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3B GH > Cardio > Flashcards

Cardio Flashcards

1
Q

Mx of VT/VF

A

defib!
if awake, anaesthetist GA/midazolam then defib
if cant have GA, amiodarone IV +/- BB

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2
Q

symptoms of VF

A

syncope/ LOC

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3
Q

symptoms of VT

A

palpitations
SOB
syncope/pre-syncope
chest pain

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4
Q

causes of VT/VF

A 
MI
drugs
LV impairment
electrolytes
channelopathies [long QT/Brugada]
HCM
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5
Q

if Pt went into VT/VF due to MI, recurrence not v likely unless another MI.
If cause is still there e.g. HCM, how would you Mx?

A

amiodarone/ BB
ICD [internal cardiac defib]
[maybe ablation]

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6
Q

VT ECG findings

A

broad complex

regular

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7
Q

VF ECG findings

A

broad complex

irregular

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8
Q

Atrial flutter ECG finding

A

saw tooth

regular

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9
Q

SVT ECG findings

A

narrow complex

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10
Q

SVT sx

A

palpitations

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11
Q

Mx of SVT

A

vagal manoeuvres [syringe + carotid massage]

adenosine 6mg, then try 12mg

verapamil

if compromised, dc cardioversion

long-term - BB, flecainide, CCB, (ablation)

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12
Q

causes of AF

A 
age
big LA
HF
mitral disease
hyperthyroid
HtN
MI > LV damage
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13
Q

tool to decide whether to anticoagulate someone with AF & score to anticoag

A

CHADS2VASC

>1 male, >2 female

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14
Q

chronic AF Mx

A

warfarin/NOAC
metoprolol [/diltiazem/verapamil/amiodarone]
digoxin in sedentary
cardioversion +/- amiodarone, or flecainide

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15
Q

should the AVR lead on an ECG have a positive or negative tracing

A

-ve

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16
Q

how can you identify a patient is in sinus rhythm from an ECG

A

every QRS must be preceded by a P wave [impulse originates from sinus node]
regular
rate 60-100

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17
Q

how do you work out the axis from an ECG

A

lead 1 and AVF should both be positive

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18
Q

what is sinus arrhythmia

A

slight shortening and lengthening with respiration, common in young

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19
Q

what causes a prolonged PR interval

A

heart block

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20
Q

what causes a short PR interval

A

accessory pathway e.g. WPW

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21
Q

how long should the PR interval be

A

3-5 small squares

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22
Q

describe the degrees of heart block

A 
1st = constant prolonged PR
2nd = mobitz 1 lengthening, then drops 1. mobitz 2 constant prolonged then drops 1.
3rd = no relationship between P + QRS
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23
Q

mx of heart block

A

pacemaker

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24
Q

define heart block

A

disrupted passage of impulse through AVN

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25
Q

causes of 1st and 2nd degree heartblock

A 
IHD/MI
myocarditis
athletes
sick sinus syndrome
drugs - digoxin, B blocker
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26
Q

what is sick sinus syndrome

A

dysfunctional sinus node (fibrosis)
can cause brady/tachycardia, AF, sinus pause
usually in the elderly

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27
Q

what causes a deep / pathological Q wave on ECG

A

MI

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28
Q

what causes a tall/big QRS on ECG

A

LV hypertrophy

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29
Q

what causes a long/ wide QRS

A

BBB [ventricle conduction problem]

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30
Q

sign of hyperkalaemia on ECG

A

tall tented T waves

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31
Q

what does T wave inversion on ECG indicate

A

infarct/ ischaemia [MI/IHD]

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32
Q

leads II, III, and AVF affected. Likely site of infarct + vessel

A

inferior. RCA

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33
Q

leads I, aVL, V4-6 affected. Likely site of infarct + vessel

A

lateral, circumflex

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34
Q

leads V1-3 affected. Likely site of infarct + vessel

A

anterioseptal, LAD

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35
Q

causes of long-QT on ECG

A

genetic predisposition [long-QT syndrome]
drugs: antipsychotics, macrolides
hypocalc/hypokal

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36
Q

what hormone abnormality might cause someone to go in and out of AF

A

hyperthyroidism

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37
Q

If the SAN gives HR of 100bpm, what slows the heart rate?

