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FINALS (not specialities) > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Which ECG leads give a lateral view of the heart?

A

Lateral = Left

I, avL, v6

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2
Q

Which ECG leads give an inferior view of the heart?

A

II, III, avF

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3
Q

Which ECG leads give an anterior view of the heart?

A

V2, V3, V4

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4
Q

What are the lateral ECG leads and which coronary artery do they correspond to?

A

I, avL, V6

Lateral Circumflex or diagonal branch of LAD

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5
Q

What are the inferior ECG leads and which coronary artery do they correspond to?

A

II, III, avF

Right Coronary Artery

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6
Q

What are the anterior ECG leads and which coronary artery do they correspond to?

A

V2, V3, V4

Left Anterior Descending (LAD)

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7
Q

How do a STEMI and an NSTEMI differ?

A
  • STEMI = ST elevation +/- Q wave formation OR NEW ONSET LBBB i.e. specific ECG changes
  • NSTEMI = Symptoms but non-specific ECG changes + elevated cardiac enzymes
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8
Q

Define Acute Coronary Syndrome

A

A collection of symptoms that can be due to one of either:

Unstable Angina
MI (STEMI OR NSTEMI)

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9
Q

What are the 5 categories of MI?

A

Due to acute ischaemia =
1 - Spontaneous, due to primary coronary event e.g. plaque rupture or dissection
2 - Secondary to ischaemia from ↑ o2 demand or ↓ o2 supply e.g. severe HTN or tachyarrhythmia

Other
3 - Sudden Cardiac Death
4 - Associated with PCI or Stenting
5 - Associated with cardiac surgery

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10
Q

How can unstable angina be differed from an MI?

A

Symptomatically
unstable angina = -ve trops
MI = +ve trops

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11
Q

What are the classic symptoms of an MI?

A 
Central, crushing chest pain +/- radiates to left arm or jaw
Sweating, N&V
Pallor
Palpitations
Feeling of impending doom
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12
Q

What is the GRACE score?

A

Scoring system to estimate the risk of death following acute coronary syndrome

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13
Q

What is the medical management of a STEMI?

A

(MONAA B)
Morphine (5-10mg IV) and Metoclompramide (10mg IV)
Oxygen
Nitrates (more of a role in NSTEMI than STEMI)
Aspirin 300mg PO
Antiplatelet - Clopidogrel

B-Blocker - Atenolol

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14
Q

What is the management of an NSTEMI?

A

MONAA B

Do a GRACE score = high risk = angioplasty, low risk = observe + OP assessment

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15
Q

What is the surgical/definitive management of a STEMI and when can this be offered?

A

Primary Percutaneous Intervention

ONLY IF within 12hr of symptom onset OR can get to a PCI centre in 120 minutes

If not, do thrombolysis

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16
Q

Give 4 short term and 4 long term complications of an MI

A 
◦ Short Term
		‣ Death
		‣ Cardiogenic Shock
		‣ Thrombosis embolisation
		‣ Pulmonary Oedema
	◦ Long Term
		‣ Heart Failure
		‣ Arrhythmias
		‣ Recurrence 
		‣ Psychosocial e.g. depression
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17
Q

What are the medications required for long term prevention of an MI?

A
  • Dual anti platelet therapy - Aspirin and Clopidogrel
  • Statin
  • ACEI
  • B-Blocker
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18
Q

What is a pathological Q wave? When does it become pathological?

A

ECG waves that occur when the myocardium becomes damaged to the point of no return. Shows as a negative deflection before the R wave

in V1-V3
>2mm deep
>1mm/40s wide
>5% of QRS
= pathological
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19
Q

What are the classical features of heart failure on chest x ray?

A 
A - alveolar oedema (bat wing opacities)
B - Kerley B lines
C - cardiomegaly
D - dilated upper lobe vessels
E - pleural effusion
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20
Q

What are the causes of left ventricular systolic dysfunction?

A

Things that impair proper contraction of the ventricle

Ischaemic heart disease
Hx MI
Cardiomyopathy

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21
Q

What are the causes of left ventricular diastolic dysfunction?

A

Things that impair proper relaxation and filling of the ventricle

Tamponade
Restrictive cardiomyopathy
Ventricular hypertrophy

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22
Q

What are the causes of right heart failure?

A

Left heart failure
Cor Pulmonale/Lung disease
Pulmonary stenosis

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23
Q

What is the management of acute heart failure?

A

◦ IV Furosemide
◦ Diamorphine + metoclompramide/anti-emetic
◦ GTN 2 puffs

24
Q

What is the management of chronic heart failure?

A

Conservative - smoking cessation/ risk reduction, cardiac rehab

Medical - ACEI/ARB, B Blocker, Diuretic, Spironolactone can be used if still symptomatic

25
Q

What is a broad complex tachycardia? Give 3 examples

A

HR >100bpm

QRS >0.12s

Ventricular tachycardia, ventricular fibrillation, torsades de pointes

26
Q

What is a narrow complex tachycardia? Give 3 examples

A

HR >100bpm

QRS <0.12s

Sinus tachy, Atrial Fibrillation, AVRT,NRT

27
Q

What is torsades de points?

