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Final year Medicine > Cardiology > Flashcards

Cardiology Flashcards

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1
Q

Define SVT

A

Rate > 100bpm

QRS <120ms

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2
Q

Causes of SVT

A

AF
AVRT
AVNRT

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3
Q

Management of SVT

A
  1. O2 and IV access
  2. Regular rhythm-> Continuous ECG
  3. Vagal manoevres. (valsalva/carotid sinus massage)
  4. Adenosine 6mg → 12mg → 12mg (verapamil 5mg over 2 mins if asthma/fails) can cause chest tightness.
  5. Amiodarone/digoxin/atenolol.

if haemodynamic compromise -

  1. Sedate
  2. DC cardiovert
  3. Amiodarone 300mg over 20-60mins.

Prophylaxis: Beta blockers, AVRT: flecainide AVNRT: verapamil.

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4
Q

Wolf parkinson white define + ECG + management

A 
Congenital accessory conduction pathway between atria and ventricles. 
Short PR interval. 
Wide QRS (delta wave/slurred upstroke)
ST-T changes.

Mx: Refer to cardiology
Sotalol (not if AF), Flecainide, Amiodarone
Electrophysiology
Ablation of accessory pathway.

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5
Q

Definition and Causes of Bradycardia

A

<60bpm

DIVISIONS

Drugs: Antiarrythmics type 1a (procainamide), amiodarone
B blockers
Ca channel blockers
Digoxin

Ischaemia (inferior MI)

Vagal hypertonia (athletes, vasovagal syncope, carotid sinus syndrome)

Infection (viral myocarditis, Rheumatic fever, infective endocarditis)

Sick sinus syndrome (damage to SAN/AVN/conducting tissue - SVT /sinus brady +/- arrest/SA/AV block).
tx: PACE (brady) AMIODARONE (tachy)

Infiltration (restrictive/dilated cardiomyopathy)

  • Autoimmune
  • Sarcoid
  • haemochromatosis
  • amyloid
  • muscular dystrophy

O
Hypothyroid
Hypokalaemia
hypothermia

Neuro (raised ICP)

Septal defect (primum ASD)

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6
Q

Management of bradycardia

A

Asymptomatic Rate >40 -> No treatment

Rate <40 -> treat underlying cause

  • Medical - Atropine 0.6-1/2g IV, Isoprenaline IVI
  • External Pacing.
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7
Q

Causes of AF

A

Common: IHD, Rheumatic Heart disease, Thyrotoxicosis, Hypertension

Other: Alcohol, Pneumonia, PE, Post op, Hypokalaemia, RA.

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8
Q

Management of Acute AF <48h

A

Haemodynamically unstable: HR >150, chest pain, critical perfusion.

  1. DC cardiovert.TOE guided. sedation/anaesthesia. give LMWH
  2. IV amiodarone. 300mg over 1h (check tfts, pulm fibrosis, photosensitive, liver function).
Stable: 
Control ventricular rate: 
1. Diltiazem or verapamil or metoprolol
2. Digoxin or amiodarone 300mg IV over 60mins (LMWH +) then 900mg over 23h. . 
3. LMWH
4. Cardiovert:

Flecainide (no LV dysfunction, coronary disease), Amiodarone or electrical.

If sinus restored, no RFs, dont need long term anticoagulation.

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9
Q

Management of persistent AF

A

> 7days

CCF/<65/first presentation/secondary to treated precipirant -> RHYTHM CONTROL

  1. TTE (structural abns)
  2. WARFARIN/DOAC 3 weeks.
  3. SOTALOL/Amiodarone 4 weeks if failure risk
  4. Electrical cardioversion/pharmacological
  5. 4 weeks of anticoagulation after.

Rate control: -> <90

  1. B blocker
  2. add Digoxin
  3. amiodarone

Can RFA, Maze procedure, Pacing.

