Cardio Flashcards Preview

Cardioresp > Cardio > Flashcards

Flashcards in Cardio Deck (452):
1

Why is hyperkalaemia so dangerous

VF + cardiac arrest

2

What are the signs and symptoms of hyperkalaemia

- fast irregular pulse
- chest pain
- weakness
- palpitations
- light headedness

3

Give three hallmark signs of hyperkalaemia

1) small p wave
2) wide qrs
3) tall tented t waves
4) slurred ST segment

4

What ecg appearance is present in patients with severe hyperkalaemia

Sine wave pattern

5

List some possible causes of hyperkalaemia being an artefact finding

- haemolysis e.g. Rapid blood transfusion
- contamination with edta (hence do FBC after u+e)
- thrombocythaemia
- delayed analysis

6

List the 4 steps of management for hyperkalaemia, with doses

1) ecg
2) 10ml 10% calcium gluconate
3) insulin e.g. 10 U rapidly acting insulin + glucose e.g. 50ml
4) nebulised salbutamol 2.5mg

7

What do you do if you've tried everything and hyperkalaemia >7mmol/L persists

Consider dialysis

8

What are the steps you take to manage a patient with stemi

1) 12 lead ecg
2) high flow O2
3) 300mg Aspirin
4) 5-10mg morphine + 10mg metroclopramide
5) GTN - 2 puffs or 1 tablet

9

What is the definitive treatment for stemi

Primary PCI within 120mins from when you can give thrombolysis and within 12hours of symptom onset
Otherwise fibrinolysis with streptokinase

10

How do you manage an nstemi

1) ECG
2) high flow O2
3) 300mg Aspirin +/- 300mg clopidogrel
4) 5-10mg morphine + 10mg metroclopramide
5) heparin e.g. Dalteparin 120U/Kg/12hours sc
6) iv nitrate if pain continues

11

What is the definitive treatment for nstemi

Urgent angio,
If high risk: infusion of gpiib/iiia inhibitors e.g. Tirofiban
If low risk and no further pain: discharge if 12hr troponin is negative

12

What is stage1 in the New York classification of hf

heart disease present but no undue dyspnoea from ordinary activity

13

What is stage2 of the New York classification of hf

Comfortable at rest, but symptoms on ordinary activities

14

What is stage 3 New York classification of hf

Less than ordinary activities cause dyspnoea, which is limiting

15

What is stage 4 of the New York classification of hf

Dyspnoea at rest, all activity causes discomfort

16

How do you manage broad complex tachycardia with no pulse

ARREST CALL

17

How do you manage a patient with broad complex tachycardia, with adverse signs present

1) sedate
2) synchronised do of 200>300>360J monophasic
3) AMIODARONE 300mg iv over 20-60 mins
4) correct K+ and Mg2+

18

What other drugs or management would you consider if normal cardio version techniques don't work

- lidocaine
- flecainide
- procainamide
- overdrive pacing

19

If a patient is in broad complex tachycardia, with no adverse signs and regular rhythm, how would you manage them

AMIODARONE 300mg iv over 20-60mins or 50mg LIDOCAINE over 2 min

20

If a patient with broad complex tachycardia, with no adverse signs and irregular rhythm present to you, how would you manage them?

Refer, Synchronised do shock 200>300>360J monophasic

21

What is the first sign you check for in a patient with broad complex tachycardia

Pulse

22

What are the two non shockable rhythms

1) asystole
2) pulse less electrical activity

23

What are the 2 shockable rhythms

1) VF
2) pulseless VT

24

How do you treat narrow complex tachycardia with an irregular rhythm

As AF

25

What are the first steps in managing narrow complex tachycardia

Continuous ecg and Vaal manoeuvres

26

How do you treat regular rhythm narrow complex tachycardia even before you assess adverse signs

ADENOSINE 6mg bolus injection

27

How do you treat narrow complex tachycardia with regular rhythm and adverse signs present

1) sedate
2) give synchronised cardioversion 100>200>300J
3) AMIODARONE 300mg iv over 20-60mins

28

If a patient has narrow complex tachycardia, with regular rhythm and no adverse signs, how do you treat them

Try any of
Esmolol
Digoxin
Amiodarone
Verapamil
Overdrive pacing if not AF

29

What is the level of k+ which makes hyperkalaemia and emergency

Over 6.5 mmol/L

30

Which condition often causes radio-radio delay

Aortic dissection

31

Which condition often causes radio femoral delay

Coarctation of the aorta

32

What does the first heart sound correspond with

Closure of the atrioventricular valves (mitral and tricuspid valves)

33

What does the second heart sound correspond with

Closure of the aortic and pulmonary valves

34

Between which heart sounds is systole

Between s1 and s2

35

Between which heart sounds is diastole

Between s2 and s1

36

Give some causes of a bounding pulse

Volume overload, co2 retention (e.g. COPD), pregnancy

37

Give a cause of regularly irregular rhythms

Atrial or ventricular ectopics

38

Give cause of irregularly irregular heart beat

AF

39

How should you investigate possible AF on auscultation during examination of the patient

Listen to apex with Steth while feeling pulse

40

Which pulse should you feel for while listening to the first heart sound

Carotids

41

What quick systems review questions would you ask for in a patient you are taking a cardiovascular history from

Bowels ok?
Any problems with waterworks

42

What is the pahtophysiological cause of third heart sounds

Stiff or dilated ventricle suddenly reaches its elastic limit and decelerates the incoming rush of blood during diastole, hence causes an extra heart sound

43

What ages is it normal to have a third heart sound

Under 30

44

List the causes of third heart sounds

1) heart failure
2) mi
3) cardiomyopathy
4) hypertension (pressure overload)

45

When do you hear a systolic and when do you hear a diastolic murmur

Systolic = between first and second heart sound
Diastolic = between second and next first heart sound

46

What is the pathophysiology of fourth heart sounds

Atrial contraction into a non compliant of hypertrophied ventricle causes fourth heart sound as the atria is struggling to puch blood into the ventricle

47

Give some causes of fourth heart sound

Ventricular hypertrophy
Hypertension
Mi
Heart failure
Hypertension
(Always abnormal)

48

What causes a heave on palpating over the murmur

LV hypertrophy

49

What is a thrill

A palpable murmur

50

Which murmurs are heard best on inspiration and which are heard best on expiration

On Inspiration - rIght sided
On Expiration - lEft sided

51

What are grades 1, 2, and 3 of intensity of heart murmurs

1- very faint
2- soft
3- heard easily

52

What are grades 4, 5, and 6 of intensity of heart murmurs

4- loud with palpable thrill
5- very loud, with thrill, may be heard with Steth partly off chest
6- very loud, with thrill, may be heard with Steth entirely off chest

53

What are the causes of mitral stenosis

Rheumatic fever
Old age and calcification

54

What are the consequences of mitral stenosis that lead to right heart failure

High LA pressure > pulmonary venous hypertension
> pulmonary arterial hypertension > RV hyper trophy
> tricuspid regurgitation > RHF

