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Flashcards in Cardiology Deck (94):
1

STEMI management

M - morphine 5-10mg IV + antiemetic - metacloperamide 10mg
O - O2 aim for highest possible start at 15l if unwell
N - GTN 2 puffs/sublingual
A - aspirin 300mg
C - clopidogrel 300mg

2

STEMI Investigations

12 lead ECG
Bloods: U+Es, troponin, glucose, cholesterol, FBC
CXR

3

Shock management

ABC - high flow O2
Raise feet
IV access - 2 wide bore cannula
Fast crystalloid infusion
Catheterise, central line if needed
Ix: FBC, U+E, ABG, cross match, cultures, ECG, CXR
*careful not to fluid overload in cardiogenic shock*

4

SVT:
Management

1. Vagal manoeuvres (breath holding, carotid massage)
2. IV adenosine (or verapamil for asthmatics)
Or DC cardiovert if haemodynamically unstable

5

Torasades de points

VT with varying axis
Crazy ECG
Caused by high QT interval, from anti arrhythmics, hypokalaemia
Tx: IV mag sulphate

6

VT:
Management

1. Amiodarone 5mg
2. DC cardiovert

7

Left-sided Heart Failure:
Causes and features

Sx: dyspnoea, poor exercise, fatigue, PND, nocturnal cough, pink frothy sputum, cadriac wheeze, muscle wasting, cold peripheries

8

Right-sided Heart Failure:
Causes and features

Causes:
- pulmonary stenosis, lung disease

Sx: peripheral edema, ascites, anorexia, facial engorgement

9

Leads:
II, III, avF

Inferior

10

Leads:
I, aVL, V5, V6

Lateral

11

Leads:
V3, V4

Anterior

12

Leads:
V1, V2

Septal

13

First degree heart block

>200ms (5 small squares) P-R interval
If really marked p wave gets lost in previous ST

14

Second degree mobitz type 1

Wenkelback phenomenon, gets progressively longer then drops the beat

15

Second degree block, mobitz type II

2:1 or 3:1 ratio

16

Third degree heart block

No relation between atrial and ventricular activity

17

Wolff Parkinson White

Congenital accessory pathway between a and v
Short PR interval but wide QRS complex due to slurred upstroke delta wave
Present like SVT
Treat with ablation

18

Multi focal atrial tachycardia

Most commonly COPD
Irregularly irregular with loads of p waves
Treat - correct hypoxia/hypercapnia, verapamil or beta blocker if HR remains high

19

Cardiac tamponadep

Accumulation of pericardial fluid raises intra-pericardial pressure➡️ poor ventricular filling ➡️ poor cardiac output

20

Cardiac tamponade:
Causes

Pericarditis
Aortic dissection
Haemodialysis
Warfarin
Cardiac biopsy

21

Cardiac tamponade:
Signs

⬆️pulse
⬇️BP
Pulsus paradoxus
⬆️JVP (rises on inspiration, no Y)
Muffled heart sounds

22

Beck triad

For diagnosis of cardiac tamponade
Falling BP, rising JVP, small quiet heart

23

Cardiac tamponade:
Tx

Referral for urgent drainage

24

Slow rise pulse:
Sign of

Aortic stenosis

25

Pulsus paradoxus:
Causes

Severe asthma
Asthma Tamponade

26

Slow-rising pulse:
Causes

Aortic stenosis

27

Collapsing pulse:
Causes

Aortic regurg
PDA
Hyperkinetic state

28

Pulsus alternans:
Cause

Severe LVF

29

Jerky pulse:
Cause

HOCM

30

ST elevation:
Causes

MI
Pericarditis
LVA
Prinzmetals angina
(Hyperkalaemia)

31

Aortic dissection:
Signs and symptoms

Severe tearing chest pain, radiates to back
Unequal BP in arms
Widened mediastinum
Hemi/paraplegia
Anuria

32

ASD:
Types

Patent foremen ovale
Ostium primum/secundum

33

ASD:
Examination findings

Ejection systolic murmur
Split second heart sound (loudest over pulmonary area)
Acyanotic
Often asymptomatic

34

VSD:
Examination findings

Severe heart failure in infancy/asymptomatic
Harsh pansystolic murmur at LSE
Pulmonary HTN

35

Long QT syndrome:
Causes

Congenital
Drug induced (amiodarone, TCAs)
Electrolyte imbalance
MI, SAH

36

CHADS2VASC

Congestive Heart Failure
HTN >160
Age 65-74
Diabetes
Stroke/TIA
Vascular disease
Age >75
Sex

Sex

37

Hypokalaemia:
ECG findings

T wave inversion and U wave (swooping curvy after qrs)

38

Dukes criteria

2 major/1 major 3 minor/ 5minor

Major:
Blood cultures
Serology
Molecular assay
Echo
New valve regurg

Minor:
Predisposing heart condition or IVDU
Fever>38
Vascular e.g Jane way, emboli
Immunological e.g solders nodes

39

Infective endocarditis:
Signs and symptoms

Fever
Roths spots
Solders nodes
Murmur
Jane way lesions
Anaemia
Nail haemorrhage
Emboli

40

Mitral stenosis: signs

Malar flush
AF
Tapping beat
JVP raised (late)

41

Acute LVF: signs

Sinus tacky/ AF
Hypotension
Cardiomegaly
3rd 4th heart sounds
Pleural effusions

42

Fourth heart sound

Always abnormal

HF
MI
cardiomyopathy
HTN

43

Third heart sound

Normal up to 30

Or HF
MI
cardiomyo
HTN
valve regurg
Constrictive pericarditis

44

Aortic regurg:
Causes

REALM

Rheumatic heart disease
Endocarditis
Ank spond/aortic dissection
Luetic heart disease
Marfans syndrome

45

Where does a left main stem MI show?

