Cardiology Flashcards
Extrinsic causes of bradycardia
B blockers, hypothyroid, hypothermia
Name an intrinsic cause of bradycardia
Ischaemia of SAN
Fibrosis of atrium
Sick sinus syndrome - failure of the SAN to depolarise.
Causes of heart block
CAD, cardiomyopathy, fibrosis within the conducting tissue.
What is first degree heart block? ECG sign?
delayed AV conduction, prolonged PR interval
What is Mobitz type 1 heart block?
Progressive PR prolongation until it doesn’t conduct and absent QRS
What is Mobitz type 2 heart block?
dropped QRS complex (no PR prolongation.)
What is third degree heart block?
All atrial activity fails to conduct to the ventricles.
Causes of wide QRS complex on ECG?
Bundle branch block
What is the definition of tachycardia?
HR >100bpm
Causes of BBB?
PE/IHD/ventricular hypertrophy/AV disease/fibrosis.
Name some pathological causes of tachycardia?
fever, anaemia, thyrotoxicosis, PE, hypovolaemia.
Name causes of narrow complex QRS complex?
AVRT/AVNRT/physiological tachycardia.
What is AVNRT?
commonest SVT. Ring of conducting pathway in AVN.
What is AVRT?
accessory pathway connecting atria and ventricles.
Example of AVRT and ECG findings?
Wolff-Parkinson-White, delta waves before the QRS complex.
Symptoms of an arrhythmia?
Palpitation, dizzy, SOB, central chest pain, syncope.
Management of supraventricular tachycardias? unstable/stable and prevention
Unstable - Emergency conversion
Stable - Vagal stimulation, IV Adenosine
Prevention - radiofrequablation, B blocker
What is the HR like in AF?
irregularly iregular
AF ECG signs?
absent P waves
How to manage an unstable AF patient?
heparinisation, DC shock, IV amiodarone
Rate control in a stable AF patient?
1st line = B blocker (C/I in asthma patients?
2nd line = CCB/digoxin
Rhythym control in stable AF patient?
B blocker e.g. Sotalol
others: amiodarone
How to assess anticoagulation in AF patient?
CHADVASC2 - CHF, HTN, >75, 65-74, DM, TIA or stroke, VD, Female
Anticoagulation choice in AF patient?
DOAC e.g Rivaroxaban/apixaban
What is ventricular fibrillation?
Rapid and irregular ventricular rhythm with no mechanical effect. No CO.
Name some causes of HF
IHD, arrhythmia, anaemia, hyperthyroid, obesity
What is the pathophysiology of HF?
read in notes
Symptoms of HF?
exertional SoB, orthopnia, paroxysmal nocturnal dyspnoea, fatigue
Ix for HF? what would they show?
CXR - enlarged heart
ECG - underlying cause
Bloods - FBC, LFT, BG, UE, TFT, BNP
ECHO
General HF management?
Educate, physical exercise, diet, pneumococcal and influenza vaccine
1st and 2nd line treatment for HF
1st line = ACEi + B blocker
2nd line = Aldosterone antagonist (Spironolactone)
3rd line = digoxin
Symptomatic Mx for HF?
pillows, furosemide
investigations for acute heart failure?
CXR, ECG, bloods, ECHO
signs of fluid overload?
hypertension, raised JVP, pulm oedema (breathless)
Management of acute heart failure?
High flow O2 and IV 50mg Furosemide
What causes myocardial ischaemia?
imbalance in supply/demand of myocardial muscle
Commonest cause of IHD? how does it cause it?
coronary artery disease - atheromatous plaques whcih narrow lumen of the artery.
Irreversible RF for IHD
age, gender, family Hx
Reversible RF for IHD
hyperlipidaemia, smoking, HTx, DM, low veg diet, stress
Symptoms of stable angina?
central crushing chest pain (retrosternal) worse with exertion and relieved by rest.
Ix of angina?
ECG, stress ECG, ECHO, coronary antiography, clinical Hx
General risk Mx in angina patients?
lifestyle advice, aspirin 75mg OD, statin
Symptomatic Mx of angina?
sublingual GTN with symptoms, B blocker e.g. atenolol
2 surgeries for Angina
PCI, CABG
What causes ACS?
rupture of atheromatous fibrous plaque which causes formation of platelet rich clot within a coronary artery
Features of unstable angina?
worsening angina on minimal exertion, pain at rest - not relieved by nitrates. New onset HF/collapse.
DD of ACS?
aortic dissection/MSK pain/GORD
Ix of ACS?
FBC, creatinine, electrolytes, glucose, lipids, ECG (STEMI or NSTEMI), toponin and CK, cardiac monitor.
Management of acute ACS?
Morphine sulfate (for pain.)
Oxygen if <88%???
Nitrates
Aspirin (300mg then 75mg daily) +/- Clopidogrel
Metoclopromide for nausea?
What scoring systems for risk of ACS?
Grace
TIMI
Featues of STEMI?
central chest pain occuring at rest. Sweating, breathless, N&V, pale/grey/sweaty
ECG signs of a STEMI?
ST segment elevation
T wave flatteningt/inversion
Mx of a stemi?
MONA + Metoclopromide + immediate primary angioplasty
Fibrinolytic agents - bolus IV streptokinase/alteplase
Complications of a stemi?
Arrhythmia, heart block, heart failure
What causes rheumatic fever?
Group A strep
Features of rheumatic fever?
fever, joint pain, heart murmer
Ix of rheumatic fever?
