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IK6 - Exams > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

tapping apex beat
loud S1
rumbling mid-diastolic murmur at apex, loudest in left lateral position on expiration

A

mitral stenosis

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2
Q

wide pulse pressure
displace, volume-overloaded apex beat
early diastolic murmur at lower left sternal edge (loudest on expiration, leaning forward)

A

aortic regurgitation

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3
Q

displaced, volume overloaded apex beat
soft S1
pansystolic murmur at apex radiation to axilla

A

mitral regurgitation

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4
Q

large systolic ‘v’ waves
pansystolic murmur lower left sternal edge (best heard on inspiration)

A

tricuspid regurgitation

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5
Q

narrow pulse pressure
heaving undisplaced apex beat
soft S2
EJS murmur in aortic area radiating to carotids + apex

A

aortic stenosis

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6
Q

harsh pansystolic murmur lower left sternal edge
left parasternal heave

A

ventricular septal defect

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7
Q

tall tented T waves, wide QRS

A

hyperkalaemia

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8
Q

hyperkalaemia

Ecg features

A

tall tented T waves, wide QR

Bradycardia

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9
Q

hypokalaemia

A

flattened T waves, prominent U waves

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10
Q

flattened T waves, prominent U waves

A

hypokalaemia

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11
Q

long QT interval, tetany, perioral paraesthesia, carpopedal spasm

A

hypocalcaemia

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12
Q

what is a normal PR interval?

A

120-200ms
3-5 small squares

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13
Q

what is a normal QRS?

A

< 3 small squares (0.12s)

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14
Q

What is Beck’s triad and what might it indicate?

A

pulsus paradoxus, JVP rise on inspiration, HS muffled

cardiac tamponade or constrictive pericarditis

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15
Q

What might these findings suggest?
pulsus paradoxus, JVP rise on inspiration, HS muffled

A

cardiac tamponade or constrictive pericarditis

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16
Q

What does a large ‘a’ wave and slow ‘y’ descent in JVP indicate?

A

JVP stenosis

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17
Q

what might cannon ‘a’ waves on JVP indicate?

A

complete heart block
VT
single chamber pacemaker

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18
Q

What does p mitrale suggest?

A

LV atrial hypertrophy
mitral stenosis

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19
Q

What counts as significant ST elevation?

A

more than 1 small square in consecutive limb leads

or more than 2 small squares in consecutive chest leads

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20
Q

What formula might you use to calculate heart rate from an ECG?

A

Number of R waves x 6 (10 second trace)

300 divided by the number of large squares between 2 R waves

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21
Q

what is normal PR interval?

A

0.12-0.2 seconds

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22
Q

What is prolonged PR interval in ECG squares?

A

larger than 5 small squares

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23
Q

What might cause a short PR interval?

A

pre-excitation syndromes such as WPW

or that the depolarisation is occurring to the AV node

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24
Q

What is a narrow and wide QRS?

A

a narrow QRS is one that is less than 0.12s (< 3 small squares)

a wide QRS is one > 0.12s (> 3 small squares)

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25
Q

what is significant myocardial ischaemia on an ECG?

A

ST depression more than 0.5mm in more than 2 continuous leads

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26
Q

what are the QTc intervals that are considered normal?

A

> 440ms in men
> 460 ms in women
> 500 ms is considered risky for torsades des pointes

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27
Q

What is the supply to the SA node?

A

right coronary artery

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28
Q

What might be a consequence of an MI or pathology affecting the right coronary artery?

A

arrhythmia as the right coronary supplies the SA node

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29
Q

How do you treat ACS?

A

oxygen
morphine (10mg) + metoclopromide (10mg)
aspirin (300mg) + clopidogrel (300mg)
GTN

if STEMI -> PCI if available in 2 hours, thrombolysis within 12hrs
if NSTEMI give fondaparinux and high risk go for PCI

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30
Q

What is the treatment for PE?

