Cardiology Finals Flashcards
Questions you get wrong
What Coronary Vessel has a complete heart block most likely affected? (Complete dissociation between atria and ventricles)
Right Coronary Artery
What are the Heart Blocks
1) If R is FAR from P - First Degree (PR>0.2)
2) LONGER LONGER LONGER - DROP ATTACK - WencKeBACK - MOB 1
3) If some P’s don’t get through - you have MOB 2
4) If P’s and Q’s don’t agree - third defree (no assx between P and QRS)
Features of Complete Heart Block
Bradycardia (<50)
Wide Pulse Pressure
JVP - cannon waves in neck
Heart failure
syncope
Variable Intensity of S1
What 3 things is an S3 heart sound associated with?
1) Due to Diastolic filling of ventricle
2) Considered normal in <30
3) Can be a sign of LVF, Constrictive Pericarditis, Mitral Regurgitation
What 3 things is an S4 heard sound associated with? (Atrial contraction against a stiff ventricle)
1) HOCM
2) Aortic Stenosis
3) Hypertension
When should Nitrates be used with cautious in ACS management?
When the patient is hypotensive
When should Oxygen be used in ACS management?
When SATS drop below 94%
When should moprhine be used in ACS management?
When patient is in extreme pain
First thing to give in ACS
300 mg Aspirin
Mx of HeartBlock (1st to 3rd degree)
1st degree - nothing unless symptomatic and other causes of symptoms excluded
2nd degree (Mobitz type I) -nothing unless symptomatic and other causes of symptoms excluded
2nd degree (Mobitz type II) pacemaker- transcut/transv
3rd degree pacemaker - transcut/transv
What do you give with PCI for STEMI
Prasugrel
(Give Clopidogrel if already on anticoagulants)
What do you give with Thrombolysis
Fondaparinux - antithrombin
Difference between Unstable Angina and NSTEMI
Present similarly on ECG - NSTEMI will have a RAISE of troponin
How to Treat Unstable Angina
Same as NSTEMI
Give examples of unmodifiable risk factors for ACS
Male SEX
Older Age
Family history
What to give with PCI for NSTEMI
Make sure in <72 hours (based on Grace score)
Give Prasugrel or Ticagrelor
What does GRACE score decide
> 3% Give coronary angiography (with follow up PCI <72HOURS)
What NSTEMI/UNSTABLE angina patients should have coronary angiography? (2)
- Those who are unstable (hypotensive)
- Those who score >3% on GRACE score
When do you give Clopidogrel over Ticagrelor in NSTEMI
When Patient is at a HIGH risk of bleeding
What is Prinzemetal (Variant) angina
HINT - You had it a lot as a kid
Clinical condition characterized by chest discomfort or pain at rest with transient electrocardiographic changes in the ST segment, and with a prompt response to nitrates
normally occurs in the younger population and in smokers.
Earlier in morning or at sleep - almost always at rest.
When should CHADVASc be started
> 1 in men
2 in women
What to do if CHADVASc suggests no need for DOAC in AF?
Transthoracic echocardiogram has been done to exclude valvular heart disease (if present - indication for DOAC)
What counts as 2 points on CHADVASc
> 75 and Prev Stroke/TIA/ThromboEmbolism
Criteria of ORBIT?
O - Older Age >75
R - Renal Failure ( eGFR <60)
B - Bleeding hx
I - Iron - LOW
T- Taking antiplatelet medication
Features of Left Ventricular FREE wall Rupture
1 - 2 weeks after MI
Beck’s triad
Features of Left Ventricular Aneurysm
Due to ischaemic damage
Persistent ST elevation NO chest pain
Management of a LV Free wall rupture
Pericardiocentesis and Thoracetomy
Most common cause of death following an MI?
Ventricular fibrillation
Features of Ventricular septal defect post MI
Acute heart failure and Pan-systolic murmur
Management of LV Aneurysm
Anticoagulation
Contraindications of Statins (2)
Pregnancy
Macrolide Antibiotics - erythromycin etc
Dosage of statin
20 mg Primary Prevention
80 mg Secondary Prevention (if non HDL has not fallen by >40% or known CVD)
What should you do if patient experiences dry cough on ACE inhibitor?
SWITCH to ARB or lower down BP pathway
ACEI side effects
DRY cough, Hyperkalaemia, Angioedema, Hypotension
Amlodipine SE
Flushing, Headache, oedema
What is Mackler Triad for Boerhave Syndrome
What is dx
what is tx
Vomiting, thoracic pain, subcutaneous emphysema (can be described as mild crepitus)
Dx is CT contrast swallow
tx is a thoractomy
AF and strokes and DOACs
When should patients with AF + TIA stroke START DOAC
When should patients with AF + Acute ischaemic (complete) stroke start DOAC
TIA - start DOAC immediately (once Haemorrhage excluded)
For acute/complete stroke - 2 WEEKS AFTER (give antiplatelet therapy meanwhile - clopidogrel)
Who may have a silent MI
Diabetic AND elderly
How to treat a PE?
2) How to treat a MASSIVE PE (HYPOTENSIVE)
1) DOAC
2) Thrombolyse
Torsade De Pointes causes
T - Thiazides
O - Olanzapine
O - Opioids
Q - Quinolones (Fluoroquinolones antibiotics)
R - Risperidone (Typical and atypical antipsychotics)
S - Sotalol (Class III antiarrhythmic)
A - Azithromycin
D - Donepezil
E - Erythromycin (Macrolide antibiotics)
S - SSRI antidepressants
Treatment of Rheumatic Fever
IM benzypenicillin/Oral penicillin V
Treatment of Broad Complex Tachycardia caused by VT
Treatement of Unstable broad complex tachy
Amiodarone IV
Or lidocaine second line
If unstable: synchronised DC
What is a BROAD complex Tachycardia
What are main causes (2)
QRS - >0.2s/3 small squares
Cause 1 - is a Ventricular Tachycardia
Cause 2 - Torsade de pointed (tx is IV magnesium)
What is contraindicated in VT?
Verapamil
Why may acute mitral regurgitation occur post -MI
may be due to ischaemia or rupture of the papillary muscle
what are the causes of long QT?
Normal is <430 ms in males and 450 ms in females.
Mechanism?
Long QT signs on ECG
HYPO - calcium, magnesium, potassium, hypothermia
Tramadol, Metoclopramide
Malnutrition
Mechanism is the blocking of the K+ CHANNELS
ECG: MORE than two large squares - LONG QT
What is the management of Long QT
Avoid causes
BB - except solatolol
implantable defib
Management for HFrEF
The four drugs used in HFrEF - ACE-inhibitors, beta-blockers, MRA (spironolactone) and SGLT2 inhibitors (e.g. Dapagliflozin).
Treatment for Bradycardia
Intravenous atropine (first line)
Inotropes (e.g., isoprenaline or adrenaline)
Temporary cardiac pacing - transcutaneous, transvenous
Permanent implantable pacemaker, when available
When should tests be done after starting a statin
3 months - lipid profile, LFTS
When should you stop a statin?
If serum AST is >3x the upper limit
When do you measure CK after starting a statin
When indicated - ex muscle pain
Features of Acute Mitral Regurgitation (post MI)
Hypotension
Pan-systolic murmur
Flash Pulmonary oedema - frothy sputum,
