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Cardiology > Extra > Flashcards

Extra Flashcards

1
Q

Pain which is relieved on leaning forward

A

Pericarditic

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2
Q

Chest pain with tenderness

A

Suggests musculoskeletal

Eg. Tietzes syndrome - costochondritis and costosternal joint swelling

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3
Q

What lead is p wave normally inverted

A

AvR

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4
Q

What leads do you normally see q waves?

A

V5, V6, AvL and I

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5
Q

What leads do you normally have inverted t wave?

A

AvR, v1 and occasionally v2

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6
Q

Order of ECG changes in MI

A

First t wave becomes peaked and St segments begin to rise
Within 24hour t wave inverts and St elevation begins to resolve
Within a few days pathological q waves begin to develop

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7
Q

Leads affected in inferior infarct and the vessel

A

II, III, AvF

Right coronary

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8
Q

Leads and vessel affected in anteroseptal infarct

A

V1-v4

Left anterior descending

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9
Q

Anterolateral MI leads and vessel

A

V4-v6, I, AvL

Maybe Left circumflex left marginal

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10
Q

Posterior infarct

A

Tall R and St depression in v1-v2

Circumflex artery

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11
Q

What to do if patient has blood pressure >140/90

A

Offer abpm

Calculate cv risk and look for organ damage

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12
Q

If abpm shows

A

Normotensive therefore no treatment unless clear end organ damage or high CV risk

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13
Q

If abpm >135/85

A

Stage 1 hypertension

Therefore treat if cv >20%/10 years or end organ damage

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14
Q

If abpm >150/95

A

Stage 2 hypertension

Therefore great

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15
Q

If clinic blood pressure >180/110

A

Consider starting treatment immediately

Then do abpm

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16
Q

Who is more commonly affected by malignant hypertension

A

Young people and black people

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17
Q

Grading of hypertensive retinopathy

A

1) tortuous arteries with thick shiny walls - silver or copper wiring
2) AV nipping - narrowing where arteries cross veins
3) flame haemorrhages and cotton-wool spots
4) papilloedema

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18
Q

Treatment bp goal in diabetics

A

130/80

Non-diabetics - 140/90

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19
Q

Treatment BP if >80

A

150/90

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20
Q

Treatment BP if proteinuria

A

125/75

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21
Q

First BP medication if >55 or black or any age

A

calcium channel blocker eg. Amlodipine or nifidepine
or
thiazide diuretic eg,chlortalidone

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22
Q

First med if

A

Ace inhibitor eg. Lisinopril
Or
ARB if acei intolerant (cough) - candesartan

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23
Q

Dose of ace-I/arb

And of thiazide/calcium channel antagonist

A

Acei/arb - around 10-40

Thiazide or calcium around 25-60

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24
Q

If need more than 1 med

A

Add the other first line drug

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25
Q

If need 3 drugs or more

A

All 3 first line drugs

then add higher dose diuretic or another diuretic (spironolactone) or add b-blocker

26
Q

When is beta blocker recommended -what do you add as 2nd for them?

A

Not first line for HTN
Can consider if young person especially if intolerant of acei/arb or woman of child bearing potential
If need second one then add calcium channel blocker not a thiazide

27
Q

How long do blood pressure meds take to have effect

A

4-8 weeks

28
Q

Treatment of malignant hypertension?

A

Unless there is encephalopathy or CCF - oral therapy - atenolol or long acting calcium antagonist

Want to decrease BP over days not hours because cerebral auto regulation is poor

29
Q

How to treat malignant HTN if encephalopathy

A

Want to reduce diastolic to 110 over 4 hours
Furosemide 40-80mg IV
Then either labetalol or sodium nitroprusside infusion

30
Q

Pain of aortic dissection

A

Instantaneous, tearing and inter scapular

May be retrosternal

31
Q

When do you get tapping non-displaced apex beat?

A

Mitral stenosis

32
Q

When do you get a heaving non-displaced apex beat?

A

Aortic stenosis

33
Q

When do you get hyper dynamic displaced apex beat

A

Mitral and aortic regurge

34
Q

When do you get hoarseness, dysphasia and bronchial obstruction with heart murmur

A

Mitral stenosis because enlarged atrial pressing on structures

35
Q

Murmur best heard with patient on left side

A

Mitral stenosis

36
Q

Murmur radiates to axilla

A

Mitral regurge

37
Q

Mid-systolic click

A

Mitral prolapse

38
Q

Slow rising pulse or anacrotic pulse

A

Aortic stenosis

39
Q

Bisferiens pulse

A

Mixed aortic stenosis and regurge

40
Q

Bounding pulse

A

Co2 narcosis
Sepsis
Liver failure

41
Q

Jerky pulse

A

HOCM

Also double apex beat

42
Q

Collapsing pulse

A

Aortic regurge

43
Q

Aortic thrill

A

Aortic stenosis

44
Q

Murmur radiates to carotids

A

Aortic stenosis

45
Q

Double apex beat

A

HOCM

46
Q

Wide pulse pressure

A

Aortic regurge

47
Q

Narrow pulse pressure

A

Aortic stenosis

48
Q

Murmur best heard sitting forward

A

Aortic regurge

49
Q

Murmur for inspiration

A

Muffles left heart murmurs - best for hearing right heart murmurs

50
Q

Corrigans sign

A

Carotid pulsation

Aortic regurge

51
Q

De Mussets sign

A

Head nodding with heart rhythm

Aortic regurge

52
Q

Duroziezs sign

A

Groin with finger pressed over femoral artery

53
Q

Traubes sign

A

Pistol shot over femoral arteries

Aortic regurge

54
Q

Quinckes sign

A

Capillary pulsations in nail beds

55
Q

S4 gallop

A

Acute myocarditis

56
Q

S3 gallop

A

Dilated cardiomyopathy

57
Q

Murmur in HOCM

A

Harsh ejection systolic murmur

Thrill over lower left sternal edge

58
Q

Chest pain worse on lying flat - relief sitting up

A

Pericarditic

59
Q

Saddle shaped/concave St elevation

A

Pericarditis

60
Q

Pulsus paradoxus

A

Cardiac tamponade

Cardiology (9 decks)

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