A

MONASH

morphine
oxygen
nitrates (GTN)
aspirin
heparin (LMWH)
warfarin

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31
Q

Why does warfarin have an initial pro-thrombotic effect?

A

initially it inhibits protein C & S which are usually anti-thrombotic. by inhibiting them overall it the patient enters a prothrombotic state

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32
Q

what are the effects of amyloidosis on the cardiovascular system?

A

restrictive cardiomyopathy
heart failure
arrhythmia
angina

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33
Q

what are the important causes of AF?

A

ischaemic heart disease
thyrotoxicosis
pneumonia
PE
alcohol
rheumatic heart disease

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34
Q

what are the reversible causes of cardiac arrest?

A

4 H’s = hypothermia, hypoxia, hypo or hyperkalaemia
4 Ts = toxins + metabolic, thromboembolic, tamponade, tension pneumothorax

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35
Q

what rhythms are shockable?

A

pulseless VT or VF

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36
Q

what are not shockable rhythms?

A

pulseless electrical activity
asystole

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37
Q

causes of a dilated cardiomyopathy?

A

idiopathic
post-viral myocarditis
alcoholism
pregnancy + post-partum
chronic HTN

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38
Q

causes of a hypertrophic cardiomyopathy?

A

mostly genetic mutations or storage disorders

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39
Q

causes of a restrictive cardiomyopathy?

A

sarcoidosis
amyloidosis
radiation induced fibrosis
haemochromatosis

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40
Q

common organisms causing infective endocarditis?

A

CASSSH

candida
aspergillus
strep viridans (most common)
staph aureus
staph epidermis
histoplasma

40% = streptococci, 35% = staphylococci, 20% = enterococci, rest HACEK organisms (rare)

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41
Q

what heart structures are most commonly affected by infective endocarditis?

A

usually aortic or mitral valve

EXCEPT in IVDU were right sided disease is more common

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42
Q

what are some signs of IE and what is their cause?

A

septic signs -> fever, tachycardia
new or changed heart murmur -> vegetations + damage to heart

vasculitis, microscopic haematuria, renal failure, glomerulonephritis, roth spots, splinter haemorrhages, osler’s node -> immune complex diposition

janeway lesions -> embolic

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43
Q

what are the cardiac causes of clubbing?

A

infective endocarditis
congenital cyanotic heart disease
atrial myxoma

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44
Q

are osler’s nodes or janeway lesions tender?

A

osler’s nodes are painful

Oh that hurts

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45
Q

what is the empirical therapy for IE on clinical suspicion?

A

benzylpenicillin and gentamicin

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46
Q

what is decubitus angina?

A

chest pain on lying down flat

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47
Q

what is prinzmetal angina?

A

due to coronary vasospasm.

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48
Q

what is coronary syndrome X?

A

angina symptoms with normal exercise ECG and angiogram

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49
Q

what are the ECG features of an MI?

A

hyperacute T waves
ST elevation
new-onset LBBB

late changes - T wave inversion, pathological Q waves

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50
Q

whats the most common cause of myocarditis in EU and USA?

A

viral
coxsackie B virus

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51
Q

what is the most common cause of myocarditis in S. America?

A

Chaga’s disease (protozoa infection)

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52
Q

what is the triad of pericarditis?

A

chest pain + pericardial friction rub + serial ECG changes

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53
Q

what are the ECG changes seen in pericarditis?

A

1 - widespread SADDLE SHAPED ST elevation, PR depression (acute)
2 - resolution of ST changes, T wave flattening (1-3 wks)
3 - flattened T waves become inverted (3+ wks)
4 - return to normal (several weeks later)

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54
Q

what is heard of auscultation in pericarditis?

A

pericardial friction rub

note these can be difficult to hear and may come and go

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55
Q

what is considered to be the threshold for pulmonary hypertension?

A

pulmonary artery pressure greater than 25mmHg when resting

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56
Q

what organism causes rheumatic fever?

A

it is a inflammatory disorder which occurs after an infection with group A beta-haemolytic streptococci

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57
Q

what are the major criteria for rheumatic fever diagnosis?

