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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
Q

What are some causes of left axis deviation?

A

LV hypertrophy

RV damage

26
Q

What are some causes of Right axis deviation?

A

RV hypertrophy

LV damage

27
Q

What are some complications of acute coronary syndrome?

A 
Arrhythmias
Heart failure
Cardiogenic shock
Myocardial rupture
Pericarditis
28
Q

What causes a MI/ define an MI.

A

Reduced blood flow through the coronary arteries due to an occlusion causing ischaemia and tissue damage

29
Q

What drugs are in the angiotensin receptor neprilysin inhibition? - Do not give with ACEi – Angiooedema

A

Valsartan (dec RAAS)

Sacubitril (inc natriuretic peptide system)

30
Q

What are early manifestations of IE?

A

Fever and murmur

In elderly or immunocompromised may be malaise and fatigue

31
Q

What tests do you need to diagnose endocarditis?

A

TTE or TOE

3 blood cultures showing the growth of bacteria

32
Q

What are some changes in HF to try and maintain CO?

A

CO= SV x HR - increased SV and HR
Increased RAAS (increase Na and water retention)
Adrenaline and NA
Cardiac myocyte hypertrophy

33
Q

What are some causes of secondary hypertension?

A 
Renal artery stenosis
Cushings, Thyroid disease, phaechromocytoma 
NSAIDs, cocaine
Obstructive sleep apnoea 
Co-arctation of the aorta
34
Q

What examination findings might you see in Secundum ASD?

A

Pulmonary flow murmur
Raised JVP
Fixed, split second heart sound

35
Q

What are some complications due to co-arctation of the aorta?

A

Increased systemic pressure proximal to the narrowing.

Headache and nosebleed. Radio-femoral delay

36
Q

What are some surgical repair options in co-arctation of the aorta?

A

Thoracotomy - Subclavian flap or End to end anastomoses

Transcatheter through femoral artery - ballooning

37
Q

Blalock Taussigs shunt can be perfumed in tetralogy of fallout, how does it work?

A

Connect the carotid or subclavian artery to the pulmonary artery. This increases pulmonary blood flow, allowing enough blood to get o2 from lungs

38
Q

What are some long term issues in a repaired TOF?

A

Pulmonary regurgitation - RV overload
Arrhythmias - RA dilation triggering arrhythmias
Pulmonary artery stenosis

39
Q

What gram -ve bacteria make up the HACEK organisms that can cause IE?

A

Haemophilus, Aggregatibacter, Cardiobacter, Eikenella corrodens, Kingella

40
Q

How would a patient with acute IE present?

A

Toxic presentation, very unwell
Progressive valve destruction, metastatic infection
s.aureus

41
Q

What are some treatment options in AF?

A
  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
Q

What treatment would you provide if someone had a CHA2DS2-VASc (in AF)score of 2+?

A

NOAC- Dabigatran, Rivaroxiban, Apixaban. Edoxaban

43
Q

What is aortic stenosis?

A

Obstruction to the outflow of blood from the LV into the aorta due to pathological narrowing of the aortic valve usually calcification.

44
Q

What is the clinical triad of symptoms in aortic stenosis?

A

Chest pain, syncope, heart failure

45
Q

What are some causes of heart failure?

A

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
Q

What is the first line Tx in heart failure?

A
  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
Q

What criteria do you use in endocarditis?

A

Dukes criteria

48
Q

What are some causes of AF?

No P waves, Irregular, narrow QRS

A

CA disease, hypertension, aortic stenosis, alcohol, hyperthyroidism

49
Q

What is a Fontan circulation used in single ventricle anomalies?

A

The single functional ventricle is used to support the systemic circulation

50
Q

What are the causes of a Type 2 MI?

A

Sepsis, HF, anaemia, arrhythmias, hypertension or hypotension

51
Q

What does ST depression in V1-V4 mean?

A

Posterior STEMI - Lcx and RCA

52
Q

Define unstable angina

A

An acute coronary event without a rise in troponin

53
Q

What does right sided endocarditis result in?

A

Pleuritic chest pain

in IVDU

54
Q

How might acute endocarditis present?

A

Acutely unwell, toxic presentation, progressive valve destruction and metastatic infection - septic emboli.
S.aureus

55
Q

What do you call painful, palpable lesions on hands and feet?

A

Oslers nodes

56
Q

What antibiotics would you give to treat endocardititis caused by MRSA (s.aureus)?

A

Vancomycin ± Gentamicin

also if enterococcus or CoNs

57
Q

What antibiotics would you give to treat endocardititis caused by Strep?

A

Benzylpenicillin ± gentamicin

Third year (15 decks)

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