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Year 3 Medicine > CVS > Flashcards

CVS Flashcards

1
Q

How would you calculate the heart rate from an ECG strip?

A

Each strip is 10 seconds long
Count the amount of QRS and then multiply by 6

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2
Q

What lead is normally the most positive? What would be the most positive in LBBB and RBBB respectively?

A

Lead II is normally the most positive
LBBB - Lead aVL
RBBB- Lead III

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3
Q

State the normal parameters for the PR interval, the QRS interval and the QT interval

A

PR - 120-200ms
QRS - <120ms
QT - 2 large squares

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4
Q

RBBB can be present without heart disease, however name three common causes of LBBB

A

Anterior MI
CHF
Left Ventricular Hypertrophy

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5
Q

Describe the diagnostic features of a STEMI

A

Cardiac Chest Pain
ECG changes (persistent ST elevation or new LBBB)
Raised Troponin I (greater than 100 nanograms)

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6
Q

What are the parameters for ECG changes in a STEMI?

A

ST elevation in atleast 2 leads
Elevation greater than 1mm in limb leads and 2mm in chest leads

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7
Q

Describe the ECG changes in an NSTEMI

A

ST segment depression
T wave inversion
Pathological Q waves

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8
Q

When might an STEMI be mistaken for an NSTEMI?

A

If you have ST segment depression in V1-V4, it may be the reciprocal changes of a posterior STEMI

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9
Q

Describe the pathophysiology of ACS

A

Plaque rupture
Thrombosis to varying degrees
Inflammation
Artery occlusion and reduced blood supply to myocardium

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10
Q

What layer of the heart do the coronary arteries lie in?

A

Epicardium

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11
Q

Describe 5 of the classical presentations of ACS

A

Central crushing chest pain lasting >20 mins
Nausea
Sweating
Breathlessness
Palpitations

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12
Q

Some ACS can be ‘Silent’, what groups of people can this occur in? How would they present?

A

Elderly and Diabetics
Syncope
Epigastric Pain

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13
Q

What is the S4 heart sound?

A

Blood striking against a non compliant ventricle

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14
Q

What happens to Troponin I in an MI

A

Begin to rise 3-4hrs post MI
Remain elevated for up to two weeks

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15
Q

When should Troponin I be sampled?

A

One sample on admission
If onset of the symptoms was less than 3 hours ago, take another sample one hour after the original

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16
Q

Give 4 false positives of Troponin I

A

Advanced renal failure
Large PE
Severe CCF
Aortic Dissection

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17
Q

Give 3 possible features of an MI on a CXR

A

Cardiomegaly
Pulmonary Oedema
Widened Mediastinum

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18
Q

In four steps describe the initial medical management of suspected ACS

A

1) Morphine and Antiemetic (Metacloperamide)
2) Oxygen (Sats>94% or <88% if CO
3) Nitrates (GTN Spray)
4) Asparin 300mg Loading Dose

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19
Q

What are the four requirements for Prasugrel in an MI?

A

Undergoing PCI
Less than 75 y/o
Weight >60kg
No prior TIA/Stroke

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20
Q

Describe the approach to an MI discharge (ABCD)

A

A - Asparin 75mg, Atorvastatin 80mg, ACEI
B- Bisoprolol
C- Cardiac Rehab, Cut out smoking
D- Diet and Alcohol, ?Dyspepsia (provide PPI with Asparin), DVLA advice (able to drive after one week, if a bus/lorry driver can’t for 6 weeks)

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21
Q

Describe the 4 step management of NSTEMI

A

Initial ACS management
GRACE score (6 month mortality) and Heart Score (6 week mortality)
Add Clopidogrel and UFH/Fondaparinux

PCI/CABG is definitive, time frame that this occurs is dependent on the level of risk derived from these scores

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22
Q

What is the Grace Score?