A

Polymorphic ventricular tachycardia

VT but the baseline varies and that kind of makes it look like VF but it isn’t
Has a big risk of developing into VF though

28
Q

How could a patient with an arrhythmia present?

A 
Palpitations
Syncope
Feeling lightheaded
Shortness of breath especially on exertion
Chest pain
29
Q

What is the pathophysiology of atrial flutter?

A

Electrical activity circles the atria 300 times per minute,

The avn passes some of these impulses on = ventricular rates that are factors of 300

Gives a ‘sawtooth’ baseline

30
Q

Describe an atrioventricular re-entry tachycardia

A

an accessory pathway e.g. the bundle of Kent in Wolff-Parkinson White allows transmission of electrical impulses from the ventricles back to the atria

creates a circuit

31
Q

Describe the appearance of Wolff-parkinson white on ECG

A

Get delta waves = slurred upstroke of the QRS

32
Q

Describe an atrioventricular nodal re-entry tachycardia

A

circuits form within the AVN = narrow complex tachycardia

33
Q

Describe atrial fibrillation

A

Multiple sites of depolarisation within the atria causes them to quiver rather than properly contracting

Atrial rate is irregular and 300-600bpm

The AVN transmits intermittently leading to an irregular pulse

CO drops as ventricles are inadequately primed + stagnation of blood within the atria predisposes coagulation and therefore stroke

34
Q

How should AF be managed acutely if there is haemodynamic INSTABILITY??

A

DC cardioversion!

35
Q

How should AF be managed acutely if there is NO haemodynamic instability?

A

Symptoms <48hr = Rate or Rhythm Control

Symptoms >48hr = anticoagulate with a DOAC for 3 weeks and then bring back for elective cardio version

36
Q

How is rate controlled pharmacologically in AF?

A

1st line = B Blocker

2nd line/if B blocker contraindicated = Rate limiting Ca Channel blocker e.g. Dilitiazem or Verapamil

3rd line = Digoxin

37
Q

How is rhythm controlled pharmacologically in AF?

A

IV Amiodarone

IV Flecainide (not if there is any structural heart disease)

38
Q

What is paroxysmal AF and how should it be managed?

A

Gets worse all of a sudden/is infrequent

Use ‘pill in the pocket’ e.g. sotalol or flecainide PRN

39
Q

Give 6 common causes of AF

A
  • Structural defects e.g. mitral valve disease
  • Pneumonia
  • PE
  • HF/HTN
  • Previous MI
  • Hyperthyroidism
40
Q

What do bifascicular and trifascicular block look like on ECG?

A

Bifascicular = RBBB + Left axis deviation

Trifascicular = RBBB + LAD + 1st degree heart block

41
Q

What counts as haemodynamic instability/adverse events during an arrhythmia? (4)

A

Syncope
Shock
Myocardial Ischaemia
Heart Failure

42
Q

What is the murmur heard with aortic stenosis? When is it the loudest?

A

Ejection systolic

Loudest on expiration

43
Q

What is the murmur heard with pulmonary stenosis? When is it the loudest?

A

Ejection systolic

Loudest on inspiration

44
Q

What is the murmur heard with mitral stenosis? When is it the loudest?

A

Mid-diastolic murmur

expiration

45
Q

What is the murmur heard with tricuspid regurgitation? When is it the loudest?

A

Pansystolic

Loudest on inspiration

46
Q

What is the murmur heard with mitral regurgitation? When is it the loudest?

A

Pansystolic

Loudest on expiration

47
Q

What are the causes of aortic stenosis?

A

Old age - the valve calcifies

Rheumatic heart disease

48
Q

What are the causes of aortic regurgitation?

A

Acute:
infective endocarditis, trauma

Chronic:
Connective tissue disorders, Takayasu’s Arteritis, PAIR athropathies, Rheumatoid arthritis

49
Q

What are the causes of mitral regurgitation? (5)

A 
Functional (lv dilatation)
Calcifies in old age
rheumatic fever
infective endocarditis
mitral valve prolapse/dysfunction Post MI
50
Q

What are the causes of mitral stenosis?

A

Rheumatic heart disease

Congenital

51
Q

What are the causes of tricuspid regurgitation? (4)

A

rv dilatation; eg due to pulmonary hypertension rheumatic fever
infective endocarditis
Ebstein’s Anomaly

52
Q

What are the causes of tricuspid stenosis?

A

Rheumatic heart disease

53
Q

What are the causes of pulmonary stenosis

A

Congenital = turner’s, TOF, Rubella

Acquired = Rheumatic Heart Disease

54
Q

What are the causes of pulmonary regurgitation?

A

Pulmonary Hypertension

55
Q

What is Beck’s triad of cardiac tamponade?

A

Muffled Heart Sounds

Hypotension

Distended neck veins

56
Q

What is Kussmaul’s sign?

Not breathing

A

distension of the jugular veins on inspiration

due to constrictive pericarditis

blood can’t enter the right atrium and is more pronounced than normal as normally would have a negative inter thoracic pressure when breathing in

FINALS (not specialities) (7 decks)

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