Large anterior
V2-6
Very ill/die

46

Where does a left anterior descending MI show?

Anteroseptal
V2-4

47

Where does a left circumflex MI show?

Anterolateral
1, aVL, V4-6

48

Where does a right coronary MI show?

Inferior
2,3, aVF
Bradyarrythmias

49

Angina vs MI

Ang:
Pain less severe
Lasts

50

Complications of an MI

SPARED

Sudden death
Pump failure
Aneurysm or arrhythmia
Re upturn of papillary muscle/septum
Embolism
Dressers syndrome

51

Features of pericardial pain

Sharp
Worse on inspiration
Central
Radiates to shoulder not arm
Worse lying flat
Better leaning towards

52

Radiographic changes of acute LVF/heart failure

Cardiomegaly
Bats wings
Diffuse mottling
Pleural effusions
Fluid in fissures -kerly b lines

53

Acute LVF:
Treatment

High dose O2
Treat arrhythmias
Diuretics
Vasodilators
Opiates

54

Hyperkalaemia:
Management

ECG +resus equipment ready
IV calcium gluconate
Glucose+insulin

55

Mechanical prosthetic valves

Noisy
Ball+cage/bi leaflet
Long term anticoag
Not for child breathing age or elderly or risk of bleeding

56

Mechanical prosthetic valves:
Complications

Valve failure (from thrombosis or mechanical failure)
Obstruction
Subacute bacterial endocarditis
Leak
Haemolysis

57

Bioprosthetic valves

Quiet
Don't need anticoag
For child bearing or bleeders
Fail suddenly with acute severe pulmonary edema and cardiogenic shock
10-15 years

58

NYHA Heart Failure Classifications

1) none: no symptoms
2) mild: breathlessness or angina on normal exertion
3) moderate: marked breathless or angina short distances
4) severe: breathless at rest

59

Infective endocarditis ABx prophylaxis

For high risk patients (previous IE, valve replacement, congenital heart disease) having high risk procedures (tooth extraction, gingival margin)

60

Infective endocarditis:
Ix

FBC (raised WCC)
Raised ERC, CRP
Urine dip - microscopic haematuria
Blood cultures x3
TTE/TOE

61

Dukes criteria for IE

Major criteria: x2 blood cultures, positive echo, new regurg
Minor: pre-disposing, fever, vascular lesions, single blood culture, immunological manifestation

2 major/ 1 major + 3 minor

62

Posterior MI

Isolated posterior MI is rare
Left circumflex (or sometimes RCA or both)
Suspect if: tall R wave in V1, ST depression, upright T waves
Move leads round to back V7-9

63

Stage 1 HTN

>140/90 (ABPM 135/85)
Treat if

64

Stage 2 HTN

>160/100 (150/95)

65

Immediate ECG changes for MI

ST elevation
Peaked T waves

66

ECG changes MI

Inverted t waves
+- ST elevation

67

ECG changes MI few days

Pathological Q waves

68

What does persistent ST elevation post MI indicate?

Left ventricular aneurysm

69

ECG changes for Digoxin

ST depression
Inverted t waves v5-6
+- arrhythmias, modal bradycardia

70

ECG change for ventricular hypertrophy

Dominant R waves

71

ECG causes of low voltage

COPD, hypothyroid, PE

72

Indications for an exercise ECG

Suspected IHD in known CAD (e.g previous MI)
Exercise induced arrhythmias

73

Angina Tx

Modify risk factors
Aspirin
Beta blocker
Nitrates
Long acting Ca2+ blockers
K+ channel activators

74

HCOM

Autosomal dominant
Young sudden collapse or death
Jerky pulse
Ejection systolic murmur (mitral and tricuspid regurg)

75

Reasons to treat stage 1 HTN

20%

76

HF Ix:
Echo vs BNP

Previous MI = echo

77

STEMI:
PCI/thrombolysis

LWMH + PCI = gold standard if available
If not thrombolysis +tPa and repeat ECG 30 mins for 50% ST reduction

78

Chest pain:
Management for different presentations/timings

72h = full assess + ECG + trop

79

AF+heart failure management

DC cardio vert

80

Aortic stenosis + ACEi

Risk of profound hypotension

81

Heart failure management:
First line

ACE + beta blocker

82

Heart failure management:
Second line

Aldosterone agonist/ARB/hydralazine + nitrate

83

Heart failure management:
Last line

Cardiac re sync/digoxin

+diuretics if fluid overload

84

New LBBB +chest pain

Treat as MI, do PCI or thrombolysis

85

Canon a waves in JVP

VT

86

Giant v wave in JVP

Tricuspid regurg

87

Absent y descent and raised JVP

Cardiac tamponade

88

Which are the cyanotic congenital heart defects?

Tetralogy of fallout
Transposition of great arteries

89

TGA

Cyanotic
Presents to 2-3 as cyanotic Abby
Needs surgery
Can have stenosis, esp pulmonary arteries, in later life

90

Tetralogy of Fallot

Pulmonary stenosis + RVH + VSD + over-riding aorta

Presents as cyanotic at 2-3, generally unwel,, poor weight

91

ASD

Presents days - months
Ejection systolic murmur loudest over pulmonary area

P pulonale + big R waves + Rbbb

92

VSD

6-8 weeks
Small ones close by themselves
Large have risk of eisenmengers in adolescence

93

Coarctation of the aorta

Presents at roughly 3 weeks
Poor feeding, lethargy, tachypnoea, heart failure
Unequal pulses, lower body cyanosis
Give prostaglandin injection

94

Complication of Kawasaki disease

Coronary artery aneurysm