Cardiac Pathology 3 Flashcards
(128 cards)
1
Q
Transcutaneous temporary pacing is often used in _______ situations. Two _____ are placed ____ the chest and _______ is required due to pain
A
Emergency situations
Pads are placed on the chest
Sedation required
2
Q
Indications for temporary transcutaneous pacing in bradyarrythmias are 1.______ and 2._________
A
Bradycardia unresponsive to atropine
Post inferior MI
3
Q
Indications for temporary transcutaneous pacing in tacyarrythmias are patient unresponsive to medical management or cardioversion in __________
A
SVT
4
Q
Transvenous temporary pacing occurs when a ______ is inserted into a ______ and passes into the _______ or ________
A
Pacemaker wire is inserted into a vein and passes into the right atrium or right ventricle
5
Q
A permanent pacemaker is inserted under the _____________
A
Skin of the chest
6
Q
Indications for PPM: 1.______, 2.________, 3._________, 4.________
A
- Heart block
- Sick sinus syndrome
- Permanent bradyarrythmias
- Cardiac resynchronisation therapy
7
Q
In right ventricular pacing the QRS morphology is similar to _____________
A
LBBB
8
Q
In left ventricular pacing the QRS morphology is similar to _____________
A
RBBB
9
Q
In atrial pacing the pacing spike precedes the ________
A
P wave
10
Q
In ventricular pacing the pacing spike precedes the ________
A
QRS complex
11
Q
Complications of PPM insertions are common and may include P_____, H_______, H_______, T_______ and I_______
A
Pneumothorax
Haemothorax
Heart perforation
Thromboembolism
Infection
12
Q
Constructive pericarditis is a result of _______ and loss of _______ of the ________
A
Scarring and loss of elasticity of the pericardial sac
13
Q
A scarred pericardium prevents normal _______ which leads to restriction of ________, _________ and ultimately ____________
A
Normal cardiac filling
Restriction of ventricular volume, stroke volume and cardiac output
14
Q
Constructive pericarditis is often _________
A
Idiopathic
15
Q
Patients with constrictive pericarditis often present with symptoms of _____________
A
Heart failure
16
Q
What is Kussmauls sign?
A
Paradoxical rise in JVP with inspiration
17
Q
A pericardial knock is a ____-pitched, __________ sound that occurs when stiff pericardium results in sudden arrest of _____________
A
High pitched
Early diastolic sound
Sudden arrest of ventricular filling
18
Q
Signs of constrictive pericarditis are raised _____, ______ sign, P________, and ________ heart sounds with a possible P______________
A
Raised JVP
Kussmauls sign
Pulsus paradoxus
Quiet HS
Pericaridal knock
19
Q
CXR in constrictive pericarditis may show a _______ +/- __________
A
Small heart +/- pericardial calcification
20
Q
Echocardiogram in constrictive pericarditis may demonstrate a _________ and Heart failure with _____________ (_______)
A
Ventricular filling defect
Preserved ejection fraction
(HFpEF)
21
Q
Management of constrictive pericarditis is _____________
A
Pericardiectomy
Excision of the fibrosed pericardium
22
Q
Restrictive cardiomyopathy is when there is increased _______________
A
Myocardial stiffness
23
Q
Causes of restrictive cardiomyopathy include __________ and _________
A
Amyloidosis
Post-radiotherapy
24
Q
Cor pulmonale refers to ___________ caused by _______ (particularly severe _____)
A
Right ventricular failure
Lung disease (severe COPD)
25
In Cor Pulmonale, chronic ______ leads to ________, placing increased strain on the ______________
Chronic hypoxia
Pulmonary hypertension
Right ventricle
26
Symptoms of **Cor pulmonale** include ________, _____________, __________
Fatigue
Peripheral oedema
Dyspnoea
27
Signs of **Cor pulmonale** include ________, _____________, right __________
Cyanosis
Elevates JVP
Right ventricular heave
28
Treatment of **Cor pulmonale** involves _________
Treating underlying problem
29
P pulmonale on an ECG refers to __________ P waves, indicating ____________
Tall peaked P waves
Right atrial enlargement
30
Pulmonary hypertension or chronic lung disease (**P pulmonale**) suggests Right __________
Atrial hypertrophy
31
A coronary artery bypass graft (CABG) is a ___________ technique used to treat _____________
Revascularisation
Coronary artery disease
32
A CABG uses harvested __________ from other parts of the body to bypass ___________ thus improving blood flow to the heart
Harvested blood vessels
Narrow coronary arteries
33
Which specific blood vessels are usually used for a CABG
long saphenous vein
Internal mammary artery (chest)
34
Common post operative complications of a CABG include ______, _______ (usually __), _________ and ______________
Post op bleeding
Arrhythmia (AF)
Low output cardiac syndrome
Midline sternotomy wound infection
35
36
Hyperkalaemia changes on ECG include _______ T waves, _________ PR, __________ p waves and ________ QRS
Tall tented T waves
Prolonged PR
flattened P waves
QRS Broadening
37
Heart block refers to a ________ in the electrical conduction system of the heart. Their obstruction can a car at various points in the conduction system including the ______, ________, _______, _________.
