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3B > Cardiovascular 2 > Flashcards

Cardiovascular 2 Flashcards

1
Q

Ventricular tachycardias

A

Broad complex - VT and VF

Monomorphic - MI
Polymorphic - Torsades de Pointes - Precipitated by prolonged QT

Management if stable…

  1. IV amiodarone
  2. IV lidocaine
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2
Q

VF / Pulseless VT management

A

Shockable!

  1. DC cardioversion - 200, 300, 360
  2. Resume CPR for 2 minutes
  3. Assess rhythm
  4. Repeat shock
    + IV amiodarone after 3 shocks
    + IV adrenaline every 3-5 minutes

Prevention - BB or ICD

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3
Q

Torsades de Pointes

A

Twisting of peaks
Polymorphic VT with long QT

Management - IV magnesium sulphate

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4
Q

Long QT aetiology

A

Delayed ventricular repolarisation

Drugs

  • Antipsychotics
  • Amitriptyline
  • Ondansetron
  • SSRIs
  • Amiodarone
  • Erythromycin
  • Haloperidol

SAH
Electrolyte imbalance - HYPO-C/K/M
Acute MI / Myocarditis
Hypothermia

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5
Q

Brugada syndrome

A

Sodium channelopathy
AD inheritance
Young
South-East asian

Presentation - Syncope

ECG findings

  • J-point elevation in V1
  • ST elevation
  • RBBB

Management - ICD

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6
Q

Asystole

A

Non-shockable

CPR
Reassess rhythm every 2 minutes
IV adrenaline every 3-5 minutes

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7
Q

Long QT features

A 
Incidental finding - Routine ECG
Long QT1 - Exertional syncope - Swimming
Long QT2 - Emotional stress
Long QT3 - At night / at rest
Sudden cardiac death
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8
Q

Long QT management

A

BBs

ICD

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9
Q

Atrial flutter aetiology

A

Increasing age

Structural heart disease
Recent cardiothoracic surgery - Surgical / post-ablation scarring of atria
HF

Hyperthyroid

COPD
Asthma
Pneumonia

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10
Q

Atrial flutter clinical features

A 
Worsening HF
Pulmonary symptoms
Palpitations
Fatigue
Syncope
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11
Q

Atrial flutter ECG findings + investigations

A

Sawtooth appearance - II, III, aVF
2:1 block - 150bpm
Flutter waves visible following carotid sinus massage or adenosine

TFTs
Serum electrolytes

CXR

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12
Q

Atrial flutter management (acute)

A

Haemodynamically unstable - Synchronised cardioversion

Haemodynamically stable 
- Rate control - BB, CCB, Amiodarone
- Synchronised cardioversion
- Pharmacological cardioversion - Ibutilide
\+ Heparin
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13
Q

Atrial flutter management (ongoing)

A

Catheter ablation of cavotricuspid isthmus

Rate control - BB or CCB
Anticoagulation - Warfarin

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14
Q

Hypertrophic obstructive cardiomyopathy pathophysiology

A

AD - Disorder of muscle tissue

Mutation in B-myosin heavy chain protein
Predominantly diastolic dysfunction
LVH - Decreased compliance - Decreased CO
Myofibrillar hypertrophy with chaotic disorganised myocytes and fibrosis

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15
Q

HOCM clinical features

A

Asymptomatic

Exertional dyspnoea
Syncope - Following exercise
Sudden death - Ventricular arrhyhtmias

Jerky pulse
Large A waves
Double apex beat

Murmur - Ejection systolic

  • Increased with valsalva
  • Decreased on squatting
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16
Q

HOCM ECG findings

A

LVH
T-wave inversion
Deep Q waves
AF

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17
Q

HOCM echo findings

A

MR SAM ASH

MR - Mitral regurgitation
SAM - Systolic anterior motion of anterior mitral valve leaflet
ASH - Asymmetric hypertrophy

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18
Q

HOCM management

A

ABCDE

Amiodarone
BBs - Verapamil
Cardioverter defibrillator
Dual chamber pacemaker
Endocarditis prophylaxis
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19
Q

Contraindicated in HOCM

A

Nitrates
ACE-I
Inotropes

20
Q

Dilated cardiomyopathy aetiology

A

Autosomal dominant

Myocarditis
IHD
HTN

Drugs - Doxorubicin, Cocaine ± Alcohol

Peripartum

Haemochromatosis / Sarcoidosis

Hyperthyroid

Duchenne’s
Wet beri beri

21
Q

Dilated cardiomyopathy pathophysiology

A

Dilated heart
Predominantly systolic function
All 4 chambers dilated - LV > RV
Eccentric hypertrophy - Sarcomeres added in series

22
Q

Dilated cardiomyopathy presentation

A

HF symptoms

Arrhythmias
Emboli
Mitral regurgitation

23
Q

Dilated cardiomyopathy examination

A

S3 gallop
Systolic murmur

JV distension
Peripheral oedema
Bibasal crackles
Hepatomegaly

24
Q

Dilated cardiomyopathy investigations

A

ECG

  • LVH
  • Wide QRS
  • LBBB
  • P-wave abnormalities - Atrial enlargement

CXR - Balloon appearance

Echo

  • Decreased wall thickness
  • LV dilatation
  • Poor systolic function

FBC - Anaemia
BNP ^^^

25
Q

Dilated cardiomyopathy management

A

Lifestyle - Same as HF!

