Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GP Matrix > CVS > Flashcards

CVS Flashcards

1
Q

What are the clinically significant bradyarrhythmias?

A
  • Sinus bradycardia
    • Normal but slow
  • 1st degree HB
    • PR interval >200ms
  • 2nd degree heart block type 1
    • Progressive PR prolongation followed by dropped QRS
  • 2nd degree heart block type 2
    • Constant PR interval with dropped QRS
  • 3rd degree heart block
    • No synchronisation between P waves and QRS complexes
  • Right bundle branch block
    • M in V1
    • W in V6
  • Left bundle branch block
    • W in V1
    • M in V6
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is 1st degree heart block?

A

Prolonged PR interval (>200msec)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is 2nd degree type 1 heart block?

A

Progressive PR prolongation followed by dropped QRS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is 2nd degree type 2 heart block

A

Constant PR interval with dropped QRS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is 3rd degree heart block?

A

Complete desynchronisation of P waves and QRS complexes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What bradyarrhythmia is associated with cannon A waves in the JVP?

A

3rd degree heart block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the primary atrial tachyarrhythmias?

A
  • Sinus tachycardia
    • Normal, but fast
  • Atrial flutter
    • Regularly irregular
    • F waves (saw tooth) in leads II, III, and aVF
  • Atrial fibrillation
    • Irregularly irregular
    • No P waves
    • Can be rapid or slow
  • AVNRT
    • Burried p waves
    • retrograde p waves (lead III)
    • Pseudo R waves (V1)
  • AVRT
    • Can be wide complex because of delta waves from QPQ
    • Short PR interval
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does atrial flutter look like?

A
  • Regularly irregular
  • F waves (saw tooth) in leads II, III, and aVF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does atrial fibrillation look like?

A
  • Irregularly irregular
  • No P waves
  • Can be rapid or slow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the emergency treatment for AVNRT?

A

Adenosine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the primary ventricular tachyarrhythmias?

A
  • Ventricular tachycardia
    • Monomorphic
    • Polymorphic
  • Ventricular fibrillation
  • Ventricular ectopics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the shockable and non-shockable rhythms?

A

Shockable:

  • VF
  • Pulseless VT

Non-shockable:

  • Asystole
  • Pulseless electrical activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the acute management of atrial fibrillation?

A

Rate control:

  • Metroprolol IV
  • Esmolol IV
  • Verapamil IV
  • If ADRs
    • Pacemaker + AV node ablation

Rhythm control:

  • Electrical cardioversion
    • Haem unstable - immediate
    • Haem stable <48h - immediate
    • Haem stable >48- check for mural thrombus of 3+weeks of anticoags.
  • Chemical cardioversion
    • Normal LVEF + No Cad

Anticoags:

  • LMWH
  • Enoxaparin
  • Clexane
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the chronic management of atrial fibrillation?

A

Rate control:

  • LVEF>40%
    • Atenolol (oral)
    • Metoprolol (oral)
  • LVEF<40%
    • Carvedilol
    • Bisoprolol
    • Metroprolol + amiodarone
  • If ADRs
    • Diltiazem
    • Verapamil

Rhythm control:

  • Normal LVEF + no CAD
    • Flecainide (oral)
    • Sotalol (oral)
  • If ADR
    • Amiodarone

Anti-coags:

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the risks of warfarin treatment?

A
  • Bleeding
  • Bruising
  • Rashes
  • N/V
  • Jaundice
  • Alopecia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What precautions must be taken whilst receiving warfarin treatment?

A
  • Avoid contact sports
  • Avoid Vitamin K rich foods
  • <2 standard drinks of alcohol in a 24h period
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What monitoring is required for warfarin treatment?

A
  • INR
    • Every day for 1 week
    • Every week for 3 weeks
    • Every month for 3 months
  • If high risk, give clexane
  • Warfarin book
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the CHADSVASC score

A
  • Congestive HF or LVEF<40% (1)
  • Hypertension (1)
  • Age >= 75 (2)
  • Diabetes (1)
  • Stroke / TIA / Thromboembolism (2)
  • Vascular disease (1)
  • Age 65-75
  • Sex Category -F (1)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What arrhythmia is shown in this ECG?

