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CV Flashcards

1
Q

Explain what the different parts of an ECG represent

A

P wave - atrial depolarisation
QRS complex - ventricular depolarisation
T wave - ventricular repolarisation

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2
Q

How long does each part of the ECG last?

A

P-R interval - 0.12-0.2s

QRS -

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3
Q

Quick way of calculating heart rate from ECG

A

300 divided by number of big squares between each QRS

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4
Q

In what condition would you see absent P waves?

A

Atrial fibrillation

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5
Q

What is classed as tachyarrhythmia? and how are they further classified?

A

Heart rate >100bpm
Narrow or broad (QRS120ms)
Supraventricular or ventricular

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6
Q

4 symptoms of atrial fibrillation

A

Breathlessness, chest pain, palpitations, fatigue

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7
Q

Main risk of atrial fibrillation

A

Embolic stroke

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8
Q

Who is most at risk for AF

A

Elderly

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9
Q

What will an ECG in AF look like

A

Absent P waves, irregular QRS

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10
Q

Some causes for AF

A

Heart failure, ischaemic heart disease, hypertension, caffeine, MI, PE, pneumonia

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11
Q

Treatment for acute AF (

A

Cardioversion, drug cardioversion (IV amiodarone)

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12
Q

What score is used to measure the risk of stroke in patients with AF?

A 
CHADS-VASc
(CHA2DS2VASc)
Congestive heart failure
Hypertension
Age >75 (2)
Diabetes
Stroke or TIA in past (2)
Vascular disease
Age 65-74
Sex
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13
Q

2 main goals in AF?

A

Rate control and anticoagulation

B-blocker/CCB first line, add digoxin, then amiodarone

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14
Q

What is atrial flutter

A

Activity 300bpm, sawtooth appearance on ECG - macro reentry around right atrium

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15
Q

What is cor pulmonale?

A

Right sided heart failure secondary to lung disease - pulmonary hypertension, COPD, fibrosis, asthma, sickle cell, PE

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16
Q

Signs and symptoms of cor pulmonale

A

Dyspnoea, fatigue, syncope, cyanosis, tachycardia

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17
Q

When does ischaemic heart disease occur?

A

Increased demand of blood supply or blood supply itself is impaired

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18
Q

4 symptoms of acute MI

A

Crushing band like chest pain may radiate to jaw/back/arm, nausea, vomiting, sweating

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19
Q

Treatment of an acute MI

A 
Morphine
Oxygen
Nitrates
Anticoagulants
Beta blockers if no contraindication
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20
Q

5 differences between STEMI and NSTEMI

A

STEMI - full thickness damage, ST elevation, pathological Q waves, more elevated markers (troponin, CK-MB), PCI to treat, Thrombolysis.
NSTEMI - partial thickness damage, markers only mildly elevated, ST depression, no Q waves, T wave inversion, PCI/CABG, thrombolysis can be harmful

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21
Q

What should patients be prescribed on discharge?

A

ACEI, BB/CCB, statin

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22
Q

Complications of MI

A 
(C PEAR DRoP)
Cardiac arrhythmia/cardiogenic shock
Pericarditis
Emboli
Aneurysm
Rupture of ventricle
Dresslers syndrome
Rupture of free wall
o
Papillary muscle rupture
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23
Q

When does angina occur?

A

Imbalance between oxygen supply and demand

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24
Q

8 risk factors for angina

A

Hypertension, obesity, smoking, diabetes, physical inactivity, family history, stress, age

