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passmed ! > cardiology > Flashcards

cardiology Flashcards

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1
Q

causes of long QT syndrome

A

congenital
- Jervell-Lange-Nielsen syndrome

drugs
- amiodarone
- sotalol
- TCA
- SSRI
- methadone
- chloroquine

electrolytes
- low CA K MG

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2
Q

causes of right axis deviation

A
  • right ventricular hypertrophy
  • left posterior hemiblock
  • lateral myocardial infarction
  • chronic lung disease → cor pulmonale
  • pulmonary embolism
  • ostium secundum ASD
  • Wolff-Parkinson-White syndrome* - left-sided accessory pathway
  • normal in infant < 1 years old
  • minor RAD in tall people
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3
Q

causes of left axis deviation

A

left anterior hemiblock
left bundle branch block
inferior myocardial infarction
Wolff-Parkinson-White syndrome* - right-sided accessory pathway
hyperkalaemia
congenital: ostium primum ASD, tricuspid atresia
minor LAD in obese people

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4
Q

contraindication to adenosine

A

asthma as it causes bronchoconstriction

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5
Q

mx of INR >8 with minor bleeding

A

Stop warfarin
Give intravenous vitamin K 1-3mg
Repeat dose of vitamin K if INR still too high after 24 hours
Restart warfarin when INR < 5.0

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6
Q

mx of INR >8 no bleeding

A

Stop warfarin
Give vitamin K 1-5mg by mouth, using the intravenous preparation orally
Repeat dose of vitamin K if INR still too high after 24 hours
Restart when INR < 5.0

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7
Q

mx of INR 5-8 minor bleeding

A

Stop warfarin
Give intravenous vitamin K 1-3mg
Restart when INR < 5.0

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8
Q

mx of INR 5-8 with no bleeding

A

withhold 1 -2 doses of warfarin
reduce subsequent maintenance dose

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9
Q

mx of major bleeding with a pt on warfarin

A

stop warfarin
Give intravenous vitamin K 5mg
Prothrombin complex concentrate - if not available then FFP

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10
Q

what is bifascicular block

A

the combination of RBBB with left anterior or posterior hemiblock
e.g. RBBB with left axis deviation

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11
Q

what is trifasciular block

A

features of bifascicular block as above + 1st-degree heart block

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12
Q

anteroseptal ECG changes in which leads and which artery is affected?

A

V1-4

LAD

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13
Q

inferior ECG changes in which leads and which artery is affected?

A

II, III, AVF

right coronary

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14
Q

anterolateral ECG changes in which leads and which artery is affected?

A

V1-6 I AVL
proximal LAD

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15
Q

lateral ECG changes in which leads and which artery is affected?

A

I, AVL, +/- V5-6
left circumflex

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16
Q

posterior ECG changes in which leads and which artery is affected?

A

V1-3
- reciprocal changes of STEMI ie horizontal ST depression

left circumflex and right coronary

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17
Q

digoxin ECG changes

A

short QT
arrhythmias

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18
Q

ECG changes hypokalaemia

A

U waves
small/absent T waves
prolonged PR
ST depression
long QT

In Hypokalaemia, U have no Pot and no T, but a long PR and a long QT

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19
Q

ECG changes hypothermia

A

bradycardia
J/osborne waves = small hump at end of QRS complex
first degree heart block

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20
Q

how to remember the difference between LBBB and RBBB

A

WiLLiaM MaRRoW
in LBBB there is a ‘W’ in V1 and a ‘M’ in V6
in RBBB there is a ‘M’ in V1 and a ‘W’ in V6

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21
Q

causes of LBBB

A

always pathological
- MI
- HYT
- AS
- cardiomyopathy
- rare = digoxin toxicity, idiopathic fibrosis

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22
Q

causes of prolonged PR interval

A

idiopathic
ischaemic heart disease
digoxin toxicity
hypokalaemia
rheumatic fever
aortic root pathology e.g. abscess secondary to endocarditis
Lyme disease
sarcoidosis
myotonic dystrophy

