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Dannys Medicine Finals > ECGs and Cardiology > Flashcards

ECGs and Cardiology Flashcards

1
Q

What does a tall P wave show?

A

P Pulmonale - RA hypertrophy

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2
Q

What may RA hypertrophy be secondary to?

A

Pulmonary HTN and Tricuspid stenosis

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3
Q

What is P Mitrale?

A

Bifid P wave, caused by LA hypertrophy, secondary to mitral stenosis

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4
Q

Signs of RVH?

on ECG

A

RAD
P pulmonale
T wave inversion

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5
Q

Causes of RVH?

A

1) Pulmonary hypertension
2) Chronic lung disease
3) Mitral stenosis
4) Congenital heart disease

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6
Q

Classic acute right ventricular strain signs? e.g PE

A

S1Q3T3

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7
Q

Sokolov Lyon Criteria for LVH diagnosis?

A

LVH present when combined total depth of S wave in V1 and height of R in V5/6 = Over 35mm

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8
Q

What is a pathological Q wave?

A

1) Greater than 40ms
2) Over 2mm in depth
3) Over 25% of depth of QRS

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9
Q

Causes of prolonged QT?

A

1) Long QT syndrome (inherited slow ventricular repolarisation)
2) ELectrolytes (hypokal, hypocalc, hypomag)
3) Medications (many..e.g antipsychotics, antiemetics)
4) Other (hypothyroid, intercranial disease)

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10
Q

Medications to increase heart rate?

A
  1. Atropine (blocks action of vagus on SAN/AVN)

2. Isoprenaline

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11
Q

Atrial flutter sign?

A

Sawtooth baseline

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12
Q

Atrial tachycardia?

A

Abnormal P wave (inverted in inferior)

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13
Q

AVNRT?

A

Absent P wave

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14
Q

What is Wolff-Parkinson-White syndrome?

A

Pre-excitation syndrome - congenital accessory pathway named Bundle of Kent

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15
Q

Signs of WPW?

A 
Short PR
Delta wave (slurred upstroke of QRS)
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16
Q

Treatment of WPW?

A

Radiofrequency ablation of accessory pathway + Sotalol/ Amiodarone/ Flecainide

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17
Q

Treatment to shorten QT?

A

IV Magnesium Sulphate

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18
Q

What is Torsades De Pointes?

A

Polymorphic VT secondary to prolonged QT/ Myocardial Ischaemia

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19
Q

STEMI ECG changes?

Minutes
0-12hrs
1-12hrs
Days 
Weeks
A

Minutes = hyperacute T waves

0-12hrs = ST elevation

1-12hrs = Q wave development

Days = T wave inversion

Weeks = T wave normal + persistent Q waves

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20
Q

Pericarditis signs?

A

ST elevation widespread and PR depression

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21
Q

Causes of J waves? (notch just after QRS)

A

1) Early repolarisation
2) Hypothermia
3) Hypercalcaemia (short QT)
4) Brugada syndrome

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22
Q

Signs of Digoxin on ECG?

A

Downsloping ST
Abnormal T
Short QT

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23
Q

Hyperkalaemia signs?

A

Tall T
Long PR
WIde flat P
Broad QRS

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24
Q

Risk factors for Coronary Artery Spasm (Prinzmetal Angina)

A
  • Cocaine

- Mg deficiency

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25
Q

Diagnosis of Coronary Artery Spasm?

A

Angiogram (inject Acetylcholine, if vessel constricts - can dx vasospasm)

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26
Q

Tx of Coronary Artery Spasm?

A

CCB (Verapamil/ Diltiazem)

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27
Q

Angina Triad?

A

1) Constricted chest pain (radiating down neck/arm)
2) Precipitated by exercise
3) Relieved by rest/ GTN within 5 mins

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28
Q

ANGINA

Anatomical non invasive tested for low risk?

A

CTCA

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29
Q

What is deemed obstructive CAD?

A

Over 70% stenosis of 1 major coronary artery segment or over 50% stenosis of left main coronary artery

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30
Q

ANGINA

Example of Non. Invasive Functional Testing?

A

1) Dobutamine stress Echo
2) Stress/contrast MRI
3) SPECT

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31
Q

ANGINA

What is investigation of choice for high risk patients?