A

Used on ACS patients to estimate their 6 month mortality

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23
Q

Describe the complications of an MI

A

Pericarditis
Cardiac Tamponade
Cardiac Arrest

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24
Q

Name four STEMI mimics

A

Early repolarisation in young & fit
Pericarditis (saddle shaped)
Brugada Syndrome (Sodium Channelopathy)
Takotsubo Cardiomyopathy (temporary and brought on by stress - broken heart syndrome)

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25
Q

What is stable angina?

A

Chest discomfort provoked by effort/emotion and relieved by rest

Req 3 of:
1) Crushing chest pain
2) Brought on by exertion
3) Relieved by GTN

2/3 is atypical angina
1/3 is non anginal pain

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26
Q

Describe four potential symptoms of Stable Angina

A

Chest Pain
Throat tightness
Arm Heaviness
Exertional Breathlessness

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27
Q

What features would make Angina unlikely?

A

Continuous/Very prolonged pain
Unrelated to activity level
Associated with other symptoms such as dizziness/dysphagia

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28
Q

Describe two methods of functional imaging for stable angina

A

1) CT Angio
2) Stress Echo

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29
Q

Describe the main pharmacological management of Stable Angina

A

All patients receive Asparin (75mg), Atorvastatin, and GTN Spray

1) Beta Blockers or CCB (Verapamil or Diltiazem)
2) Beta Blockers and CCB (Amlodipine)
3) Long term nitrates (Isosorbide Mononitrate - alternate dosing) and referral for PCI

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30
Q

When would you prescribe Ivabradine?

A

As an alternative to a Beta Blocker, for example if the patient is Hypotensive

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31
Q

When would you prescribe Ranolazine in Stable Angina?

A

If intolerant to all the other drugs
Commenced by consultants
eGFR>30
(reduces sodium and hence calcium - relaxes muscle)

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32
Q

Other than Stable/Unstable, describe two other types of Angina

A

Decubitus Angina - precipitated by lying flat
Vasospastic Angina - spasm of coronary artery

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33
Q

How would you educate a patient in how to use GTN spray in Stable Angina?

A

Repeat dose after 5 minutes if required
If still persisting after 5 minutes of the second dose, call an ambulance
SE: Headache, Hypotension

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34
Q

Describe the classes of HTN in terms of clinic readings

A

Class 1 - 140/90
Class 2 - 160/100
Severe - 180/110

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35
Q

Describe the classes of HTN in terms of home readings

A

Class 1 - 135/85
Class 2 - 150/95

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36
Q

Give 4 broad causes of Secondary HTN

A

Renal (Renal Artery Stenosis, PCKD)
Pregnancy
Drugs (Steroids, COCP, Cocaine)
Endocrine (Cushings, Conns)

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37
Q

What is Malignant Hypertension?

A

Rapid rise in blood pressure to over 200/130, leading to vascular and organ damage
Can causes bilateral retinal haemorrhages, headache, visual disturbances

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38
Q

How does Hypertension present?

A

Generally asymptomatic
If sweating/palpitations - Phaeochromocytoma
If muscle tetany/weakness - Hyperaldosteronism

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39
Q

Describe 5 investigations (apart from BP) necessary for HTN

A

Full range of bloods (inc cholesterol)
Urinalysis (A:Cr, Protienuria, Haematuria)
ECG
Fundoscopy
Cardiac Echo

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40
Q

You should aim to reduce blood pressure slowly in Hypertensive patients. What is the BP goal in treated patients?

