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Year 6 - MBBS COPY > Firms: Cardio > Flashcards

Firms: Cardio Flashcards

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1
Q

How would you present a murmur?

A

HS 1+2+Added

When, where, insp/exp, radiation, at least grade three

Indicates, ddx, ECG/echo

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2
Q

Which murmurs get louder on insp/exp?

A

RILE

Right sided w Insp + Left sided w Exp

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3
Q

List the four classic murmurs you hear

A

AS - ESM - lub whoosh dub

AR - EDM - lub durrr

MS - MDM - rrrlub dub

MR - PSM - lub oof dub

NB: HOCM also ESM + ASD also MDM

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4
Q

Which is worse a longer or louder murmur?

A

Longer > Louder

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5
Q

What are the differentials of aortic stenosis? (2)

A

Aortic Sclerosis
Pulmonary Stenosis

NB: if it radiates to the carotids stenosis > sclerosis

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6
Q

If the pt has aortic sten what should you advise?

A

Any chest pain, feeling faint, SOB come back to us

NB: also in order of worsening risk of mortality angina, syncope, dyspnoea

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7
Q

How would you present an ECG?

A

Pt details, date and time, calibration, rate, rhythm, axis, pqrst, overall impression

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8
Q

How many seconds are the small and large squares?

A

Small - 0.04s

Large - 0.2s

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9
Q

How can you calculate rate from the rhythm strip?

A
  1. Number of complexes in 10s x6
  2. Divide 300 by number of big squares b/w R waves
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10
Q

How can the rhythm be described? (3)

A

Sinus, AF, Block

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11
Q

The quick method of testing for axis deviation

A

Use leads I+II and if the R waves:

Point away - leaving - LEFT

Point together - reaching - RIGHT

And if lead III is more neg think left vs more pos think right

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12
Q

Which p wave shows which atrial hypertrophy?

A

Bifid P mitrale - left atrial hypertrophy eg mitral stenosis/regurg

Peaked P pulmonale - right atrial hypertrophy eg tricuspid stenosis/regurg

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13
Q

How long should the PR interval be?

A

0.12-0.2s ie 3-5 small squares

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14
Q

Outline the different degrees of AV heart block

A

1st: prolong PR interval

2nd: Mobitz 1 - prolongation then dropped QRS + Mobitz 2 - constant PR and often wide QRS w occ dropped QRS

3rd: complete dissociation b/w p waves and QRS complexes

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15
Q

Which heart block is also called Wenckebach?

A

2nd Degree Mobitz I

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16
Q

Which heart block is also called Hay?

A

2nd Degree Mobitz II

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17
Q

Which Mobitz type is more likely to degenerate into 3rd degree?

A

Type 1

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18
Q

How long should the QRS complex be?

A

<0.12s ie <3 small squares

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19
Q

What does a narrow QRS suggest?

A

SVT

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20
Q

What does a broad QRS suggest?

A

BBB, VT, VF, WPW

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21
Q

Which BBB is more concerning?

A

A new LBBB is always pathological whereas RBBB could be a normal variant

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22
Q

S1Q3T3

A

Rare sign of PE w deep S in I, pathological Q in III, inverted T in III

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23
Q

Anteroseptal MI Leads

A

V1-V4

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24
Q

Anteroseptal MI Artery

A

LAD

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25
Lateral MI Leads
V5-V6, I, aVL
26
Lateral MI Artery
Left Circumflex
27
Anterolateral MI Leads
V4-V5, I, aVL
28
Anterolateral MI Arteries
LAD + Left Circumflex = Left Coronary
29
Inferior MI Leads
II, III, aVF
30
Inferior MI Artery
Right Coronary
31
What else does the right coronary artery supply?
SA + AV Nodes
32
Posterior MI Leads
Global ST depression w dominant R waves in V1-V2
33
Posterior MI Arteries
Left Circumflex + Right Coronary
34
Comps of LCA v RCA occlusion
LCA - left ventricular failure + pericarditis RCA - rhythm abnormalities Plus aneurysm + PE
35
Immediate mx of a STEMI
MONAT + PCI/Thrombolysis
36
Tx of Pericarditis
NSAIDs
37
Tx of Complete Heart Block
Pacemaker
38
What are the ECG changes of left ventricular aneurysm?
Persistent ST Elevation
39
What are the ECG changes of PE?
No Changes Sinus Tachycardia RV Strain Inverted T Waves S1Q3T3
40
What med should pts be on following MI or stroke life long?
Aspirin
41
What does a saddled ST segment suggest? (2)
Pericarditis Tamponade
42
What does a reverse tick ST segment suggest?
Digoxin Toxicity
43
Which leads is where T wave inversion is normal?
III, aVR, V1
44
Tx of AF
Unstable: A-E + DCCV Stable: look for treatable causes (structural, thyroid, clot, infection, K/Mg/Ca) + ultimate tx is to mx risk of HF due to tachy and risk of stroke due to clot in LA Risk of HF: Rate (β-blocker/CCB and digoxin) + Rhythm (DCCV or flecainide/amiodarone if structural heart disease) Risk of Stroke: Anticoag (CHA2DS2-VASc + HAS-BLED) - start DOAC or warfarin 2wks after
45
Why do you tx the rate component of AF w beta blockade > digoxin?
Beta blockade allows the HR to change w exercise
46
Which drugs should you NOT give to AF + WPW pts?
Verapamil + Digoxin Risk of sudden cardiac death in young pts
47
When would flecainide NOT be first line rx for rhythm control in AF?
There’s an underlying structural heart disease
48
When do you do rhythm > rate control first line?
Reversible cause, new onset <48hrs, more suitable based on clinical judgement, HF primarily caused by AF
49
When do you refer AF to the cardiologist?
Rhythm control is appropriate, rate control tx fails to control sx, ECG: WPW/LQTS, echo: valvular disease
50
What are the signs of heart failure on CXR?
A - alveolar oedema B - Kerley B lines C - cardiomegaly D - dilated UL vessels E - pleural effusion
51
Which cardiac drugs can lead to gynaecomastia? (2)
Spironolactone + Digoxin
52
Which dysmorphic features suggest what cardiac disease?
Short stature: Turner (bicuspid aortic valve and coarctation), Noonan (pulm stenosis and HOCM), Down (AVSD, VSD, TOF) Tall stature: Marfans (aortic regurg)
53
If the pulse is regularly regular, is the pulse sinus rhythm?
You can never tell if a pulse is sinus rhythm at the bedside unless you have an ECG w a p wave before every QRS complex
54
If the pulse is irregularly irregular, does the pt have AF?
Prbly but can’t say for sure w/o an ECG showing lack of p waves Ddx: complete heart block and sinus rhythm w multiple ventricular ectopics
55
What are the four aspects of pulse? And where is volume measured?
Rate, Rhythm, Volume, Character Rate + Rhythm - Radial Volume + Character - Carotid
56
What is the carotid pulse like in AS?
Low volume and slow rising character
57
What are the causes of a RR delay? (2)
Coarctation of Aorta Blalock-Taussig Shunt
58
What does a tapping apex beat always suggest?
Mitral Stenosis
59
What causes a hyperdynamic apex beat? (2)
Pressure Loaded - severe HTN, AS, HOCM - LV hypertrophy Volume Loaded - MR and AR - LV dilatation
60
What causes an impalpable apex beat? (5)
DOPES Dextrocardia Obesity Pericardial Effusion Emphysema Shock
61
Ddx of an ESM
Any systolic murmur but if specifically ejection systolic: aortic stenosis, aortic sclerosis, HOCM
62
Typical HOCM pt
PC: exertional lightheadedness +/- syncope FHx: SCD in middle age O/E: jerky carotid pulse, double apical impulse, ESM
63
What is the inheritance pattern of HOCM?
Autosomal Dominant
64
When does the ESM in HOCM pts get louder?
Valsalva
65
When does the ESM in HOCM pts get quieter?
Squatting
66
What is a/w HOCM?
WPW + Friedrich’s Ataxia
67
What is pathognomonic of HOCM on an echo?
Systolic anterior motion of the anterior mitral valve leaflet
68
Tx of HOCM
M: beta blockers and negatively inotropic CCB S: ICD, myomectomy, alcohol septal ablation
69
The main causes of AS (2)
