Cardio Flashcards
(143 cards)
1
Q
How does a first degree AV block present (clinically and ECG)
A
Consistent prolongation of the PR interval (>0.2 seconds), due to delayed AV node conduction. No dropped QRS complexes. Regular rhythm, every P wave present. Usually asymptomatic and not progress to higher class of AV blocks
2
Q
How does a second degree, Mobitz type I, AV block present? (clinically and ECG)
A
- progressive prolongation of PR interval until atrial impulse is not conducted. Regular pattern, irregular rhythm. All P waves present, not all QRS. Usually benign
3
Q
How does a second degree, Mobitz type II, AV block present? (clinically and ECG)
A
- irregular. More P wavs than QRS. Intermittently dropped QRS waves, with no progressive elongation of PR interval before
- pathological
- can experience syncope, regular irregular pulse
4
Q
What AV blocks are benign and which require rapid treatment?
A
- 1st degree and mobitz type 1: normally benign. May have slight increased risk of AF
- Mobitz type 2 and third degree: require immediate treatment
5
Q
How does a third degree, AV block present? (clinically and ECG)
A
- ECG: no electrical communication between atria and ventricles. Variable rhythm. P wave presence, but no association with QRS
- palpitations, syncope, shortness of breath
6
Q
How does AF present on an ECG and clinical?
A
- ECG: irregular rhythm, no p wave, variable ventricular rate, thinner QRS
- clinical: tachycardia, irregular HR. Reduced exercise tolerance and heart failure. Dyspnoea, angina, palpitations, dizziness.
- SYNCOPE = RARE
7
Q
What is the aetiology and mnemonic for AF?
A
PIRATES
- P: pulmonary, post operative, pericarditis
- I: idiopathic, IHD
- R: rheumatic heart disease
- A: alcohol, anaemia
- T: thyroid disease
- E: elevated BP (HTN)
- S: sepsis, sleep apnoea
8
Q
What is the treatment for AF?
A
Beta-blockers and calcium channel blockers are first-line agents for rate control in AF. These drugs can be administered either intravenously or orally.
9
Q
What is the ECG presentation for atrial flutter?
A
- narrow complex tachycardia
- regular atrial activity
- flutter waves
- regular QRS
- regularly irregular pulse
10
Q
What is atrial flutter?
A
Supraventricular tachycardia caused by a re-entry circuit to RA. AV node can’t keep up, so blocks some impulses
11
Q
What is long QT syndrome?
A
Represents time taken from ventricular repolarisation to repolarisation. Inversely proportional to heart rate. Shorter when faster. Abnormally prolonged can risk ventricular fibrillation
12
Q
What is Wolf Parkinson White syndrome? How does it present on ECG?
A
Pre excitation syndrome. Combination of congenital accessory pathway and episodes of tachyarrhythmia. Impulses bypass AV node vis the accessory pathway.
- ECG: short PR interval, delta wave (slow slurring rise of QRS), QRS prolonged
- form of supra ventricular tachycardia
13
Q
What are the four forms of supraventricular tachycardia and what pathophysiology do they all have in common?
A
- AF, atrial flutter, wolf parkinson white syndrome, PVST
- all tachycardia that originate above the level fo the bundle of His
14
Q
What is a fusion beat (and what is is also known as?
A
- Dressler’s beat
- when P wave starts during VT
15
Q
What view of the heart do leads I, aVL and V5-V6 give, and if there is ST elevation in these leads, where is the MI located?
A
lateral views. Left circumflex
16
Q
What view of the heart do leads II, III and aVF give, and if there is ST elevation in these leads, where is the MI located?
A
inferior view. Right coronary artery
17
Q
What view of the heart do leads V1-V4 give, and if there is ST elevation in these leads, where is the MI located?
A
anterior/sepal view. Left anterior descending artery
18
Q
What marker is used for HF?
A
B-type natriuretic peptide. Due to ventricle stretch
19
Q
What is the most common cause of right axis deviation? What leads would be most positive and negative?
A
- right ventricular hypertrophy
- III = most positive
- I = most negative
20
Q
What is the most common cause of left axis deviation? What leads would be most positive and negative?
A
- electrical conduction issues
- I is most positive
21
Q
What is the treatment for SVT?
A
- young: Valsalva manoeuver: stimulates vagus nerve
- amiodarone: broad complex tachycardia
22
Q
What time period does one large square represent on ECG?
A
0.2 seconds
23
Q
How long is the average PR interval?
A
120-200 m/s
24
Q
How long should QRS complex be?
A
<110m/s
25
What is the J point?
Point between QRS and ST segment
26
What murmur is heard in mitral stenosis? Where is it heard? Does it radiate?
Diastolic.
Apex.
No radiation
27
What murmur is heard in mitral regurg? Where is it heard? Does it radiate?