Obstruction
Sinoatrial node
Atrial ventricular node
Bundle of his
Or bundle branches.
38
First-degree heart block is caused by ________conduction of electrical activity through the_____
Prolonged
AV node
39
1st° heart block can be identified on an ECG by finding a PR interval of > _________ms
>200ms
40
Causes of **first-degree heart** include; AAED
Athleticism
Acute inferior MI
Electrolyte abnormalities: hyperkalaemia
Drugs
41
Drug causes of **first-degree heart** block include (4)
NHP – CCBS
Beta blockers
Digoxin
Cholinesterase inhibitors
42
Management or 1st° heart block involves:
Managing any underlying cause (first-degree heart block itself is benign)
43
Second-degree heart block is into _______ and ________
Mobitz type 1
Mobitz type 2
44
**Mobitz 1** is AKA _________ and is a type of 2nd-degree heart block that is usually due to a _________ block at the _________
Wenckeback
Reversible conduction block at the AV NODE
45
Causes of **Mobitz 1 (Wenckebach)** include M_____, drugs such as _____&______, A______, M_______ and C________
Myocardial infection
Beta or calcium channel blockers and digoxin
Athleticism due to **high vagal tone**
Myocarditis
Cardiac surgery
46
**Mobitz type 1 (Wenckebach) generally requires _______ management
no
47
**Mobitz type 2** is a type of ___________ where there are intermittent ___________ waves
2nd degree HB
non-conducting p waves
48
A way to remember Mobitz type one (prolonged refractory period;)
Wenckebach
Each time it takes longer ;)
PR prolongation
49
In Mobitz type two the PR interval is _________ and there may be no ________ or fixed _______
PR interval is Constant
No pattern or fixed ratios
50
**Mobitz type 2 block** is usually caused by a _________ failure, especially at the__________ system
Conduction system failure
His-PURKINJE system
51
** Mobitz type 2** is normally more **severe** and can be caused by; I_______, S_____, R____, F______, I_____, M______
Infarction
Surgery
Inflammatory/auto mean
Fibrosis
Infiltration
Medication
52
What two cardiac surgeries are associated with Mobitz T2?
Mitral valve repair
Septal ablation
53
What three infiltration associated conditions can cause a Mobitz type two heart block?
Sarcoid
Haemochromatosis
Amyloidosis
54
What for inflammatory/autoimmune conditions can cause Mobitz T2 heart block
Rheumatic heart disease
SLE
Systemic sclerosis
Myocarditis
55
What four main medications can cause Mobitz T2 heart block?
Beta blockers,
Channel calcium blockers
Digoxin
Amiodarone
56
In most cases of**Mobitz T2 block** there is a _______QRS indicating a ______ block in the ________ system and many patients have pre-existing _______/________
Broadened QRS
Distal block in the His-purkinje system
LBB/ bifascicular block
57
What two things would you look for on an ECG in Mobitz T2 heart block?