A

vagal tone (activity of the vagus nerve)

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38
Q

signs of ischaemia/ infarct on ECG

A

ST elevation/ depression
T wave inversion
Q waves

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39
Q

blood results/ biomarkers that might be seen in alcoholism

A

^GGT
low urea
^MCV
[^AST + ALT]

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40
Q

brugada on ecg

A

high J point
coved ST elevation
“saddleback” between ST + T wave

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41
Q

what causes brugada

A

autosomal dominant

causing Na+ chanelopathy

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42
Q

brugada Sx

A

syncope

sudden death

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43
Q

brugada Mx

A

internal defib

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44
Q

what causes a bifid P wave

A

1 atria hypertrophy e.g. mitral stenosis

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45
Q

in terms of the level of damage to myocardium, what do STEMI and NSTEMI represent

A 
STEMI = transmural infarct
NSTEMI = ischaemia/ not fully occluded vessel
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46
Q

likely troponin findings in STEMI, NSTEMI and unstable angina

A

stemi + nstemi = raised troponin

unstable angina not

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47
Q

immediate Tx of suspected MI

A 
300mg aspirin
morphine 5-10mg
anti-emetic e.g. metoclopramide 10mg
anticoag: bivalirudin/enoxaparin/fondaparinux
[O2]
[GTN]
cath lab for PCI
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48
Q

consequences of MI

A

cardiac arrest
HF
VF
AF

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49
Q

long term Mx of ACS

A 
aspirin + clopidogrel
anticoag [fondaparinux] til discharge
atorvastatin
BB
ACEi
STOP SMOKING
antiHTN, DM Mx
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50
Q

usual pathology in ACS

+ rarer causes

A

plaque rupture
thrombosis
inflammation

vasculitis
emboli
coronary spasm

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51
Q

causes of secondary hyperTN

A 
cushings
conn's disease
phaeochromocytoma
renal disease
coarctation of the aorta
drugs: NSAIDs, COCP, steroids
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52
Q

secondary causes of hyperlipidaemia

A 
renal failure
liver disease
hypothyroidism
diabetes
excess alcohol
biliary obstruction
drugs: steroids, oestrogens
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53
Q

what is the side effect of statins, how would someone present and how would you investigate this?

A

myositis

muscle tenderness

CK

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54
Q

53 yr old hypertensive male Pt presents w/ sudden onset severe central CP, radiating to scapular.
BP low, sweaty, pale, early diastolic murmur, ECG shows LVH only. CXR widened mediastinum. Main differential?

A

aortic dissection

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55
Q

how do you confirm a suspected aortic dissection?

A

CT

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56
Q

how do you manage BP 80/40 in Pt with aortic disection/

A

conservatively /permissive hypoTN
until aorta repaired
provided Pt awake [cerebral perfusion] + bilateral radial pulses

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57
Q

68 yr old w/ dizzy spells increasing in frequency + w/ exertion.
Hx of angina, neuro exam normal, BP 110/70, sinus rhythm, systolic murmur which radiates across precordium + to carotids. Likely diagnosis?

A

aortic stenosis

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58
Q

Ix technique for suspected aortic stenosis

A

transthoracic echo

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59
Q 
68 yr old 
^SOB, palpitations, CP.
HR 160, BP 88/40, sat 92, RR 22, creps.
ECG shows AF.
Acute Mx of the tachyarrhythmia?
A

electrical cardioversion [with sedation or GA]

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60
Q

ECG axis deviation - looking at lead I and lead II, what will you notice in left and right axis deviation

A

Left Leaving [away from each other]

Right axis deviation - pointing towards each other

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61
Q

on ECG, how many little squares should the PR interval and the QRS complex be

A

PR - 3-5 small squares

QRS - up to 3 small squares

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62
Q

what is the most common heart valve problem after MI?

A

mitral regurg

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63
Q

signs of bleeding in your patient

A 
visible bleeding
low BP
tachycardia
weak pulses
cold/clammy peripheries
prolonged cap refill
not talking [=not perfusing brain]
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64
Q

what movement improves pericarditic pain

A

leaning forward

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65
Q

what would you notice in BP in aortic dissection?