CHAD2DS2VAS score determines necessity of anticoagulation in AF

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10
Q

CHa2DS2 VAs score

A 
Determines necessity of anticoagulation in AF
CHF:1
HTN: 1
Age>75 (2) 65-74 (1)
Diabetes:1 
Stroke/tia/vTE: 2
Vascular disease (MI/Peripheral artery disease/aortic plaque)1 
Sex (female 1)
Score 0-1 - None/ANtiplatelet
>1 - Doac
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11
Q

STEMI mx

A

12 lead ECG

O2 aim 94-98

IV access - FBC,U+E, glucose, Lipids

Brief assessment - CVD hx, Thrombolysis CIs, CV exam

Aspirin 300mg PO, Clopidogrel 300mg PO

Analgesia - morphine 5-10mg IV
metoclopramide 10mg IV

ANti ischaemia - GTN 2 puffs, B blocker atenolol 5mg iv

LMWH

Admit for CCU monitoring - arrythmias

<12h Primary PCI

> 24h - thromboylysis - Alteplase,

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12
Q

Continuing therapy STEMI

A 
ACEi (within 24h) e.g. lisinopril 2.5mg
B blocker (bisoprolol 10mg OD)
Cardiac rehab - exercise/info/manual
Aspirin Lifelong. 75mg. Clopidogrel 75mg 12 m
Statin (atorv 80mg)

Advice: stop smoking, diet, exercise, work 2m, sex 1m, driving 1m

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13
Q

NSTEMI mx

A 
Aspirin 
Clopi
Fondaparinux 2.5mg SC
morphine 5-10mg
Metoclopramide  10mg IV
GTN, B blocker,

HIGH RISK: Persistent/Recurrent ischaemia, ST depression, DM, positive trop -> Angiography +/- PCI in 96h. Tirofiban,eptifabatide

LOW RISK: no further pain, flat/inverted t waves/ normal ECG, neg trop . -> d/c in 12h if trop neg.
OP angio, perfusion scan, stress echo.

stop LMWH - when pain free/3-5 days

ongoing mx ; Same as STEMI 
Acei 
B blocker
cardiac rehab
statin

Aspirin lifelong, clopi 1 yea

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14
Q

CCF Mx

A
  1. ACEi/ARB
  2. B blocker (increase) e.g. bisoprolol
  3. Frusemide
  4. Lifestyle advice - smoking , exercise, salt, weight, exercise, aspriin, statins.

(specialist advice)

  1. spironolactone
  2. Hydralazine + ISDN
  3. Digoxin

LEVF <35%: ICD
transplant

<30% LBBB
cardiac resynchronisation therapy w BV pacemaker

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15
Q

Acute HF (severe pul edema mx)

A 
sit up
o2
IV access + ECG (trop, fbc, u+e, BNP, ABG) 
Diamorphine 2.5mg + metoclopramide 10mg
Frusemide 40-80mg IV
GTN
hypotensive: Inotropes
CPAP, ISMN infusion

Monitor: BP, HR, RR, JVP, UO, ABG

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16
Q

Cardiogenic Shock MX

A 
ABCDE
O2 
Diamorphine 2.5mg + metoclopramide 10mg
correct arrythmias, Electrolyte, acid base
CXR, ECHO, CT 
Consider FLuids, CPAP
Monitor CVP, BP, ABG, ECG, UO
Consider Dobutamine
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17
Q

Causes cardiogenic shock

A 
MI 
Hyperkalaemia
Endocarditis
Aortic dissection
Rythm disturbance
Tamponade

Obstructive - Tension PTX
Massive PE.

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18
Q

Tamponade Signs

A

Becks triad: low BP, high JVP, muffled HS
Kussmauls sign: raised JVP on inspiraion
Pulsus paradoxus - pulse fades on inspiration.

IX: ECHO
CXR- globular heart.

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19
Q

Hypertension Mx

A

> 140/90 -> 1. ABPM
2. HBPM
Ix: risk of CVS disease
End organ damage.

> 180/120
observe for signs of retinal haemorrhage
papilloedema

  1. ACEi ARB/CCB
  2. +CCB/thiazide
  3. +both
  4. add spironolactone, alpha/beta blocker.
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20
Q

Aortic stenosis causes

A

Calcification w age
Congenital bicuspid
Rheumatic fever.

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21
Q

Aortic stenosis signs

A

ESM rt 2nd ICS
(louder sitting forward on expiration)-> carotids.

Slow rising pulse
narrow pulse pressure.
Quiet s2
forceful apex

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22
Q

Ix AS

A

Bloods: FBC, Lipids, U+E, glucose

ECG: LVH
CXR: Calcified valve
LVH, dilatation aorta.

Echo. + dopplers.
exercise stress if asymptomatic.

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23
Q

AS Mx

Study These Flashcards
A

Optimise RFs: statins, antihypertensives, DM

Monitor
B blocker if angina
HF - ACEi, diuretics.

surgical:
valve replacement if severe symptoms, low EF, undergoing CABG.

Mechanical if younger.
bioprosthetic - older.