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25
3 exacerbating factors
Excitement, cold weather, exertion, heavy meal
26
4 components of Tetralogy of Fallot
Pulmonary stenosis, ventricular septal defect, over riding aorta, right ventricle hypertrophy
27
Treatment of angina
GTN as required, aspirin, beta blockers - contraindicated in asthma and COPD, CABG/PTCA
28
Findings on a CXR of heart failure
``` Alveolar oedema Kerly B lines Cardiomegaly Dilated prominent upper lobe vessels pleural Effusion ```
29
Which classification systems are used for heart failure?
New York - symptoms (1-asymptomatic, 2-dyspnoea on activity, 3-dyspnoea on less than normal activity, 4-dyspnoea present at rest) or Framingham for congestive cardiac failure diagnosis
30
5 symptoms of left sided heart failure
Dyspnoea, orthopnoea, fatigue, low exercise tolerance, nocturnal cough, wheeze, +/- pink frothy sputum, weight loss, muscle wasting
31
5 symptoms of right sided heart failure
Peripheral oedema, nausea, anorexia, facial engorgement, epistaxis
32
What is the key investigation in heart failure?
Echocardiography. Do if either ECG or BNP (b type natriuretic protein) abnormal. Can show dilated cardiomyopathy, systolic/diastolic dysfunction
33
Treatment for chronic heart failure
Diuretics (furosemide) ACEI - ramipril (if cough is a problem ARB - losartan) Beta blockers, spiranolactone, digoxin
34
3 causes of aortic stenosis
Calcification, congenital bicuspid valve, rheumatic heart disease
35
3 symptoms of aortic stenosis
Dyspnoea, syncope, angina
36
Describe the murmur heard in aortic stenosis
Crescendo decrescendo ejection systolic murmur radiating to the carotid arteries
37
Possible complications of aortic stenosis
Arrhythmias, sudden death infective endocarditis
38
2 features of the pulse in aortic stenosis
Narrow pulse pressure, slow rising pulse
39
6 causes of aortic regurgitation
Acute - cusp rupture, connective tissue disorders (marfans), aortic dissection Chronic - Rheumatoid arthritis, ankylosing spondylitis, syphilis
40
3 symptoms of aortic regurgitation
Dyspnoea, angina, heart failure
41
2 features of the pulse in aortic regurgitation
Waterhammer pulse, wide pulse pressure
42
3 complications of aortic regurgitation
Arrhythmias, heart failure, infective endocarditis
43
3 signs of aortic regurgitation
De Musset's sign - head bobbing Traube's sign - pistol sound heard over femoral artery Quincke's sign - pulse felt in nail
44
Describe the murmur heard in aortic regurgitation
Decrescendo early diastolic murmur
45
How is aortic regurgitation treated?
Underlying conditions treated, heart failure treated, valve replacement is treatment of choice
46
Which imaging technique is used to confirm a diagnosis of valve disease?
ECHO
47
5 causes of mitral stenosis
Calcification, rheumatic heart disease, rheumatoid arthritis, ankylosing spondylitis, SLE
48
4 symptoms of mitral stenosis
Dyspnoea, palpitations if in AF, heart failure, haemoptysis
49
Describe the murmur heard in mitral stenosis
Mid diastolic murmur with opening snap
50
4 signs of mitral stenosis
Malar flush, irregularly irregular pulse if in AF, Ortner's syndrome - hoarse voice, tapping apex beat
51
3 complications of mitral stenosis
Atrial fibrillation, heart failure, infective endocarditis
52
Treatment of mitral stenosis
Manage AF and heart failure, valve replacement
53
4 causes of mitral regurgitation
Rheumatic heart disease, papillary muscle rupture, infective endocarditis, prolapse
54
4 symptoms of mitral regurgitation
Palpitations if in AF, symptoms of infective endocarditis, heart failure
55
2 signs of mitral regurgitation
Irregularly irregular pulse if in AF, displaced apex beat
56
Describe the murmur heard in mitral regurgitation
Harsh pansystolic murmur radiating to the axilla
57
4 complications of mitral regurgitation
Infective endocarditis, atrial fibrillation, heart failure, pulmonary hypertension
58
Treatment of mitral regurgitation
Treat heart failure and atrial fibrillation, valve repair is preferred because valve replacement might damage papillary muscles
59
What are the two layers of the peridcardium?
Outer fibrous and inner serous
60
6 causes of acute pericarditis?
Viral (cocsackie A+B, herpes simples, influenza), post MI, uraemia, bacterial, tuberculosis, fungal
61
2 causes of chronic pericarditis
Connective tissue disease, rheumatoid arthritis
62
How does pericarditis present?
Sharp central chest pain, exacerbated by movement, respirating and lying down. Relieved by sitting forward. Fever and dyspnoea.
63
What would be seen on an ECG in a patient with pericarditis?
Saddle shaped ST elevation
64
How is pericarditis treated?
Cause treated if known, oral NSAIDs, aspirin, colchicine

Phase 2A (9 decks)

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