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Year 5/6 > Medicine: Cardio > Flashcards

Medicine: Cardio Flashcards

1
Q

How would you present a murmur?

A

HS 1+2+Added

When, where, insp/exp, radiation, at least grade three

Indicates, ddx, ECG/echo

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2
Q

Which murmurs get louder on insp/exp?

A

RILE

Right sided w Insp + Left sided w Exp

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3
Q

List the four classic murmurs you hear

A

AS - ESM - lub whoosh dub

AR - EDM - lub durrr

MS - MDM - rrrlub dub

MR - PSM - lub oof dub

NB: HOCM also ESM + ASD also MDM

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4
Q

Which is worse a longer or louder murmur?

A

Longer > Louder

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5
Q

What are the differentials of aortic stenosis? (2)

A

Aortic Sclerosis
Pulmonary Stenosis

NB: if it radiates to the carotids stenosis > sclerosis

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6
Q

If the pt has aortic sten what should you advise?

A

Any chest pain, feeling faint, SOB come back to us

NB: also in order of worsening risk of mortality angina, syncope, dyspnoea

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7
Q

How would you present an ECG?

A

Pt details, date and time, calibration, rate, rhythm, axis, pqrst, overall impression

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8
Q

How many seconds are the small and large squares?

A

Small - 0.04s

Large - 0.2s

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9
Q

How can you calculate rate from the rhythm strip?

A
  1. Number of complexes in 10s x6

2. Divide 300 by number of big squares b/w R waves

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10
Q

How can the rhythm be described? (3)

A

Sinus, AF, Block

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11
Q

The quick method of testing for axis deviation

A

Use leads I+II and if the R waves:

Point away - leaving - LEFT

Point together - reaching - RIGHT

And if lead III is more neg think left vs more pos think right

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12
Q

Which p wave shows which atrial hypertrophy?

A

Bifid P mitrale - left atrial hypertrophy eg mitral stenosis/regurg

Peaked P pulmonale - right atrial hypertrophy eg tricuspid stenosis/regurg

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13
Q

How long should the PR interval be?

A

0.12-0.2s ie 3-5 small squares

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14
Q

Outline the different degrees of AV heart block

A

1st: prolong PR interval
2nd: Mobitz 1 - prolongation then dropped QRS + Mobitz 2 - constant PR and often wide QRS w occ dropped QRS
3rd: complete dissociation b/w p waves and QRS complexes

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15
Q

Which heart block is also called Wenckebach?

A

2nd Degree Mobitz I

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16
Q

Which heart block is also called Hay?

A

2nd Degree Mobitz II

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17
Q

Which Mobitz type is more likely to degenerate into 3rd degree?

A

Type 1

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18
Q

How long should the QRS complex be?

A

<0.12s ie <3 small squares

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19
Q

What does a narrow QRS suggest?

A

SVT

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20
Q

What does a broad QRS suggest?

A

BBB, VT, VF, WPW

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21
Q

Which BBB is more concerning?

A

A new LBBB is always pathological whereas RBBB could be a normal variant

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22
Q

S1Q3T3

A

Rare sign of PE w deep S in I, pathological Q in III, inverted T in III

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23
Q

Anteroseptal MI Leads

A

V1-V4

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24
Q

Anteroseptal MI Artery

A

LAD

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25
Q

Lateral MI Leads

A

V5-V6, I, aVL

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26
Q

Lateral MI Artery

A

Left Circumflex

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27
Q

Anterolateral MI Leads

A

V4-V5, I, aVL

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28
Q

Anterolateral MI Arteries

A

LAD + Left Circumflex = Left Coronary

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29
Q

Inferior MI Leads

A

II, III, aVF

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30
Q

Inferior MI Artery

A

Right Coronary

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31
Q

What else does the right coronary artery supply?

