Week 5 - Cardiology Flashcards
What are the anterior leads in an ECG?
V1-V4
What are the lateral leads?
I, aVL, V5, V6
What are the inferior leads?
II, III, aVF
When would you use an ECG?
First line in chest pain, palpitations or blackouts
lifesaving in the management of arrhythmias and acute MI
What is heart failure
Failure of the heart to pump oxygenated blood at a rate sufficient to meet the metabolic requirements of the tissue
What coronary arteries are associated with the anterior of the heart?
Left anterior descending
What CA is associated with the lateral aspect of the heart?
Left circumflex
What CAs are associated with the inferior of the heart?
Right coronary artery and circumflex
What CAs are associated with the posterior of the heart?
Right coronary artery or circumflex
What is the normal range for the PR interval?
< 1 large small square or 5 small squares
< 200ms
What is the normal QRS range?
< 3 small squares
< 120ms
What is the normal QT interval range?
< 11 small squares
< 440ms
How would you assess the thromboembolic risk of a patient?
CHA2DS2-VASc score
What are some non CA causes of a rise in troponin?
Not an MI - renal failure, chronic heart failure, infiltrative cardiomyopathies
Type 2 MI - sepsis, PE, congestive heart failure
What are some complications of an MI?
Arrhythmias, myocardial rupture, cariogenic shock, heart failure
How does the foetal circulation get oxygenated?
Maternal placenta
What are the Gold standard investigations in endocarditis?
Microbiology - 2 blood cultures
TTE or TOE
What are the congenital abnormalities in tetralogy of fallout?
VSD, Overriding aorta, pulmonary stenosis, RV hypertrophy
Give some examples of single ventricle anomalies
tricuspid atresia, hypo plastic left heart syndrome, double inlet left ventricle
What might an ECG show in a 1st degree heart block?
Fixed prolonged P-R intervals. Regular
What might an ECG show in a 2nd degree heart block?
P-R interval slowly increases then the QRS is dropped (Mobitz 1). Irregular
What might an ECG show in 2nd degree heart block type 2 (mobitz 2)?
P-R interval fixed but with dropped beats. Irregular, Normal P-R but absent QRS
What might an ECG show in 3rd degree block?
P and QRS completely unrelated. Regular
What are other causes of STEMI?
Pericarditis (ST elevation in most leads, Pwave depression)
CA vasospam
LV hypertrophy - hypertension (tall QRS, ST depression in lateral leads)
What are some causes of left axis deviation?
LV hypertrophy
RV damage
What are some causes of Right axis deviation?
RV hypertrophy
LV damage
What are some complications of acute coronary syndrome?
Arrhythmias Heart failure Cardiogenic shock Myocardial rupture Pericarditis
What causes a MI/ define an MI.
Reduced blood flow through the coronary arteries due to an occlusion causing ischaemia and tissue damage
What drugs are in the angiotensin receptor neprilysin inhibition? - Do not give with ACEi – Angiooedema
Valsartan (dec RAAS)
Sacubitril (inc natriuretic peptide system)
What are early manifestations of IE?
Fever and murmur
In elderly or immunocompromised may be malaise and fatigue
What tests do you need to diagnose endocarditis?
TTE or TOE
3 blood cultures showing the growth of bacteria
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
What are some causes of secondary hypertension?
Renal artery stenosis Cushings, Thyroid disease, phaechromocytoma NSAIDs, cocaine Obstructive sleep apnoea Co-arctation of the aorta
What examination findings might you see in Secundum ASD?
Pulmonary flow murmur
Raised JVP
Fixed, split second heart sound
What are some complications due to co-arctation of the aorta?
Increased systemic pressure proximal to the narrowing.
Headache and nosebleed. Radio-femoral delay
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
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
What are some long term issues in a repaired TOF?
Pulmonary regurgitation - RV overload
Arrhythmias - RA dilation triggering arrhythmias
Pulmonary artery stenosis
What gram -ve bacteria make up the HACEK organisms that can cause IE?
Haemophilus, Aggregatibacter, Cardiobacter, Eikenella corrodens, Kingella
How would a patient with acute IE present?
Toxic presentation, very unwell
Progressive valve destruction, metastatic infection
s.aureus
What are some treatment options in AF?
- Rate controlled - (1st line) Atenolol or bisprolol, 2nd verapamil. or 3rd digoxin
- Rhythm controlled - Direct cardio version, catheter ablation (Cryo-ablation, radio freq alblatio (of PV or AV node), Flecainide, propafenone, Amiodarone, sotalol or dronedarone
What treatment would you provide if someone had a CHA2DS2-VASc (in AF)score of 2+?
NOAC- Dabigatran, Rivaroxiban, Apixaban. Edoxaban
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.
What is the clinical triad of symptoms in aortic stenosis?
Chest pain, syncope, heart failure
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
What is the first line Tx in heart failure?
- ACEi (captopril or enalapril) or BB (Atenolol)
- MRA (spironolactone or eplerenone)
- ARNi (valsartan and sacubitril)
- Implantable cardioverter defibrillator or ivabradine
What criteria do you use in endocarditis?
Dukes criteria
What are some causes of AF?
No P waves, Irregular, narrow QRS
CA disease, hypertension, aortic stenosis, alcohol, hyperthyroidism
What is a Fontan circulation used in single ventricle anomalies?
The single functional ventricle is used to support the systemic circulation
What are the causes of a Type 2 MI?
Sepsis, HF, anaemia, arrhythmias, hypertension or hypotension
What does ST depression in V1-V4 mean?
Posterior STEMI - Lcx and RCA
Define unstable angina
An acute coronary event without a rise in troponin
What does right sided endocarditis result in?
Pleuritic chest pain
in IVDU
How might acute endocarditis present?
Acutely unwell, toxic presentation, progressive valve destruction and metastatic infection - septic emboli.
S.aureus
What do you call painful, palpable lesions on hands and feet?
Oslers nodes
What antibiotics would you give to treat endocardititis caused by MRSA (s.aureus)?
Vancomycin ± Gentamicin
also if enterococcus or CoNs
What antibiotics would you give to treat endocardititis caused by Strep?
Benzylpenicillin ± gentamicin