A

CASES

Carditis - endocarditis, pericarditis, new murmur
Arthritis - migrating, fleeting polyarthritis or large joints
Syndenham’s chorea
Erythema marginatum - crescent/ring-shaped red patches on trunk + proximal limbs
Subcutaneous nodules - extensor, joints, tendons

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58
Q

what blood test should be done if suspected rheumatic fever?

A

anti-streptolysin O titre (raised)

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59
Q

what CVD is pulsatile liver associated with?

A

tricuspid regurgitation

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60
Q

what wave is elevated in the JVP with tricuspid regurgitation?

A

V wave

caused by atrial filling at the same time as ventricular contraction. seen after S1

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61
Q

what does absent A waves indicate in the JVP?

A

atrial fibrillation

62
Q

what murmur does tricuspid regurgitation give?

A

pansystolic murmur heard at the lower left sternal edge on inspiration

63
Q

what are the triggers for vasovagal syncope?

A

emotional upset
fear
pain
orthostatic stress - heat, standing for a long time

64
Q

What are the risk factors for ischaemic heart disease?

A

smoking
diabetes mellitus
hypertension
hyperlipidaemia
previous episode of IHD
FHx of IHD

65
Q

Differentials for chest pain

A

cardiac: IHD/ACS, aortic dissection, pericarditis
resp: PE, pneumonia, pneumothorax

GI: oesophageal spasm, oesophagitis, gastritis

Musculoskeletal: costochondritis

66
Q

ECG pattern for left ventricular hypertrophy

A

deep S in V1/V2
tall R wave in V5/V6

largest S and largest R in chest leads > 45mm when added together

67
Q

ECG features of ischaemia

A

ST change (elevation or depression)
T wave inversion (MI)
pathological Q waves (old MI)

68
Q

Which leads on an ECG represent a lateral view of the heart?

A

I, aVL, V5, V6

69
Q

what coronary artery supplies the lateral territory of the heart?

A

circumflex artery

70
Q

what ECG leads present the anterior aspect of the heart?

A

V3, V4 and V2 to some extent

71
Q

what coronary artery supplies areas of the heart matching to V3, V4 and V2 (to an extent)?

A

right coronary artery

72
Q

what coronary artery supplies areas of the heart matching to I, aVL, V5 and V6?

A

circumflex artery

73
Q

what ECG leads represent the septal region of the heart?

A

V1 and V2

74
Q

What coronary artery supplies the septal region of the heart?

A

left anterior descending

75
Q

what coronary artery supplies the region corresponding to V1 and V2 on ECG?

A

left anterior descending

76
Q

what ECG leads correspond to the inferior aspect of the heart?

A

II, III and aVF

77
Q

what coronary artery supplies the inferior region of the heart?

A

right coronary artery

78
Q

what coronary artery supplies the area of the heart corresponding to II, III and AvF?

A

right coronary artery

79
Q

what does a long QT on ECG mean?

A

abnormal ventricular repolarisation which predisposes patients to ventricular tachycardias

80
Q

differentials for a raised JVP

A

right heart failure - secondary to LHF or pulmonary HTN

tricuspid regurgitation

constrictive pericarditis (infection, CTD, malignancy)

81
Q

what causes a systolic murmur?

A

aortic stenosis
mitral regurgitation
tricuspid regurgitation
ventricular septal defect

82
Q

Causes of sinus tachycardia

A

sepsis
hypovolaemia
thyrotoxicosis
phaeochromocytoma
anxiety
PE

83
Q

causes of atrial fibrillation

A

thyrotoxicosis
ischaemic damage to heart muscle
chest infection
alcohol

pathology affecting the heart or lungs

84
Q

causes of ventricular tachycardia

A 
ischaemia 
electrolyte abnormality (K+, Mg+) 
long QT
85
Q

Robert attends A&E with palpitations. His ECG shows an supra-ventricular tachycardia. His BP is 125/85 mmHg.

