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FLASH FINALS > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Amiodarone drug monitoring:
Before tx.:
Monitoring:

A

TFT, LFT, U&E, CXR prior to initiating treatment

TFT, LFT every 6 months

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2
Q

Angina pectoris Mx:
All patients should be started on a:
To abort acute attacks:
First line:

A

Statin for all pts. w/out contraindications

Sublingual glyceryl trinitrate

Beta-blocker or CCB

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3
Q

CCB used in angina

as monotherapy

A

Verapamil or Diltiazem - rate limiting

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4
Q

Angina: if CCB and BB are used in combination which CCB should be used

A

long acting dihydropiridine - NIFEDIPINE

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5
Q

Can beta blockers be prescribed with Verapamil?

A

NO

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6
Q

Angina: If pt. is on monotherapy and cannot tolerate addition of CCB/BB which drugs can be added?

A

Long-acting nitrate, ivabradine, nicorandil, ranolazine

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7
Q

Nitrate tolerance: How long are pts. advised to maintain a daily nitrate free time for?

A

10-14 hours

although this is not seen in pts. who take once daily modified release isosorbide mononitrate

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8
Q 
Anti-platelets: 
ACS - 1) and 2) 
PCI - 1) and 2) 
TIA - 1) and 2) 
Ischaemic stroke - 1) and 2) 
Peripheral arterial disease - 1) and 2)
A

ACS -

1) Aspirin and ticagrelor
2) asprin CI? - clopidogrel

PCI -

1) aspirin plus prasurgel or ticagrelor
2) asprin CI? - clopidogrel

TIA -

1) Clopidogrel
2) Aspirin and dipyridamole

Ischaemic stroke -

1) Clopidogrel
2) Aspirin and dipyridamole

Peripheral arterial disease -

1) Clopidogrel
2) Aspirin

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9
Q

Investigation of choice in suspected aortic dissection:
stable pt?
unstable pt?

A

CT CAP angiography
suitable for stable pts.
a false lumen is a key finding

Transoesophageal echocardiography (TOE) - if too risky take to CT scanner

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10
Q

Mx of aortic dissection
Type A;
Type B:

A

Type A: surgical management, but blood pressure should be controlled to a target systolic of 100-120 mmHg whilst awaiting intervention

Type B:
conservative management
bed rest
reduce blood pressure IV labetalol to prevent progression

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11
Q

Features of Aortic regurgitation:
describe the murmur:
Pulse?:
Pulse pressure?:

A

Early diastolic
Collapsing pulse
Wide pulse pressure

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12
Q 
Features of aortic stenosis: 
Describe the murmur: 
Radiates to? 
Pulse?
Pulse pressure
A

Ejection systolic murmur - reduced with valsalva
Carotids
slow rising pulse
Narrow pulse pressure

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13
Q

Mx. Aortic stenosis:
Asymptomatic:
Symptomatic:

A

Asymptomatic: Observation
Symptomatic: valve replacement

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14
Q

Arrhythmogenic right ventricular cardiomyopathy - second most common cause of SCD in young people after HOCM

mx. (BB)
mx. surgical

A

Mx: Drugs: Sotalol
Catheter ablation
ICD

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15
Q

Arrhythmogenic right ventricular cardiomyopathy - ECG findings:

A

ECG V1-V3 = T-wave inversion

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16
Q

Most common primary cardiac tumour:
Murmur:
most commonly attached to:

A

Atrial myxoma
mid diastolic - tumour plop
Fossa ovalis

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17
Q

Two types of ASD:

A 
Ostium secundum (70%)
Ostium primum
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18
Q

Effects of BNP
Vasodilation/constriction?
Diuretic/anti-diuretic
supress/enhances symapthetic tone and RAAS?

A

Vasodilator
diuretic and natriuretic
suppresses both sympathetic tone and RAAS

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19
Q

BNP value of?

Makes chronic heart failure unlikely

A

<100 pg/ml

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20
Q

Contraindications of Beta blockers? (4)

A

Uncontrolled heart failure
Asthma
Sick sinus syndrome
Concurrent use of VERAPAMIL: may precipitate severe bradycardia

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21
Q

Cardiac enzymes?protein markers:
First to rise:
Useful to look for reinfarction as it returns to normal 2-3 days

A

Myoglobin

CK-MB

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22
Q

Cardiac tamponade Beck’s triad:

A

Hypotension
Raised JVP
Muffled heart sounds

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23
Q

What is pulsus paradoxus

A

An abnormally large drop in BP during inspiration

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24
Q

Takotsubo cardiomyopathy:
induced by?
Transient aplical balooning of ?
tx.