A

Invasive Coronary Angiography (for assessing stenosed arteries + provide revascularisation at the time of diagnosis)

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32
Q

ANGINA

Lifestyle advice?

A

WESAD

Weight Loss
Exercise 30-60mins
Smoking Cessation 
Alcohol under 12 units weekly 
Diet (limit sat fats to under 10% of total calorie intake)
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33
Q

ANGINA

Pharmacological management?

A

GTN +

1) BB / CCB (Amlodipine)

2) Long acting Nitrate
Ivabradine
Nicorandil
Ranolazine

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34
Q

What CCBs are contraindicated with beta blockers?

A

Non dihydropyridine CCBs such as Verapamil and Diltiazem due to the risk of AV block

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35
Q

Invasive Management of Angina?

A

PCI and CABG

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36
Q

What medication is given alongside PCI

A

Dual antiplatelet therapy (Aspirin + Clopidogrel) for 6 months

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37
Q

DIC treatment?

A

Tranexamic Acid
FFP
Cryoprecipitate

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38
Q

Treatment of GI bleed?

A
  1. Ceftriaxone IV 1g
  2. Octreotide 50 ug bolus + 50ug hourly
  3. Erythromycin 250mg
  4. PPI Pantaprazole 80mg IV bolus
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39
Q

Types of Shock?

A 
Cardiogenic 
Septic  
Hypovolaemic
Neurogenic 
Anaphylactic
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40
Q

What types of shock have warm peripheries?

A

Distributive

  • neurogenic/ Septic/ Anaphylactic
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41
Q

3 in 3 out management of Septic Shock

A

3 in - Fluid Bolus, Tazocin (Abx), High flow O2

3 out - Blood cultures, lactate, measure urine output

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42
Q

Treatment of Neurogenic shock?

A

Vasopressors

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43
Q

What is Sepsis characterised by?

A

Temperature under 36 or over 38

HR >90

RR >20

WBC >12,000mm3 or <4000mm3

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44
Q

Famous Cause of Toxic Shock syndrome in the 80s?

A

Infected tampons , containing Staphylococcal Exotoxins

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45
Q

Symptoms of Toxic Shock Syndrome?

A
  1. Fever >38.9
  2. Hypotension
  3. Sun burn like rash (desquamation of palms/soles)
  4. 3+ organ involvement
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46
Q

Types of MI?

A
  1. due to primary CA event e.g plaque rupture
  2. due to oxygen supply demand mismatch
    3 sudden expected cardiac death
    4 Associated with PCI / stent complications
    5 Associated with cardiac surgery
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47
Q

Chest Pain differentials?

Cardiac
Respiratory
GI
Other

A

C - Angina, ACS, Aortic Dissection, Pericarditis

R - PE, Pneumothorax, Pneumonia

GI - Oesophagitis, Peptic Ulcer, Oesophageal spasm

Other - Depression, MSK (rib fracture), herpes zoster

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48
Q

Immediate Management of ACS?

A

MONA (aspirin 300mg loading dose)

take morphine + anti-emetic (metoclopramide)

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49
Q

What should be done within 120 mins of STEMI

A

Primary PCI / Coronary Angiography

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50
Q

What should be done if action not completed within 120 minutes of STEMI?

A

Give fibrinolytic agent e.g alteplase

  1. Clopidogrel + LMWH/UFH and PCI within 24hrs
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51
Q

what should be given prior to PCI

A

2nd antiplatelet (Prasugrel/ Clopidogrel/ Ticagrelor)

+ LMWH/ UFH

+ Glycoprotein IIb/IIIa inhibitor

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52
Q

What is GRACE score?

A

Estimates 6 month mortality risk in patients with NSTEMI/ UA

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53
Q

NSTEMI/UA Management Pathway?

A

1st - Consider risk using GRACE/HEART score

  1. GIve antiplatelet + Fondaparinux or UFH if PCI <24hrs
  2. do Angiography if under 96hrs of presentation and consider PCI/ CABG

IF pain free/ over 96hrs of presentation just do echo, if positive do angiography

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54
Q

Long term management after ACS?

A

Aspirin, ACE-I, Atorvastatin

BB

Cardiac Rehab, cessation of smoking

Driving, Diet/Alcohol, Dyspepsia (PPI!!)

