Cardiology pathology Flashcards
What is the most significant risk factor for aortic disseaction?
Hypertension especially if uncontrolled
What is the pathophysiology of aortic dissection?
Weakening of the aortic wall leads to tearing of the tunica intima of the aorta which then forms a sub haematoma.
Describe the pain classically experienced in aortic dissection?
Tearing sharp pain radiating to between the scapula.
How is dressler’s syndrome managed?
With NSAIDs
When does Dressler’s syndrome typically present?
2-6 weeks post MI
What is thought to be the pathology of Dressler’s syndrome?
An autoimmune response to antigenic proteins which are formed as the myocardium recovers from the MI
List 10 complications which can occur from a myocardial infarction?
Cardiac arrest Bradyarrhythmias Tachyarrhythmias Dressler' Syndrome / Pericarditis LV Aneurysm Cardiogenic shock Left ventricular wall rupture VSD Acute mitral regurgitation Chronic heart failure
Which complication post MI is the most common cause of death?
Ventricular tachycardia / V fib - cardiac arrest
What classification system is used to grade heart failure?
New York Heart Association (NYHA system)
Where is the most common site for aortic dissection?
Proximal aorta
Distal aorta only occurs 1/3rd of the time
In an aortic dissection can there be ST elevation?
Yes signs of an inferior MI will possibly be seen on ECG
What ECG changes will be seen in hypothermia?
Bradycardia Long QT interval J waves Arrhythmias 1st Degree heart block
Ischaemic changes with ST elevation in leads II III and aVF means which vessel is affected?
Right coronary
Inferior MI
Ischaemic changes in leads I aVL V5 V6 means which vessel has been affected?
Left circumflex
In patients who have had successful catheter ablation for AF, what is then the appropriate management for their warfarin? (Stop / continue / change)
Continue lifelong
According to their CHADSVASC score this is the most appropriate option
Catheter ablation does not reduce the stroke risk, it only controls the rate
What are some complications which may occur from catheter ablation?
Cardiac tamponade
Stroke
Pulmonary valve stenosis
In patients with hypercalcaemia (especially seen secondary to malignancy) what ECG changes would you anticipate?
Shortening of the QT interval
What antihypertensive medication may cause erectile dysfunction?
Beta blockers
What medication should beta blockers not be co-prescribed with and why?
Verapamil
Can lead to bradycardia, heart block and CCF
In all patients with suspected congestive cardiac failure, what is the first line investigation?
BNP
What medications are contraindicated in aortic stenosis>
Nitrates
What group of antibiotics can cause torsade des pointes syndrome? (Give an example)
Macrolides
Clarithromycin
What electrolyte imbalances can cause a prolonged QT?
Hypocalcemia
Hypokalaemia
Hypomagnesaemia
List some medications which can cause a prolonged QT interval?
TCAs Citalopram Sotalol Class Type 1a antiarrhythmic Methadone Ondansetron chloroquine terfenadine** erythromycin haloperidol Tramadol Metoclopramide
How long before surgery should warfarin therapy be stopped?
5 days
What is the 1st line investigation for PE?
CTPA
When would a CTPA not be appropriate as a 1st line investigation for PE?
in renal impairment or allergy to contrast
What is the most common ECG finding seen in a PE?
Sinus tachycardia
While textbooks always quote S1 Q3 T3 it is rarely seen
What medication is given to manage torsade des pointes?
IV magnesium sulfate
How is symptomatic bradycardia managed?
IV atropine
Following an ECG and bloods in palpitations, what would be the next most appropriate investigation?
Holter monitor
Polycystic kidneys is associated with what type of valve dsease?
Mitral valve prolapse
Tall R waves seen on V1 V2 ECG are usually pathognomonic of what?
Posterior MI
What is the cause of death most times in patients with HOCM?
Ventricular arrhythmias
What antihypertensives are the most likely cause of angioedema>
ACE inhibitors
A patient with Acute coronary syndrome is managed medically and opts not to have angioplasty. What are the rules for driving for this patient?
Cannot drive for 4 weeks
If he’d had angioplasty it would’ve been 1 week