A

Stress
Myocardium
Supportive

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25
Q

Stable chest pain imaging investigations:

for pts. who cannot be excluded to have stable angina, NICE recommends the following investigations:

A

1) CT coronary angiography
2) non-invasive functional imaging (looking for reversible myocardial ischaemia)
3) Invasive coronary angiography.

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26
Q

First line test for Chronic heart failure:

A

B-type natriuretic peptide (BNP)

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27
Q

If BNP (released by left ventricular myocardium in repsonse to strain) levels are
High:
Raised:
When should specialist assessment be arranged

A

High: 2 weeks
Raised: 6 weeks

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28
Q

Factors which increase BNP:

A 
Left ventricular hypertrophy 
ischaemia
tachycardia 
right ventricular overload 
hypoxaemia 
GFR < 60 
sepsis 
COPD 
Diabetes 
age > 70 
liver cirrhosis
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29
Q

Factors which decrease BNP:

think cardio drugs plus one other

A 
Obesity 
Diuretics 
ACEis
Beta-blockers 
ARBs 
Aldosterone antagonist
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30
Q

Chronic heart failure first line tx:
Second line tx:
Third line tx: (to be initiated by a specialist)

A

1) ACEi AND a beta blocker
2) Aldosterone antagonist
3) Ivabradine, sacubitril-valsartan, digoxin, hydralazine w/ nitrate

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31
Q

Additional vaccines for heart failure pts.

A

Offer annual influenza vaccine

Offer one-off pneumococcal vaccine (usually one off but if splenic dysfunction or CKD, offer booster every 5 years )

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32
Q

concurrent use of clopidogrel and X may make clopidogrel less effective:

A

Proton pump inhibitors

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33
Q

Monoclonal antibody drug for reversal of DABIGATARAN

A

Idarucizumab

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34
Q

Antihypertensive used in diabetes regardless of age?

A

ACEi

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35
Q

Most common cardiomyopathy?

A

Dilated cardiomyopathy

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36
Q 
DVLA cardiovascular disorders: how long off driving?
Angioplasty:
CABG:
ACS: 
Angina: 
Pacemaker insertion: 
ICD
Aortic aneurysm diameter to disqualify from driving:
Heart transplant:
A

Angioplasty: 1 week
CABG: 4 weeks
ACS: 4 weeks
Angina: driving must cease if sx. occur at rest
Pacemaker insertion: 1 week off
ICD: 6 months, 1 month if inserted prophylactically
Aortic aneurysm diameter to disqualify from driving: 6.5 cm
Heart transplant: 6 weeks but do not need to inform DVLA

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37
Q

Describe Eisenmenger’s syndrome:

Management:

A

Left to right shunt in a congenital heart defect due to PULMONARY HYPERTENSION - eventually causes obstruction to pulmonary blood.
associations with: VSD, ASD, patent ductus arteriosus

Mx = Heart lung transplant required

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38
Q 
Diagnostic work-up for acute heart failure: 
Bloods tests: 
CXR:
Echocardiogram:
BNP:
A

Bloods tests: look for underlying abnormality
CXR: pulmonary congestion, interstitial oedema, cardiomegaly
Echocardiogram: pericardial effusion and cardiac tamponade
BNP: raised levels >100mg/litre (indicates myocardial damage and are supportive of diagnosis)

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39
Q

Heart failure acute management:

A

IV loop diuretics (furosemide or bumetanide)

possible additional tx:
Oxygen
Vasodilators (nitrates) - not always, but have a role if concomitant MI , severe hypertension or regurgitant aortic or mitral valve disease.

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40
Q

Heart failure mx: patients with hypotension

A

Inotropic agents: Dobutamine
vasopressor agents: Norepinephrine
Mechanical circulatory assistance: Intra-aortic baloon counterpulsation or ventricular assist device

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41
Q

Should B-blockers be stopped in AHF?