Balloon valvuloplasty
tAVI

24
Q

Aortic regurgitation causes

Study These Flashcards
A

Acute: Infective endocarditis, Type A aortic dissection.

Chronic: Congenital bicuspid aortic valve, rheumatic heart disease, Connective tissue disease (marfans/ED) , autoimmune Ank Spond, RA.

Sx: LVF: SOBOE, PND, Orthopnea, arryhmias AF
angina.

25
Signs of Aortic regurgitation
``` Collapsing pulse Wide pulse pressure. Apex displaced. Soft S2 EDM at URSE + 3rd left parasternal. sitting forward. expiration. severe - MDM (austin flint murmur). ``` Quinkes sign -nail bed pulsation corrigans sign - pulsation.
26
AR ix:
FBC lipids, u+E, glucose ECG - LVH CXR - Cardiomegaly, Dilated aorta, pul oedema ECHO
27
AR mx
optimise Rfs monitor echo reduce HTN (reduce afterload) Surgery - replacement. if HF, LV dysfunction
28
Mitral stenosis causes
Rheumatic fever prosthetic valve congenital (rare)
29
MS pathophysiology
Valve narrows -> increased left atrial pressure -> Loud S1 /atrial hypertrophy -> AF pul oedema /pul htn -> loud p2/PR -> RVH -> left parasternal heave. TR-> v waves RHF -> JVP , oedema, Ascites.
30
Signs of Mitral stenosis
``` AF Malar flush JVP - a waves, v waves. LEft parasternal heave. Tapping apex. Loud S1 Loud P2 (PHT) Rumbling mid diastolic murmur at apex. radiates t axilla . Graham steel murmur if pR. ```
31
ix of MS
``` Bloods ECG - AF RVH - ST dep/Twi v1-2. CXR - LA enlargement, Pul oedema, calcification ECho + doppler. Catheterisation assess coronarys. ```
32
Mx: MS
``` Optimise RFs Monitor echo Pen V - rheum fever prophylaxis. AF - rate control/anticoagulate. Diuretics - ``` Surgical - mod severe - PERCUTANEOUS BALLOON VALVULOPLASTY surgical valvotomy replacement.
33
Mitral regurgitation causes
``` Mitral valve prolapse LV dilatation (AR/AS/HT) Calcification Post Mi - papilary rupture rheumatic fever connective tissue disease inf endoc ```
34
Signs MR
AF SOB, fatigue, pul HTN, oedema Left parasternal heave displaced apex - > volume overload - > eccentric hypertrophy Soft S1 loud p2 blowing Pan systolic murmur apex -> axilla
35
Ix MR
``` BLoods Ecg - LVH, AF p mitrale CXR- LA/lv hypertrophy pul odema Echo + doppler ```
36
Mx MR
optimise RFs monitor echo af rate control nad anticoagulate drugs -> reduce afterload - ACE i / b blockers, diuretics Surgical - replacement or repair. severe.
37
TR Causes, Symptoms, Signs, Ix, Mx
Causes: RV dilatation, rheum fever, infective endocarditis, carcinoid Symptoms: Fatigue, Hepatic pain on exertion ascites, oedema ``` Signs: raised JVP (giant Vwaves) RV heave PSM LLSE (on inspiratin) pulsatile hepatomegaly jaundice ``` Ix: LFTs, EcHO MX: tx cause, diuretics, acei, digoxin, valve replacement.
38
Infective endocarditis RFs
``` Cardiac disease: -> subacute. Normal valves -> acute Prosthetic valves degenerative valvulopathy vsd, PDA, CoA Rheumatic fever Dental caries post op wounds IVDU (tricuspid) Immunocompromised ```
39
Infective endocarditis Casues
Culture +ve S viridans S aureus ``` Culture neg Haemophilus Actinobacilus cardiobacterium eikenella Kingella Coxiella chlamydia ``` Non infective SLE Marantic (libman sacks)
40
Clinical features Infective endocarditis
``` sepsis - fever, rigors nt sweats wt loss anaemia splenomegaly clubbing ``` Cardiac - new/changing murmur MR 85%, AR 15% aV block LVF Embolic - abscesses brain, liver, heart, kidney , spleen, gut. Janeway lesions ``` Immune complex - Micro haematuria (GN) Vasculitis roth spots splinter haemorrhages oslers nodes ```
41
Dukes criteria IE
