Cardiovascular Flashcards
Cause dementia, prescribed beta blocker and bradycardia
Beta-blocker overdose
Treat w glucagon
When is atropine required in bradycardia?
Adverse features
Risk factors for asystole
First line for brady management
Thyroid function, electrolytes, observe
Brady treatment after maximum atropine?
Isoprenaline 5mg/m, transuctaneous pacing, adrenaline 2-10mg/m
ECG finding of A wave in complete heart block
Cannon A-waves
Management of AF with heart failure
Digoxin
ALS Algorithm in SVT
Vagal Manoeuvres
IV Adenosine
Additional Adenosine Treatment
6mg
12mg
18mg
Atrial flutter treatment
2.5mg bisoprolol, PO
Beta blocker
Haemodynamically unstable BP?
Systolic <90mmHg
AF treatment without HF
Beta blocker
if contraindicated, Diltiazem
Contraindication for adenosine
Asthma
give verapamil instead
Imaging for aortic dissection
CT
Trans-oeso echo (TOE)
Stanford Type B management
(Desc aorta - Medical management)
Labetalol to control BP
Type A dissection features
Asc aorta
Located anteriorly
Thicker than desc aorta
Coronary artery dissection on ECG
ST elevation in inferior leads
Mos common cause of aortic regurg
Rheumatic HD
Best inv for aortic regurg
TTE
Symptomatic AR treatment w HF symptoms
Surgical valve replacement
Pulse pressure in AR?
Wide PP
Pulse in aortic stenosis
Slow-rising
Determining severity of aortic stenosis
Elevated pressure gradient >40mmHg across valve
Does aortic sclerosis radiate to carotids?
No
Surgery in symptomatic severe AS?
TAVI
AF treatment <48h onset
LMWH and DC cardioversion
What CHA2DS2-VASc score should AF patients have to be anticoagulated?
0
All AF patients should be anticoagulated
First line rate control for fast AF in haem stable
Cardioselective blocker - bisoprolol
Anticoag drugs in AF
Apibaxin
Dabigatran
Rivaroxaban
Asymptomatic AF with score 0 - which anticoag?
None
Treatment of fast AF with failed rhythm control
Digoxin, carvdilol, warfarin
Drugs causing TdP
Antibiotics
Antiarrhythmics
Rate of compressions in vent tachy
100-120 per min
30:2 breaths
First line for haemo stable vent tachy
Amiodarone
HF on auscultation
Bibasal crackles
Magnesium sulfate in vent tachy
TdP with no adverse features (If QRS is twisting around baseline)
Definitive management of Brugada
ICD
How long should a patient wait after angio to drive?
1 week
6 months if ICD is implanted
Chest pain <12h onset
Angio + PCI
Type of stroke risk after angio
Embolic
Haem unstable and failure to respond to med therapy… type of pacing?
Trans-cutaneous/venous pacing
Dual chamber pace rhythm
2 spikes
1 before P, 1 before QRS - means there’s 2 leads pacing the rhythm
Pacing for sinus arrest >3s
Permanent pacemaker
Amyloidosis
Amyloid protein depos in body tissues e.g. kidneys, heart
Leads to restrictive cardiomyopathy (sparkling on echo)
How does heart compensate during HF?
Elevated right atrial pressure
What vessels control blood flow through capillaries?
Arterio-venous anastomoses
Changes in arteries w sympathetic stimulation
Vasoconstriction
Incr systemic vasc resistance
Reduced distal blood flow
Dextrocardia
Heart points to RHS
Function of autoregulation
Maintaining constant blood flow in organs such as the kidney and brain
MAP=
COxTPR
e.g. 6.3 x 20 = 126
Isovolumetric Contraction
AV valves closed
Semilunar valves closed
Sudden decr in blood pressure causes increases in…
Vasoconstriction
HR
Force of myocardial contraction
Indication for IE valve surgery
HF symptoms (bilateral crackles, elev JVP, SOB)
If strep. bovis is found in IE what investigation must be performed?
Colonoscopy
Common acute murmur seen 2-10 days post-MI
Mitral regurgitation
Management of asympto mitral stenosis w no HF symptoms
6 month follow-up
Features of cornary artery vasospasm
Central chest pain on exertion
Strongly assoc w cocaine
GRACE score
Estimates in-hosp mortality and 6-month post-discharge mortality
What anti-coag should be given w dual anti-platelet in acute MI?
LMWH
Left bundle branch block on ECG
Broad QRS
Dominant S wave in V1
Notched R waves (M shaped QRS)
**Treat same as STEMI
What ECG do you need for a posterior infarct?
15-lead ECG
3 extra leads (V7, 8, 9
What clotting factors does warfarin act on?
1972
10, 9, 7, 2
Brown deposition in legs?
Haemosiderin deposition
Left renal artery origin?
L1
5 Features of HF on CXR
Alveolar oedema B lines Cardiomegaly Diversion of vessels Effusion
LV ejection fraction =
(stroke vol/end diastolic LV vol) x 100
What vessel is beside the inferior parathyroid gland?
Common carotid
Reduced ejection fraction in HF?
Less than 40%
Where is great saphenous vein?
Anterior to medial malleolus
JVP waveform features
Upward deflections
a wave = atrial contraction
c wave = ventricular contraction
v wave = atrial venous filling
Downward deflections
x wave = atrium relaxes and tricuspid valve moves down
y wave = ventricular filling
Jones Criteria for RF
Major - arthritis, pancarditis, Sydenham’s chorea, erythema marginatum, subcutaneous nodules
Minor - fever, athralgia, raised acute phase protein (ERS and CRP), prolonged PR interval
Diag of RF
Evidence of recent strep infection
PLUS
2 majors OR 1 major, 2 minor
Treatment of RF
Benzylpenicillin
LBBB vs RBBB pneumonic
V1 QRS looks like W and V6 QRS looks like M - WiLLaM
V1 looks like M and V6 looks normal (sometimes slurred S) - MaRRoW
Sick sinus on ECG
Sinus bradycardia
Sinoatrial block
Periods of sinus arrest
Abnormally long pauses after a premature beat
1st line inv after ECG for angina
CT coronary angio
Indicated for atypical/atypical angina pain
OR
ECG ischaemic changes in chest pain w <2 angina features
Angina treatment if BBs and Ca blockers are contraindicated
Long-acting nitrate e.g. Isosorbide Mononitrate
Ivabradine
Nicorandil
Ranolazine
Contraindication to CTCA
Renal impairment which risks contrast induced nephropathy
Instead use myocardial perfusion imaging
Tricuspid regurg on JVP waveform
Prominent V wave
WPW on ECG
Delta waves (slurred upstroke in the QRS)
Short PR interval (<120ms)
Broad QRS
If a re-entrant circuit has developed the ECG will show a narrow complex tachycardia
First line treatment for WPW
Catheter ablation of the accessory conduction pathway
Why do ACE inhibitors cause a dry cough?
Increased bradykinin
Side effects of thiazide diuretics
Hypokalaemic metabolic alkalosis, impaired glucose tolerance, impotence
First line for suspected STEMI secondary to pericarditis if NSAIDs are contraindicated
Colchicine or steroids
ECG changes characteristic of digoxin treatment
Down-slopping ST segments seen in leads V4-V6, I and aVL
(ST segment = hockey stick)
What type of cardioversion of haem unstable patient with AF?
Synchronised DC cardioversion under sedation
Recent viral illness and sudden onset chest pain with no ECG changes
Myocarditis
Indications for permanent pacing
Severe HF (unresponsive to meds)
Complete Av block
Mobits 2
Sympomatic bradycardia
Symptomatic sick sinus
Drug-resistant tacharrythmias
Most common type of VSD?
Type 2 - membranous
Most common cause of myocarditis
Coxsackievirus B
Initial management of SVT
Vagal manoeuvres e.g. blow into empty syringe
Murmur assoc with SLE
Mitral stenosis
What are the components of Tetralogy of Fallot?
VSD
Pulmonary stenosis
Right ventricular hypertrophy
Overriding aorta
Is R common carotid a direct branch of aorta?
No (only the left)
ID vessels of heart on CT from left right
SVC, asc aorta, pulm artery, pulm vein
Which leads would show ST elevation in anterolateral STEMI?
V1-V4