A

SA + AV Nodes

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32
Q

Posterior MI Leads

A

Global ST depression w dominant R waves in V1-V2

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33
Q

Posterior MI Arteries

A

Left Circumflex + Right Coronary

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34
Q

Comps of LCA v RCA occlusion

A

LCA - left ventricular failure + pericarditis

RCA - rhythm abnormalities

Plus aneurysm + PE

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35
Q

Immediate mx of a STEMI

A

MONAT + PCI/Thrombolysis

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36
Q

Tx of Pericarditis

A

NSAIDs

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37
Q

Tx of Complete Heart Block

A

Pacemaker

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38
Q

What are the ECG changes of left ventricular aneurysm?

A

Persistent ST Elevation

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39
Q

What are the ECG changes of PE?

A

No Changes

Sinus Tachycardia

RV Strain

Inverted T Waves

S1Q3T3

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40
Q

What med should pts be on following MI or stroke life long?

A

Aspirin

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41
Q

What does a saddled ST segment suggest? (2)

A

Pericarditis

Tamponade

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42
Q

What does a reverse tick ST segment suggest?

A

Digoxin Toxicity

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43
Q

Which leads is where T wave inversion is normal?

A

III, aVR, V1

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44
Q

Tx of AF

A

Unstable: A-E + DCCV

Stable: look for treatable causes (structural, thyroid, clot, infection, K/Mg/Ca) + ultimate tx is to mx risk of HF due to tachy and risk of stroke due to clot in LA

Risk of HF: Rate (β-blocker/CCB and digoxin) + Rhythm (DCCV or flecainide/amiodarone if structural heart disease)

Risk of Stroke: Anticoag (CHA2DS2-VASc + HAS-BLED) - start DOAC or warfarin 2wks after

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45
Q

Why do you tx the rate component of AF w beta blockade > digoxin?

A

Beta blockade allows the HR to change w exercise

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46
Q

Which drugs should you NOT give to AF + WPW pts?

A

Verapamil + Digoxin

Risk of sudden cardiac death in young pts

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47
Q

When would flecainide NOT be first line rx for rhythm control in AF?

A

There’s an underlying structural heart disease

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48
Q

When do you do rhythm > rate control first line?

A

Reversible cause, new onset <48hrs, more suitable based on clinical judgement, HF primarily caused by AF

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49
Q

When do you refer AF to the cardiologist?

A

Rhythm control is appropriate, rate control tx fails to control sx, ECG: WPW/LQTS, echo: valvular disease

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50
Q

What are the signs of heart failure on CXR?

A 
A - alveolar oedema
B - Kerley B lines
C - cardiomegaly
D - dilated UL vessels
E - pleural effusion
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51
Q

Which cardiac drugs can lead to gynaecomastia? (2)

A

Spironolactone + Digoxin

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52
Q

Which dysmorphic features suggest what cardiac disease?

A

Short stature: Turner (bicuspid aortic valve and coarctation), Noonan (pulm stenosis and HOCM), Down (AVSD, VSD, TOF)

Tall stature: Marfans (aortic regurg)

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53
Q

If the pulse is regularly regular, is the pulse sinus rhythm?

A

You can never tell if a pulse is sinus rhythm at the bedside unless you have an ECG w a p wave before every QRS complex

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54
Q

If the pulse is irregularly irregular, does the pt have AF?

A

Prbly but can’t say for sure w/o an ECG showing lack of p waves

Ddx: complete heart block and sinus rhythm w multiple ventricular ectopics

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55
Q

What are the four aspects of pulse? And where is volume measured?

A

Rate, Rhythm, Volume, Character

Rate + Rhythm - Radial

Volume + Character - Carotid

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56
Q

What is the carotid pulse like in AS?

A

Low volume and slow rising character

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57
Q

What are the causes of a RR delay? (2)

A

Coarctation of Aorta

Blalock-Taussig Shunt

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58
Q

What does a tapping apex beat always suggest?