Younger - bicuspid aortic valve Older - degenerative calcification PLUS Rheumatic heart disease
70
What ausc gives away a bicuspid aortic valve?
Ejection systolic click
71
What usually coexists w bicuspid aortic valve?
Coarctation
72
Mx of AS
Sx or severe ie echo gradient >50mmHg = surgery
73
What is Heyde’s syndrome?
Angiodysplasia in aortic stenosis due to an acquired deficiency of vWF caused by areas of high shear stress
74
What is the definitive tx for Heyde’s syndrome?
AVR
75
Comps of valve replacement (5)
FIBAT Failure Infection Bleeding Anaemia Thromboembolism
76
The main causes of AR (3)
Leaflets don’t work (endocarditis, bicuspid, HTN) or work but don’t meet in the middle (aortitis a/w syphilis and ank spond) and connective tissue disease
77
Eponymous signs of aortic regurg (5)
Quincke’s Sign: capillary pulsation in the nail beds DeMusset’s Sign: head nodding w systole Corrigan’s Sign: big neck pulses Traube’s Sign: pistol shot femorals Duroziez’s Sign: to and fro double murmur over femoral artery when pressure is applied distal to site of ausc
78
Sx and signs of severity in aortic regurg
Sx - angina + SOBOE Signs - wide pulse pressure, displaced apex, CCF
79
Mx of AR
Acute - emerg surgery Chronic - afterload reduction NB: again like AS if sx or echo criteria (end systolic diameter >55mm, aortic root dilatation >50mm, ejection fraction <50%) consider valve replacement
80
What does polycythaemia inc your risk of? (2)
Gout + VTE
81
Which ventricle dilates in VSD?
Left because during diastole blood enters the LV from both the LA and RV
82
What are VSD pts at risk of?
Endocarditis
83
Tx of VSD
Percutaneous Amplatzer device insertion or open heart surgery
84
If a pt has a stroke following a DVT instead of a PE what does this elude to?
PFO + ASD
85
Which ASD is more common?
Secundum > Primum
86
Which murmur is heard if a pt has an ASD?
MDM + fixed split S2 that doesn’t change w respiration
87
What are ASD pts at risk of?
AF + Paradoxical Emboli
88
Ix for ASD
ECG RBBB + Bubble Echo
89
Which syndrome is TOF a/w?
DiGeorge 22q11
90
Ddx of a MDM
Anything that obstructs the mitral orifice: MS, LA thrombus, atrial myxoma, Carey-Coombs murmur (mitral valvulitis) PLUS TS and Austin-Flint murmur (severe AR)
91
Typical mitral stenosis pt
PC: preg lady recurrently worsened SOBOE and orthopnea PMHx: recurrent pharyngitis + AF O/E: malar flush, low-normal BP, tapping apex beat, loud and palpable first HS, rumbling MDM
92
Causes of MS (2)
Rheumatic fever, abs to group A beta haemolytic strep, 2-3wks after pharyngitis Carcinoid syndrome, right sided valvular stenosis due to elevated serotonin production, left sided valvular stenosis due to lung mets
93
Mx of MS (ECG + Rx)
ECG: AF +p mitrale in lead II Rx: of the AF + valvuloplasty if valve leaflets pliable and uncalcified or closed/open valvotomy
94
Comps of MS (3)
AF Pulm HTN -> cor pulmonale LA enlargement -> Ortner’s syndrome
95
What is cor pulmonale?
Enlargement and failure of the RV due to pulm stenosis or pulm HTN
96
Why can you get a hoarse voice w mitral stenosis? And what syndrome is this called?
The LA enlargement compresses the recurrent laryngeal nerve resulting in Ortner’s syndrome
97
What is S1? LUB
Closure of mitral and tricuspid valves denoting the start of systole
98
What is S2? DUB
Closure of aortic and pulm valves denoting the start of diastole
99
What is S3? KEN-TU-CKY
Rapid ventricular filling: MR + HF Normal/Abnormal
100
What is S4? TE-NNE-SSEE
The atrial contract against a stiff ventricle: AS + HTN Always Abnormal
101
How is Rheumatic fever diagnosed?
ASOT
102
What are the Duckett-Jones criteria?
Require 2 major OR 1 major and 2 minor Major: Carditis, migratory flitting polyArthritis, Sydenham’s chorea, Erythema marginatum, Subcutaneous nodules Minor: raised ESR, raised WCC, prolonged PR interval, arthralgia, pyrexia, prev RF
103
How is Rheumatic fever treated?
High dose aspirin + penicillin V NB: use clindamycin if penicillin allergic
104
What is Takotsubo’s cardiomyopathy?
A catecholamine mediated myocardial stunning resulting in transient LV impairment that will fully recover in ~1w Typically presentation is chest discomfort and SOB in post menopausal woman following bout of emotional stress No RFs, rise in trop and ant stemi on ECG, unobstructed coronaries on emerg angiogram
105
Do you get a trop rise in cardiac syndrome X?
No
106
What is the Vaughan Williams classification of anti-arrhythmic drugs?
Class I: sodium channel blockers - procainamide, lidocaine, flecainide Class II: beta blockers - bisoprolol + propranolol Class III: potassium channel blockers - amiodarone + sotalol Class IV: calcium channel blockers - verapamil + diltiazem
107
What are the five types of MI?
I: impaired blood flow to myocardium, plaque rupture, revascularise II: imbalance b/w O2 supply and demand, inc risk of VF and type I, tx underlying disease eg HR, BP, sepsis III: MI resulting in death when biomarker values are unavailable IV: MI related to PCI or stent thrombosis V: MI related to CABG
108
What does prolonged ST elevation in several leads w/o Q waves in a young pt suggest?
Pericarditis
109
What are the ECG findings of WPW? (3)
Shortened PR interval, delta wave, prolonged QRS complex
110
What are the top cause of AF?
IHD + RHD Plus reversible causes: thyrotoxicosis, PE, excess alcohol/caffeine
111
What are the CXR findings of a pt w mitral stenosis? (2)
Enlarged left atrium + scattered dense opacities
112
What are the doses in MONAT?
Diamorphine IV 2.5-5mg Aspirin PO 300mg -> 75mg OD lifelong Ticagrelor PO 180mg -> 90mg BD 12mnths
113
Comps of MI
FAM: failure (LCA), arrhythmias (RCA), murmurs (MR + VSD) Plus: aneurysm, pericarditis, PE
114
What are the ECG findings of left ventricular aneurysm?
Persistent ST Elevation
115
What are the ECG findings of a PE?
Normal ECG Sinus Tachycardia Right Ventricular Strain Inverted T waves in V1-4 S1Q3T3 + Right Axis Deviation
116
Tx of SVT
1. Vagal stimulation: carotid sinus massage + valsalva manoeuvre 2. Adenosine IV 6-12-12mg 3. Monitor ECG continuously
117
What are the Jones criteria for acute rheumatic fever?
Evidence of recent group A strep infection plus two major or one major two minor Major: carditis, arthritis, s/c nodules, erythema marginatum, sydenham’s chorea Minor: prolonged PR interval, arthralgia, raised ESR, fever, hx of rheumatic fever
118
What valves problems are common in chronic rheumatic heart disease?
MS+AR
119
Ddx of ARF
Carditis: infective endocarditis, cardiomyopathy, Kawasaki disease Arthritis: reactive, JIA, HSP Erythema: multiforme, migrans, adverse drug reactions Chorea: Wilson’s + Huntington’s
120
CHA2DS2-VASc
Congestive HF, HTN, age >74, diabetes, stroke, vasc disease, age 65-74, sex=female
121
What should you do if the CHA2DS2-VASc score is >=2?
Start pt on warfarin or DOAC If the score is 1 for male consider and 1 for female none is needed
122
HAS-BLED
HTN, abnormal liver +/or renal function, stroke, bleeding hx, labile INR, elderly >65, drugs +/or alcohol
123
What should you do if the HAS-BLED score is >=3?
Alternatives to anticoag should be considered as pt is at high risk of major bleeding
124
Which rhythms are shockable?
VF + Pulseless VT
125
Which rhythms are non-shockable?
PEA + Asystole
126
What will the MRI show if alcoholic DCM is fully reversible?
No mid-wall fibrosis
127
When would you consider CRT in heart failure pts?
EF <35% + QRS >120ms
128
What BNP excludes heart failure in the acute setting?
<100ng/mL
129
What are other causes of a raised BNP?
Pulm HTN Pneumonia Pulm Embolus Renal Failure Sepsis
130
What are other causes of a raised troponin?
Infection Inflammation Malignancy
131
Which ECG lead colours go where?
Ride Your Green Bike: right arm red, left arm yellow, left leg green, right leg black
132
Where do you commonly find reciprocal ST depression in a STEMI?
The next letter along in PAILS: posterior, anterior, inferior, lateral, septal
133
What gives you a double impulse apex?
HCOM
134
What are the Brugada criteria used for?
VT vs SVT w Aberrancy If there’s absence of an RS complex in all precordial leads, R-S >100ms in one precordial lead, AV dissociation or morphology criteria for VT in V1-2 and V6 then VT > SVT
135
Tx of Cardiac Tamponade
Pericardiocentesis
136
What affects the apex beat position?
YES - dilatation caused by volume overload: AR, MR, ASD/VSD NO - concentric hypertrophy caused by pressure overload: AS, HTN, coarctation of aorta
137
What are the causes of a dominant R wave in leads V1-2?
PPRRDDWPW Posterior MI PE RVH RBBB Dextrocardia Duchenne WPW
138
What are the causes of cardiomyopathy?
Hypertrophic: autosomal dominance inheritance Restrictive: SHAPE - sarcoidosis, haemochromatosis, amyloidosis, primary endomyocardial fibrosis, endocarditis Dilated: DILATE - dystrophy, infection, late preg, AI, toxins, endocrine
139
What are the Framingham criteria used for?
Dx of CCF: two major OR one major + two minor
140
What should you suspect if the creatinine starts shooting up after starting ACEi?
Renal Artery Stenosis
141
Which beta blocker has anti arrhythmic properties?
Sotalol
142
Why do we worry about non-sustained VT?
NSVT -> Sustained VT
143
Mx of Hyperlipidaemia
1. Lifestyle 2. Atorvastatin 3. Ezetimibe 4. Alirocumab
144
When should you stop statins? (2)
If inc CK >10 fold OR AST >100U/L
145
Ix for IE
Blood Cultures x3 + TOE Plus: urinalysis, ECG, CXR
146
What axis deviation is seen in WPW syndrome?
Left
147
Which electrolyte abnormality can cause a long QT interval?
HypoK
148
Which drug in the tx of hypertension can cause angioedema?
ACEi
149
TdP
PVT + QT Prolongation

Year 6 - MBBS COPY (35 decks)

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