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Phase 3b > CARDIOLOGY > Flashcards

CARDIOLOGY Flashcards

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1
Q

what is the most common cause of mitral stenosis

A

rheumatic fever

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2
Q

Hypoglycaemia with impaired GCS

A

give IV Glucose if there is access- 100 ml of 20%

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3
Q

Management of hypoglycaemia

A

In patients with hypoglycaemia causing a low GCS, the BNF advises IV glucose administration if there is IV access. An alternative is IM glucagon - not IV glucagon. In this instance, the patient has IV access and so the STAT dose of IV glucose can easily be administered. If the GCS was not impaired, than proprietary products of quick-acting carbohydrate such as GlucoGel® can be given or alternatively the above-mentioned soft drinks.

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4
Q

What calcium channel blocker should never be prescribed with a beta blocker

A

verapamil - has rate limiting effects, so if prescribed with BB can cause complete heart block

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5
Q

first line management for angina

A

beta blocker or ccb
gtn
statin

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6
Q

what medication for angina do patients become tolerant to

A

nitrites

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7
Q

what is De Musset’s sign

A

head bobbing with aortic regurge

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8
Q

changes to NICE hypertension guidelines

A

lowering the threshold for treating stage 1 hypertension in patients < 80 years from 20% to 10%
angiotensin receptor blockers can be used instead of ACE-inhibitors where indicated
if a patient is already taking an ACE-inhibitor or angiotensin receptor blocker, then a calcium channel blocker OR a thiazide-like diuretic can be used. Previously only a calcium channel blocker was recommended

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9
Q

what ecg change can hypokalaemia cause

A

long qt

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10
Q

what are the acquired causes of long qt

A

Electrolyte imbalance: hypokalaemia, hypocalcaemia and hypomagnesaemia
Medications: in addition to those listed in the subject notes below: tramadol, metoclopramide and domperidone.
CNS lesions: subarachnoid haemorrhage and ischaemic stroke
Malnutrition
Hypothermia

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11
Q

drugs that cause long qt

A 
amiodarone, sotalol, class 1a antiarrhythmic drugs
tricyclic antidepressants, selective serotonin reuptake inhibitors (especially citalopram)
methadone
chloroquine
terfenadine**
erythromycin
haloperidol
ondanestron
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12
Q

First line anti hypertensive for diabetes pt

A

ACE inhibitor

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13
Q

Causes if aortic dissection

A 
Marfans 
HTN 
Bicuspid aortic valve 
Pregnancy 
Traumatic injury 
Atherosclerosis (calcium deposits in aorta)
High intensity weight lifting
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14
Q

Signs of aortic dissection on CXR

A

Widened mediastinum
Calcification of aorta
Double layer in aorta (calcification and then blood where dissection has occurred)
Covid

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15
Q

What does a small and large square represent time wise on an ecg

A

Small square = 0.04 s

Large square = 0.2 s

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16
Q

what length of time does the rhythm strip at the bottom of ecg show

A

10 s

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17
Q

how can you quickly calculate hr from ecg

A

300/ number of big squares

count the number of QRS across rhythm strip and x by 6 as it is 10s

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18
Q

what is a normal range for corrected QT for men and women

A 
men = 0.45
women = 0.47
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19
Q

what do the ecg waves represent - from p, qrs, t

A
  • P wave - atrial depolarisation
  • Q wave - septal left side first deflection
  • R wave - septal (early ventricular) depolarisation
  • S wave - circumference (late ventricular) depolarisation
  • T wave - ventricular repolarisation
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20
Q

how does a posterior infarct look om ecg

A

st depression in v1 and 2

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21
Q

method for reviewing an ecg

A 
rate 
rhythm 
axis (reaching inwards R, leaving L)
segments - st (character)
waves - p and t (bipid p waves, tall tented t waves) 
intervals - pr, qrs, qt (time)
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22
Q

what 10 rules should you check in an ecg

A

PR interval should be 120 - 200ms. 3-5 little squares
QRS should not be more than 120 ms, <3 small squares
QRS should be dominantly upright in leads I and II
QRS and T waves should have the same general direction in the same limb lead
All leads are negative in aVR.
The R wave must from V1 to at least V4; S wave must grow from V1 - V3, and disappear in V6
ST segment should start isoelectric, expect in V1 and V2 where it may be elevated
P waves should be upright in I, II and V2 - V6
There should be no q wave or small q wave, less than 0.04 in I, II, v2-v6
T wave must be upright in I, II, v2-v6.