55

Which valve abnormality may result as a consequence of mitral stenosis

Tricuspid regurg

56

What are some of the signs which may be associated with mitral stenosis

AF on pulse
Malar flush
Tapping apex beat due to palpable 1st heart sounds

57

What may be heard on auscultation of a patient with mitral stenosis

Loud s1
Opening snap
Rumbling mid diastolic murmur

58

What is the best way to hear mitral stenosis

With bell of the stethoscope held lightly at apex with patient lying on their left side

59

What are some of the CXR signs in mitral stenosis

Normal sized heart with enlarged left atrium
The signs of pulmonary oedema

60

What are some of the ecg changes of a patient with mitral stenosis

1) AF
2) bifid p waves if sr
3) rvh causes right axis deviation and tall r waves in leads v1 and v2

61

What are the causes of mitral regurgitation

1) prolapsing mitral valve
2) rheumatic mitral regurg
3) papillary muscle rupture
4) cardiomyopathy of any sort
5) connective tissue disorders e.g. Marfans

62

List some of the connective tissue disorders that may lead to mitral regurg

Marfans syndrome
Ehlers Danlos
Osteogenesis imperfecta

63

What are some of the signs that may be found in a patient with mitral regurg

Malar flush
Displaced apex beat
Palpable thrill

64

What may be heard on auscultation of a patient with mitral regurg

Pansystolic murmur radiating to axilla

65

What may a CXR of a patient with mitral regurg show

Left atrial and left ventricular enlargement - cardiomegaly

66

Which chamber is likely to be affected by disease in a patient with bifid p waves on ecg

LA

67

What may be seen on ecg of a patient with mitral regurgitation

Bifid p wave
Left ventricular hypertrophy

68

What are some of the causes of aortic stenosis

Bicuspid aortic valve
Age related calcification
Rheumatic fever

69

What are some of the symptoms of aortic stenosis

Exercise induced syncope - Angina and dyspnoea develop

70

What is found on the pulse of patients with aortic stenosis

Slow rising
Low volume
Narrow pulse pressure

71

What is felt on palpation of the apex region with aortic stenosis

Forceful apex beat

72

What is heard on auscultation of a patient with aortic stenosis

Ejection systolic murmur radiating to the carotids

73

Where else should you listen with the diaphragm of the Steth in a patient with aortic stenosis

The carotids

74

What do you listen for with the bell of the Steth in the carotid area

Bruits

75

What may be seen on the CXR of a patient with aortic stenosis

Relatively small heart with a prominent, dilated ascending aorta

76

Why do you get a dilated ascending aorta in patients with aortic stenosis

Post stenosis dilatation

77

What may be seen on ECG of a patient with aortic stenosis

LVH
LV strain pattern - depressed St segments and t wave inversion I leads directed towards left ventricle

78

How is aortic regurgitation best heard on auscultation

Sit the patient forward with their breath held in expiration
Listen at left eternal edge in the fourth intercostal space

79

What is the typical murmur of a patient with aortic regurgitation

High pitched early diastolic murmur

80

What are the causes of aortic regurg

Rheumatic fever
Bicuspid valve
Infective endocarditis
Marfans
Tertiary syphillis

81

Give two infective causes of aortic regurgitation

Syphillis
Infective endocarditis

82

What is the typical pulse sign in patients with aortic regurg

Collapsing
Wide pulse pressure

83

What is the difference in pulse pressure between aortic regurg and aortic stenosis

Aortic stenosis has a narrow pulse pressure
Aortic regurg has a wide pulse pressure

84

What is quincke's sign in aortic regurg?

Capillary pulsation in nail beds

85

What is de mussels sign in aortic regurg

Head nodding with each heart beat

86

What aid the pistol shot femorals sign in aortic regurg

Sharp bang heard on auscultation over femoral arteries in time with each heartbeat

87

What may be seen on an ecg of a patient with aortic regurg

LVH

88

What is p. mitrale on an ecg, and what is it an indication of

Bifid p wave
LA abnormality e.g. Dilatation, hypertrophy

89

What is p. pulmonale on ECG and what is it an indication of

Peaked p waves >2.5mm
An indication of Right atrium enlargement

90

What is the pathophysiological cause of fourth heart sounds

Atrial contraction into a non compliant or hypertrophied ventricle

91

Why are right heart murmurs heard best on inspiration

Inspiration increases venous blood return to the right side of the heart

92

When are left sided murmurs heard loudest

On expiration

93

What is a grade 1 and 2 murmur

1) very faint
2) soft

94

What is grade 3 and 4 murmur

3) heard easily
4) loud, with palpable thrill

95

What is grade 5 and 6 murmur

5) very loud, with thrill, may be heard with Steth partly off chest
6) very loud, with thrill, may be heard with Steth entirely off chest

96

On an ecg, what is he normal PR interval

3-5 small sq (0.12-0.2 secs)

97

What is the normal QRS interval length

2-3 small sq

98

What is the normal ST segment length

2-3 small sq (0.08-0.12s)

99

How do you calculate heart rate from a regular rhythm strip

300 divided by number of big squares between R-R interval

100

How do you calculate heart rate in a ecg rhythm strip which is irregular rhythm

Count number of qrs complexes in a 19 second rhythm strip and multiply by 6

101

What defines sindus rhythm

Each qrs preceded by p wave, with normal rhythm

102

What does atrial flutter look like on ecg

Sawtooth p waves

103

At what rate do atria and ventricles contract in atrial flutter

Atria contact at 300 bpm but eb tricked do not conduct that many atrial ap's so the ventricular date is often around 150 bpm

104

How do you calculate the rate of block in atrial flutter, considering the atrial rate is usually 300 bpm and the ventricles don't contract at the same rate

Ventricular rate 150 = 2:1 conduction
Rate 100 = 3:1 conduction
Rate 75 = 4:1 conduction

105

What does ventricular tachycardia look like on ecg

Fast 120-180 bpm, broad complexes

106

What is the cardiac axis

The direction of spread of depolarisation through the ventricles

107

How do you work out the heart axis looking at an ecg

Find the isoelectric lead (or most isoelectric lead). The axis is perpendicular to that
Compare the leads to lead II, III, AVL and AVR in terms of which ones show negative and positive deflections

108

What angles does the normal axis lie between

-30 to +90

109

At which angles does left axis deviation lie

Less than -30 deg

110

At which angles does right axis deviation lie

At over +90 deg

111

Is the lead I is greatly positive and lead II and AVF are negative, what axis deviation is it likely to be

Left axis deviation

112

If lead AVF/III is greatly positive and lead I is negative, what axis derivation is it likely to be

Right axis deviation

113

What does left atrium enlargement show in ecg

P mitrale - bifid p waves

114

What does right atrial enlargement show on ECG

Tall p waves (p pulmonale)

