Cardiology 2 Flashcards by H JP

Wells score likely Ix
Wells score unlikely Ix

CTPA, if will be delayed then anticoagulate with a DOAC
If negative then consider US to r/o DVT

If unlikely - arrange d-dimer, if +ve then for CTPA

How well did you know this?

Not at all

Perfectly

Wells score
Likely versus unlikely

> 4 PE likely
=<4 PE unlikely

How well did you know this?

Not at all

Perfectly

PERC criteria (8)

> =50
Haemoptysis
Unilateral leg swelling
Recent surgery
HR >=100
Sats <=94%
Prev DVT use
Oestrogen use

How well did you know this?

Not at all

Perfectly

What is the PERC rule?

Pulmonary embolism rule-out criteria (PERC)

all the criteria must be absent to have negative PERC result, i.e. rule-out PE

How well did you know this?

Not at all

Perfectly

Acute hypotension and pulmonary oedema post MI?

Mitral regurg

How well did you know this?

Not at all

Perfectly

Within 1 week post MI acute heart failure associated with a pan-systolic murmur =

ventricular septal defect

How well did you know this?

Not at all

Perfectly

2-6 weeks post MI complication
48 hours

Dresslers syndrome
Pericarditis

How well did you know this?

Not at all

Perfectly

Most common cause of death post MI

How well did you know this?

Not at all

Perfectly

Mitral stenosis features (7)

Dyspnoea
Haemoptysis
Mid- late diastolic murmur
Loud S1
Low volume pulse
Malar flush
AF

How well did you know this?

Not at all

Perfectly

Mitral stenosis
Causes (3)

RhF, RhF, RhF

How well did you know this?

Not at all

Perfectly

Mitral regurg murmur (4)

Pan systolic murmur
Blowing
Radiates to axilla
Quiet S1

How well did you know this?

Not at all

Perfectly

Mitral regurg causes (5)

Collagen disorders
Mitral valve prolapse
Infective endocarditis
Post MI
Rh F

How well did you know this?

Not at all

Perfectly

Minor Criteria (4)
Rheumatic fever

raised ESR or CRP
pyrexia
arthralgia (not if arthritis a major criteria)
prolonged PR interval

How well did you know this?

Not at all

Perfectly

Rh Fever Dx criteria

Major Criteria (5)

1 major 2 minor or 2 major

Major
Erythema marginatum
Subcutaneous nodules
Sydenhams Chorea
Polyarthritis
Pancarditis

How well did you know this?

Not at all

Perfectly

Rheumatic fever bacteria –>
Rx (2)

strep pyogenes
Rx NSAIDs, penicillin V

How well did you know this?

Not at all

Perfectly

What is Kussmaul’s sign?
Seen in which condition?

paradoxical rise in JVP during inspiration seen in constrictive pericarditis

How well did you know this?

Not at all

Perfectly

1st line management of isolated systolic hypertension

thiazides

How well did you know this?

Not at all

Perfectly

Explain the heart sounds
S1 closure of which valves, soft and loud in which valvular disease
S2 closure of which valves, soft in which valvular disease
S3 name two conditions
S4 name three conditions

S1 closure of mitral and tricuspid
soft if mitral regurg
loud in mitral stenosis

S2 closure of aortic and pulmonary valves
soft in aortic stenosis

S3
Heard in dilated cardiomyopathy or constrictive pericarditis.

S4 aortic stenosis, HOCM, HTN

How well did you know this?

Not at all

Perfectly

Causes of inverted T waves (6)

Study These Flashcards

MI
Dig tox
SAH
Arrhythmogenic right ventricular hypertrophy
PE
Brugada syndrome

Causes of ST elevation (7)

Study These Flashcards

MI
Pericarditis
Normal variant (high take off)
Left ventricular aneurysm
Prinzmetal’s angina
Takotsubo cardiomyopathy
SAH

Causes of ST depression (3)

Study These Flashcards

Ischaemia
Digoxin
Hypokalaemia

Causes of prolonged PR (7)

Study These Flashcards

IHD
Dig toxicity
Low K+
Rheumatic fever
Endocarditis
Lyme disease
Sarcoidosis

Increased P wave amplitude =
Bifid P waves

Two causes

Study These Flashcards

Cor pulmonale
Mitral stenosis

Acute hypotension and pulmonary oedema post MI =

Study These Flashcards

Mitral regurg

1st degree heart block 2nd Type 1, type 2 (mobitz I + II) Third degree

Prolonged PR Type 1 progressive prolongated PR with dropped QRS Type 2 long PR, random QRS dropped Third degree no association

