Cardiology Flashcards by Harisanth Rajaram

Posterior MI - ECG

Tall R waves V1-2

Reciprocal changes of STEMI are typically seen:
Horizontal ST depression
Tall, broad R waves
Upright T waves
Dominant R wave in V2

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Wolff-Parkinson White - define

Congenital accessory conducting pathway between the atria and ventricles leading to atrioventricular re-entry tachycardia (AVRT).

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Management of WPW

Radiofrequency ablation of the accessory pathway

Medical therapy:
sotalol
amiodarone
flecainide

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Long QT syndrome - define

Delayed repolarization of the ventricles.

May lead to ventricular tachycardia/torsade de pointes

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Congenital causes of a prolonged QT interval

Jervell-Lange-Nielsen syndrome (includes deafness and is due to an abnormal potassium channel)

Romano-Ward syndrome
(no deafness)

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Drugs causes of prolonged QT interval

Amiodarone/sotalol

Tricyclic antidepressants, selective serotonin reuptake inhibitors
Methadone

Erythromycin

Haloperidol

Ondanestron

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ECG features of hypokalaemia

U waves

Small or absent T waves

Prolong PR interval

ST depression

Long QT

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Most common cause of infective endocarditis

Staphylococcus aureus

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Streptococcus viridans

Streptococcus mitis

Streptococcus sanguinis

Poor dental hygiene

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Commonly colonize indwelling lines and are the most cause of endocarditis in patients following prosthetic valve surgery

Staphylococcus epidermidis

After 2 months the spectrum of organisms which cause endocarditis return to normal

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Streptococcus bovis

Associated with colorectal cancer

Streptococcus gallolyticus

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Management of HOCM

Amiodarone

Beta-blockers or verapamil for symptoms

Cardioverter defibrillator

Dual chamber pacemaker

Endocarditis prophylaxis

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Drugs to avoid in HOCM

Nitrates

ACE-inhibitors

Inotropes

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Arrhythmogenic right ventricular cardiomyopathy - Define and treatment

Autosomal dominant

Right ventricular myocardium is replaced by fatty and fibrofatty tissue

Sotalol

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Turner’s syndrome

45,X

Bicuspid aortic valve (15%), Coarctation of the aorta (5-10%)

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Cardiac resynchronisation therapy

For patients with heart failure and wide QRS

Biventricular pacing

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What drug is contraindicated in VT

Verapamil

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First-degree heart block

PR interval > 0.2 seconds

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Second-degree heart block

Type 1 (Mobitz I, Wenckebach): progressive prolongation of the PR interval until a dropped beat occurs

Type 2 (Mobitz II): PR interval is constant but the P wave is often not followed by a QRS complex

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Third-degree (complete) heart block

No association between the P waves and QRS complexes

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Cardiac tamponade - features

Beck’s triad:

Hypotension
Raised JVP
Muffled heart sounds

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ECG features of tamponade

Electrical Alternans

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Contraindicated to the use of Ranolazine

Liver dysfunction

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Treatment of torsades de pointes

IV magnesium sulfate

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Native valve endocarditis caused by S.aureus - treatment?

IV Flucloxacillin

Prosthetic valve endocarditis caused by staphylococci - treatment?

Flucloxacillin + rifampicin + low-dose gentamicin

Electrolyte causes of prolonged QT interval

Hypocalcaemia Hypokalaemia Hypomagnesaemia

Interpretation of ABPI

> 1.2: may indicate calcified, stiff arteries. This may be seen with advanced age or PAD 1.0 - 1.2: normal 0.9 - 1.0: acceptable < 0.9: likely PAD. Values < 0.5 indicate severe disease

INR 5.0-8.0 (minor bleeding)

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

Most specific ECG finding in acute pericarditis

PR Depression

Positive response to acute vasodilator testing in PAH - treatment?

Calcium channel blocker - Nifedipine

Negative response to acute vasodilator testing in PAH - treatment?

Prostacyclin analogues: treprostinil, iloprost Endothelin receptor antagonists Non-selective: bosentan Selective antagonist of endothelin receptor A: ambrisentan Phosphodiesterase inhibitors: Sildenafil

ANGINA Treatment:

1st line: PRN GTN + Aspirin + Statin 2nd line: BB or CCB (dont mix BB with Diltiazem or Verapamil -> risk of CHB). 3rd line: Add on CCB/BB (whatever was missed in 2nd line) 4th line (if no hypotension after 3rd line) ISMN/nicorandil 5th line (if no hypotension after 4th line) Add on ISMN or nicorandil (wtv was missed) 6th line (if hypotension after 5th line): HR<70: RANOLAZINE (contraindicated in severe renal/liver disease) HR>70: IVABRADINE (contraindicated in Sick sinus syndrome)

Electrical alternans

Cardiac tamponade

Beck's triad

Cardiac tamponade: Hypotension Raised JVP Muffled heart sounds

Aortic dissection - Management of Type A

Type A - ascending aorta IV Labetalol + Surgery

Aortic dissection - Management of Type B

Type B - descending aorta, distal to left subclavian origin Medically manage with IV labetalol

Arrhythmogenic right ventricular cardiomyopathy - ECG

T wave inversion in V1-3

Major bleeding in patients with Warfarin - management

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

Drugs to avoid using in WPW

(ABCD) Adenosine Beta blockers Calcium channel blockers Digoxin

Common causes of Acute pericarditis

Viral infections (Coxsackie) Tuberculosis Uraemia Post-myocardial infarction

Ranolazine - contraindicated when?

