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Phase 3 > Week 5 - Cardiology > Flashcards

Week 5 - Cardiology Flashcards

1
Q

ECG: What does the PR interval represent?

A

Time for ventricular filling

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2
Q

ECG: what does the ST segment represent?

A

Plateau between ventricular contraction and relaxation

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3
Q

What is a normal QRS complex?

A

< 120 ms (3 small boxes)

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4
Q

What is a normal PR interval?

A

< 200ms (1 big box)

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5
Q

What is a normal QT interval?

A

< 440ms (11 small boxes)

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6
Q

ECG: How do you determine heart rate?

A

300/ number of boxes

OR

number of QRS complexes in ECG x 10

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7
Q

ECG: How much time are small and large boxes equivalent to?

A 
small = 40ms
large = 200ms (0.2s)
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8
Q

What ECG leads represent the anterior heart?

A

V1-V4

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9
Q

What ECG leads represent the inferior heart?

A

II, III, aVF

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10
Q

What ECG leads represent the lateral heart?

A

aVL, I, V5-V6

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11
Q

What ECG leads represent the posterior/superior heart?

A

aVR

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12
Q

At what degrees on an axis should the heart normally sit?

A

-30 to +90 (aVL to aVF)

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13
Q

What polarity should the limb leads in an ECG have normally?

A 
I +
II +
III o/ not much in either direction
aVR -
aVL o/+
aVF +
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14
Q

What is 1st degree heart block?

A

Prolonged conduction between atria and ventricles, so prolonged PR intervals

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15
Q

What is 3rd degree heart block?

A

No conduction between atria and ventricles (AV node), so no correlation between P and QRS

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16
Q

What are the types of 2nd degree heart block?

A

1) Wenkebach/ Mobitz 1
2) Mobitz 2
3) Ratio

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17
Q

What is Wenkebach/ Mobitz-1 2nd degree heart block?

A

Progressive lengthening of PR interval then a missed ventricular conduction (missing QRS)

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18
Q

What is Mobitz-2 2nd degree heart block?

A

Consistent PR length but QRS missed every so often (e.g. every 3 atrial beats misses 1 ventricular beat)

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19
Q

What is Ratio 2nd degree heart block?

A

Only a ventricular beat after a certain number of atrial beats

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20
Q

How would bundle branch block of one side present?

A

Broad QRS complex

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21
Q

How would bundle branch block of both sides present?

A

Same as complete/ 3rd degree heart block

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22
Q

ECG: Difference between STEMI and Endocarditis

A 
STEMI = ST elevation in affected leads and opposite reciprocal ST depression
Endocarditis = ST elevation of all leads and no depression
23
Q

What should be given in a case of narrow complex tachycardia to help determine the underlying pathology? and why?

A

Atropine - to slow heart rate and see P waves

24
Q

Is it possible to get a bundle branch block with a normal QRS?

A

In the right - yes

Left - no, always heart disease, usually of LV

25
Q

Describe the 3 different classes of guidelines in EBM

A

Class 1 - Evidence in agreement that it is effective
Class 2a - Conflicting, most evidence in agreement of effectiveness
Class 2b - Conflicting, slightly less evidence in agreement of effectiveness
Class 3 - evidence in agreement that it is ineffective

26
Q

Describe the 3 levels of evidence in EBM

A

A - multiple RCTs or meta analyses
B - single RCT or large non-randomised study
C - retrospective/ expert opinion/ small studies/ registries

27
Q

What is the difference between a hard and soft outcome of a clinical trial?

A 
Hard = definitive e.g. MI, death
Soft = spectrum e.g. QoL
28
Q

What factors can make a trial statistically robust?

A 
P value (<0.005)
95% Confidence interval
29
Q

Define heart failure

A

Failure of the heart to pump adequate blood to supply tissues metabolic demands

30
Q

What are the main symptoms/signs of heart failure?

A

SOB (orthopnea, PND)
Fluid retention/odema (ankle, ascites, sacrum, pulmonary)
Fatigue/ effort intolerance
Cough

Raised JVP
3rd heart sound
Displaced apex beat (LV hypertrophy)
Pleural effusion

31
Q

Causes/ risk factors of heart failure (UK)

A 
Coronary artery disease/ MI
Hypertension
Toxins - alcohol/drugs/chemo
Genetic predisposition
Idiopathic
Valvular disease
Infection
Congeintal
Metabolic (hamoechromatosis/ amyloid/ thyrotoxicosis)
Pericardial disease (TB)
Endocardial disease
32
Q

What is the difference between HF-REF and HF-PEF?

A

HF-REF (systolic) = ventricles fail to pump out blood
usually younger, male patients, due to coronary aetiology

HF-PEF (diastolic) = ventricles can pump out most of there blood but there is a problem with their filling
usually older women, hypertensive aetiology

33
Q

Why does heart failure result in neurohumeral activation (activation of RAAS in kidney)?

A

decreased amount of blood pumped by heart -> determined by the kidney as blood loss -> so kidney causes water retention

Makes situation worse as fluid overload -> BP is elevated even more -> further dilation and dysfunction of heart

34
Q

Does heart failure have high or low levels of BNP (brain natriuretic peptide)?

A

High

35
Q

What are the NYHA classification of heart failure?

A

1 - no limitation and no symptoms in ordinary activity
2 (Mild) - mild symptoms and slight limitation in ordinary activity
3 (Moderate) - marked limitation due to symptoms in less-than-ordinary activity, only comfortable at rest
4 (Severe) - severe limitation due to symptoms even at rest, usually bed-bound

36
Q

What investigations can be done to confirm heart failure diagnosis after BNP has been confirmed high?

A

1) Echocardiography
2) Ambulatory ECG
Coronary angiogram
Exercise stress test
Myocardial biopsy
Genetic test

37
Q

Explain the the cycle of heart failure and neurohumeral activation

A

Myocardial injury -> LV dysfunction -> perceived low circulating blood volume -> neurohumeral activation -> increased BP (sodium and water retention + systemic vasoconstriction) -> further LV dysfunction to to myocardial stretch

38
Q

What neurohumeral factors are activated in heart failure

A

Increase retention:

  • RAAS
  • Natriuretic peptides
  • Sympathetic NS
  • AVP (arginine vasopressin)/ ADH
  • ET (endothelin)
39
Q

What are the 1st line drugs/treatments given for heart failure?

A

Beta-blocker + ACE inhibitor/ ARB (if intolerant to ACEI)

40
Q

What are the 2nd line drugs/treatments given for heart failure?

A

Aldosterone (Mineralocorticoid) antagonist + ACEI/ARB (

41
Q

What are the 3rd line drugs/treatments given for heart failure?

A

Sacubatril/Valsartan (Entresto) + BB + MRA

42
Q

What are the 4th line drugs/treatments given for heart failure?

A

ICD / CRT + Ivabradine

43
Q

What treatments are used for heart failure if it is refractory to all other treatments?

A

Digoxin + Hydralazine/ isosorbide dinitrate

44
Q

What is the last resort if heart failure cannot be treated by drug?

A

Referral to National Tranplant Unit for LVAD/ transplant

45
Q

What is the function of an ACE inhibitor/ ARB?

A

Prevent the action of angiotensin 2 (either blocking receptors or blocking formation from angiotensin 1), which prevents:
Vasoconstriction
Sodium and water retention
Aldosterone secretion from kidneys which would also cause sodium and water retention
Vasopressin secretion
Sympathetic NS activation

46
Q

What is cardiac resynchronisation therapy?

A

Electrodes resynchronise both sides of the heart so they beat at the same time

47
Q

What is the function of Ivabradine?

A

Inhibits sinus node, reducing sinus rate

48
Q

What is the function of Hydralazine - Isosorbide dinitrate?

A

Causes dilation of blood vessels, given when renal function is poor instead of ACE inhibitor

49
Q

What are ventricular assist devices?

A

Implanted into the body and do the work of the heart, while connected to an external battery pack

50
Q

What is the problem with ventricular assist devices?

A

They can cause clotting so need to be put on blood thinners

51
Q

What are the 6 main hospital treatments for acute heart failure?

A

1) Nitrates, nitroprusside, dobutamine - arterial dilation
2) Nitrates, morphine - venodilation
3) Furosemide (diuretic) - natriuresis
4) Ultrafiltration - aqua/natriuresis
5) Dobutamine, dopamine, milrinone = increased inotropy (forced contraction)
6) Bilevel or continuous positive airway pressure - preload reduction

52
Q

What are the CHAMP aetiologies of acute heart failure?

A 
acute Coronary syndrome
Hypertension emergency
Arrhythmia
acute Mechanical cause
Pulmonary embolism
53
Q

What do wet/ dry/ warm/ cold refer to in a heart failure patient?

A 
Wet = congestion
Dry = no congestion
Warm = no hypoperfusion
Cold = hypoperfusion

Phase 3 (4 decks)

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