Miscellaneous Cardiology Flashcards

Question

Restrictive cardiomyopathy

Answer 1

Amyloidosis Post radiotherapy Loefflers endocarditis Beriberi

Answer 2

ABCDE Amiodarone Beta blocker or verapamil for Sx Cardiovertee defibrillator Dual chamber pacemaker Endocarditis prophylaxis (not always) Avoid- nitrates, ACE-I, inotropes

Answer 3

Thrombus Infective endocarditis (staphylococcus) Haemolysis (anaemia)

Answer 4

Symptomatic bradycardia Mobitz type 2 AV block Third degree heart block Severe heart failure HOCM (ICD)

Answer 5

Sharp vertical line before all leads on the trace

Answer 6

A line before either the P or the QRS complex

Answer 7

A line before either the P or the QRS

Answer 8

Vitamin K and PCC

Answer 9

Apixaban/rivaroxaban- andexanet alpha Dabigatran- idarucizumab

Answer 10

0- no anticoagulation 1- consider anticoagulation 2- offer anticoagulation

Answer 11

TFT LFT UE CXR

Answer 12

a form of inherited cardiovascular disease which may present with syncope or sudden cardiac death.

Answer 13

ECG abnormalities in V1-3, typically T wave inversion. An epsilon wave is found in about 50% of those with ARV - this is best described as a terminal notch in the QRS complex echo changes are often subtle in the early stages but may show an enlarged, hypokinetic right ventricle with a thin free wall magnetic resonance imaging is useful to show fibrofatty tissue

Answer 14

drugs: sotalol is the most widely used antiarrhythmic catheter ablation to prevent ventricular tachycardia implantable cardioverter-defibrillator

Answer 15

Uses- ALS and VTach MOA- blocking potassium channels SE's- hypo and hyperthyroid, fibrosis (lung and liver), neuropathy, grey skin, increased QT interval

Answer 16

Uses- SVT MOA- causes transient heart block in the AV node, and is an agonist of the A1 receptor in the atrioventricular node SE's- avoid in asthmatics, chest pain, bronchospasm transient flushing (sense of heart stop & impending doom), can enhance conduction down accessory pathways, resulting in increased ventricular rate (e.g. WPW syndrome)

Answer 17

Bradycardia SE's- anticholinergic

Answer 18

VSD (more common) ASD (most common new diagnosis in adults- present later) PDA Coarctation of aorta Aortic valve stenosis

Answer 19

Teratology of Fallot Transposition of the great arteries (TGA) Tricuspid atresia

Answer 20

VSD RVH RV outflow tract obstruction, pulmonary stenosis Overriding aorta

Answer 21

Most common cause of congenital cyanotic heart disease, although as it presents at 1-2 months, TGA is more common at birth Cyanosis Right to left shunt Systolic murmur Right sided aortic arch (25% patients) Boot shaped heart X ray, ECG- RVH Surgical repair (2 parts, beta blockers)

Answer 22

caused by diastolic filling of the ventricle considered normal if < 30 years old (may persist in women up to 50 years old) heard in left ventricular failure (e.g. dilated cardiomyopathy), constrictive pericarditis (called a pericardial knock) and mitral regurgitation

Answer 23

Causes- recent cardiac surgery, any cause of pericarditis, particularly TB Features; dyspnoea right heart failure: elevated JVP, ascites, oedema, hepatomegaly JVP shows prominent x and y descent pericardial knock - loud S3 Kussmaul's sign is positive (a paradoxical rise in JVP during inspiration) NB- pericardial calcification on CXR

Answer 24

JVP: tamponade, only X (tamponade tampaX), pericarditis, X & Y Pulsus parodoxus (fall in BP >10 during inspiration): tamponade, present, pericarditis, absent Kussmaul's sign: tamponade, rare, pericarditis, present CXR calcification- constrictive pericarditis

Answer 25

Normal variants on the ECG: -Sinus arrhythmia -Right axis deviation (tall and thin individuals) -Left axis deviation (short, obese individuals) -Partial right bundle branch block Athletes often have a high vagal tone which results in additional normal variants: -Sinus bradycardia -1st degree atrioventricular block -Wenckebach phenomenon (2nd degree atrioventricular block Mobitz type 1) -Junctional escape rhythm NB- LBBB is never a normal variant

Answer 26

No systolic (outflow) problem, but a diastolic (backlog) problem

Answer 27

Both diastolic and systolic dysfunction

Answer 28

surgical AVR is the treatment of choice for young, low/medium operative risk patients. Cardiovascular disease may coexist. For this reason, an angiogram is often done prior to surgery so that the procedures can be combined transcatheter AVR (TAVR) is used for patients with a high operative risk balloon valvuloplasty may be used in children with no aortic valve calcification in adults limited to patients with critical aortic stenosis who are not fit for valve replacement

Answer 29

Cardiogenic Shock: e.g. MI, valve abnormality increased SVR (vasoconstriction in response to low BP) increased HR (sympathetic response) decreased cardiac output decreased blood pressure Hypovolaemic shock: blood volume depletion e.g. haemorrhage, vomiting, diarrhoea, dehydration, third-space losses during major operations increased SVR increased HR decreased cardiac output decreased blood pressure Septic shock: occurs when the peripheral vascular dilatation causes a fall in SVR similar response may occur in anaphylactic shock, neurogenic shock reduced SVR increased HR normal/increased cardiac output decreased blood pressure

Answer 30

used for rate control in the management of atrial fibrillation. As it has positive inotropic properties it is sometimes used for improving symptoms (but not mortality) in patients with heart failure MOA; 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 Monitoring; digoxin level is not monitored routinely, except in suspected toxicity if toxicity is suspected, digoxin concentrations should be measured within 8 to 12 hours of the last dose

Answer 31

Toxicity; Toxicity may occur even when the concentration is within the therapeutic range. Features; generally unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green vision arrhythmias (e.g. AV block, bradycardia) gynaecomastia Precipitating factors 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 increasing age renal failure myocardial ischaemia hypomagnesaemia, hypercalcaemia, hypernatraemia, acidosis hypoalbuminaemia hypothermia hypothyroidism drugs: amiodarone, quinidine, verapamil, diltiazem, spironolactone (competes for secretion in distal convoluted tubule therefore reduce excretion), ciclosporin. Also drugs which cause hypokalaemia e.g. thiazides and loop diuretics Management; Digibind correct arrhythmias monitor potassium

Answer 32

Atrial fibrillation with bundle branch block is the most likely cause of an irregular broad complex tachycardia in a stable patient

Answer 33

The following are risk factors for asystole. Even if there is a satisfactory response to atropine specialist help is indicated to consider the need for transvenous pacing: complete heart block with broad complex QRS recent asystole Mobitz type II AV block ventricular pause > 3 seconds

Answer 34

5 types Cardiogenic Hypovolaemic Neurogenic Anaphylactic Septic All cause hypotension and tachycardia, except neurogenic which causes hypotension and bradycardia C/H shock cause increased SR A/S shock cause decreased SR