Cardio Flashcards
(181 cards)
1
Q
eqn for CO
A
CO = HR x SV
2
Q
eqn for MAP
A
MAP = CO x TPR
3
Q
normal MAP
A
70-150mmHg
4
Q
what is MAP
A
the average arterial BP in one cardiac cycle
5
Q
cause of 1st HS
A
closure of AV valves
mitral and tricuspid
6
Q
what does 1st HS signify
A
start of systole
7
Q
cause of 2nd HS
A
closure of aortic and pulmonary valves
8
Q
what does 2nd HS signify
A
start of diastole
9
Q
3rd HS
A
early diastolic sound
10
Q
4th HS
A
late diastolic sound
11
Q
normal calibration of ECG
A
25 mm/sec
12
Q
PR interval
A
AV nodal delay
13
Q
normal PR interval length
A
0.12-0.20 secs
3-5 small squares
14
Q
Lead I
A
LA - RA
15
Q
Lead II
A
RA - LL
16
Q
Lead III
A
LA - LL
17
Q
1 large sq on ECG - length of time?
A
0.2secs
5 large sq = 1 sec
18
Q
QRS complex
A
ventricular depolarisation
19
Q
normal length of QRS complex
A
< 0.12 sec
20
Q
QT interval
A
start of the QRS to the end of the T wave
ventricular depolarization + ventricular repolarization
21
Q
assessing axis deviation
A
left hand = lead 1
right hand = aVF
both hands up = normal
left up = LAD
right up = RAD
22
Q
sinus tachy HR
A
> 100 bpm
23
Q
sinus brady HR
A
< 60 bpm
24
Q
Mx sinus brady
A
atropine 500 mcg
25
mode of action of atropine
non selective muscarinic antagonist -
| reduces parasympathetic drive to the heart by blocking the vagus nerve
26
bradys at risk of asystole
recent asystole
Mobitz type II
complete heart block with broad QRS
ventricular pauses >3s
27
pathology of AF
fibrillating atria -
impulses don't travel co-ordinated from the SA node to the AV node, leading to multiple wavelets of re-entry in the atria.
28
classifications of AF
lone
paroxysmal - self terminating. last <7d
persistent - not self-terminating. last >7d
permanent - continuous AF that cannot be cardioverted
29
sinus arrhythmia
physiological - beat to beat variation in the P-P interval
30
ECG in AF
absent P waves
| irregularly irregular rhythm
31
Mx of AF if presenting acutely
DC cardioversion
32
which is 1st line in AF Mx: rate or rhythm control
rate, EXCEPT if:
- co existent HF
- first onset AF
- obvious reversible cause
33
rate control Mx of AF
```
b-blocker
rate limiting CCB (e.g. diltiazem)
digoxin (if sedentary lifestyle)
- any as monotherapy
- then offer dual therapy
```
34
criteria for attempting rhythm control on AF pts
- must meet the conditions for rhythm control as 1st line
- had symptoms for <48h
- been anticoagulated for 4w beforehand
35
electrical rhythm control Mx of AF
Trans-oesophageal echo or anti-coagulation for 3/4w
then DC cardioversion
36
pharmacological rhythm control Mx of AF if no HD
flecanide
37
pharmacological rhythm control Mx of AF if Hx of HD
amiodarone
38
method for assessing anticoagulation in AF
CHADS2 VAS score
0 = no Tx
1 = consider (males ), no Tx (female)
2 or more = offer Tx
39
anticoagulation in AF
warfarin or NOAC
40
CHADS2 VAS score
```
C = congestive HF
H = HTN
A = age >75 = 2
D = diabetes
S = previous stroke or TIA
```
```
V = vascular disease
A = age 65-74 = 1
S = sex female
```
41
ECG in atrial flutter
saw tooth baseline
| flutter waves
42
Mx atrial flutter
1. radiofrequency ablation of tricuspid valve (curative)
2. rate control
3. rhythm control (pharmacological or electrical)
+ anticoagulation
43
what is AV re-entry tachycardia (AVRT)
a SVT
there is an accessory pathway allowing conduction re-entry between the atria and the ventricles.