ACE-I / ARB
BB
Diuretics
Digoxin

Aspirin
Warfarin

LVAD
Pacemaker
ICD

Heart transplant

26
Q

Takotsubo cardiomyopathy

A

Broken heart syndrome
Non-ischaemic cardiomyopathy
Transient apical ballooning of myocardium - Octopus pot

Presentation - Triggered by stress

  • Chest pain
  • HF symptoms
  • ST elevation

Management - Supportive

27
Q

Peripartum cardiomyopathy

A

Last month of pregnancy to 5 months post-partum
More common in older women
Increased risk with greater parity and multiple pregnancies

28
Q

Cardiac conditions considered severe risk in pregnancy

A

Pulmonary HTN
Systemic left heart obstruction
Systemic ventricular impairment - Ejection fraction < 30%
Marfan’s syndrome with aortic root diameter > 47mm

29
Q

Aortic aneurysm aetiology

A

True - All 3 layers
False - 1 layer

Arterial disease - HTN, DM, smokers, etc.
Connective tissue disease
Age ^

Male - Increased prevalence
Female - Increased risk of rupture

30
Q

Aortic aneurysm clinical features

A

Palpable pulsatile mass
Abdo/back/groin pain
Hypotension - Rupture?

31
Q

Aortic aneurysm investigations and management

A

Abdominal USS

Ruptured or symptomatic - Urgent surgical repair

32
Q

Aortic aneurysm screening

A

< 3cm - Normal width
3-4.4cm - Small - Rescan every 12 months
4.5-5.4cm - Medium - Rescan every 3 months
> 5.5cm - Large - Referral < 2 weeks + Endovascular repair

33
Q

Aortic dissection aetiology

A

Smoking
Family history

Atherosclerosis
HTN

Connective tissue disorder
Bicuspid aortic valve
CoA

34
Q

Aortic dissection presentation

A 
Marfan's / ED
Acute severe chest pain = Tearing, radiates to the back
Left/right BP differential
Pulse deficit
Diastolic murmur
35
Q

Aortic dissection investigations

A

ECG - ST depression or elevation
CXR - Widened mediastinum
Cardiac enzymes - Negative
CT angiography - Intimal flap

TOE if unstable

36
Q

Aortic dissection management

A

Analgesia

Control BP!

  • Labetalol
  • Nitroprusside

Type A - Surgical repair
Type B - Conservative

On discharge - Anti-HTN

37
Q

PVD aetiology

A

Age > 40
Smoking
Sedentary lifestyle

DM
HTN

Hyperlipidaemia
Atherosclerosis

38
Q

PVD clinical features

A

Asymptomatic?

Intermittent claudication
Thigh or buttock pain on exertion - Relieved at rest

Diminished or absent pulse

Erectile dysfunction?

39
Q

6 Ps of acute limb ischaemia

A 
Pale
Pulseless
Painful
Paralysed
Paraesthesia
Perishingly cold
40
Q

PVD investigations and management

A

Ankle/Brachial pressure index < 0.9

Antiplatelet therapy - Aspirin/Clopidogrel
Analgesia - Opioid
Anticoagulation - Heparin

CV risk factor management

Endovascular or surgical revascularisation

41
Q

Shock

A

Life-threatening
Acute circulatory failure
Inadequate oxygen delivery to cells

42
Q

Shock risk factors

A

History of sepsis
Recent MI
Surgery, trauma, haemorrhage
Exposure to known allergens

Change in medication
Significant comorbidities

43
Q

Shock clinical features

A

Hypotension
Tachycardia

Skin changes - Cyanosis
Oliguria < 0.5ml/kg/hr
Altered mental state - GCS

44
Q

Shock investigations

A

ABG - Metabolic acidosis with raised lactate

Glucose ^ 
FBC - Anaemia
WCC - Infection?
Urea - GI bleed?
Clotting screen - DIC - Septic shock
CRP - Inflammation - Sepsis?
ECG - Cardiogenic cause?
45
Q

Shock complications

A

Multiple organ dysfunction
End-organ damage
Death

46
Q

Reversible causes of cardiac arrest

A

4 Hs

  • Hypoxia
  • Hypovolaemia
  • Hypo/hyperkalaemia
  • Hypothermia

4 Ts

  • Thrombosis - Coronary or pulmonary
  • Tension pneumothorax
  • Tamponade
  • Toxins

3B (23 decks)

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