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55
Q

what should be given alongside dual antiplatelet therapy?

A

PPI as increased. risk of peptic ulcer disease

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56
Q

What is Dresslers Syndrome?

A

Autoimmune pericarditis 2/3 weeks post MI.

Autoimmune reaction to myocardial antigens post infarction

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57
Q

3 functions of Pericardium?

A

Barrier - reduces external friction
Mechanical - limits cardiac dilation (maintains ventricular compliance and aids atrial filling)
Anatomical - fixes heart through ligamentous function

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58
Q

major risk factors of Pericarditis?

A 
Fever over 38
Subacute onset
Large pericardial effusion
Cardiac tamponade 
poor response to 1 week of tx
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59
Q

Describe Pericarditis pain?

A

Sharp pleuritic chest pain

BETTER - leaning forward / sitting up
WORSE - inspiration

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60
Q

How is Pericarditis Diagnosed?

A

2/4 of:

New/ worsening pericardial effusion
Classic chest pain
Pericardial friction rub (Squeaky sound heard over heart)
Characteristic ECG changes

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61
Q

ECG signs of PEricarditis?

A

ECG - widespread ST elevation + PR depression

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62
Q

Cardiac Tamponade features?

A
  1. Muffled heart sounds
  2. Distended JVP
  3. Pulsus Paradoxus (BP drop >10mmHg on inspiration)
  4. Hypotension
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63
Q

Tx of Pericarditis

A

NSAID + Colchicine

+ PPI

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64
Q

Tx of tamponade?

A

Urgent pericardial paracentesis

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65
Q

Management of Acute Pulmonary Oedema?

A

Furosemide (IV 40mg)
Oxygen (high flow)
Nitrates (sublingual infusion)
Diamorphine (IV)

may require CPAP if fails

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66
Q

What is a synonym of perihilar shadowing

A

Alveolar Oedema

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67
Q

Hypercalcaemia symptoms?

A

stones, bones, groans and psychic moans

bone pain, renal stones, abdo pain, low mood

short QT on ECG

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68
Q

Adenosine side effects?

A

chest pain
bronchospasm
transient flushing
can enhance conduction down accessory pathways, resulting in increased ventricular rate (e.g. WPW syndrome)

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69
Q

What is Adenosine mainly used for?

A

Termination of SVT

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70
Q

What enhances the effect of Adenosine and what blocks the effect of Adenosine?

A

Enhances - Dipyridamole (antiplatelet agent)

Blocked - theophyllines

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71
Q

What should Adenosine be avoided in?

A

Asthmatics due to risk of bronchospasm

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72
Q

HEART FAILURE

Types of heart failure?

A

Vascular (HTN, IHD)
Muscular (Dilated Cardiomyopathies)
Valvular
Electrical

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73
Q

Definition of preload?

A

Stretching of cardiomyocytes at the end of diastole

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74
Q

Definition of afterload?

A

Pressure or load against which the ventricles must contract

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75
Q

Definition of Inotropy?

A

The force of muscular contraction

76
Q

HEART FAILURE

Describe the basic pathophysiology

A
  • ESV increases which reduces CO
  • Body compensates by:
    1) Increase preload (Increase EDV to maintain CO)
    2) Increase heart rate
    3) Activate RAAS (salt and water retention = oedema)
    4) Baroreceptors activate sympathetic - vasoconstriction 1
77
Q

HEART FAILURE

Symptoms?

A 
SOB
Fatigue
Oedema
Paroxysmal nocturnal dyspnoea 
Orthopnoea
78
Q

HEART FAILURE

Signs?

A 
S3/S4 HS
Ankle swelling
Wheeze
Pulsus Alternans 
Ascites
Hepatomegaly 
Increased JVP
Displaced apex beat
79
Q

HEART FAILURE

Dx?

A

Echo + BNP

80
Q

Causes of increased BNP?

A
  • CKD
  • Cirrhosis
  • Heart failure
  • Hypoxaemia
  • Diabetes
  • Old age
  • Sepsis
81
Q

HEART FAILURE

Management?

A

1st - ACE-I + BB + DIURETIC

2nd + MRA (Eplerenone)

3rd - Digoxin, Ivabradine, Hydralazine + Nitrate

82
Q

Last line management of HF?

