Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

IPE > Cardiology > Flashcards

Cardiology Flashcards

(128 cards)

Start Studying
1
Q

Name some causes of left ventricular/congestive heart failure

A
  • Pump failure
    • Heart muscle disease (IHD, cardiomyopathy)
    • Restricted filling (pericarditis, tamponade)
    • Inadequate heart rate (B blockers, heart block, post-MI)
    • Negatively inotropic drugs (antiarrhythmics)
  • Excessive preload
    • Mitral regurg
    • Fluid overload (NSAIDs causes retention, renal disease)
  • Chronic excessive afterload
    • Atrial stenosis
    • Hypertension
  • High output failure (anaemia, pregnancy, hyperthyroidism)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name some symptoms of left heart failure

A
  • Fatigue
  • Dyspnoea on exertion
  • Exercise intolerance
  • Orthopnoea
  • Paroxysmal nocturnal dyspnoea
  • Persistent coughing (especially nocturnal)
    • Pink, frothy sputum
  • Leg/ankle swelling
  • Wheeze
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Name some signs of left heart failure

A
  • General
    • Patients looks ill and exhausted
    • Cool peripheries
    • Peripheral cyanosis
  • Pulse
    • Resting tachycardia
    • Pulsus alternans
  • Auscultations
    • S3 gallop
    • Aortic/mitral murmurs
  • Chest
    • Tachypnoea
    • Bibasal end inspiratory crackles
    • Wheeze
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Name some causes of right heart failure

A
  • Chronic lung disease
  • Pulmonary hypertension
  • PE
  • Tricuspid/Pulmonary valve disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Name some symptoms of right heart failure

A
  • Fatigue
  • Dyspnoea
  • Anorexia
  • Loss of appetite
  • Abdominal swelling
  • Sudden weight gain
  • Protruding neck veins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Name some signs of right heart failure

A
  • Jugular venous distension
  • Cardiomegaly
  • Hepatomegaly
  • Ascites
  • Pitting oedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the compensatory mechanisms active during heart failure and explain why these mechanisms lead to some signs of heart failure

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Name some investigations for suspected heart failure

A
  1. ECG and BNP, then echo OR just echo (if previous MI)
  • Bloods - FBC, U&E, BNP, TFT, LFT, cholesterol, glucose, eGFR
  • CXR
  • Echo
  • ECG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the CXR findings for heart failure

A
  • Alveolar oedema (bat’s wings)
  • Kerley B lines (interstitial oedema)
  • Cardiomegaly
  • Dilated prominent upper lobe vessels
  • Effusion (pleural)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is heart failure classified?

A

New York classification (NYHA):

  1. Heart disease present but no undue dyspnoea
  2. Comfortable at rest but dyspnoea with ordinary activities
  3. Less than ordinary activity causes dyspnoea, limiting lifestyle
  4. Dyspnoea present at rest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the general priniciples of treating chronic heart failure

A
  • Treat the cause (arrythmias, valve disease, anaemia, thyroid disease, hypertension)
  • Avoid exacerbating factors (NSAIDS - fluid retention, verapamil - negative inotrope)
  • Lifestyle changes (less salt, weight loss, stop smoking, education)
  • Cardiac rehabilitation
  • Drugs
  • Surgical options (revascularisation, implantable cardioverter defibrillators, transplant)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Name the drugs used to treat chronic heart failure

A
  1. Loop diuretics if acute (furosemide 40mg/24hr PO)
  2. ACE inhibitor (lisinopril 10mg/24hr PO)
  3. B-blockers (start low and go slow)
  4. Hydrazaline with nitrate if black
  5. 2nd line - Spironolactone (25mg/24hr PO)
  6. Digoxin (0.125-0.25mg/24hr PO) if remaining symptomatic or AF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the contraindications of ACE-inhibitors?

A
  • Renal failure
  • Hyperkalaemia (K+ > 5.5)
  • Hyponatraemia (Na+ < 130)
  • Hypovolaemia
  • Hypotension (systolic BP < 90)
  • Aortic stenosis
  • Pregnancy/lactation
  • COPD or cor pulmonale
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the side effects of ACE inhibitors?

A
  • Hypotension
    • Especially 1st dose - begin laying down)
  • Dry cough
  • Taste disturbance
  • Hyperkalaemia
  • Renal impairment
  • Urticaria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What value defines hypertension?