How would you manage this patient?

A

he is HAEMODYNAMICALLY STABLE

  1. Vagal manoeuvres (e.g. carotid sinus massage)
  2. Adenosine (IV) x 3
  3. if unable to return to sinus may DC cardiovert

adenosine is CI in asthmatics

86
Q

what are the 2 common types of supra-ventricular tachycardia?

A

AV nodal reentrant tachycardia [AVNRT]

atrioventricular reciprocating tachycardia [AVRT} - accessory pathway present

87
Q

Alex attends A&E with palpitations. His ECG shows an supra-ventricular tachycardia. His BP is 80/60mmHg.

How would you manage this patient?

A

he is haemodynamically unstable

the arrhythmia is compromising his CO.

DC cardioverstion

88
Q

Jo attends GP for a health check. The GP feels her pulse and finds it to be irregularly irregular. An ECG confirms AF.

How would you manage Jo?

A

as don’t know onset….

Rhythm control:
anti-coagulate for 3-4 weeks if suitable candidate for cardioversion. use NOAC or warfarin

Rate control: beta blocker, digoxin

prophylaxis: CHADs VASC vs HASBLED. anti-coagulate with NOAC or warfarin e.g. riveroxaban

investigate possible underlying causes and treat

89
Q

Lucy attends A&E with palpitations. Her ECG shows a ventricular tachycardia. She has a palpable radial pulse. her BP is 120/80mmHg

A

as she is haemodynamically stable do not shock immediately

  1. IV amiodarone

if pulseless VT -> start ALS and cardioversion as soon as possible

90
Q

what is S3 associated with?

A

rapid ventricular filling

91
Q

what is S4 associated with?

A

ventricular hypertrophy and the atria trying to contract against the stiff ventricle

92
Q

Max is a 65yr old man who attends A&E with an acute deterioration of his heart failure.

How do you manage him in A&E?

A
  1. sit him up
  2. oxygen if saturations are low
  3. GTN infusion (venodilates reducing preload)
  4. diaMorphine (venodilates)
  5. Furosemide IV - diuretic and venodilates

treat any underlying cause e.g. infection

93
Q

What are ECG features of pericarditis?

A

saddle-shaped ST elevation across all leads or most of them (not belonging to a specific heart territory)

94
Q

Long term management of heart failure

A
  1. ACEi -> prevent cardiac remodelling
  2. beta-blocker - reduce work
  3. spironolactone - prevents chronic RAAS activity
  4. diuretic (furosemide)
  5. digoxin

ABDDS

95
Q

What is CHADSVASC score ?

A

Assessment of stroke risk in AF, > 1 in men and > 2 in female warrants consideration for anti coagulation

C - congestive heart failure 1
H - HTN 1
A2 - age > 75 2
D - DM 1
S2 - previous stroke of TIA 2
V - known vascular disease 1
A - age 65-74 1
Sc - female 1

96
Q

What are the anticoagulant options for AF?

A
  • DOAC e.g. Apixiban, dabigatran, riveroxaban
  • warfarin
  • LMWH e.g SC enoxaparin, rare only if not tolerating oral
97
Q

Describe the HASBLED score

A

Risk of significant bleed.

H - HTN 1
A - abnormal liver or renal function 1
S - previous stroke 1
B - previous major bleed 1
L - labile INR 1
E - elderly 65 + 1
D - drugs and ETOH 1 if single, 2 if both

98
Q

What criteria is in the ORBIT score ?

A

Assessment of bleeding risk

Sex
Hb - < 13 in M, < 12 in F, 2 points
Age - 74+, 1
Bleeding history, 2
Renal function eGFR < 60, 1
Concomitant anti platelet, 1

99
Q

general MI complications

A

FAM

  • Failure - heart failure
  • Arrhythmias
  • Murmurs
100
Q

what features indicated aortic sclerosis?