A

Normal <140/90
Diabetic <130/80

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41
Q

Describe the four step (up) management of Hypertension

A

1) Under 55 - ACEI/ARB
Over 55/AfroCaribbean - CCB
2) ACEI/ARB + CCB
3) ACEI/ARB + CCB + Thiazide - LIKE (Indampamide)
4) Measure K+
If K+>4.5 add Alpha/Beta Blocker
If K+<4.5 add Spironolactone

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42
Q

Describe the 3 classes of CCBs, an example of each and their actions

A

Dihydropyridine - acts on peripheral vasculature (eg Amlodipine, Nifedipine)

Phenylalkamine - acts on cardiac vasculature (eg Verapamil)

Benzothiazepine - acts on cardiac and peripheral vasculature (eg Diltiazem)

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43
Q

Describe the difference between a Hypertensive Emergency and a Hypertensive Urgency

A

Emergency - High BP with critical illness (AKI,MI, Encephalopathy)
Urgency - High BP without critical illness at the moment, often accompanied by retinal damage

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44
Q

Describe the management of a Hypertensive EMERGENCY

A

Reduce diastolic to 110mmHg in 3-12hrs
Use IV Sodium Nitroprusside/Labetolol/GTN/Esmolol (acts in 30s)

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45
Q

Describe the management of a Hypertensive URGENCY

A

Reduce diastolic to 100mmHg in 48-72hrs
Usually use Nifedipine AND Amlodipine for 3 days and then continue Amlodipine alone

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46
Q

Heart Failure is when cardiac output fails to meet the body’s requirements. Using the mnemonic HEART MAy DIE, give some causes.

A

Hypertension, Embolism, Anaemia, Rheumatic fever, Thyrotoxicosis, MI, Arrhythmia, Diet, Infection, Endocarditis

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47
Q

Describe the features of SYSTOLIC Heart Failure

A

Inability of the heart to contract, EF<40%
Caused by IHD/MI/Cardiomyopathies

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48
Q

Describe the features of DIASTOLIC Heart Failure

A

Inability of the heart to relax, EF>50% (HFpEF)
Caused by Ventricular Hypertrophy/Tamponade

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49
Q

Right Ventricular Failure is caused by LVF or Chronic Lung Disease, give 3 features

A

Peripheral Oedema
Ascites
Facial Engorgement

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50
Q

State 3 causes of ACUTE Heart Failure

A

Infections
Anaphylaxis
PE

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51
Q

Heart Failure can be Low Output or High Output, give some causes of High Output

A

IE High but not high enough
Pregnancy, Hyperthyroidism, Anaemia

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52
Q

Describe the use of BNP

A

BNP can be used to rule out Heart Failure if it is less than 100ng/l
Not diagnostic as BNP can be raised by anything that causes chamber stress (AF etc)

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53
Q

Using the A-E mnemonic describe the 5 features of a CXR of Heart Failure

A

A - Alveolar Oedema (Bat Wings)
B - Kerley B Lines (Interstitial Oedema)
C - Cardiomegaly
D - Dilated Veins
E - Effusions

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54
Q

Other than bloods and CXR, what is the gold standard for testing cardiac function?

A

Echocardiography

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55
Q

What is Cardiac MRI used for in the context of Heart Failure?

A

Better at imaging the RV
Good at assessing scar tissue

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56
Q

Give 5 features of Heart Failure

A

Cyanosis
Low BP
Narrow Pulse Pressure
Apex Displacement
RV Heave

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57
Q

Describe the New York Classification of Heart Failure

A

I - Heart Disease present but no limitations
II - Comfortable at rest but dyspnoea in normal activities
III - Less than ordinary activity causes dyspnoea
IV - Dyspnoea at rest

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58
Q

There are many medications that can be given for Heart Failure, but what device could patients have fitted?

A

Cardiac Resynchronisation Therapy
Adds pacing to septal and lateral walls will reduce QRS width
Considered if signs of LBBB
Can combine with Defib device

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59
Q

State four causes of Aortic STENOSIS

A

Senile Calcification
Congenital (Bicuspid Valves)
CKD
Rheumatic Fever

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60
Q

Describe the triad of Aortic STENOSIS

A

Angina
Heart Failure
Syncope

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61
Q

Give four features of the murmur heard in Aortic STENOSIS

A

Ejection Systolic
Aortic Area
Radiates to carotids
Crescendo Decrescendo

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62
Q

What instances would you consider a valve replacement in Aortic Stenosis

A

Symptomatic
Asymptomatic with abnormal LV function, abnormal exercise test, other cardiac surgeries

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63
Q

What valve procedure would you consider if elderly/comorbidities?