A

140/90

(malignant = BP > 200/130)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Name some causes of hypertension

A
  • Essential hypertension
  • Renal disease (impairs volume regulation and RAAS)
    • Glomerulonephritis
    • Polyarteritis Nodosa
    • Polycystic kidneys
    • Chronic pyelonephritis
    • Renovascular disease
  • Endocrine
    • Cushings
    • Conns (hyperaldosteronism)
    • Hyperparathyroidism
  • OCP
  • Pregnancy
  • Steroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Name some signs and symptoms of hypertension

A
  • Headaches
  • Renal disease - fluid overload/retention, bruits
  • Radiofemoral delay
  • Cushings disease - central obesity, purple striae, thin limbs
  • End organ damage
    • Retinopathy
    • LVH
    • Proteinuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Name some consequences of hypertension

A
  • Coronary heart disease
  • Left ventricular hypertrophy
  • Renal damage
  • Stroke
  • Retinopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe the appearance of hypertensive retinopathy

A

Grades:

  1. Tortuous arteries
  2. A-V nipping (narrowing where arteries cross veins)
  3. Flame haemorrhages and cotton wool spots
  4. Papilloedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Name some investigations into hypertension

A
  • If 140/90 or higher - offer ambulatory BP monitoring to confirm diagnosis (unless severe)
  • Bloods - glucose, U&Es, creatinine, eGFR, cholesterol
  • ECG
  • Urine analysis (protein/blood)
  • Fundoscopy
  • Specific to exclude a cause
    • Renal ultrasound
    • Cortisol / renin/ aldosterone
    • Echo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe the stages of hypertension

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe the treatment of hypertension

A
  • Lifestyle changes
    • Stop smoking
    • Lose weight
    • Redue alcohol and salt intake
  • Drugs
    • Thiazide diuretics (bendroflumethiazide 2.5mg/24hr PO)
    • Beta blockers (atenolol 50mg/24hr PO)
    • ACE inhibitor (lisinopril 2.5-20mg/24hr PO)
    • Calcium channel antagonist (nifedipine 30-60mg/24hr)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe hypertension treatment based on age and ethnicity

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is stable angina?