Severe Kidney Disease

Cannon V waves

Right sided heart failure

Pansystolic murmur

Tricuspid or Mitral regurgitation

Kussmaul's sign

Paradoxical elevation of the JVP on inspiration Seen in Constrictive Pericarditis, Cardiac tamponade and Restrictive cardiomyopathy

Reversal of dabigatran

Idarucizumab

Dabigatran - MOA

Direct thrombin inhibitor

Hypertension in diabetics

ACE inhibitors/ARBs are first-line regardless of age

Warfarin - MOA

Inhibits epoxide reductase preventing the reduction of vitamin K to its active hydroquinone form This in turn acts as a cofactor in the carboxylation of clotting factor II, VII, IX and X (mnemonic = 1972) and protein C.

Ejection systolic murmur, fixed splitting of S2

Atrial Septal Defects (ASD)

Wolff-Parkinson-White syndrome - ECG

Short PR interval - (Pre-excitation syndrome) Wide QRS with a slurred upstroke (delta wave)

Deeply inverted or biphasic T waves in V2-V3 suggests

Wellen's Syndrome High risk of critical LAD stenosis

Features of left ventricular hypertrophy on an ECG

Deep S waves in V1 and V2 and tall R-waves in V5 and V6

Empirical treatment of choice in prosthetic valve endocarditis

IV vancomycin + rifampicin + low-dose gentamicin

Anticoagulation in MS patient with AF

Warfarin

Tall Long fingered Downward lens dislocation Learning difficulties DVT

Homocystinuria Treatment is vitamin B6 (pyridoxine) supplements.

Investigation for PE in severe CKD?

V/Q scan

Indication for use of Ivabradine in HF

Sinus rhythm >75 LEVF <35%

U waves Small or absent T waves (occasionally inversion) Prolong PR interval ST depression Long QT

Hypokalaemia

What drug should NOT be used in VT.

Verapamil

Short stature Shield chest, widely spaced nipples webbed neck Bicuspid aortic valve (15%), Coarctation of the aorta (5-10%) Primary amenorrhoea

Turner's Syndrome (45 XO)

Most common cause of infective endocarditis - IVDUs

Staphylococcus aureus

Commonly colonize indwelling lines and are the most cause of endocarditis in patients following prosthetic valve surgery

Staphylococcus epidermidis

Streptococcus bovis

Infective Endocarditis Colorectal cancer Streptococcus gallolyticus is most linked with colorectal cancer

Features of Cholesterol embolisation

Eosinophilia Purpura Renal failure Livedo reticularis

Management of SVT

Vagal manoeuvres Intravenous adenosine (6-12-18) contraindicated in asthmatics - Verapamil is a preferable option (and would also be the next step after adenosine) Electrical cardioversion

Prevention of episodes of SVT

Beta-blockers Radio-frequency ablation

New AF in mitral regurgitation - what do you do?

Refer for mitral valve replacement

Treatment for Torsades de pointes

IV Magnesium sulphate

Patients with heart failure and an ejection fraction < 35% who are euvolaemic and are already taking an ACE-inhibitor and a beta-blocker - management?

Aldosterone antagonist

Mitral stenosis - valve cross sectional area of less than 1cm2 which is an indication for?

Surgery

Treatment acute idiopathic or viral pericarditis

Combination of NSAIDs and colchicine

Most important risk factor for aortic dissection

Hypertension

Inherited long QT syndrome, sensorineural deafness

Jervell and Lange-Nielsen syndrome

Inherited long QT syndrome - no deafness

Romano-Ward syndrome

Non-dihydropyridine calcium channel blockers

Diltiazem and verapamil

INR > 8.0 (minor bleeding)

Stop warfarin, give intravenous vitamin K 1-3mg

Major bleeding on warfarin

Stop warfarin Give intravenous vitamin K 5mg Prothrombin complex concentrate

Indications of surgery in MR:

1. EF < 60% 2. Left ventricular end systolic diameter > 40mm 3. New onset of AF or PHT 4. High likelihood of durable repair with low surgical risk and absence of risk factors

Xanthelasma is often associated with

Hypercholesterolaemia

The most characteristic ECG finding in arrhythmogenic right ventricular dysplasia (ARVD) is

Epsilon wave (a small positive deflection at the end of the QRS complex)

Prominent V waves on JVP

Tricuspid regurgitation

Empirical treatment of choice in native valve endocarditis

IV amoxicillin

Cardiology Flashcards

(83 cards)