A

TAVI
Transcatheter Aortic Valve Insertion
via Femoral

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64
Q

Give two acute and two chronic causes of Aortic REGURGITATION

A

Acute - Chest Trauma, Infective Endocarditis
Chronic - Congenital, Rheumatic Fever

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65
Q

Describe three features of Aortic REGURGITATION

A

Exertional Dyspnoea
Orthopnea
PND

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66
Q

Other than the murmur, describe two signs of Aortic REGURGITATION

A

Corrigan’s Pulse - Collapsing pulse
De Musset’s Sign - Head bobbing with heartbeat

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67
Q

Describe two managements of Aortic REGURGITATION

A

Afterload reduction (ACEI/ARB)
Valve replacement

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68
Q

State three causes of Mitral STENOSIS

A

Rheumatic Fever
Congenital
Infective Endocarditis

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69
Q

Describe two ways in which Mitral STENOSIS can present

A

Pulmonary Hypertension (Dyspnoea, Haemoptysis, Malar Flush)
LA Compression (Hoarseness, Dysphagia)

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70
Q

Describe three features of the murmur of Aortic REGURGITATION

A

Early Diastolic
Left Sternal Edge
Best heard sat forward in expiration

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71
Q

Describe two features of the murmur of Mitral STENOSIS

A

Mid Diastolic murmur
Best heard on expiration with patient on left

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72
Q

Describe four possible managements of Mitral STENOSIS

A

AF - Rate control and anticoagulate
Diuretics
Balloon Valvuloplasty
Valve Replacement

73
Q

Describe four causes of Mitral REGURGITATION

A

Rheumatic Fever
Mitral Valve Prolapse (APCKD, Marfans)
IHD
Infective Endocarditis

74
Q

Give 5 features of Mitral REGURGITATION

A

Dyspnoea
Fatigue
Palpitations
Displaced Apex
AF

75
Q

State 3 features of the Mitral REGURGITATION murmur

A

Pan Systolic Murmur
Heard in Mitral Area
Radiates to Axilla

76
Q

What two features indicate Infective Endocarditis unless proven otherwise

A

Fever
New Murmur

77
Q

Give 4 risk factors of Infective Endocarditis

A

Mitral Valve Prolapse
Prosthetic Material (not stent)
Rheumatic Heart Disease
Poor Dental Hygiene + Procedure

78
Q

Describe four features of Infective Endocarditis

A

Sepsis
Cardiac Lesions - New Murmur
Immune Complex Deposition - Vasculitis, Splinter Haemorrhages
Emboli - Janeway Lesions

79
Q

State the two most effective diagnostic methods for Infective Endocarditis

A

Blood Cultures - Atleast 3 from different sites over a few hours
TOE

80
Q

Describe the criteria of MAJOR Infective Endcarditis

A

Positive Blood Cultures
Endocardial Involvement
Positive Echo
Valvular Regurg

81
Q

Describe the criteria of MINOR Infective Endcarditis

A

Predisposing factors
Pyrexia
Embolic/Vasculitis Signs
Suggestive blood cultures (not meeting criteria)
Suggestive Echo

82
Q

Antibiotics are given via a central line in Infective Endocarditis. Give the Empirical, Strep, Enterococci and Staph management

A

Empirical - Amoxicillin and Gentamicin
Strep - Benzylpenicillin and Gentamicin
Enterococci - Amoxicillin and Gentamicin
Staph - Flucloxacillin and Gentamicin

83
Q

How would you monitor Infective Endocarditis?

A

Echo Weekly
ECG Twice Weekly
Bloods Twice Weekly

84
Q

Bradycardia can be caused by SA or AV node dysfunction. Give 4 causes of SA node dysfunction

A

Hypothyroidism
Hypothermia
Rheumatic Fever
Haemachromatosis

85
Q

What is Sick Sinus?

A

Sinus Node Fibrosis
Presents as Tachy Brady

86
Q

What is 1st Degree HB? How would you manage?

A

PR Interval >0.2 seconds (5 large squares)
No specific treatment, just monitor

87
Q

What is 2:1 HB? How would you manage?

A

AKA Wenkebach
Progressive lengthening of PR followed by drop of QRS
Can occur in young fit patients OR after MI
No specific treatment, just monitor

88
Q

What is 2:2 HB? How would you manage?

A

Constant PR interval then QRS suddenly dropped
Pacing required as can progress to complete HB

89
Q

Complete HB occurs when there is no relationship between P and QRS. How does the ECG change depending on where the block is?

A

Occurring at Bundle of His - Narrow Escape Complex
Occurring below Bundle of His - Broad Escape Complex

90
Q

Give 3 causes of Complete HB

A

Digoxin toxicity
Inferior STEMI
Severe Hyperkalaemia

91
Q

Complete HB requires urgent pacing. What medical management can you give?

A

Atropine - Muscarinic Antagonist
Isoprenaline - Beta Agonist

92
Q

What is a Junctional Rhythm

A

Abnormal rhythm arising from AV node

93
Q

Give 4 causes of AF

A

Heart Failure
Hypertension
PE
Hypokalaemia

94
Q

What investigations would you do for AF?

A

ECG - May wish to use home monitor if intermittent
Echo - to look for any underlying structural abnormalities/prepare for cardioversion

95
Q

How would you manage ACUTE AF (<48hrs ago)? What do you need to consider?

A

Give Heparin and aim to DC cardiovert
Generally cardiovert young patients due to stroke risk (always listen for carotid bruits first)

96
Q

What anticoagulation would you give in Chronic AF? State the two scoring systems used.

A

DOACs - Rivaroxiban, Apixiban, Dabigatran
Warfarin
CHADS VASc and ORBIT

97
Q

Describe the rate control of AF

A

1 - Beta Blockers
2 - CCB
3 - Amioderone

98
Q

Describe the rhythm control of AF

A

Flecainide or Amioderone
If cardioverting will require atleast 3 weeks of anticoagulation and an echo prior

99
Q

AVRTs are Narrow Complex Tachycardias, describe their pathway

A

Impulse starts in AV node, travels to ventricles and then back up into atria via accessory pathway (ORTHODROMIC)

100
Q

AVNRTs are Narrow Complex Tachycardias, describe their pathway

A

Re-entrant loops form within the AV node itself

101
Q

What is diagnostic on an ECG about AVRT/AVNRTs?

A

No P Waves

102
Q

Describe the managements of AVRT/AVNRT

A

Aim to transiently block the AVN (also helps differentiate it from AF)
1 - Vagal Manouvres
2 - IV Adenosine (6mg, then 12g, then 18mg with long flush)

103
Q

Describe 3 side effects of Adenosine

A

Chest Discomfort
Transient Hypotension
Flushing

104
Q

Describe the 2 types of VT

A

Monomorphic - Appearance of all beats match eachother, common post MI scarring
Polymorphic - Beat to beat variation, includes Torsades de Pointes

105
Q

What is Torsades de Pointes? Give two causes.

A

A type of long QT syndrome
Amioderone, Hypokalaemia

106
Q

Ventricular Tachycardia can be managed medically (lidocaine), but when would you cardiovert?

A

If haemodynamically compromised

107
Q

What are fusion beats?

A

Sinus and ventricular beats fuse

108
Q

What are capture beats?

A

Normal conduction of SVT beats
Appears normal

109
Q

What is SVT with Aberrancy?

A

Aberrancy is a functional BBB with increased HR
Won’t be able to tell the different between SVT with BBB until back in sinus rhythm

110
Q

What is Antidromic WPW?

A

AVRT that conducts the opposite way
Conducts down through accessory pathway and up through AV node
Delta waves form as the impulse passes through accessory pathway
Treated the same as NCT

111
Q

What is a Cardiac Tamponade?

A

Accumulation of blood/fluid/pus/clots/gas resulting in reduced ventricular filling an haemodynamic compromise

112
Q

Give 5 causes of Cardiac Tamponade

A

Malignancy
Trauma
Aortic DIssection
Infective
Drugs (Hydralazine, Isoniazid)

113
Q

Give 5 presentations of Cardiac Tamponade

A

Becks Triad - Hypotension, Raised JVP, Muffled heart sounds

Pulsus Paradoxus - abnormally large drop in BP with inspiration

ECG - electrical alternans

114
Q

What is Pulsus Parodoxus?

A

Exaggeration of a normal decrease in systolic in inspiration in Cardiac Tamponade
Helps differentiate between that and Pericardial Effusion

115
Q

Name two investigations you would do for Cardiac Tamponade. What would they show?

A

Bloods - CK, Troponin, Us and Es
CXR - Water Bottle shaped heart

116
Q

Describe three managements of Cardiac Tamponade

A

Pericardiocentesis
Oxygen
Leg Elevation - promotes venous return

117
Q

How would an Ostium Secondum ASD present?

A

Usually asymptomatic until left to right shunt develops
Shunt becomes more exaggerated as you age due to decreased LV compliance
Onset of Dysponea/HF aged 40-60

118
Q

How would an Ostium Primum ASD present? What are it’s associations?

A

Usually presents in childhood
May be asymptomatic or may be fatigued, dyspnoea
Associated with Downs Syndrome and AV Valve abnormalities

119
Q

How would ASD present on an ECG and a CXR?

A

RBBB with LAD (primum) or RAD (secondum)
CXR - Atrial Enlargement, Small aortic knuckle

120
Q

Give two complications of ASD

A

Eisenmenger Syndrome (Reversal of shunt an subsequent cyanosis)
Paradoxical Emboli

121
Q

Describe some possible presentations of VSD

A

May present with Heart Failure in infancy, or may remain asymptomatic until later life
Signs of Pulmonary Hypertension
Murmur (Harsh pansystolic at left sternal edge with left parasternal heave)

122
Q

VSD present normally on an ECG, how would they present on a CXR?

A

Small VSD - Normal
Large VSD - Cardiomegaly, Large pulmonary arteries

123
Q

What is Coarctation of the Aorta? Name two associations

A

Congenital narrowing of descening aorta usually distal to left subclavian
Associated with Bicuspid Valve and Turner’s Syndrome

124
Q

Name 5 presentations of Coarctation of the Aorta

A

Radioradial delay
Weak femoral pulse
Hypertension
Systolic murmur over left scapula
Cold feet

125
Q

Name two investigations for Coarctation of the Aorta

A

CT/MRI Aortogram
CXR - Rib notching (blood diverts down intercostal arteries to supply lower body, causing these vessels to dilate and erode ribs)

126
Q

Tetralogy of Fallot is the most common cyanotic heart defect, what is the embryological cause?

A

Abnormal separation of Truncus Arteriosus into Aorta and Pulmonary Artery

127
Q

What are the four abnormalities in Tetralogy of Fallot

A

VSD
Pulmonary Stenosis
RV Hypertrophy
Overriding Aorta

128
Q

How might Tetralogy of Fallot present?

A

May be asymptomatic at birth but gets more cyanotic as PA closes
May squat (increases vascular resistance to decrease the degree of shunting)
Repaired adult - exertional dyspnoea, palpitations

129
Q

What 3 investigations could you do for suspected Tetralogy of Fallot

A

ECG - RV hypertrophy with RBBB
CXR - classical boot shaped heart
Echo

130
Q

What is Dressler’s Syndrome?

A

Late onset Pericarditis post MI
Usually 1-6 weeks after initial MI (may be immune mediated)

131
Q

How might Dressler’s Syndrome present?

A

Pain - left shoulder, pleuritic, worse when lying down
Malaise
Dyspnoea
Fever

132
Q

Describe 3 Investigations of Dressler’s Syndrome

A

FBC - Leucocytosis
Heart Autoantibodies
ECG - ST Elevation

133
Q

Describe the management of Dressler’s Syndrome

A

Asparin - 750-1000mg tds for 2 weeks before tapering
Colchicine - Improves response to NSAIDs

134
Q

State two congenital causes of Long QT syndrome

A

Jervell and Lange Nielson Syndrome - sensorineural deafness
Romano Ward

135
Q

Describe the pathophysiology of Rheumatic Fever

A

Peak incidence between 5-15 y
Triggered 2-4wks after Strep Pyogenes infecton

136
Q

Why does Rheumatic Fever cause valvular manifestations?

A

Antibody to carbohydrate wall of Streptococcus cross reacts with valve tissue (antigenic mimicry)

137
Q

What is the Jones Criteria for Rheumatic Fever?

A

Requires evidence of Strep Infection (titre, throat culture) +2 major symptoms OR 1 major and 2 minor

138
Q

How do you manage Rheumatic Fever?

A

Bed rest until CRP has been normal for 2 weeks (this may take up to 3 months)

Penicillin V
Asparin

139
Q

Describe three features of Salicyclate Toxicity

A

Tinnitus, Hyperventilation, Metabolic Acidosis

140
Q

State three associations of Dilated Cardiomyopathy

A

Alcohol
Hypertension
Haemochromatosis

141
Q

How does Dilated Cardiomyopathy present?

A

Same symptoms as Heart Failure

142
Q

Define Cardiomyopathy

A

Myocardial disorder where the heart muscle is structurally or functionally abnormal without Coronary Artery Disease, Hypertension, Valvular, or Congenital Heart Defects

143
Q

What is Hypertrophic Cardiomyopathy?

A

Autosomal Dominant genetic disorder characterised by LV Hypertrophy, impaired diastolic filling, and abnormalities of mitral valve
Most common cause of sudden cardiac death in young adults and athletes

144
Q

How does Hypertrophic Cardiomyopathy present?

A

Varies between asymptomatic to profound exercise limitations, arrhythmias and sudden death
Symptoms of mitral regurg

145
Q

What is the most common arrhtyhmia seen in Hypertrophic Cardiomyopathy?

A

Atrial Fibrillation

146
Q

Describe three possible managements for Hypertrophic Cardiomyopathy

A

Rhythm Control (Anti Arrhythmics, Catheter Ablation)
Anticoagulation (AF risk)
ICD (Implantable Cardioverter Defibrillator)

147
Q

What is Restrictive Cardiomyopathy?

A

Normal left ventricular cavity size and systolic function, but with increased myocardial stiffness
Usually idiopathic or caused by increased deposition (eg Fabry’s Disease)

148
Q

How would you manage Restricitve Cardiomyopathy?

A

Children - Transplant
Adults - Heart Failure Management

149
Q

Acute Pericarditis can be primary (idopathic) or secondary. Name four secondary causes.

A

Infective
Autoimmune
Drugs (Procainamide, Hydralazine, Isoniazid)
Metabolic (Uraemia, Hypothyroidism)

150
Q

Describe the presentation of Acute Pericarditis

A

Chest pain WORSE on inspiration/lying flat, IMPROVED by sitting forward
May hear pericardial rub

151
Q

What would the ECG of Acute Pericarditis?

A

Saddle shaped ST elevation

152
Q

How would you manage Pericarditis?

A

NSAIDs/Asparin with PPIs for 1-2wks
Colcihicine for 3 months for prevention
If non resolving/autoimmune - steroids

153
Q

Apart from dyspnoea/chest pain in Pericardial Effusion, give three other signs/symptoms

A

Hiccoughs (compression of phrenic nerve)
Nausea (compression of diaphragm)
Bronchial Breathing at left lung base (Ewarts Sign)

154
Q

What is Constrictive Pericarditis?

A

Heart is encased in rigid pericardium, normally idiopathic or following TB/Pericarditis

155
Q

How would Constrictive Pericarditis present?

A

Right heart failure with raised JVP
Kussmaul’s Sign (JVP rising paradoxically with Inspiration)

156
Q

What would you see on XRAY of Constrictive Pericarditis?

A

Small heart
Pericardial Calcification

157
Q

Using LMNOP mnemonic, how would you manage Acute Heart Failure?

A

Loop Diuretics
Morphine
Nitrates
Oxygen
Position

158
Q

Name a cause of Right Axis Deviation

A

Pulmonary Embolism

159
Q

Give two points about preparing a patient for an ECG

A
  • The skin must be clean and dry (any recent use of moisturiser will require alcohol wipe)
  • If excessively hairy and unable to get a good connection (eg by parting the hairs) then the chest must be shaved
160
Q

State the five steps to describing an ECG

A

1) Rhythm (Regular/Irregular)
2) Conduction Intervals (eg prolonged PR)
3) Cardiac Axis (any deviation)
4) QRS Description
5) ST segment description

161
Q

Which Mobitz type is also called Wenkebach ?

A

Type 1

162
Q

Describe the septations of the Left Bundle Branch

A

Divided into anterior and posterior fascicle

Anterior fascicle is normally the blocked one

163
Q

How would blockage of the left anterior fascicle present on ECG?

A

LBBB and
Left Axis Deviation

164
Q

How would blockage of the Left Posterior Fascicle present on an ECG?

A

Right Axis Deviation

165
Q

What is Bifascicular block and how would it present on an ECG?

A

When there is both RBBB and Left Anterior Fascicle blockage

Shows as RBBB and Left Axis Deviation

166
Q

What is Trifascicular Block?

A

Blockage of both the anterior and posterior left fascicles, and the right bundle branch

AKA complete HB

167
Q

Name three places that a supraventricular rhythm can originate

A

SA node
AV node
Atrial Muscle

168
Q

How would ventricular pacing appear on an ECG?

A

A pacing spike prior to each QRS complex

169
Q

How would dual chamber pacing appear on an ECG?

A

A pacing spike before each P wave and each QRS complex

170
Q

Once a STEMI is confirmed, describe the management options if a PCI centre is quickly accessible.

A

If the onset of the STEMI was within 12 hours, and a PCI is available within 2 hours.

Give loading dose of Prasugrel (60mg) or Clopidogrel (600mg) AND UFH.
PCI

171
Q

Once a STEMI is confirmed, describe the management options if a PCI centre is NOT quickly accessible.

A

Thrombolyse with Alteplase
Clopidogrel AND UFH
PCI when possible

172
Q

Why is UA managed the same as other ACS initially?

A

Rise in troop in may take hours so cannot be distinguished from NSTEMI

173
Q

How is Unstable Angina treated after MONA?

A

As an NSTEMI

174
Q

How should you describe an ECG in exams?

A

12 Lead ECG

175
Q

What are the four types of MI?

A

Type 1 - Typical ACS
Type 2 - Following increased demand (ie anaemia, hypovolaemia)
Type 3 - Sudden death
Type 4 - Associated with PCI/CABG

176
Q

What are the complications of MI (DREAD)?

A

Death
Rupture of Papillary Muscles/Septum (Mitral regurg)
Edema (HF)
Arrhythmia
Dresslers

177
Q

Name the 6As of secondary medical prevention after MI

A

Atorvastatin
ACEI
Atenolol
Aldosterone Antag
Aspirin
Another antiplatelet (continued for 12m)

178
Q

Describe the management of HOCM (ABCDE)

A

A- Amiodarone
B - Beta Blockers or Verapamil
C - Cardioverter defibrillator
D - Dual chamber pacing
E - Endocarditis prophylaxis

Year 3 Medicine (10 decks)

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