A

When coronary artery flow is limited by >70% stenosis due to atherosclerosis. During emotional or exertional stress the increased oxygen demand cannot be met, causing ischaemia and pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Name some causes of angina
* Atherosclerosis * Anaemia * Atrial stenosis * Tachyarrhythmias *
26
Name some signs and symptoms of angina
* Crushing central chest pain * May radiate to jaw/neck/left arm * Dyspnoea * Dizziness/syncope
27
Name some investigations for the diagnosis of angina
* Exercise stress test ECG * ST depression (stable) or elevation (unstable) * Flat or inverted T waves * Possible arrhythmia * Coronary angiography * Thallium 201 - visualise ischaemic tissue * Investigations into precipitating factors * FBC (anaemia) * Glucose/BM (diabetes) * Cholesterol * T3/T4
28
How is angina managed?
* Lifestyle modifications (stop smking, exercise, weight loss * Modify/control risk factors (hypertension, diabetes) * Aspirin (75-100mg/24hrs) * Beta blockers or CCB * Long acting nitrate if not tolerated * GTN spray for symptom relief * Statin if total cholersterol \> 5mmol/L * Revascularisation
29
What are the contraindications of beta blockers?
* Asthma * COPD * Left ventricular failure * Bradycardia * Coronary artery spasm
30
Describe the pathophysiology of a myocardial infarction
* Plaque rupture * Platelet aggregation and thrombosis * Thrombus propogates into coronary artery * Inflammation * Total occlusion of lumen = ischaemia * Infarction
31
What are the risk factors for Acute Coronary Syndrome?
* Non modifiable * Age * Male sex * Family history of IHD (MI in 1st degree relative \< 55 years old) * Modifiable * Smoking * Hypertension * Diabetes * Hyperlipidaemia * Obesity * Sedentary lifestyle
32
Name some symptoms of ACS
* Central crushing chest pain \> 20 min * May radiate to jaw/arms/neck * Sweating * Cold and clammy extremities * Nausea/vomiting * Dyspnoea * Intense anxiety * SYncope
33
Describe the appearance of an MI on ECG
* ST elevation * Or new LBBB * Tall T waves * T wave inversion * Increased Q waves (pathological)
34
Describe some other investigations (other than ECG) into ACS
* CXR * Cardiomegaly * Pulmonary oedema * Widened mediastinum? * Blood tests * FBC * U&E * Glucose (inc) * Lipids (dec) * Cardiac enzymes - creatine kinase, troponin T
35
Describe the immediate management of an MI
* Morphine 5-10mg IV * + antiemitic (metoclopramide) * High flow oxygen by face mask * GTN spray 2 puffs * Aspirin 300mg chewed * Thrombolysis \<90 min onset * Streptokinase * Alteplase (if SK used previously) * Tissue plasminogen activator
36
What are the indications for thrombolysis?
* Presentation within 12 hours * Ideally 90 mins * ST elevation \> 2mm in 2 or more chest leads * ST elevation \> 1mm in 2 or more limb leads * Posterior infarction * New onset LBBB
37
What are the contraindications of thrombolysis?
* Internal bleeding * Suspected aortic dissection * Prolonged or traumatic CPR * Previous allergic reaction * Heavy bleeding * Vaginal * Varices * Peptic ulcer * Acute pancreatitic/lung/liver disease * Recent trauma or surgery
38
Describe the long term management of a patient after an MI
* Lifestyle management * Antiplatelets/anticoagulants * Heparin (5000U/12hrs SC) * Aspirin (75-150mg/24hrs) * Beta blocker (metoprolol 50mg/6hrs) * ACE inhibitor * Statin (simvastatin 10-40mg PO at night) * General advice * Employment * Diet - oily fish, fibre, low sat. fats * Travel
39
Name the BMI categories
40
Name some complications of MI
* Cardiac arrect * Bradycardias / heart block * Tachyarrhythmias * Left/right ventricular failure * Pericarditis * DVT / PE * Cardiac tamponade * Mitral regurg
41
What is CABG?
The use of a conduit (internal thoracic artery/saphenous vein) to anastamose between the Aorta and coronary arteries distal to stenosis
42
What are the risks of CABG?
* Systemic inflammatory response * Bleeding from attached graft * Atrial fibrillation * Thromboemboli * Stroke * MI * Reaction to anasthesia * Infection at incision site
43
What is PCI/angioplasty?
Non-surgical procedure where a stenosed artery's lumen is increased by inflating a balloon catheter * Introduced via a guiding wire through the femoral, brachial or radial artery * Within 2 hours of chest pain
44
What are the risks of PCI?