Canon waves JVP in neck Wide pulse pressure Regular brady

Complete heart block

NYHA classification

NYHA Class I no symptoms no limitation: ordinary physical exercise does not cause undue fatigue, dyspnoea or palpitations NYHA Class II mild symptoms slight limitation of physical activity: comfortable at rest but ordinary activity results in fatigue, palpitations or dyspnoea NYHA Class III moderate symptoms marked limitation of physical activity: comfortable at rest but less than ordinary activity results in symptoms NYHA Class IV severe symptoms unable to carry out any physical activity without discomfort: symptoms of heart failure are present even at rest with increased discomfort with any physical activity

Stress induced, family member dies then develops chest pain and features of heart failure. Rx apical ballooning of the myocardium

What is Takotsubo cardiomyopathy?

Name four causes of dilated cardiomyopathy

1. Cocksackie virus B 2. ETOH 3. wet Beri Beri 4. Doxorubicin

HOCM ECHO findings (3)

1. MR 2. Systolic anterior motion of the anterior mitral valve (SAM) 3. Asymmetrical septal hypertrophy

Which two types of cardiomyopathies are AD? Mx

HOCM and arrhythmic right ventricular dysplasia ICD

Statins - when do you increase the dose in the context of primary prevention?

increase the dose if non-HDL has not reduced by >= 40%

Long QT1 Long QT2 Long QT3

Syncope following: Long QT1 exertional syncope e.g swimming Long QT2 emotional stress, exercise or auditory stimuli Long QT3 often at night or at rest

Cause of long QT

SSRIs TCAs/ terfenadine Ondansetron Methadone/ MI/ myocarditis/ macrolides Amiodarone Chloroquine, ciprofloxacin Hypothermia/ haloperidol Low K, Mg, Ca Erythromycin SAH Sotalol STOMACHLESS

Long QT can lead to? Mx (2)

VT or torsade de pintes BB ICD if high risk

Choking First question to ask How to differentiate between mild and severe 3 steps for mild If unconscious (2)

1. Are you choking? (if responds - mild, otherwise severe) If mild 1. Encourage patient to cough 2. Five back blows 3. Five abdominal thrusts Then repeat If unconscious 1. Call for an ambulance 2. CPR

Stable angina investigations (3)

1st line CT coronary angiography 2nd line myocardial perfusion scan, OR stress ECHO 3rd line invasive coronary angiography

When do you give oxygen with CP?

Sats <94% who are not at risk of hypercapnia OR COPD patient aiming sats 88-92%

CP referral CP within 12 hours with an abnormal ECG CP 12-72 hours ago CP >72 hours ago

ED Refer to hospital for same day assessment Perform full ECG and troponin

Hypokalaemia ECG findings (5)

U have no Pot and no T, but a long PR and a long QT And ST depression U waves, small or absent T waves, long PR, long QT

Digoxin toxicity findings on ECG (4)

Down sloping ST depression Flattened/ inverted T waves Short QT Long PR

Causes of LAD (6)

Left bundle branch block MI (inferior) Wolff-Parkinson-White syndrome - right-sided accessory pathway Hyperkalaemia Congenital: ostium primum ASD, tricuspid atresia Obesity

RAD causes (8)

RVH MI lateral Chronic lung disease → cor pulmonale PE Congenital ostium secundum ASD Wolff-Parkinson-White syndrome* - left-sided accessory pathway Normal in infant < 1 years old Tall people

Coronary territories Anteroseptal ECG and artery Anterolateral Lateral Inferior Posterior

V1-V4 LAD V4-V6, I, aVL LAD or left circumflex I, aVL +/- V5-V6 Left circumflex II, III, aVF right coronary V1-V3 Left circumflex

What can decrease BNP? (5)

Obesity Diuretics ACE inhibitors/ ARBs BB Aldosterone antag

BNP, NTproBNP Values of high, raised and normal

High >400, >2000 100-400, 400-2000 <100, <400

Chronic heart failure 1st line investigation

NTproBNP

Cardiology 2 Flashcards

(47 cards)