115

Over how many squares is considered a prolonged p wave

>3 small squares

116

How many square's height is considered tall p waves

Over 3 small squares height

117

List the degrees of heart block

- first deg
- second deg - mob its I (wenkebach) and Mobitz 2
- third deg

118

What is first degree heart block

PR interval prolonged by constant amount

119

What is Mobitz type 1 (wenckebach) heart block

Progressive lengthening of PR interval until one qrs complex is dropped

120

What is mobitz type II second degree heart block

Intermittent failure of AVN to conduct atrial depolarisation to the ventricles
May be fixed 2:1 , 3:1 etc

121

What is third degree heart block

No relationship between the p waves and qrs complexes

122

What is the usual HR in patients with third degree heart block

30-50bpm

123

What is consistently firing off in third degree heart block

P waves

124

What does increased qrs height indicate

Left or right ventricular hypertrophy

125

What does increased qrs width indicate

Left or tight bundle branch block

126

What ecg features indicate left ventricle hypertrophy

S wave in V1+ R wave in V5 or V6 together over 35mm (3.5 large ecg squares)

127

What are the ecg features of right ventricular hypertrophy

R wave tall in right ventricular leads (>5mm) + RAD

128

How do you determine right bbb from left bbb

Compare lead V1 with V6
Lbbb: W in V1 and M in V6
Rbbb: M in V1 and W in V6

129

List some causes of St segment elevation

Acute mi
Pericarditis (widespread)

130

How do you define St depression

> 1 mm in 2 consecutive limb leads OR
> 2 mm in 2 consecutive chest leads

131

What are the ecg changes seen over time with stemi

- within hours : St elevation
- within days : St elevation and t wave inversion, pathological q waves
- within weeks : St flattening, t wave inversion and pathological q waves persist
- months : pathological q waves persist

132

Which leads are affected in septal infarct

v1 and v2

133

Which leads are affected in anterior infarct

V3 and 4

134

Which leads are affected in lateral infarct

V5 and 6

135

Which leads are affected in high lateral infarct

I, AVL

136

Which leads are affected by inferior infarct

II, III, AVF

137

What ECG changes are seen in PE

S1, Q3, T3

Large S wave in lead 1
Q wave inversion in lead 3
T wave inversion in lead 3

138

List some other precipitates of angina expect for exercise

Emotion, cold weather, heavy meals

139

Which special investigations may be tried in patients with angina pectoris

- exercise stress ecg
- coronary angiography
- cardiac ct
- stress echo

140

Which angina patients should be considered for referral

- diagnostic uncertainty
- new angina of sudden onset
- recurrent angina e.g. Past mi/cabg
- angina uncontrolled by drugs
- unstable

141

What is Percutaneous Transluminal Coronary Angioplasty

balloon dilatation of stenotic vessels

142

List the steps for management of angina pectoris

- modify lifestyle risk factors
- aspirin
- Beta blockers
- nitrates
- long acting calcium antagonists
- potassium channel activator

143

What is the mechanism of action of nicorandil

Potassium channel activator - promotes K+ efflux

144

When is cabg performed

Left mainstem disease
Multi vessel disease
Multiple severe stenosis
Those unsuitable for angioplasty or failed angioplasty
Refractory angina

145

How is the procedure of cabg performed

Angiography
Heart stopped and blood pumped artificially by a machine outside the body
Patients own saphenous vein / internal mammary artery used as graft

146

What is aortic dissection

Blood splits the aortic media

147

How does aortic dissection present

Sudden tearing chest pain +/- radiation to the back

148

What is the typical sign of aortic dissection found on examination

Radio radial delay

149

As a result of aortic dissection, branches of the aorta may occlude, what can then result

- Hemiplegia (carotid)
- unequal arm pulses or bp
- paraplegia (anterior spinal artery)
- Anuria (renal arteries)

150

What is the difference between type a and b aortic dissection

A - ascending aorta involved
B - ascending aorta not involved

151

Which type of aortic dissection requires urgent surgical review more than the other - a or b

A (involves aortic arch)

152

What is the definition for heart failure

CO is inadequate for body's requirements

153

List the main causes of heart failure

Ischaemic heart failure
Non ischaemic dilated cardiomyopathy
Hypertension

154

List the congenital heart diseases that can lead to heart failure

Asd, vsd

155

List some pericardial diseases that can lead to heart failure

Constrictive pericarditis, pericardial effusion

156

List some causes of RHF

Pulmonary hypertension, PE, RV infarct

157

List the pathophysiological changes in heart failure

Ventricular dilatation, myocyte hypertrophy

158

What are the systemic blood pressure changes in the pathophysiology of heart failure

- sympathetic stimulation
- peripheral vasoconstriction
- salt and water retention
Leads to increased ANP secretion

159

What is starlings law

The greater the volume of blood entering the heart during diastole, the greater the volume of blood ejected from the LV during systolic contraction (stroke volume)

160

What is the ejection fraction

Fraction of blood pumped out of the ventricles with each heart beat

161

How is ejection fraction measured

ECHO

162

What is the difference between systolic and diastolic heart failure

Systolic - inability of ventricle to contract therefore reduced ejection fraction
Diastolic - inability of ventricle to relax and fill normally

163

List some chases of systolic heart failure

IHD, cardiomyopathy

164

List some causes of diastolic heart failure

Constrictive pericarditis, tamponade

165

What are the early compensatory mechanisms for marinating cardiac output in heart failure

Venous pressure increased, preload increased, therefore end diastolic volume increased
Coupled with sinus tachycardia
Reduced ejection fraction

166

What are the late compensatory mechanisms for marinating co in mod-severe heart failure

Co can only be maintained by massive increases in venous pressure, which leads to dyspnoea, hepatomegaly, ascites, dependent oedema

167

Can CO be maintained in severe heart failure

No, it is decreased even at rest despite increased venous pressure and sinus tachy

168

What are the main causes of left heart failure

- IHD
- non ischaemic dilated cardiomyopathy
- hypertension
- mitral/aortic valve disease

169

List the main symptoms of left heart failure

Fatigue, exertional dyspnoea, orthopnoea, PND, pink frothy sputum, poor exercise tolerance

170

What are the physical signs on doing a cardiovascular examination of left heart failure

Displaced apex beat, gallop rhythm on auscultation (3rd heart sound), mitral regurgitation, crackles at lung bases, dependent pitting oedema

171

How do ANP and BNP act on the kidneys

Increase GFR, and decrease renal sodium absorption

172

What investigations should be carried out, except for blood tests, in heart failure

CXR, echocardiogram
ECG may indicate cause

173

Which molecule should be tested for in blood tests of patients with heart failure

B type natriuretic peptide

174

What is class 1 and 2 NYHA heart fissure classification

1 - no limitation to physical activity
2 - slight limitation to physical activity

175

What is stage 3 and 4 of NYHA classification of HF

3- marked limitation on physical activity
4- symptoms at rest

176

List the causes of right heart failure

- chronic lung disease (cor pulmonale)
- PE or pulmonary hypertension
- tricuspid/pulmonary valve disease