FBC, ESR, Ducket jones criteria, throat swab for strep
Mx of rheumatic fever?
high dose aspirin, penicillin
Causes of Mitral stenosis?
Rheumatic fever
what would you hear on auscultation of a pt with mitral stenosis?
mid diastolic rumbling murmer with loud first heart sound?
Ix for any valve pathology?
CXR, ECHO, ECG
How does mitral regurgitation cause pulm oedema?
back log into the LA and back into the lungs.
auscultation of mitral regurgitation?
pansystolic murmer + thrill
Cause of prolapsing valves?
Marfan syndrome.
Causes of aortic stenosis?
degeneration, calcification, rheumatic HD
Symptoms of Aortic stenosis? Why do you get these?
Obstructed LV exit - causes angina, exertional syncope, congestive HF
Auscultation of aortic stenosis?
harsh ejection systolic murmer
Signs of aortic regurgitation?
collapsing water hammer pulse
Symptoms of aortic regurgitation?
dyspnoea, orthopnea, LV failure (fatigue)
What criteria is used for infective endocarditis?
Dukes criteria
Causative organisms of infective endocarditis?
Strep.Pneumoniae, Staph.Aureus
Features of infective endocarditis?
fever, malaise, weight loss, anaemia, new onset HF, murmers, emboli
Ix of IE?
blood cultures, ECHO, CXR. ECG, FBC, ESR, Serum IGs
What is the definition of pulmonary HTN?
pressure in pulm arteries >25mmHG at rest (normally 10-14mmHG)
Causes of pulm HTN?
idiopathic, hereditary, inflammatory (SLE/RA)
Ix of pulm HTN? what would these show?
CXR - enlarged pulmonary arteries
ECG - RV hypertrophy
ECHO
Mx of pulm HTN?
O2, warfarin, diuretic, CCB (pulm vasodilators.)
Features of a PE?
breathless, pleuritic chest pain, haemoptysis, tachypnoec, shocked, pale, sweaty, tachycardic, death
Risk score for a PE? what does it look at?
WELLS Score - clinical signs of DVT, alternative diagnosis is less likely, HR > 100, recent immobilisation, previous DVT/PE, haemoptysis, malignancy (>4 = high suspicion of a PE.)
Management of a PE in a high risk patient?
High risk –> start DOAC/LMWH –> CTPA –> diagnosis
management of PE in a low risk patient?
low risk –> D Dimer / other IX –> positive –> CTPA
General Mx of a PE patient?
Give O2, thrombolysis if massive, morphine, IV fluids
What does a D dimer show? When is it not useful?
fibrinogen degradation products when the clot is dissolved - false positives in pregnancy/malignancy.
Name 2 cardiomyopathies
hypertrophic, dilated
Causes of acute pericarditis?
Viral (Coxasackie), MI, uraemia, malignancy
Features of acute pericarditis?
sharp retrosternal chest pain (relieved by leaning forwards), pain worse on inspriation and pericardial friction rub.
what does an ECG show in acute pericarditis?
Saddle shaped ST segment
mx of acute pericarditis
1st line = NSAIDS
2nd line = corticosteroids
pain relief, look at underlying cause
what is cardiac tamponade?
medical emergency. rapid accumulation of fluid restricting diastolic filling of the ventricles which reduces CO.
Features of pericardial effusion?
soft heart sounds, low BP, increased HR, raised JVP, kussmauls resp
Mx of cardiac tamponade?
pericardiocentesis
Causes of essential HTN?
genetics, low birth weight, obesity, increased alcohol and salt intake
secondary causes of hypertension?
pre-eclampsia, renal stenosis, Conns, phaemochromcytoma, coarction of aorta, COCP, NSAIDS
What histology is shown with hypertension?
fibrinoid necrosis of the vessel walls
name end organ damage that occurs due to hypertension?
Kidneys - haematuria, proteinuria, progressive CKD
Brain - oedema, haemorrhage
Retina - flame haemorrage, cotton wool spots, pappilodoema
CVS - acute HF, aortic dissection
What Ix do you do for HTN?
serum UE, urine stix, BG, lipids, ECG
non pharm Mx measures for HTN?
weight loss, low fat and salt diet, reduce alcohol, exercise, increase fruit and veg, stop smoking
pharm management of HTN patheway?
1st line = <55/T2DM - ACEi, Afro-Carib,>55 - CCB
2nd line (A+C) or (A+D)
3rd line = (A + C + D)
Examples of ACEi/their action/side effects
lisinopril/ramipril
they block the conversion of angiotensin 1 –> angiotensin 2 (vasoconstrictor.)
SE = cough/rash/hypotension
Example of ARB and how they work?
Losartan - blocks angiotensin 2 receptor - good in ACEi patients who cannot tolerate cough.
Example of CCB/how they work/side effects
Amlodipine/nifedipine
cause dilation of peripheral arterioles
SE = headache/flushing/periphera oedema
name the 2 different types of diuretic and an example
loop diuretic - furosemide
thiazide - bendroflumethiazide
Definition of an aortic aneurysm?
vessel Diameter >3cm. Permanent localised dilation of an artery.
Features of abdo/thoracic aneurysms
ABDO - pulsating mass, epigastric or back pain
THORACIC - back pain, dysphagia, cough
What occurs during dissection? Features?
tear in the intima, false lumen created. Abrupt onset severe tearing central chest pain which radiates to the back.
Neuro signs, absent pulses, unequal BP in arms!!
Ix of dissected anuerysm?
CXR - widened mediastinum.
CT/ECHO/MRI