A

Only if HR <50 bpm, 2nd or 3rd degree AV block or shock

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42
Q

Heart failure types:
HFpEF:
HFrEF:
What is the dysfunction of each with regards to the cardiac cycle (systolic or diastolic)

A

HFpEF: Diastolic dysfunction
HFrEF: systolic dysfunction

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43
Q

Causes of:
systolic dysfunction:
diastolic dysfunction:

A

Systolic dysfunction: Ischaemic heart disease,
dilated cardiomyopathy
myocarditis
arrhythmias

Diastolic dysfunction: HOCM
Restrictive CM
Cardiac tamponade
Constrictive pericarditis

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44
Q

Describe high-output heart failure:

causes:

A

Normal heart is unable to pump enough blood to meet the metabolic needs of the body
Causes: anaemia, AVM, Paget’s disease, pregnancy, thyrotoxicosis, thiamine deficiency (wet beri-beri)

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45
Q

What is an S3 heart sound:
Is it ever normal?
Heard in (conditions) ?

A

caused by diastolic filling of the ventricle
Yes if less than 30 y/o
Left ventricular failure, constrictive pericarditis and mitral regurgitation

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46
Q

What is an S4 heart sound:

Heard in (conditions) ?
Coincides with which wave on ECG:
A

Atrial contraction against a STIFF ventricle

Heard in aortic stenosis, HOCM, Hypertension
P wave

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47
Q

Hypercalcaemia effect on ECG QT interval?

A

SHORTENED QT

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48
Q

Newly diagnosed hypertension investigations (6):

A 
Fundoscopy: hypertensive retinopathy
Urine dipstick: renal disease 
ECG: LVH or ischaemic heart disease
U&Es: 
HbA1c: check for co-existing diabetes
Lipids: hyperlipidaemia
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49
Q

Thiazide diuretics effect on Na and K

A

Both LOWERED: HYPOnatraemia, kalaemia

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50
Q

Clinical BP and HBPM
stage 1 HTN:
stage 2 HTN:
Severe HTN:

A

1) >140/90, 135/85
2)>160/100, 150/95
Severe: Clinic systolic BP>180 or diastolic BP >120

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51
Q

HBPM: regime

Do you use the first day of readings in the average?

A

Each BP recording: two must be taken at least 1 minute apart
Should be recorded twice daily for at least 4 days (7 ideally)
NO

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52
Q

Drug causes of hypertension:

A 
Steroids
MOAis
COCP 
NSAIDS 
Leflunomide
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53
Q

HOCM ECHO findings ‘MR SAM ASH’

A 
Mitral regurgitation (MR)
systolic anterior motion (SAM)
asymmetrical hypertrophy (ASH)
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54
Q

Management of HOCM: ‘ABCDE’

Drugs to avoid:

A 
Amiodarone
Beta-blockers or Verapamil for symptoms
Cardioverter defibrillation
Dual chamber pacemaker 
Endocarditis prophylaxis

Nitrates, ACEis, inotropes

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55
Q 
Hypothermia investigations findings: 
ECG: 
FBC:
Blood glucose: 
ABGs
Coagulation factors
CXR
A

ECG: 12 lead, as temperature approaches 32 degrees, acute ST elevation and J waves or Osborn waves may appear
FBC: serum electrolytes - Hb and haematocrit can be elevated due to haemoconcentration. Platelets and WBCs will be low due to sequestration in the spleen.
Blood glucose: Stress hormones are increased - body can have more peripheral resistance to insulin

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56
Q

Strongest risk factor for infective endocarditis?

Most common valve affected?

A

Previous episode of endocarditis

Mitral valve

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57
Q

Most common BACTERIAL cause of infective ENDOCARDITIS

A

STAPH AUREUS - particularly common in acute px. and IVDU

58
Q

Poor dental hygiene or dental procedure leading to endocarditis
What is the causative organism?

A

Strep VIRIDANS

No longer most common cause (*except in developing countries)

59
Q

Prosthetic valve endocarditis most common causative organism?

A

Staph EPIDERMIDIS

usually the result of preoperative contamination

60
Q

After how many months do they most common organisms of endocarditis return to normal?

A

2 Months

61
Q

Bacterial cause of endocarditis associated with colorectal cancer

A

Strep BOVIS

62
Q

Libman Sachs endocarditis is associated with which AI condition

A

SLE.

63
Q

DUKES criteria (endocarditis) Major criteria (4)

A

2 positive blood cultures showing typical organisms (strep, HACEK) - 3 if less specific pathogen (staph aureus, epidermis etc.)

