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XUAN MSRA > Cardiology > Flashcards

Cardiology Flashcards

(51 cards)

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1
Q

What is Beck’s triad for cardiac tamponade and when is thi seen clinically?

A

1) Hypotension
2) Raised JVP
3) Muffled heart sounds

Seen in cardiac tamponade

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2
Q

What is the most important cause of ventricular tachycardia?

A

Hypokalaemia

Followed by hypomagnesaemia
NOTE: severe hyperkalaemia can also cause in certain circumstances e.g. in patients with structural heart disease

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3
Q

What are the shockable rhythms? And their drug management?

A

1) Ventricular fibrillation
2) Pulsess VT

Management: Amiodaraone 300mg (or lidocaine), after 3 shocks

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4
Q

What are the non-shockable rhythms?

A

1) Asystole
2) PEA

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5
Q

When do you give adrenaline in cardiac arrest? Also what dose

A

Non-shockale- ASAP
Shockable- after 3rd shock
Repeat adrenaline every 3-5mins
Adrenaline 1mg

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6
Q

What are the reversible causes of cardiac arrest?

A

Hs:
Hypoxia
Hypovolaemia
Hypothermia
Hyperkalaemia, hypokalaemia, hypoglycaemia, hypocalcaemia, acidaemi and other metabolic disorders

Ts:
Thrombosis
Tension pneumothorax
Tamponade (cardiac)
Toxins

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7
Q

What is the drug management of angina?

A

1st line: beta-blocker or rate-limiting calcium channel blocker (e.g. verapamil or diltiazem)
2nd line: both (if used in combo with BB use elongating CCP e.g. amlodipine, MR nifedipine)
3rd line: long-acting nitrate, ivabradine, nicorandil, ranolazine (and refer for PCI/CABG)

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8
Q

What are the ECG changes caused by hypokalaemia?

A

1) U waves
2) small or absent t waves
3) Prolonged PR interval
4) St depression
5) long QT interval

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9
Q

What ECG changes do you expect with pericarditis?

A

Often global/widespread changes
1)’saddle-shaped ST elevation”
2) PR depression (most specific for pericarditis)

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10
Q

Side effects of GTN spray

A

Hypotension
Tachycardia
Headache

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11
Q

Characterise aortic regurgitation murmur?

A

Early diastolic

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12
Q

Characterise mitral regurgitation murmur?

A

Pansystolic

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13
Q

What are the complications of MI?

A

1) Cardiac arrest (VF- most common cause
2) Cardiogenic shock
3) Chronic heart failure
4) Tachyarrhythmia- e.g. VF
5) AV block after Inferior MI
6) Pericarditis- normally in first 48hrs
7) Dressler’s syndrome- 2-6 weeks later (fever, pleuritic pain, pericardial effusion and raised ESR)
8) Left ventricular aneurysm (persistent ST elevation LVF)
9) Left ventricular free wall rupture
10) Ventricular septal defect
11) Acute mitral regurgitation- acute hypotension and flash pulmonary oedema

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14
Q

Characterise aortic stenosis

A

Ejection systolic murmur

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15
Q

Causes of RBBB

A

1) normal variant - more common with increasing age
2) right ventricular hypertrophy
3) chronically increased right ventricular pressure - e.g. cor pulmonale
4) pulmonary embolism
5) myocardial infarction
6) atrial septal defect (ostium secundum)
7) cardiomyopathy or myocarditis

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16
Q

Chronic heart failure management

A

1st line: ACEi and Beta-blocker
2nd: Aldosterone antagonist e.g. spironolactone or eplerenone
3rd line: Ivabradine, sacubitril-valsartan, hydralazine in combo with nitrate, digoxin and cardiac resynchronisation

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17
Q

Management of hypertension in patients with T2 diabetes?

A

ACE inhibitor or an angiotensin receptor blocker regardless of age

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18
Q

Characterise mitral stenosis murmur

A

mid-late diastolic murmur

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19
Q

Management of angina if there is co-existent AF and chronic heart failure?

A

Digoxin

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20
Q

Pharmacological cardioversion for AF

A

1) flecainide or amiodarone if there is no evidence of structural or ischaemic heart disease or
2) amiodarone if there is evidence of structural heart disease.’

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21
Q

ECG changes for hypercalcaemia

22
Q

When is PCI used?

Study These Flashcards
A
  • should be offered if the presentation is within 12 hours of the onset of symptoms AND PCI can be delivered within 120 minutes of the time when fibrinolysis could have been given (i.e. consider fibrinolysis if there is a significant delay in being able to provide PCI)
23
Q

When is fibrinolysis used?

Study These Flashcards
A

should be offered within 12 hours of the onset of symptoms if primary PCI cannot be delivered within 120 minutes of the time when fibrinolysis could have been given

24
Q

What is antiplatelet therapy for patients with STEMi prior to PCI?