A

unequal between L and R arms

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66
Q

causes of palpitations

A

arrhythmia: sinus tachy, ectopics, AF, SVT, VT

Thyrotoxicosis
Anxiety
Phaeochromocytoma

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67
Q

when do you see a J wave on ECG

A

hypothermia
SAH
hypercalcaemia

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68
Q

causes of sinus bradycardia

A 
fitness
vasovagal
sick sinus syndrome
drugs: BB, digox, amiod
hypothyroid
hypothermia
^ICP
cholestasis
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69
Q

common causes of AF

A 
IHD/MI
HF
HTN
thyrotox
alcohol
obesity
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70
Q

causes of 3rd degree heart block

A 
IHD/MI
idiopathic fibrosis
congenital
aortic valve calcification
cardiac trauma/ surg
digoxin toxicity
infiltration: abscess, granuloma, tumour, parasite
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71
Q

what is prinzmetals angina?

A

coronary spasm

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72
Q

causes of T wave inversion

A

many including ischemia, BBB, hypertrophy, PE

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73
Q

PE ECG changes

A

sinus tachy
RBBB
RV strain [R axis dev, dominant R wave, T wave inv/ ST dep in V1/V2]
(SIQIIITIII)

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74
Q

hyperkal on ECG

A

tall tented T waves
wide QRS
absent P
‘sine wave’ appearance

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75
Q

hypokal on ECG

A

small flattened T waves
prominent U waves
peaked P waves

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76
Q

hypercalc on ECG

A

short QT

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77
Q

hypocalc on ecg

A

long QT

small T waves

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78
Q

what are bifascicular and trifascicular block

A

bi = RBBB + left bundle hemi block
manifests as axis deviation

tri = bi + 1st degree heart block

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79
Q

define heart failure

A

cardiac output inadequate to meet body’s requirements

80
Q

describe the diff between systolic and diastolic HF

A

inability of ventricle to contract vs inability to relax/fill

81
Q

causes of systolic HF

A

MI
cardiomyopathy
IHD

82
Q

causes of diastolic HF

A 
constrictive pericarditis
restrictive cardiomyopathy
ventricular hypertrophy
tamponade
obesity
83
Q

Sx of LV HF

A 
dyspnoea
poor exercise tolerance
fatigue
orthopnoea
paroxysmal nocturnal dyspnoea
nocturnal cough
pink frothy sputum
wheeze [cardiac asthma]
nocturia
cold peripheries
weight loss
84
Q

casues of RV HF

A

LVF
pulm stenosis
lung disease [cor pulm]

85
Q

Sx of RV HF

A 
peripheral oedema
ascites
nausea
anorexia
facial engorgment
epistaxis
86
Q

when RV HF and LV HF occur together this is called

A

CCF

87
Q

what criteria could you use to diagnose CCF?

A

framingham

88
Q

what classificaiton system can you use to assess severity in HF

A

new york classification of HF

89
Q

Ix a pt with suspected HF

A

ECG
BNP
echo

CXR
FBC, U+E

90
Q

briefly outline the new york classification of HF

A 
I = present, no undue SOB
II = comfortable @rest, activity =SOB
III = limited by SOB from less than ordinary activity
IV = SOB @rest
91
Q

CXR features of heart failure

A 
alveolar oedema [bat wings]
kerley B lines [interstitial oedema]
cardiomegaly
dilated vessels
effusion
92
Q

Mx of acute HF

A 
sit up
high flow O2 IF low sats
ECG -> treat any arrhythmia [AF]
diamorphine
furosemide
GTN [only BP>90]
nitrate infusion [BP>100]
consider CPAP
93
Q

causes of severe pulm oedema

A 
MI/IHD
arrhythmia
valve disease
malig HTN
ARDS
fluid overload neurogenic [head injury]
94
Q

differentials for severe pulm oedema

A

asthma/COPD

penumonia

95
Q

Sx of severe pulm oedema

A

dyspnoea
orthopnoea
pink frothy sputum

96
Q

signs in severe pulm oed

A 
distressed
^RR
^HR
sweaty, pale
wheeze
pink frothy sputum
pulsus alternans
^JVP
fine lung crackles
triple/gallop rhythm
97
Q

Ix in acute pulm oed

A 
CXR
ECG [MI/arrhyth]
U+E
trop
ABG
[echo, BNP]
98
Q

lifestyle Mx points in chronic HF

A

stop smoking
stop alcohol
less salt
optimise weight and nutritoion

99
Q

medical [non-lifestyle] mx of HF

A

treat cause [e.g. arrhyth]
treat any exac factors [anaemia]

BB
ACEi/ARB
diuretics [furos>spiro>thiazide]
digox
vasodilator [hydrazaline + isosorbide dinitrate]

avoid NSAID, verapamil
flu + pneumococcal vacc

pacemaker
LVAD
transplant

100
Q

how would you manage an admitted pt with bad HF

A 
IV diuretics
opiates
IV nitrates 
Na and fluid restict
DVT proph
101
Q

are left/ right heart murmurs best heard on inspiraiton or expiration?