Persistent bacteraemia from 2 blood cultures taken 12 hours apart

Positive serology for Cox Burnetti, Bartonella, chlyamydia psttaci

Postive molecular assays for specific gene targets.

64
Q

DUKES criteria (endocarditis) minor criteria (4)

A

predisposing heart condition or intravenous drug use

microbiological evidence does not meet major criteria

fever > 38ºC

vascular phenomena: major emboli, splenomegaly, clubbing, splinter haemorrhages, Janeway lesions, petechiae or purpura

immunological phenomena: glomerulonephritis, Osler’s nodes, Roth spots

65
Q

Infective endocarditis: poor prognostic factors:

A

Staph aureus infection
Prosthetic valve
culture negative endocarditis
low complement levels

66
Q

Endocarditis treatment
Initial blind therapy:

Native valve:
Pen allergic, MRSA or SEPSIS:

Prosthetic valve:

A

Amoxicillin, consider adding low-dose gentamicin

Vancomycin + low-dose gentamicin

Vancomycin + rifampicin + low-dose gentamicin

67
Q

Native valve endocarditis tx: Staphylococci

A

FLUCLOXACILLIN

If penicillin allergic or MRSA
vancomycin + rifampicin

68
Q

Prosthetic valve endocarditis caused by staphylococci tx.

A

Flucloxacillin + Rifampicin + low-dose gentamicin

If penicillin allergic or MRSA
Vancomycin + Rifampicin + low-dose Gentamicin

69
Q

Endocarditis caused by fully-sensitive streptococci (e.g. viridans) tx.

Endocarditis caused by less sensitive streptococci tx:

A

Benzylpenicillin

If penicillin allergic
Vancomycin + low-dose Gentamicin

Benzylpenicillin + low-dose gentamicin

If penicillin allergic
vancomycin + low-dose gentamicin

70
Q

Endocarditis indications for surgery:

A

Severe valvular incompetence

Aortic abscess (often indicated by a lengthening PR interval)

Infections resistant to antibiotics/fungal infections

Cardiac failure refractory to standard medical treatment

Recurrent emboli after antibiotic therapy

71
Q

Procedures which may require prophylactic ABs for endocarditis:

A

GI or GU procedure at site where there is a suspected infection

72
Q

Palpitations investigations (4):

Investigation for capturing episodic arrhythmias:

A

12-lead ECG
TFT
U&Es
FBC

HOLTER monitoring

73
Q

IVABRADINE adverse effects:

“eyevabradycardiene”

A

Visual effects (luminous phenomena)
Headache
Bradycardia, heart block

74
Q

What is Kussmauls sign (JVP)

A

paradoxical rise in JVP during inspiration seen in CONSTRICTIVE PERICARDITIS

75
Q

Long QT syndrome: drug causes:

1) cardiac drugs
2) antidepressants
3) misc.

A

1) Amiodarone, Sotalol, class 1a anti arrhythmic drugs
2) TCA, SSRIs (CITALOPRAM ++)
3) Methadone, chloroquine, ERYTHROMYCIN, Haloperidol, Ondansetron

76
Q

Long QT causes:
Electrolytes:
hypo/hyperthermia?
Cardiac/neuro conditions?

A

Hypocalcaemia
Hypokalaemia
Hypomagnesaemia

Hypothermia

Acute MI, myocarditis, subarachnoid haemorrhage

77
Q

Management of Long QT syndrome:

A

Avoid drugs which cause
Beta-blockers (NOT SOTALOL)
ICD

78
Q

Loop diuretics adverse effects:
Electrolytes:
blood sugar?

A

HYPO EVERYTHING,
Hypochloaraemic alkalosis

May cause hyperglycaemia (less common than with thiazides)

79
Q

Mitral regurgitation:
signs: murmur? radiation?
ECG:

A

Signs: pansystolic ‘blowing’ murmur

ECG - may cause P wave broadening

80
Q

MR treatment options:
TO INCREASE CO:
medical:

A

TO INCREASE CO: Acute cases: nitrates, diuretics, positive inotropes, intra-aortic balloon pump

For pts. in heart failure ACEis, BBs and spironolactone

81
Q

Mitral stenosis MAIN CAUSE:

Fx:

