Cardiology III Flashcards
What is the treatment for antiphospholipid syndrome in pregnancy? [2]
aspirin + LMWH
Describe the pathophysiology, triggers and diagnosis of Brugada syndrome [3]
Automsomal dominant Na channelopathy associated with arrythmias such as VF or VT
- Triggers typically are heavy alcohol use, fever, heavy meal, dehydration, certain medications
- Diagnosis is via ECG
What is the first and second line treatment for Brugada syndrome? [2]
- Lifestyle (avoid XS alcohol, fever treated with paracetamol, hydration)
- Definitive management: ICD. Can use Quinidine if needed on top
A patient presents with nausea and vomiting, blurred vision/discolouration of vision, fatigue and syncope.
They tell you they are on a medication for their heart but can’t remember which one.
What is the most likely drug? [1]
Digoxin
- suffering from digoxin toxicity
Which electrolyte imbalances are a risk factor for digoxin toxicity? [3]
hypokalaemia, hypomagnesaemia or hypercalcaemia.
State the three steps to manage digoxin toxicity [3]
The management of digoxin toxicity depends on the severity of symptoms, ECG features and the serum digoxin levels.
Stop digoxin
Correct dyselectrolytaemia
Administer digifab (digoxin specific antibody indicated in lifethreatening digoxin toxicity).
What is the most appropriate management strategy for patients with rheumatic fever? [1]
Secondary prophylaxis with long-term penicillin is the most appropriate management strategy for patients with rheumatic fever. It helps prevent recurrent group A streptococcal infections, which can lead to further episodes of rheumatic fever and potential complications, such as rheumatic heart disease.
A patient presents to the hospital after an MI with acute SOB with a new systolic murmur loudest at the apex radiating to the axilla.
What is the most likely cause? [1]
Flash pulmonary oedema can occur after acute mitral valve regurgitation due to myocardial infarction
A patient presents with features that suggest an MI, such as crushing chest pain, sweating and a feeling of dread. After an hour this has resolved. She has a background of ischaemic heart disease.
You perform an ECG and see deeply inverted T-waves in leads V2-V3 (which may extend to V1-V6) with no or minimal ST-elevation and preserved R wave progression.
What is the most likely diagnosis? [1]
Describe the pathophysiology [1]
Wellens syndrome:
Critical stenosis of the left anterior descending artery and is a medical emergency, requiring urgent PCI as per ACS protocol
A patient is diagnosed with HOCM.
What medication should be avoided in this patient?
Amiodarone
Atenolol
Disopyramide
Ramipril
Verapamil
A patient is diagnosed with HOCM.
What medication should be avoided in this patient?
Amiodarone
Atenolol
Disopyramide
Ramipril
Verapamil
Angiotensin-converting enzyme (ACE) inhibitors are contraindicated in hypertrophic obstructive cardiomyopathy (HOCM) with left ventricular outflow tract (LVOT) obstruction. ACE inhibitors can reduce afterload which may worsen the LVOT gradient
What is the pneumonic for signs of HOCM on ECHO? [3]
MR SAM ASH
- mitral regurgitation (MR)
- systolic anterior motion (SAM) of the anterior mitral valve leaflet
- asymmetric hypertrophy (ASH)
A patient presents with fever, neuro signs, thrombocytopenia, haemolytic anaemia and renal failure. What is the most likely diagnosis? [1]
TTP
Think FATRN - fever, anaemia, thrombocytopenia, renal failure, neuro features
What are the risk factors for IE?
- Intravenous drug use
- Structural heart pathology
- Chronic kidney disease (particularly on dialysis)
- Immunocompromised (e.g., cancer, HIV or immunosuppressive medications)
- History of infective endocarditis
Describe the symptoms of IE [7]
- Fever (90%)
- Malaise, lethargy
- Anorexia
- Weight loss
- Abdominal pain: splenic abscess
- Haematuria: renal embolic phenomenon
- Cardiac symptoms: shortness of breath, chest pain, palpitations
Name and describe this sign of IE [1]
Is it more likely in acute or subacute?
Roth spots: exudative, oedematous hemorrhagic lesions of the retina with pale centre (immune complex deposition)
Subacute > acute.
Name this sign of IE [1]
Conjunctival petechiae in infective endocarditis
Which neurological emboli can IE cause? [4]
cerebral abscess
intracerebral haemorrhage
embolic stroke
seizures
Describe the investigations used to investigate IE
Blood cultures BEFORE Abx:
- Three blood culture samples are recommended, usually separated by at least 6 hours and taken from different sites.
Transoesophageal echocardiography (TOE)
- Vegetations (an abnormal mass or collection) may be seen on the valves
Special imaging investigations may be used in patients with prosthetic heart valves:
- 18F-FDG PET/CT
- SPECT-CT
What is the name for the criteria used for IE? [1]
Describe how a diagnosis is made from Dukes criteria [1]
Modified Duke criteria
A diagnosis requires either:
* One major plus three minor criteria
* Five minor criteria
What are the major criteria in Dukes classification of IE? [2]
What are the minor criteria in Dukes classification of IE? [5]
Major criteria:
* Persistently positive blood cultures (typical bacteria on multiple cultures)
* Specific imaging findings (e.g., a vegetation seen on the echocardiogram)
Minor criteria are:
* Predisposition (e.g., IV drug use or heart valve pathology)
* Fever above 38°C
* Vascular phenomena (e.g., splenic infarction, intracranial haemorrhage and Janeway lesions)
* Immunological phenomena (e.g., Osler’s nodes, Roth spots and glomerulonephritis)
* Microbiological phenomena (e.g., positive cultures not qualifying as a major criterion)
Which Abx are the mainstay treatment for IE? [1]
Intravenous broad-spectrum antibiotics (e.g., amoxicillin and optional gentamicin) are the mainstay of treatment
The choice of antibiotic may be more specific once the causative organism is identified on cultures.
Describe the treatment regime for Staphylococcus aureus IE:
Methicillin-sensitive staphylococcus aureus (MSSA)? [1]
Methicillin-resistance staphylococcus aureus (MRSA)? or penicillin allergy? [1]
Methicillin-sensitive staphylococcus aureus (MSSA):
* flucloxacillin 12 g/day in 4-6 doses. Duration 4-6 weeks.
Methicillin-resistance staphylococcus aureus (MRSA) or penicillin allergy:
* vancomycin 30-60 mg/kg/day in 2-3 doses. Duration 4-6 weeks.
How do you alter Staph. aureus treatment of IE if a patient has a prosethetic valve? [3]
NOTE: in the presence of a prosthetic valve, rifampicin and gentamicin should be added to both regimens and the duration should be ≥6 weeks.
Describe the treatment regimes for IE, typically used for oral Streptococci and Streptococcus bovis:
Standard four-week regimen [1]
Standard two-week regimen [1]
Penicillin allergic [1]
The regimen depends on how resistant the organism is to penicillin. If no resistance, the usual antibiotics may include:
- Standard four-week regimen: penicillin G, OR amoxicillin, OR ceftriaxone
- Standard two-week regimen: penicillin G, OR amoxicillin, OR ceftriaxone combined with gentamicin.
- Penicillin allergic: vancomycin for four weeks
