Cardiac Pathology 1 Flashcards
(124 cards)
1
Q
ACS refers to 3 distinct diagnoses: u________, _______ , ______
A
Unstable angina
NSTEMI
STEMI
2
Q
What is ACS caused by
A
Coronary artery disease
3
Q
Unstable angina is caused by ______ occlusion of a coronary artery. Troponin will be ______
A
Partial occlusion
Negative troponin
4
Q
NSTEMI is caused by severe but ________ occlusion of a coronary artery
A
Incomplete
5
Q
Troponins are positive in chest pain in __________ and ______
A
NSTEMI
STEMI
6
Q
STEMI is caused by _______ occlusion of a coronary artery
A
Complete
7
Q
Chest pain in ACS is usualllg sudden, crushing and _____/____sided ; it may radiate to the _____ arm, ____, ____
A
Left sided or central chest pain
Radiate to left arm, neck, jaw
8
Q
Associated symptoms found in ACS include n______, d______, s_____, s_____
A
Nausea
Diaphoresis (sweating)
Syncope
SOB
9
Q
When may a patient have a ‘silent’ (no pain) MI
A
Diabetic patient
10
Q
Diagnosis of any ACS is made generally by ________ and _______
A
ECG
TROPONIN
(+/- relief with GTN)
11
Q
An inferior STEMI would affect leads ________ and therefore the _______ coronary artery
A
II, III, aVF
Right coronary artery
12
Q
A septal STEMI would affect leads ________ and therefore the _______ coronary artery
A
V1-V2
Proximal LAD
13
Q
An Anterior STEMI would affect leads ________ and therefore the _______ coronary artery
A
V3-V4
LAD
14
Q
What is the immediate management of ACS ? (POcMAN)
A
Position upright
O2
(CLOPIDOGREL 300mg)
Morphine
Aspirin 300mg
GTN (nitrite)
15
Q
STEMI can be treated with PCI is present within ______hrs of onset of pain and are <__hr since first medical contact
A
12hours
<2hrs
16
Q
When may you start low molecular weight heparin or fondaparinux in ACS
A
NSTEMI - if for an immediate angiogram
17
Q
ALL post-MI patients should be started on the following 5 drugs:
A
- Aspirin 75mg
- Clopidogrel 75mg
- BB (bisoprolol)
- ACEi (ramipril)
- Statin (atorvastatin)
18
Q
Post MI pericarditis is called ______, typically presenting with fever and pleuritic pain between _____weeks and ____ months after an MI
A
Dressers syndrome
2-3wks -> a few months
19
Q
Management of Dresslers Syndrome
A
High dose aspirin
20
Q
A post-MI ventricular free wall rupture needs to be treated immediately with ______ and _______
A
Pericardiocentesis
Surgery
21
Q
VSD can occur after MI features include: S____,C____, H_____, H_____
A
SOB
CHEST PAIN
HF
HYPOTENSION
22
Q
Stable angina occurs during _____
A
Exertion
23
Q
If NSAIDS are contraindicated in your pericarditis patient, what drug management could you give? (2)
A
Colchicine
Corticosteroids
24
Q
IVDUs have a predisposition to ________ infection and ____sided valves disease which can cause ______ endocarditis
A
Staph aureus
Right sided
Tricuspid endocarditis
25
What is the most common organism that causes infective endocarditis in poor dental hygiene
Steph viridans
26
What bacteria is associated with Prosthetic valve endocarditis ?
Coagulase negative staph
27
Clinical features of infective endocarditis is generally not specific but _____ and _____ are the most common
Fever
Myalgia
28
What are Janeway lesions
Painless haemorrhagic cutaneous lesions in the palms and soles
29
What are Oslers Nodes
Painful pulp infarcts on end of fingers
30
What are Roth spots
Boat shaped retinal haemorrhages with pale centres seen on fundoscopy
31
What criteria is used for infective endocarditis
Modified Duke Criteria
32
First line imaging for infective endocarditis
TTE
33
Mainstay treatment of infective endocarditis is
Broad spec abx
34
1st line therapy for IE cause by S.aureus
Flucloxacillin
(If contraindication: vancomycin + rifampicin)
35
1st line therapy for prosthetic valve IE (3)
Flucloxacillin + rifampicin + gentamicin
36
37
Long QT syndrome is characterised by a ______ QT internal ( <______ in men and <_____ in women)
Prolonged QT
<440ms in men
<460ms women
38
Long QT Syndrome predisposes to arrythmias like ________ and _______
Torsade de pointe
VF
39
What are the causes of acquired Long QT (TIMMES)
Toxins
Ischamia
Myocarditis
Mitral valve prolapse
Electrolytes
Subarachnoid haemorrhage
40
What drugs can cause Long QT (CAAT)
Clarithromycin
Anti-arrhythmics
Anti psychotics
Tricyclic antidepressants
41
What 3 electrolyte abnormalities are seen in Long QT syndrome (K/C/M)
Hypokalaemia
Hypocalcaemia
Hypomagnesia
42
Congenital causes of Long QT include: R______, J______ and L______ syndrome
Romano-Ward
Jervell
Lange-Nielsen
43
Treatment of acquired long QT
Reverse cause
44
Treatment of congenital Long QT syndrome ~ 1st line ________, 2nd line ______
Beta blockade
ICD insertion or cardiac pacing
45
46
______ syndrome is a genetic condition characterised by a ________ channelopathy
Brugada syndrome
Sodium channelopathy
47
Brugada syndrome predisposes individuals to dangerous _______ and sudden __________
Arrhythmias
Sudden cardiac death
48
Brugada syndrome follows a __________ inheritance pattern
Autosomal dominant
49
In Brugada syndrome whilst some patients may be symptomatic, others may experience P_______, E_________, or S___________
Palpitations
Exertional syncope
Sudden cardiac death
50
Diagnosis of Brugada syndrome is based on ECG changes and clinical criteria? What ECG changes would you see? (2)
VF or Polymorphic VT
51
Brugada syndrome needs to meet at least one clinical criteria to be diagnosed. Name 4 (not ECG)
Family history
Syncope
Inductive VT
NOCTURAL AGONAL BREATHING
52
Conservative management of Brugada syndrome
Lifestyle (reduce triggers)
53
What are the triggers for Brugada syndrome?
1. S_________
2. H________
3. D_______
4. M_________
5. E_________
6. F_________
Sleep
Heavy meals
Dehydration
Medications
Electrolyte imbalance
Fevers
54
Definitive management of Brugada syndrome (surgical + medication)
Insertion of ICD
QUINIDINE (anti-arrhythmic)
55
A bundle branch block occurs when electrical impulses to the ______ are _______ or _______
Ventricles
Delayed or blocked
56
A bundle branch block results in a __________ QRS complex
Widened
57
58
A LBBB is recognised by the “_____” pattern in _____ and _____ leads
“WILLIAM”
V1-V6
59
A RBBB is recognised by the “_____” pattern in _____ and _____ leads
MARROW
V1-V6
60
Causes of LBBB include; A______, I______, H_______, D_____, M______
Aortic stenosis
IHD
Hyperkalaemia
Digoxin toxicity
Myocardial infarction
61
Causes of RBBB include; R_________, P______, I___, C_______ (ASD), N________
Right ventricular hypertrophy
Pulmonary embolism
IHD
congenital heart disease
normal
62
63
Cardiac myxomas are benign tumours composed of _____________ within a __________
Unspecialised mesenchymal cells
Mucopolysaccharide stroma
64
Cardiac myxomas predominantly originate in the _____ atrium
Left atrium
65
Symptoms of cardiac myxomas include F_____, W____, D____, O_____, C_____, P____ and rarely E______ leading to ACS
Fever
Weight loss
Dyspnoea
Orthopnoea
Cough
Palpitations
Embolisation
66
Diagnosis of cardiac myxomas are made through ______ & ______
Echocardiography
Cardiac MRI
67
What is the definitive treatment of cardiac myxomas
Surgical removal
68
Complications of cardiac myxomas include: V______, H_____, and A_______
Valvular heart disease
Heart failure
ACS
69
Acute pulmonary oedema is a medical emergency and needs to be treated with urgent O_____, IV _____ and potentially C_______
Oxygen
Diuretics
Continuous positive airway pressure (CPAP)
70
Symptoms of **long QT** (3)
Syncope
Palpitations
Sudden cardiac death
71
Myocarditis is inflammation of the _________
Myocardium
72
What is the most common viral cause of myocarditis?
Cocksackie B virus
73
Symptoms of myocarditis include C______, S___, P_____, S______, F_____ and a V_________
Chest pain (sharp/stabbing)
SOB
Palpitations
Syncope
Fever
Viral prodrome
74
What may you hear on auscultation of the heart in myocarditis (2+1)
Dull heart sounds
Pericardial rub
(Signs of heart failure)
75
Management of myocarditis is_____
Corticosteroids
76
What is the gold standard diagnostic investigation for myocarditis
Endomyocardial biopsy
77
What will be found on Endomyocardial biopsy in myocarditis:
Infiltration of inflammatory cells in the myocardium and myocardial necrosis
78
79
Rheumatic fever is an autoimmune complication of ______infection (_________)
Group A beta-haemolytic strep
Scarlet fever
80
Treatment of rheumatic fever should involve: STAT dose of ______, and a course of _______, along with ______ or ______ and ________
IV BENPEN
PHENOXYMETHYLPENECILLIN
aspirin or NSAIDs
Analgesia
81
Initial investigations for **syncope** should include a ________BP, E__, B_____, and bloods to screen for abnormalities such as __________
Lying standing BO
ECG
Blood glucose
Hyponatraemia
82
83
Causes of **cardiac syncope** can be divided into two main categories:
Structural and electrical
84
What’s are the 6 structural cardiac causes of **syncope**; CHAIM
Cardiac tamponade
HOCM
Aortic stenosi
Ischaemic cardiomyopathy
Myocardial infarction
85
Causes of reflex syncope include V_______, S_____, C______
Vasovagal syncope
Situational syncope
Carotid sinus syndrome
86
How does **carotid sinus syndrome** occur?