177

What how can asd/vsd cause right heart failure

Left to right shunts, putting more pressure on the right side of the heart which is not adapted to such high pressures

178

List some of the symptoms of RHF

Fatigue, dyspnoea, anorexia, nausea

179

List some of the physical signs on examination of a patient with right heart failure

- increased jugular venous pressure
- cardiomegaly
- hepatic enlargement
- ascites
- dependent pitting oedema

180

List some of the general management steps in heart failure

Low level exercise, low salt diet, stop smoking, education, vaccination
As well as treating the cause

181

List the steps of a management in heart failure

1) diuretics
2) ace inhibitor
3) beta blockers
4) spironolactone (aldosterone antagonist)
5) inotropic agents e,g, digoxin
6) nitrates
7) anticoagulation

182

What are the first, second and third line diuretics used in heart failure

Step 1- furosemide
Step 2- change to bumetanide
Step 3- add a thiazide

183

List a thiazide diuretic that is commonly used in heart failure

Metolazone

184

If a patient on ace inhibitors for heart failure gets a dry cough side effect, which drug class can be sued instead

Angiotensin receptor blockers

185

How does dobutamide work

It is an inotrope - acts as a beta 1 agonist, acting as a sympatheticomimetic

186

When is digoxin considered in the treatment of hf

Patients who have severe hf in spite of therapy with vasodilators, beta blokes and diuretics

187

How do nitrates work positively to help with hf

Reduce preload and after load

188

List the nitrate drugs that may be given in heart failure

Glyceryl trinitrate, isosorbide momonitrate

189

What are the other non pharmacological treatments for hf

Revascularisation, biventricular pacemaker, defibrillator, cardiac transplant

190

What is the difference between low input and high output heart failure

Low output - co reduced and fails to increase normally with exertion
High output - this is rare. Output is increased with increased needs, however with high output filature inability to increase CO in response is of faster onset than in the normal heart

191

What are the Framingham criteria for

Diagnosis of CCF

192

How many minor and major criteria are required in Framingham CCF criteria

2 major or
1 major and 2 minor

193

List the major Framingham criteria

1) PND
2) crepts
3) s3 gallop
4) cardiomegaly
5) increased Central venous pressure
6) weight reduction in response to treatment
7) neck vein distension

194

What are the minor criteria for framinghams CCF diagnostic criteria

1) bilateral ankle oedema
2) dyspnoea on exertion
3) tachy >120
4) reduction in vital capacity
5) nocturnal cough
6) hepatomegaly
7) pleural effusion

195

List the CXR signs of hf

1) dilated prominent upper lobe vessels
2) alveolar oedema - bats wings sign
3) cardiomegaly
4) kerley b lines
5) pleural effusion

196

Why does pleural a effusion occur with CCF

Increased pulmonary capillary pressure

197

What is the pathophysiology of bats wings and kerley b lines in CCF chest Xray

Alveolar oedema - bats wings sign
Interstitial oedema - kerley b lines

198

List the pathophysiological steps of atherosclerosis

- triggered by injury
- lipoproteins oxidised
- taken up by macrophages and creates foam cells
- release of cytokines
- accumulation of fat and smooth muscle proliferation
- plaque formation

199

List the steps where atherosclerotic plaques becomes myocardial ischaemia

- rupture of coronary artery plaque
- platelet aggregation and adhesion
- localised thrombus, vasoconstriction
- myocardial ischaemia results

200

What are the ECG criteria for diagnosing a stemi at j point

- 0.2 mV or more increased in leads V1-V3
- 0.1 mV or more increased in any of the other leads

201

How do you manage a stemi, after a-e assessment, iv access, and 12 lead ecg has been sorted

- assess for risk factors e.g. Pulse, bp, jvp, murmurs
- aspirin 300mg
- morphine 5-10mg IV + metoclopramide 10mg
- GTN sublingual 2 puffs
- assess for PCI

202

Within how many minutes should a PCI be performed in stemi

120 minutes of when thrombolysis could have been given and within 12 hours of symptom onset

203

What is given to a patient who cannot have a PCI within 120 minutes with a stemi

Thrombolysis, e.g. Streptokinase, or more commonly reteplase

204

How is an n-stemi treated?

- admit to CCU
- O2 - 2-4litres aiming for sats over 95%
- morphine - 5-10mg plus metoclopramide 10mg
- aspirin - 300mg +/- clopidogrel 300 mg
- oral beta blocker
- heparin
- IV nitrate if pain continues

205

If a patient with n-stemi is managed adequately and is low risk, with no further pain, and negative Troponin, how are they managed next

Discharge, if repeat troponin is negative over 12 hours. Treat medically and arrange further investigation.

206

If a patient with n-stemi is treated adequately but is still high risk, has recurrent ischaemia, ST depression, or troponin is raised, how do you manage them next

Urgent angiogram, tirofiban plus clopidogrel. Optimise health with beta blocker, CCB, ACI, Nitrates, statins

207

If there is still no improvement with n-stemi patients who are high risk, and have been treated adequately, what is the final step in their management

Angiography +/- PCI/CABG

208

Which enzymes do you test for in the blood of a patient suspected with MI

CK, troponin I

209

Which leads does ST elevation occur in in anteroceptal MIs

V1-4

210

Which leads show ST elevation in a lateral stemi

V5-6

211

Which leads show ST elevation in a high lateral STEMI

Lead I, AVL

212

Which leads show ST elevation in an inferior STEMI

Leads II, III, AVF

213

Which coronary artery is usually the cause of an inferior STEMI

RCA

214

Which coronary artery is responsible for a STEMI in the anteroceptal region

LAD

215

The circumflex artery becoming blocked can lead to which two areas becoming ischaemic hence causing a STEMI

Lateral and high lateral MI

216

List the indications for thrombolysis in a STEMI

Less than 12 hours onset of pain plus any of the following:

217

List the complications of STEMI

- heart failure/ pericarditis
- rupture of papillary muscles or septum
- embolism
- aneurysm/arrhythmias
- Dressler's syndrome
- sudden death

218

List the symptoms of Dressler's syndrome

Low grade fever, pleuritic chest pain, pericarditis, pericardial effusion

219

Which drugs are given to patient with STEMI after discharge

Aspirin, clopidorgel
Acei
B blockers
Statin
Address modifiable risk factors/comorbidities

220

How many months off work do you have to take after suffering a STEMI

1 month

221

Who long do you have to abstain from driving after an STEMI

4 weeks

222

How do you distinguish between NSTEMI and unstable angina

Troponin I - negative troponin in unstable angina

223

What is flash pulmonary oedema

Rapid onset pulmonary oedema, most often precipitated by acute mi or mitral regurgitation, heart failure.

224

How does acute LV failure present

Acute pulmonary oedema
With symptoms of breathlessness, frothy pink sputum, orthopnoea, collapse, arrest, cardiogenic shock

225

List the signs of acute LV failure

- distressed, pale and sweaty
- tachycardia
- fine crepts bilaterally
- gallop rhythm 3rd heart sound

226

What are the commonest causes of LVF

Myocardial ischaemia, hypertension, aortic stenosis, aortic incompetence, mitral incompetence

227

How do you treat acute LVF, after a to e assessment

100% O2 via non rebreathe mask
Morphine 5 mg iv + metoclopramide 10mg
Nitrate if high systolic bp
Furosemide 40-80 mg iv
CPAP

228

List the narrow complex tachycardias

AF, atrial flutter, re entrant tachycardia, others e.g. Atrial tachycardia

229

Lost the main crowd complex tachycardias

VT
SVT with BBB

230

List the three main mechanisms of tachy arrhythmia production

1) accelerated automaticity
2) triggered activity e.g, myocardial damage
3) re entry

231

How is regular SVT managed

-A-E, O2 and iv access
- Vagal manoeuvres
- Adenosine
Seek help
- Antiarrhythmiac
- DC cardioversion if haemodynamically unstable

232

How are narrow complex SVTs which are irregular managed

As per AF
- b blocker iv or digoxin iv
- AMIODARONE 300 mg iv

233

How is narrow complex SVT with regular rhythm managed

Vagal manoeuvres
Adenosine 6mg iv, then further doses as per guidelines
Monitor ecg continuously

234

List the causes of ventricular tachycardia

- torsades de pointes
- SVT with bbb
- pre excited tachycardia

235

What is pre excitement

When ventricles become depolarised too early, which leads to their partial premature contraction. Abnormal pathway leads to lack of normal AVN delay

236

How are broad complex tachycardias managed if they show no adverse signs

Amiodarone/lidocaine
K+/Mg2+ if needed
Sedation and DC cardioversion

237

How are broad complex tachycardias treated if they show adverse signs

Sedation, DC cardioversion, amiodarone/lidocaine

238

Which diuretic classes cause hypokalaemia and which cause hyperkalaemia

Loop and thiazide diuretics - hypokalaemia
k+ sparing diuretics - hyperkalaemia

239

What type of drug is metolazone

Thiazide like diuretic

240

Which particular part of the LoH do loop diuretics affect

TAL

241

What are the side effects of loop diuretics

Hypokalaemia, deafness (ototoxicity), hypovolaemia , and hypotension

242

List some side effects of thiazide diruetics

Hypokalaemia, hyponatraemia, hyperuricaemia, hyperglycaemia

243

List some contraindications to thiazide diuretics

Refractory hypokalaemia, hyponatraemia, hypercalcaemia, Addison's disease,

244

What is the mechanism of action of spironolactone

Aldosterone antagonist

245

What is the mechanism of a iron of amiloride

Inhibits ENaC channels

246

Which drugs are potassium sparing diuretics co used with

K+ losing diuretics e,g, furosemide

247

What are the side effects of potassium sparing diuretics (spironolactone, amiloride)

Impotence, gynaecomastia, menstruated problems,
Hyperkalaemia, hyponatraemia

248

Why can spironolactone cause menstruated problems, gynaecomastia etc.

Blocks mineralcocorticoid receptors, but also has effects on androgens

249

What are the three main lipid lowering drug classes

- statins
- Fibrates
- ezetimibe

250

What are the two principal mechanism of action of statins

1) inhibit HMG-coA reductase, hence inhibiting liver cholesterol synthesis
2) increased absorption of Ldls from the bloodstream into the liver, dour to upregulation of ldl receptors

251

List the side effects of statins

Myositis, rhabdomyolysis, altered LFTs, paraesthesia, GI effects

252

What are the contraindications of statins

Acute liver disease, pregnancy, breast feeding

253

Which particular lipids do Fibrates act to lower

Triglycerides MORE than LDL

254

How does Ezetimibe work

Lowers cholesterol absorption in the intestine

255

What would you suspect in a patient with freer and a new murmur

Endocarditis until proven otherwise

256

What is infective endocarditis

Microbial infection of normal or prosthetic heart valves, the endothelial surface of the heart, or a congenital defect such as PDA

257

What is the main causative organism for infective endocarditis

Streptococcus viridans

258

Which patients are at risk of infective endocarditis caused by staphylococcus aureus

Those with Skin infections, abscesses, central lines, iv drug abusers

259

List the steps in the pathophysiology of infective endocarditis

1) endothelial damage/damaged valve
2) platelets and fibrin deposited
3) bacteria is delivers bacteria to surface of heart
4) adherence and colonisation of bacteria
5) fibrin aggregates protect bacteria vegetation from host defence mechanisms

260

List the consequences of infective endocarditis

- disruption of valve cusps, commonly leading to mitral or aortic regurgitation
- vegetations embolise
- deposition of immune complexes

261

Where can infective endocarditis vegetations embolise in the body

Cerebral, pulmonary, coronary, renal
Can cause abscesses/haematuria

262

What are the immune vasculitis presentations of infective endocarditis

- Roth spots
- oslers nodes and janeway lesions
- clubbing
- splinter haemorrhages
- glomerulonephritis

263

What are the two major criteria in diagnosing infective endocarditis

- positive blood culture for IE (2 separate +ve cultures, or persistently positive cultures)
- evidence of endocardial involvement (+ve Echo, or new vascular regurg)

264

What is TOE in cardiology

Trans oesophageal echo

265

List the five minor criteria in diagnosing infective endocarditis

1) predisposition
2) fever >38 deg
3) vascular/immunological signs
4) positive blood culture not meeting major criteria
4) positive echo not meeting major criteria

266

What combinations of major and minor criteria lead to a diagnosis of infective endocarditis

- 2 major
- 1 major + 3 minor
- 5 minor

267

How many cultures do you take in suspected infective endocarditis, and where from

3 different cultures form different places, at oeak temperature

268

How is infective endocarditis managed

A to E
Refer to cardio and micro
Drugs depends on organism
Empirical treatment of benzylpenicillin and gentamicin, at least 4 weeks

269

What is the empirical treatment. For infective endocarditis

Benzylpenicillin and gentamicin

270

When should surgery be considered in infective endocarditis

Heart figure, valvular obstruction,mrepreatrd emboli, fungal endocarditis, abscess, unstable infective prosthetic valve

271

Why is antibiotc prophylaxis no longer given to patients at risk of infective endocarditis who are undergoing procedures

It has shown little evidence of benefit in practice and must be weighed up with the negatives of adverse effects a DM antibiotic resistance

272

Wha it's the visceral layer of the pericardium made of

Mesothelial cells

273

Where does pericardial fluid drain

Via the thoracic duct and right lymphatic duct into the right pleural space

274

What are the signs and symptoms of acute pericarditis

Chest pain, pericardial friction rub, serial ecg changes

275

What is the pathophysiology of pericarditis

Inflammation of pericardium;
Infiltration of polmorphonuclear leucocytes and pericardial vascularisation

276

What are the possible consequences of pericarditis

- constrictive pericarditis
- pericardial effusion

277

Why can constrictive pericarditis occur in pericarditis

Exudates and adhesions encase the heart

278

What may pericardial effusion lead to as it develops from pericarditis

Accumulation of pressure can lead to cardiac tamponade

279

What is the most common cause of pericarditis

Virus - particularly Coxsackie virus

280

Expect for viral causes, what are the other causes of pericarditis

- TB
- bacterial
- cardiovascular disease e.g, mi, Dressler's syndrome
- neoplasm
- renal failure
- inflammatory/autoimmune

281

How is bacterial pericarditis treated

Antibiotics for at least 4 weeks and drainage of pericardial fluid

282

List some inflammatory conditions associated with pericarditis

- rheumatoid arthritis
- sarcoidosis
- SLE

283

List the main symptoms of pericarditis

- pleurisy: sharp pain worse on inspiration
- central chest pain, radiating to left shoulder
- eased sitting forward

284

What may be found on examination of a patient with pericarditis

- tachycardia
- tachypnoea
- fever
- pericardial friction rub
- shins of RHF / high pitched loud s3

285

Apart form the usual bloods, which other serology investigations should you do on a patient with suspected pericarditis

- virology screen
- blood cultures
- antistreptolysin culture
- rheumatoid factor
- antinuclear antibodies
- anti DNA antibodies
- tuberculin testing and sputum test for acid fast bacilli

286

What are the serial ecg changes in pericarditis

1) saddle shaped ST elevation
2) ST segment returns to normal a couple of days later
3) T wave inversion
4) ECG returns to pre pericarditis baseline weeks to months after onset

287

How is pericarditis imaged

Echocardiography
Ct/mri

288

What is the treatment of pericarditis

- high dose PO aspirin and bed rest
- corticosteroids sometimes used if disease does not subside rapidly
- pericardial window/pericardiectomy

289

What is the calculation for the ejection fraction

Stroke volume/end diastolic volume

290

Define a pericardial effusion

Abnormal accumulation of fluid in the pericardial cavity

291

Define cardiac tamponade

Pericardial effusion causing haemodynamically significant cardiac compression

292

How does pericardial effusion affct venous return

Inhibits it

293

How does cardiac tamponade affect blod flow int he heart and body

Reduces cardiac output hence results in hypotension and shock

294

What are some of the acute causes of oericardial effusion

- trauma
- iatrogenic
- aortic dissection
- spontaneous bleed
- cardiac rupture post mi

295

What are the subacute causes of pericarditis

- malignancy
- idiopathic pericarditis
- uraemia
- infection
- radiation

296

What is Becks triad of signs in pericardial effusion

- increased jvp
- decreased blood pressure
- muffled heart sounds

297

The presentation of pericardial effusion depends on the speed at which fluids collects. Give some of the different presentations of the condition

- cardiac arrest
- hypotension
- confusion
- shock
- sob, dysphagia, cough, hiccups if slowly developing

298

What is kussmauls sign

Jvp is increased with inspiration

299

What is pulsus paradoxus

Massive decrease in bp on inspiration

300

What is pulsus paradoxus a sign of

Pericardial effusion

301

How is pericardial effusion/tamponade managed

Emergency
- a to e
- iv access and fluids
- ecg
- bloods
- senior help
- pericardiocentesis +/- drain

302

How is pericardiocentesis performed

Needle inserted in xiphisternum, USS guided. Ai, for tip of left scapula and aspirate continuously

303

What do you do with pericardial fluid aspirated from pericardial effusion

- send for micro and cytology

304

List two af risk factor scores

- CHADVASC
- HASBLED

305

What is chadvasc used to predict

The risk of stroke in patients with AF, taking a variety of factors such as age, gender. And conditions such as DM into account

306

What is HASBLED used as a predictor of

Assess 1 year risk of major bleeding in patients with AF, taking into account factors such as stroke, labeled inrs, abnormal liver and renal function etc.

307

List a type 1A Antiarrhythmiac

Quinidine

308

List a type 1B antidysrrhythmic

Lidocaine

309

List a type 1C antidysrrhythmic

Flecainide

310

List a class 2 antidysrrhythmic

B blocker e,g, bisoprolol

311

List a class 3 antidysrrhythmic

K+ channel blocker e.g. amiodarone

312

List a type 4 antidysrrhythmic

CCBs e.g. Diltiazem

313

What are the effects of b blockers on the heart

Negatively chronological and inotropic

314

List the side effects of beta blockers

Bradycardia, hypotension, cold peripheries. Bronchospasm,

315

How does adenosine work

Causes transient heart block by inhibiting A1 therefore inhibiting Ca2+ influx and hence contraction

316

Which antidysrrhythmic class can exacerbate Raynaud's phenomenon

Class 2 - beta blockers

317

What are the contraindications to beta blockers

Asthma, marked bradycardia, heart block

318

List the two main types of CCBs

- non dihydropyridines: verapamil, Diltiazem
- dihydropyridines: amlodipine, nifedipine

319

How do CCBs work

Dilates peripheral arteries, reduces after load of heart, dilates coronary vessels (acts on coronary apvessels more than myocardium)

320

List some of the side effects of verapamil and Diltiazem

COSNTIPATION, flushing, headache

321

List some side effects of amlodipine

Palpitations, flushing. Headache, dizziness

322

When are verapamil and Diltiazem contraindicated

Hf, 2nd and 3rd deg heart block, cardiogenic shock

323

When are dihydropyridines such as amlodipines contraindicated

Unstable angina, significant AS

324

What are dihydropyridines used to treat

HTN, prevention of angina

325

What is verapamil used for

Fast AF, SVT, HTN

326

What are the id citations for nitrates

Stable angina, unstable angina, acute hf, chronic hf

327

What are the contraindications to nitrates

Hypotension conditions, hypovolaemia, cardiac tamponade, constrictive pericarditis

328

What are some of the side effects of nitrates

Postural hypotension, throbbing headache, dizziness, tachy

329

What positive benefits do ace inhibitors have for conditions of the heart

- reversal of LV hypertrophy
- reversals of endothelial dysfunction

330

What are some of the side effects of ace inhibitors

Renal impairment m chronic cough. Angio oedema, pancreatitis

331

List some of the constrain cations to ace inhibitors

Hypersensitivity to ace I, renal artery stenosis, pregnancy

332

What cod it one is digoxin used in

AF and atrial flutter with rapid ventricular response

333

How does digoxin work

Slows down the conduction in the AVN, I crashing its refractory period, hence reducing the ventricular rate

334

What arrhythmia is magnesium used to treat and how does it work

Torsades de pointes - shortens the QT interval

335

What is prinzmetals angina

Angina at rest occurring due to vasospams of the coronary arteries

336

Hey is prinzmetals angina treated

CCBs and nitrates. NOT b blockers

337

List the different types of anti platelets

Aspirin, clopidogrel, dipyridamole, glycoprotein IIA/IIIB antagonists

338

What is the mechanism of action of aspirin

Suppresses production of prostaglandins and thromboxane by irreversible inhibiting COX enzyme