A

Rheumatic fever, rheumatic fever, rheumatic fever

Mid-late diastolic murmur (best heard in expiration).
Loud S1, opening snap
Low volume pulse
Malar flush
ATRIAL FIBRILLATION
82
Q

Mitral stenosis: Mx:

A

Patients w/ assoc. AF require WARFARIN

asymptomatic pts: monitor with regular echocardiograms

symptomatic pts.:
Percutaneous mitral balloon valvotomy
mitral valve surgery

83
Q

Features of mitral valve prolapse:
Main complaint:
Murmur:
Complications

A

Atypical chest pain or palpitations

mid systolic click (occurs if pt. squatting),
late systolic murmur (longer if pt. standing)

Complications:
Mitral regurgitation, arrhythmias, emboli, sudden death

84
Q

Ejection systolic murmurs:
Louder on expiration:
Louder on inspiration:

A

Aortic stenosis, HOCM

Pulmonary stenosis, ASD

85
Q

Late systolic murmurs

A

mitral valve prolapse

coarctation of aorta

86
Q

Holosystolic murmurs:

Mitral/tricuspid regurgitation: which gets LOUDER during inspiration?

A

TRICUSPID
think during inspiration, the venous blood flow into the right atrium and ventricle are increased which increases the stroke volume of right ventricle during systole.

87
Q

All pts. should be offered which drugs after a MI: (4)

A

Statin
Dual anti platelet therapy (Aspirin plus one other usually)
BB
ACEi

88
Q

Patients with acute MI who have symptoms or signs of heart failure and LVSD should also be treated with what, post MI…

A

Aldosterone antagonist (Eplerenone)

89
Q

Glycaemic control in MI for diabetics
What BM should be aimed for
how is this achieved?

A

11.0 mmol/L

dose-adjusted insulin infusion

90
Q 
With which demographic is myocarditis associated with 
Can myocarditis increase 
inflammatory markers?
cardiac enzymes?
BNP?

Management:

A

Young pts. who px. with chest pain

Yes.

Supportive, treat underlying cause (antibiotics if required)

91
Q

Side effects of Nicorandil:

Contraindication:

A

Headache, flushing, skin, mucosal and eye ulceration,
GI ulcers incl. anal ulceration

contraindicated in Left Ventricular Failure

92
Q

Orthostatic hypotension diagnostic fx:

A

A drop in BP (usually >20/10 mm Hg) within three minutes of standing

presyncope, syncope

93
Q

Examples of direct thrombin inhibitors: (2)

A

Bivalirudin

Dabigataran

94
Q

Bradycardia acute tx.

1)
2)
3)

Risk factors for asystole:

A

ATROPINE 500 mcg IV repeat (X6) up to 3 mg

transcutaneous pacing

isoprenaline/adrenaline infusion titrated to response

complete heart block with broad QRS.
recent asystole
Mobitz type II AV block
Ventricular pause > 3 seconds

95
Q

Peri-arrest tachycardia if unstable tx:

A

Synchronised DC shocks should be given

Up to 3 can be given. after this, get extra help

96
Q

Broad complex tachycardia mx:
Regular:
irregular:

A

assume ventricular tachycardia:

Loading dose of AMIODARONE followed by 24 hour infusion

seek expert help

97
Q

Orthostatic hypertension drug causes (1)

possible treatment options:

A

Cause: ALPHA BLOCKERS

Tx. options: Midodrine, Fludrocortisone

98
Q

Long term anti-coagulation requirement:
biological valves: (bovine/porcine)
Mechanical valves:

A 
biological valves (bovine/porcine): NO
Mechanical valves: YES (warfarin)
99
Q

Normal pulmonary artery occlusion pressure:

High:

A

8-12 mmHg

>18 mmHg (overload)

100
Q

If PE is ‘likely’ i.e >4 points scored on Wells, what is the immediate management:

Should anti-coagulation be given if there is a delay in getting a CTPA? What should be given if so?

A

Immediate CTPA
YES -
DOAC now preferred (Rivaroxaban, Apixaban)

101
Q

If CTPA is negative but Wells >4 what scan should you consider:

A

Proximal leg vein ultrasound.

102
Q

If PE is ‘unlikely’ (<4 points on Wells) what should be arranged?

If this is positive, what should then be arranged? - should AC be given while awaiting this?

if negative, then PE unlikely, what should you do with AC?

A

D-dimer
CTPA - Yes
Stop anti-coagulation

103
Q

PE: Ix of choice IN RENAL IMPAIRMENT:

A

V/Q scan

104
Q

PE: mx of VTE:
cancer patients:

If DOAC (Apix, Rivarox) CI:

Severe renal disease (15/min):

A

DOACs
DOACs

LMWH followed by Dabigataran or LMWH followed by Vit K antagonist: WARFARIN

LMWH or LMWH followed by Warfarin

105
Q

Length of anticoagulation:
Provoked:
Non-provoked:

Scoring tool to assess risk of bleeding

A

Provoked: 3 months
Non-provoked: 6 months

HAS-BLED

106
Q

Massive PE with Haemodynamic instability (circulatory failure) 1st line tx.

A

Thrombolysis

107
Q

Collapsing pulse causes (3)

A

Aortic regurgitation
Patent ductus arteriosus
Hyperkinetic states (anaemia, thyrotoxic, fever, exercise/pregnancy)

108
Q

Rheumatic fever:
Develops after infection with which organism.

Outline Mx:

A

Strep Pyogenes (2-6 weeks ago)

Antibiotics: Oral Pen V
Anti-inflammatories: NSAIDs
Tx. any complications that may develop (heart failure)

109
Q 
Scoring systems: 
ABCD2:
Child Pugh classification:
HAD:
PHQ-9 
GAD-7 
SCOFF: 
Epworth: 
Waterlow:
Frax: 
Ranson:
A

ABCD2: prognostic risk stratification in TIA
Child Pugh classification: Severity of liver cirrhosis
HAD: Hospital anxiety and depression scale
PHQ-9: Patient health questionnaire
GAD-7: Screening tool for GAD
SCOFF: eating disorders
IPSS: international prostate symptom score
Epworth: obstructive sleep apnoea
Waterlow: pressure sores risk
Frax: 10 year fracture risk for pts. with osteoporosis
Ranson: acute pancreatitis

110
Q

Statins side effects:

contraindications (2): antibiotic class?

A 
MYOPATHY 
Liver impariment (LFTs at 3 and 12 months)

Macrolides
Pregnancy

111
Q

When should statins be taken:

A

At night - as this is when cholesterol synthesis takes place

112
Q

Statin doses:
Recommended regimen
Primary prevention:
Secondary prevention:

A

ATORVASTATIN
Primary prevention: 20mg
Secondary prevention: 80mg

113
Q

SVT: prevention of episodes management:

A

B-blockers

Radiofrequency ablation

114
Q

Thiazide diuretics main difference from loop diuretics in terms of electrolyte disturbance?

A

Loop = HYPOcalcaemia

Thiazide may cause HYPERcalcaemia

115
Q

Thiazide diuretics main S/Es

A

dehydration,hyponatraemia-kalaemia, HYPERCALCAEMIA GOUT, impaired GLUCOSE TOLERANCE

116
Q

Torsades de pointes: Management:

assoc. with long or short QT?

A

IV MAGNESIUM SULPHATE

Long

117
Q

Tricuspid regurgitation causes:

A 
Pulmonary hypertension (COPD) 
Rheumatic heart disease
Infective endocarditis
Ebsteins anomaly
Carcinoid syndrome
118
Q 
Ventricular tachycardia mx: 
if pt. haemodynamically unstable:  
if not: 
medical: 
if these fail:
A

Immediate cardioversion
Medical: Amiodarone, lidocaine or procainamide

electrophysiological study -> ICD

119
Q

Warfarin: managing high INR:

Major bleeding:

INR > 8.0
Minor bleeding:

INR > 8.0
No bleeding

INR 5.0-8.0
Minor bleeding

INR 5.0-8.0
No bleeding

A

Major bleeding: Stop warfarin -> IV VIT K 5mg, prothrombin complex concentrate

INR > 8.0
Minor bleeding: Stop warfarin, IV Vit K 1-3mg
restart at INR 5.0

INR > 8.0
No bleeding:
Stop warfarin, IV vit K (1-5mg) restart at INR 5.0

INR 5.0-8.0
Minor bleeding: Stop warfarin, IV vit K (1-3mg) restart at INR 5.0

INR 5.0-8.0
No bleeding: withhold 1 or 2 doses of warfarin -> reduce subsequent maintenance dose

120
Q

ECG: causes of left axis deviation:

A 
Left anterior hemiblock 
LBBB
Inferior MI 
WPW syndrome with RIGHT sided accessory pathway
Hyperkalaemia 
Ostium primum

minor LAD in obese people

121
Q

ECG: causes of right axis deviation:

A 
Right ventricular hypertrophy 
Left posterior hemiblock
Lateral MI
Chronic lung disease (cor pulmonale) 
Pulmonary embolism 
WPW with LEFT sided accessory pathway
ostium secundum

minor RAD in tall people

122
Q

bifasicular block combo?

trifasicular block combo?

A

Combination of RBBB with left anterior or posterior hemiblock

bifasicular plus 1st degree heart block

123
Q

ECG coronary territories: Anteroseptal

ECG changes:
Coronary artery affected:

A

ECG changes: V1-V4

Coronary artery affected: Left anterior descending (LAD)

124
Q

ECG coronary territories: Inferior

ECG changes:
Coronary artery affected:

A

II,III,aVF

Right coronary artery

125
Q

ECG coronary territories: Anterolateral

ECG changes:
Coronary artery affected:

A

V4-V6, I, aVL

LAD or Left circumflex

126
Q

ECG coronary territories: Lateral

ECG changes:
Coronary artery affected:

A

I, aVL +/- V5-V6

Left circumflex

127
Q

ECG coronary territories: Posterior

ECG changes:
Coronary artery affected:

Confirmed by?

A

Changes in V1-V3

Reciprocal changes of STEMI typically seen:

  • horizontal ST depression
  • tall broad R waves
  • upright T waves
  • dominant R wave in V2

Left circumflex also right coronary

Posterior infarction is confirmed by ST elevation and Q waves in posterior leads (V7-V9)

128
Q

A new diagnosis of what may point towards a diagnosis of ACS?

A

New LBBB

129
Q

ECG features: Digoxin

A

down-sloping ST depression (‘reverse tick’, ‘scooped out’)
flattened/inverted T waves
short QT interval
arrhythmias e.g. AV block, bradycardia

130
Q

ECG features: Hypokalaemia

‘U have no Pot and no T, but a long PR and a long QT’

A 
U waves 
small or absent T waves 
Prolonged PR interval 
ST depression 
Long QT
131
Q

ECG features: Hypothermia

A 
Bradycardia
J wave - small hump at the end of QRS complexes
First degree heart block
Long QT interval 
Atrial and ventricular arrhythmias
132
Q

Causes of LBBB (5)

A 
Myocardial infarction 
Hypertension 
Aortic stenosis 
cardiomyopathy 
rare: idiopathic fibrosis, digoxin toxicity, Hyperkalaemia
133
Q

Posterior MI causes ST elevation/depression?

A

Depression

134
Q

Cause of increased P wave amplitude?

Think increased atrial pressure..

A

COR PULMONALE

135
Q

Causes of RBBB

A 
NORMAL VARIANT in old people (in contast to LBBB which is always pathological)
RVH
Cor Pulmmonale 
Pulmonary embolism 
MI
136
Q 
Causes of ST depression: 
2 cardiac muscle issues 
1 ECG feature 
1 electrolyte imbalance 
1 cardiac drug
A

Posterior MI
ischaemia
secondary to abnormal QRS complex (LVH, L/R -BBB, Digoxin, hypokalaemia)

137
Q

Causes of ST elevation:

+1 rare cause (neuro)

A 
MI
Pericarditis/myocarditis 
Normal variant 
left ventricular aneurysm (persistent ST elevation)
rare: subarachnoid haemorrhage
138
Q

T wave changes:

Peaked (2):

inverted (6):

A

Peaked: Hyperkalaemia
MI

Inverted: 
MI,
Digoxin toxicity
Subarachnoid haemorrhage
Pulmonary embolism S1Q3T3
Brugada syndrome
139
Q

ECG Wellens syndrome
Cause:
ECG features

A

high-grade stenosis in the LAD coronary artery

ECG: 
Biphasic or deep 
T wave inversion V2-V3 
Minimal ST elevation 
NO Q waves
140
Q

As well as heart failure, which other condition can increase BNP:

A

Chronic renal failure

141
Q

Is LBBB more assoc. w/ NSTEMI or STEMI

A

STEMI

FLASH FINALS (34 decks)

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