A

Mitral Stenosis

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59
Q

What causes a hyperdynamic apex beat? (2)

A

Pressure Loaded - severe HTN, AS, HOCM - LV hypertrophy

Volume Loaded - MR and AR - LV dilatation

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60
Q

What causes an impalpable apex beat? (5)

A

DOPES

Dextrocardia
Obesity
Pericardial Effusion
Emphysema
Shock
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61
Q

Ddx of an ESM

A

Any systolic murmur but if specifically ejection systolic: aortic stenosis, aortic sclerosis, HOCM

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62
Q

Typical HOCM pt

A

PC: exertional lightheadedness +/- syncope

FHx: SCD in middle age

O/E: jerky carotid pulse, double apical impulse, ESM

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63
Q

What is the inheritance pattern of HOCM?

A

Autosomal Dominant

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64
Q

When does the ESM in HOCM pts get louder?

A

Valsalva

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65
Q

When does the ESM in HOCM pts get quieter?

A

Squatting

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66
Q

What is a/w HOCM?

A

WPW + Friedrich’s Ataxia

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67
Q

What is pathognomonic of HOCM on an echo?

A

Systolic anterior motion of the anterior mitral valve leaflet

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68
Q

Tx of HOCM

A

M: beta blockers and negatively inotropic CCB

S: ICD, myomectomy, alcohol septal ablation

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69
Q

The main causes of AS (2)

A

Younger - bicuspid aortic valve

Older - degenerative calcification

PLUS Rheumatic heart disease

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70
Q

What ausc gives away a bicuspid aortic valve?

A

Ejection systolic click

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71
Q

What usually coexists w bicuspid aortic valve?

A

Coarctation

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72
Q

Mx of AS

A

Sx or severe ie echo gradient >50mmHg = surgery

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73
Q

What is Heyde’s syndrome?

A

Angiodysplasia in aortic stenosis due to an acquired deficiency of vWF caused by areas of high shear stress

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74
Q

What is the definitive tx for Heyde’s syndrome?

A

AVR

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75
Q

Comps of valve replacement (5)

A

FIBAT

Failure
Infection
Bleeding
Anaemia
Thromboembolism
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76
Q

The main causes of AR (3)

A

Leaflets don’t work (endocarditis, bicuspid, HTN) or work but don’t meet in the middle (aortitis a/w syphilis and ank spond) and connective tissue disease

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77
Q

Eponymous signs of aortic regurg (5)

A

Quincke’s Sign: capillary pulsation in the nail beds

DeMusset’s Sign: head nodding w systole

Corrigan’s Sign: big neck pulses

Traube’s Sign: pistol shot femorals

Duroziez’s Sign: to and fro double murmur over femoral artery when pressure is applied distal to site of ausc

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78
Q

Sx and signs of severity in aortic regurg

A

Sx - angina + SOBOE

Signs - wide pulse pressure, displaced apex, CCF

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79
Q

Mx of AR

A

Acute - emerg surgery

Chronic - afterload reduction

NB: again like AS if sx or echo criteria (end systolic diameter >55mm, aortic root dilatation >50mm, ejection fraction <50%) consider valve replacement

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80
Q

What does polycythaemia inc your risk of? (2)

A

Gout + VTE

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81
Q

Which ventricle dilates in VSD?

A

Left because during diastole blood enters the LV from both the LA and RV

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82
Q

What are VSD pts at risk of?

A

Endocarditis

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83
Q

Tx of VSD

A

Percutaneous Amplatzer device insertion or open heart surgery

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84
Q

If a pt has a stroke following a DVT instead of a PE what does this elude to?

A

PFO + ASD

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85
Q

Which ASD is more common?

A

Secundum > Primum

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86
Q

Which murmur is heard if a pt has an ASD?

A

MDM + fixed split S2 that doesn’t change w respiration

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87
Q

What are ASD pts at risk of?

A

AF + Paradoxical Emboli

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88
Q

Ix for ASD

A

ECG RBBB + Bubble Echo

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89
Q

Which syndrome is TOF a/w?

