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