A

Left heart lesions are louder in expiration,

right-sided lesions are louder on inspiration.

102
Q

indications for temporary cardiac pacing

A

symptomatic brady, unresponsive to atropine

post MI in: 2nd/3rd degree HB, bi/trifascicular block

drug resistant SVT/VT

[other:
in cardiac surg
in GA
electrophysiological studies
drug overdose -BB/digox/verapamil]
103
Q

indications for permanent pacemaker

A 
3rd degree HB, mobitz II
post MI persistent HB
symptomatic brady e.g. sick sinus synd
HF
drug resistant tachyarrhythmia
104
Q

long QT syndromes put the patient into what ventricular arrhythmia?

A

torsades de pointes

105
Q

pt presents with Hx of passing out. ECG shows coved ST elevation. He says he is concerned as his grandad and uncle had similar episodes and both died very suddenly of cardiac arrest of unknown cause.
Diagnosis?

A

brugada

106
Q

why dont you give diltiazem/verapamil with BB?

A

risk of severe bradycardia [+/- LVF]

107
Q
  1. what is malignant HTN?
  2. give some symptoms and signs
  3. what are some emergency complications
A
  1. rapid rise in BP leading to vascular damage
  2. headache, [visual disturbance]
    retinal haemorrhages and exudates, [papilloedema]
  3. AKI, encephalopathy, HF
108
Q

give 4 casues of secondary HTN

A

renal disease [glom neph, PAN, SSc, pyelo, PKD, vasc]

cushings, conns, phaeo, acroM, ^PTism

coarctation
preg
steroids, MAOI, OCP

109
Q

findings in HTNive retinopathy

A 
tortuous arteries with thick shiny walls [silver/copper wiring]
AV nipping
flame haemorrhages
cotton wool spots
papilloedema
110
Q

Mx of hypertensive encephalopathy

A

labetalol

111
Q

Mx of prinzmetals angina

A 
GTN
correct low Mg
stop smoking
avoid triggers such as recreational drugs
CCB
\+/- long acting nitrate
112
Q

describe the pathophysiology behind rheumatic fever

A

group A beta haemolytic strep pharyngeal infection leads to antibody production. Antibodies mistakenly react with valve tissue.
2-4 weeks later

113
Q

give some clinical features of rheumatic fever

A

recent strep infection
fever

tachy
murmur [mitral + aortic regurg]
pericardial rub
CCF
ccardiomegaly
conduction defects

arthritis
nodules
erythema marginatum
[chorea]

114
Q

Mx of rheumatic fever

A 
ben pen stat
then phenoxymethylpenicillin
analgesia [aspirin/NSAID]
[pred]
[haloperidol/diazapam for chorea]
115
Q

using 5 words max, explain the pathology behind ACS

A

plaque rupture, thrombosis, imflammation

116
Q

other than plaque rupture, thrombosis, imflammation… what other pathologies can cause ACS?

A

emboli, coronary spasm, vasculitis

117
Q

unstable angina vs MI - what will troponin show?

A

MI = trop release

unstable angina does not

118
Q

ACS non-modifiable risk factors. [3]

A

age
male
FH [MI in 1st deg relative <55]

119
Q

ACS modifiable risk factors - list 4

A 
smoking
HTN
DM
^lipidaemia
obesity
sedentary
cocaine
120
Q

diagnostic factors for ACS

A

new ischaemic ECG changes e.g. Q waves
trop ^
echo e.g. reduced wall movement

121
Q

Sx ACS

A

acute central crushing CP

ass. w/ nausea, sweating, SOB

122
Q

2 types of patient that have silent MIs [ACS without chest pain]

A

diabetics

elderly

123
Q

how might a silent MI present

A 
post op hypoTN or oliguria
vomiting
syncope
pulm oedema
acute confusion
124
Q

signs in ACS

A 
pallor
sweaty
distress/anxious
tachy or bradycardia
BP hyper or hypoTN
4th heart sound

HF: ^JVP, lung crackles, 3rd HS

pansystolic murmur [VSD/ pap muscle dysfn/rupture]

low grade fever

later: pericardial friction rub, peripheral oedema

125
Q

STEMI ECG changes a) within hrs, and b) over hrs to days

A

a) hyperacute (tall) T waves, ST elevation, new LBBB

b) T-wave inversion, pathological Q waves

126
Q

possible NSTEMI ECG findings

A

ST dep
T wave inv
non-spec changes
normal

127
Q

bloods to take in MI/ ACS

A 
FBC
U+E
glucose
lipids
cardiac enzymes
128
Q

differentials for ACS/MI - give 4

A 
stable angina
pericarditis
myocarditis
takotsubo cardiomyopathy
dissection
PE
GORD
oesphageal spasm
pneumothorax
MSK pain
pancreatitis
129
Q

troponin levels can be high with what other causes of myocardial damage [other than ACS]

A

myocarditis
pericarditis
ventricular strain
tacharrhythmia

CPR
DC CV
ablation therapy

130
Q

non-cardiac causes of raised trop

A

PE > RV strain

SAH, burns, sepsis, renal failure

131
Q

STEMI includes ST elevation on ECG [or inf. w/ ST depression] and also what other ECG change?

A

new LBBB

132
Q

immediate STEMI Mx

A

aspirin

PCI

ticagrelor

heparin

[if no PCI within 2 hrs - fibrinolysis]

133
Q

management of chest pain in MI

A

GTN PRN

morphine

consider nitrate infusion

134
Q

when managing chest pain in STEMI, if the patient has recently used sildenafil, which treatment would you omit?

A

nitrate infusion

135
Q

if AF started more than 48 hours ago, what should you do before cardioversion, and why?

A

anticoagulate with DOAC[apixaban]/warf for 3 weeks, because intracardiac clots may have formed.

136
Q

give 5 causes of AF

A 
HF
HTN
IHD
PE
mitral valve disease
pneumonia
hyperthyroidism
caffeine
alcohol
post-op
low K+/Mg2+

rarer: lung CA, cardiomyopathy, sick sinus syndrome, constrictive pericarditis, endocarditis, haemochromatosis, sarcoid

137
Q

AF may be asymptomatic but what sx can it cause?

A

faitness
palpitations
CP
dyspnoea

138
Q

blood tests to order in AF

A

U+E
TFT
cardiac enzymes

139
Q

Mx of patient in acute AF with shock/ MI/ syncope/HF

A

ABCDE + senior input
DCCV
amiodarone if unsusccessful

140
Q

Mx of acute AF if pt is stable and AF started <48hrs ago

A

DCCV or flecainide or amiod

heparin

141
Q

contraindications of using flecainide for new AF

A

structural heart disease e.g. scar tissue from MI

IHD

142
Q

Mx of acute AF if Pt is stable and AF started >48 hrs ago or unclear time of onset

A

rate: bisoprolol or diltiazem

anticoag for at least 3 weeks before rhythm control!

143
Q

managing chronic AF

A

rate control: BB or rate limiting CCB [verapamil], 2nd line digoxin, 3rd line amiod, [or sedentary - digoxin alone]

anticoag: CHADSVASC/ HASBLED then DOAC or warfarin
rhythm: DCCV/ amiod/ flecainide/ AVN ablation with pacing

144
Q

in managing chronic AF, the main goals are rate control and anticoag. When would you also give rhythm control?

A 
symptomatic
CCF
young
1st presentation with unprovoked
AF from a corrected prescipitant eg electrolytes
145
Q

how is paroxysmal AF managed? [terminates in <7 days but may recur]

A

sotalol or flecainide PRN

anticoag based on CHADSVASC - DOAC or warf

consider ablation if symptomatic or frequent

146
Q

management of Atrial flutter

A

DCCV if haemodyn unstable

if stable: metoprolol/verpamil/diltiazem. [amiod]

heparin and warf

ablation

147
Q

modifiable risk factors to advise ACS patients on

A

stop smoking

treat DM, HTN, ^lipidaemia

diet: ^oily fish, fruit n veg, fibre, low in sat fat

exercis/ cardiac rehab

MH

148
Q

cardioprotective meds to start ACS pt on

A

aspirin + clopi 12 month [+PPI]

fondaparinux til discharge

BB [if contraindicated, verapamil/diltiazem]

ACEi/ARB if HTN/DM/LV dysfn

atorvastatin

eplerenone if post-MI HF

149
Q

how soon after ACS can you drive?

what about after successful angioplasty?

what about lorries/buses?

