Cardiology & Cardiac Surgery Flashcards

Question

Best indicator of myocardial re-infarction?

Answer 1

CK-MB - short half-life of 12 hours

Answer 2

CK elevated Troponin detectable ECG ST depression, no Q wave

Answer 3

Yes! If not the risk of embolic event and stroke is very high. Warfarin for 4 weeks before and maintain therapeutic INR for 4 weeks after the electrical cardioversion. ~ 8 weeks in total!

Answer 4

Fibrates (fenofibrate or gemfibrozil) - Triglyceride Fish oil is second line Statins - LDL or TC Other lipid-lowering drugs in the market: Nicotinic acid, bile acid resins (isolated cholesterolaemia), ezetimibe inhibitors, fish oil

Answer 5

Transaminase is persistently x3 above upper limit CK is x 10 the upper limit Persistent unexplained muscle pain

Answer 6

Low Risk: every 5 years Moderate Risk: every 2 years High Risk: every year

Answer 7

Viral or idiopathic **First line treatment: NSAIDS (7-10 days) + Colchicine (3 months)**

Answer 8

Clinical manifestations Blood cultures (or other microbiological data) ECHO - vegetation Modified Duke’s Criteria

Answer 9

1. Diet rich in mono- and poly-unsaturated fat 2. Diet low in glycaemic index carbohydrates food 3. Weight loss by caloric restriction and exercise 4. Consider marine omega 3 fatty acids (fish oil) and fibrates Aim for TG < 1.5 mmol/L

Answer 10

NO. Follow CHA2DS2-VASc Score.

Answer 11

Streptokinase Many have high levels of anti-streptokinase IgG level Resistant to streptokinase reperfusion therapy

Answer 12

V/Q scan CTPA is contraindicated as contrast-induced renal damage will be a problem.

Answer 13

- Increased risk of AF - Loud first heart sound (S1) - P2 increased in intensity and widely transmitted as pulmonary HTN develops - Murmur: low-pitched diastolic rumble (heard at apex, using bell of stethoscope, laying patient at left side) - Mild MS: murmur in late diastole, just before S1, called presystolic accentuation. NO THIRD HEART SOUND

Answer 14

Likely viral myocarditis Give one dose of frusemide, then Send to hospital as URGENT TTE is required to rule out cardiomyopathy and heart failure

Answer 15

Management: **ABG or VBG** - to assess severity and need for supported ventilation Followed by ECG, cardiac troponin, serum BNP level, CXR, FBC, RP, LFT Morphine O2 Nitrates Diuretics

Answer 16

Pulmonary rales, ronchi; expiratory wheezing

Answer 17

Jones Criteria

Answer 18

Cannot pee, cannot see, cannot walk. All inflamed! Has history of GI or genitourinary infection

Answer 19

Single joint History of unsafe sex and urethral discharge

Answer 20

Common chronic disease of childhood At least 6 weeks history of arthritis prior (often with morning stiffness and spiking fevers)

Answer 21

Beta Blockers! Not recommend in those with baseline HR 60 or SBP < 90mmHg or when time is not sufficient for titration

Answer 22

Most Common: Coronary heart disease Smoking HTN Obesity DM Valvular heart disease

Answer 23

Lab tests: ECG, CBC, urinalysis, serum creatinine, potassium and albumin, and TFT. ECHO! To identify structural abnormalities and measure EF

Answer 24

- Ejection clicking in S1 + Harsh, rasping cresendo-decrescendo systolic murmur - Heard best at second intercostal space at right upper sternal border (radiates to carotid) - Carotid pulse: small and rises slowly (pulsus parvus et tardus) - In elderly, commonly heard in the apex, resembling MR - Paradoxical splitting S2 - Use diaphragm of stethoscope

Answer 25

- Airway and oxygenation assessment and management (SPO2, O2, ventilatory support, vital sings, IV access, seated posture…) - Initiate tx: prompt diuretic therapy - Then early vasodilator therapy (for severe HTN, acute MR, or acute AR); later vasodilator use Nitroprusside lowers arterial tone Nitroglycerin lowers venous tone - Urine output monitoring - VTE prophylaxis - Sodium restriction - Generally avoid opioid therapy in ADHF patients Page 130 MPlusX PDF

Answer 26

ECG: PR Interval > 200ms Causes: Increased vagal tone (younger patients / athletes) Fibrosis (elderly patients) Drugs (AV node blocking agents: BB, CCB, Digoxin) Normal Variant Coronary Artery Disease Mitral Valve Surgery Electrolyte Imbalance (hypokalaemia, hypomagnesaemia) Significance: Usually asymptomatic Occasional progresses 3x risk of developing AF If symptomatic, with PR interval > 300ms, pacemakers can be considered

Answer 27

Mobitz 1 = Wenkebach Block Mobitz 2 = Hay Block

Answer 28

ECG: - Progressively longer PR interval, followed by non-conducted beat (Due to progressively fatigue of AV cells) - Cyclical, e.g. 4:3 (P:QRS) Causes: Increased vagal tone Normal variant Myocardial Infarction (Inferior) Drugs Mitral Valve Surgery Hyperkalaemia Significance: Does not usually require treatment May cause bradycardia and hypotension - atropine, reduce AV blockers, pacing

Answer 29

ECG: - PR interval constant with intermittent dropped beat - May have fixed ration P:QRS e.g. 2:1, 3:1 Causes: Usually structural heart disease (myocardial ischaemia / fibrosis) ** Below Bundle of His in 75% - wide QRS ** Within Bundle of His in 25% - narrow QRS Significance: Often symptomatic (syncope, fatigue, chest pain, death) High risk progression 35% per year risk of asystole Requires temporary pacing —> pacemaker Atropine can precipitate Complete Heart Block

Answer 30

ECG: No correlation of P waves and QRS complexes Number of P waves > QRS complexes Causes: Inferior Myocaridal Infarction AV blocking agents (digoxin/metoprolol) Degeneration of conduction system Significance: Often symptomatic (syncope, fatigue, chest pain, SOB, death) Atropine (initial treatment), however rarely effective - Dopamine / Adrenaline are other medical options Transcutaneous/transvenous pacing (treatment of choice) —> pacemaker

Answer 31

- High blood pressure with end organ damage (retinopathy!) - BP rises rapidly + diastolic BP > 120mmHg - Histologic changes: fibrinoid necrosis of vessel wall; if not treated, may lead to death from progressive renal failure, heart failure, aortic dissection or stroke Treatment: IV sodium nitroprusside Or infusion of labetalol Nicardipine Hydralazine (pregnant women) Can give frusemide or losartan once diastolic BP is ~ 100mmHg

Answer 32

Pulmonary Hypertension Mitral valve stenosis → increase in left atrial pressure → backup of blood into lungs → increased pulmonary capillary pressure → cardiogenic pulmonary edema → **pulmonary hypertension** → backward heart failure and right ventricular hypertrophy Heart Failure Mitral valve stenosis → obstruction of blood flow into the left ventricle (LV) → limited diastolic filling of the LV (↓ end-diastolic LV volume) → decreased stroke volume → decreased cardiac output (forward heart failure)

Answer 33

Vagal manoeuvres + IV adenosine 6mg

Answer 34

- Sinus tachycardia - RBBB - T-wave inversions - S1Q3T3 commonly seen in PE **Well’s Score**

Answer 35

Fever! Followed by Anaemia New murmur/worsening of known murmur Less common ones are Haematuria Splenomegaly Splinter haemorrhages Janeway lesions (irregular, non-tender Haemorrhagic macules) Roth spots (white-centred retinal haemorrhages)

Answer 36

Blood cultures At least 3 sets of blood cultures from different venipuncture site must be obtained PRIOR to starting antibiotics (for clinically stable patients) OR empirical antimicrobials therapy (for clinically unstable). Regardless, blood cultures must be repeated every 2-3 days from the initiation of antibiotics until bacteraemia is cleared.

Answer 37

**Modified Duke's Criteria** Definitive Diagnosis: 2 major criteria or 1 major and 2 minor criteria or 5 minor criteria Possible Diagnosis: 1 major and 1 minor criteria or 3 minor criteria

Answer 38

**Central Retinal Artery or one of its branches** Phenomena: amourosis fugax Cholesterol emboli (Hollenhorst plaques) may be seen on fundoscopic examination even on asymptomatic patients.

Answer 39

IV BB to control HR IV nitroprusside to control BP (titrate to SBP < 120mmHg) Diagnose with TEE / MR / CTA Urgent surgery may be required in proximal type aortic dissection.

Answer 40

Rate-control: - BB - Diltiazem/verapamil - Digoxin (if needed to add a second drug) Usually BB +/- Digoxin is preferred. Long term management will require anticoagulation as well if CHA2DS2-VASc score is 2 or above to prevent thromboembolism or for planned pericardioversion procedure.

Answer 41

Central Venous Pressure is affected by a variety of factors. Increase CVP: Vasoconstrictor drugs PPV (with/without PEEP) Mediastinal compression Hypervolaemia APO (when clinically significant) Decrease CVP: Sepsis (releases vasodilator mediator and loss of intravascular plasma volume)

Answer 42

**Coxsackievirus B infection** Acute illness with fever and/or flu-like symptoms and painful spasms of chest and upper abdomen due to irritation of the pleura and muscles Most common cause of viral myocarditis Case: Cough, sore throat, fever that develops into chest pain after several days

Answer 43

Left ventricular hypertrophy (LVH)

Answer 44

- LA enlargement (“P mitrale”) - LVH a/w ST segment / T-wave abnormalities - Deep, narrow (“dagger-like”) Q waves in the lateral > inferior leads - Giant precordial T-wave inversions in apical HCM - Signs of WPW (short PR, delta waves) - Dysrhythmias: AF, SVT, PACs, PVCs, VT

Answer 45

Renal Failure! Impaired renal function Low EGFR

Answer 46

PAOP or wedge pressure: pressure (pulmonary artery waveform) measured by wedging a pulmonary catheter with an inflated balloon (slow injection) into a SMALL pulmonary artery branch. **Pulmonary vein stenosis** - most commonly a/w prior radiofrequency ablation procedures for AF in adults Pulmonary disease and respiratory failure —> cause PAOP/PAWP to exceed the LV end-diastolic pressure due to constriction of small veins in hypoxic lung segments.

Answer 47

- Heart failure with preserved ejection fraction/LV function (HFpEF) - Stiff LV with decreased compliance and impaired relaxation —> increased end diastolic pressure DX: Doppler ECHO Diastolic dysfunction and HFpEF are not synonymous. Diastolic dysfunction = functional abnormality/abnormal mechanical properties of the ventricle; part of normal human aging; risk factor for developing HFpEF HFpEF = six of clinical HF in a patient with normal LVEF and LV diastolic dysfunction

Answer 48

- Diuretics - Vasodilators (e.g. nitrates) - Arteriaal vasodilators (hydralazine) - Digoxin and other inotropic drugs

Answer 49

Stage 1: Diffuse ST elevations PR segment depression ST depression in aVR and V1 Stage 2: normalisation of ST changes, generalised T waves flattening (1-3 weeks) Stage 3: flattened T waves becomes inverted (3 to several weeks) Stage 4: ECG returns to normal (several weeks onwards) Other ssx: pericardial friction rub

Answer 50

- Low QRS voltage - Tachycardia - Electrical alternans

Answer 51

Stop Warfarin 3-5 days before surgery, Once INR < 2, Start bridging with a therapeutic dose of unfractionated heparin or LMWH. Last dose of LMWH should be given 12-24H before surgery. Restart Warfarin within 24H of the surgery. Once INR is at therapeutic range, Cease heparin.

Answer 52

A disorder of myocardial depolarisation ECG: prolonged QT interval A/W life-threatening cardiac arrhythmias —> Torsades de pointes [Case: can be caused by tricyclic antidepressants]

Answer 53

- weak MV leaflets - weak chordiec tendinae - poor leaflets gets bowed back (rock hitting leaflet) —> click - congenital abnormality that frequently manifests in adolescents or later - common in girls > boys - autosomal dominant **O/E: Mid-systolic CLICK + apical murmur noted in late systole** **DX: ECHO - prolapse of the mitral leaflets during mid-late systole** ECG and CXR usually normal Others: - Increased risk of IE - In Australia, antibiotic prophylaxis is recommended for dental treatment in selected patients - Most common symptom: non-anginal chest pain. - Others: palpitations, dyspnea, exercise intolerance, dizziness or syncope, panic and anxiety disorders - Majority are asymptomatic - Auscultation + ECHO can diagnose in 10% of population - Possible complications: SVT and ventricular arrhythmias may result in sudden death - As clot originates from left atrium, rarely will PE take place, rather the intra-atrial formation may predispose to cerebral or peripheral embolism.

Answer 54

- Hypertension - Pulmonary Hypertension - Cardiac Hypertrophy - Congestive Cardiac Failure (x 2 of normal value) - Renal disease BNP - used to define cause of fluid overload in patient. [Not elevated in chronic liver disease]

Answer 55

**Class III antiarrhythmic drug - used other treat ventricular tachyarrhythmias such as VFib and VT - conscious patient** If patient loses consciousness, must defibrillate urgently.

Answer 56

Low-risk procedure for IE. Therefore, there is no need for antibiotic prophylaxis. [Case: has asymptomatic MVP —> still do not need antibiotic prophylaxis]

Answer 57

Test used to evaluate heart’s electrical system and check for abnormal heart rhythms Have been used to diagnose those with unexplained syncope

Answer 58

Acute thrombosis (with primary involvement of platelets) Give Aspirin immediately to dysfunction platelets from forming the thrombus and preventing further damage

Answer 59

- **Positive inotrope**: **heart muscle contracts stronger**, raising cardiac output to a normal level and increasing the amount of blood the heart can pump out. Helps organs get the blood and oxygen they need to keep working - Decreases oxygen consumption - Binds to and inhibits sodium/potassium-ATPase (sodium pump) within the plasma membrane of cardiac myocytes - Increases intracellular sodium, which in turn increases the intracellular calcium —> increased cardiac contractility.

Answer 60

1. Cease digoxin 2. **Correct K according to severity** (HYPOKALAEMIA) 3. Start cardiac monitoring for any rhythm disturbances and treat any rhythm abnormalities accordingly 4. Check digoxin level and other electrolytes in the blood 5. In certain cases, (with severe haemodynamic compromise), **Fab fragments of digoxin-specific antibodies** may be required Initial ECG: biphasic T-wave

Answer 61

Thiazide diuretic can cause hypokalaemia, making even usual doses of digoxin to cause digoxin toxicity. After ceasing digoxin, correct K and other measurements, change thiazide diuretic to another potassium-sparing diuretic or antihypertensive drug.

Answer 62

Only those with LV systolic dysfunction. Absence of such dysfunction has not been shown to improve outcomes

Answer 63

Regularly, monthly injection of penicillin - should be continued for many years - to stop only when specialist doctor advice Cause high risk of redeveloping strep throat —> acute rheumatic fever

Answer 64

- Elevated JVP - Prominent a-waves (due to increased atrial contraction pressure in pulmonary HTN often cause by large emboli) - 4th heart sound (occurs near the end of diastole at the time atrial contraction)

Answer 65

Sildenafil (PDE-5 inhibitor) Can only use after 24H of taking sildenafil/vardenafil or after 48H of taking tadalfil. Use morphine/fentanyl instead.

Answer 66

If possible, at least 12 months. High risk for stent thrombosis Requires dual-antiplatelet therapy for at least 12 months.

Answer 67

– A change in the pattern of previously stable angina with increased frequency, duration or more easily precipitated attacks. – The onset of angina at rest or with minimal exertion. – Prolonged episodes fo angina pain, lasting more than 20 minutes. – The serial troponin levels are not elevated.

Answer 68

– Acute central crushing chest pain. – The pain may radiate the jaw, neck or arms. – The duration of pain is between 1-15 minutes. – The pain may be associated with dyspnea, faintness, and relieved by glyceryl nitrate. – The ECG is usually normal.

Answer 69

Myxomas - typically pedunculated, does not involve ventricular myocardium

Answer 70

Haemodynamically stable: - IVI Amiodarone 150-300mg over 30 mins —> IVI Amiodarone 900mg over 24H Haemodynamically unstable: - Direct current cardioversion

Answer 71

Jerky, uncoordinated movement, espeically affecting hands, feet, tongue and face Movement may disappear during sleep and may get worse when they know they’re being watched. It’s related to acute rheumatic fever, post streptococcal infection

Answer 72

Cyanosis and clubbing of the lower extremities with normal upper extremity nail beds Usually diagnostic of PDA with pulmonary hypertension An occurrence of right-to-left. [In contrast, **peripheral cyanosis** is usually related to reduced extremity blood flow due to small vessel constriction; Seen in severe HF, shock, peripheral vascular disease.]

Answer 73

Does not affect mortality Reduces the need for subsequent procedure! It slowly releases a drug to block cell proliferation, preventing fibrosis and clots (thrombus)

Answer 74

- Hypothyroidism - Hypothermia - Hypocalcaemia, hypokalaemia, hypomagnesaemia... - Sotalol - Methadone - Antipsychotics: olanzapine, haloperidol, quetiapine, haloperidol and chlorpromazine - Antidepressants: TCA, SSRI

Answer 75

- Adenosine - Digoxin - CCB (verapamil) - BB (propranolol)

Answer 76

No. They do require anticoagulants (warfarin).

Answer 77

Those with decompensated HF or reduced LV systolic function

Answer 78

**Cease warfarin 2-3 days Give Vitamin K 12-18 hours before the surgery if INR not < 1.5** Bridging usually not necessary for those with low-risk AF. If urgent surgery required, can give prothrombinex or FFP to reverse the anticoagulant effect,

Answer 79

- Symptomatic severe aortic stenosis - High risk unstable angina - Acute MI - Unstable heart failure - Acute pulmonary embolism - Acute aortic dissection

Answer 80

ABCDE - Asthma - Block (heart blocks) - COPD - DM - Electrolyte (Hyperkalaemia)

Answer 81

Patient foramen ovale ASD VSD Etc.

Answer 82

TOF = pulmonary stenosis + overriding aorta + RV hypertrophy + VSD Transposition of the Great Vessels Persistent Truncus Arteriosus

Answer 83

IV Atropine 0.5mg every 3-5 minutes, max dose of 3mg in total Dopamine and epinephrine may be beneficial Not improving? Temporary cardiac pacing

Answer 84

Right Herat Failure - **peripheral oedema, raised JVP, positive hepatojugular reflux** Pulmonary Hypertension - **loud P2** Cor-Pulmonale should be suspected in anyone with COPD - globally decreased air entry

Answer 85

Chest X-Ray - first exclude pathologies that mimic PE - usually normal in PE - May present with: Focal oligemia (Westermark’s sign) Peripheral wedged-shaped density above the diaphragm (Hamptom’s Hump) Enlarged right descending pulmonary artery (Palla’s Sign) [CTA - investigation of choice for diagnosis; V/Q scan - second line]

Answer 86

Within 4-12 hours after symptoms If normal after 8-12 hours, unlikely infarct

Answer 87

Haemodynamically unstable Rhythm control first They’d usually go for electrical cardioversion (first line first), if failed, then go for pharmacological (flecainide)

Answer 88

Treat the chorea! Carbamazepine and sodium valproate (preferred over haloperidol) [Benzodiazepines is for acute anxiety disorders]

Answer 89

An exaggerated response to pressure applied to the carotid sinus located in the carotid bifurcation, resulting in bradycardia, vasodilation and hypotension. This response is manifested clinically as syncope or presyncope and can cause fatal consequences.

Answer 90

1. Those with 3VD OR LV dysfunction 2. Those with left main coronary artery disease 3. Those with comorbid conditions (DM or COPD) and 2VD [PCI with drug-eluding stents - better reserved for low-risk patients having 1VD or 2VD without the involvement of left main coronary artery]

Answer 91

1. Paget disease of the bone 2. Aortic valve regurgitation (AR) 3. Patient ductus arteriosus (PDA) 4. AV fistula 5. Thyrotoxicosis 6. Wet beriberi 7. CO2 retention 8. Atherosclerosis 9. Fever 10. Pregnancy [AS is low volume pulse due to decrease cardiac output secondary to decrease stroke volume]

Answer 92

Muffled heart sounds Hypotension Raised JVP

Answer 93

Mitral Regurgitation caused by **papillary muscle dysfunction** If EF is low, might mean that papillary muscle have ruptured.

Answer 94

- ST depression - T-wave depression —> becomes progressively smaller with marked hypokalaemia - U-wave elevation —> becomes increasingly more significant with market hypokalaemia

Answer 95

- Tall, tented T waves - Short QT interval - Prolonged PR interval - Widening QRS complex with disappearance of P waves if K > 6.5 —> can progress to VFib or asystole

Answer 96

Symptoms of heart failure and dyspnea and weakness over few days to weeks - usually starts after recent viral infection (fevers + myalgia, some may have pleuritic/angina-like chest pain)

Answer 97

- Cease the warfarin - Give IV phytomenadione (Vitamin K) 5-10mg - Consider Prothrombinex-VF - Consider Fresh Frozen Plasma - Assess until INR < 5 (and bruising improves)

Answer 98

Protamine Sulphate

Answer 99

Popliteal artery, pedal pulses.... According to anatomy

Answer 100

- usually affects distal extremities in symmetric fashion - manifests at rest and often at night - frequently a/w paresthesia/hyposthesia and decreased reflexes

Answer 101

- young males, heavy smokers - acute inflammation of the whole neurovascular bundle (arteries, veins, nerves) - Obstruction of arterial, venous blood flow + nerve involvement - Often leads to amputation of fingers and toes

Answer 102

Torsades de pointes: polymorphic VT a/w QT prolongation Most important cause: Medication (Long list) Example: - Antibiotics (erythromycin, clarithromycin, levofloxacin, clindamycin) - Class 1A and Class 3 antiarrhythmic - Some antihistamines (astemizole and terfenadine) - Some antipsychotics - Cocaine - Methadone

Answer 103

- Prosthetic valve or material used for cardiac valve repair - Previous IE - Congenital heart diseases (unrepaired cyanotic defect, completely repaired defect during the first 6 months after the procedure, repaired defects with residual defects) - Cardiac transplantation with subsequent development of cardiac valvulopathy - Rheumatic heart disease in Indigenous Australians only.

Answer 104

Stenosis > 50%

Answer 105

'E' of the JONES CAFE PAL criteria for ARF

Answer 106

Confirm by taking **throat swab** to show preceding GAS infection first and foremost. (Blood Culture is only for cases where one is unsure or unaware of GAS infection)

Answer 107

ECG FIRST, THEN CHEST X-RAY DIAGNOSE: CTPA/V/Q SCAN

Answer 108

- Women of reproductive age (< 55 years old) - Those with poor GFR (< 40) or those with progressively declining renal function - Those with known allergic reaction to contrast media

Answer 109

**Unfractioned Heparin or LMWH** - **renal diseased patient: unfractioned heparin** preferred as LMWH is excreted really. If have to use LMWH, must adjust according to GFR. After INR reaches 2-3, then warfarin for long term. Thrombolysis reserved for haemodynamically unstable patients - with no contraindications.

Answer 110

- < 2% of all phaemochromocytoma - Overproduction of catecholamines —> paroxysmal or sustained HTN - Diagnosis: measure urinary catecholamines and their metabolites

Answer 111

- a/w myasthenia gravis, agammaglobulinemia, red blood cell aplasia - Tumours are typically cystic, occurring in anterior mediastinum - Those that are a/w MG are commonly hyperplasticity (rather than neoplastic)

Answer 112

- Half the cases have renal stones - Other related disorders: peptic ulcers, pancreatitis, bone disease, CNS symptoms - Occasionally, parathyroid adenoma occur in conjunction its neoplasm of other endocrine organs AKA multiple endocrine adenomatosis.

Answer 113

Hodgkin Disease

Answer 114

- Cystic, contain poorly pigmented hair, sebaceous material and occasionally teeth - Dermoid Cysts include endodermal, ectodermal, mesodermal; occur in the gonads and CNS and mediastinum. - With rare exceptions, these lesions are benign.

Answer 115

1. Vertigo (spinning sensation / sensation of movement of the environment around the patient) 2. Disequilibrium (feeling of imbalance) 3. Light-headedness (sensation of giddiness) 4. Presyncope (faint)

Answer 116

A drop of at least 20mmHg in systolic or 10mmHg in diastolic confirms with high certainty

Answer 117

- holosystolic murmur at left sternal border - left-to-right shunt After Birth: PVR declines —> RV contracting against pulmonary vascular resistance (PVR) + LV contracting against systemic vascular resistance (SVR) —> pressure difference causes left-to-right shunting. Small VSDs: usually insignificant **Larger VSDs: - volume overload and dilation of RV —> excess volume pumped through the lungs and delivered to LA - Increased left atrial preload —> LA and LV also enlarges THEREFORE, see enlarged left heart contour and and RV**

Answer 118

The left-to-right shunt through a large VSD reverses to right-to-left flow Over years Causing cyanosis

Answer 119

- Often secondary to viral pericarditis (+/- pleural effusions) - ECG: ‘’electrical alternans” (QRS complexes whose amplitudes vary from beat to beat = heart swinging back and forth within an increased quantity of pericardial fluid) + Jugular vein distension, muffled heart sounds, borderline low BP developing cardiac tamponade - CXR: Enlargement of cardiac silhouette often seen - ECHO is confirmatory

Answer 120

- a type of heart arrhythmia caused by an accessory pathway, or an extra electrical conduction pathway, called the Bundle of Kent. It connects the atria and ventricles, or the upper and lower chambers of the heart. - In WPW, the ventricles start to contract a little bit early, which is called pre-excitation. If the Bundle is on the left side of the heart, it’s called “type A pre-excitation.” If it’s on the right side, it’s called “type B pre-excitation.” Type A is a lot more common. ECG: - **short PR interval with a delta wave (upsloping just before QRS complex), as well as QRS prolongation.** - This makes sense because the signal is taking the shortcut and contracting the ventricles early. - Also, the ST segment and T wave (representing repolarization), will often be directly opposite the QRS complex.

Answer 121

Left-sided cardiac abnormalities (common) - bicuspid aortic valve - coarctation of the aorta - increased risk of aortic root dilation —> aortic dissection or rupture (+ Hypertension)

Answer 122

AV Canal Defects: - ASD - VSD

Answer 123

Mitral Valve Prolapse

Answer 124

Increased blood volume in pregnancy places additional strain on the aorta —> further increases risk of dissection + sharp/tearing chest or back pain that radiates to neck or abdomen + nerve ischaemia can also lead to extremity tingling + asymmetry of pulses of BP, hypotension, aortic regurgitation

Answer 125

**Haemodynamically Unstable: immediate electrical cardioversion** **Haemodynamically Stable: Rhythm control with anti-arrhythmic drugs: ibutilide or procainamide is preferred** [AF occurs in 10-30% of AF patients —> bypass AV node —> rapid ventricular response rate —> can deteriorate to VF] [Should not use AV nodal blocking agents: adenosine, BB, CCB (esp verapamil) and digoxin for AF with WPW —> promotes conduction across accessory pathway —> AF into VF]

Cardiology & Cardiac Surgery Flashcards

(154 cards)