A

ejection systolic murmur

Aortic sclerosis - no radiation, normal pulse, normally elderly

101
Q

raised JVP causes

A
  • Right sided heart failure
  • Fluid overload
  • Pericardial effusion or cardiac tamponade
  • Tricuspid regurgitation
  • Superior vena cava obstruction
    • Non-pulsatile
  • Complete heart block
102
Q

complications of prosthetic valves

A
  • Complications - FIBAT
    • Failure
    • Infection - infective endocarditis
    • Bleeding - from warfarin or from operation
    • Anaemia - haemolysis (macroangiopathic) or bleeding
    • Thromboembolic → PE, stroke
103
Q

complications of mitral stenosis

A

AF

pulmonary HTN (loud P2, L parasternal heave, Graham steel murmur)

104
Q

causes of an irregular pulse (on palpation)

A

AF

ventricular ectopics

SVT with variable block

105
Q

weak pulse on 1 side differentials

A
  • coarctation
  • Takayasu’s
  • iatrogenic - stenosis after angiogram or repeated COPD ABGs
106
Q

collapsing pulse differentials

A
  • AR (severe)
  • hyperdynamic circulation
    • AV fistula/PDA
    • Pregnancy
    • Anaemia
    • Fever
    • Thyrotoxicosis
    • Paget’s disease of the bone
      • AV malformations can form
      • Inferior collapsing pulse
107
Q

Causes of raised JVP

A
  • Fluid overload
  • Tricuspid regurgitation
  • Pulmonary HTN
  • Pericardial effusion
  • Pericarditis
108
Q

Causes of fixed raised JVP

A

superior vena cava obstruction

109
Q

cannon A waves

A

AF

110
Q

large V waves

A

severe tricuspid regurgitation

111
Q

cardiac conditions associated with the following syndromes

  • marfans
  • turner
  • noonan
  • williams
A
  • marfans - mitral valve prolapse, bicuspid aortic valve, aortic dilation
  • turner - coarctation of aorta, bicuspid aortic valve
  • noonan - pulmonary stenosis
  • williams - supravalvular aortic stenosis
112
Q

what are the severity signs for aortic stenosis?

A
  • outflow obstruction - slow rising pulse, low volume pulse, narrow PP
  • HS abnormal - soft S2, longer murmur, S4, reversed split S2
  • LVH
  • heart failure signs
113
Q

what are the Sx of AS and relation to severity?

A

in order of increasing severity

  • angina
  • syncope
  • dyspnoea

SOB - highest death rate in 5 years

114
Q

echo features of severe AS

A
  • aortic valve size < 1 cm^2
  • gradient > 50mmHg

NICE - for asymptomatic

  • Vmax (peak aortic jet velocity) > 5m/s on echocardiography
  • Aortic valve area < 0.6cm2 on echo
  • BMP/NT-proBNP > 2x upper limit of normal
  • Symptoms unmasked during exercise test
115
Q

what conduction abnormality can be associated with AS?

A

LBBB due to LVH

116
Q

causes of AS

A

age related degeneration (degenerative calcification)

bicuspid valve (present < 50 y.o)

rheumatic heart disease

117
Q

Heyde’s syndrome

A

AS associated

angiodyplasia in GI tract due to acquired vWF deficiency → high sheer stress vWF cleaved + removed by ADAMTS13 as passing through stenosed AS

friable capillaries develop in GI tract → IDA

Tx - AS replacement

118
Q

causes of a wide split S2

A
  • late closure of pulmonary valve
    • RBBB
    • pulmonary HTN
    • pulmonary stenosis
  • early aortic valve closure
    • mitral regurgitation
119
Q

causes of reversed split (S2 widens on expiration rather than narrows)

A
  • severe AS
  • LBBB
  • HOCM
120
Q

what are key echo features that are concerning?