A

1 week after angioplasty

4 weeks after ACS without successful angioplasty

stop driving + inform DVLA, may be able to restart after 6 weeks, depending on fn.al tests

150
Q

jobs that cannot restart post-MI + jobs that have to do functional testing e.g. exercise testing

A

airline pilot + air traffic controller cannot restart

public service driver or HGV - exercise testing

151
Q

list 5 complicaitons of MI

A 
cardiac arrest
cardiogenic shock
HF
Bradyarrhythmias [sinus brady, HB, BBB]
tachyarrhythmias [sinus tachy, SVT, AF, flutter, VT, VF]
Pericarditis
Embolism
tamponade
mitral regurg
ventricular septal defect
Dressler's syndrome
LV aneurysm
152
Q

cardiac arrest advanced life support algorithm:

management if patient is unresponsive and not breathing normally

A 
call resus team
head tilt/chin lift/jaw thrust
look/listen/feel for breathing
if any doubt whether breathing is normal:
start CPR 30:2
give adrenaline every 3-5 mins
attach defibrillator

if VF or pulseless VT, 1 shock then resume CPR

amiodarone after 3 shocks

return to spontaneous circulation: ABCDE + treat cause

153
Q

list the treatable reversible causes of cardiac arrest

A

Hypoxia
Hypovolaemia
Hypo/hyperkalaemia /metabolic
Hypothermia

Thrombosis [coronary/pulm]
Tension pneumothorax
Tamponade
Toxins

154
Q

in a cardiac arrest situation, what are the non-shockable rhythms?

A

asystole

pulseless electrical activity

155
Q

causes of cardiogenic shock?

A 
MI
arrhythmias
PE
tension pneumothorax
tamponade
myocarditis
myocardial depression [drugs, hypoxia, acidosis, sepsis]
valve destruction e.g. endocarditis
aortic dissection
156
Q

in a patient with cardiogenic shock, if you suspect an aortic dissection or PE as the cause, what other investigation may be indicated?

A

CT thorax

157
Q

causes of cardiac tamponade

A 
lung/breast CA
pericarditis
MI
trauma
bacteria e.g. TB
coronary dissection in PCI, ruptured ventricle
158
Q

which drugs should be stopped in 2nd and 3rd degree HB?

A

BB and CCB

159
Q

should you insert pacemaker in the varying degrees of heart block, and BBB?

A

1st - no
2nd wenckeback [mobitz 1] - no, unless poorly tolerated
2nd [mobitz 2] - YES.
3rd - sometimes

trifascicular block should be paced

160
Q

murmurs: soft first Heart sound means

A

mitral regurg

161
Q

murmurs: gallop rhythm + 3rd HS

A

CCF

162
Q

murmurs: loud 1st HS + opening snap in diastole

A

mitral stenosis

163
Q

post MI pt w/ central CP relieved by sitting forward, ECG shows saddle shaped ST elevation. What is the diagnosis? investigation of choice? and management?

A

pericarditis

echo [to check for effusion]

NSAIDs

164
Q

why does systemic embolism occur as a complication of MI? and how would you combat it?

A

arise from LV mural thrombus

consider warfarin for 3 months

165
Q

describe kussmaul’s signs in cardiac tamponade

A

JVP rises during inspiration

166
Q

give 3 possible indications for CABG

A 
pt not suitable for PCI
failed PCI
multi-vessel disease
left main stem disease
multiple severe stenoses
refractory angina
167
Q

post-CABG:

a) medication you give patient to avoid graft embolism
b) driving considerations
c) how long before back to work

A

a) aspirin
b) 1 month, tell DVLA only if HGV driver
c) e.g. 3 months

168
Q

cardiac and non-cardiac causes of arrhythmias

A

cardiac: IHD, cardiomyopathy, mitral stenosis >LA enlargement, pericarditis, myocarditis, abherrant conduction pathways

non cardiac:
alcohol, smoking, caffeine
pneumonia
drugs [BB, digox, L-dopa, tricyclics, doxorubicin]
metabolic [K+/Ca2+/Mg2+, hypoxia/hypercapnia, met acidosis, thyroid]
phaeo

169
Q

what arrhythmias can be caused by sick sinus syndrome?

