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Third year > Week 5 - Cardiology > Flashcards

Week 5 - Cardiology Flashcards

1
Q

What are the anterior leads in an ECG?

A

V1-V4

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2
Q

What are the lateral leads?

A

I, aVL, V5, V6

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3
Q

What are the inferior leads?

A

II, III, aVF

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4
Q

When would you use an ECG?

A

First line in chest pain, palpitations or blackouts

lifesaving in the management of arrhythmias and acute MI

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5
Q

What is heart failure

A

Failure of the heart to pump oxygenated blood at a rate sufficient to meet the metabolic requirements of the tissue

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6
Q

What coronary arteries are associated with the anterior of the heart?

A

Left anterior descending

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7
Q

What CA is associated with the lateral aspect of the heart?

A

Left circumflex

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8
Q

What CAs are associated with the inferior of the heart?

A

Right coronary artery and circumflex

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9
Q

What CAs are associated with the posterior of the heart?

A

Right coronary artery or circumflex

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10
Q

What is the normal range for the PR interval?

A

< 1 large small square or 5 small squares

< 200ms

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11
Q

What is the normal QRS range?

A

< 3 small squares

< 120ms

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12
Q

What is the normal QT interval range?

A

< 11 small squares

< 440ms

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13
Q

How would you assess the thromboembolic risk of a patient?

A

CHA2DS2-VASc score

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14
Q

What are some non CA causes of a rise in troponin?

A

Not an MI - renal failure, chronic heart failure, infiltrative cardiomyopathies
Type 2 MI - sepsis, PE, congestive heart failure

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15
Q

What are some complications of an MI?

A

Arrhythmias, myocardial rupture, cariogenic shock, heart failure

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16
Q

How does the foetal circulation get oxygenated?

A

Maternal placenta

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17
Q

What are the Gold standard investigations in endocarditis?

A

Microbiology - 2 blood cultures

TTE or TOE

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18
Q

What are the congenital abnormalities in tetralogy of fallout?

A

VSD, Overriding aorta, pulmonary stenosis, RV hypertrophy

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19
Q

Give some examples of single ventricle anomalies

A

tricuspid atresia, hypo plastic left heart syndrome, double inlet left ventricle

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20
Q

What might an ECG show in a 1st degree heart block?

A

Fixed prolonged P-R intervals. Regular

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21
Q

What might an ECG show in a 2nd degree heart block?

A

P-R interval slowly increases then the QRS is dropped (Mobitz 1). Irregular

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22
Q

What might an ECG show in 2nd degree heart block type 2 (mobitz 2)?

A

P-R interval fixed but with dropped beats. Irregular, Normal P-R but absent QRS

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23
Q

What might an ECG show in 3rd degree block?

A

P and QRS completely unrelated. Regular

24
Q

What are other causes of STEMI?

A

Pericarditis (ST elevation in most leads, Pwave depression)
CA vasospam
LV hypertrophy - hypertension (tall QRS, ST depression in lateral leads)

25
What are some causes of left axis deviation?
LV hypertrophy | RV damage
26
What are some causes of Right axis deviation?
RV hypertrophy | LV damage
27
What are some complications of acute coronary syndrome?
``` Arrhythmias Heart failure Cardiogenic shock Myocardial rupture Pericarditis ```
28
What causes a MI/ define an MI.
Reduced blood flow through the coronary arteries due to an occlusion causing ischaemia and tissue damage
29
What drugs are in the angiotensin receptor neprilysin inhibition? - Do not give with ACEi -- Angiooedema
Valsartan (dec RAAS) | Sacubitril (inc natriuretic peptide system)
30
What are early manifestations of IE?
Fever and murmur | In elderly or immunocompromised may be malaise and fatigue
31
What tests do you need to diagnose endocarditis?
TTE or TOE | 3 blood cultures showing the growth of bacteria
32
What are some changes in HF to try and maintain CO?
CO= SV x HR - increased SV and HR Increased RAAS (increase Na and water retention) Adrenaline and NA Cardiac myocyte hypertrophy
33
What are some causes of secondary hypertension?
``` Renal artery stenosis Cushings, Thyroid disease, phaechromocytoma NSAIDs, cocaine Obstructive sleep apnoea Co-arctation of the aorta ```
34
What examination findings might you see in Secundum ASD?
Pulmonary flow murmur Raised JVP Fixed, split second heart sound
35
What are some complications due to co-arctation of the aorta?
Increased systemic pressure proximal to the narrowing. | Headache and nosebleed. Radio-femoral delay
36
What are some surgical repair options in co-arctation of the aorta?
Thoracotomy - Subclavian flap or End to end anastomoses | Transcatheter through femoral artery - ballooning
37
Blalock Taussigs shunt can be perfumed in tetralogy of fallout, how does it work?
Connect the carotid or subclavian artery to the pulmonary artery. This increases pulmonary blood flow, allowing enough blood to get o2 from lungs
38
What are some long term issues in a repaired TOF?
Pulmonary regurgitation - RV overload Arrhythmias - RA dilation triggering arrhythmias Pulmonary artery stenosis
39
What gram -ve bacteria make up the HACEK organisms that can cause IE?
Haemophilus, Aggregatibacter, Cardiobacter, Eikenella corrodens, Kingella
40
How would a patient with acute IE present?
Toxic presentation, very unwell Progressive valve destruction, metastatic infection s.aureus
41
What are some treatment options in AF?
1. Rate controlled - (1st line) Atenolol or bisprolol, 2nd verapamil. or 3rd digoxin 2. Rhythm controlled - Direct cardio version, catheter ablation (Cryo-ablation, radio freq alblatio (of PV or AV node), Flecainide, propafenone, Amiodarone, sotalol or dronedarone
42
What treatment would you provide if someone had a CHA2DS2-VASc (in AF)score of 2+?
NOAC- Dabigatran, Rivaroxiban, Apixaban. Edoxaban
43
What is aortic stenosis?
Obstruction to the outflow of blood from the LV into the aorta due to pathological narrowing of the aortic valve usually calcification.
44
What is the clinical triad of symptoms in aortic stenosis?
Chest pain, syncope, heart failure
45
What are some causes of heart failure?
Myocardial dysfunction - MI, cardiomyopathy Volume overload - Renal failure, mitral regurgitation Obstruction to outflow - Valve stenosis (e.g. aortic) or regurgitation High output - severe anaemia, hypertension AF, SVT, toxins, genetic
46
What is the first line Tx in heart failure?
1. ACEi (captopril or enalapril) or BB (Atenolol) 2. MRA (spironolactone or eplerenone) 3. ARNi (valsartan and sacubitril) 4. Implantable cardioverter defibrillator or ivabradine
47
What criteria do you use in endocarditis?
Dukes criteria
48
What are some causes of AF? | No P waves, Irregular, narrow QRS
CA disease, hypertension, aortic stenosis, alcohol, hyperthyroidism
49
What is a Fontan circulation used in single ventricle anomalies?
The single functional ventricle is used to support the systemic circulation
50
What are the causes of a Type 2 MI?
Sepsis, HF, anaemia, arrhythmias, hypertension or hypotension
51
What does ST depression in V1-V4 mean?
Posterior STEMI - Lcx and RCA
52
Define unstable angina
An acute coronary event without a rise in troponin
53
What does right sided endocarditis result in?
Pleuritic chest pain | in IVDU
54
How might acute endocarditis present?
Acutely unwell, toxic presentation, progressive valve destruction and metastatic infection - septic emboli. S.aureus
55
What do you call painful, palpable lesions on hands and feet?
Oslers nodes
56
What antibiotics would you give to treat endocardititis caused by MRSA (s.aureus)?
Vancomycin ± Gentamicin | also if enterococcus or CoNs
57
What antibiotics would you give to treat endocardititis caused by Strep?
Benzylpenicillin ± gentamicin

Third year (15 decks)

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