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23
Q

signs of ischemia on ecg

A

ST depression, t wave inversion

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24
Q

signs of hyper acute MI

A

Tall (giant) T waves

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25
what do bifid p waves show (p mitrale)
left atrial enlargement
26
what do tall p waves show (p pulmonale)
right atrial enlargement
27
what does a short PR interval indicate
WPW - accessory pathway
28
what does a long PR interval indicate
1st degree heart block
29
how deep is a pathological q wave
>2 mm
30
How can you look for BBB, how can you work out which side it is on
Look in precordial leads (chest leads) Look at V1 - the defection will tell you if its L or R Look if it is widened If it is widened and has a positive deflection in V1 = RBBB bc the later RV depolarisation (via current from LV) is moving towards V1 electrode = positive If it is widened and has a negative deflection in V1 = LBBB bc the later LV depolarisation is moving away from V1 electrode
31
How can an MI show on an ecg
Giant T waves ST elevation LBBB ST depression - anteroseptal leads (V1-4) - posterior
32
How can an MI show on an ecg
Giant T waves ST elevation LBBB ST depression - anteroseptal leads (V1-4) - posterior (also possibly ?posterior infarct with inferior ST depression)
33
What are the causes of BBB
1. Ventricular strain - PE, RHF, COPD (RBBB), Valve disease (AS - LBBB) 2. Vascular - Ischemia/ infarct - MI - LBBB
34
What BBB is most commonly associated with an MI
LBBB
35
What is a hemi block on ecg
When the QRS is not widened
36
What is a bifasicular block, and causes
When 2 of the 3 conducting pathways are blocked LBBB is always bifasicular RBBB plus anterior or posterior hemiblock is a bifasicular block
37
How can you tell right and left ventricular hypertrophy on ecg
R - look in R leads V1, V2 - S+R >10 | L - look in L leads V5, V6 - S+R >45
38
What is a delta wave
J-like sloping where Q wave should be | Sign of aberrant pathway
39
What is an epsilon wave
Wave that shows R ventricular dysplasia/ cardiomyopathy
40
What is an osborne or 'J wave'
Sign of hypothermia
41
PE ECG trace
s1, q3, t3
42
What is brugada syndrome What are symptoms What are changes on ecg
Genetic disorder affecting sodium channels Can cause arrhythmias at rest and during sleep Symptoms - syncope/ blackouts ECG changes 3 types: type 1 - ST elevation V1 - sharks tail type 2 - saddle v2,3 type 3 - saddle v2,3
43
How does hypertrophic cardiomyopathy look on ecg
LVH changes (large R waves) plus T wave inversion and st segment depression
44
List some ecg findings with coronary artery disease
``` Pathological (>2mm) Q waves ST depression T wave inversion and peaking BBB AV block ```
45
what is the definition of st elevation on ecg
ST elevation >1 mm in 2 limb leads next to each other | ST elevation >2mm in 2 precordium leads next to each other
46
Explain the temporal ecg changes that occur with myocardial ischemia
J segment depression (where S meets isoelectric line) ST depression ST elevation U wave inversion
47
Explain the temporal ecg changes that occur with myocardial infarction (transmural)
``` Peaked/ giant t waves (minutes) ST segment elevation/ progression (mins - hours) Loss of R wave (hours - days) T wave inversion (days) T wave normalisation (weeks to months) ```
48
how many leads should a q wave be in
2 or more
49
Infarct of which coronary artery can affect the SA and AV nodes
right coronary
50
what are the different classes of antiarrhythmics
I - sodium blockers II - beta blockers III - K+ blockers IV - calcium blockers
51
pharmacological management of tachycardia in acute heart failure
never beta blockers | can use digoxin if need to - negative inotrope, positive chronotrope
52
what should you never use in acute heart failure
beta blockers
53
what should you consider when prescribing digoxin
kidney function | can overdose if have ckd as need dose adjustments
54
what is the half life of amiodarone, what does this mean clinically
around 50 days | need high loading doses
55
what is the effect of amioderone on the liver
it is an enzyme inhibitor so it can prevent other medicines from being metabolised eg when prescribed with digoxin, digoxin dose must be halved
56
what arrhythmia can amiodarone cause
long qt | should not be prescribed with other medicines that can cause long qt
57
combination of which two cardio drugs can cause AV block
Beta blockers and verapamil
58
what is the definition of sinus bradycardia
HR <60 bmp
59
what drug can be given for sinus bradycardia
atropine
60
what drugs can cause AV block
Beta-blockers Rate limiting calcium-channel blockers (e.g. diltiazem, verapamil) Digoxin
61
List some of the causes of AV block
``` Cardiomyopathy Conduction system fibrosis Connective tissue disease Hypothyroidism Ischaemic heart disease Radiotherapy Sarcoidosis ```
62
explain first, second and third degree AV block
first = long PR interval (atria) second = mobitz type 1 is when there is increasing PR interval then the QRS drops (AV node) type 2 is when the QRS drops randomly - usually in a certain ration eg 3:1 (bundle of his) third = no relationship between p and qrs (below AV node) - if QRS is narrow escape rhythm has come from just below AV node, if wide from further down in ventricles
63
describe an approach to differentiate different tachyarrhythmias
1. is the qrs regular, if irregular = AF 2. is qrs narrow or broad - narrow above AV, wide below 3. P wave morphology and P:R ratio P waves normal and P:R 1:1 = sinus tachycardia P waves abnormal and P:R 1:1 = focal atrial tachycardia no p waves = AVRT or AVNRT p wave rate >250 = flutter P:R 2:1 or greater = re-entrant tachy with AV block
64
what drug management should you give to an unstable patient with a tachy arrhythmia
Intravenous adenosine (providing there is no contraindication) at a dose of 6 mg, then if no effect 12 mg, then if no effect a further 18 mg (maximum total dose of 36 mg). This should temporarily lead to AV blockade and so provide more information regarding the underlying rhythm (e.g. is there underlying AF?)
65
what are the main drugs associated with long QT
Macrolide antibacterials (e.g. erythromycin), many antipsychotics and tricyclic antidepressants have all been associated with a prolonged QT. Baseline ECGs are often recommended.
66
In which patients is flecanide contraindicated in
ischaemic heart disease or known structural cardiac abnormalities
67
list some contraindications to cardioversion
Contraindications to anticoagulants Structural heart disease Permanent AF (usually more than 12 months) A history of multiple failed attempts are/or relapses even with concomitant use of antiarrhythmics or non-pharmacological approaches An ongoing but reversible cause of AF
68
which cardiac drugs can induce AV block
antiarrhythmics

Phase 3b (13 decks)

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