- pan systolic murmur
- heard at the apex
- radiates to the axilla
28
What murmur is heard in aortic stenosis? Where is it heard? Does it radiate?
- ejection systolic (crescendo-decrescendo)
- heart at 2nd line intercostal space, sternal edge
- radiates to the carotid artery
29
What murmur is heard in aortic regurg? Where is it heard? Does it radiate?
- early diastolic
- heard at left sternal edge, 4th intercostal space
- no radiation
30
What does aortic stenosis cause, and consequently what is the clinical presentation?
- decreased cardiac output, due to obstruction of the left ventricular outflow
- decreased CO leads to syncope on exertion, dyspnoea on exertion, angina
- LV hypertrophy seen on ECG
31
What symptoms are seen with mitral regurgitation?
fatigue, oedema, dyspnoea on exertion
32
What is the preload?
stretching of myocytes before contraction. Relates to ventricular filling
33
What is afterload?
amount of resistance needed to open aortic valve and push blood out
34
What are the four compensatory mechanisms of the heart in heart failure?
1. RAAS system activation
2. natriuretic peptides release
3. ventricular dilation
4. activation of the sympathetic nervous system
35
What are common causes of heart failure in the developing world?
HTN, IHD, dilated cardiomyopathy
36
What is the pharmacological reatment for heart failure?
1. Vasodilation: ACE-I (excrete salt and water, which increases cardiac output and reduces afterload). Beta blocker (blocks chronically activated sympathetic system. Decreases arteriolar constriction)
2. Diuretics: get rid of renal overload
3. Digoxin: rhythm control in HF and AF
37
What biomarkers are used in MI Dx?
- increased CK (creatinine kinase)
| - increased troponin I and T (released from myocardium)
38
What is seen on a ECG for a MI?
- ST elevation: peaked T waves, T wave inversion
- new LBBB
- pathological Q waves
- can also see ST depression in NSTEMI
39
When is O2 indicated in an MI?
When oxygen sats are <94%
40
What are the CXR findings in heart failure?
ABCDE
- alveolar odema
- Kerley B lines (represent interstitial oedema)
- cardiomegaly
- dilation of upper lobe vessels
- effusions
41
What is CHAD2 used for?
Risk of MI with AF
42
What us QRISK3?
risk of developing a heart attack/stroke in the next 10 years
43
What does JVP provide information on?
right atrium filling/pressures
44
What is Prinzmetal's angina? What causes it? What us seen on an ECG?
- at rest, coronary artery spasm.
- causes: stress, vasoconstriction, cocaine
- ST elevation on ECG
45
What is Decubitus angina?
- angina when lying down, due to increased strain on the heart
46
How does GTN spray work?
- vasodilation of venous return
| - decreases preload and dilates coronary arteries
47
What is the general aetiology of heart block?
- cardiomyopathy, fibrosis of conducting tissue, coronary artery disease
48
What symptoms are seen in mitral stenosis?
Pink frothy sputum, malar flush due to increased CO2
49
What valve is most commonly affected by rheumatic heart disease?
Mitral valve: stenosis.
50
What causes rheumatic heart disease?
Group A streptococcus
51
What vavular heart disease do Marfan's and Ehler's Danlos relate to?
mitral regurg
52
When might a third heart sound be heard?
mitral regurg
53
When are symptoms seen with aortic stenosis?
When the valve is 1/4 of what is should be
54
What is the most commony cause of aortic stenosis?
Calcification of the aortic valve with age
55
Which valvular heart disease might have an associated Austin Flint Murmur?
Aortic Regurg. Fluttering of cusps due to blood flow stream
56
What are the four features of Fallot's tetralogy?
ventricular septal defect, pulmonary valve stenosis, RV hypertrophy, overriding aorta
57
What is the direction of the shunt in Fallot's tetralogy?
right to left
58
What is seen on investigation of Fallot's tetralogy?
- RV hypertrophy with RBBB
| - CXR: boot shaped heart.
59
What is eisenmenger's complex?
- initial left to right shunt due to ventricular septal defects
- leads to pulmonary HTN
- increasing right heart pressure, until they exceed left. then , shunt reversal.
- cyanosis: less blood enters systemic system
60
What are the two types of atrial septal defect, and which is more common?
- ostrium secondum and ostrium primum
| - secondum = more common
61
What murmur is heard in ventricular septal defect?
Pansystolic murmur
62
What is coartication of the aorta?
Congenital narrowing of the descending aorta. Level of the ductus arteriosus (origin of left subclavian artery)
63
What are the four stages of heart failure (New York Heart Association)
A: no symptoms
B: comfortable at rest, symptoms with exercise
C: minor exercise triggers
D: symptoms at rest
64
What is the treatment for heart failure?