A

DiGeorge 22q11

90
Q

Ddx of a MDM

A

Anything that obstructs the mitral orifice: MS, LA thrombus, atrial myxoma, Carey-Coombs murmur (mitral valvulitis)

PLUS TS and Austin-Flint murmur (severe AR)

91
Q

Typical mitral stenosis pt

A

PC: preg lady recurrently worsened SOBOE and orthopnea

PMHx: recurrent pharyngitis + AF

O/E: malar flush, low-normal BP, tapping apex beat, loud and palpable first HS, rumbling MDM

92
Q

Causes of MS (2)

A

Rheumatic fever, abs to group A beta haemolytic strep, 2-3wks after pharyngitis

Carcinoid syndrome, right sided valvular stenosis due to elevated serotonin production, left sided valvular stenosis due to lung mets

93
Q

Mx of MS (ECG + Rx)

A

ECG: AF +p mitrale in lead II

Rx: of the AF + valvuloplasty if valve leaflets pliable and uncalcified or closed/open valvotomy

94
Q

Comps of MS (3)

A

AF

Pulm HTN -> cor pulmonale

LA enlargement -> Ortner’s syndrome

95
Q

What is cor pulmonale?

A

Enlargement and failure of the RV due to pulm stenosis or pulm HTN

96
Q

Why can you get a hoarse voice w mitral stenosis? And what syndrome is this called?

A

The LA enlargement compresses the recurrent laryngeal nerve resulting in Ortner’s syndrome

97
Q

What is S1? LUB

A

Closure of mitral and tricuspid valves denoting the start of systole

98
Q

What is S2? DUB

A

Closure of aortic and pulm valves denoting the start of diastole

99
Q

What is S3? KEN-TU-CKY

A

Rapid ventricular filling: MR + HF

Normal/Abnormal

100
Q

What is S4? TE-NNE-SSEE

A

The atrial contract against a stiff ventricle: AS + HTN

Always Abnormal

101
Q

How is Rheumatic fever diagnosed?

102
Q

What are the Duckett-Jones criteria?

A

Require 2 major OR 1 major and 2 minor

Major: Carditis, migratory flitting polyArthritis, Sydenham’s chorea, Erythema marginatum, Subcutaneous nodules

Minor: raised ESR, raised WCC, prolonged PR interval, arthralgia, pyrexia, prev RF

103
Q

How is Rheumatic fever treated?

A

High dose aspirin + penicillin V

NB: use clindamycin if penicillin allergic

104
Q

What is Takotsubo’s cardiomyopathy?

A

A catecholamine mediated myocardial stunning resulting in transient LV impairment that will fully recover in ~1w

Typically presentation is chest discomfort and SOB in post menopausal woman following bout of emotional stress

No RFs, rise in trop and ant stemi on ECG, unobstructed coronaries on emerg angiogram

105
Q

Do you get a trop rise in cardiac syndrome X?

106
Q

What is the Vaughan Williams classification of anti-arrhythmic drugs?

A

Class I: sodium channel blockers - procainamide, lidocaine, flecainide

Class II: beta blockers - bisoprolol + propranolol

Class III: potassium channel blockers - amiodarone + sotalol

Class IV: calcium channel blockers - verapamil + diltiazem

107
Q

What are the five types of MI?

A

I: impaired blood flow to myocardium, plaque rupture, revascularise

II: imbalance b/w O2 supply and demand, inc risk of VF and type I, tx underlying disease eg HR, BP, sepsis

III: MI resulting in death when biomarker values are unavailable

IV: MI related to PCI or stent thrombosis

V: MI related to CABG

108
Q

What does prolonged ST elevation in several leads w/o Q waves in a young pt suggest?

A

Pericarditis

109
Q

What are the ECG findings of WPW? (3)

A

Shortened PR interval, delta wave, prolonged QRS complex

110
Q

What are the top cause of AF?