A

AVNRT

  • Narrow complex tachy (150bpm)
  • No visible P waves
  • Pseudo R’ waves in V1-2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What arrhythmia is shown in this ECG?

A

2nd degree- type 2 heart block

  • PR interval constant
  • Dropped QRS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the pathphysiology of CAD?

A
  • Endothelial dysfunction leads to LDL deposition and the formation of foam cells (lipid phagocytosis from macrophages)
  • This is followed by smooth muscle proliferation and fibrous cap formation (fibroblast initiation).
  • A necrotic core forms
  • ACS occurs when the fibrous cap rutpures. This results in platelet aggregation and the formation of a mural thrombus
  • Agina can occur when the luminal space is narrowed sufficiently to produce ischemia in the absence of full occusion or thrombus.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the risk factors for CAD?

A
  • Non-modifiable
    • Age
    • Male, or post-menopausal female
    • Family history of early onset CVD
    • Ethnicity (south asian, Maori/Pacifica)
  • Modifyable
    • Metabolic syndrome
      • HTN
      • Dyslipidaemia
      • Obesity
      • Impaired glucose tolerance
    • Smoking
    • High alcohol consumption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

CAD is a common comorbidity of which diseases?

A
  • CKD / Protinuria
  • Gout
  • Chronic inflammation
  • Antiphospholipid syndrome
24
Q

What are the ECG changes in STEMI?

A
  • Hyperacute t-waves (wide + tall occur in minutes)
  • ST elevation + depression in reciprocal leads (occurs in hours)
    • >=2 contiguous leads
    • >=2mm in V2&3, >=1mm in others
  • T wave inversion + pathological Q waves (24 hours)
  • Changes do not normalise with nitrates
  • New LBBB
25
Q

What is the acure management of STEMI?

A

MONASH B

  • Morphine
  • O2 (if less than 90%)
  • Nitrates
  • Antiplatelets
    • Aspirin
    • P2Y12
      • Clopidogrel (no PCI)
      • Tricagrelor (PCI)
    • GPIIb for PCI (Tirofiban)
  • Statins
  • Heparin
  • Beta-blockers

+ reperfusion

26
Q

What are the contraindications for fibrinolytic therapy?

A
  • Current bleeding disorder or anticoagulation
  • Previous stroke
  • Previous ICH
  • Known cerebral lesion (AVM)
  • Arterial aneurism / dissection
  • Active PUD
  • Prolonged cardiac compression
  • Infective endocarditis
27
Q

What is the acute management of NSTEMI?

A

ABnCs

  • Antiplatelets (Asprin +/- Clopidogrel)
  • Beta-blockers
  • Nitrates
  • Anticoags (LMWH)
  • Statins
28
Q

What is the chronic management of ACS?

A

SNAPW

Pharm (DABS)

  • Dual anti-platelets (aspirin + Clopidogrel / Tricagrelor)
  • ACEi
  • Beta-Blocker (metroprolol)
  • Statin
29
Q

In what situations do you use ECG, Echo, and nuclear thalium cardiac stress tests?

A
  • ECG
    • When there are no underlying ECG changes
  • Echo
    • When valvular function needs to be assessed
  • Nuclear thallium
    • When there are underluing ECH changes
30
Q

What is the chronic management of stable angina?

A
  • SNAPW (manage risk factors)
  • BB (contra-indicated in asthma)
    • Primary ADR is bradycardia
  • CCBs (amlodipine
    • Dihydro - vessels
    • Non-dihydrio - Cardiac
  • Nitrates
31
Q

What is the aetiology of HFrEF?

A
  • ACS
  • Dilated cardiomyopathy
    • Idiopathic
    • Alcohol
    • Myocarditis
  • Vascular disease
    • Aortic stenosis
32
Q

What is the aetiology of HFpEF?

