Cardiology Flashcards
What are the symptoms of AF?
palpitations, chest pain, SOB, dizziness, irregularly irregular pulse
What is the treatment for AF
apixaban, warfarin
What is rhythm control for AF?
LMWH, amiodarone
What is rate control for AF?
B-blocker, digoxin, anti-coagulation
What is the treatment for unstable AF?
DC cardioversion
What is the treatment for hyperkalaemia?
Calcium gluconate via IV injection, then insulin and dextrose, then nebuliser salbutamol
What are the causes of hyperkalaemia from impaired excretion?
AKI, CKD, ACEi, potassium sparing diuretics, NSAIDs, LMWH, Ciclosporin, Hypoaldosteronism, Addison’s
What are the causes of hyperkalaemia from increased release from cells?
Lactic acidosis, insulin deficiency, haemolysis, Digoxin toxicity, beta-blockers
What causes Torsades de pointes and how do you treat it?
VT - caused by meds/long QT syndrome
DC shock, then IV amiodarone, then once stable, IV magnesium sulphate, remove drugs and correct electrolyte abnormalities
What are the causes of systolic HF?
IHD, dilated cardiomyopathy, myocarditis, infiltration, HTN
Use EF to assess severity
What are the causes of diastolic HF?
Hypertrophic obstructive cardiomyopathy, restrictive cardiomyopathy, cardiac tamponade, constructive pericarditis
What are the causes of high-output HF?
Anaemia, AV malformation, Paget’s disease, pregnancy, thyrotoxicosis, thiamine deficiency
What are the signs of LHF?
Pulmonary congestion and systemic hypoperfusion
Cor pulmonale, SOB, orthopnoea, PND, nocturnal cough, tachpnoea, bibasal fine crackles
What are the signs of RHF?
Venous congestion and systemic hypoperfusion
Ankle swelling, weight gain, abdo distension, anorexia/nausea, increased JVP, peripheral oedema, ascites, hepatomegaly
What investigations are done for HF?
ECG, BNP (releases by ventricles in response to myocardial stretch).
Echo - ventricular dysfunction
Chest X-ray
What is seen on a chest X-ray for HF?
Alveolar collapse Kerley B lines Cardiomegaly Upper lobe diversion Pleural effusion Fluid in horizontal fissure
What interventions are given for HF patients.
Smoking cessation, decreased salt and fluid intake, cardiac rehabilitation
Pharmacological: ACEi and beta-blocker, loop diuretic, aldosterone antagonists, Digoxin
Surgical: ICD
What are the signs and symptoms of acute mitral regurgitatation?
Hypotension, tachycardia, pulmonary oedema
SOB, exertional dyspnoea, fatigue, weakness
2-10 days post-MI, medical emergency - need valve repair and replacement
What are the signs and symptoms of malignant HTN?
What other conditions can it lead to?
Headache and blurry vision (papilloedema in both eyes)
BP > 180/120
Symptomatic, end organ damage, intracranial haemorrhages, raised ICP, aortic dissection and AKI
What are the signs and symptoms of myocarditis?
Chest pain, ECG changes, raised troponin, Hx of viral illness, fatigue, palpitations, symptoms of HF
How does HOCM present?
Asymptomatic, young exertion syncope, SOB, chest pain, palpitations, HF, double apex pulse, ejection systolic murmur
What are the signs of aortic regurgitation?
Wide pulse pressure, decreased DBP, high pulse pressure, early diastolic murmur
What treatment is given in an anterior STEMI?
Aspirin 300mg (anti-thrombotic and analgesic)
GTN, IV morphine
PCI if less than 12 hours
What is seen in hypertensive retinopathy?
Flare haemorrhages and cotton wool spots
How do you assess stable angina?
CT coronary angiography, then stress Echo/MRI
What is the diagnosis and management if a pt presents with SOB, chest pain, worse on coughing and a STEMI 3 weeks ago
Pericarditis/Dressler’s syndrome
What is seen in a JVP with complete heart block?
Cannon A-wave (atrial contraction against closed tricuspid valve)
After what conditions is Mobitz type 2 likely to present?
MI, mitral valve repair, rheumatic heart disease
What are some causes of first degree heart block?
athlete, MI, electrolyte disturbance, B-blocker, CCB, digoxin
What treatment is given in orthostatic hypotension?
Fludrocortisone and midrodrine (increase renal Na+ reabsorption)
What can be given within 6 hours after an inferior STEMI?
IV tenecteplase (fibrinolysis), PCI is done within 2 hours
What is the management for fast AF?
DC cardioversion (due to adverse features, e.g. syncope, HF, myocardial ischaemia and shock) B-blocker if there are no adverse features
What are the signs of aortic stenosis?
