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cardio Flashcards

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1
Q

What ECG findings suggest brugada syndrome?

A

Elevated J point

Coved/saddleback ST elevation

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2
Q

Whats are patients with brugada syndrome at risk of?

A

Going into VF/ sudden cardiac death

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3
Q

What is the only available tx for brugada syndrome?

A

ICD

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4
Q

Which artery is affected in an inferior stemi?

A

Posterior descending artery

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5
Q

What should you assume a broad complex tachycardia to always be in exams?

A

VT

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6
Q

What drug do you give if VT with no adverse signs?

A

Amiodarone

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7
Q

Define the classes of antiarrythmic drugs and give examples?

A

I - sodium channel blockers (fleicanide)
II - Beta blockers (bisoprolol)
III - prolong action potential (amiodarone)
IV - CCBs (verapamil, diltiazem)

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8
Q

What are the three presenting features of typical angina?

A

1) Constricting heavy discomfort in chest, jaw, neck, arms
2) Sx brought on by exertion
3) Relieved within 5 mins by rest/GTN

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9
Q

Which two patient groups are at risk of silent MI?

A

Elderly

Diabetics

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10
Q

Mx for angina

A

1) low dose aspirin
2) statin
3) GTN spray
4) beta blocker and/or amlodipine (diltiazem on own)
5) long acting nitrate

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11
Q

What test is now first line for diagnosing angina? (in patients lower than 90% probability)

A

CT coronary angiography

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12
Q

Give two examples of non-invasive functional testing for diagnosing angina?

A

Stress myocardial perfusion scintigraphy
Stress echo
Cardiac MRI stress test
Exercise ECG testing

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13
Q

Which nerve innervates the pericardium?

A

Phrenic nerve

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14
Q

What are the roles of the pericardium?

A

Fixes heart
Prevents overfilling
Lubrication
Protection from infection

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15
Q

What does left anterior hemiblock look like on an ECG?

A

L axis deviation

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16
Q

What does bifascicular block look like on ECG?

A

RBBB and left axis deviation

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17
Q

What does trifascicular block look like on ECG?

A

Bifascicular block and 1st degree heart block

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18
Q

What is a normal cardiac axis?

A

-30-90 degrees

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19
Q

How do you calculate rate from an ECG?

A

300 divided by no. of large squares

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20
Q

Whats a normal PR interval?

A

120-200ms (3-5 small squares)

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21
Q

What signs on an ECG suggest WPW?

A

Short PR interval
Delta wave
Widened QRS

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22
Q

What could tall T waves be a sign of?

A

Hyperacute STEMI

hyperkalaemia

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23
Q

What type of drug is atropine?