A

IHD + RHD

Plus reversible causes: thyrotoxicosis, PE, excess alcohol/caffeine

111
Q

What are the CXR findings of a pt w mitral stenosis? (2)

A

Enlarged left atrium + scattered dense opacities

112
Q

What are the doses in MONAT?

A

Diamorphine IV 2.5-5mg

Aspirin PO 300mg -> 75mg OD lifelong

Ticagrelor PO 180mg -> 90mg BD 12mnths

113
Q

Comps of MI

A

FAM: failure (LCA), arrhythmias (RCA), murmurs (MR + VSD)

Plus: aneurysm, pericarditis, PE

114
Q

What are the ECG findings of left ventricular aneurysm?

A

Persistent ST Elevation

115
Q

What are the ECG findings of a PE?

A

Normal ECG

Sinus Tachycardia

Right Ventricular Strain

Inverted T waves in V1-4

S1Q3T3 + Right Axis Deviation

116
Q

Tx of SVT

A
  1. Vagal stimulation: carotid sinus massage + valsalva manoeuvre
  2. Adenosine IV 6-12-12mg
  3. Monitor ECG continuously
117
Q

What are the Jones criteria for acute rheumatic fever?

A

Evidence of recent group A strep infection plus two major or one major two minor

Major: carditis, arthritis, s/c nodules, erythema marginatum, sydenham’s chorea

Minor: prolonged PR interval, arthralgia, raised ESR, fever, hx of rheumatic fever

118
Q

What valves problems are common in chronic rheumatic heart disease?

119
Q

Ddx of ARF

A

Carditis: infective endocarditis, cardiomyopathy, Kawasaki disease

Arthritis: reactive, JIA, HSP

Erythema: multiforme, migrans, adverse drug reactions

Chorea: Wilson’s + Huntington’s

120
Q

CHA2DS2-VASc

A

Congestive HF, HTN, age >74, diabetes, stroke, vasc disease, age 65-74, sex=female

121
Q

What should you do if the CHA2DS2-VASc score is >=2?

A

Start pt on warfarin or DOAC

If the score is 1 for male consider and 1 for female none is needed

122
Q

HAS-BLED

A

HTN, abnormal liver +/or renal function, stroke, bleeding hx, labile INR, elderly >65, drugs +/or alcohol

123
Q

What should you do if the HAS-BLED score is >=3?

A

Alternatives to anticoag should be considered as pt is at high risk of major bleeding

124
Q

Which rhythms are shockable?

A

VF + Pulseless VT

125
Q

Which rhythms are non-shockable?

A

PEA + Asystole

126
Q

What will the MRI show if alcoholic DCM is fully reversible?

A

No mid-wall fibrosis

127
Q

When would you consider CRT in heart failure pts?

A

EF <35% + QRS >120ms

128
Q

What BNP excludes heart failure in the acute setting?

129
Q

What are other causes of a raised BNP?

A 
Pulm HTN
Pneumonia
Pulm Embolus
Renal Failure
Sepsis
130
Q

What are other causes of a raised troponin?

A

Infection
Inflammation
Malignancy

131
Q

Which ECG lead colours go where?

A

Ride Your Green Bike: right arm red, left arm yellow, left leg green, right leg black

132
Q

Where do you commonly find reciprocal ST depression in a STEMI?

A

The next letter along in PAILS: posterior, anterior, inferior, lateral, septal

133
Q

What gives you a double impulse apex?

134
Q

What are the Brugada criteria used for?

A

VT vs SVT w Aberrancy

If there’s absence of an RS complex in all precordial leads, R-S >100ms in one precordial lead, AV dissociation or morphology criteria for VT in V1-2 and V6 then VT > SVT

135
Q

Tx of Cardiac Tamponade

A

Pericardiocentesis

136
Q

What affects the apex beat position?