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23
Q

causes of short PR interval

A

WPW syndrome

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24
Q

causes of RBBB

A

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

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25
causes of inverted T waves
myocardial ischaemia digoxin toxicity subarachnoid haemorrhage arrhythmogenic right ventricular cardiomyopathy pulmonary embolism ('S1Q3T3') Brugada syndrome
26
what is S1 heart sound
closure of mitral and tricuspid valves
27
what is S2 heart sounds
closure of aortic and pulmonary valves
28
what causes S3 heart sound
diastolic filling of ventricle normal if <30 abnormal - LV failure -> dilated cardiomyopathy - constrictive pericarditis - MR
29
what causes S4
AS HOCM HYT caused by atrial contraction against stiff ventricle
30
mnemonic for heart sounds
My Two Apple Pies are Very Sweet M - Mitral S1 T - Tricuspid S1 A - aortic S2 P - pulmonary S2 V - ventricular filling S3 S - stiff ventricle S4
31
what causes a loud vs quiet S1
loud = MS, short PR quiet = MR
32
what condition causes: - persistent ST elevation 4 weeks post MI - bi-basal crackles - s3 and s4 heart sounds
left ventricular aneurysm
33
what complication of MI causes an acute mitral regurgitation
infero-post MI causes ischaemia/rupture of papillary muscle causes hypotension, MR, pul oedema
34
antiplatelets - TIA or ischaemic stroke
lifelong 1st = clopidogrel 2nd = aspirin and dipyridamole
35
antiplatelets - PCI
aspirin lifelong prasugrel/clopidogrel 12 months
36
antiplatelets ACS (no PCI)
aspirin lifelong ticagrelor 12 months
37
antiplatelets PAD
lifelong 1st = clopidogrel 2nd = aspirin
38
causes of acute pericarditis
coxsackie TB uraemia post MI -> weeks = autoimmune Dresslers radiotherapy lung/breast cancer trauma RA/SLE
39
ECG changes pericarditis
saddle shapped ST elevation PR depression
40
fx of pericarditis
pleuritic chest pain, relieved sitting forward flu like symptoms pericardial rub
41
ix pericarditis
ECG TT echo bloods -> inflamm and troponin
42
mx pericarditis
NSAIDS and colchicine
43
if triple therapy for HYT is ineffective and potassium <4.5 which drug should be added
spironolactone if >4.5 add beta or alpha blocker
44
echo findings for atrial myxoma
pedunculated heterogeneous mass most common primary cardiac tumour
45
which BP would require urgent further IX?
>180/120
46
what signs to look for if BP >180/120
retinal haemorrhage papilloedema new onset confusion chest pain HF signs AKI headache, palp, sweating
47
definitive mx for brugada syndrome
implantable cardioverter-defib
48
drugs used to prevent angina attacks
beta blocker or verapamil/diltazem
49
which CCB are rate limiting
diltiazem or verapamil
50
which beta blockers are cardioselective
aten or bisoprolol
51
1st line tx for reduced LVEF?
ACEi+ BB CCB are contraindicated in HF as depress heart function and exacerbate symptoms - except amlodipine
52
tamonade vs pericarditis
tamponade - elevated JVP - muffled heart sounds - hypotension - electrical alternans on ECG - pericarditis can cause tamponade
53
what is pulsus paradoxus and what is it assoc with
drop in BP of >10mmHg during inspiration assoc with tamponade
54
indications for temporary pacemakers
unstable/unresponsive to atropine bradycardia post anterior MI with type 2 or complete heart block trifascicular block prior to surgery
55
mackler triad for boerhaave syndrome
vomiting thoracici pain subcut emphysema
56
what fx are present in a proximal aortic dissection
aortic regurgitation and inferior MI
57
drug mx of angina
everyone: statin, aspirin, GTN reliever 1st line: BB or CCB - if poor response at start, increase to max dose if CCB monotherapy = verapamil or diltiazem 2nd line: combine BB and CCB if in combo with BB = amlodipine if cannot tolerate combo or waiting on PCI/CABG start isosorbide nitrate -> asymmetric dosing ivabradine nicorandil ranolazine
58
if a pt is started on ACEi and has significant renal dysfunction within short time of taking drug, what could be underlying diagnosis
bilateral renal A stenosis likely cause of HYT in young pt
59
mx of aortic dissection
Type A: ASS Surgery and Systolic Management of 100-120 Type B: BooBs Bed rest and Beta Blockers IV labetalol
60
what ECG changes are assoc with PE
sinus tachy S1Q3T3 - deep S waves in I - pathological Q waves in III - inverted T waves in III
61
where is furosemide site of action
ascending thick loop of henle
62
inheritance pattern of hypertrophic cardiomyopathy
autosomal dominant
63
contraindications to statins
macrolides -> clarithromycin as increases risk of rhabdomyolysis/myopathy causing kidney damage so check creatine kinase levels pregnancy
64
what is the biggest RF for aortic dissection
hypertension
65
JVP rising on inhalation is a sign of which condition
contrictive pericarditis -> kussmaul's sign in tamponade, it is raised but doesn't increase with inspiration
66
reversal for dabigatran
idarucizumab
67
ECG finding of HOCM
left ven hypertrophy = tall R waves in V4-6 and deep S waves in V1-3 that exceed 40mm
68
mx for native valve endocarditis
amox + gentamicin
69
mx for native valve endocarditis + severe sepsis/pen allergy/MRSA
vancomycin + gentamicin
70
mx for native valve endocarditis with RF for gram -ve infection
vancomycin + meropenem
71
mx prosthetic valve endocarditis
vancomycin, gentamicin + rifampacin
72
dose of atorovastatin for primary vs secondary prevention
80mg secondary, 20mg primary
73
when are thiazide-like diuretics contraindicated in the tx of HYT
if pt has gout as increase levels of serum uric acid
74
what is atypical anginal pain
NICE define anginal pain as the following: 1. constricting discomfort in the front of the chest, or in the neck, shoulders, jaw or arms 2. precipitated by physical exertion 3. relieved by rest or GTN in about 5 minutes patients with all 3 features have typical angina patients with 2 of the above features have atypical angina patients with 1 or none of the above features have non-anginal chest pain
75
which valve disease is most commonly assoc with marfan syndrome
aortic regurg mARfans
76
which ECG change is common with mitral stenosis and what does it represent?
P mitrale = left atrial hypertrophy/strain
77
in a pt with CKD and potassium >6, what should be done regarding their antiHYT
stop ACEI and switch to different agent
78
secondary casues of HYT
RECENT Renal Endocrine Coarc of aorta Estrogen Neurological Treatment
79

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