Study These Flashcards
A

‘dual antiplatelet therapy’, i.e. aspirin + another drug:
- if the patient is not taking an oral anticoagulant: prasugrel
- if taking an oral anticoagulant: clopidogrel

25
What is antiplatelet therapy for patients with STEMi during PCI?
Radial access: unfractionated heparin with bailout glycoprotein IIb/IIIa inhibitor (GPI) Femoral access: bivalirudin with bailout GPI
26
What is drug therapy for patients with NSTEMi prior to PCI?
1) antithrombin treatment: - fondaparinux should be offered to patients who are not at a high risk of bleeding and who are not having angiography immediately - if immediate angiography is planned or a patients creatinine is > 265 µmol/L then unfractionated heparin should be given 2) DAPT i.e. aspirin + another drug: - if the patient is not taking an oral anticoagulant: prasugrel or ticagelor - if taking an oral anticoagulant: clopidogrel For PCI unfractionated heparin should be given regardless of whether the patient has had fondaparinux or not
27
What is the conservative management of NSTEMi/ unstable angina?
'dual antiplatelet therapy', i.e. aspirin + another drug) if the patient is not at a high risk of bleeding: ticagrelor if the patient is at a high risk of bleeding: clopidogrel
28
What are the two types of aortic dissection?
1) type A - ascending aorta, 2/3 of cases 2) type B - descending aorta, distal to left subclavian origin, 1/3 of cases
29
What are the investigations for aortic dissection?
For stable pts: CT angiography of the chest, abdomen and pelvis- shows false lumen For unstable pts: Transoesophageal echocardiography (TOE) CXR- shows widened mediastinum
30
What is the management of aortic dissection?
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
31
What are the complications of aortic dissection?
Backward tear: 1) Aortic regurgitation/incompetence 2) MI (normally inferior due to RCA involvement) Forward tear: 3) unequal arm pulses and BP 4) stroke 5) renal failure
32
What vessel is affected by inferior MI and where are the expected ECG changes?
Right coronary artery II, III and aVF
33
What vessel is affected by posterior MI and where are the expected ECG changes?
left circumflex and right coronary artery V1-V3 Reciprocal changes of STEMI are typically seen: horizontal ST depression tall, broad R waves upright T waves dominant R wave in V2 Posterior infarction is confirmed by ST elevation and Q waves in posterior leads (V7-9)
34
What vessel is affected by anterior MI and what are the expected ECG changes?
Left anterior descending Anterolateral: V1-6, I, aVL Anteroseptal: V1-V4
35
What vessel is affected by lateral MI and what are the expected ECG changes?
Left circumflex I, aVL +/- V5-6
36
What is Brugada syndrome and its management?
A form of inherited cardiovascular disease with may present with sudden cardiac death Autosomal dominant Management: implantable cardioverter-defibrillator
37
What is the management of HOCM?
Amiodarone Beta-blockers or verapamil for symptoms Cardioverter defibrillator Dual chamber pacemaker Endocarditis prophylaxis*
38
What drugs should you avoid in HOCM?
nitrates ACE-inhibitors inotropes
39
What are the ECG findings for Wolff-Parkinson-White?
1) Short PR (<120ms) 2) wide QRS (>110ms) 3) delta wave (slurred, slow rising QRS upstroke)
40
What is the management of a stable narrow complex tachycardia?
Regular: Vagal manouvres then 6,12,18mg adenosine Irregular: probable AF- BB or rate-limiting CCB (e.g. diltiazem)
41
What is the management of a stable broad complex tachycardia?
irregular- prabable AF with BB->BB or rate-limiting CCB (e.g. diltiazem) regular- probable VT-> amiodarone 300mg , if not Dc cardioversion
42
What is the management of smoking cessation and their contraindications?
1) Varenicline= nicotine receptor agonist CIs: Depression/suicidal ideation. 2) Bupropion= dopamine reuptake inhibitor CIs: Epilepsy.
43
What are the features of tricuspid regurgitation?
Pansystolic murmur loudest on inspiration Left parasternal heave JVP - large V waves.
44
What are the causes of tricuspid regurgitation?
Pulmonary hypertension and infective endocarditis
45
What is the cause of mitral stenosis?
Rheumatic fever
46
What are causes of mitral regurgitation?
post-MI/ischaemic heart disease MV prolapse Rheumatic fever
47
What are the different heart blocks?
1st: PR>200ms 2nd: Mobitz I (Wenkeback) progressive PR until dropped QRS Mobitz II- Prolonged PR interval is constant with dropped QRS complexes 3rd: Complete dissociation between P waves and QRS complexes
48
What are causes of canon A waves?
Regular= VT Irregular Complete HB
49
What is the stage 4 management of hypertension?
- If K+ <4.5→ spironolactone - If K+ >4.5→ A or B blocker
50
What is the antibiotic treatment of infective endocarditis?
Amoxicillin and gentamicin If staph-> fluclox If strep- benzylpenicllin
51
What is the management of acute pericarditis?
NSAID + colchicine

XUAN MSRA (20 decks)

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