339

What does cox enzyme act to do

Convert arachidonic acid to prostaglandin

340

What is the mechanism of action clopidogrel

Inhibits ADP-induced aggregation of platelets

341

How does dipyridamole work

Phosphodiesterase inhibitor to block platelet aggregation In conjunction with aspirin

342

List a glycoprotein IIA/IIIB inhibitor

Abciximab, tirofiban

343

Is LMWH fully reversible with protamine

No

344

Which factors does warfarin hip hint the production of

Vit k dependent - II, VII, IX, X

345

How is warfarin overdose treated if INR is

Decrease/omit warfarin

346

How is warfarin overdose treated if INR is 6-8

Stop warfarin and restart when INR is less than 5

347

How is warfarin overdose treated if INR is > 8

If no bleeding stop warfarin and give 9.5-2.5 mg vitamin K if at risk of bleeding

348

If a patient experiences a major bleed with warfarin od, how do you manage it

Stop warfarin
Prove prothrombin complex concentrate (beriplex) which contains factors 2, 7, 9 and 10
Or FFP
Give 5mg vit k
Get help/refer!!

349

What is the difference in the mechanism of action of UFH and LMWH

Both affect factor Xa and activate ATIII but LMWH does NOT affect thrombin

350

Give some contraindications of heparin

Uncontrolled bleeding, risk o fbleeding, peptic ulcer, recent de renal haemorrhage, endocarditis

351

What are the ecg changes in posterior MI

Dominant R wave v1-v3, with ST depression and upright t waves

352

Which other murmur is often associated with mitral stenosis and why

Tricuspid regurg - increased LA pressure caused by mitral stenosis leads to pulmonary venous, hence pulmonary arterial HTN. This causes RV hypertrophy and leads therefore to tricuspid regurg.

353

What are the Sokolow-Lyon ecg criteria for LVH

S wave in v1 + r wave in v5 or v6 (whichever largest) >35mm (7 large squares) - there is LVH

354

What are the ecg changes in posterior MI

v1-v3 show ST depression + tall (broad) QRS complexes

355

Which murmur can be heard with ventricular septal defect on auscultation

Harsh Pansystolic murmur at left eternal edge

356

Which type of deviation is seen on ecg of a patient with congenital septal a defects

Left axis deviation

357

What are the 4 features of tetralogy of fallot

1) overriding aorta
2) vsd
3) rv hypertrophy
4) pulmonary stenosis

358

What is grade 1 hypertensive retinopathy

Tortuous Arteries with thick shiny walls

359

What is Grade 2 hypertensive retinopathy

Av nipping (narrowing where arteries cross veins)

360

What is grade 3 hypertensive retinopathy

Flame haemorrhages and cotton wool spots

361

What is grade 4 hypertensive retinopathy

Papilloedema

362

What is the treatment for malignant hypertension

Iv nitroprusside

363

What is the defintion of malignant hypertension

BP >220/120 mmHg
+ bilateral retinal haemorrhage + exudates +/- papilloedema

364

What is the triad of symptoms you get in cardiac tamponade

- reduced bp
- raised jvp
- muffled heart sounds

365

What is kussmauls sung in cardiac tamponade

Raised jvp on inspiration

366

Raised levels of which electrolyte can cause cardiac tamponade

Urea

367

What are the major criteria for rheumatic fever

- carditis
- erythema marginatum
- arthritis
- subcut nodules
- Sydenham's chorea

368

List some viruses which can cause acute pericarditis

- Coxsackie
- EBV
- flu
- HIV
- varicella
- mumps

369

Give an example of iib/iiia antagonist

Tirofiban

370

Which class of drug do you stop in patients post mi

CCB

371

What are the four adverse signs looked for in patients with broad complex tachycardia

1) bp less than 90 mmHg
2) HR over 150 bpm
3) hf
4) chest pain

372

List the steps folded in the sinoatrial node action potential

First there is slow Na+ influx, followed by rapid Ca2+ influx causing depol. There is then outfit of K+ causing hyperpolarisation

373

Lost the steps in the cardiac action potential

Phase 0 - NA+ in
Phase 1 - K+ out, Cl- out
Phase 2 - Ca2+ in, K+ out
Phase 3 - Ca2+ channels close and K+ out
Phase 4 - K+ in

374

Go through how digoxin works on the heart

1) inhibits Na+ - K+ - ATPase which means more Na+ accumulates within cell of myocardium
2) increased Na+ levels means there is reversal of Na+ - Ca2+ exchanger, hence less Na+ will come into the cell and less Ca2+ will leave the cell
3) this causes increased Ca2+ levels in the myocardial cell, hence increased amounts available for contraction of myofibrils (actin and myosin) causing prolongation of the cardiac action potential

375

Which condition are you thinking about when asking a young patient with suspected heart problems about family history of sudden death

Hypertrophic cardiomyopathy

376

What are stokes Adams attacks

Transient arrhythmias causing reduced cardiac output and loss of consciousness

377

What features are suggestive of epilepsy rather than a faint

Aura, attacks when lying down, identifiable trigger e.,g tv, altered breathing, urinary incontinence, tongue biting, post ictal drowsiness prolonged, confusion, amnesia

378

What is carotid sinus syncope

Hypersensitive baroreceptors causing excessive reflex bradycardia with minimal stimulation e.g. Tight collar, or shaving

379

Which category of bacteria cause rheumatic fever

Lance field group A, beta haemolytic streptococci

380

List the major criteria for rheumatic fever

1) carditis
2) arthritis
3) subcut nodules
4) eryhtema marginatum
5) Sydenham's chorea

381

What is the definitive treatment for rheumatic fever

Benzylpenicillin/penicillin/erythromycin

382

List the common secondary causes for hypertension

- glomerular disease
- renal artery stenosis
- cocp
- pregnancy
- diabetes
- cushings
- phaeochromocytoma

- Conns syndorme

383

What are the broad categories of causes for pericarditis

1) infection
2) drugs
3) MI, Dressler's
4) autoimmune

384

What is the typical ecg chnage shown in acute pericarditis

Saddle shaped ST elevation

385

How is acute pericarditis managed

Analgesia, treat cause, steroids/immunosuppressants if relapsing

386

How is pericardial effusion managed

Treat cause (all causes of acute pericarditis can cause pericardial effusion)
Pericardiocentesis

387

What do you do with the fluid you aspirate from pericardiocentesis in a patient with pericardial effusion

Culture, cytology, ZN stain, TB culture

388

List two signs of pericarditis on auscultation

1) muffled heart sounds
2) pericardial rub

389

What is constrictive pericarditis

Heart encased in rigid pericardium, with unknown cause, but e,sew here in the world it is TB, or pericarditis of any cause