A

PCI
CRT
ICD
Heart transplant

83
Q

What are MRAs / aldosterone receptor antagonists contraindicated in?

A

Hyperkalaemia
Hyponatraemia
AKI

84
Q

What would an echo show if a person had Hypertrophic Obstructive Cardiomyopathy>

A
  • Mitral regurgitation
  • Systolic anterior motion (SAM) of anterior mitral valve
  • Asymmetrical septal hypertrophy
85
Q

Classic ECG sign in Arrhythmogenic right ventricular dysplasia?

A

inverted T V1-3 and EPSILON wave (terminal notch in QRS)

86
Q

Describe flow murmurs? (7 S’s)

A
  • Slow
  • Short
  • Systolic
  • Symptomless
  • Sounds (normal S1 and S2)
  • Standing/ sitting (positional)
  • Special tests normal (Echo/ECG)
87
Q

Causes of dilated cardiomyopathies?

A 
ABCD
Alcohol
Beri Beri (Thiamine B1 deficiency)
Coxsackie B virus  
Doxorubicin
88
Q

What is Becks Triad?

A

S3 signs of Acute Cardiac Tamponade?

1) Raised JVP
2) Hypotension
3) Muffled heart sounds

89
Q

What is Aortic Dissection

A

When the medial aortic layers separate

1) Intimal tear allowed blood to enter intima-media space
2) false lumen fills with blood it may propagate proximally/distally

3) This results in either:

Rupture through adventitia
OR
Reentry to true lumen via 2nd intimal tear

90
Q

AORTIC DISSECTION

Describe Stanford Classification

A

Type A - ascending aorta involved

Type B - Ascending aorta not involved

91
Q

AORTIC DISSECTION

Describe DeBakey classification

A

Type 1 Involves ascending, extends into arch and beyond

Type 2 Limited to ascending

Type 3a Involves descending thoracic (proximal to coeliac artery)

Type 3b Involves descending aorta and abdominal aorta

92
Q

AORTIC DISSECTION

Congenital risks?

A 
Noonans
Turners
Marfans
Ehlos Danlos
Osteogenesis Imperfecta
93
Q

AORTIC DISSECTION

Acquired risk?

A 
Cocaine
HTN
Pregnancy
Syphillitic arthritis 
Iatrogenic (cannulation)
94
Q

AORTIC DISSECTION

Symptoms?

A

Tearing chest pain
Back and abdo pain
Dyspnoea
Syncope/ colllapse

95
Q

AORTIC DISSECTION

Signs?

A

Horners syndrome
Arm BP differential
Neuro deficit
Absent peripheral pulses

96
Q

AORTIC DISSECTION

Acute complications?

A

Cardiac Tamponade and Aortic Regurgitation

97
Q

Aortic Regurgitation signs

A

Diastolic murmur
Wide pulse pressure
Heart failure signs

98
Q

AORTIC DISSECTION

Gold standard imaging?

A

CT angiogram

Echo - good if ascending and to assess complications - tamponade/ AR

99
Q

AORTIC DISSECTION

Management of Stanford Type A/B?

A

Type A = surgery! (50% mortality in first 48hrs)

Type B = Analgesia and BP control (Labetolol)

100
Q

How big is a AAA?

A

Over 3cm

101
Q

AAA are more likely in males. Screening is available to those aged 65, whart are the pathways based on the size of the AAA on screening?

A

3-4.4cm = Annual USS + seen in 12 weeks

4.5-5.4cm = 3 montly USS + seen in 12 weeks

> 5.4cm = 2 week wait

102
Q

RIsk factors for AAA?

A 
Family history 12x
Male 6x
Smokers
Hypertensive
Diabetics
Connective tissue disorders (Marfans)
103
Q

Marfans complications?

A 
Mitral valve prolapse
Aortic Dissection
Retinal detachment 
Fibrillin - 1 - mutation 
Arachnodactyly
Near sighted
Sclerosis
104
Q

Commonest causes of aortic Regurgitation

A

Congential (bicuspid valve) + degenerative (calcification)

105
Q

Aortic Regurgitation murmur?

A

Early diastolic + water hammer pulse

106
Q

Aortic Stenosis clinical features?

A

Syncope (exertional)
Angina
Dyspnoea

107
Q

Murmur heard in Aortic Stenosis?

A

Ejection systolic murmur + slow rising pulse

108
Q

INR aim in patients with aortic mechanical valve replacement ?

A

3.0 - long term anti-coagulation required

warfarin, if ischaemic add aspirin

109
Q

murmur heard in MR?

A

Pansystolic + S3 due to rapid filling of dilated ventricle

110
Q

signs on ECG if MR?

A

LVH and P Mitrale (bifid P wave)

111
Q

Murmur heard in. MS?

A

Mid diastolic (lie on left side while holding expiration)

112
Q

What is Ortner Syndrome

A

left recurrent laryngeal palsy (hoarse voice)

can be caused by left atrial enlargement

113
Q

Management of MR?

A

Nitrates, Diuretics + Inotropes

114
Q

INR aim in mechanical mitral valve replacement?

A

3.5.

115
Q

If degenerative regurgitation, what should be the surgical treatment?

A

REPAIR over replace

116
Q

What can left atrial enlargement cause

A 
Ortner Syndrome
Right heart failure (Oedema, raised JVP, hepatomegaly)
Pulmonary HTN
Mitral facies
AF
117
Q

IF a patient has mitral stenosis and persistent AF, which anticoagulation should they be on

A

VKA not NOACs

118
Q

ATRIAL FIBRILLATION

Signs?

A 
Irregularly irregular pulse 
Palpitations
SOB
Angina
Presyncope
119
Q

What does HASBLED stand for

A 
Hypertension
Abnormal liver/renal func
Stroke
Bleeding (prior)
Labile INR
Elderly >65
Drugs/ alcohol
120
Q

What does CHA2DS2VASc stand for

A 
CCF
HTN
Age >75 +2
Diabetes 
Stroke/TIA +2
Vascular disease
Age 65-74
Sc- Female
121
Q

ATRIAL FIBRILLATION

IF pt has paroxysmal AF with no co-morbidities what is the treatment?

A

Flecainide

122
Q

ATRIAL FIBRILLATION

Management of rate?

A

1st - BB Metoprolol
Rate limiting CCB - Verapamil

2nd - Digoxin

123
Q

ATRIAL FIBRILLATION

Rhythm control?

A

Cardioversion

if onset <48hrs = immediate

if >48hrs = 3-6 weeks of anticoagulation then cardioversion

Electrical
Pharmacological (amiodarone, sotalol)

124
Q

ATRIAL FIBRILLATION

Anticoagulation management?

If 1st line contraindicated?

A

DOACs - Rivaroxaban /Dabigatran

if DOAC contraindicated = Aspirin + Clopidogrel (dual ap treatment)

125
Q

Rivaroxaban mode of action?

A

Xa inhibitor

126
Q

Dabigatran mode of action?

A

Direct thrombin inhibitor

127
Q

ATRIAL FIBRILLATION

If drug therapy fails what is final treatment>

A

ABLATION

128
Q

ATRIAL FIBRILLATION

When should anticoagulation be used?

A

If CHADSVASC 2 or more

129
Q

Treatment of SVT

A
  • electrical cardioversion
  • vagal manoeuvres (carotid sinus massage / valsalva)

2nd IV Adenosine 6mg-12mg-12mg

130
Q

What is Adenosine contraindicated in and what is the preferred treatment

A

Asthmatics - prefer verapamil

131
Q

1st line medication in VT

A

Amiodarone

132
Q

Drugs that can prolong QT?

A 
Methadone
Ondansetron
Sotalol
Citalopram
Haloperidol
Amiodarone
Terfenadine
Erythromycin
133
Q

electrolyte causes of prolonged QT?

A

HYPO cal, kal, mag

134
Q

Management of prolonged QT syndrome

A

Beta blockers plus avoid exacerbating drug/ strenuous exercise

implantable cardioverter defibs in high risk cases

135
Q

What is Sodium Nitroprusside?

A

potent vasodilator (hypertensive crisis)

136
Q

Acute NSTEMI treatment?

A

B – Beta blockers unless contraindicated
A – Aspirin 300mg stat dose
T – Ticagrelor 180mg stat dose
M – Morphine titrated to control pain
A – Anticoagulant: Low Molecular Weight Heparin (LMWH) at treatment dose (e.g. enoxaparin 1mg/kg twice daily for 2-8 days)
N – Nitrates (e.g. GTN) to relieve coronary artery spasm

137
Q

Treatment of Regular Broad complex Tachycardia?

A

Assume VT - loading dose amiodarone (after DC)

138
Q

Cause of irregular broad complex tachycardia?

A

AF with BBB
AF with ventricular pre excitation
torsades de pointes

139
Q

Treatment of regular narrow complex tachycardia

A

Vagal manoeuvres followed by IV adenosine

IF above unsuccesful consider flutter dx and control rate

140
Q

Cause of irregular narrow complex tachycardia?

A

Probable AF! if onset <48hrs then cardioversion

control rate with BB

141
Q

Secondary causes of Hypertension

A

Endocrine - Aldosteronism, Cushings, Phaeochromocytoma, Acromegaly
Renal - Renovascular disease, Intrinsic disease (CKD, AKI, glomerulonephritis)
Drugs - Glucocorticoids, oral contraceptive, SSRIs, NSAIDs
Coarctation of the Aorta

142
Q

Signs of hypertension

A

Cardiomegaly, Arrhythmias, Retinopathy, Proteinuria

143
Q

What can Nicorandil cause?

A

Ulceration in GI tract

144
Q

when can you not give Nicorandil

A

Patients with LVF

145
Q

What is Conn’s Syndrome?

A

Adrenal adenoma causing hyperaldosteronism

146
Q

What electrolyte disturbances does Conn’s Syndrome cause?

A

Hypokalaemia

Hypernatraemia

147
Q

BP targets for under 80 and over 80s with hypertension?

A

Under = 135/85

Over = 145/85

148
Q

Give an example of hypertensive emergency

A

Papilloedema + Retinal Haemorrhage

149
Q

Treatment of hypertensive crisis

A

IV Nitroprusside, Labetolol and GTN

150
Q

Treatment of Pheochromocytoma crisis?

A

Phentolamine

151
Q

What is Phaeochromocytoma?

A

Catecholamine secreting tumour

152
Q

Pheochromocytoma investigation?

A

25hr urine collection of metanephrines

153
Q

treatment of Pheochromocytoma

A 
Surgery definitive 
but pt must first be stabilised with:
1) Alpha blocker (phenoxybenzamine)
MUST BE GIVEN BEFORE
2) beta blocker (propanolol)
154
Q

What is Metanephrine

A

Metanephrine is a metabolite of epinephrine created by action of catechol-O-methyl transferase on epinephrine

155
Q

What are the main Catecholamines

A

The main catecholamines are epinephrine (adrenaline), norepinephrine (noradrenaline), and dopamine.

156
Q

What antiplatelet is given for conservatively managed NSTEMI

A

aspirin, plus either:
ticagrelor, if not high bleeding risk
clopidogrel, if high bleeding risk

157
Q

What is a common interaction with statins

A

Macrolides (cause increase CK)

158
Q

Aortic stenosis - most common cause:

A

younger patients < 65 years: bicuspid aortic valve

older patients > 65 years: calcification

159
Q

INFECTIVE ENDOCARDITIS

Types of endocarditis and their incidence %?

A

Native Valve Endocarditis

Prosthetic Valve Endocarditis (10-20%)

IV Drug Abuse Endocarditis (50%)

TYPICALLY MITRAL VALVE THEN AORTIC

160
Q

INFECTIVE ENDOCARDITIS

Risks?

Cardiac Risks?

A

Age >60
Male
IVDU
Poor dental hygiene

Cardiac:
Structural/ valvular HD
Congenital HD
Prosthetic valves
Intravascular devices
161
Q

INFECTIVE ENDOCARDITIS

Typical bacterial cause of NVE?

A

Alpha - haemolytic Strep Bovis (70%)

S.aureus (25%)

162
Q

INFECTIVE ENDOCARDITIS

What is Strep Bovis linked to?

A

Colorectal cancer

163
Q

INFECTIVE ENDOCARDITIS

What bacteria accounts for 30% of PVE infections?

Likely Bacterial cause within 1 year of prosthetic?

Over 1 year?

A

Coagulase - negative staphylococcus (CoNS)
such as Staphylococcus epidermidis

<1 year = staph

> 1 year = strep

164
Q

INFECTIVE ENDOCARDITIS

What is vegetation made up of?

A 
fibrin
platelets
WBCs
RBCs
Clusters of bacteria
165
Q

INFECTIVE ENDOCARDITIS

Symptoms and signs?

A 
Symptoms:
Fever (90%)
Malaise 
weight loss
cardiac symptoms

Signs:
regurgitant murmurs (MR and AR)
features of HF

166
Q

INFECTIVE ENDOCARDITIS

classic signs

A

Janeway lesions (macules on palms/soles)

Osler Nodes (nodules on pads of finger/toes)

Roth spots (lesion on retina with pale centre)

splinter haemorrhages (under nails)

167
Q

INFECTIVE ENDOCARDITIS

Investigations of choice?

A

Echo

Blood cultures (3 sets with 30 min intervals)

168
Q

INFECTIVE ENDOCARDITIS

Major criteria?

A

Endocardial involvement with

Typical organisms from two separate blood cultures or persistently positive BCs 12hrs apart

169
Q

INFECTIVE ENDOCARDITIS

Management of Methicillin sensitive staph?

Methicillin resistant?

A

Sensitive = Flucloxacillin

Resistant = Vancomycin

170
Q

INFECTIVE ENDOCARDITIS

Management of prosthetic?

A

Add rifampicin and gentamicin

171
Q

INFECTIVE ENDOCARDITIS

Management of strep?

A

Penicillin G
Amoxicillin
Ceftriaxone or vancomycin

172
Q

INFECTIVE ENDOCARDITIS

Prophylactic for dental procedures

A

Amoxicillin 2g orally / clindamycin

173
Q

Empirical Abx for NVE or late PVE?

A

Ampicillin, Fluclox and Gent

OR

Vancomycin, Gent and rifampicin

174
Q

Reversible causes of Cardiac Arrest?

A

Hypoxia
Hypovolaemia
Hyperkal, hypokal, hypogly, hypocalc
Hypothermia

Thrombosis
Tamponade
Tension pneumothorax
Toxins

175
Q

1st line antiplatelet for following dx:

ACS

PCI

TIA

Ischaemic stroke

PAD

A

ACS - Aspirin + Ticagrelor

PCI - Aspirin + Ticagrelor or Prasugrel

TIA - Clopidogrel

Ischaemic stroke - Clopidogrel

PAD - Clopidogrel

176
Q

Digoxin monitoring rules?

A

digoxin level is not monitored routinely, except in suspected toxicity

HOWEVER

if toxicity is suspected, digoxin concentrations should be measured within 8 to 12 hours of the last dose

177
Q

Method of action of Digoxin?

A
  • decreases conduction through the atrioventricular node which slows the ventricular rate in atrial fibrillation and flutter
  • increases the force of cardiac muscle contraction due to inhibition of the Na+/K+ ATPase pump.

Also stimulates vagus nerve

178
Q

Which drugs might precipitate Digoxin toxicity?

A 
Amiodarone
Diltiazem & Verapamil 
Spironolactone
Thiazides and loop diuretics 
Ciclosporin
179
Q

Management of Digoxin toxicity?

A

Digibind

180
Q

What electrolyte imbalance causes Digoxin toxicity and why?

A
  • classically: hypokalaemia

digoxin normally binds to the ATPase pump on the same site as potassium.

Hypokalaemia → digoxin more easily bind to the ATPase pump → increased inhibitory effects

181
Q

Digoxin features?

A

generally unwell, lethargy, nausea & vomiting, anorexia, confusion,

yellow-green vision

arrhythmias (e.g. AV block, bradycardia)

gynaecomastia

182
Q

Side effects of beta blockers?

A 
bronchospasm
cold peripheries
fatigue
sleep disturbances, including nightmares
erectile dysfunction
183
Q

Side effects of CCBs?

A

• Headache
• Flushing
• Ankle oedema

184
Q

Side effects of Bendroflumethiazide?

A

• Gout
• Hypokalaemia
• Hyponatraemia
• Impaired glucose tolerance

185
Q

How to distinguish between mitral and tricuspid regurgitation murmur?

A

Both pansystolic
BUT
tricuspid regurgitation becomes louder during inspiration, unlike mitral which is louder on expiration

aortic is also louder on expiration

Dannys Medicine Finals (9 decks)

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