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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
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2
Q

What is 1st degree heart block?

A

Prolonged PR interval (>200msec)

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3
Q

What is 2nd degree type 1 heart block?

A

Progressive PR prolongation followed by dropped QRS

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4
Q

What is 2nd degree type 2 heart block

A

Constant PR interval with dropped QRS

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5
Q

What is 3rd degree heart block?

A

Complete desynchronisation of P waves and QRS complexes

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6
Q

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

A

3rd degree heart block

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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
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8
Q

What does atrial flutter look like?

A
  • Regularly irregular
  • F waves (saw tooth) in leads II, III, and aVF
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9
Q

What does atrial fibrillation look like?

A
  • Irregularly irregular
  • No P waves
  • Can be rapid or slow
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10
Q

What is the emergency treatment for AVNRT?

A

Adenosine

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11
Q

What are the primary ventricular tachyarrhythmias?

A
  • Ventricular tachycardia
    • Monomorphic
    • Polymorphic
  • Ventricular fibrillation
  • Ventricular ectopics
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12
Q

What are the shockable and non-shockable rhythms?

A

Shockable:

  • VF
  • Pulseless VT

Non-shockable:

  • Asystole
  • Pulseless electrical activity
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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
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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:

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15
Q

What are the risks of warfarin treatment?

A
  • Bleeding
  • Bruising
  • Rashes
  • N/V
  • Jaundice
  • Alopecia
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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
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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
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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)
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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
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20
Q

What arrhythmia is shown in this ECG?

A

2nd degree- type 2 heart block

  • PR interval constant
  • Dropped QRS
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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.
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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
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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
What is the acure management of STEMI?
**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
What are the contraindications for fibrinolytic therapy?
* Current bleeding disorder or anticoagulation * Previous stroke * Previous ICH * Known cerebral lesion (AVM) * Arterial aneurism / dissection * Active PUD * Prolonged cardiac compression * Infective endocarditis
27
What is the acute management of NSTEMI?
**ABnCs** * Antiplatelets (Asprin +/- Clopidogrel) * Beta-blockers * Nitrates * Anticoags (LMWH) * Statins
28
What is the chronic management of ACS?
SNAPW Pharm (**DABS**) * Dual anti-platelets (aspirin + Clopidogrel / Tricagrelor) * ACEi * Beta-Blocker (metroprolol) * Statin
29
In what situations do you use ECG, Echo, and nuclear thalium cardiac stress tests?
* 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
What is the chronic management of stable angina?
* SNAPW (manage risk factors) * BB (contra-indicated in asthma) * Primary ADR is bradycardia * CCBs (amlodipine * Dihydro - vessels * Non-dihydrio - Cardiac * Nitrates
31
What is the aetiology of HFrEF?
* ACS * Dilated cardiomyopathy * Idiopathic * Alcohol * Myocarditis * Vascular disease * Aortic stenosis
32
What is the aetiology of HFpEF?
* Increased afterload resulting in concentric remodelling * Hypertrophic cardiomyopathy (HOCM) * Restrictive cardiomyopathy * Infiltrative disease * Amyloidosis * Sarcoidosis
33
What are precipitating factors for acute exacerbations of Heart failure?
**MAD HATTER** * **M**yocardial ischaemia * **A**rrhythmia * **D**rugs (NSAIDS, Thiazolinediones) * **H**ypertension * **A**naemia * **T**emperature * Infection * **T**hyroid dysfunction * **E**thanol * **R**estrict * Non-compliance with fluid restriction)
34
What are three key components in the pathophysiology of HFrEF?
**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
What are the main complications of Heart failure?
* Acute decompensation of CCF * Arrhythmias (AFIB) * Renal impairment * Hepatomegaly * Pulmonary hypertension * **Acute Pulmonary Oedaema**
36
What are typical history and exam signs for heart failure?
**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
What are the investigations that should be done for heart failure?
**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
What is the acute management for HFrEF?
* DRSABCD * **CCF workup** * Fluid + Na restriction * Fluid balance chart * Weighings * Manage APO * LMNOP backwards * **P**osition upright * **O**xygen (BiPAP) * **N**itrates * **M**orphine * **L**asix (furosemide * Manage underlying cause * ACS (SAAB-CG) * **S**tatins * **A**spirin * **A**CEi * **B**eta blockers * **C**alcium channel blockers * **G**TN
39
What is the chronic management of HFrEF?
* Lifestyle * SNAPW * Fluid and salt restriction * Medical first line (BAD) * **B**eta blockers (Carvedilol or metroprolol) * Stable CCF * ADR- Hypotension * **A**CEi/ARB (Ramipril) * ADR - dry cough, angioedema, hypotension, hyperkalaemia * C/I - Bilateral renal artery stenosis, pregnancy * **D**iuretics (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
What is the management for HRpEF?
No specific treatements reduce morbidity or mortality. * Symptomatic treatment of Fluid overload with diuretics * Manage comorbid AF
41
What are the features of aortic stenosis?
* 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
What is the classic HOPC for aortic stenosis?
old man with cardiac RFs Ranges from asymptomatic to → **SAD**- **S**yncope, **A**ngina, **D**yspnoea
43
What are the main causes of aortic stenosis?
* Age related calcification * Congenital bicuspid valve * RHD
44
What are the severity signs for aortic stenosis?
* “slow-rising”/ plateau pulse * narrow pulse pressure * split S2 * presence of S4 * long/ late murmur * LVF
45
What is the management for aortic stenosis?
* AVR (aortic valve reconstruction) * TAVI (Transcatheter aortic valve inplantation) * balloon angioplasty
46
What are the features of mitral regurg?
* High pitched pan/ holosystolic murmur at apex * Radiates to axilla * Louder with squatting, Left lateral maneuver, and expiration
47
What are common causes of mitral regurg?
* Dilated Cardiomyopathy * Rheumatic heart disease * Ischaemic/ post AMI papillary muscle rupture * Prolapse of mitral valve * Endocarditis
48
What are the clinical signs associated with mitral regurg?
* Displaced/ volume loaded apex * Apical thrill * Soft S1 * Loud S2 * S3 gallop
49
What are the risk factors for essential hypertension?
**Non-modifiable** * Age * FHx * Sex * Ethnicity **Modifiable** * Smoking * High sugar and salt diet * Alcohol * Sedentary lifestyle * Weight * Stress
50
What are some causes of secondary hypertension?
* Renal disease * Carrdiovascular disease * Obstructive sleep apnoea * Pregnancy * Endocrine problems * Hyperthyroid * Cushings * Pheochromocytoma * Conns syndrome (primary hyperaldosteronism)
51
What is the blood pressure targets for chronic management of hypertension?
* 140/90 * \<120 + monitor for ADRs if * Over 75 * High risk of stroke * High risk of CKD
52
What are the ECG changes associated with Left ventricular hypertrophy in hypertension?
* S wave in V1 and R wave in V5/6 larger than 35mm (7 large boxes)
53
What is the management for hypertension?
* 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
What are the specific drugs used in hypertension in the presence of comorbidities
55
What are the complications of hypertension?
* 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)

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