Broaden QRS
LBBB
58
Definitive management of **Mobitz T2** is with a ____________
Permanent pacemaker
59
Complete heart block occurs when the _________ fail to be conducted to the _________
Atrial impulses
Ventricles
60
ECG of **complete HB (3rd degree)** will show severe ________, and complete dissociation between _______ and ________
Bradycardia
Dissociation between P waves and QRS complexes
61
3rd degree HB patients are at high risk for ______, _______, and _________!
Asystole
VT
cardiac arrest
62
Medication causes of 3rd degree HB *(think of drugs acting at the AVN)* are (3)
BBSs
Dihydropyridine CCBs
Adenosine
63
Management of 3rd degree HB:
Permanent pacemaker
64
Hypertrophic cardiomyopathy is an __________, characterised by ______________ without apparent cause.
Autosomal dominant condition
Left ventricular hypertrophy.
65
HCOM is attributed to mutations in genes encoding __________ leading to chaotic and disorganised _________,
Sarcomere proteins
Cardiac myocytes
66
HCM may be asymptomatic but can also lead to (4)
Exertional syncope
Dyspnoea
Chest pain
Heart failure
67
68
Definitive diagnosis of HCM is made via what?
Echocardiogram
69
Management of HCM involves lifestyle, medication such as _________(4) and surgical.
beta blockers
Non-dihydropyridine calcium blockers (verapamil)
Anti-arrythmics (amiodarone)
Anticoagulation
70
First line treatment for HCM is beta blockers to reduce _______ and ________
Palpitation symptoms
Ectopic beats
71
Surgical and interventional management of septal hypertrophy in those with severe _____________(LVOTO) in HCM include (2)
**Ventricular outflow obstruction (LVOTO)**
1. Surgical septal myectomy
2. Septal ablation.
72
A way to remember the key findings of HOCM is the mneumonic Mr Sam Ash… What is this?
**Systolic anterior motion** of the mitral valve often associated with **asymmetric septal hypertrophy**
73
HOCM is associated with left ventricular hypertrophy therefore ECG may show _______, and sometimes pathological _______
T wave inversion
Pathological Q waves
74
Malignant hypertension is a medical emergency characterised by ___________ leading to _________
Rapid increase in blood pressure that leads to end organ damage
75
Malignant hypertension pathophysiology involves increased ________due to ________leading to _________ and _______
Systemic vascular resistance
Vasoconstriction
Hypo perfusion and vascular damage
76
Drug causes of malignant hypertension include (3)
Cocaine
Amphetamines
Sympathomimetics
77
Renal causes of malignant hypertension include GRSS
Glomerulonephritis
Renal arteries stenosis
SLE
Systemic sclerosis
78
Endocrine causes of Millicant hypertension include (3)
Phaeochromocytoma
Cushing’s
Cons disease
79
Neurological causes of malignant hypertension include (4)
Head injury
Ischaemic stroke
Haemorrhagic stroke
80
In Malignant hypertension, you would see a blood pressure of _____mmHg Systolic and ________mmHg diastolic
>180
>120
81
Management of **malignant hypertension** includes reversing causes and medical management. 1st line medical management is __________ including ________or________
Controlling BP
Calcium blocker is including amlodipine or nifedipine
82
What is a major complication of malignant hypertension?
Hypertensive encephalopathy
83
How should you treat hypertensive encephalopathy ?
IV labetolol or
IV sodium nitroprusside
84
If malignant hypertension is caused by a phaeochromocytoma you should treat it with:
IV phenoxybenzamine
BEFORE
beta blockade
85
Turner syndrome (_______) is a genetic condition that only affects _______
45 XO
Females
86
Turner syndrome is characterised by (4)
Short stature,
Webbed neck
Primary amenorrhoea
Congenital heart block
87
The most common congenital cardiac defect in Turner syndrome is ___________ and sometimes ________
Bicuspid aortic valve
Coarctation of the aorta
88
Prenatal Turner syndrome can be investigated initially via ultrasound and then confirmed with _________ or _____
Amniocentesis or CVS
89
Management of Turner’s syndrome include ______ and ______
Human growth hormone replacement (height)
Oestrogen replacement therapy
90
Regular screening for potential complications is needed in Turner’s syndrome: ie. (3)
Impaired glucose tolerance
TFTS
Hearing
91
What are the two most important complications of Turner’s syndrome ?
CVD (due to aortic stenosis)
Aortic dissection (due to aortic coarctation)
92
93
Wellens syndrome is an ECG patter cause by severe ___________, posing a risk of major ________________ myocardial infarction
Severe proximal LAD stenosis
Major anterior wall MI
94
ECG findings in Wellens syndrome are ________ and a ______ pattern in leads ___ & ____
T wave inversion
Biphasic pattern
V2 & V3
95
Treatment of Wellens syndrome is:
PCI to the LAD
96
________ is a congenital pre-excitation syndrome
WPW
97
WPW is characterised by the presence of an abnormal _________ between the ______ & ____
Accessory electrical pathway
Atria and ventricles
98
WPW predisposes individuals to ______ including _____
Arrhythmias
SVT
99
SVT can lead to ____
VF
100
Diagnosis is WPW is made via ECG findings (3)
Delta waves
Shortened PR
Broad QRS
101
Delta waves are indicative of
WPW
102
Emergency Management of WPW w/ narrow complex tachycardia: 1st _______, 2nd_______
Vagal manoeuvres
Adenosine
103
Emergency Management of WPW w/ broad complex tachycardia: 1st _______, 2nd_______
IV anti-arrhythmics (flecainide)
DC cardioversion
104
Medical long term management of WPW; 1._________, 2._________ (contraindicated in structural HD)
Amiodarone
Sotalol
105
Definitive management of WPW is…
Radio frequency ablation
106
VSD is a congenital defect when there is a ____ in the _____ that separates the _________
Hole in the septum that separates the ventricles
107
Small VSDs may be ________, but larger VSDs may present with symptoms of ___
Asymptomatic
HF
108
VSD can be identified by auscultation: a ______________ murmur that is heard loudest at the ____________
Loud, harsh Pansystolic murmur
Left lower sternal edge
109
Definitive diagnosis of VSD is madd through _______
Echo
110
What is Eisenmengers syndrome?
Cyanosis and clubbing
111
Medical management of VSD may be (2)
Diuretics & ACEi
112
Most VSDs will ________ but some may require _______
Spontaneously resolve
Surgery
113
Dilated cardiomyopathy refers to a _____ heart with __________ (_____)
Dilated heart
Impaired systolic function
HFrEF
114
Causes of dilated cardiomyopathy include _______, _______, ______ (via _______)
Idiopathic
Alcohol
Cocksackie B virus (myocarditis)
115
Common signs of dilated cardiomyopathy include: D______, S_________, M____, HF signs
Displaced apex beat
S3 gallop rhythm
Mitral regurge
Signs of HF
116
Echo of Dilated cardiomyopathy would show…
Globular dilated heart with rEF
117
**Takotsubo cardiomyopathy** looks like an **octopus pot on ECHO**; there is ________ due to severe ______ of mid and apical segments with preservation of _________
Apical ballooning
Hypokinesis
Basal segments
118
Takotsubo cardiomyopathy is usually triggered by ____
Stress
119
_____ is suspected in those with troponin +ve chest pain, significant stressor, and ______ on ECG (+ normal CAs on angio)
Takotsubo
ST ELEVATION
120
Treatment of Takotsubo is ______
Supportive
121
Definitive diagnosis of mitral valve prolapse is made with _______
Echocardiogram
122
Rheumatic fever is caused by ____________ infection
Group-A beta-haemolytic strep
123
Rheumatic fever is treated with a STAT dose of __________ and a 10 day course of __________
IV Benzylpenecillin
Phenoxymethylpenecillin
124
125
What 4 anomalies make up Tetralogy of Fallot
1. Pulmonary stenosis
2. Overriding aorta
3. VSD
4. Right ventricular hypertrophy
126
Tetralogy of Fallot is the most common cause of __________
Blue baby syndrome
127
Right ventricular hypertrophy is a compensatory result of __________
Pulmonary stenosis
128