390

What are the CXR changes seen in constrictive pericarditis

Small heart, pericardial calcification

391

How is constrictive pericarditis managed

Surgical excision

392

What is cardiac tamponade

Accumulation of pericardial fluid raises intra pericardial pressure, causing poor ventricular filling and reduced cardiac output

393

List some causes of cardiac tamponade

1) any pericarditis
2) aortic dissection
3) haemodialysis
4) warfarin

394

What is the typical triad of cardiac tamponade

Pulsus paradoxus, increased jvp and muffled heart sounds

395

What is pulsus paradoxus

Abnormally large decreased in pulse rate during inspiration

396

In which conditions is electrical alternans seen

Cardiac tamponade, severe pericardial effusion

397

What is electrical alternans

Changing qrs complex amplitude between beats

398

What should you suspect in fever + new onset murmur

Infective endocarditis

399

What is the chief cause of infective endocarditis

Strep viridans

400

Which conditions predispose to infective endocarditis of acute course

Dermatitis, iv injections, renal failure, DM

401

What are the two types of clinical course for infective endocarditis

Acute (normal valves) and subacute (abnormal valves)

402

What are the risk factors for subacute course of infective endocarditis ( ii of abnormal valves)

Valve disease, iv drug use, congenital defects of the heart e,,g vsd, coarctation, patent ductus arteriosus, prosthetic valves

403

What is the empirical treatment for infective endocarditis

Benzylpenicillin + gentamicin

404

List some of the causes of acute myocarditis

- viral infection e.g, flu, mumps, rubella, HIV, Coxsackie, polio
- bacterial TB, meningococcus,clostridium
- spirochete e.g. Syphillis, Lyme
- Protozoa e.g. Chagas
- drugs
- toxins
- vasculitis

405

What would you hear on auscultation of a patient with acute myositis

S4 gallop

406

What are the changes in bloods in acute myocarditis

Troponin I and T positive

407

What other things is dilated cardiomyopathy associated with

Alcohol, HTN, haemocromatosis, viral infection

408

How may dilated cardiomyopathy present

Symptoms of rvf or arrhythmias

409

What is heard on auscultation of a patient with dilated cardiomyopathy

S3 gallop

410

Which blood test in particular would you do in a patient with dilated cardiomyopathy

Bnp

411

What is the management for dilated cardiomyopathy

As per hf - diuretics, digoxin, acei, anticoag, biventricular pacing, implantable cardiverter defibrillation

412

What is hypertrophic cardiomyopathy

Inherited condition where there is LV obstruction from septal hypertrophy

413

What ecg changes may be found in patients with hypertrophic cardiomyopathy

LVH, arrhythmias associated

414

What is the management for hypertrophic cardiomyopathy

B blockers, verapamil, AMIODARONE for associated arrhythmias

415

List some cusses of restrictive cardiomyopathy

Sarcoidosis, amylodosis, scleroderma, endomyocardial fibrosis

416

What is cardiac myxoma

A rare cardiac benign tumour

417

What are the features of restrictive cardiomyopathy

Like those of constrictive pericarditis

418

List the three types of AF

- paroxysmal
- persistent
- permanent

419

What is paroxysmal AF

AF that terminates SPONTANEOUSLY, usually within 48 hours

420

What is persistent AF

AF that terminates with cardioversion (electrical or chemical) but does NOT resolve spontaneously

421

What is permanent AF

AF that will not terminate spontaneously and is refractory to cardioversion

422

Which beta blocker is used for rate control in AF

Metoprolol

423

How is acute AF treated

Emergency cardioversion (chemical or electrical depending on signs)
Then give vp rate control drugs e.g. CCBs and b blockers, digoxin, amiodarone

424

Which drugs are given for rate control first line in AF

CCBs - verapamil, Diltiazem
B blocker - metoprolol
(NOT both CCB and b blocker at same time)
Then LMWH

425

Which drugs are given for chemical cardioversion of AF

Amiodarone or flecainide (WITH CAUTION)

426

What is chronic AF management

Rate (or rhythm) control, anticoag
Rate control - first line

427

What are the first line drugs for chronic AF rate control

First line - b blocker (metoprolol) or CCB (verapamil, Diltiazem)

428

What are the second line drugs for rate control in patients with AF

Digoxin or amiodarone

429

Which combination of drugs do you NOT give in AF, unless advised by an EXPERT

CCBs and b blocker

430

What is the management for patients with paroxysmal AF

"pill in pocket" - sorta lol or flecainide
+ anticoagulation

431

What is the anticoagulation in acute AF

Heparinise; use warfarin if high risk of emboli

432

What are the anticoagulation options for chronic AF

Warfarin
Dabigatran
Apixaban, rivaroxiban

NOT aspirin

433

What is the CHADVASC score a measure of

Risk of stroke per year - increases as score increases

434

What are the components of the CHADSVASC score

CCF (1)
HTN (1)
Age >75 (2)
DM (1)
Stroke/Tia (2)
Vascular disease (1)
Age 65-74 (1)
Sex (F) (1)

435

What is the CHADSVASC score out of and what score is needed to put. As patient on anticoagulation

Out of 9 max
Score of 2 or higher needed to treat with warfarin etc

436

What does the HASBLED score assess risk of

1 year risk of major bleed in patients with AF

437

What are the parts that make up the HASBLED score

HTN (1)
Abnormal liver/kidney function (2x1)
Stroke (1)
Bleeding (1)
Labile INRs (1)
Elderly (>65 yo) (1)
Drugs/alcohol (2x1)

438

What is the HASBLED score out of, and what score is concerning

Out of 9
Score of 3 or more requires regular review as they are high risk of bleeding

439

Ecg arrhythmia may wpw underlie

AF

440

Which drugs should be avoided in wow sydnrome

Verapamil, Diltiazem and digoxin (as these affect the AVN)

441

Which drug may be used in wpw syndrome

Flecainide

442

Which drug may be given in patients with u resolving bradycardia

Atropine

443

Which two places should you palmate if a patient has AF

Feel apex beat and radial pulse at same time

444

What is the typical ecg appearance of atrial flutter

Sawtooth baseline +/- 2:1 av block depending on ventricular and atrial rates

445

Which two things can you do to try and find the underlying rhythm in a patient with atrial flutter

Vagal manoeuvre e.g. Carotid sinus massage
Iv adenosine

446

What is the treatment for asymptomatic bradycardia with rate over 40

No treatment

447

What is treatment for bradycardia with rate under 40bpm or patient who is symptomatic

Atropine

448

What wells score makes pe likely

4 or more, if below 4 do D dimer

449

Which 2 factors would score 3 points on wells score

- clinically suspected PE
- alternative diagnosis to PE less likely

450

Which 3 factors would score 1.5 points in a wells score

- bpm over 150
- immobilisation
- prev PE/DVT

451

Which two factors would score 1 on a wells score

- haemoptysis
- malignancy

452

Symptoms of which emergency can b blockers mask

Hypoglycaemia