Corrections Flashcards
1st line mx of acute pericarditis?
NSAIDs
Side effects of adenosine?
- chest pain
- bronchospasm
- transient flushing
- feeling of doom
Why should adenosine be avoided in asthmatics?
Due to possible bronchospasm
Most common bacterial cause of endocarditis:
a) normally
b) <2 months post valve surgery
a) Staph. aureus
b) Staph. epidermis
Conservative mx of NSTEMI:
a) high bleeding risk
b) not high bleeding risk
Aspirin plus:
a) clopidogrel
b) ticagrelor
The most common type of coarctation of the aorta seen in adults is the postductal variety, i.e. the aortic narrowing is distal to the ductus arteriosus.
How does this affect UL and LL BP?
Upper limb BP > lower limb BP as the narrowing occurs after the left subclavian artery branches from the aorta.
Can orthostatic hypotension be triggered by heavy meals?
Yes (postprandial hypotension)
Does a new early diastolic murmur indicate aortic dissection affecting the ascending or descending aorta?
Ascending –> aortic regurgitation
T wave inversion in which lead is a normal variant?
III
ECG features of hypokalaemia?
- small or absent T waves (occasionally inversion)
- prolong PR interval
- ST depression
- long QT
Mx of patients on warfarin with major bleeding (e.g. variceal haemorrhage, intracranial haemorrhage) no matter what the INR?
Stop warfarin
IV vitamin K 5mg
PCC
What is the definitive treatment of WPW?
radiofrequency ablation of the accessory pathway
Surgical options for aortic stenosis:
a) low/medium operative risk patients
b) high operative risk patients
a) surgical AVR
b) transcatheter AVR
If thrombolytic drugs are given during ALS, how long should CPR continue?
prolonged period of CPR (e.g. 60-90 mins) should be considered
A lateral MI is generally caused by a lesion in what artery?
Left circumflex artery
Mx of infective endocarditis causing congestive cardiac failure?
An indication for emergency valve replacement surgery
What is the main ECG abnormality seen with hypercalcaemia?
Shortening of the QT interval
Site of action of loop diuretics?
Ascending loop of Henle
Mx of patients on warfarin if their INR becomes <2?
They needs immediate anti-coagulation with rapid acting LMWH.
Warfarin dose should be increased.
Mx of angina in those with an inadequate response to verapamil (if beta blockers are contraindicated)?
Add a long acting nitrate e.g. isosorbide mononitrate
What is torsades de pointes?
A form of polymorphic VT that occurs due to prolonged QT interval.
Mx of VF/pulseless VT?
1) A single shock followed by 2 minutes of CPR
2) Amiodarone 300 mg should be given 3 shocks have been administered
3) A further dose of amiodarone 150 mg should be given after 5 shocks have been administered
If a cardiac arrest is witnessed in a monitored patient (e.g. in a coronary care unit), what is mx?
up to 3 quick successive (stacked) shocks, rather than 1 shock followed by CPR
Mx of non-shockable rhythms?
adrenaline 1 mg as soon as possible
How to measure QT interval on an ECG
Time between start of Q wave and end of T wave
How can mitral stenosis cause haemoptysis?
Due to increased pressures causing rupture of pulmonary vessels.
What murmur does an ASD vs VSD cause?
ASD - ejection systolic, louder on inspiration
VSD - pansystolic
Target BP for T2D?
<14/90
What is the main ECG abnormality seen with hypercalcaemia?
Shortening of the QT interval
1st line mx of acute pericarditis?
Ibuprofen + colchicine
When should ivabradine be considered in HF?
If the patient has sinus rhythm >75/min and a LV EF <35% and has not responded to triple therapy
When should amiodarone be delivered in VF/pulseless VT?
300mg after 3 shocks
further 150mg dose after 5 shocks
Mx of torsades de pointes?
IV magnesium
For a patient with hypertension who is already taking an ACEi, a history of gout would favour the addition of what?
CCB > thiazide diuretic
How can pulmonary HTN be heard?
Loud S2 (due to loud P2)
How is dextrocardia seen on an ECG?
1) inverted P wave in lead I
2) right axis deviation
3) loss of R wave progression
Signs of tricuspid regurgitation?
- pansystolic murmur
- prominent/giant V waves in JVP
- pulsatile hepatomegaly
- left parasternal heave
Causes of tricuspid regurg?
1) RV infarction
2) pulmonary HTN e.g. COPD
3) rheumatic heart disease
4) infective endocarditis (especially IVDU)
5) Ebstein’s anomaly
6) carcinoid syndrome
Infective endocarditis most commonly affects what valve?
Mitral
Infective endocarditis most commonly affects what valve in IVDU?
Tricuspid valve leading to regurg
What is the intensity of the murmur in AR increased by?
Handgrip manouevre
Most common cause of mitral stenosis?
Rheumatic fever
What causes malar flush in mitral stenosis?
It is due to the back pressure of blood into the pulmonary system, causing a rise in CO2 and vasodilation.
Describe murmur heard in MS
Mid-diastolic, low-pitched “rumbling” murmur (due to a low blood flow velocity).
There is an opening snap after S2, which triggers the onset of the murmur.
2 causes of mitral stenosis?
1) RHD
2) infective endocarditis
Key complications of MS?
1) AF
2) Pulmonary HTN
3) Thromboembolism
4) Infective endocarditis
How is infective endocarditis a complication of mitral stenosis?
Damaged mitral valve leaflets are more susceptible to infection.
Where does the murmur radiate to in mitral regurgitation?
L axilla
Long-term anticoagulation in biological valves?
Long-term anticoagulation not usually needed.
Warfarin may be given for the first 3 months depending on patient factors.
Low-dose aspirin is given long-term.
What is the most common causative organism of infective endocarditis in patients following prosthetic valve surgery?
Coagulase-negative Staphylococci such as Staphylococcus epidermidis.
Murmur in aortic stenosis vs aortic sclerosis?
Both valvular defects cause an ejection systolic murmur.
In aortic sclerosis there is no radiation of the murmur to the carotids.
How soon before surgery should warfarin be stopped?
5 days
How will LV systolic dysfunction affect an aortic stenosis murmur?
Will result in a decreased flow-rate across the aortic valve and hence a quieter murmur.
Target INR in mechanical valves:
a) aortic valve
b) mitral valve
a) 3.0
b) 3.5
Investigation of choice in a suspected PE with a Wells PE score of ≤4?
D-dimer
Investigation of choice in PE in renal impairment?
V/Q scan
Most common cause of endocarditis:
a) normally
b) <2m post valve surgery
a) Staph. aureus
b) Staph. epidermis
Moderate to severe aortic stenosis is a contraindication to which med?
ACEi