A 
sinus brady
sinus pause
atrial tachy
AF
tachy brady syndrome
170
Q

causes of myocarditis [50% are idiopathic]

A

viral [EBV/CMV/HSV/HIV], bacterial [staph/strep/TB]
drugs (cyclophos/mabs/pen/spiro)
toxins [cocaine/alc/lithium/lead]
immuno(SLE/sarcoid/rejection)

171
Q

murmur in myocarditis

A

soft S1, S4 gallop

172
Q

ECG changes in myocarditis

A 
ST changes
T wave inv
atrial arrhythmias
AV block
QT prolongation
173
Q

what bloods might be raised in myocarditis?

A

trop
CPR, ESR
viral serology

174
Q

what may be seen on an echo in myocarditis

A

diastolic dysfn, regional wall abnormalities

175
Q

following bloods, ecg, echo in myocarditis, what other 2 investigaions might you consider? 1 of which is the gold standard

A

cardiac MRI if stable

endomyocardial biopsy

176
Q

Mx of myocarditis

A

suppoortive, treat cause, treat arrhythmias + HF

NSAID use is controv

avoid exercise - can precipitate arrhyth

177
Q

what secondary problem can patients with myocarditis get? sometimes even yrs after apparent recoveyr

A

dilated cardiomyopathy

[and severe HF]

178
Q

associations of dilated cardiomyopathy

A 
alcohol, HTN
chemo
haemochrom
viral infection
autoimmune
peri/postpartum
thyrotoxicosis
congenitkal x linked
179
Q

signs in dilated cardiomyopathy

A 
tachycardia
low BP
raised JVP
displaced diffuse apex
S3 gallop
mitral/tricusp regurg
pleural effusion
oedema
jaundice
hepatomeg
ascites
180
Q

echo findings in dilated cardiomyopathy

A

globally dilated hypokinetic heart, low ej fraction

[look for MR/TR, LV mural thrombus]

181
Q

management of dilated cardiomyopathy

A

bed rest, BB, diuretics, ACE-i, anticoag, bivent pacing, ICD, LVAD, transplant

182
Q

define the pathology of HCM

A

LV outflow tract obstruction from asymmetric septal hypertrophy

183
Q

leading cause of sudden cardiac death in the young

A

HCM

184
Q

inheritance pattern of HCM

A

auto dom, or 50% sporadic

185
Q

how does HCM present

A 
sudden death
angina
dyspnoea
palpitations syncope
CCF
186
Q

signs in HCM

A 
jerky pulse
a wave in JVP
double apex beat
systolic thrill at lower left sternal edge
harsh ejection systolic murmur
187
Q

ECG findings in HCM

A

LVH
progressive T-wave inv
deep q waves
AF, WPW, ventricular ectopics, VT

188
Q

echo findings in HCM

A

assymetrical septal hypertrophy
small LV cavity with hypercontractile post wall
mid-systolic closure of aortic valve
systolic anterior movement of mitral valve

189
Q

Mx of HCM

A 
BB, verapamil for Sx
amiod for arrhythmias
anticoag for AF/emboli
septal myomectomy in severe
ICD
190
Q

causes of restrictive cardiomyopathy [some is idiopathic]

A 
amyloidosis
haemochrom
sarcoidosis
scleroderma
endomyocardial fibrosis
191
Q

what signs and symptoms may a cardiac myxoma present with?

A

may mimic IE [fever, WL clubbing, ^ESR, emboli]
or mitral stenosis [left atrial obstruction, AF]

tumour ‘plop’ may be heard

192
Q

describe pulsus paradoxus and give 3 causes

A

drop in pulse pressure on inspiration

cardiac tamponade, chronic sleep apnea, croup, and obstructive lung disease

193
Q

new diagnosis of angina. what drugs will you prescribe

A

GTN spray and BB or CCB

[alternatives:
isosorbide mononitrate
ivabradine]

aspirin

consider ACEi

statin

(anti-HTN if required)

194
Q

advice to patient about GTN

A

if they experience chest pain they should:
Stop what they are doing and rest.
Use their GTN spray or tablets as instructed.
Take a second dose after 5 minutes if the pain has not eased.
Call 999 for an ambulance if the pain has not eased 5 minutes after the second dose, or earlier if the pain is intensifying or the person is unwell.

195
Q

mechanism of action for BB and CCB in angina

A

negatively chronotropic and inotropic

196
Q

undisplaced tapping apex beat indicates

A

A tapping apex beat reflects the perception of the opening snap in mitral stenosis.

3B GH (16 decks)

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