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Medicine > Cardio > Flashcards

Cardio Flashcards

1
Q

Definition of bradycardia

A

Less than 60bpm

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2
Q

Classification of bradycardias

A
  1. Failure of impulse formation (sinus bradycardia)

2. Failure of conduction (atrioventricular blocks/herat blocks)

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3
Q

Causes of sick sinus syndrome

A

1) Idiopathic fibrosis
2) Structural damage:
a. Ischaemic heart
b. Cardiomyopathies
c. Myocarditis.

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4
Q

Types of heart block bradycardia

A
  1. Of the AV node: 1st, 2nd and 3rd degree

2. Of the bundle branches: delay or complete, hemiblock/fascicular, bifascicular or bundle branch

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5
Q

Causes of sinus bradycardia

A

A) Intrinsic - congenital, infart/ischaemia, degeneration
B) extrinsic

DIVISIONS
D - drugs (ABCD) - antiarrhythmics, Beta blockers, Ca channel blockers, Digoxin
I - ischaemia/infarction (post-MI)
V - vagal hypertonia - athlete, vasovagal syncope, carotid sinus syndrome
I - infection: viral myocarditis, infective endocarditis, rheumatic fever
S - sick sinus syndrome
I- infiltrative: cardiomyopathy (autoimmune, sarcoid, amyloid, haemochromatosis, muscular dystrophy)
O - hypothermia, hypothyroidism, hypo/hyperkalaemai
N - neural: increased ICP
S - septal defect (primum ASD)
S - surgery/catheterisation.

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6
Q

Causes of sick sinus syndrome

A

1) Idiopathic fibrosis
2) Structural damage:
a. Ischaemic heart
b. Cardiomyopathies
c. Myocarditis.

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7
Q

Management of bradycardia

A

1) Asymptomatic/ >40bmp - do not Rx
2) Acutely -
a. Rx underlying cause
b. Medical: atropine 0.6-1.2g IV over 5 min (max 3g)
c. External pacing - management of choice.
3) Elective -
a. Conservative - stocking, increase salt intake, avoid triggers
b. Permanent pacing

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8
Q

Causes of sinus tachycardias

A
  1. Physiological - pregnancy, emotion, exercise
  2. Pathological.
    A) 1º - extremely rare
    B) 2º -
    I. Acute - pain, fever, infection, acute HF, acute PE, hypovolaemia
    II. Chronic - excess catecholamines, hyperthyroidism, anaemia
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9
Q

Differential of a narrow complex tachycardia

A
  1. Sinus tachycardia - may be appropriate or inappropriate.
  2. Atrioventricular junctional tachycardias: AVNRT, AVRT
  3. Atrial tachycardias: Atrial fibrillation, flutter and tachycardia
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10
Q

ECG features of AVNRT

A
  1. Narrow complex tachycardias
  2. P waves absent or after the complex.
  3. Regular rhythm about 140-240 bpm
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11
Q

ECG features of AVRT

A
  1. Tachycardia
  2. P waves present
  3. QRS may be narrow or wide.
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12
Q

ECG features of atrial tachycardia

A
  1. Abnormally shaped P waves as they do not originate in the SAN
  2. Normal QRS
  3. Regular (-ish) at >150bpm
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13
Q

ECG features of atrial flutter

A

Saw toothed baseline. Usually 2:1 ratio Also 3:1 and 4:1.

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14
Q

ECG features of atrial fibrillation

A

No P waves, irregular line.

Irregularly irregular QRS and RR interval.

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15
Q

Causes of atrial fibrillation

A 
Cardiac and non-Cardiac
A) Cardiac 
- Top 3: Ischeamic heart/MI, HTN and valvular disease (inc rheumatic)
- CCF
- Cardiomyopathies
-Myocarditis and pericarditis
- Sick sinus syndrome
- WPW
- Cardiac tumours
- Cardiac surgery
B) Non-cardiac
Number 1 = thyrotoxicosis
- Pulmonary: chronic or acute PE, pneumonia, COPD
- Meta: Electrolyte disturbance - low K+
- Endo: phaeochromocytoma
- Alcohol abuse, caffeine, smoke, recreational drugs
- Neuro: Increased sympathetic or parasympathetic tone (inc. exercise)
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16
Q

Signs of atrial fibrillation (two)

A
  1. Irregularly irregular pulse

2. Pulse deficit

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17
Q

Management of atrial fibrillation principles

A
  1. Rate control

2. Rhythm control

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18
Q

Management of acute AF (less than 48 hours)

A
  1. Control ventricular rate - 1st line: dilitazem, verapamil, metoprolol, 2nd line: digoxin, amiodarone
  2. Cardiovert - electrical or medial (1st line flecanide, 2nd line amiodarone)
  3. Anticoagulant - start LMWH, consider long term based on CHADSVAS score > 0 and recurrence risk
  4. Tx underlying cause
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19
Q

Management of paroxysmal AF

A

Self limiting

  1. Anticoagulant using CHADVAS
  2. Control/prevent: beta blocker: sotalolol or amiodarone
  3. Pill in pocket: flecanide or propafenone
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20
Q

Management of persistent AF (>7 days)

A
  1. Rate control: AV node slowing agent + warfarin

2. Rhythm control: anti arrhythmic –> DC cardioversion –> anticoagulant

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21
Q

Criteria for use of rate control as first line treatment in AF

A
  • > 65
  • persistent tacky with failed cardioversion
  • no heart failure
  • mild Sx’s
22
Q

