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Cardiovascular JC > Week 5 > Flashcards

Week 5 Flashcards

1
Q

What is acute coronary syndrome?

A

Any acute presentation of coronary artery disease e.g angina, MI

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2
Q

How can ACS occur?

A

Due to rupture of the atheromatus plaque, from lipid content of plaque, thickness of fibrous cap, change in pressure, twisting of arteries, mechanical injury

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3
Q

Man presents acutely with MI what is your treatment?

A

MONA T

Morphine (antiametic)
Oxygen
Nitrates (GTN)
Aspirin (300mg)

Ticagrelor

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4
Q

Man presents with ST elevation MI, its been less than 20 minutes, what is the treatment?

A

MONA plus T

Coronary angioplasty

If more than 4 hours give thrombolysis

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5
Q

Man presents with non-ST elevation MI, treatment?

A

Mona plus T

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6
Q

In the capillaries what is the main starling force that governs entry and exit of materials from capillary to lumen?

A

Outwards; capillary hydrostatic pressure (result of BP in capillary)

Inwards; capillary osmotic pressure (due to pressure of plasma proteins in the blood)

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7
Q

What are some of the causes of left sided heart failure?

A

Ischaemic heart disease

Dilated Cardiomyopathy

Valvular disease

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8
Q

Man presents with dysponea on exertion, orthopnoea, paroxysmal dyspnoea, pulmonary oedema. On examination, has tachycardia, crepitations and a third heart sound with galloping rhythm. What is the diagnosis?

A

Left sided heart failure

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9
Q

What is the treatment for left sided heart failure?

A 
Sit them up
Give oxygen
IV Furosemide (diuretic)
IV Diamorphine 
IV nitrates

LMNOP (loop diuretic, morphine, nitrates, oxygen, position),

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10
Q

Women present with oedema in ankles, a raised JVP, enlarged liver, ascites. She is known to have COPD

A

Right sided heart failure

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11
Q

What are the drugs in the ACE inhibitors

A

Captopril
Enalapril
Lisinopril

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12
Q

You suspect an MI, what blood tests would you order?

A

Troponin

CK

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13
Q

Define an ectopic beat

A

Beats of rhythms that originate in places other than the SA node

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14
Q

What is wolf parkinson white syndrome?

A

Where there is more than one conduction pathway of the heart with a different speed of depolarisation causing delta waves to be present ( on the qrs complex it has two different gradients)

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15
Q

What factors can increase phase 4 of the cardiac myocyte action potential? AKA increase heart rate

A 
Hyperthermia
Hypoxia
Hypercapnia
Cardiac dilation
Hypokalaemia (prolonging repolariszation)
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16
Q

What is the arrhythmia torsades de pointes

A

A type of ventricular tachycardia in people with long QT intervals. Will look like quick irregular QRS complexes. This can progress to VF

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17
Q

What would you use a 24 hr holter ECG to investigate?

A

Paroxysmal arrhythmia

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18
Q

Patient is classed as bradycardic, what is his heart rate?

A

Less than 60

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19
Q

AV nodal re-entrant tachycardia, Av reciprocating tachycardia and ectopic atrial tachycardia. Are all causes of what arrythmia?

A

Regular supraventricular tachycardia

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20
Q

Describe the treatment for a supraventricular tachycardia

A

Increase vagal tone by the valsava maneouvre (closing nose and breathing against it), carotid massage

Slowing down AVN conduction by adenosine IV or verapamil IV

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21
Q

What is radiofrequency catheter ablation?

A

Selective cauterisation of cardiac tissue to prevent tachycardia- targeting an automatic focus of re-entry circuit

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22
Q

What is lenegres disease? Who does it commonly effect?

A

Acquired complete heart block due to idiopathic fibrosis and calcification of the electrical conduction system of the heart.

Commonly seen in elderly

23
Q

Describe 1st degree heart block

A

Where PR interval is longer than 0.2 s

24
Q

Describe 2nd degree heart block

A

Where there is progressive lengthening of PR interval then dropping QRS

25
Q

Describe 3rd degree heart block

A

Where there is no action potentials going from SA node to AV node, P waves and QRS dissociated

26
Q

What are dual chamber pacemakers used for?

A

Maintaining Atrio-ventricular synchrony, used in atrio ventricular disease

27
Q

Which arrythmia is shockable with a defib?

A

Ventricular fibrillation

28
Q

What is the treatment for ventricular tachycardia?

A

Adenosine IV

VT catheter ablation

Cardiovertor defibrillators

29
Q

Man 70 presents with an irregularly irregular heart beat that is paroxysmal (comes and goes). He is also obese with hypertension. what is this likely to be?

A

Atrial fibrillation

30
Q

What are some of the causes of atrial fibrillation?

A 
Hypertension
Heart failure
Coronary heart disease
Obesity
Thyropid disease
Cardiac valve disease
Alcohol abuse
Heart disease
COPD
Pneumonia
Pericardiits
31
Q

What are the risk factors for thrombo-embolism?

A

CHAD’S VAS

Congenital heart failure
Hypertension
Age over 75
Diabetes
Stroke
Vascular disease
Age 65-74
Sex female
32
Q

What are some rate controlling anti-arrhythmia drugs?

A

Digoxin
Beta blockers
Verapamil or diltiazem

33
Q

What are the 4 H’s that can reversibly cause cardiac arrest?

A

Hypoxia
Hypovolaemia
Hypo/hyperkalaemia
Hypothermia

34
Q

What are the 4 T’s that can reversibly cause cardiac arrest? How would you treat them?

A

Thrombosis; thrombolysis
Tension pneumothorax; needle thoracentesis
Cardiac tamponade; needble cardiocentesis
Toxins; specific

35
Q

How do you determine the axis of the heart on an ECG?

A

Looking at the limb leads

If lead I has higher QRS than lead III then axis lying to the left

36
Q

Someone presents with STEMI 45 minutes after the event, what is the treatment?

A

MONA plus C
Morphine, oxygen, nitroglycerin (GTN), aspirin (300mg), clopidogrel (600mg)

PCI

37
Q

Patient presents with pulmonary oedema following right sided heart failure, what is the treatment>

A

LMNOP

Lasix (frusemide)
Morphine
Nitrates
Oxygen
Position (Sit up)
38
Q

Post MI what is the likely medication a patient will be given

A 
LMWH
Aspirin and clopidogrel
ACE inhibitor
Spironolactone
Furosemide
Beta blocker
Statin
39
Q

What is the normal PR interval?

A

0.12-0.2s

40
Q

What is the usual time interval for QRS complex?

A

0.1s or less

41
Q

What is the usual time interval for atrial depolarisation?

A

P wave should be 0.08-0.1s

42
Q

There is ST elevation in leads II, III, and aVF. What part of the heart is this?

A

Inferior

43
Q

There is ST elevation in leads V3 and V4. What part of the heart is this?

A

Anterior

44
Q

There is ST elevation in leads V1 and V2. What part of the heart is this?

A

Septal

45
Q

There is ST elevation in leads I, aVL, V5, V6. What part of the heart is this?

A

Lateral

46
Q

There is ST elevation in leads V1, V2, V3, V4. What part of the heart is this?

A

Anterior septal

47
Q

How would you calculate the heart rate from an ECG?

A

Count no of QRS in 30 large squares then x10

48
Q

What does the presence of an inverted T wave suggest?

A

Indicative of a past MI

49
Q

You suspect an inferior MI. What changes would you expect on ecg?

A

ST elevation of leads II, III and AVF

50
Q

You suspect an anterolateral MI what changes would you see on ECG?

A

I, AvL, V1-V6

ST elevation

51
Q

Define the four different types of heart block

A

Type 1; PR is long but doesnt effect QRS
Type 2a; PR intervals get longer and longer then drop QRS
Type 2b; Long PR interval with regular QRS drops
Type 3; P waves and QRS are unrelated

52
Q

What symptoms would you expect of someone with an arrhythmia?

A 
Palpitations
SOB 
Dizziness
Loss of consciousness (syncope)
Faintness (presyncope)
Angina/ heart failure
Death
53
Q

What are the two shockable rhythms?

A

Ventricular tachycardia
Ventricular fibrillation

(If ventricle problem then wide QRS complex

54
Q

What would you expect to see on ECG in somoene with left axis deviated heart?

A

High QRS in lead I with negative QRS in lead III

Cardiovascular JC (8 decks)

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