MLA Cardiology Flashcards
What is a Q wave on an ECG?
A negative deflections before the QRS complex
It’s a sign of present/ old MI
What does ST elevation indicate?
A complete occlusion of the epicardial coronary artery
An NSTEMI is a partial occlusion
What is primary percutaneous intervention (PCI)?
AKA angioplasty with stent
- It opens up the coronary arteries
What is unstable angina?
When there is no evidence of myocardial damage or raised troponin yet the patient will suffer with:
- prolonged (>20 minutes) angina at rest
- new onset of severe angina
angina that is increasing in frequency, longer in duration, or lower in threshold
- angina that occurs after a recent episode of myocardial infarction
What is peripheral arterial disease?
A build-up of fatty deposits in the arteries restricts blood supply to leg muscles
When does screening for AAA begin?
When the man turns 65
What are key symptoms of an AAA?
Pulsing in the stomach
Nausea/vomiting
clammy skin
What are the key symptoms of an aortic dissection?
A sudden severe pain felt mostly at the back between the shoulder blades
What is the presentation of aortic stenosis disease on examination?
(Left heart disease)
Reduced S2
Ejection systolic murmur, loudest at aortic area
Radiates to the carotids
What is the presentation of mitral regurgitation of examination?
(Right heart disease)
Pansystolic murmur, loudest at mitral area
Radiates to the axilla
What is the most common valve disease?
Mitral valve regurgitation
What are some causes of aortic valve disease?
Rheumatic fever
Endocarditis
Marfan syndrome
Syphilis
Rheumatoid arthritis
Systemic lupus erythematosus, Ankylosing spondylitis
High blood pressure
What are some causes of mitral valve disease?
Age
Rheumatic fever
Autoimmune disease like SLE
Endocarditis
MI’s
What are arterial ulcers?
Usually occur in legs and feet due to inadequate blood flow
What is the difference between essential and secondary hypertension?
Essential: no cause
Secondary: clear, fixable cause
What are some presentations of heart failure?
SOB on activity/ laying flat
Fatigue
Oedema
How does haemochromatosis affect the heart?
The excess iron can build up and damage the muscles and vessels to cause heart failure and arrhythmias
How is haemochromatosis diagnosed?
Iron studies
Abnormal liver enzymes
What is the pathophysiology of myocarditis?
When the heart muscle becomes inflamed
Caused by common infections
What is pericardial disease?
Inflammation of the sac that contains the heart
Usually goes away by itself, but can be life threatening
Caused by common infections
What is the classic presentation of a PE?
Abrupt onset of pleuritis chest pain, SOB, and hypoxia
What is pleuritic chest pain?
Pain on inspiration
What are some causes of pulmonary hypertension?
Heart failure
PE
HIV
Autoimmune damage to the lungs
What type of stroke is most common?
Ischaemic stroke (80%)
How does atrial fibrillation present on ECG?
Irregularly irregular with no P waves
What is atrial flutter?
When the atria beat too quickly
Caused by hight bp, congenital, lung disease, thyroid disease, diabetes, alcoholism
How does atrial flutter present on an ECG?
Flutter lines with no isoelectric lines between QRS complexes
‘saw-tooth’ pattern
What is AV node re-entrant tachycardia (AVNRT)?
An arrhythmia caused by a re-entry circuit confined to the AV node and perinodal atrial tissue
A type of supraventricular tachycardia
What are the different types of supraventricular tachycardia?
Focal:
- Sinus
- Atrial
- Multifocal atrial
- functional
Re-entry:
- Atrial flutter
- Atrial fibrillation
- AVNRT
- Atrio-ventricular
What is the management of focal tachycardias?
Treat with meds like beta-blockers, ivabradine, or calcium channel blockers
Or treat cause like sepsis
How are re-entry tachycardias managed?
Rate or rhythm control with meds like beta-blockers, calcium channel blockers, digoxin, amiodarone, or flecainide
Offer ablation for cure
What is the clinical presentation of a supraventricular tachycardia?
Anxiety, palpitations, chest discomfort, light-headedness, syncope, dyspnoea
What is a ventricular tachycardia?
High HR that prevents blood from circulating to the body and can cause death by cardiac arrest
How does ventricular fibrillation present on an ECG?
Disorganised electrical activity with no identifiable QRS complexes
It will develop into asystole if not treated
What is pulseless ventricular tachycardia?
When the contractions of the heart are so rapid that the heart doesn’t have time to fill causing an undetectable pulse
It’s a shockable rhythm
What is Torsade de pointes?
A type of ventricular tachycardia characterised by long QT interval
Usually caused by electrolyte imbalances
What causes heart block?
AV node blocking drugs like beta-blockers, calcium channel blockers, and digoxin
Or idiopathic degeneration of the conducting system
What are the different types of heart block?
1st degree: consistent PR interval >0.20s
2nd degree type 1: progressive PR interval prolongation until a QRS is dropped
2nd degree type 2: consistent PR interval with intermittently dropped QRS
3rd degree: no communication between atria and ventricles
What is the clinical presentation of heart block?
first degree and 2nd type 1 are usually asymptomatic
second degree and 3rd may present with palpitations, syncope, confusion, SOB, chest pain
What is the management of heart block?
- Stop AV node blocking drugs
- If symptomatic, may require pacemaker insertion
3rd degree urgently requires pacing or permanent pacemaker
What is sick sinus syndrome?
Causes a slow HR and pauses or irregular beats
Requires a permanent pacemaker
What are the different types of heart failure?
Systolic (reduced ejection fraction)
- Muscle is too weak to pump enough blood
Diastolic (preserved ejection fraction)
- muscle is too stiff to relax and fill with blood
What is the clinical presentation of pericarditis?
Pain centrally or on left
Worse on coughing, lying down, or taking a deep breath
What are some causes of pericarditis?
Infection (normal + HIV,TB)
Autoimmune (lupus, rheumatoid arthritis)
Meds like blood thinners
Cancer
Immune mediated