A

Muscarinic receptor antagonist

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24
Q

Define 1st degree heart block

A

PR constant but greater than 0.2s

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25
Define Mobitz type one heart block (2nd degree)
PR prolonged until QRS dropped
26
Define Mobitz type 2 heart block (2nd degree)
Dropped QRS random | PR is constant and prolonged
27
Which Mobitz type carries greatest risk of progression to complete heart block?
Mobitz 2 (need pacing if bradycardic)
28
How is third degree heart block managed?
Admission to hospital and pacing
29
What is the most likely cause of sudden onset palps and chest pain in a young woman. ECG shows SVT. Previous ECG had no abnormalities.
AVNRT
30
How is AVNRT managed long term?
Beta blockers | Ablation of accessory pathway
31
What is the accessory pathway called in WPW?
Bundle of kent
32
What must be fulfilled before you can consider an AF patient for cardioversion?
Onset < 48h or already anticoagulated for 3 weeks
33
How is SVT managed?
Vagal manoeuvres | Adenosine
34
What are the three types of AF?
Paroxysmal (stops within 7 days) Persistent (>7 days) Permanent (over 1 yr)
35
What are the classic causes of AF?
Alcohol intoxication Thyrotoxicosis Rheumatic heart disease HTN Heart failure
36
Which drugs can be used for rate control in AF?
Beta blockers or CCB
37
Long term what scoring system is used to determine if a pt on rate control for AF needs anticoagulation
CHADS-VASC
38
What is used to assess the risk of bleeding when starting a patient on anticoagulation?
HASBLED
39
What factors contribute to poor warfarin control?
``` Impaired cognitive function Poor adherence to tx Illness Interacting medications Diet Alcohol consumption ```
40
What are the risk factors for atrial flutter?
``` CAD HTN Hyperthyroid Obesity Alcohol ```
41
How long must you anticoagulated before you can cardiovert an AF or atrial flutter patient?
3 weeks
42
What can prolong QT?
Drugs Congenital Electrolyte abnormality (hypohalaemia, hypomagnaesaemia)
43
What ECG abnormality is seen in hypercalcaemia?
Decreased QT interval
44
How do you manage torsades de pointes?
Congenital - beta blockers | Acquired - stop precipitant, correct hypokalaemia and give magnesium sulphate
45
What are the side effects of chronic use of amiodarone?
``` Sun sensitivity Pneumonitis AV Block grey discolouration Hypothyroidism optic neuropathy ```
46
What sign on ECG indicates digoxin toxicity?
ST segment depression (reverse tick sign)
47
Can you use verapamil with a beta blocker?
No - risk of severe bradycardia
48
When are beta blockers CI?
Asthma
49
How can you grade murmurs?
Levines scale
50
What valve disorder does a loud S1 indicate?
Mitral stenosis
51
What is an Austin flint murmur?
Rumbling diastolic murmur heard best at apex | Due to severe AR
52
What signs on exam suggest aortic stenosis?
Slow rising pulse Narrow pulse pressure Apex thrill Systolic murmur
53
What criteria are used to dx rheumatic fever?
Jones criteria
54
What forms the jones criteria for diagnosing rheumatic fever?
``` Carditis Arthritis SC nodules Erythema marginatum Sydenhams chorea ``` + evidence of recent strep infection e.g. positive ASOT or throat culture
55
How do you ix for carditis in rheumatic fever?
Doppler USS
56
Mx for rheumatic fever
Bed rest IV benzylpenicillin Aspirin
57
Which organisms cause IE most commonly?
S.viridans | S.aureus (IVDU)
58
What can be used to classify disability/functional limitation due to heart failure?
New York heart association classification
59
Name a diagnostic criteria used for heart failure
Framingham criteria
60
Ix for heart failure
ECG BNP Echocardiography CXR
61
CXR signs of HF
``` Alveolar oedema kerley B lines Cardiomegaly Dilated upper lobe vessels pleural Effusion ```
62
What should you monitor when putting a heart failure pt on diuretic therapy in the hospital?
Renal function Weight Urine output
63
What is the acute mx of heart failure?
O2 and IV diuretics (+NIV)
64
How is chronic heart failure managed?
``` Lifestyle modification Flu vaccine and pneumococcal vaccine Inform DVLA LOOP DIURETICS (e.g. furosemide) ACE-I BETA BLOCKERS (+digoxin) ```
65
What is the main side effect of loop diuretics such as furosemide?
Hypokalaemia (therefore monitor U & Es) | Renal impairment
66
Which drug might you switch to if furosemide is causing hypokalaemia?
Spironolactone
67
What are the causes of secondary hyperlipidaemia?
nephrotic syndrome Cushing's syndrome Hypothyroidism cholestasis
68
Who would you start treatment with a statin?
Known CVD CKD type 1 DM Qrisk > 10%
69
When are statins CI?
Pregnancy | Cholestasis
70
When should you discontinue statins?
If liver enzymes greater than 3 times the upper limit of normal range
71
What blood tests should you do before starting a patient on a statin?
Lipid profile LFTs CK
72
What drug can be given if a patient cannot tolerate a statin?
ezetimibe
73
What Ix would you do in hypertension for evidence of end organ damage?
Urine dipstick U & Es 12 lead ECG Fundoscopy
74
What Ix would you do in htn for a secondary cause?
``` U & Es (low K+ in Conns) Ca (increased in hyperparathyroidism) renal US (renal artery stenosis) 24h urine for metanephrines (phaeochromocytoma) urinary free cortisol (cushings) MRI aorta (coaractation) ```
75
What drugs is a patient discharged on post ACS?
Aspirin lifelong Clopidogrel 12 months Beta blocker (12months/ lifelong if LV dysfunction) ACE-I statin spironolactone if evidence of heart failure
76
How long are you not allowed to drive post ACS?
1 month (technically 1 week if successful PCI)
77
What triad is associated with cardiac tamponade?
Becks triad: Falling BP Rising JVP Muffled heart sounds
78
What ECG changes are seen in cardiac tamponade?
Low voltage QRS +- electrical alternans (alternating QRS amplitude)
79
Diagnostic Ix for cardiac tamponade
echo
80
Tx for cardiac tamponade
pericardiocentesis
81
What classification is used for PAD?
Fontaine classification
82
What is buergers disease?
Pattern of thrombophlebitis and ischaemia seen in young heavy smokers
83
Mx for PAD?
Clopidogrel Supervised exercise Naftidofuryl (if sx don't improve with exercise)
84
sx of aortic dissection
``` SUDDEN tearing chest pain neurological deficit Acute limb ischaemia paraplegia angina ```
85
Hyperkalaemia ECG changes
Tall, peaked T waves P wave flattens Wide QRS
86
Hypokalaemia ECG changes
Small T waves Prolonged PR Depressed ST Prominent U waves
87
What condition should you suspect in a hypertensive, hypokalaemic pt not taking diuretics?
Conn's syndrome
88
How does hypomagnesaemia px on an ECG?
Prolonged QTc
89
Generally what length of QT is concerning
>0.5s (about 12 squares)
90
Comps of MI
``` Cardiac arrest Shock LV failure Arrythmia Pericarditis Systemic embolism Cardiac tamponade MR VSD ```
91
What is the first test you undertake on a suspected angina pt?
Calculate their pre-test probability
92
How does aspirin act?
COX inhibitor | Decreases THROMBOXANE and prostaglandin synthesis
93
How does clopidogrel act?
P2Y12 inhibitor
94
What are side effects of ACE-I?
Cough Hypotension Acute renal failure Hyperkalaemia
95
What are the side effects of CCBs?
Flushing Headache Oedema Palps
96
How do thiazide diuretics act?
Inhibit sodium-chloride transporter in distal tubule
97
What side effects are associated with nitrates?
Headache | Syncope
98
Which viruses most commonly cause pericarditis?
coxsackievirus | echovirus
99
What are the features of tetralogy of Fallot?
1) VSD 2) Pulmonary stenosis 3) RV hypertrophy 4) Overriding aorta
100
What is the gold standard Ix for IE?
TOE
101
What is P mitrale and what is it a sign of?
Notched P waves | Classically a sign of left atrial enlargement due to mitral stenosis
102
What is P pulmonale a sign of?
Peaked P wave Due to PULMONARY HTN (e.g. from chronic lung disease (cor pulmonale) or congenital heart disease or primary pulmonary htn)

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