LOON
- L; loop diuretics
- O: O2
- O: opioids
- PN: nitrates
65
What are the symptoms of left sided heart failure?
dyspnoea, tachypnoea, crackles at lung base, wheezing, cyanosis. laterally displaced apex beat
66
What are the symptoms of right heart sided heart failure?
ascites, oedema, increased JVP, liver enlargement
67
What is the definition of shock?
- BP: systolic below 90 mmHg
- severe lactic acidosis
- decreased urine
68
What are the 5 types of shock?
- haemorrhagic
- neurogenic (sympathetic innervation lost due to CNS damage)
- cardiogenic
- anaphylaxis
- sepsis
69
What are the symptoms of neurogenic shock?
instantaneous hypotension, bradycardia, warm flushed skin, priprism
70
What is peripheral vascular disease?
narrowing of arteries distal to aortic arch
71
What are the 6 p's of critical limb ischaemia?
The classic presentation of limb ischemia is known as the "six Ps," pallor, pain, paresthesia, paralysis, pulselessness, and poikilothermia
72
What are the four types of cardiomegaly?
1. dilated
2. hypertrophic
3. arrythmogenic RV
4. restrictive
73
What is the aetiology of dilated cardiomyopathy?
genetic: dominant heterogenous mutation fo the cytoskeleton
74
What is the cause of hypertrophic cardiomyopathy?
loss of normal myocyte arrangement: myofibrillar disarray. Also, fibrosis present
75
What is hypertrophic cardiomyopathy?
hyperdynamic contraction of the heart due to thickening of walls and IV septum. Impaired relaxation. Leads to LV hypertrophy, impaired diastole, reduce stroke volume and abnormal mitral valve. Causes dnyamic obstruction of LV outflow
76
What are the symptoms of hypertrophic cardiomyopathy?
forceful apex beat, late ejection systolic murmur, jerky carotid pulse, alpha wave in JVP, AF.
77
What is cardiomyopathy?
disease of cardiac muscle
78
What is restrictive cardiomyopathy?
normal left ventricular cavity size and systolic function, increased myocardial stiffness. This restricts diastolic filling, and leads to ventricular incompliance
79
What is the aetiology of restrictive cardiomyopathy?
infiltrative myocardial disease. Amyloid heart disease. Sarcoidosis
80
What is the most common cause of sudden cardiac death?
hypertrophic cardiomyopathy
81
What is arrhythmogenic RV cardiomyopathy?
Associated with desmosomes. Fibrofatty replacement of RV myocytes. Leads to loss of function and decreased streak volume and cardiac output
82
What is Naxos disease?
Form of arrhythmogenic RV cardiomyopathy. symptoms: wooly hair, white soles of feet. Due to consanguinity
83
What is the most common cause of infective endocarditis?
S.aureus
84
What is used to assess severity of infective endocarditis?
Modified Dukes Criteria
85
What are the signs of infective endocarditis?
Roth Spots, Osler's nodes, Janeway lesions, splinter haemorrhages, fever
86
What is acute pericarditis?
Inflammation of the pericardium: with or without pericardial effusion
87
What are the symptoms of pericarditis?
Chest pain (dull, sharp, burning, pressing). Rapid onset. Radiates to neck and shoulders due to phrenic nerve. Aggravated by swallowing, coughing, or laying flat. Relieved by sitting up. Pericardial rub heard. Tachycardia, tachypnoea
88
What is the aetiology pericarditis?
- viral: enterovirus, coxsackie virus, adenovirus, parvovirus
- bacterial: mycobacterium tuberculosis
- autoimmune: Sjogrens, rheumatoid, scleroderma, systemic vasculitis
- neopastic
- metabolic
- trauma
- post MI, some drugs
- most idiopathic
89
what is the potential compx of pericarditis?
If effusion, can become haemorrhagic and lead to cardiac tamponade
90
What is Beck's triad?
Beck triad is a collection of three clinical signs associated with pericardial tamponade which is due to an excessive accumulation of fluid within the pericardial sac. The three signs are: low blood pressure (weak pulse or narrow pulse pressure) muffled heart sounds. raised jugular venous pressure.
91
How do you distinguish chronic effusive and chronic constrictive pericarditis?
cardiac catheterisation
92
What is chronic constrictive pericarditis?
Occurs with 1% of people with acute pericarditis. Calcification thickens pericardium and affects function. Due to prolonged damage
93
What is the presenation of chronic constrictive pericarditis?
Kaussmaul's sign, dyspnoea, oedema, increased JVP, pulsatile hepatomegaly, hx of cardiac surgery
94
What is an aortic dissection?