i.e. AV conduction + accessory pathway
44
direction of the accessory pathway in AVRT
either direction - anterograde or retrograde or both
45
example of AVRT
wolff Parkinson white syndrome (WPW)
46
pre-excitation definition
when the ventricles are excited quicker via the accessory pathway as there is no AV node in this pathway to slow down conduction
47
WPW on ECG
regular narrow complex tachy
slurred upstroke (delta wave)
48
Mx AVRT
(regular narrow complex tachy Mx)
1. vagal manoeuvres
2. adenosine 6mg IV
- if no effect give 12mg
- if no effect give further 12mg
49
Mx SVT- in asthmatics
DONT GIVE ADENOSINE
| - verapamil
50
what is AV nodal re-entry tachycardia (AVNRT)
a SVT
there is an entire re-entry circuit in the AV node
51
causes of AVNRT
caffeine
spontaneous
alcohol
beta agonists
52
AVNRT on ECG
regular narrow complex tachy
53
MX AVNRT
(regular narrow complex tachy Mx)
1. vagal manoeuvres
2. adenosine 6mg IV
- if no effect give 12mg
- if no effect give further 12mg
54
mode of action of adenosine
blocks the AV node
55
causes of a broad complex tachy of Supraventricular origin
regular:
- SVT with BBB
irregular:
- AF with BBB
- pre-excited AF (i.e. AF with WPW)
56
Mx of SVT with BBB
same as for regular narrow complex Mx
1. vagal manoeuvres
2. adenosine 6mg IV
- if no effect give 12mg
- if no effect give further 12mg
57
Mx AF with BBB
Tx as for irregular narrow complex Mx
1. rate control with b blocker or diltiazem
58
Mx of pre-excited AF
consider amiodarone
59
what medicine should not be given in pre-excited AF
adenosine!!
this blocks the AV node and increases conduction down the aberrant pathway, and if they're in AF this will make them more likely to go into VT or VF.
60
supraventricular ectopics
- what are they
- ECG appearance
ectopic beat from the atria
ECG: premature P wave in the ST seg of sinus beat previously
61
what is a junctional rhythm
origin of the electrical impulse at the AV node, so electrical impulses travel up to atria and down to ventricles simultaneously.
62
cause of a junctional rhythm
digoxin toxicity
63
junctional rhythm ECG
inverted P wave after the QRS complex, in the ST segment
64
bigeminy ventricular premature complex
1 sinus beat - 1 ventricular premature complex
65
trigeminy ventricular premature complex
2 sinus beats - 1 ventricular premature complex
66
how to distinguish between VT and SVT with aberrancy
give adenosine - blocks AV node
no response = increase likelihood of VT
67
monomorphic VT Mx
IV amiodarone
68
most common cause of VT
MI
69
most common cause of polymorphic VT
prolongation of the QT interval (many causes)
70
polymorphic VT = ?
torsades de pointes
71
Mx polymorphic VT
IV magnesium sulphate 2g over 5min
72
ECG VF
no clear discernable waveforms
73
Mx VF
ALS Mx
150J DC shock
amiodarone 300mg IV after 3 shocks
74
1st degree heart block
prolongation of PR
| stable
75
Mobitz type 1 heart block
type of 2nd degree HB
progressive PR lengthening
then eventual missed ventricular beat
76
Mobitz Type II heart block
type of 2nd degree HB
constant PR interval, with eventual missed beat
77
types of 2nd degree heart block
Mobitz type I
| Mobitz type II
78
3rd degree heart block
no relationship between P wave and QRS complexes
79
Mx 3rd degree heart block
bradycardia algorithm
IV atropine 500mcg + isoprenaline
Transvenous pacing insertion
80
LBBB
WilliaM
```
V1 = W
V6 = M
```
81
RBBB
MorroW
```
V1 = M
V6 = W
```
82
3 features of typical anginal pain
1. substernal chest discomfort
2. pain brought on by exertion
3. pain is relieved by rest or GTN
83
criteria for a pt to have 'atypical' angina pain
2 of the features of typical angina
84
Mx stable angina
(all get: lifestyle changes + aspirin + statin + GTN)
1. B-blocker or CCB
- rate limiting CCB (verapamil or diltiazem)
2. Dual therapy
- (CCB must be switched to nifedipine - cant co-prescribe b blocker and verapamil!)
3. if not tolerating addition of dual therapy, give either:
- long acting nitrate
- ivabradine
- nicorandil
- ranolazine
4. PCI or CABG - if max therapy unsuccessful
85
cause of angina
atherosclerotic plaque forms physical blockage in the lumen of the coronary artery.
86
cause of MI
rupture of atherosclerotic plaque, causing complete blockage of the coronary artery.
