfit for surgery –> MitraClip edge-to-edge

  • Symptomatic
  • Asymptomatic AND LVEF < 50%
  • Asymptomatic AND AF
  • Asymptomatic AND Mitral valve prolapse (most common reason)
86
Q

Tx for mitral stenosis

A

(1) Percutaneous mitral commissurotomy (PMC)

(2) Mitral valve replacement

  • Symptomatic
  • Asymptomatic AND worsening function (e.g. AF)
87
Q

Left/Right Arm BP differential

Chest pain raiating to back

CXR wided mediastinum

Diagnosis? Ix?

A

Aortic dissection

Ix: CT aortic angiogram (if stable)

or TTE (if unstable)

88
Q

Tx for aortic dissection

A

Type A (ascending aorta) –> Medical + Surgical

Type B (desecending aorta) –> Medical

Aggressive BP control with IV Lebetalol

89
Q

Changes in hypertensive retinopathy

A
90
Q

Tx of Hypertension

A
91
Q

ACS cardiac enzymes

A

Myoglobin is the first to rise

CK-MB is useful to look for re-infarction

Troponin stays elevated for 10 days

92
Q

Tx for uraemic pericarditis

A

Haemodialysis

rw fy1 (15 decks)

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