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Flashcards in Cardio and resp - from pass medicine Deck (101)
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1

Possible ECG features in WPW include: (4)

short PR interval
wide QRS complexes with a slurred upstroke - 'delta wave'
left axis deviation if right-sided accessory pathway*
right axis deviation if left-sided accessory pathway*

2

Associations of WPW

HOCM (hypertrophic obstructive cardiomyopathy)
mitral valve prolapse
Ebstein's anomaly
thyrotoxicosis
secundum ASD

3

Management of WPW

definitive treatment: radiofrequency ablation of the accessory pathway
medical therapy: sotalol**, amiodarone, flecainide

4

in the majority of cases, or in a question without qualification, Wolff-Parkinson-White syndrome is associated with ... axis deviation

left

5

A 51-year-old female presents to the Emergency Department following an episode of transient right sided weakness lasting 10-15 minutes. Examination reveals the patient to be in atrial fibrillation. If the patient remains in chronic atrial fibrillation what is the most suitable form of anticoagulation?

CHADS-VASc score = 3, so warfarin, target INR 2-3

6

If low risk (age <65 and no risk factors), what anticoagulation?

Aspirin 75mg-300mg/day

7

What does CHA2DS2-VASc stand for?

C Congestive heart failure 1
H Hypertension (or treated hypertension) 1
A2 Age >= 75 years 2
D Diabetes 1
S2 Prior Stroke or TIA 2
V Vascular disease (including ischaemic heart disease and peripheral arterial disease) 1
A Age 65-74 years 1
S Sex (female) 1

8

Restrictive lung diseases

Pulmonary fibrosis
Asbestosis
Sarcoidosis
Acute respiratory distress syndrome
Infant respiratory distress syndrome
Kyphoscoliosis
Neuromuscular disorders

9

Obstructive lung diseases

Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans

10

2 level PE Wells Score


Clinical feature Points
Clinical signs and symptoms of DVT (minimum of leg swelling and pain with palpation of the deep veins) 3
An alternative diagnosis is less likely than PE 3
Heart rate > 100 beats per minute 1.5
Immobilisation for more than 3 days or surgery in the previous 4 weeks 1.5
Previous DVT/PE 1.5
Haemoptysis 1
Malignancy (on treatment, treated in the last 6 months, or palliative) 1

11

common bendroflumethiazide SE?

hypokalaemia

12

Hypokalaemia causes on ECG

U waves
small or absent T waves (occasionally inversion)
prolong PR and QT interval
ST depression

'In Hypokalaemia, U have no Pot and no T, but a long PR and a long QT'

13

Two main types of VT:

monomorphic VT: most commonly caused by myocardial infarction
polymorphic VT: A subtype of polymorphic VT is torsades de pointes which is precipitated by prolongation of the QT interval. The causes of a long QT interval are listed below

14

Management of VT?

Management

If the patient has adverse signs (systolic BP < 90 mmHg, chest pain, heart failure or rate > 150 beats/min) then immediate cardioversion is indicated. In the absence of such signs antiarrhythmics may be used. If these fail, then electrical cardioversion may be needed with synchronised DC shocks

Drug therapy
amiodarone: ideally administered through a central line
lidocaine: use with caution in severe left ventricular impairment
procainamide

15

A 72-year-old man presents with lethargy and palpitations for the past four or five days. On examination his pulse is 123 bpm irregularly irregular, blood pressure is 128/78 mmHg and his chest is clear. An ECG confirms atrial fibrillation. What is the appropriate drug to control his heart rate?

B-blocker. A number of factors including age and symptoms would favour a rate control strategy. The NICE guidelines suggest either a beta-blocker or a rate limiting calcium channel blocker (i.e. Not amlodipine) in this situation. Some clinicians would prefer to use a more cardio-selective beta-blocker such as bisoprolol, although this is not stipulated in current guidelines

16

Agents used to maintain sinus rhythm in patients with a history of atrial fibrillation

sotalol
amiodarone
flecainide
others (less commonly used in UK): disopyramide, dofetilide, procainamide, propafenone, quinidine

17

Management of a PRIMARY Pneumothorax

if the rim of air is < 2cm and the patient is not short of breath then discharge should be considered
otherwise aspiration should be attempted
if this fails (defined as > 2 cm or still short of breath) then a chest drain should be inserted

18

Secondary pneumothorax

Recommendations include:

If the patient is > 50 years old and the rim of air is > 2cm and/or the patient is short of breath then a chest drain should be inserted.
otherwise aspiration should be attempted if the rim of air is between 1-2cm. If aspiration fails (i.e. pneumothorax is still greater then 1cm) a chest drain should be inserted. All patients should be admitted for at least 24 hours

19

Iatrogenic pneumothorax -
recommendations include:

less likelihood of recurrence than spontaneous pneumothorax
majority will resolve with observation, if treatment is required then aspiration should be used
ventilated patients need chest drains, as may some patients with COPD

20

Left ventricular aneurysm

a patient is noted to have persistent ST elevation 4 weeks after sustaining a myocardial infarction. Examination reveals bibasal crackles and the presence of a third and fourth heart sound

21

Ischaemia of the papillary muscle

a patient is noted to have a new early-to-mid systolic murmur 10 days after being admitted for a myocardial infarction

22

Causes of respiratory alkalosis

pulmonary embolism
anxiety leading to hyperventilation
pregnancy
salicylate poisoning (initial stages)
CNS disorders e.g. stroke, subarachnoid haemorrhage, encephalitis
altitude

23

Causes of respiratory acidosis

COPD
opiate overdose
obesity hypoventilation syndrome
neuromuscular disease
life-threatening asthma (decompensated)
benzodiazepines overdose

24

Drugs CId in asthma?

beta-blockers
adenosine

25

Drugs CId in recent myocardial infarction?

metformin
sildenafil
sumatriptan
hydralazine

26

What soes pulsus paradoxus imply?

severe asthma

27

a 60-year-old man with a history of tuberculosis presents with dyspnoea and fatigue. On examination the JVP is elevated, there is a loud S3 and Kussmaul's sign is positive. Hepatomegaly is also noted
- stereotypical Hx of?

constrictive pericarditis

28

Stereotypical Hx of left ventricular free wall rupture

a patient develops acute heart failure 10 days following a myocardial infarction. On examination he has a raised JVP, pulsus paradoxus and diminished heart sounds

29

What SE do all these drugs have in common?

levodopa
verapamil
diltiazem
isosorbide mononitrate
bromocriptine
amlodipine
most diuretics (ACE inhibitors, thiazides and loop diuretics)
atracurium

hypotension

30

2 drugs causing bronchospasm?

Bronchospasm
beta-blockers
adenosine