* Restenosis (intimal hyperplasia) * Thrombosis * Decreased with aspirin/clopidogrel * Acute MI * Stroke * Cardiac tamponade * Systemic bleeding
45
Describe the criteria for PCI vs CABG
PCI = 1 or 2 diseased coronaries CABG: * 3 or more diseased coronaries * Poor left ventricular function * Significant stenosis in left coronary mainstrem
46
What is Virchow's Triad? Include examples
3 categories that contribute to thrombosis * Hypercoagulability - thrombocytosis, antithrombin deficiency, smoking, OCP * Stasis - cardiac failure, immobility, surgery * Endothelial damage - atherosclerosis, catheters, trauma, MI, hypertension, valve disease
47
Name some anti-platelet drugs and their mechanisms of action
* Aspirin - COX inhibitor to decrease thromboxane A2 which decreases platelet activation * Clopidogrel - blocks P2Y receptors which inhibits ADP-induced platelet activation * Used in aspirin intolerance and stents * Abciximab (monoclonal antibody) - stops fibrinogen binding to GPIIb/IIIa receptors on activated platelts to decreased aggregation
48
Name some uses of antiplatelet drugs
* Ischaemic stroke * MI / transient ischaemic attack * Prior to PCI * ACS
49
Name some anticoagulant drugs and their mechanisms of action
* Heparin - activates antithrombin which inhibits clotting factors * Unfractionated (glycosaminoglycan) - rapid onset and recovery used perioperatively, thromboembolic disease and unstable angina * LMWH (dalteparin) - longer and more predictable response used in outpatients * Warfarin - inhibits vitamin K * Fondaparinux - factor Xa inhibitor
50
Name some causes of mitral stenosis
* Rheumatic fever * Congenital * Old age calcification
51
Name some signs of mitral stenosis
* Rumbling mid-diastolic murmur * Best heard in expiration lying on left side * Opening snap * Loud S1 * Malar flush * Atrial fibrillation * Tapping apex beat * Pulmonary congestion (hypertension, oedema)
52
How is mitral stenosis managed?
* Digoxin for rate control (if in AF) 0.125-0.25mg/24hrs * Beta blocker if rate \> 90 * Warfarin for anticoagulation * Diuretics to decrease preload and pulmonary venous congestion Surgery if not controlled: * Balloon valvuloplasty (if non-calcified valve) * Mitral valvotomy / valve replacement
53
What are the indications for anticoagulation?
* DVT and PE * Stroke prevention * Atrial fibrillation * Prosthetic heart valve * Prevention of thromboembolism post-op
54
What are the antidotes to anticoagulants?
Heparin = protamine sulphate (1mg IV) Warfarin = prothrombin complex concentrate (\<50 units/kg) and Vit K (5mg IV)
55
Name some causes of mitral regurgitation
* Prolapsed valve * Rheumatic fever * Post MI * Cardiomyopathy * LV dilatation * Annular calcification (elderly) * HCTD * Infective endocarditis
56
What are the signs of mitral regurg?
* Pansystolic murmur * Apex radiating to axilla * Malar flush * Displaced apex beat * Thrill * RV heave * AF * LV hypertrophy * Pulmonary oedema
57
How is mitral regurg managed?
* Digoxin (if AF) * Anticoagulation * AF * History of thromboembolism * Prosthetic valve * Additional mitral stenosis * Diuretics * ACE inhibitor * Antibiotics to prevent infective endocarditis * Valvuloplasty or replacement
58
What are the causes of aortic stenosis?
* Calcification due to age * Bicuspid valve (congenital) * Rheumatic fever
59
What are the signs of aortic stenosis?
* Ejection systolic murmur * Radiates to carotids * Slow rising pulse with narrow pulse pressure * Forceful apex beat * LV hypertrophy
60
How can aortic stenosis present?
* Angina * Dyspnoea * Decreased exercise tolerance * Dizziness and fainting * Systemic emboli (if infective endocarditis)
61
How is aortic stenosis managed?
* Valve replacement (+ anticoagulation) * TAVR * Valvuloplasty (balloon catheter) * Antibiotics for endocarditis prophylaxis
62
What are the causes of aortic regurg?
* Rheumatic fever * Bicuspid valve (congenital) * HCTD * Infective endocarditis * Dilation of aortic root * Dissection * Marfans * Age * Hypertension
63
Name some signs of aortic regurg
* Early diastolic murmur * High pitched * Best heard when leaning forward and in expiration * Collapsing pulse * Quincke's sign = capillary pulsation in nail beds * De Mussets sign = head nodding * Pistol shot femorals
64
How is aortic regurg managed?
Surgery if: * Increasing symptoms * Enlarging heart on CXR/echo * ECG deterioration (T wave inversion in lateral leads) Endocarditis prophylaxis
65