A
  • Increased afterload resulting in concentric remodelling
  • Hypertrophic cardiomyopathy (HOCM)
  • Restrictive cardiomyopathy
  • Infiltrative disease
    • Amyloidosis
    • Sarcoidosis
33
Q

What are precipitating factors for acute exacerbations of Heart failure?

A

MAD HATTER

  • Myocardial ischaemia
  • Arrhythmia
  • Drugs (NSAIDS, Thiazolinediones)
  • Hypertension
  • Anaemia
  • Temperature
    • Infection
  • Thyroid dysfunction
  • Ethanol
  • Restrict
    • Non-compliance with fluid restriction)
34
Q

What are three key components in the pathophysiology of HFrEF?

A

Bad

  1. Sympathetic activation (leads to high heart rate and cardiac output)
  2. RAAS stimulation (leads to fluid retention and high blood pressure)

Good
3. BNP release due to ventricular stretch (Prevents remodelling, diuretc +vasodilator activity)

35
Q

What are the main complications of Heart failure?

A
  • Acute decompensation of CCF
  • Arrhythmias (AFIB)
  • Renal impairment
  • Hepatomegaly
  • Pulmonary hypertension
  • Acute Pulmonary Oedaema
36
Q

What are typical history and exam signs for heart failure?

A

History:

  • SOB
  • Orthopnoea
  • PND
  • Fatigue
  • Dizziness
  • Rapid weight gain
  • Ankle swelling
  • Ascites and bloating
  • Diaphoresis

Exam:

  • Cardiomegaly
  • S3 (HFrEF)
  • S4 (HFpEF)
  • Murmurs (AS and MR)
  • Bibasal inspiratory crackles
  • Bibasal expiratory wheeze
  • Frothy sputum
37
Q

What are the investigations that should be done for heart failure?

A

Bedside

  • ECG

Bloods

  • Serial toponins (check for ACS)
  • BNP (Can be falsely low in obese patients)
  • FBE, ESR, UEC (High Na+, low K+), LFTs (right heart) INR, HB1AC, Fasting lipids

Imaging

  • CXR (APO)
  • _Dopler echocardiogram **gold standard**_
    • Determines LVEF, Cardiac output and structual abnormalities
38
Q

What is the acute management for HFrEF?

A
  • DRSABCD
  • CCF workup
    • Fluid + Na restriction
    • Fluid balance chart
    • Weighings
  • Manage APO
    • LMNOP backwards
      • Position upright
      • Oxygen (BiPAP)
      • Nitrates
      • Morphine
      • Lasix (furosemide
  • Manage underlying cause
    • ACS (SAAB-CG)
      • Statins
      • Aspirin
      • ACEi
      • Beta blockers
      • Calcium channel blockers
      • GTN
39
Q

What is the chronic management of HFrEF?

A
  • Lifestyle
    • SNAPW
    • Fluid and salt restriction
  • Medical first line (BAD)
    • Beta blockers (Carvedilol or metroprolol)
      • Stable CCF
      • ADR- Hypotension
    • ACEi/ARB (Ramipril)
      • ADR - dry cough, angioedema, hypotension, hyperkalaemia
      • C/I - Bilateral renal artery stenosis, pregnancy
    • Diuretics (Spironolactone because it is K sparing)
      • ADR - Hyperkalaemia, gyenaecomastia
      • Furosemide can be used, but only for symptomatic relief
  • Medical second line (NDO)
    • Nitrates
      • ADR - Flushing, headache, hypotension
    • Digoxin
      • ADR - Hypokalaemia, hynaecomastia
    • Other drugs
      • Ivabradine (sinus node inhibitor - doesn’t effect contractility)
  • Surgical / electrical
    • ICD
    • Biventricular pacing
    • LV assist devices (end stage)
    • transplant if refractory
40
Q

What is the management for HRpEF?

A

No specific treatements reduce morbidity or mortality.

