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Final year Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Define SVT

A

Rate > 100bpm

QRS <120ms

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2
Q

Causes of SVT

A

AF
AVRT
AVNRT

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3
Q

Management of SVT

A
  1. O2 and IV access
  2. Regular rhythm-> Continuous ECG
  3. Vagal manoevres. (valsalva/carotid sinus massage)
  4. Adenosine 6mg → 12mg → 12mg (verapamil 5mg over 2 mins if asthma/fails) can cause chest tightness.
  5. Amiodarone/digoxin/atenolol.

if haemodynamic compromise -

  1. Sedate
  2. DC cardiovert
  3. Amiodarone 300mg over 20-60mins.

Prophylaxis: Beta blockers, AVRT: flecainide AVNRT: verapamil.

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4
Q

Wolf parkinson white define + ECG + management

A 
Congenital accessory conduction pathway between atria and ventricles. 
Short PR interval. 
Wide QRS (delta wave/slurred upstroke)
ST-T changes.

Mx: Refer to cardiology
Sotalol (not if AF), Flecainide, Amiodarone
Electrophysiology
Ablation of accessory pathway.

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5
Q

Definition and Causes of Bradycardia

A

<60bpm

DIVISIONS

Drugs: Antiarrythmics type 1a (procainamide), amiodarone
B blockers
Ca channel blockers
Digoxin

Ischaemia (inferior MI)

Vagal hypertonia (athletes, vasovagal syncope, carotid sinus syndrome)

Infection (viral myocarditis, Rheumatic fever, infective endocarditis)

Sick sinus syndrome (damage to SAN/AVN/conducting tissue - SVT /sinus brady +/- arrest/SA/AV block).
tx: PACE (brady) AMIODARONE (tachy)

Infiltration (restrictive/dilated cardiomyopathy)

  • Autoimmune
  • Sarcoid
  • haemochromatosis
  • amyloid
  • muscular dystrophy

O
Hypothyroid
Hypokalaemia
hypothermia

Neuro (raised ICP)

Septal defect (primum ASD)

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6
Q

Management of bradycardia

A

Asymptomatic Rate >40 -> No treatment

Rate <40 -> treat underlying cause

  • Medical - Atropine 0.6-1/2g IV, Isoprenaline IVI
  • External Pacing.
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7
Q

Causes of AF

A

Common: IHD, Rheumatic Heart disease, Thyrotoxicosis, Hypertension

Other: Alcohol, Pneumonia, PE, Post op, Hypokalaemia, RA.

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8
Q

Management of Acute AF <48h

A

Haemodynamically unstable: HR >150, chest pain, critical perfusion.

  1. DC cardiovert.TOE guided. sedation/anaesthesia. give LMWH
  2. IV amiodarone. 300mg over 1h (check tfts, pulm fibrosis, photosensitive, liver function).
Stable: 
Control ventricular rate: 
1. Diltiazem or verapamil or metoprolol
2. Digoxin or amiodarone 300mg IV over 60mins (LMWH +) then 900mg over 23h. . 
3. LMWH
4. Cardiovert:

Flecainide (no LV dysfunction, coronary disease), Amiodarone or electrical.

If sinus restored, no RFs, dont need long term anticoagulation.

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9
Q

Management of persistent AF

A

> 7days

CCF/<65/first presentation/secondary to treated precipirant -> RHYTHM CONTROL

  1. TTE (structural abns)
  2. WARFARIN/DOAC 3 weeks.
  3. SOTALOL/Amiodarone 4 weeks if failure risk
  4. Electrical cardioversion/pharmacological
  5. 4 weeks of anticoagulation after.

Rate control: -> <90

  1. B blocker
  2. add Digoxin
  3. amiodarone

Can RFA, Maze procedure, Pacing.

CHAD2DS2VAS score determines necessity of anticoagulation in AF

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10
Q

CHa2DS2 VAs score

A 
Determines necessity of anticoagulation in AF
CHF:1
HTN: 1
Age>75 (2) 65-74 (1)
Diabetes:1 
Stroke/tia/vTE: 2
Vascular disease (MI/Peripheral artery disease/aortic plaque)1 
Sex (female 1)
Score 0-1 - None/ANtiplatelet
>1 - Doac
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11
Q

STEMI mx

A

12 lead ECG

O2 aim 94-98

IV access - FBC,U+E, glucose, Lipids

Brief assessment - CVD hx, Thrombolysis CIs, CV exam

Aspirin 300mg PO, Clopidogrel 300mg PO

Analgesia - morphine 5-10mg IV
metoclopramide 10mg IV

ANti ischaemia - GTN 2 puffs, B blocker atenolol 5mg iv

LMWH

Admit for CCU monitoring - arrythmias

<12h Primary PCI

> 24h - thromboylysis - Alteplase,

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12
Q

Continuing therapy STEMI

A 
ACEi (within 24h) e.g. lisinopril 2.5mg
B blocker (bisoprolol 10mg OD)
Cardiac rehab - exercise/info/manual
Aspirin Lifelong. 75mg. Clopidogrel 75mg 12 m
Statin (atorv 80mg)

Advice: stop smoking, diet, exercise, work 2m, sex 1m, driving 1m

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13
Q

NSTEMI mx

A 
Aspirin 
Clopi
Fondaparinux 2.5mg SC
morphine 5-10mg
Metoclopramide  10mg IV
GTN, B blocker,

HIGH RISK: Persistent/Recurrent ischaemia, ST depression, DM, positive trop -> Angiography +/- PCI in 96h. Tirofiban,eptifabatide

LOW RISK: no further pain, flat/inverted t waves/ normal ECG, neg trop . -> d/c in 12h if trop neg.
OP angio, perfusion scan, stress echo.

stop LMWH - when pain free/3-5 days

ongoing mx ; Same as STEMI 
Acei 
B blocker
cardiac rehab
statin

Aspirin lifelong, clopi 1 yea

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14
Q

CCF Mx

A
  1. ACEi/ARB
  2. B blocker (increase) e.g. bisoprolol
  3. Frusemide
  4. Lifestyle advice - smoking , exercise, salt, weight, exercise, aspriin, statins.

(specialist advice)

  1. spironolactone
  2. Hydralazine + ISDN
  3. Digoxin

LEVF <35%: ICD
transplant

<30% LBBB
cardiac resynchronisation therapy w BV pacemaker

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15
Q

Acute HF (severe pul edema mx)

A 
sit up
o2
IV access + ECG (trop, fbc, u+e, BNP, ABG) 
Diamorphine 2.5mg + metoclopramide 10mg
Frusemide 40-80mg IV
GTN
hypotensive: Inotropes
CPAP, ISMN infusion

Monitor: BP, HR, RR, JVP, UO, ABG

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16
Q

Cardiogenic Shock MX

A 
ABCDE
O2 
Diamorphine 2.5mg + metoclopramide 10mg
correct arrythmias, Electrolyte, acid base
CXR, ECHO, CT 
Consider FLuids, CPAP
Monitor CVP, BP, ABG, ECG, UO
Consider Dobutamine
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17
Q

Causes cardiogenic shock

A 
MI 
Hyperkalaemia
Endocarditis
Aortic dissection
Rythm disturbance
Tamponade

Obstructive - Tension PTX
Massive PE.

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18
Q

Tamponade Signs

A

Becks triad: low BP, high JVP, muffled HS
Kussmauls sign: raised JVP on inspiraion
Pulsus paradoxus - pulse fades on inspiration.

IX: ECHO
CXR- globular heart.

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19
Q

Hypertension Mx

A

> 140/90 -> 1. ABPM
2. HBPM
Ix: risk of CVS disease
End organ damage.

> 180/120
observe for signs of retinal haemorrhage
papilloedema

  1. ACEi ARB/CCB
  2. +CCB/thiazide
  3. +both
  4. add spironolactone, alpha/beta blocker.
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20
Q

Aortic stenosis causes

A

Calcification w age
Congenital bicuspid
Rheumatic fever.

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21
Q

Aortic stenosis signs

A

ESM rt 2nd ICS
(louder sitting forward on expiration)-> carotids.

Slow rising pulse
narrow pulse pressure.
Quiet s2
forceful apex

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22
Q

Ix AS

A

Bloods: FBC, Lipids, U+E, glucose

ECG: LVH
CXR: Calcified valve
LVH, dilatation aorta.

Echo. + dopplers.
exercise stress if asymptomatic.

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23
Q

AS Mx

A

Optimise RFs: statins, antihypertensives, DM

Monitor
B blocker if angina
HF - ACEi, diuretics.

surgical:
valve replacement if severe symptoms, low EF, undergoing CABG.

Mechanical if younger.
bioprosthetic - older.

Balloon valvuloplasty
tAVI

24
Q

Aortic regurgitation causes

A

Acute: Infective endocarditis, Type A aortic dissection.

Chronic: Congenital bicuspid aortic valve, rheumatic heart disease, Connective tissue disease (marfans/ED) , autoimmune Ank Spond, RA.

Sx: LVF: SOBOE, PND, Orthopnea, arryhmias AF
angina.

25
Q

Signs of Aortic regurgitation

A 
Collapsing pulse
Wide pulse pressure.
Apex displaced. 
Soft S2
EDM at URSE + 3rd left parasternal. 
sitting forward.  expiration.  
severe - MDM (austin flint murmur).

Quinkes sign -nail bed pulsation
corrigans sign - pulsation.

26
Q

AR ix:

A

FBC lipids, u+E, glucose
ECG - LVH
CXR - Cardiomegaly, Dilated aorta, pul oedema
ECHO

27
Q

AR mx

A

optimise Rfs
monitor echo
reduce HTN (reduce afterload)
Surgery - replacement. if HF, LV dysfunction

28
Q

Mitral stenosis causes

A

Rheumatic fever
prosthetic valve
congenital (rare)

29
Q

MS pathophysiology

A

Valve narrows -> increased left atrial pressure -> Loud S1 /atrial hypertrophy -> AF

pul oedema /pul htn -> loud p2/PR -> RVH -> left parasternal heave.

TR-> v waves

RHF -> JVP , oedema, Ascites.

30
Q

Signs of Mitral stenosis

A 
AF
Malar flush
JVP - a waves, v waves. 
LEft parasternal heave. 
Tapping apex.
Loud S1 
Loud P2 (PHT)
Rumbling mid diastolic murmur  at apex. radiates t axilla . Graham steel murmur if pR.
31
Q

ix of MS

A 
Bloods 
ECG - AF 
RVH - ST dep/Twi v1-2.
CXR - LA enlargement, Pul oedema, calcification 
ECho + doppler. 
Catheterisation assess coronarys.
32
Q

Mx: MS

A 
Optimise RFs
Monitor echo
Pen V - rheum fever prophylaxis.
AF - rate control/anticoagulate.
Diuretics -

Surgical - mod severe -
PERCUTANEOUS BALLOON VALVULOPLASTY

surgical valvotomy
replacement.

33
Q

Mitral regurgitation causes

A 
Mitral valve prolapse 
LV dilatation (AR/AS/HT)
Calcification
Post Mi  - papilary 
rupture
rheumatic fever
connective tissue disease
inf endoc
34
Q

Signs MR

A

AF
SOB, fatigue, pul HTN, oedema

Left parasternal heave
displaced apex - > volume overload - > eccentric hypertrophy

Soft S1
loud p2
blowing Pan systolic murmur
apex -> axilla

35
Q

Ix MR

A 
BLoods
Ecg - LVH, AF
p mitrale
CXR- LA/lv hypertrophy
pul odema
Echo + doppler
36
Q

Mx MR

A

optimise RFs
monitor echo
af rate control nad anticoagulate
drugs -> reduce afterload - ACE i / b blockers, diuretics

Surgical - replacement or repair. severe.

37
Q

TR Causes, Symptoms, Signs, Ix, Mx

A

Causes: RV dilatation, rheum fever, infective endocarditis, carcinoid

Symptoms: Fatigue, Hepatic pain on exertion
ascites, oedema

Signs: raised JVP (giant Vwaves) 
RV heave
PSM LLSE (on inspiratin) 
pulsatile hepatomegaly
jaundice

Ix: LFTs, EcHO

MX: tx cause, diuretics, acei, digoxin, valve replacement.

38
Q

Infective endocarditis RFs

A 
Cardiac disease: -> subacute.
Normal valves -> acute
Prosthetic valves
degenerative valvulopathy
vsd, PDA, CoA
Rheumatic fever
Dental caries
post op wounds
IVDU (tricuspid)
Immunocompromised
39
Q

Infective endocarditis Casues

A

Culture +ve
S viridans
S aureus

Culture neg 
Haemophilus
Actinobacilus
cardiobacterium
eikenella
Kingella 
Coxiella
chlamydia

Non infective
SLE
Marantic (libman sacks)

40
Q

Clinical features Infective endocarditis

A 
sepsis - fever, rigors
nt sweats
wt loss
anaemia
splenomegaly
clubbing

Cardiac - new/changing murmur MR 85%, AR 15%
aV block
LVF

Embolic - abscesses brain, liver, heart, kidney , spleen, gut.
Janeway lesions

Immune complex - Micro haematuria (GN)
Vasculitis
roth spots
splinter haemorrhages
oslers nodes
41
Q

Dukes criteria IE

A

2 major
1 major 3 minor
5 minor

Major: 1. +ve blood culture (2 separate cultures, e.g. 3 12 h apart)
2. +ve echo - > vegetation, abscess, valve dehiscence, new regurgitation murmur.

Minor:

  1. Predisposition (cardiac lesion/ IVDU)
  2. fever >38
  3. Emboli (septic infacts, splinters, janeways)
  4. Immune phenomenon (GN common, Oslers, roth spots, RF)
  5. +ve blood culture not meeting criteria.
42
Q

Ix IE

A 
Bloods
Normochromic normocytic anaemia 
ESR CRP
IgG RF
Cultures 3 x 12 h apart. 
serology

urine - micro haematuria

ECG: AV block/LVF

Echo - TTE - Vegetations >2mm
TOE (more sensitive )

43
Q

Mx: IE

A

Empiric: Acute severe: Fluclox + gentamicin IV

Subacute: Benpen + gent IV

rifampicin if staph

surgery - if HF, Emboli, valve obstruction, prosthetic valve.

44
Q

Rheumatic fever

Cause

A

Group A strep
(strep pyogenes)
cross reactivity t2 hypersensitivity

45
Q

Jones criteria

A 
Evidence of GAs infection
- +ve throat culture
-rapid strep ag test
-ASOT increase , DNase B
- recent scarlet fever
\+ 
2 major
- Carditis
-arthritis
-Sydenhams chorea
-Erythema marginatum
-Subcutanoeus noduels

1 major + 2 minor

  • Fever
  • ESR, CRP
  • Arthralgia
  • prolongedPR
  • prev rheum fever
46
Q

Ix Rheum fever

A

BLoods: strep ag test
ASOT titire
FBC
ESR,CRP

ECG
ECHO

47
Q

Mx rheum fever

A

Bed rest until CRP normal for 2 weeks

BENpen 0.6-1.2mg IM 10 days
analgesia NSAIDS
can use haldol or diazepam for chorea

48
Q

Causes of pericarditis

Ix, MX:

A

Viral: Coxsackie, Flu, EBV, HIV
Bacterial: pneumonia, rheumatic fever, TB, staph
Fungi
MI, Dresslers
Drugs: penicillin, isoniazid, procainamide, hydralazine
Other: uraemia, RA, SLE, sarcoid, Radiotherapy.

Ix: ECG: saddle ST elevation + PR depression
bloods: FBC, esr, trop, cultures, virology.

Mx: Analgesia - ibuprofen 400mg PO /8h
consider steroids, immunosuppression
txcause

49
Q

Symptoms and Signs of HOCM

A

Sx: Angina, SOB, Palpitations (AF/WPW/VT)
exertional syncope
Sudden death

Signs: Jerky pulse
Double apex beat
Harsh ESM @LLSE
S4

50
Q

Ix and MX of HOCM

A

ECG, ECHO - assymetric septal hypertrophy

Mx: Medical : 1. B blocker, 2. verapamil
Amiodarone if arrhythmias
anticoagulate if AF/emboli

Septal myomectomy if severe sx.
consider ICD

51
Q

causes of dilated cardiomyopathy

A 
Dystrophy
Infection (myocarditis)
Late pregnancy
Autoimmune (SLE)
Toxins (etoh, doxorubicin, cyclophosphamide, DXT)
Endocrine (thyrotoxicosis)
52
Q

Cardiac causes of clubbing

A

Infective endocarditis
Congenital cyanotic heart disease
Atrial myxoma

53
Q

Broad complex Tachycardia definition

A

Rate > 100bpm

QRS > 120ms

54
Q

Broad complex tachy Differentials

A

VT
Torsades de points
SVT with BBB

55
Q

Causes of VT

A

IM QVICK

Infarction (esp with ventricular aneurysm)
Myocarditis
QT interval
Valve problem (AS, mitral prolapse)
Iatrogenic ( digoxin, antiarrythmics, catheter)
Cardiomyopathy (dilated)
K (hypokalaemia, hypomagnesemia, hypoxaemia, acidosis).

56
Q

Mx of VT

A

O2 + IV access
Unstable -> sedate -> DC cardioversion (200-300 - 360J)/amiodarone (300mg over 20-60m) then 900mg over 23h.

Stable - Correct electrolyte problems (e.g. 60mM KCL @ 20mm/h. /4ml 50% MgSO4 in 30mins.

Regular rhythm (VT) -> Amiodarone, 
lignocaine.

Irregular (AF + BBB) -> Flecainide /Amiodarone
TDP -> MgSO4 2g IV over 10mins
fails-> DC cardiovert.

57
Q

Indications for a pacemaker

A 
Sinus node dysfunction: 
-symptomatic sinus bradycardia. 
-complete heart block
-symptomatic 2nd degree.
chronic bifasicular block. 
Cardiac transplant
Post MI
HOCM
Severe HF
Congenital heart disease

Final year Medicine (18 decks)

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