Describe the pathogenesis of atherosclerosis
1. Endothelial damage (smoking, HTN, diabetes, hyperchosterolaemia) 2. Promotes adhesion of circulating monocytes 3. Accumlation and oxidation of LDLs * Uptake into macrophages = foam cells 4. Release of cytokines to cause migration and proliferation of smooth muscle 5. Formation of fibrous cap and thombi = narrowing of lumen
66
How is hyperlipidaemia treated?
* Low fat and high carb diet for 3 months * Statins (HMG-CoA reductase inhibitors - reduce hepatic synthesis) * ADR = hepatotoxicity, myositis, rhabdomyolysis * Bile acid sequestrants (cholestryamine - trap bile acids in the intestine to increase excretion) * Nicotinic acid (inhibits synthesis of VLDL by liver * Fibrates (stimulate lipoprotein lipase)
67
Name some causes of atrial fibrillation
* Heart failure * Hypertension * MI * Mitral valve disease * Pneumonia * Hyperthyroidism * Alcohol
68
Describe some investigations into valve dysfunction
* Echocardiography - assesses LV function and visualise valve * Doppler echo - assesses size and site of jet * Cardiac catheterisation - assesses coronary artery disease * ECG * Hypertrophy * Axis deviation * CXR * Enlargement * Pulmonary oedema * Calcification
69
How can AF present?
* Chest pain * Palpitations * Dyspnoea * Presyncope * Light headedness * Feeling faint * Blurred vision * Stroke/TIA
70
Name some signs of AF
* Irregularly irregular pulse * Apical pulse rate \> radial pulse rate * Signs of emboli / PE * Signs of hyperthyroidism / mitral valve disease
71
Describe the appearance of atrial fibrillation on ECG
* Absent P waves * Narrow QRS complex (\<120ms) * Irregularly irregular rhythm * Tachycardia (\>100bpm
72
How is acute AF treated?
1. Treat associated acute illness (MI, pneumonia) 2. Control ventricular rate with beta blocker or digoxin (0.5mg/12hr PO) 3. Control rhythm with amiodarone (5mg/kg 1hr IV) or class I (flecainide 2mg/kg for \> 25 mins) 4. DC cardioversion (200J - 360J) - first line if heart failure, reversible cause or haemodynamic instability 5. Left atrial ablation
73
How is chronic AF managed?
1. Rate control with beta blocker * Consider digoxin if non-paroxysmal and sedentary lifestyle 2. Consider amiodarone if not controlled 3. Anticoagulate with warfarin/apixaban if CHADSVASC \>2 for women or \>1 for men * Use aspirin if \<65 with no other risk factors
74
How is paroxysmal AF managed
* Sotalol * Alternative: amiodarone * Anticoagulate with warfarin
75
Describe the appearance of atrial flutter on ECG
* Continuous atrial depolarisation (300/min) * Sawtooth baseline * +/- 2:1 AV block * Narrow QRS complex (\<120 ms) * Tachycardia (\>100 bpm)
76
How is atrial flutter treated?
* Beta blocker and flecainide * Catheter ablation NB: Carotid sinus massage or IV adenosine transiently blocks the AV node and may unmask flutter waves
77
Describe some differential diagnoses of supraventricular (narrow complex) tachycardia
* Sinus tachycardia * AF = unstable re-entrant loops (350-500bpm) * Atrial flutter = re-entry rhythm in atria (300bpm) with AV nodal conduction usually 2:1 or 4:1 * Atrial tachycardia = ectopic pacemaker (120-240bpm) * Supraventricular premature beats = ectopic impulses arising in the atria or AVN conducted to the ventricles to cause a premature beat, pause, normal rhythm * Wolf-Parkinson-White Syndrome = congenital accessory conduction pathway between atria and ventricles
78
Describe the broad principles of treating supraventricular tachycardia
* Lifestyle - reduce coffee, alcohol and tobacco * Physical manoevres - valsava / coughing / face into ice water * Carotid sinus massage * Caution if carotid bruit * Rate control (amiodarone/beta blocker/verapamil) * Amiodarone (rhythm control) * Adenosine 6mg bolus injection (suppresses AV conduction) * DC cardioversion
79
Name some the categories and differentials of tachycardia
80
Name some causes of ventricular tachyarrythmias
* Ischaemic heart disease * Increase in SNS * Increase in K+ * Slow conduction * Cardiomyopathy * Heart failure * Rare - caffeine, alcohol, exercise
81
Describe the management of VT
* Correct hypokalaemia and hypomagnesaemia * Magnesium sulphate 2g IV over 10 min * Amiodarone or lignocaine * DC cardioversion
82
How is the recurrence of VT prevented?
* Antiarrhythmic drugs * Implantable defibrillators * Surgical isolation of arrythmogenic area
83