Due to hypersensitivity of the carotid sinus baroreceptor
87
Non-cardiac and non-reflex causes of **syncope** include: O_____, P_____, B______, H_____, H________
Orthostatic hypotension
Pulmonary embolism
Brain haemorrhage
Head trauma
Hypoglycaemia
88
Questions to ask about before a blackout/ syncopal episode (6)
1. Triggers (what were they doing before)
2. Viral prodrome
3. Current illness
4. Chest pain/palpitstiins
5. Headache or visual disturbance
6. Lightheaded
89
Questions to ask about during a blackout/ syncopal episode (6)
Injury acquired
Tongue biting
Incontinence
Duration
Seizure
Appearance (ie. Eyes open/closed/ pallor)
90
Questions to ask about after a blackout/ syncopal episode (3)
Confusion
Weakness
Injuries sustained
91
Sick sinus syndrome occurs when the ____ node doesn’t work properly (often occurs in elderly)
SA NODE
92
Symptoms in **sick sinus syndrome** include (4)
Dizzy
Syncope
Chest pain
Palpitations
93
________ heart failure may be present in **sick sinus syndrome**
Low output
94
ECG features of **sick sinus syndrome** include; S______, _____ block, periods of ______ and abnormally _____ pauses after a premature beat
- Sinus bradycardia
- Sinoatrial block
- Periods of sinus arrest
- Abnormally long pauses after a premature beat
95
Management of Sick sinus syndrome is with a _________
Pacemaker
96
Target INR for patients with **AF or following VTE** should be
2-3
97
Target INR for patients with **aortic valve replacement** should be
2-3
98
Target INR for patients with **mitral valve replacement** should be
2.5-3.5
99
Patients with **recurrent** VTEs should have a target INR of_____
3-4
100
TORSADES de pointes is a type of ___________________ that occurs in the context of ____________
Polymorphic ventricular tachycardia
Prolonged QT
101
Specific ECG findings in TdP are the QRS ‘______’ around the ________.
Twisting around the isoelelectric line
102
Approximately _______% of TdP patients are asymptomatic
50%
103
Symptoms of TdP may include; P_______, L_____, S______, C____, N_____, C_____, D______, and in 10% of patients ________ can occur!
Palpitations
Lightheadedness
Syncope
Chest pain
Nausea
Cold sweats
Dyspnoea
Sudden cardiac death
104
The main 3 primary investigations you’d want to do in suspected TdP are:
ECG
VENOUS BLOOD GAS
BLOODS (U+Es)
105
**Management of TdP** involves R_____, treating the _______, 2g IV _____ and if they are haemodynamically unstable then _______
Resuscitation (IV fluids)
Treat reversible causes
IV MAGNESIUM
DC cardioversion
106
_______ are the first like treatment in congenital **long QT syndrome** (usually _______)
Beta blockers
Propranolol
107
A narrow complex tachycardia refers to a _______ that has a HR of >____bpm and a QRS <___ms
Dysrhythmia
>100bpm
QRS <120ms
108
Sinus tachycardia frequently change ____ and gradually speeds up/ slows down over ______________
Changes rate
Over seconds to minutes
109
SVT starts _______ and then stays the same ____ until it ends
Suddenly
Stays the same rate
110
SVT and Sinus tachycardia are both examples of __________________
Narrow complex tachycardia
111
Narrow complex tachycardias can be classified depending on if they are ________ or _______
Regular or irregular
112
Focal atrial tachycardia is when there are ______atrial cells acting like the ________. There is an ________ P wave morphology
Autonomous atrial cells
Acting like the SA NODE
abnormal P wave morphology
113
Atrioventricular re-entry tachycardia (AVRT) is when there is an _________ between the atria and ventricles that is not filtered by the ________. It is associated with ____\\
Accessory pathway
AVN (AV node)
WPW
114
AVRT + AVNRT are examples of __________
Regular narrow complex tachycardias
115
Atrioventricular nodal re-entry tachycardia (AVNRT) is when there are ________ within or near the ____\ causing ___
Re-entrant circuits
AVN
causing SVT
116
Signs of narrow complex tachycardia are (2)
Tachycardia
Haemodynamic instability (Shock/ chest pain/ HF, Syncope)
117
Symptoms of narrow complex tachycardia include (5)
Palpitations
Lightheadedness
Dyspnoea
Chest pain
Syncope
118
Bedside testing of narrow complex tachycardia (3)
ECG
24hr tape
BLOODS
119
Imaging for narrow complex tachycardia (3)
Echo
Loop recorder
Cardiac catheterisation
120
If someone has an irregular narrow complex tachycardia it is probably _______ so should be treated with ________
AF
beta blockers
121
1st line treatment of narrow complex tachycardia; _________, 2nd line is __________, 3rd line is ________, 4th is ___________.
1st: Vagal manoeuvres
2nd: IV Adenosine
3rd: verapamil or BB
4th: synchronised DC cardioversion
122
Persistent recurrent SVT should be treated with __________
Cardiac ablation
123
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