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Cardio Flashcards

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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
causes of 1st and 2nd degree heartblock
``` IHD/MI myocarditis athletes sick sinus syndrome drugs - digoxin, B blocker ```
26
what is sick sinus syndrome
dysfunctional sinus node (fibrosis) can cause brady/tachycardia, AF, sinus pause usually in the elderly
27
what causes a deep / pathological Q wave on ECG
MI
28
what causes a tall/big QRS on ECG
LV hypertrophy
29
what causes a long/ wide QRS
BBB [ventricle conduction problem]
30
sign of hyperkalaemia on ECG
tall tented T waves
31
what does T wave inversion on ECG indicate
infarct/ ischaemia [MI/IHD]
32
leads II, III, and AVF affected. Likely site of infarct + vessel
inferior. RCA
33
leads I, aVL, V4-6 affected. Likely site of infarct + vessel
lateral, circumflex
34
leads V1-3 affected. Likely site of infarct + vessel
anterioseptal, LAD
35
causes of long-QT on ECG
genetic predisposition [long-QT syndrome] drugs: antipsychotics, macrolides hypocalc/hypokal
36
what hormone abnormality might cause someone to go in and out of AF
hyperthyroidism
37
If the SAN gives HR of 100bpm, what slows the heart rate?
vagal tone (activity of the vagus nerve)
38
signs of ischaemia/ infarct on ECG
ST elevation/ depression T wave inversion Q waves
39
blood results/ biomarkers that might be seen in alcoholism
^GGT low urea ^MCV [^AST + ALT]
40
brugada on ecg
high J point coved ST elevation "saddleback" between ST + T wave
41
what causes brugada
autosomal dominant | causing Na+ chanelopathy
42
brugada Sx
syncope | sudden death
43
brugada Mx
internal defib
44
what causes a bifid P wave
1 atria hypertrophy e.g. mitral stenosis
45
in terms of the level of damage to myocardium, what do STEMI and NSTEMI represent
``` STEMI = transmural infarct NSTEMI = ischaemia/ not fully occluded vessel ```
46
likely troponin findings in STEMI, NSTEMI and unstable angina
stemi + nstemi = raised troponin | unstable angina not
47
immediate Tx of suspected MI
``` 300mg aspirin morphine 5-10mg anti-emetic e.g. metoclopramide 10mg anticoag: bivalirudin/enoxaparin/fondaparinux [O2] [GTN] cath lab for PCI ```
48
consequences of MI
cardiac arrest HF VF AF
49
long term Mx of ACS
``` aspirin + clopidogrel anticoag [fondaparinux] til discharge atorvastatin BB ACEi STOP SMOKING antiHTN, DM Mx ```
50
usual pathology in ACS + rarer causes
plaque rupture thrombosis inflammation vasculitis emboli coronary spasm
51
causes of secondary hyperTN
``` cushings conn's disease phaeochromocytoma renal disease coarctation of the aorta drugs: NSAIDs, COCP, steroids ```
52
secondary causes of hyperlipidaemia
``` renal failure liver disease hypothyroidism diabetes excess alcohol biliary obstruction drugs: steroids, oestrogens ```
53
what is the side effect of statins, how would someone present and how would you investigate this?
myositis muscle tenderness CK
54
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?
aortic dissection
55
how do you confirm a suspected aortic dissection?
CT
56
how do you manage BP 80/40 in Pt with aortic disection/
conservatively /permissive hypoTN until aorta repaired provided Pt awake [cerebral perfusion] + bilateral radial pulses
57
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?
aortic stenosis
58
Ix technique for suspected aortic stenosis
transthoracic echo
59
``` 68 yr old ^SOB, palpitations, CP. HR 160, BP 88/40, sat 92, RR 22, creps. ECG shows AF. Acute Mx of the tachyarrhythmia? ```
electrical cardioversion [with sedation or GA]
60
ECG axis deviation - looking at lead I and lead II, what will you notice in left and right axis deviation
Left Leaving [away from each other] Right axis deviation - pointing towards each other
61
on ECG, how many little squares should the PR interval and the QRS complex be
PR - 3-5 small squares | QRS - up to 3 small squares
62
what is the most common heart valve problem after MI?
mitral regurg
63
signs of bleeding in your patient
``` visible bleeding low BP tachycardia weak pulses cold/clammy peripheries prolonged cap refill not talking [=not perfusing brain] ```
64
what movement improves pericarditic pain
leaning forward
65
what would you notice in BP in aortic dissection?
unequal between L and R arms
66
causes of palpitations
arrhythmia: sinus tachy, ectopics, AF, SVT, VT | Thyrotoxicosis Anxiety Phaeochromocytoma
67
when do you see a J wave on ECG
hypothermia SAH hypercalcaemia
68
causes of sinus bradycardia
``` fitness vasovagal sick sinus syndrome drugs: BB, digox, amiod hypothyroid hypothermia ^ICP cholestasis ```
69
common causes of AF
``` IHD/MI HF HTN thyrotox alcohol obesity ```
70
causes of 3rd degree heart block
``` IHD/MI idiopathic fibrosis congenital aortic valve calcification cardiac trauma/ surg digoxin toxicity infiltration: abscess, granuloma, tumour, parasite ```
71
what is prinzmetals angina?
coronary spasm
72
causes of T wave inversion
many including ischemia, BBB, hypertrophy, PE
73
PE ECG changes
sinus tachy RBBB RV strain [R axis dev, dominant R wave, T wave inv/ ST dep in V1/V2] (SIQIIITIII)
74
hyperkal on ECG
tall tented T waves wide QRS absent P 'sine wave' appearance
75
hypokal on ECG
small flattened T waves prominent U waves peaked P waves
76
hypercalc on ECG
short QT
77
hypocalc on ecg
long QT | small T waves
78
what are bifascicular and trifascicular block
bi = RBBB + left bundle hemi block manifests as axis deviation tri = bi + 1st degree heart block
79
define heart failure
cardiac output inadequate to meet body's requirements
80
describe the diff between systolic and diastolic HF
inability of ventricle to contract vs inability to relax/fill
81
causes of systolic HF
MI cardiomyopathy IHD
82
causes of diastolic HF
``` constrictive pericarditis restrictive cardiomyopathy ventricular hypertrophy tamponade obesity ```
83
Sx of LV HF
``` dyspnoea poor exercise tolerance fatigue orthopnoea paroxysmal nocturnal dyspnoea nocturnal cough pink frothy sputum wheeze [cardiac asthma] nocturia cold peripheries weight loss ```
84
casues of RV HF
LVF pulm stenosis lung disease [cor pulm]
85
Sx of RV HF
``` peripheral oedema ascites nausea anorexia facial engorgment epistaxis ```
86
when RV HF and LV HF occur together this is called
CCF
87
what criteria could you use to diagnose CCF?
framingham
88
what classificaiton system can you use to assess severity in HF
new york classification of HF
89
Ix a pt with suspected HF
ECG BNP echo CXR FBC, U+E
90
briefly outline the new york classification of HF
``` I = present, no undue SOB II = comfortable @rest, activity =SOB III = limited by SOB from less than ordinary activity IV = SOB @rest ```
91
CXR features of heart failure
``` alveolar oedema [bat wings] kerley B lines [interstitial oedema] cardiomegaly dilated vessels effusion ```
92
Mx of acute HF
``` 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
causes of severe pulm oedema
``` MI/IHD arrhythmia valve disease malig HTN ARDS fluid overload neurogenic [head injury] ```
94
differentials for severe pulm oedema
asthma/COPD | penumonia
95
Sx of severe pulm oedema
dyspnoea orthopnoea pink frothy sputum
96
signs in severe pulm oed
``` distressed ^RR ^HR sweaty, pale wheeze pink frothy sputum pulsus alternans ^JVP fine lung crackles triple/gallop rhythm ```
97
Ix in acute pulm oed
``` CXR ECG [MI/arrhyth] U+E trop ABG [echo, BNP] ```
98
lifestyle Mx points in chronic HF
stop smoking stop alcohol less salt optimise weight and nutritoion
99
medical [non-lifestyle] mx of HF
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
how would you manage an admitted pt with bad HF
``` IV diuretics opiates IV nitrates Na and fluid restict DVT proph ```
101
are left/ right heart murmurs best heard on inspiraiton or expiration?
Left heart lesions are louder in expiration, | right-sided lesions are louder on inspiration.
102
indications for temporary cardiac pacing
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
indications for permanent pacemaker
``` 3rd degree HB, mobitz II post MI persistent HB symptomatic brady e.g. sick sinus synd HF drug resistant tachyarrhythmia ```
104
long QT syndromes put the patient into what ventricular arrhythmia?
torsades de pointes
105
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?
brugada
106
why dont you give diltiazem/verapamil with BB?
risk of severe bradycardia [+/- LVF]
107
1. what is malignant HTN? 2. give some symptoms and signs 3. what are some emergency complications
1. rapid rise in BP leading to vascular damage 2. headache, [visual disturbance] retinal haemorrhages and exudates, [papilloedema] 3. AKI, encephalopathy, HF
108
give 4 casues of secondary HTN
renal disease [glom neph, PAN, SSc, pyelo, PKD, vasc] cushings, conns, phaeo, acroM, ^PTism coarctation preg steroids, MAOI, OCP
109
findings in HTNive retinopathy
``` tortuous arteries with thick shiny walls [silver/copper wiring] AV nipping flame haemorrhages cotton wool spots papilloedema ```
110
Mx of hypertensive encephalopathy
labetalol
111
Mx of prinzmetals angina
``` GTN correct low Mg stop smoking avoid triggers such as recreational drugs CCB +/- long acting nitrate ```
112
describe the pathophysiology behind rheumatic fever
group A beta haemolytic strep pharyngeal infection leads to antibody production. Antibodies mistakenly react with valve tissue. 2-4 weeks later
113
give some clinical features of rheumatic fever
recent strep infection fever ``` tachy murmur [mitral + aortic regurg] pericardial rub CCF ccardiomegaly conduction defects ``` arthritis nodules erythema marginatum [chorea]
114
Mx of rheumatic fever
``` ben pen stat then phenoxymethylpenicillin analgesia [aspirin/NSAID] [pred] [haloperidol/diazapam for chorea] ```
115
using 5 words max, explain the pathology behind ACS
plaque rupture, thrombosis, imflammation
116
other than plaque rupture, thrombosis, imflammation... what other pathologies can cause ACS?
emboli, coronary spasm, vasculitis
117
unstable angina vs MI - what will troponin show?
MI = trop release unstable angina does not
118
ACS non-modifiable risk factors. [3]
age male FH [MI in 1st deg relative <55]
119
ACS modifiable risk factors - list 4
``` smoking HTN DM ^lipidaemia obesity sedentary cocaine ```
120
diagnostic factors for ACS
new ischaemic ECG changes e.g. Q waves trop ^ echo e.g. reduced wall movement
121
Sx ACS
acute central crushing CP ass. w/ nausea, sweating, SOB
122
2 types of patient that have silent MIs [ACS without chest pain]
diabetics | elderly
123
how might a silent MI present
``` post op hypoTN or oliguria vomiting syncope pulm oedema acute confusion ```
124
signs in ACS
``` 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
STEMI ECG changes a) within hrs, and b) over hrs to days
a) hyperacute (tall) T waves, ST elevation, new LBBB | b) T-wave inversion, pathological Q waves
126
possible NSTEMI ECG findings
ST dep T wave inv non-spec changes normal
127
bloods to take in MI/ ACS
``` FBC U+E glucose lipids cardiac enzymes ```
128
differentials for ACS/MI - give 4
``` stable angina pericarditis myocarditis takotsubo cardiomyopathy dissection PE GORD oesphageal spasm pneumothorax MSK pain pancreatitis ```
129
troponin levels can be high with what other causes of myocardial damage [other than ACS]
myocarditis pericarditis ventricular strain tacharrhythmia CPR DC CV ablation therapy
130
non-cardiac causes of raised trop
PE > RV strain SAH, burns, sepsis, renal failure
131
STEMI includes ST elevation on ECG [or inf. w/ ST depression] and also what other ECG change?
new LBBB
132
immediate STEMI Mx
aspirin PCI ticagrelor heparin [if no PCI within 2 hrs - fibrinolysis]
133
management of chest pain in MI
GTN PRN morphine consider nitrate infusion
134
when managing chest pain in STEMI, if the patient has recently used sildenafil, which treatment would you omit?
nitrate infusion
135
if AF started more than 48 hours ago, what should you do before cardioversion, and why?
anticoagulate with DOAC[apixaban]/warf for 3 weeks, because intracardiac clots may have formed.
136
give 5 causes of AF
``` 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
AF may be asymptomatic but what sx can it cause?
faitness palpitations CP dyspnoea
138
blood tests to order in AF
U+E TFT cardiac enzymes
139
Mx of patient in acute AF with shock/ MI/ syncope/HF
ABCDE + senior input DCCV amiodarone if unsusccessful
140
Mx of acute AF if pt is stable and AF started <48hrs ago
DCCV or flecainide or amiod heparin
141
contraindications of using flecainide for new AF
structural heart disease e.g. scar tissue from MI | IHD
142
Mx of acute AF if Pt is stable and AF started >48 hrs ago or unclear time of onset
rate: bisoprolol or diltiazem anticoag for at least 3 weeks before rhythm control!
143
managing chronic AF
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
in managing chronic AF, the main goals are rate control and anticoag. When would you also give rhythm control?
``` symptomatic CCF young 1st presentation with unprovoked AF from a corrected prescipitant eg electrolytes ```
145
how is paroxysmal AF managed? [terminates in <7 days but may recur]
sotalol or flecainide PRN anticoag based on CHADSVASC - DOAC or warf consider ablation if symptomatic or frequent
146
management of Atrial flutter
DCCV if haemodyn unstable if stable: metoprolol/verpamil/diltiazem. [amiod] heparin and warf ablation
147
modifiable risk factors to advise ACS patients on
stop smoking treat DM, HTN, ^lipidaemia diet: ^oily fish, fruit n veg, fibre, low in sat fat exercis/ cardiac rehab MH
148
cardioprotective meds to start ACS pt on
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
how soon after ACS can you drive? what about after successful angioplasty? what about lorries/buses?
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
jobs that cannot restart post-MI + jobs that have to do functional testing e.g. exercise testing
airline pilot + air traffic controller cannot restart public service driver or HGV - exercise testing
151
list 5 complicaitons of MI
``` 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
cardiac arrest advanced life support algorithm: | management if patient is unresponsive and not breathing normally
``` 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
list the treatable reversible causes of cardiac arrest
Hypoxia Hypovolaemia Hypo/hyperkalaemia /metabolic Hypothermia Thrombosis [coronary/pulm] Tension pneumothorax Tamponade Toxins
154
in a cardiac arrest situation, what are the non-shockable rhythms?
asystole | pulseless electrical activity
155
causes of cardiogenic shock?
``` MI arrhythmias PE tension pneumothorax tamponade myocarditis myocardial depression [drugs, hypoxia, acidosis, sepsis] valve destruction e.g. endocarditis aortic dissection ```
156
in a patient with cardiogenic shock, if you suspect an aortic dissection or PE as the cause, what other investigation may be indicated?
CT thorax
157
causes of cardiac tamponade
``` lung/breast CA pericarditis MI trauma bacteria e.g. TB coronary dissection in PCI, ruptured ventricle ```
158
which drugs should be stopped in 2nd and 3rd degree HB?
BB and CCB
159
should you insert pacemaker in the varying degrees of heart block, and BBB?
1st - no 2nd wenckeback [mobitz 1] - no, unless poorly tolerated 2nd [mobitz 2] - YES. 3rd - sometimes trifascicular block should be paced
160
murmurs: soft first Heart sound means
mitral regurg
161
murmurs: gallop rhythm + 3rd HS
CCF
162
murmurs: loud 1st HS + opening snap in diastole
mitral stenosis
163
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?
pericarditis echo [to check for effusion] NSAIDs
164
why does systemic embolism occur as a complication of MI? and how would you combat it?
arise from LV mural thrombus consider warfarin for 3 months
165
describe kussmaul's signs in cardiac tamponade
JVP rises during inspiration
166
give 3 possible indications for CABG
``` pt not suitable for PCI failed PCI multi-vessel disease left main stem disease multiple severe stenoses refractory angina ```
167
post-CABG: a) medication you give patient to avoid graft embolism b) driving considerations c) how long before back to work
a) aspirin b) 1 month, tell DVLA only if HGV driver c) e.g. 3 months
168
cardiac and non-cardiac causes of arrhythmias
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
what arrhythmias can be caused by sick sinus syndrome?
``` sinus brady sinus pause atrial tachy AF tachy brady syndrome ```
170
causes of myocarditis [50% are idiopathic]
viral [EBV/CMV/HSV/HIV], bacterial [staph/strep/TB] drugs (cyclophos/mabs/pen/spiro) toxins [cocaine/alc/lithium/lead] immuno(SLE/sarcoid/rejection)
171
murmur in myocarditis
soft S1, S4 gallop
172
ECG changes in myocarditis
``` ST changes T wave inv atrial arrhythmias AV block QT prolongation ```
173
what bloods might be raised in myocarditis?
trop CPR, ESR viral serology
174
what may be seen on an echo in myocarditis
diastolic dysfn, regional wall abnormalities
175
following bloods, ecg, echo in myocarditis, what other 2 investigaions might you consider? 1 of which is the gold standard
cardiac MRI if stable endomyocardial biopsy
176
Mx of myocarditis
suppoortive, treat cause, treat arrhythmias + HF NSAID use is controv avoid exercise - can precipitate arrhyth
177
what secondary problem can patients with myocarditis get? sometimes even yrs after apparent recoveyr
dilated cardiomyopathy | [and severe HF]
178
associations of dilated cardiomyopathy
``` alcohol, HTN chemo haemochrom viral infection autoimmune peri/postpartum thyrotoxicosis congenitkal x linked ```
179
signs in dilated cardiomyopathy
``` tachycardia low BP raised JVP displaced diffuse apex S3 gallop mitral/tricusp regurg pleural effusion oedema jaundice hepatomeg ascites ```
180
echo findings in dilated cardiomyopathy
globally dilated hypokinetic heart, low ej fraction | [look for MR/TR, LV mural thrombus]
181
management of dilated cardiomyopathy
bed rest, BB, diuretics, ACE-i, anticoag, bivent pacing, ICD, LVAD, transplant
182
define the pathology of HCM
LV outflow tract obstruction from asymmetric septal hypertrophy
183
leading cause of sudden cardiac death in the young
HCM
184
inheritance pattern of HCM
auto dom, or 50% sporadic
185
how does HCM present
``` sudden death angina dyspnoea palpitations syncope CCF ```
186
signs in HCM
``` jerky pulse a wave in JVP double apex beat systolic thrill at lower left sternal edge harsh ejection systolic murmur ```
187
ECG findings in HCM
LVH progressive T-wave inv deep q waves AF, WPW, ventricular ectopics, VT
188
echo findings in HCM
assymetrical septal hypertrophy small LV cavity with hypercontractile post wall mid-systolic closure of aortic valve systolic anterior movement of mitral valve
189
Mx of HCM
``` BB, verapamil for Sx amiod for arrhythmias anticoag for AF/emboli septal myomectomy in severe ICD ```
190
causes of restrictive cardiomyopathy [some is idiopathic]
``` amyloidosis haemochrom sarcoidosis scleroderma endomyocardial fibrosis ```
191
what signs and symptoms may a cardiac myxoma present with?
may mimic IE [fever, WL clubbing, ^ESR, emboli] or mitral stenosis [left atrial obstruction, AF] tumour 'plop' may be heard
192
describe pulsus paradoxus and give 3 causes
drop in pulse pressure on inspiration cardiac tamponade, chronic sleep apnea, croup, and obstructive lung disease
193
new diagnosis of angina. what drugs will you prescribe
GTN spray and BB or CCB [alternatives: isosorbide mononitrate ivabradine] aspirin consider ACEi statin (anti-HTN if required)
194
advice to patient about GTN
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
mechanism of action for BB and CCB in angina
negatively chronotropic and inotropic
196
undisplaced tapping apex beat indicates
A tapping apex beat reflects the perception of the opening snap in mitral stenosis.

3B GH (16 decks)

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