Tear in intima. blood between layers of the aortic wall: false lumen. Can present with migrating pain
95
What is lidocaine used to treat?
ventricular fibrillation. Inactivates gate of the sodium channel
96
How does digoxin work?
makes membrane potential more positive, releasing ACh from parasympathetic nerves
97
What transporter does furosemide block?
Na/K/2Cl
98
What is a s/e of calcium antagonists?
postural hypotension
99
What percentage of vessel must be slerosied for symptoms of angina?
70-80%
100
What is the gold standard diagnosis for angina?
CT coronary angiography
101
What is the pathophysiology of an NSTEMI?
partial occlusion: subendothelial infarct
102
What group of people are most likely to have a silent infarct?
Diabetics
103
What management should be done within 120 minutes of a STEMI? If this doesn't happen, what's the next step?
PCI.
| If not, fibrinolysis
104
What is the GRACE score?
assess risk of further cardiac events in a NSTEMI
105
What are possible post MI complications?
```
Mnemonic: DREAD:
D: death
R: rupture of heart septum, papillary muscles
E: edema
A: aneurysm
A: arrhythmia
D: Dresslers syndrome
```
106
What are the causes of secondary hypertension?
ROPE:
- R: renal disease
- O: obesity
- P: pregnancy
- E: endocrine (eg, Conn's)
107
How can peripheral thrombolisms occur in aortic aneurysms?
thrombi form due to turbulent flow
108
What is an aortic dissection?
tear in the intimal layer of the aorta which leads to a collecting of blood between intima and medial layers
109
What is a asymmetric BP a sign on?
aortic dissection
110
What is the definite diagnosis of aortic dissection?
CT
111
What disease can the ankle brachial pressure index be used for, and what would the result be?
- peripheral vascular disease
| - <0.90
112
Which valvular heart disease can have increased prevalence in connective tissue disorders?
Regurg disorders
113
What is the most common valve defect?
aortic stenosis
114
What are the signs of heart failure?
- tachycardia
- increased JVP
- cardiomegaly
- 3rd/4th heart sound
- ascites
- tender hepatomegaly
- displaced apex beat
- bi basal crackles
- pleural effusion
115
What is cor pulmonale caused by?
right sided HF caused by pulmonary arterial HTN. Can be caused by chronic lung disease, pulmonary vascular disorders, neuromuscular and skeletal disorders
116
what murmur can be heard in cor pulmonale?
pan systolic murmur
117
What are saw tooth pattern (f-waves) diagnostic of?
atrial flutters
118
What does IV amidarone do?
restore sinus rhythm
119
What are the causes of RBBB?
PE, IHD, atrial ventricular septal defect
120
What are the causes. of LBBB?
IHD, aortic valve disorder
121
What does IV atropine treat?
Bradycardia
122
What is sick sinus syndrome?
inability of hearts pacemaker to keep rhythm
123
What are hyperkalaemia, hypocalcaemia, drugs (amiodarone, tricyclic antidepressants) and bradycardia, causative factors of?
Prolonged QT syndrome and Wolf PArkinson white syndrome
124
What is the most common cause of pericarditis in people who are immunocompromised?
histoplasma Spp.
125
What are signs of pleural effusion?
bronchial breathing out at left base, muffled heart sounds
126
What is seen on an ECG for pericarditis?
Saddle shaped ST elevation. PR depression
127
What can colchicine reduce the recurrence of (as well as gout)
pericarditis
128
What inheritance is hypertrophic cardiomyopathy, and what is the most common presenting feature?
Autosomal dominant.
| Sudden cardiac death :-)
129
What is the mutation to in cardiomyopathy?
sarcomere protein
130
What is the fever + new murmur until proven otherwise?
IE
131
What is the common causative organisms of I.E
s.aureus, pseudomonas auroginosa, streptococcus viridans, enterococci, coxiella burnetti
132
What is the treatment for s.aureus. What is added if it is MRSA?
1. flucoxacillin, macrolides
| 2. add vancomycin
133
What causes rheumatic fever (and an example)
Lancefield Group A-B haemolytic streptococci. EG, pyogenes
134
What is the presentation of rheumatic fever?
chorea, fatigue, SOB, arthritis, fever
135
What rash can be seen in rheumatic fever?
erythema maginatum (red rash with raised edges and clear centre on trunk, thighs, arms)
136
What is the diagnostic tool for Rheumatic fever?
Jones Criteria
137
what is often the first ECG change in an MI?
Tall T waves
138
Which artery is likely occluded in a complete heart block?
Right coronary
139
What does S4 indicate?
forceful atrial contraction
140
first line tx for HF?
ACE-I and BB
141
How is postural hypotension diagnosed?
Measure BP lying down and standing up. If drop in >20mmHg in systolic pressure, or below 90 = diagnosis
142
What indicates severe aortic stenosis?
small volume and slow rising pulse
143
What is the most common cause of heart failure?
IHD