87
unstable angina presentation
- new ST depression or T wave inversion in the presence of ischaemic sympt
- prolonged angina at rest
- NO increase in cardiac biomarkers @ 12h
88
NSTEMI presentation
- new ST depression or T wave inversion in the presence of ischemic sympt
- INCREASE in cardiac biomarkers @12h
89
STEMI presentation n
- new ST elevation or new LBBB in the presence of ischemic symptoms
- INCREASE in cardiac biomarkers @12h
90
Initial Mx of ACS
'MONA + T'
```
M = morphine 10mg in 10ml slow IV
O = oxygen if sats <94-98%
N = sublingual GTN
A = aspirin 300mg PO (then 75mg OD)
T = ticagrelor 180mg PO (then 90m OD )
```
91
timeframe for PCI in STEMI
<2h
| if >2h, thrombolyse
92
timescale for PCI in NSTEMI or UA
if haemodynamically unstable - immediately
if intermediate GRACE score - within 3 d
if low risk GRACE score - as out pt
93
long term Mx ACS
CVS risk reduction:
- aspirin (lifelong)
- ticagrelor (12m)
- BP control
B-blocker
ACEi
GTN
94
Mx heart failure
1. ACEi + Beta-Blocker
2. + Spironolactone
3. + Ivabradine
4. + Digoxin or Hydralazine/Isosorbide mononitrate
(Loop Diuretic - furosemide for symptom relief)
95
Ix for HF
1. Basic bloods, incl BNP level or NT-proBNP level, urinalysis, ECG, CXR
2. Echo
96
ECG findings in HF
non-specific:
- pathological Q waves
- left bundle branch block
- left ventricular hypertrophy (LVH)
- atrial fibrillation
- non-specific ST and/or T-wave changes
97
Mx acute HF
'PODMAN'
```
P = position
O = oxygen (high flow)
D = diuretic (IV furosemide 40mg stat)
M = morphine
A = anti-emetic
N = nitrates
```
98
pathology of left HF
low CO from left heart.
| blood backs up into L atrium - pulmonary veins - lungs.
99
presentation left HF
```
pulmonary oedema
orthopneoa
paroxysmal nocturnal dyspnea
cough (pink frothy sputum)
3rd HS
```
100
orthopnoea
SOB when lying flat
101
CXR appearance in HF
'ABCDE'
```
A = alveolar oedema 'bats wings'
B = kerley B lines
C = cardiomegaly
D = dilated prominent upper lobe vessels
E = pleural effusion
```
102
pathology of right HF
low CO from right heart.
| blood flows back up into R atrium - SVC - peripheral.
103
presentation right HF
```
peripheral oedema
elevated JVP
hepatomegaly
ascites
normal CXR
```
104
pt has clinic BP reading >140/90 mmHg - whats the next step
ABP< (24h monitoring) or HBPM
105
pt has ABPM of <135/85mmHg - what happens next
monitor - not HTN.
106
pt has ABPM of >135/85mmHg - what happens next
they have stage 1 HTN
only get Tx if <80y and any of:
- target organ damage
- CVS disease
- renal failure
- diabetes
- 10y CVS risk >20%
107
pt has ABPM of >150/95mmHg - what happens next
they have stage 2 HTN
- start drug Tx for HTN
108
Drug Mx HTN
1. < 55 - ACEi
> 55 or Afro-Caribbean - CCB
2. A + C
3. A + C + D
4. + spironolactone (if K <4.5)
+ thiazide like diuretic (if K >4.5)
5. + alpha blocker or beta-blocker
109
primary prevention statin dose
atorvastatin 20mg
110
secondary prevention statin dose
atorvastatin 80mg
111
what are statins also called
HMG-CoA reductase inhibitors
112
why should simvastatin be taken at night
have short half life - most cholesterol is synthesized at night when dietary intake is low
113
ECG lead changes - inferior MI
II, III, aVF
114
coronary artery affected - inferior MI
right coronary artery
115
ECG lead changes - anterior MI
V1-V4
116
coronary artery affected - anterior MI
left anterior descending artery
117
ECG lead changes - posterior MI
reciprocal changes in V1-V2
118
ECG lead changes - lateral MI
I, aVL, V5-V6
119
coronary artery affected - lateral MI
left circumflex artery
120
PAILS mnemonic
```
P = posterior
A = anterior
I = inferior
L = lateral
S = septal
```
ST elevation in these leads commonly causes reciprocal ST depressions in the corresponding leads in the next letter
121
rheumatic fever
autoimmune disease that can occur following Group A strep infection
122
presentation rheumatic fever
```
fever
joint pains
chest pain
SOB
swollen joints
```
123
common heart murmur in rheumatic fever
mitral regurg
124
Mx rheumatic fever
IM benzathine benzylpenicillin
125
cause of acute native valve endocarditis
s. aureus
126
causes of subacute native valve endocarditis
strep viridans
| enterococcus