A

YES - dilatation caused by volume overload: AR, MR, ASD/VSD

NO - concentric hypertrophy caused by pressure overload: AS, HTN, coarctation of aorta

137
Q

What are the causes of a dominant R wave in leads V1-2?

A

PPRRDDWPW

Posterior MI
PE
RVH
RBBB
Dextrocardia
Duchenne
WPW
138
Q

What are the causes of cardiomyopathy?

A

Hypertrophic: autosomal dominance inheritance

Restrictive: SHAPE - sarcoidosis, haemochromatosis, amyloidosis, primary endomyocardial fibrosis, endocarditis

Dilated: DILATE - dystrophy, infection, late preg, AI, toxins, endocrine

139
Q

What are the Framingham criteria used for?

A

Dx of CCF: two major OR one major + two minor

140
Q

What should you suspect if the creatinine starts shooting up after starting ACEi?

A

Renal Artery Stenosis

141
Q

Which beta blocker has anti arrhythmic properties?

142
Q

Why do we worry about non-sustained VT?

A

NSVT -> Sustained VT

143
Q

Mx of Hyperlipidaemia

A
  1. Lifestyle
  2. Atorvastatin
  3. Ezetimibe
  4. Alirocumab
144
Q

When should you stop statins? (2)

A

If inc CK >10 fold OR AST >100U/L

145
Q

Ix for IE

A

Blood Cultures x3 + TOE

Plus: urinalysis, ECG, CXR

146
Q

What axis deviation is seen in WPW syndrome?

147
Q

Which electrolyte abnormality can cause a long QT interval?

148
Q

Which drug in the tx of hypertension can cause angioedema?

149
Q

TdP

A

PVT + QT Prolongation

150
Q

How are the precordial leads classified?

A

V1-2: Septal
V3-4: Anterior
V5-6: Lateral

151
Q

What other leads would show changes in an anterolateral STEMI?

A

Maximal ST elevation in V3-6, I, aVL

Reciprocal ST depression in III + aVF

152
Q

What would shock and a new systolic murmur suggest post-MI?

A

Development of VSD

153
Q

Which meds are CI in a shocked pt?

A

Beta blockers + thrombolysis

154
Q

Ddx of systolic murmur

A 
AS
PS
HOCM
ASD
TOF

MR
TR
VSD

Mitral valve prolapse
Coarctation of the aorta

155
Q

Ddx of diastolic murmur

A

AR
Graham-Steel

MS
Austin-Flint

Patent ductus arteriosus

156
Q

Immediate mx of STEMI

A

Cardiac monitor, MONAT, PCI +/- stent

157
Q

Which coronary artery is the culprit vessel for each territory?

A

Anterior + Lateral - LAD

Lateral + Posterior - LCX

Inferior - RCA

158
Q

What does MONAT stand for?

A

IV Diamorphine 5mg

IV Metoclopramide 10mg

High Flow O2 if low sats

Sublingual GTN spray

PO Aspirin 300mg

PO Ticagrelor 180mg

159
Q

What are the NICE guidelines for the secondary prevention of MI?

A

Aspirin 75mg OD

Ticagrelor 90mg BD

Ramipril up to 10mg OD

Bisoprolol up to 10mg OD

Atorvastatin 80mg OD

160
Q

What is usually performed in pts prior to undergoing aortic valve replacement?

A

Trip to cathlab for a catheter coronary angiogram to establish any underlying ischaemia

161
Q

Most common aetiology in young/old for AS

A

Young - Bicuspid

Older - Degenerative

162
Q

What are the acute signs on CXR of pulm oedema?

A

The same as HF

163
Q

How does mitral regurg often px?

A

Palps, SOB, fatigue

164
Q

What are the clinical signs of MR?

A

Pansystolic murmur at the apex radiating to the axilla, displaced hyperdynamic apex, AF

165
Q

What is mitral facies a/w?