Ejection systolic murmur, radiates to carotids on inspiration, narrow pulse pressure, slow rising pulse, syncope, angina, dyspnoea
Severe: peak trans-valvular pressure gradient over 40 mmHg
What 3 things could a pan-systolic murmur be?
Mitral regurgitation - loudest at apex, radiates to axilla, loudest on expiration
Tricuspid regurgitation - loudest at left sternal edge on inspiration
Ventricular septal defect - loudest at left sternal edge, common in Down’s
What is the main causative agent for infective endocarditis?
Staphylococcus aureus, found on skin, can enter through IV needles
What is a side-effect of statins?
Rhabdomyolosis - pain/swelling, brown urine, AKI
What is torsades de pointes and what is the treatment?
Ventricular tachycardia, prolonged QT
Treatment - IV magnesium sulphate, stop causative medications, haemodynamically unstable - defib
What are the causes and signs of aortic regurgitation?
Rheumatic fever, pancarditis, fibrosis, stenosis, regurgitation of valves
Signs: SOB, fatigue, signs of HF, wide pulse pressure, CVS collapse
What is the treatment for SVT?
6mg bolus adenosine, then 12mg, then 30mg, verapamil if asthmatic
If irregular - amiodarone, and then B-blocker to control rate
What is the treatment for VF?
Unsynchronised cardioversoin, 1mg adrenaline, 300mg amiodarone
Define long QT syndrome
Uncorrected QT interval > 460 ms, HR 60bpm, precipitated by anti-epileptic meds
Why is there tachypnoea with acute decompensated HF? What is the treatment?
Impaired left ventricle secondary to IHD, less flow to kidneys, AKI, back pressure into pulmonary veins, alveolar oedema, tachypnoea
Treatment: IV loop diuretic, chest x-ray and echo
What is aortic sclerosis?
Ejection systolic murmur with no radiation, age-related senile degradation of valve
What is the first-line treatment for HF?
ACE-i, B-blocker, loop diuretic, aldosterone receptor antagonist
If not, then cardiac resynchronisation therapy - decreased LVEF, sinus rhythm, prolonged QRS
Final step: digoxin/left ventricular assist device
If sinus and impaired EF: Ivabradine
What is prescribed when a pt has HTN and T2DM
ACEi
What are the side effects of amlodipine?
Leg swelling - unresponsive to diuretic therapy
What are the causes of high-output HF?
Pregnancy, anaemia, hyperthyroidism, AV malformation, Paget’s disease, thiamine deficiency
Increased pulse, JVP, pitting oedema
What is the management for stable narrow-complex tachycardias?
Regular - vagal manoeuvre, adenosine
Irregular - AF: LMWH if < 48h, B-blocker and anti-coagulation if > 48h
What is the management if an AAA is more than 5.5 cm?
Refer for surgery in 2 weeks, BP control, smoking and cessation
What is hereditary haemochromatosis, treatment and what does it cause?
Iron deposits in ventricles, then atria, then LV dysfunction and cardiomyopathy (restrictive and dilated cardiomyopathy)
Need regular venesection
Causes DM, cirrhosis, arthropathy and depression
What can cause RBBB?
Can be a normal finding, RV hypertrophy, PE, IHD, CHD
What are the signs of mitral stenosis and what causes it?
Opening snap, malar flush, AF - increased LA pressure and LA dilatation, rheumatic disease
What is the treatment for symptomatic aortic stenosis?
Surgical aortic vale replacement
What is the initial treatment for varicose veins?
Weight loss
What is the A:V ratio in atrial flutter?
2:1
What is amyloidosis and what does it cause?
Amyloid protein deposition - heart, restrictive cardiomyopathy, HF w/ preserved EF
Arrhythmia, conduction disturbances, nephrotic range proteinuria = oedema
What are the contraindications for GTN?
Low BP, GTN decreases it further, can cause cardiac arrest
What are the 2 most common causes of infective endocarditis?
Staph aureus, Strep viridans
How is pulmonary HTN diagnosed?
Right heart catheterisation, pulmonary pressures
What is the best combination for B-blocker and CCB?
Bisoprolol and Felodipine - dihydropyridine, less chance of bradycardia and AV block
What complication can rhabdomyolysis lead to?
Hyperkalaemia -> arrhythmia e.g. VT
What JVP waveform is seen in tricuspid regurgitation?
Prominent V-wave
What complication can amiodarone cause in terms of thyroid function?
Abnormal TFTs -> induces thyrotoxicosis
What is the management of a Mobitz type 2?
Permanent pacemaker - chance of a complete heart block
What valve deformity is common in Marfan’s syndrome?
Mitral valve prolapse
What is the sign for Boerhaave’s perforation?
Vomiting, ripping chest pain (oesophageal perforation), crackling sound between S1 and S2