LA, LV, septum, EF

A
  • LA diameter > 45mm - ↑ risk of AF/clot formation
  • LV diameter > 55m (diastole) = dilated
  • Ventricular septum > 13 mm = LVH
    • More sensitive and specific than ECG
  • Normal ejection fraction if > 55%
    • >65% is usually considered hyperdynamic
121
Q

what are the complications of valve replacement

A

FIBAT

  • Failure
  • Infection
  • Bleeding
  • Anaemia (haemolytic)
  • Thromboembolism
122
Q

core principle of AS

A

valve has smaller lumen → LV works harder → LVH to compensate → eventually maximal compensation has occurred + onset of heart failure

123
Q

key features of AR

A
  • Big pulse
  • Collapsing character of pulse (severe)
  • Wide pulse pressure
    • Hypertension SBP, low DBP, very wide PP
  • Obvious, thrusting/hyperdynamic apex
  • Early diastolic murmur
    • S1 + S2 + murmur (slurring of S2)
124
Q

core principles of AR

A
  • regurgitation of blood back → extra volume in LV during diastole → LV dilatates
  • the extra blood → volume loaded LV → higher SV → high volume pulse
  • dilation is the initial compensation to maintain SV/CO but eventually fails → HF
125
Q

severity signs for aortic regurgitation

A
  • wide PP
  • displaced apex
  • heart failure
  • shorter murmur
  • angina (coronary branches have reduced filling due to regurgitation)
126
Q

causes of AR

A
  • Non-functioning leaflets
    • Endocarditis
    • Bicuspid
  • Functioning valves, but do not meet in the centre → aortic root dilation
    • Aortitis (inflammation)
      • Syphilis - Argyll-Robinson pupil
    • Ank. Spondylitis (4%)
    • CTD - Marfan’s
127
Q

mitral stenosis signs

A
  • Rumbling mid-diastolic murmur
  • Mitral facies - peripheral vasodilatation due to ↑ pulmonary venous pressure
  • Atrial fibrillation
  • ↑ JVP
  • Pulmonary HTN
    • May be mildly hypoxic if severe
  • Tapping apex beat (palpable first heart sound)
    • Pathognomonic for MS
  • Loud S1 + P2
  • Opening snap
128
Q

severity signs of Mitral stenosis

A
  • Pulmonary HTN
  • LA enlargement and AF
  • Echo - Valve area < 1cm2
  • Symptoms of CCF
129
Q

core principles of Mitral stenosis

A

stenosised valves mean more blood stays in LA → dilates → contributes to LA and increases pulmonary vein pressure → high pressure transmitted through pul. vasculature → raised pulmonary artery pressure → R heart strain + RVH

130
Q

what is ortner’s syndrome?

A

LA dilation so severe it compresses recurrent laryngeal nerve → hoarse voice

e.g. mitral stenosis

131
Q

causes of mitral stenosis

A
  • rheumatic fever
  • mitral annular calcification
  • carcinoid syndrome
  • SLE (Libman-Sacks endocarditis)
132
Q

features of pulmonary HTN

A
  • Loud and palpable P2
  • Raised venous pressure - systolic V waves in JVP up
  • Parasternal heave
  • Pulmonary regurgitation murmur
    • Graham Steele - shorter than AR murmur and louder in inspiration
  • TR - murmur louder in inspiration (Carvallo’s sign)
133
Q

differentials for a mid-diastolic murmur

A
  • MS
  • Austin-Flint murmur (AR)
  • Tricuspid stenosis
  • Atrial septal defect
  • Myxoma
    • LA mass, fever, clubbing
134
Q

treatable causes of AF

A
  • Valvular heart disease e.g. MS
  • Thyroid disease
  • Electrolyte disturbance
  • Alcohol
  • Infection
  • Hypovolaemia
  • ASD
  • Sleep apnoea
  • Obesity
  • COPD
135
Q

syndrome associated with R sided heart valve stenosis

A

carcinoid syndrome

  • GI tract tumours which produce serotonin → venous system → first valves encountered are tricuspid and pulmonary
    • Once in lungs serotonin is metabolised and won’t really reach the L heart
    • Serotonin causes ↑ regulation of TGF-beta-1 and ECM components including collagen