  • Symptomatic treatment of Fluid overload with diuretics
  • Manage comorbid AF
41
Q

What are the features of aortic stenosis?

A
  • systolic ejection crescendo decrescendo + early systolic ejection at right upper sternum
  • Radiates to carotids (may not radiate with atherosclerosis)
  • Louder on expiration quieter/ no change with valsalva (HOCM louder with valsalva)
42
Q

What is the classic HOPC for aortic stenosis?

A

old man with cardiac RFs

Ranges from asymptomatic to → SAD- Syncope, Angina, Dyspnoea

43
Q

What are the main causes of aortic stenosis?

A
  • Age related calcification
  • Congenital bicuspid valve
  • RHD
44
Q

What are the severity signs for aortic stenosis?

A
  • “slow-rising”/ plateau pulse
  • narrow pulse pressure
  • split S2
  • presence of S4
  • long/ late murmur
  • LVF
45
Q

What is the management for aortic stenosis?

A
  • AVR (aortic valve reconstruction)
  • TAVI (Transcatheter aortic valve inplantation)
  • balloon angioplasty
46
Q

What are the features of mitral regurg?

A
  • High pitched pan/ holosystolic murmur at apex
  • Radiates to axilla
  • Louder with squatting, Left lateral maneuver, and expiration
47
Q

What are common causes of mitral regurg?

A
  • Dilated Cardiomyopathy
  • Rheumatic heart disease
  • Ischaemic/ post AMI papillary muscle rupture
  • Prolapse of mitral valve
  • Endocarditis
48
Q

What are the clinical signs associated with mitral regurg?

A
  • Displaced/ volume loaded apex
  • Apical thrill
  • Soft S1
  • Loud S2
  • S3 gallop
49
Q

What are the risk factors for essential hypertension?

A

Non-modifiable

  • Age
  • FHx
  • Sex
  • Ethnicity

Modifiable

  • Smoking
  • High sugar and salt diet
  • Alcohol
  • Sedentary lifestyle
  • Weight
  • Stress
50
Q

What are some causes of secondary hypertension?

A
  • Renal disease
  • Carrdiovascular disease
  • Obstructive sleep apnoea
  • Pregnancy
  • Endocrine problems
    • Hyperthyroid
    • Cushings
    • Pheochromocytoma
    • Conns syndrome (primary hyperaldosteronism)
51
Q

What is the blood pressure targets for chronic management of hypertension?

A
  • 140/90
  • <120 + monitor for ADRs if
    • Over 75
    • High risk of stroke
    • High risk of CKD
52
Q

What are the ECG changes associated with Left ventricular hypertrophy in hypertension?

A
  • S wave in V1 and R wave in V5/6 larger than 35mm (7 large boxes)
53
Q

What is the management for hypertension?

A
  • Lifestyle (SNAPW)
    • Stop smoking
    • Reduce salt intake and saturated fat, and increase fibre
    • Reduce drinking to 2 per day 4 occasionally
    • 30 mins moderate excercise per day 5 days per week
    • Weight loss (BMI<25)
  • Refferal
    • Quitline (smoking)
    • Dietitian (nutrition)
    • Alcohol support groups
  • Comorbidities
    • Diabetes
    • Dyslipidaemia
  • Medication
    • If high risk, BP >160 / 100, unresponsive to lifestyle changes, or cardiovascular event.
    • Mostly ACE Inhibitor
54
Q

What are the specific drugs used in hypertension in the presence of comorbidities

A
55
Q

What are the complications of hypertension?

A
  • Hypertensive retinopathy
    • Chronic
      • Vasoconstriction
      • A/V nipping ( artery presses on vein)
    • Acute
      • Retinal haemorrhages (dark red patches)
      • Cotton wool spots
      • Hard exudate
      • Papilledema (swelling of the optic nerve)
  • Stroke and TIA
  • AMI
  • Heart failure
  • PVD
  • CKD
  • AKI
  • Aortic dissection

GP Matrix (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions