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Cardio Flashcards

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1
Q

How to calculate rate in ECG

A

300/number of squares (R-R)

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2
Q

how long should p-wave be

A

120-200ms

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3
Q

what does prolonged PR interval indicate

A

AV block

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4
Q

what does shortened PR interval indicate?
eg?
what other feature do you seen on ecg?

A

accessory pathway

eg WPW –> delta wave (slurred QRS upstroke)

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5
Q

QRS normal length?

A

80-120ms

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6
Q

where is the j-point?

A

where S wave meets ST segment

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7
Q

when is ST elevation significant?

A

> 1mm in >2 limb leads

> 2mm in >2 chest leads

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8
Q

what is t-wave?

A

ventricular repolarisation

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9
Q

when is a t-wave tall?

A

> 5mm in limb AND >10mm in chest

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10
Q

what does tall t-wave indicate

A

hyperacute STEMI

hyperkalaemia

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11
Q

which leads is inverted t-wave normal

A

V1

III

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12
Q

inverted t waves assos with?

A

ischaemia
PE
BBB

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13
Q

what is sinus brady?

A

<60bpm

every p-wave followed by QRS

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14
Q

physiological causes of sinus brady?

pathological causes?

A

Physiological: athletes, young

pathological: acute MI, drugs, hypothyroid, hypothermia, sick sinus, raised ICP

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15
Q

when do you treat bradycardia

A

<40bpm / symptomatic

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16
Q

mx of symptomatic brady

A

IV atropine

temp pacing wire

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17
Q

what is sick sinus syndrome?

causes?

A

result of SAN dysfunction - impaired ability to generate impulse

idiopathic fibrosis of node; ischaemia; digoxin

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18
Q

causes of AV block

A

MI
SLE
myocarditis
degeneration of His-Purkinje

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19
Q

define 1st degree heart block?

A

PR > 0.2s
PR interval constant
every P followed by QRS

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20
Q

define 2nd degree heart block?

A

intermittent failure of conduction from A to V
some P not followed by QRS

Mobitz I = failure at AVN - PR is progressively increased until QRS missed

Mobitz II = intermittent failure of P wave conduction. PR is constant + prolonged. Dropped QRS 2:1 / £:1

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21
Q

define 3rd degree heart block?

A

complete failure of conduction between atria and ventricles

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22
Q

cause of 3rd degree heart block?

A

myocardial fibrosis

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23
Q

causes of RBBB

A 
Rheumatic heart disease
RVH
IHD
myocarditis 
cardiomyopathy
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24
Q

ECG changes of RBBB

A

MarroW

QRS > 0.12s (broad)

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25
causes of LBBB
CAD HTN dilated cardiomyopathy anterior infarction
26
ECG changes of LBBB
WilliaM | QRS > 0.12s (broad)
27
ix in brady
ECG electrolytes TFT
28
mx of brady
treat cause stop negative chronotropes IV atropine 0.5mg
29
sinus tachy pres
angina like sx -> chest pain, faintness, sob
30
define sinus tachy?
HR > 100bpm | every P followed by QRS
31
causes of sinus tachy?
physiological: exertion, anxiety, pain Pathological: fever, anaemia, hypovolaemia Endocrine: thyrotoxicosis, phaeochromocytoma Pharma: adrenaline, alcohol, caffeine, salbutamol
32
ix in sinus tachy?
ECG, cardiac enzymes, FBC, TFT
33
mx of acute sinus tachy
vagal manoeuvres: carotid massage, valsalva, cold water
34
mx of chronic sinus tachy
BB / CCB (diltiazem, verapamil)
35
egs of SVTs?
AF / flutter sinus tachy AV re-entry tachy
36
Mx of WPW?
vagal manoeuvres +/- adenosine pharma: flecainide / sotalol surgery: radiofrequency ablation is curative
37
mx of narrow SVT? (if BP<90, chest pain, HF, HR>200)
DC cardioversion with general anaesthetic | +/- IV amiodarone
38
mx of AF?
Rate: 1. BB/CCB 2. Dual therapy (NOT VERAPAMIL + BB) Rhythm: if <48h -> DC cardioversion if >48h -> Warfarin for 3w before cardioversion Anticoag
39
Pharmacological cardioversion?
IV amiodarone
40
Mx of atrial flutter
Rhythm: cardioversion - DC (if >48h ensure adequate anticoag) - IV amiodarone
41
mx of broad complex tachy? if unstable?
ABCDE monitor ECG, BP, sats Cardioversion - DC shock / amiodarone
42
what do you need to consider long term for VT? why?
requires maintenance anti-arrhythmics (BB/CCB) or implantable defibrillator usually due to damage
43
What does TdP look like on ECG?
like a sound wave | varied axis + amplitude QRS
44
what can happen to torsades if untreated?
--> VF
45
mx torsades?
IV MgSO4
46
what does VF look like on ECG
chaotic (varying amplitudes) | no identifiable P, QRS or T
47
mx of acute VF? | long term?
defibrillation | BB and ICB
48
ECG finding in PE
sinus tachycardia +/- S1Q3T3
49
ECG of hypothermia
bradycardia J-wave (late delta wave, positive deflection at j point)
50
when do you use amiodarone?
tachyarrhythmias (AF, AFlut, SVT) when other drugs or DC shock dont work
51
SEs of amoidarone
hypotension during IV infusion Chronic -> pneumonitis, AV block, hepatitis, thyroid
52
when do you use adenosine?
first line diagnostic and therapeutic in SVT
53
SE of adnosine?
patient feels like they are going to die!
54
mech of adenosine
blocks SA + AV node - causes bradycardia and asystole --> feeling of doom
55
Indications for Digoxin
Reduce ventricular rate (AF, AFlut) - after CCB or BB | Severe heart failure - 3rd line
56
important to remember in digoxin
low therapeutic index
57
interactions with digoxin?
loop / thiazide like diuretics -> hypokalaemia amiodarone, CCB, spironolactone -> increase plasma digoxin
58
monitoring for digoxin toxicity?
monitor sx / ventricular rate + ECG + renal dysfunction + hypokalaemia
59
target blood conc of digoxin
1 - 1.5 nmol/L | >2 suggests toxicity
60
CCBs indication
rate control in SVT
61
BBs indication
IHD to reduce angina CHF to improve prognosis AF to reduce rate and maintain sinus SVT to restore sinus rhythm
62
SEs of BBs
fatigue, cold extremities, headache, impotence
63
when are BBs CI? | what can you use?
Asthma - B2 block causes bronchospasm Can use B1 selective (atenolol, bisoprolol, metoprolol)
64
MR murmur
pansystolic
65
MS murmur
loud S1 + mid-diastolic murmur
66
how to differentiate between MR and TR
both pan systolic | TR does not radiate to axilla
67
PS murmur interesting fact
crescendo-decrescendo ejection systolic murmur disappears on inspiration
68
PR murmur
early diastolic
69
when are aortic murmurs best heard
holding breath
70
AS murmur
crescendo-decrescendo ejection systolic murmur
71
AR best heard?
early diastolic | best heard leaning forwards + holding breath (PR disappears on holding breath)
72
usual cause of AS
senile calcification
73
triad of sx in AS
chest pain HF syncope
74
o/e AS
slow rising pulse narrow pulse pressure LVH-> apex thrill
75
Confirm dx of AS?
Echo
76
Mx of AS?
avoid heavy exertion, modify RFs for CAD valve replacement if not fit for surgery -> balloon valvluoplasty / TAVI
77
comps of mechanical heart valves?
predispose to IE | small emboli
78
how to prevent IE with new heart valves?
Abx prophylaxis
79
target INR in valve replacement
anticoag | INR 2.5-3.5 for aortic
80
causes of AR
bicuspid rheumatic fever IE collagen [Marfans, E-D, Turners]
81
pres of AR?
SOBOE | non-specific sx of left heart failure [orthopnea, paroxysmal nocturnal dyspnoea]
82
o/e AR
early diastolic murmur, not transmitted to carotids collapsing water hammer pulse wide pulse pressure
83
CXR of AR?
signs of HF, volume overload
84
normal size of mitral valve?
4-6cm2
85
what sx does large left atrium cause?
hoarseness | dysphagia
86
o/e of MS
malar flush, raised JVP, RVH signs of RHF late diastolic murmur, loud S1 w opening snap
87
mx of MR?
surgery
88
cause of rheumatic fever
Group A beta haemolytic streptococci (pyogenes)
89
when does rheumatic fever occur? | what is affected?
2-4w post-strep pharyngitis / skin infection joints, skin, heart, nervous system
90
blood test providing evidence of strep infection?
antistreptolysin O titre or DNase B titre
91
What criteria to use for diagnosis of rheumatic fever?
``` Jones criteria: Required Criteria Evidence of antecedent Strep infection: ASO / Strep antibodies / Strep group A throat culture / Recent scarlet fever / anti-deoxyribonuclease B / anti-hyaluronidase Major Diagnostic Criteria Carditis Polyarthritis Chorea Erythema marginatum Subcutaneous Nodules Minor Diagnostic Criteria Fever Arthralgia Previous rheumatic fever or rheumatic heart disease Acute phase reactions: ESR / CRP / Leukocytosis Prolonged PR interval ```
92
ix rheumatic fever?
throat culture, ASO rise during 1st month ECG: PR, ST elevation CXR: ?HF FBC, ESR, CRP Doppler echo
93
mx of rheumatic fever? how to eradicate strep? treat HF? for chorea?
enforce bed rest until inflam markers normal Eradicate strep -> IV benzylpenicillin Treat HF: diuretics, ACEi, digoxin Suppress inflam: NSAIDs Chorea: self-limiting. maybe haloperidol
94
fever + new murmur = ?
endocarditis until proven otherwise
95
IE RFs
``` valve disease/replacement congenital structural defect previous IE HOCM IVDU ```
96
pres of IE
fever + chills + poor appetite + wt loss
97
signs of IE
``` FROM JANE Fever > 38 + tachy Roth's spots Osler's nodes Murmur Janeway lesions Anaemia/arthritis Nail haemorrhage Emboli ```
98
cause of IE? | which murmur is classic?
S. aureus tricuspid murmur
99
comps of IE
MI / pericarditis glomerulonephritis stroke
100
ix in IE?
``` FBC, ESR/CRP, RF TTE Blood cultures CXR ECG ```
101
how long to give Abx for IE? | which for staph / strep? / MRSA
4 weeks staph - fluclox strep - benpen MRSA - vanc
102
ix for cardiomyopathy
Bloods: FBC, ESR, U+Es, LFT, cardiac enzymes, TFT CXR ECG TTE MRI; distinguish constrictive / restrictive
103
features of HF on CXR?
``` ABCDE Alveolar oedema B-lines; Kerley Cardiomegaly Dilated upper lobe vessels Effusion; pleural ```
104
cause of sudden cardiac death in young people?
hypertrophic cardiomyopathy | arrhythmia / LV outflow tract obstruction
105
cause of myocarditis
coxsackie
106
ix for myocarditis
``` FBC Viral serology **endomyocardial biopsy * ECG CXR ```
107
Sx of HF
breathless, fatigue, ankle swelling
108
signs of HF
``` tachyc, tachyp pulmonary rales pleural effusion raised JVP peripheral oedema hepatomegaly ```
109
difference between LHF/RHF in pres
RHF: peripheral oedema, ascites, facial engorgement, pulsing in neck (TR) LHF: dyspnoea, fatigue, cold peripheries, muscles wasting, orthopnea, PND, noct cough - pink frothy sputum
110
if prev MI and new HF what ix? and when?
2WW for specialist + doppler echo
111
Ix for HF
BNP - if high -> 2WW for echo ECG bloods CXR
112
Acute mx of HF? when stable?
O2 + IV diuretics +/- NIV when stable: BB + ACEi + spiro +/- digoxin f/u in 2w
113
mx of chronic HF?
lifestyle annual vaccinations manage comorbs
114
how do statins work
HMG-CoA reductase inhibitors
115
when to prescribe statins
QRISK2 > 10% history of CVD hypercholesterolaemia >85yo
116
SEs of statins
myalgia - stiff, weakness, cramps
117
what to monitor with statins
LFTs
118
secondary causes of HTN
``` renal endocrine coarctation pre-eclampsia drugs ```
119
signs of end organ damage in HTN
``` encephalopathy - seizure, vomiting, nausea dissection - delayed/weak femoral pulses pulm oedema nephropathy - proteinuria eclampsia papilloedema retinopathy ```
120
Mx of HTN
``` 1. <55 - ACEi/ARB >55 - CCB 2. dual 3. + indapamide 4. resistant + spiro ```
121
SE of amlodipine
ankle swelling
122
target BP
<140/90
123
``` Which leads and arteries? anterior leads? lateral leads? inferior leads? septal leads? ```
anterior leads = V3/V4 - LAD lateral leads = 1, V5, V6 - Cx inferior leads = I, II, aVF - RCA septal leads = V1, V2 - LAD
124
what to do with all new angina?
refer to rapid access chest pain clinic for confirmation of Dx and severity assessment within 2w
125
DDx angina
``` MI - pain over 5 mins Pericarditis - worse on inspiration, lying flat, swallowing MSK - worse on mvmt GORD Pleuritic pain - sharp on inspiration ```
126
Ix in angina
``` ECG - ST flattening FBC FBG Cholesterol LFTs TFTs ```
127
non-pharma mx of stable angina
``` modify RFs (?aspirin/statin) patient education ```
128
pharma mx of stable angina
acute - GTN 1st BB / CCB 2nd combination 3rd + ivabradine
129
what if angina not controlled by pharma
CABG / PCI
130
Ix in ACS?
ECG cardiac enzymes - troponin, CK bloods CXR
131
mx for ACS
ABCDE GTN + IV opioid with antiemetic Antiplatelet - 300mg aspirin, ticagrelor O2 if <94%
132
mx of STEMI
``` MONA Morphine Oxygen Nitrates Aspirin ``` reperfusion - PCI (if within 120mins) / fibrinolysis
133
drug used for fibrinolysis
alteplase | streptokinase
134
Pharma post MI?
``` ABSeeD ACEi BB Statin Dual antiplatelet (aspiri+clopidogrel) ```
135
driving post ACS?
4weeks off
136
dresslers syndrome?
post-ACS late pericarditis -> inflam reaction to necrotic tissue occurs at 2-8weeks
137
comps post MI?
``` DEPARTS + fails Death, dresslers Electrical: tachyc/bradyc Pericarditis, papillary muscle rupture Aneurysm Re-MI, rupture Thrombus Shock VSD Heart failure ```
138
unresponsive cardiac arrest
``` 999 A+B C - CPR 30:2 D - defibrillator: AED 2 mins of CPR between defib, after 3rd shock give adrenaline + amiodarone ```
139
causes of pericarditis
``` Viral: coxsackie, EBV Rheum: SLE, sarcoid Post-MI Drugs: hydralazine Other: uraemia ```
140
what causes granulomatous pericarditis
TB, sarcoid, fungal, RA
141
pericarditis aggravating pain? relieving pain?
aggravated by inspiration, cough, swallow, lying flat relieved by sitting up/fwd
142
o/e acute pericarditis
pericardial friction rub | tachypnoea, tachycardia, fever
143
Beck's triad in tamponade?
hypotension elevated JVP muffled heart sounds
144
Ix in pericarditis?
ECG CXR bloods Echo
145
mx of stable pericarditis
rest + treat cause + NSAIDs +/- PPI
146
when to admit pericarditis
if fever, tamponade, large effusion, fail to respond to NSAIDs
147
pericarditis with falling BP, what should you suspect?
cardiac tamponade
148
Mx of cardiac tamponade?
immediate pericardiocentesis | O2 + inotrope + increase venous return
149
mx of recurrent pericarditis
colchicine
150
pres of peripheral arterial disease
intermittent claudication [cramping in calf/thigh/buttock on walking -> relieved by rest] ischaemic rest pain
151
o/e lower limb ischaemia
absent/reduced femoral pulses trophic changes - pale, cold, hairless, skin change ulcers cap fill prolonged
152
ddx of lower limb ischaemia
sciatica spinal stenosis DVT entrapment
153
ix in lower limb ischaemia
``` BP FBC ESR renal function **ABPI** ```
154
ABPI for mild/mod/severe PAD
normal = 1 mild <0.9 mod <0.8 severe <0.5 --> ischaemic rest pain
155
Ps of acute limb ischaemia
pale, pulseless, pain, perishingly cold, paraesthesia, paralysis
156
mx of acute lower limb ischaemia
requires re-vasc in 4-6h
157
comps of PAD
acute limb ischaemia infection poor healing gangrene
158
general mx of PAD
``` modify RFs statin ACEi antiplatelet pain management ```
159
aortic dissection?
intimal tear -> disruption of media -> layers separate and form a false lumen
160
simple ix in aortic dissection
BP may be different in both arms
161
what must you differentiate from aortic dissection? why?
differentiate from MI thrombolysis is fatal in dissection
162
imaging in aortic dissection
CXR - widened mediastinum TTE MRI
163
comps of aortic dissection
rupture + multi-organ failure + cardiac tamponade + hypotension
164
mx of aortic dissection
O2, morphine ICU IV labetalol + nitroprusside Surgical repair
165
ix AAA? what sign could indicate imminent rupture?
FBC, clotting, U+Es, LFT, crossmatch, ECG, CXR USS for initial assessment CT for more detail -> crescent sign indicates blood within thrombus
166
mx of AAA
regular USS monitoring lifestyle Surgical repair if >5.5cm or rapid expansion
167
Triad in AAA rupture
hypotension pulsatile abdo mass flank/back pain
168
mx AAA rupture
``` large bore IV access group + crossmatch immediate theatre graft repair (death is highly likely) ```
169
organs at risk in sepsis?
kidney (acute tubular necrosis) lungs (ARDS) heart (MI) brain (confusion, coma)
170
ix in hypovolaemic shock?
Hb, U+Es, LFT, group + crossmach, ABG, UO
171
Mx of hypovolaemic shock?
raise legs ABCDE -> 2large bore cannulae, airway, high flow O2, fluid resus. if haemorrhage -> give blood ASAP [O-ve]
172
cause of cardiogenc shock
acute MI
173
monitor in cardiogenic shock?
cardiac monitoring BP - arterial line venous pressuer UO
174
mx cardiogenic shock?
``` ABCDE fluids O2 pain relief cardiac inotropes [dopamine or dobutamine] Revascularisation ```
175
mx of anaphylactic shock?
ABCDE life flat high flow O2 [+/- intubate] IM adrenaline IV fluids IV chlorphenamine + hydrocortisone Bronchodilators; salbutamol
176
signs of septic shock?
HAT Hypotension < 100mmHg Altered mental state GCS<15 Tachypnoea >22
177
mx of sepsis
``` Blood cultures + septic screen Urine output Fluid resus Abx - taz Lactate - ABG Oxygen ```
178
other ix in sepsis
FBC, U+Es, urinalysis, LFTs, glucose, clotting, CXR, AUSS
179
comps of sepsis?
DIC, renal railure, cardioresp failure
180
SEs of amiodarone
prolong QT | pseudohypothyroidism
181
cause of ST elevation in all leads?
pericarditis | SAH
182
mx of PE
Short term - LMWH Long term - warfarin 3-6m

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