A

Mitral Stenosis

166
Q

Causes of sinus bradycardia (8)

A

Aerobic training, vagal stimulation, MI, beta blockers, hypothyroidism, hypothermia, raised ICP, infection

167
Q

List three infections that cause bradycardia

A

Legionnaire’s disease, Lyme disease, typhoid fever

168
Q

What is hypocalcaemia a/w?

A

Prolonged QT interval

169
Q

What is the usual mode of death in HOCM?

A

Arrhythmia

170
Q

Sx of HOCM

A

Asx OR
Angina
Dyspnoea
Syncope

171
Q

Mx of HOCM

A

Beta blockers, CCBs, amiodarone - implantable defibrillator - surgery

172
Q

What are CIs for thrombolysis?

A

AGAINST: aortic dissection, GI bleeding, allergic reaction prev, iatrogenic recent surgery, neuro stroke or malignancy, severe HTN, trauma

173
Q

Ejection Systolic Murmurs

A

AS, PS, HOCM, ASD, TOF

174
Q

Pansystolic Mumurs

A

MR, TR, VSD

175
Q

Late Systolic Murmurs

A

Mitral valve prolapse + coarctation of the aorta

176
Q

Early Diastolic Murmurs: ‘Blowing’

A

AR + Graham-Steel (PR)

177
Q

Mid-Late Diastolic Murmurs: ‘Rumbling’

A

MS + Austin-Flint (AR)

178
Q

Continuous Machine-Like Murmur

A

Patent ductus arteriosus

179
Q

Tx of bradycardia

A

If shock, syncope, MI or HF commence IV atropine 500mcg

180
Q

How many doses of atropine are given w no improvement before starting external pacing when tx bradycardia?

181
Q

What is HOCM a/w? (2)

A

WPW + Friedrich’s Ataxia

182
Q

What does the ECG of WPW look like?

A

Short PR (<120ms), wide QRS (>120ms), upsloping delta wave

183
Q

What inc/dec the ESM in HOCM?

A

Inc - Valsalva + Dec - Squatting

184
Q

What should you monitor before/during ACEi tx and what is acceptable?

A

Renal function w inc in creatinine up to 30% and electrolytes w inc in potassium up to 5.5mmol/L

185
Q

ACEi SEs (4)

A

Cough
Angioedema
Hyperkalasmia
First dose hypotension

186
Q

What are the variants of long QT syndrome?

A

LDT1 - exertional syncope

LQT2 - emotional stress

LQT3 - at night or rest

187
Q

Name two congenital causes of a prolonged QT interval

A

Jervell-Lange-Nielsen (inc deafness) + Romano-Ward Syndrome (no deafness)

188
Q

What abx classes can prolong the QT interval? (2)

A

Macrolides + Fluoroquinolones

189
Q

Which electrolyte abnormalities can prolong the QT interval? (3)

A

HypoCa, HypoK, HypoMg

190
Q

Mx of Aortic Dissection

A

A - ascending - control BP and surgery

B - descending - control BP

191
Q

DeBakey Classification

A

Aortic Dissection:
I - originates in ascending aorta + propagates to at least the arch

II - originates in + is confined to the ascending aorta

III - originates in descending aorta + can extend distally>proximally

192
Q

New onset AF w structural heart disease tx

A

Amiodarone

193
Q

WPW Px

A

Tachy, Palps, Dizziness

194
Q

FA Px

A

Weakness, poor coordination, hearing impairment

195
Q

Bi/Trifascicular Blocks

A

Bi: RBBB + LAD

Tri: above + 1DHB

196
Q

Buerger’s Disease Px

A

Young male smoker w intermittent claudication, ischaemic ulcers, superficial thrombophlebitis, Raynaud’s phenomenon

197
Q

How does LQTS commonly px?