Describe the classes of anti-arrythmia drugs and what they are used to treat
1. Na+ channel blocker (lignocaine, flecainide) * Ventricular arrhythmia, AF, WPW 2. Beta blockers (propanolol, atenolol) * MI, tachyarrhythmia 3. K+ channel blocker (amiodarone, sotalol) * WPW, AF, VT 4. Ca2+ channel blocker (verapamil) * AV block, AVNRT, AF 5. Adenosine (suppresses Ca2+ channel in A1 receptor) * SVT 6. Digoxin (stimulates vagus nerve) * AF, SVT (heart failure)
84
Name ECG
Atrial fibrillation with fast ventricular response: * Tachycardia (100-150 bpm) * Irregularly irregular rhythm * No P wave * Narrow QRS
85
Name ECG
Atrial flutter: * Tachycardia (150bpm) * Regular rhythm * Normal axis * Saw tooth baseline (no P waves)
86
Name ECG
Ventricular tachycardia: * Tachycardia (150 bpm) * Regular rhythm * Left axis deviation * Wide QRS complex
87
Name ECG
Acute anterolateral MI: * ST elevation in V2-6 * Reciprocal depression in II, III and aVF
88
Name ECG
Wolff-Parkinson-White Syndrome ( * Normal rate and regular rhythm * Shortened PR interval * Slurred upstroke on QRS = delta wave
89
Name ECG
Pericarditis: * Normal rate and regular rhythm * PR segment depression * Narrow QRS * Widespread ST elevation * Saddle shaped
90
Name ECG
Pumonary embolism: * Tachycardia (100 bpm) * Right axis deviation with right BBB * Wide QRS * T wave inversion in lead III S1Q3T3: * Deep S wave in lead I * Pathological Q wave in lead III * Inverted T wave in lead III (and other anterior leads)
91
Name ECG
Torsades de Pointes (VT): * Highly variable rate (up to 300 bpm) * Irregular rhythm * Wide QRS *
92
Name ECG
Long QT syndrome: * Everything normal * Prolonged QT interval * \> 480 ms (over half way to next QRS) Main causes: Clarithromycin and diphenhydramine
93
Describe the different types of Heart Block and how to recognise them on ECG
* 1st degree = PR \> 200ms * 2nd degree * Mobitz 1 = progressive PR lengthening, then a non-conducted P wave * Mobitz 2 = occasional non-conducted beats * 2:1/3:1 = 2 or 3 P waves per QRS compex with a regular P wave rate * 3rd degree = no relationship between P waves and QRS complexes (usually wide)
94
Describe the appearance of RBBB on ECG
* Wide QRS \> 120 ms * Positive V1 with 2 R waves (RSR) pattern * Inverted T waves in V1 (and V2-3) * Deep and wide S waves in V6 MaRRoW V1 = M QRS pattern V6 = W QRS pattern
95
Describe the appearance of LBBB on ECG
* Wide QRS \> 120 ms * Negative V1 * Inverted T waves in I, aVL, V5-6 WiLLiaM V1 = W QRS pattern V6 = M QRS pattern
96
Describe the appearance of left axis deviation on ECG
* Negative QRS in II and III * High QRS in I and aVL
97
Name some causes of left axis deviation
* WPW * Left anterior hemiblock * Inferior MI * VT * LVH
98
Describe the appearance of right axis deviation on ECG
* Negative in I and aVL * Positive in III and aVF
99
Name some causes of right axis deviation
* Tall or thin * RVH * Lateral MI * Dextrocardia * WPW
100
Name the infarct areas and affected leads
101
Describe the methodological approach to ECGs
* Presenting complaint and patient demographics * Rate (300 / number of big squares in R-R interval) * Rhythm * Axis * P wave (and relationship with QRS) * P-R interval (normally 0.12-0.2s * QRS complex (normally 0.12s) * QT interval * ST segment * Elevation \>1mm * Depression \< 0.5mm * T wave * Peaked in hyperkalaemia * Flattened in hypokalaemia
102
Name ECG
1st degree heart block: Prolonged P-R interval (\>0,2s)
103
What is dilated cardiomyopathy? Name some associations
A dilated, flabby heart with decreased contractile function. Presents in a similar way to congestive heart failure * Alcohol * Hypertension * Haemochromatosis * Autoimuune * Thyrotoxicosis
104
What is hypertrophic cardiomyopathy?
Septal/LV hypertrophy not caused by chronic pressure overload. Leading to impaired ventricular relaxation and high diastolic pressures due to stiff thickened muscles. Usually genetic causes (autosomal dominant)
105
How is hypertrophic cardiomyopathy managed?
* Beta blockers - reduce oxygen demand * Ca2+ channel blockers - reduce ventricular stiffness * Control of arrhythmias * Amiodarone (100-200mg/24hr) * Implantable defibrillator * Anticoagulation if AF * Myomyectomy
106
What is restrictive cardiomyopathy?
Abnormally rigid ventricles with impaired diastolic filling but usually normal systolic function. Due to fibrosis or infiltration. * Idiopathic * Scleroderma * Infiltrative - sarcoidosis / amyloidosis * Storage disease - haemochromatosis
107
Name some causes of acute pericarditis
* Viral - coxsackie, influenza, Epstein-Barr, varicella * TB (from mediastinal lymph nodes) * Pyogenic bacteria (pneumococcus / staph * MI * Uraemic (dialysis) * Metastatic * HCTD * Drugs (procainamide)
108
Describe the clinical features of acute pericarditis
* Sharp and pleuritic chest pain * Worse on inspiration and lying flat * Relieved by sitting forward * Dyspnoea * Fever * Pericardial friction rub on auscultation
109
Describe some investigations into acute pericarditis
* ECG - global ST elevation (saddle shaped) and PR depression * Bloods - WCC, ESR, CRP, troponin I, viral serology * Echo - pericardial effusion? * TB skin prick * Serology * Malignancy (metastases)
110
How is acute pericarditis treated?
* Rest * Pain relief - analgesia/NSAID * Corticosteroids if sever * Antibiotics * Catheter drainage Treat cause
111
Name some causes of pericardial effusion
* Any cause of pericarditis * Hypothyroidism (Inc. capillary permeability) * Congestive heart failure (Inc. hydrostatic pressure) * Cirrhosis/nephrotic syndrome (dec. oncotic pressure)
112
Describe the clinical features of of pericardial effusion
* Dull constant ache in left side of chest * Compression of adjacent structures * Dysphagia * Dyspnoea * Hoarseness * Hiccups * Pericardial rub on auscultation * Soft heart sounds
113
How is pericardial effusion treated?
* Treat cause * Pericardiocentesis * Send fluid for culture (TB)
114
What is cardiac tamponade?
Progression of pericardial effusion to compression of cardiac chambers which causes poor ventricular filling and cardiac output
115
Name some causes of cardiac tamponade
* Same as pericardial effusion * Neoplastic * Viral * Uraemic (haemodialysis) * Acute haemorrhage * Chest trauma * Surgery * LV rupture * Dissection Aortic aneurysm
116
Describe the clinical features of cardiac tamponade
* Sinus tachycardia * Becks triad * Hypotension with pulsus paradoxus * Raised JVP * Quiet precordium (muffled heart sounds) * Kussmauls sign
117
Name some causes of aortic aneurysms
Abnormal localised dilatation \> 50% of normal vessel width * Cystic medial necrosis (degeneration) * HCTD * Marfans * EDS * Atheroscelerosis + risk factors * Genetic * Arterial wall infections * Vasculitis
118
Describe the clinical features af aortic aneurysm
* Pulsatile mass * Compression * Trachea - cough, dyspnoea, pneumonia * Oesophagus - dysphagia * Recurrent laryngeal nerve - hoarseness * Aortic regurg * Abdo/back pain
119
Describe the clinical features of a ruptured aortic aneurysm
* Hypotension * Haemothorax / pericardial effusion * Into abdomen * Abdo pain * Radiates to back / iliac fossa / groin
120
How is a ruptured aortic aneurysm treated?
* ABCDE * Fluid resuscitation (2 large bore cannulae) * Target systolic 90 * Cross match 6 units * Activate massive haemorrhage protocol * Pain relief * FBC, U+E, clotting * ABG * ECG * Refer to vascular surgeon urgently
121
Name some causes of aortic dissection
* Chronic hypertension * Ageing (6th/7th decades) * Cystic medial necrosis * HCTD * Traumatic insult
122
Describe the clinical features of aortic dissection
* Sudden, severe pain in anterior chest * Rupture = haemothorax / pericardial effusion * Compression = MI / stroke / visceral ischaemia / renal failure * Aortic regurg * Hypertension * Unequal arm pulses
123
How is aortic dissection treated?
* Beta blockers (lower BP and HR) * Vasodilators (lower BP) * Surgical repair - suture / graft
124
What are the indications for the insertion of a pacemaker?
* Complete AV block (3rd degree) * Mobitz II heart blok * Persistent AV block after MI * Symptomatic bradycardias * Drug-resistant tachyarrhythmias
125
What is the GRACE score?
Predictor of 6-month mortality for patients with ACS
126
What is the CHADSVASC score?
Calculator for the risk of developing stroke in AF patients
127
Name some complications of infective endocarditis
* Cardiac - heart failure, perivalvular abscess, pericarditis * Septic emboli * Neurological - stroke, brain abscess, meningitis * Renal - renal infarction or abscess * MSK - vertebral osteomyelitis, septic arthritis
128
What organism is most likely to cause endocarditis in an IVDU? Which valve?
Organism - staph aureus Valve - tricuspid

IPE (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions