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Cardiology Flashcards

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1
Q

Classical presentation of aortic stensosis

A

SAD
syncope (on exertion commonly)
Angina
Dyspnoea

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2
Q

ECG signs of aortic stenosis

A

LVH
P-Mitrale
AV block
Poor r wave progression

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3
Q

Signs of aortic stenosis

A

Ejection systolic murmur
Slow rising pulse - delayed through stiff ventricle
Narrow pulse pressure - reduced gap between systole/diastolic
Non-displaced but sustained/heaving apex
Aortic thrill

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4
Q

What constitutes severe aortic stenosis?

A

<1cm valve opening and symptoms

Valve gradient >40mmHg

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5
Q

Causes of aortic regurgitation

A 
Congenital - bocuspid valve 
Aortic root dilatation- Marian's, ehlers
Inflammatory- SLE, RA, rheumatic heart disease
Infective endocarditis 
Aortic dissection
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6
Q

Signs and symptoms aortic regurg

A

LVF symptoms, dyspnoea, orthopnoea
Signs - early diastolic murmur
Collapsing pulse - rapid increase then collapse
Wide pulse pressure

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7
Q

Symptoms of AF

A

Palpitations
SOB
Angina (rate associated ischaemia)
Syncope

Symptoms of complications - HF and stroke

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8
Q

ECG findings of AF

A

Irregularly irregular R waves
Absent P waves
HR > 100 = FAST AF

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9
Q

Management of AF

A

Rate control - B-blocker or rate limiting calcium channel blocker. Consider dioxin if sedentary

Rhythm control - for acute new-onset <48 hours
- electrical cardioversion ideally - anticoagulation before (heparin). If elective, anticoag for 3 weeks prior

Pharm. Electrocardioversion - flecainide if no structural damage, otherwise amiodarone

Anticogaulte (assess chadsvasc and hasbled) - DOACs ideally

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10
Q

Ecg findings of broad complex tachycardia

A

Usually 150-250 bpm
QRS > 120ms
Can be monomorphic or polymorphic

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11
Q

Torsades de pointes is a complication of what and how is it treated?

A

Long QT syndrome

Manage with IV magnesium sulphate

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12
Q

Management of VT

A

ABCDE
Cardiac arrest = arrest protocol
Pulseless VT and VF - non-synchronised DC cardiovert

Is a pulse:
Synchronised DC cardiovert - up to 3 if unstable
Followed by 300 mg IV amiodarone over 20 mins
Another shock
Followed by 900 mg over 24 hr

If stable - straight to amiodarone, correct electrolyte abnormalities

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13
Q

Example of suoraventricular tachycardias

A 
Sinus tachycardia 
Atrial tachycardia 
WPW
Avrt 
AVNRT
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14
Q

Typical SVT ECG

A

HR > 100 bpm
Narrow QRS
Weird P wave morphology (different depending on type of SVT)

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15
Q

Management of SVF

A

Slow AV node via - vagal maneuvers (valsalva or carotid sinus massage)
IV drugs - 1st line - adenosine, verapamil 2nd line, 3rd line - b blocker
Synchronised DC if haempdynamically unstable

Prevention- teach valsalva
If no-pre-extiement - verapamil
If pre excitement (WPW) - flecainide (if no structural damage, if so then admiodarone)

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16
Q

ECG signs of WPW

A

Delta wave
Short PR
Broad QRS (if with delta wave)

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17
Q

Management of WPW

A

Svt treatment
Control rate - b blocker
Accessory pathway ablation

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18
Q

First line medications for hypertension

A

<55 or T2DM - ACEi

>55 or afro-carribean - calcium channel blocker

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19
Q

Commonest type of cardiomyopathy

A

Dilated cardiomyopathy

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20
Q

Inheritance pattern for HCM

A

Autosomal dominant (50%)

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21
Q

Signs and symptoms of HCM

A 
SOB
Angina
Syncope 
Palpitations 
Asymptomatic 
Sudden cardiac death
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22
Q

ECG findings of HCM

A

Deep and narrow (dagger) Q waves
AF common complication
Non-specific ST segment and T wave abnormalities

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23
Q

Causes of bradycardia

A 
Sick sinus syndrome
Drugs- b-blocker, digoxin, amiodarone
Cushing's response - to raised ICP
Drugs to CNS - opioids 
Metabolic - hyperkalaemia, hypothermia, hypothyroidism 
Anorexia 
High level of fitness, pain
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24
Q

What is sick sinus syndrome, its causes

Study These Flashcards
A 
Basically sinus node dysfunction 
Usually caused by sinus node fibrosis
Usually idiopathic
But can be secondary to cardiomyopathy, sarcoidosis, infiltrative disease (amyloidosis, sarcoidosis) 
Drugs - b-blockers, digoxin
25
Management of severe bradycardia
ABCDE Do ecg, correct electrolyte abnormalities or administer antidotes causing IF ADVERSE SIGNS - ATROPINE 500mcg IV (unless transplanted hear. If unresponsive, can repeat every 3-5 mins Consider - transcutaneous pacing, adrenaline If a risk of asystole (recent asystole, AVN block mobitz 2 of complete heart block with broad QRS) - then will need specialist and possible transcutaneous pacing regardless of response to atropine or adverse signs
26
What is 1st degree av block
Prolonged PR interval (>0.2s)
27
Treatment for 1st degree heart block
No treatment needed
28
What is the normal PR interval?
0.2 secs
29
What is 2nd degree heart block?
Intermittent conduction of P waves to the ventricles
30
What is Mobitz type 1 heart block
Progressive PR prolongation until a QRS drops (there isn't one)
31
What is mobitz type 2 heart block?
No progressive PR prolongation but intermittent failure to transmit to the ventricles (high risk of becoming 3rd degree)
32
What is 3rd degree heart block and its management?
No association of P waves and QRS (no transmission of P waves to the ventricles with ventricular escape rhythm taking over) Needs pacemaker
33
Causes of acute pericarditis
Usually idiopathic or viral Bacteria - TB Fungi Acute MI or post-MI (dresslers syndrome) Drugs Autoimmune (SLE, RA, sarcoidosis) Other - uraemia, chest trauma, hypothyroidism, cancer
34
Signs and symptoms of pericarditis
Chest pain - worse on lying down and inspiration, relieved by sitting forward Pericardial friction rub Fever
35
ECG findings of pericarditis
Widespread saddle shaped ST elevation
36
Management of acute pericarditis
NSAIDs Analgesia Oxygen if hypoxic Add colchicine if viral or idiopathic - continue for 3 months as prevents recurrence
37
What is cardiac tamponade and its signs and symptoms
Fluid in the pericardial sac that increases the pressure so much it prevents ventricular filling, reducing cardiac output Beck's triad - decreased BP, reduced heart sounds, raised JVP Increased HR Pulses paradoxes
38
What is pulses paradoxus and what is it a sign of?
Reduced BP with inspiration | Sign of cardiac tamponade
39
Causes of cardiac tamponade
Trauma Aortix dissection Medical procedure - carherisation, heart surgery Pericardial effusion causes - cancer, infection
40
Management of cardiac tamponade
Urgent pericardiocentesis
41
What medication should never be given in VT?
Verapamil
42
ECG findings of hypokalaemia
``` U waves Prolonged PR Small or absent T waves ST depression Long QT ```
43
ECG signs of hyperkalaemia
Peaked or tall T waves Loss of P waves Broad QRS Ventricular fibrillation
44
What are the stockade rhythms?
Pulseless VT | VF
45
What are U waves
Small deflection immediately following T wave | Sign of hypokalaemia
46
Inheritance pattern of long QT syndrome
Autosomal dominant
47
Causes of long QT syndrome
``` Congenital Drugs - amiodarone Tricyclic antidepressants Erythromycin Electrolytes - htpokalaemia, hypomagnesia Myocarditis Acute MI ```
48
Presentation of long QT
Syncope Palpitations SCD Triggers - stress, exercise
49
Management of long QT
Avoid triggers including drugs B-blocker ICD
50
Aortic stenosis murmur
Ejection systolic Narrow, tough valve - harder to get blood out during ventricular systole
51
Mitral regurgitation mumur
Pansystolic murmur Backflow of blood into the atria during ventricular systole Therefore occurs throught systole
52
Aortic regurg murmur
Early diastolic murmur When ventricles relax during diastole, aortic valves are shut but leaky so blood flows back into the atria during diastole
53
Mitral stenosis murmur
Low-pitched, mid-diastolic murmur Blood flowing through mitral valve during diastole into the ventricles but is tough because of stenosis (later in diastole due to increased filling as atria contract)
54
Pulmonary stenosis murmur
Ejection systolic
55
Tricuspid regurgitation murmur
Pansystolic murmur Return of blood when ventricles contract
56
Tricuspid stenosis murmur
Mid diastolic murmur
57
Important differentials of broad complex tachy
VT SVT with altered conduction to ventricles (BBB or WPW) E.g. Aflutter with BBB
58
Drug treatments in chronic heart failure
``` ACEi / ARB If not tolerated - hydralazone and nitrates B-blocker Entresto Mineralocorticoid receptor antagonists ``` Diuretics- for symptomatic relief Other - Digoxin Entresto (never put ACEi with this as has ARB in) Ivabradine Dapagliflozin

Medicine (25 decks)

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