127
valve usually affected by IVDU endocarditis
tricuspid
128
cause of prosthetic valve endocarditis
coagulase negative staph
129
acute endocarditis
- how quickly does it present
- presentation
days - weeks
spiking fevers, tachy, fatigue
130
subacute endocarditis
- how quickly does it present
- presentation
weeks - months
constitutional symptoms
131
janeway lesions
painless macular plaques on palms and soles
| - endocarditis sign
132
osler nodes
small painful nodules on fingers and toes
| - endocarditis sign
133
roth spots
oval pale retinal lesions
| - endocarditis sign
134
Mx native valve subacute endocarditis
amox + gent
135
Mx native valve acute endocarditis
fluclox
136
Mx prosthetic valve endocarditis or MRSA
vanc + gent
137
systolic murmurs
radiate
138
diastolic murmurs
need to be accentuated
139
MRS ASS
mitral regurg + aortic stenosis
- both systolic
140
mitral valve location
between lt atria and lt ventricle
141
tricuspid valve location
between rt atria and rt ventricle
142
mitral stenosis
- mitral valve is hardened
- diastolic murmur
- low rumbling mid diastolic murmur with opening snap
- loud S1
- malar flush
- tapping apex
143
where is mitral stenosis best heard
- at the apex in the left lateral position during expiration
144
mitral regurgitation
- mitral valve is leaky
- systolic murmur
- pansystolic murmur
- radiates to the axilla
145
aortic stenosis
- aortic valve is hardened, and struggles to open
- systolic murmur
- ejection systolic murmur
- radiates to the carotids
146
pulse in aortic stenosis
slow rising
147
pulse in aortic regurg
collapsing
148
aortic regurgitation
- aortic valve is leaky
| - diastolic murmur
149
where is aortic regurg heard best
left sternal edge sitting forwards
150
corrigans sign
visible carotid pulsation
- aortic regurg
- sign of backflow
151
quinkes sign
red coloured pulsation in nails
- aortic regurg
- sign of backflow
152
de mussets sign
head bobbing
- aortic regurg
- sign of backflow
153
causes of acute myocarditis
```
idiopathic
viral (flu, HIV, hepatitis)
bacterial
drugs
toxins
```
154
presentation myocarditis
acute Hx
| young person, chest pain, SOB, tachycardia
155
typical HS in myocarditis
soft S1, S4 gallop
156
Mx myocarditis
supportive
157
causes of dilated cardiomyopathy
alcohol
HTN
viral infections
158
presentation dilated cardiomyopathy
mitral regurg
| HF sympt
159
Mx dilated cardiomyopathy
same as for HF
160
inheritance of hypertrophic cardiomyopathy
autosomal dominant
161
typical pulse in hypertrophic cardiomyopathy
double apical 'jerky' pulse
| double carotid pulsation
162
ECG in hypertrophic cardiomyopathy
deep Q waves
LVH
non specific ST seg and T wave changes
+/- AF
163
Ix used for family screening in hypertrophic cardiomyopathy
echo
164
dressler's syndrome
pericarditis post-MI
165
pericarditis presentation
acute central chest pain
worse on lying down
relieved by sitting forwards
166
ECG pericarditis
saddle shaped ST elevation n
| PR depression
167
Mx pericarditis
NSAIDS + PPI
168
what is pericardial effusion
accumulation of fluid within the pericardial sac, has potential to progress to tamponade
169
most common cause of constrictive pericarditis
TB
170
constrictive pericarditis
heart is encased in a rigid thickened and fibrotic pericardium.
171
beck's triad
muffled HS
raised JVP
falling BP
172
what is becks triad seen in
cardiac tamponade
173
pulsus paradoxus
reduced BP on inspiration (cardiac tamponade)
174
ECG in hypokalaemia
```
increased amplitude of PR
PR prolongation
T wave flattening + inversion n
ST depression
U waves
```
175
ECG in hyperkalaemia
tall tented T waves
flattening of P wave
QRS prolongation
arrhythmia
176
postural hypotension definition
fall in systolic BP of <20mmHg on standing
177
driving own car after PCI
don't need to tell DVLA
| start driving aft 4 w
178
driving bus or lorry after PCI
need to tell DVLA
| not drive for 6 w, then DVLA reassesses
179
J wave on ECG
hypothermia (small hump at end of QRS)
180
half life of adenosine
10secs
181
adverse effects of adenosine
chest pain
bronchospasm
transient flushing
can enhance conduction down accessory pathways, resulting in increased ventricular rate (e.g. WPW syndrome)