2 major 1 major 3 minor 5 minor Major: 1. +ve blood culture (2 separate cultures, e.g. 3 12 h apart) 2. +ve echo - > vegetation, abscess, valve dehiscence, new regurgitation murmur. Minor: 1. Predisposition (cardiac lesion/ IVDU) 2. fever >38 3. Emboli (septic infacts, splinters, janeways) 4. Immune phenomenon (GN common, Oslers, roth spots, RF) 5. +ve blood culture not meeting criteria.
42
Ix IE
``` Bloods Normochromic normocytic anaemia ESR CRP IgG RF Cultures 3 x 12 h apart. serology ``` urine - micro haematuria ECG: AV block/LVF Echo - TTE - Vegetations >2mm TOE (more sensitive )
43
Mx: IE
Empiric: Acute severe: Fluclox + gentamicin IV Subacute: Benpen + gent IV rifampicin if staph surgery - if HF, Emboli, valve obstruction, prosthetic valve.
44
Rheumatic fever | Cause
Group A strep (strep pyogenes) cross reactivity t2 hypersensitivity
45
Jones criteria
``` Evidence of GAs infection - +ve throat culture -rapid strep ag test -ASOT increase , DNase B - recent scarlet fever + 2 major - Carditis -arthritis -Sydenhams chorea -Erythema marginatum -Subcutanoeus noduels ``` 1 major + 2 minor - Fever - ESR, CRP - Arthralgia - prolongedPR - prev rheum fever
46
Ix Rheum fever
BLoods: strep ag test ASOT titire FBC ESR,CRP ECG ECHO
47
Mx rheum fever
Bed rest until CRP normal for 2 weeks BENpen 0.6-1.2mg IM 10 days analgesia NSAIDS can use haldol or diazepam for chorea
48
Causes of pericarditis Ix, MX:
Viral: Coxsackie, Flu, EBV, HIV Bacterial: pneumonia, rheumatic fever, TB, staph Fungi MI, Dresslers Drugs: penicillin, isoniazid, procainamide, hydralazine Other: uraemia, RA, SLE, sarcoid, Radiotherapy. Ix: ECG: saddle ST elevation + PR depression bloods: FBC, esr, trop, cultures, virology. Mx: Analgesia - ibuprofen 400mg PO /8h consider steroids, immunosuppression txcause
49
Symptoms and Signs of HOCM
Sx: Angina, SOB, Palpitations (AF/WPW/VT) exertional syncope Sudden death Signs: Jerky pulse Double apex beat Harsh ESM @LLSE S4
50
Ix and MX of HOCM
ECG, ECHO - assymetric septal hypertrophy Mx: Medical : 1. B blocker, 2. verapamil Amiodarone if arrhythmias anticoagulate if AF/emboli Septal myomectomy if severe sx. consider ICD
51
causes of dilated cardiomyopathy
``` Dystrophy Infection (myocarditis) Late pregnancy Autoimmune (SLE) Toxins (etoh, doxorubicin, cyclophosphamide, DXT) Endocrine (thyrotoxicosis) ```
52
Cardiac causes of clubbing
Infective endocarditis Congenital cyanotic heart disease Atrial myxoma
53
Broad complex Tachycardia definition
Rate > 100bpm | QRS > 120ms
54
Broad complex tachy Differentials
VT Torsades de points SVT with BBB
55
Causes of VT
IM QVICK Infarction (esp with ventricular aneurysm) Myocarditis QT interval Valve problem (AS, mitral prolapse) Iatrogenic ( digoxin, antiarrythmics, catheter) Cardiomyopathy (dilated) K (hypokalaemia, hypomagnesemia, hypoxaemia, acidosis).
56
Mx of VT
O2 + IV access Unstable -> sedate -> DC cardioversion (200-300 - 360J)/amiodarone (300mg over 20-60m) then 900mg over 23h. Stable - Correct electrolyte problems (e.g. 60mM KCL @ 20mm/h. /4ml 50% MgSO4 in 30mins. ``` Regular rhythm (VT) -> Amiodarone, lignocaine. ``` Irregular (AF + BBB) -> Flecainide /Amiodarone TDP -> MgSO4 2g IV over 10mins fails-> DC cardiovert.
57
Indications for a pacemaker
``` Sinus node dysfunction: -symptomatic sinus bradycardia. -complete heart block -symptomatic 2nd degree. chronic bifasicular block. Cardiac transplant Post MI HOCM Severe HF Congenital heart disease ```

Final year Medicine (18 decks)

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