Cardiac Shock + Myopathies

Question 1

What does a correctly functioning ventricular pacemaker show on ECG?

Answer 1

Pacing spike followed by widened and bizarre QRS

Question 2

Management of cardiac shock

Answer 2

Nitrate
Diamorphine
NIV if in HF

Question 3

Management of septic shock

Answer 3

O2
Culture, empirical abx
Vasopressors, inotropes

Question 4

Management of hypovolaemic shock

Answer 4

Fluid replacement
Give blood
Inotropes if no response

Question 5

What are the ECG findings for Wolff PW?

Answer 5

Delta wave

Narrow complex tachycardia

Question 6

Causes of hypovolaemic shock

Answer 6

Bleeding
Burns
GI losses
Pancreatitis
Sepsis
DM

Question 7

S+S hypovolaemic shock

Answer 7

Thirst, cold/ clammy peripheries
Decreased cap refill
Reduced JVP

Question 8

SIRS criteria

Answer 8

2 or more:
Temp <36 or >38
HR >90
RR >20
WCC <4 or >12

Question 9

What is sepsis vs septic shock?

Answer 9

Sepsis = SIRS secondary to infection

Septic shock = sepsis + hypotension

Question 10

Cautions + CI with B blocker + what bloods need checking?

Answer 10

CI = asthma
Caution = COPD
Baseline U+E + BP = check 2 weeks after starting + every dose change

Question 11

What is Eisenmenger’s syndrome?

Answer 11

When a left to right shunt becomes right to left due to increased pulmonary blood flow + RVH

Question 12

Which are the right to left shunts?

Answer 12

Transposition of vessels

Tetralogy of Fallot

Question 13

What are the left to right shunts?

Answer 13

ASD, PDA, VSD

Question 14

What type of cardiomyopathy is seen in sudden death of young athletes?

Answer 14

Hypertrophic cardiomyopathy

Question 15

Describe the histological changes seen after MI (in 24 hrs, first week, 3 weeks + months after)

Answer 15

First 24hrs: dark discolouration due to coagulative necrosis
First week: yellow pallor due to inflammation
1-3 weeks: granulation tissue is seen as red border around yellow pallor
Months after = white fibrosis tissue

Question 16

What heart condition is Turners associated with?

Answer 16

Coarctation of the aorta

Question 17

What is the main complication of the macrophage phase post MI, and when is this?

Answer 17

4-7 days post MI
Macrophages can cause cardiac rupture causing:
Cardiac tamponade/ shunt through ventricular wall/ mitral insufficiency (due to ruptured papillary muscles)

Question 18

What are the signs of cardiac tamponade + what is the name given to these signs?

Answer 18

Hypotension
Muffled heart sounds
Increased jugular venous distension
^ called Beck’s triad

Question 19

What heart condition is associated with foetal alcohol syndrome?

Answer 19

VSD

Question 20

What heart condition is associated with congenital rubella?

Answer 20

PDA

Question 21

What heart condition is associated with maternal diabetes?

Answer 21

Transposition of great vessels

Question 22

What heart condition is associated with Downs?

Answer 22

ASD

Question 23

When can you get an acquired VSD? Describe the murmur this causes.

Answer 23

VSD following large left anterior descending artery infarct

Pansystolic murmur at lower sternal border + apex

Question 24

What is asterixis + what causes it?

Answer 24

CO2 flap - hands tremor when wrists extended

Due to hypercapnia, hepatic encephalopathy + uraemia

Question 25

What are the main cardiomyopathies?

Answer 25

Dilated, hypertrophic, restrictive, arrhythmogenic RV

Question 26

What are inotropic drugs + give examples?

Answer 26

Digoxin Calcium Drugs that increase force of contractions

Question 27

Describe the PDA murmur

Answer 27

PDA – continuous machinery murmur in systole + diastole, heard inferior to left clavicle

Question 28

Describe the pulmonary stenosis murmur

Answer 28

Ejection systolic murmur in 2nd IC space left side

Question 29

How do you treat PDA?

Answer 29

Cardiac catheter lab plugging

Question 30

When does rheumatic fever occur?

Answer 30

2-4 weeks after strep throat

Question 31

What is the difference between critical aortic stenosis + coarctation of the aorta?

Answer 31

Critical aortic stenosis = radial + brachial pulses are also hard to palpate (whereas coarctation, only femoral pulses are hard to palpate)

Question 32

What is dilated cardiomyopathy + what causes it?

Answer 32

``` Unexplained dilation + impaired systolic function of ventricle(s) Causes: Idiopathic Alcohol Genetic Uncontrolled tachycardia (AF) Collagen disease (SLE etc) Infectious NMD ```

Question 33

S+S of dilated cardiomyopathy

Answer 33

CHF PE Arrhythmias Sudden death

Question 34

ECG changes for dilated cardiomyopathy

Answer 34

Variable ST-T abnormalities Poor R wave progression Conduction defects

Question 35

What investigations + results would you expect for dilated cardiomyopathy?

Answer 35

CXR = globular heart, signs of HF + pleural effusion Echo = chamber enlargement ECG Bloods = CBC, U+E, BNP, trop, LFTs, TSH

Question 36

Management of dilated cardiomyopathy

Answer 36

Treat underlying disease Anticoagulation with warfarin Immunise against influenza S pneumoniae Surgery

Question 37

What is hypertrophic cardiomyopathy + what are the causes?

Answer 37

Unexplained ventricular hypertrophy | Caused by genetic defect in cardiac sarcometric proteins - autosomal dominant

Question 38

S+S of hypertrophic cardiomyopathy

Answer 38

``` Asymptomatic SOBOE Angina Syncope CHF Spike + dome pattern in carotid pulse ```

Question 39

Murmur for hypertrophic cardiomyopathy

Answer 39

Paradoxically split S2, S4 | Harsh systolic diamond shaped murmur at apex, enhanced by squat to standing/ Valsalva

Question 40

Investigations + results for hypertrophic cardiomyopathy

Answer 40

ECG - LVH, prominent Q waves in lead 1, aVL, V5 + V6 Tall R wave in V1 TTE + Echo - asymmetrical septal hypertrophy Cardiac catheterisation

Question 41

Management of hypertrophic cardiomyopathy

Answer 41

Avoid competitive sports + factors which increase obstruction (eg volume depletion) BB, disopyramide, verapamil, phenylephrine (if in cardiac shock) Surgical myectomy Septal ablation High risk of sudden death = ICD Screen 1st degree relatives

Question 42

What is restricted cardiomyopathy + what causes it?

Answer 42

Impaired ventricular filling with preserved systolic function in a non-dilated, non-hypertrophic ventricle Causes: Infiltrative = amyloidosis, sarcoidosis Non-infiltrative = scleroderma, myocardial fibrosis Endomyocardial (endocarditis, carcinoid syndrome)

Question 43

S+S of restricted cardiomyopathy

Answer 43

CHF with preserved LV function Arrhythmias Elevated JVP (Kussmaul's sign) PE