A

Young person w cardiac syncope, palps, tachyarrhythmias, arrest

198
Q

Tx for massive PE + hypotension

A

Thrombolyse

199
Q

HF Drug Mx

A
  1. ACEi + β-blocker
  2. Aldosterone Ant

PLUS one off pneumoococcal and annual influenza vaccines

200
Q

When should you commence anticoag for a pt w AF + acute stroke? Why?

A

2wks after due to the risk of haemorrhagic transformation

201
Q

When would you surg tx aortic stenosis?

A

One of: symptomatic, gradient >40mmHg and LV systolic dysfunction, coexisting CVD

202
Q

When is balloon valvuloplasty performed in pts for aortic stenosis?

A

If critical and not fit for valve replacement

203
Q

What are the stages of HTN?

A
  1. Clinic >140/90 and subsequent ABPM/HBPM avg >135/85
  2. Clinic >160/100 and subsequent ABPM/HBPM >150/95
  3. Clinic SBP >180 or DBP >110
204
Q

Mx of HTN

A

Confirm dx w subsequent ABPM or HBPM readings

Identify and tx any RFs w lifestyle modifications and cause eg renal failure and hypothyroidism

Drug tx depending on their age, ethnicity, diabetes status: <55 or T2DM vs >55 or Afro Caribbean

If they reach step 4 the drug choice depends on if K above/below 4.5mmol/L

Regular monitoring for efficacy and SEs

205
Q

When is oxygen given to pts in the initial mx of ACS?

206
Q

What are the STEMI criteria?

A

Clinical sx w >20mins ECG features: 2.5mm in V2-3 men <40yo, 2.0mm in V2-3 men >40yo, 1.5mm in V2-3 women, 1.0mm in other leads, new LBBB

207
Q

Mx of STEMI

A

Identify + Aspirin 300mg

If PCI possible within 120mins give praugrel + PCI

If PCI not possible within 120mins give antithrombin + fibrinolysis then repeat ECG @ 60-90mins

208
Q

Mx of NSTEMI + Unstable Angina

A

Identify + Aspirin 300mg

If no immediate PCI planned give fondaparinux

If GRACE score high risk offer PCI within 72hrs and give antipl + unfractionated heparin

If GRACE score low risk give ticagrelor

209
Q

What med changes should you make in mx of ACS if pt is at high risk of bleeding or already on oral anticoags?

A

Swap praugrel/ticagrelor for clopidogrel

210
Q

What are the features of Buerger’s disease?

A

Strongly a/w smoking

Extremity ischaemia, superficial thrombophlebitis, Raynaud’s phenomenon

211
Q

What is the adrenaline dose for cardiac arrest?

A

IV 1mg given as 10mls of 1:10,000 solution + followed by 20mls of 0.9% NaCl

212
Q

What is the adrenaline dose for anaphylaxis?

A

IM 0.5mg given as 0.5mls of 1:1,000 solution

213
Q

What is HOCM a/w? (2)

A

Friedreich’s Ataxia + WPW

214
Q

What are the echo findings in HOCM? (3)

A

MR SAM ASH

Mitral Regurg

Systolic Ant Motion

Asymmetric Hypertrophy

215
Q

Ddx of ST Elevation

A

MI, pericarditis, high take off, LV aneurysm, Prinzmetal’s angina

216
Q

What are the common causes of IE?

A

Strep viridans, staph aureus (IVDU), staph epidermidis (prosthetic valves)

217
Q

Comps of MI

A

Immediate: VF, VT, heart block

Early: rupture of septum -> cardiogenic shock, papillary muscle -> acute MR, free wall -> tamponade

Late: LV aneurysm -> stroke, chronic HF, pericarditis

218
Q

Why should a beta blocker NOT be co presc w verapamil?

A

Risk of complete heart block

219
Q

What can be done to red the risk of nitrate tolerance on standard release?

A

Use an asymmetric dosing interval to maintain a daily nitrate free time of 10-14hrs

220
Q

What are the BP targets for T1DM and T2DM?

A

T1: <135/85

T2: <140/90

Year 5/6 (20 decks)

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