treat with octreotide

if L stenosis then mets in lungs

136
Q

pathogens for IE and their considerations

A
  • Streptococcus viridans = most common
  • Staphylococcus aureus (rising incidence)
    • Associated with seeding from joint prosthesis or metal valves
  • HACEK group (culture negative)
    • Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella
  • Streptococcus bovis is associated with colorectal cancer
    • need colonoscopy
137
Q

investigations in IE

A
  • 2 x blood cultures 24 hours apart, no Abx unless septic or embolic features
  • TOE (gold standard)
    • TTE can be done first 50-60% sensitive
  • monitor renal function (GN)
  • if aortic valve affected → ECG every 2 days as abscess formation causes PR prolongation by affecting conductive septum
138
Q

features of tricuspid regurgitation

A
  • Big neck pulsations (CV waves)
  • Peripheral oedema
  • Pulsatile hepatomegaly
  • Pansystolic murmur
  • Pulmonary HTN (late complication)
139
Q

causes of tricuspid regurgitation

A
  • pulmonary hypertension
  • endocarditis (IVDU, dialysis patients)
  • Ebstein’s anomaly - apical displacement of TV (congenital)
  • Carcinoid syndrome
140
Q

what are the core principles of R sided valve pathology

A
  • diuretics - manage Sx, no other prognostic meds
  • surgery - final resort
141
Q

mitral regurgitation features

A
  • AF (large LA)
  • Dilated LV - therefore infero-lateral apical displacement
  • S3 due to rapid ventricular filling
  • Pan systolic murmur
142
Q

causes of mitral regurgitation

A
  • ACUTE
    • papillary muscle rupture in MI
    • non-ischaemic papillary muscle rupture (IE, RHD, trauma, spontaneous)
  • CHRONIC
    • age related degeneration
    • RHD
    • IE
    • SLE
    • CTD
    • HOCM
143
Q

what are the newer prognostic drugs in heart failure?

A
  • ivabradine
    • HCN channel blocker, sodium-potassium inward current that controls spontaneous diastolic SA node depolarisation so controls heart rate
  • entresto
    • neprolysin inhibitor + ARB together,
    • neprilysin is responsible for ANP and BNP degradation
144
Q

how to differentiate ICD vs pacemaker on x-ray

A

ICD has thick coil (1 or 2)

145
Q

what graft is associated with the best prognosis in CABG for LAD?

A

LIMA (left internal mammary artery)

146
Q

when timing JVP to pulse what is normal and not?

A

JVP should be in diastole

JVP during systole (with pulse) is abnormal, feature of TR

147
Q

stages of normal JVP wave

A

JVP

  • a - atrial contraction
  • C - closure of tricuspid
  • X descent - atrial dilation
  • V - filling of atrium
  • Y descent - ventricular relaxation
148
Q

cannon A wave

A

extra large A wave due to atrium contracting against closed tricuspid (A + V)

  • complete heart block
  • atrial flutter
  • single chamber pacing
  • nodal rhythm
  • ventricular ectopic
  • ventricular tachycardia
149
Q

Large A wave causes

A
  • tricuspid stenosis - atria contracts against stiff tricuspid and so pressure in atria rises higher than normal
  • pulmonary hypertension - there are generally higher pressures on the right side of the heart
  • pulmonary stenosis
150
Q

raised JVP with normal waveform causes

A
  • right heart failure
  • fluid overload
  • bradycardia
151
Q

what should JVP nromally do with respiration?

A

Normally the JVP should rise on expiration and fall on inspiration.

When the JVP rises on inspiration it indicates (paradoxical)

  • Pericardial effusion
  • constrictive pericarditis
  • pericardial tamponade
152
Q

differential for ST elevation

A
  • myocardial infarction
  • pericarditis/myocarditis
  • normal variant - ‘high take-off’
  • Takotsubo cardiomyopathy
  • Left ventricular aneurysm
  • Prinzmetal angina
  • Subarachnoid haemorrhage

IK6 - Exams (24 decks)

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