Criteria for use of rhythm control as first line treatment in AF

A
  • Age more than 65
  • symptomatic or heart failure
  • first presentation
  • secondary to a treated precipitant
23
Q

Rate control in AF

A

AV node slowing agent plus warfarin.
1st line) beta blocker or rate limiting CCB (not both)
2nd line) add digoxin
3rd line) consider amiodarone

Target INR 2.5

24
Q

Rhythm control in AF

A

> 4 weeks rhythm control + warfarin –> cardioversion –> >4 weeks anticoagulate

1) Rhythm control: TTE to exclude structural abnormality + 3 weeks of warfarin unless clot excluded on TOE + 4 weeks of amiodarone or sotalolol
2) Electrical or pharmacological cardioversion: flecanide, amiodarone
3) 4 weeks anticoagulate INR target = 2.5

Maintain with 1) beta-blocker or 2) amiodarone. Not needed if cause is successfully treated.

25
Q

Management of atrial flutter

A

1st line) cave-tricuspid isthmus ablation

2nd line) As per AF (amiodarone, sotalol…)

26
Q

How to determine anticoagulant to use in patients with risk of cardiovascular disease

A

CHA2-DS2 VAS score

  1. CCF
  2. HTN
  3. Age >75 (2 points)
  4. Diabetes
  5. Stroke/TIA (2 points)
  6. DM
  7. Sex female

0 = aspirin
>0 =warfarin (INR 2-3)

27
Q

Risk factors of acute coronary syndrome

A 
Modifiable: 
- obesity
- high cholesterol
- smoking
- diabetic control 
- HTN
Non-modifiable:
- Male
- Age
-FH age less than 55
28
Q

Acute coronary syndrome is encompassed by three conditions

A
  1. Unstable angina
  2. NSTEMI
  3. STEMI
29
Q

Progression of ECG changes in a STEMI

A
  1. Normal ECG
  2. ST elevation + hyper acute T waves
  3. Pathological Q waves if full thickness
  4. ST normalisation
  5. T wave inversion
30
Q

Progression of ECG changes in a NSTEMI

A
  1. ST depression

2. T wave inversion

31
Q

An inferior MI is caused by occlusion of which vessel? and appears in what leads?

A

RCA

aVF, II, III

32
Q

An anterior MI is caused by occlusion of which vessel? and appears in what leads?

A

LCA/LMS

V2-V6

33
Q

An anterior-lateral MI is caused by occlusion of which vessel? and appears in what leads?

A

LCx

V4-V6, I, aVL

34
Q

An anterior-septal MI is caused by occlusion of which vessel? and appears in what leads?

A

LAD

V2-V4

35
Q

A posterior MI is caused by occlusion of which vessel? and appears in what leads?

A

RCA

V1-V3 reciprocal

36
Q

Troponin must be measure at ____ hours to exclude an MI

a. 2 hours
b. 3 hours
c. 6 hours
d. 12 hours
e. 24 hours

A

Troponin elevates between 3 and 12 hours, peaking at 24 hours.

Is must be measured at 12 hours to exclude an MI.

37
Q

Troponin returns to baseline in ___ days

A

Return to baseline is in 5-14 days.

38
Q

How to differentiate between NSTEMI, STEMI and unstable angina

A
  1. STEMI - typical symptoms + ST elevation (or new onset LBBB)
  2. NSTEMI - typical symptoms + no ST elevation + +ve trop
  3. Unstable angina - typical symptoms + no ST elevation + -ve trop
39
Q

Presentation of silent MIs and people who get them

A

Diabetics and elderly patients

Syncope, delirium or post-op oliguria/hypotension

40
Q

Features of a pathological Q wave.

A
  1. Q wave >25% of its R wave
  2. At least in two contiguous leads

(Likely pathological if Q wave more than 0.02 s in leads V1-3)

41
Q

Complications of an MI

A 
Death Passing PRAED St.
D - death: VF, LVF, CVA
P - pump failure
P - Pericarditis
R - rupture: myomalacia cordis - 
   1. LV - cardiac tamponade
   2. Papillary muscles - MR
   3. Septum 
A - arrhythmias -
   1. Tachycardias: SVT (AF and AFlutter) and ventricular (VT, VF, PVC)
    2. Bradycardias: sinus, AV block, ventricular 
A - aneurysm
E - emboli
D - dressler's syndrome
42
Q

ECG features of pericarditis

A
  1. ST saddle shaped elevation

2. +/- PR depression

43
Q

Management of pericarditis

A

NSAIDs and Echo to exclude an effusion

44
Q

Becks triad is made up of? and indicates a diagnosis of?

A

Cardiac tamponade.

  1. Increased JVP
  2. Muffled heart sounds
  3. Low BP
45
Q

Diagnostic features of cardiac tamponade are?

A

Becks triad and pulses paradoxus (>10mmHg)

46
Q

What is dressler’s syndrome?

A

Autoimmune pleura-pericarditis: antibodies against myocyte sarcolemma

47
Q

Features of Dressler’s syndrome?

A
  1. Recurrent pericarditis
  2. Increased ESR
  3. Pleural effusion
  4. Fever
  5. Anaemia

2-6 weeks post-MI

48
Q

management of Dressler’s syndrome?

A

NSAIDs and steroids if severe.

49
Q

Presentation of a ventricular aneurysm post MI, including time frame?

A

4-6 weeks post MI

Recurrent VT
Angina
LVF
Systemic emboli

50
Q

ECG features of a ventricular aneurysm

A

Persistant ST elevation

51
Q

Management of a ventricular aneurysm

A

Anticoagulant + consider excision.

Medicine (6 decks)

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