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General Finals & SBA Review > Laz Cardiology > Flashcards

Laz Cardiology Flashcards

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1
Q

Left bundle branch block signs on ECG

A

Broad QRS (>0.12)
WiLLiaM MaRRoW
So will see W in V1 and M in V6

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2
Q

Definition of angina

A

Chest pain on exertion, relieved by rest

It’s because there is a mismatch in oxygen supply and demand to myocardium

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3
Q

Treatment of stable angina

A

Beta blockers (reduce the heart rate). This helps with the mismatch between oxygen and myocardium! Because not working as hard.

GTN spray

Risk factor modification

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4
Q

ACS is what?

A

Symptoms caused by a sudden reduced blood flow to the heart muscle

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5
Q

First line investigation in ACS

A

ECG

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6
Q

ACS Sx with no ST elevation, what do you do?

A

Troponin

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7
Q

ACS Sx, no ST elevation, raised troponin =>

A

NSTEMI

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8
Q

Ischaemic changes on ECG

A

Dynamic T wave inversion (a new finding, because can be normal). Try to find a previous ECG!
ST depression

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9
Q

Generic ACS management

A

Morphine 5-10mg
10mg metoclopramide to help with nausea from morphine

300mg aspirin
300mg clopidogrel
Or
180mg ticagrelor

GTN spray

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10
Q

How many medications do ACS patients get discharged on?

A

5

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11
Q

Discharge medications for MI

A 
Aspirin 75mg 
Clopidogrel 75mg 
Bisoprolol (beta blocker) 2.5mg 
ACEi 2.5mg 
Statin 80mg

All once daily

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12
Q

Aim of STEMI Mx

A

Establish coronary repurfusion

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13
Q

STEMI Mx <12hr

A

PCI

Only if you can get PCI within 2hr of diagnosis

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14
Q

STEMI Mx >12hr

A

Angiography followed by PCI if necessary

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15
Q

If they have a STEMI <12hr but you cannot get PCI in less than 2 hours, what do you do?

A

Thrombolysis

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16
Q

Management of NSTEMI

A

Give 2.5mg SC fondaparinux
Do a GRACE score to determine risk
High risk -> angiography
Low risk -> medical management

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17
Q

All patients undergoing PCI should be on what medication to prevent the wire causing clotting?

A

IV unfractionated heparin

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18
Q

What type of drug is tacrolimus?

A

Calcineurin inhibitor

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19
Q

What is impregnated into a coronary stent?

A

Tacrolimus

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20
Q

Definition of heart failure

A

Inability of the heart to pump sufficiently to meet the demands of the body

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21
Q

Which side of the heart does the blood come from the body

A

Right side

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22
Q

Which side of the heart does blood come from the lungs?

A

Left side

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23
Q

ABCDE of pulmonary oedema

A 
Alveolar oedema 
Kerly B lines 
Cardiomegaly 
Upper lobe diversion
Pleural effusion
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24
Q

Causes of heart failure

A

IHD
Valvular disease
HTN

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25
Sudden heart failure Ix
``` ECG Chest X-ray ABG Echo BNP ```
26
Management of acute heart failure
Sit the patient up Oxygen 15/L non-rebreathe Diuretics 40mg furosemide IV to clear some fluid If already on diuretics (acute on chronic) go for higher dose of 80mg furosemide GTN spray 5mg morphine IV
27
Long term heart failure management
Beta blocker ACEi Risk factor modification
28
Acute heart failure, you’ve sat them up, oxygen, GTN, morphine, furosemide 80mg, they are still bad, what do you do?
CPAP
29
Great explanation by Laz about oxygen therapy and ventilation. In a poorly functioning lung, there will be bits that are working ok and bits that aren’t working very well. How does oxygen therapy work and how does ventilation work?
Oxygen therapy looks to help the bits that are already working, by increasing the diffusion gradient Ventilation works by recruiting more of the dysfunctioning lung
30
Analogy for CPAP
Putting your head out of the car window, constant light pressure pushing air in and opening alveoli to aid ventilation
31
Summary of BiPAP using IPAP and EPAP
IPAP is higher than EPAP | I.e. air is pushed in
32
Why do we start someone on CPAP?
Say they are COPD, the airway is fragile and so when you try to breathe out, the airways collapse and lock off CPAP keeps those alveoli open Increases the surface area that is participating in gas exchange
33
Why do we start someone on BiPAP?
Keeps the alveoli open but then also aids in clearing the CO2! So this is good for type 2 respiratory failure!
34
Causes of AF
``` Very common, loads of things can precipitate it Idiopathic Cold drinks Drugs Pneumonia PE Alcohol Hyperthyroidism IHD ```
35
What is AF
Irregularly irregular rhythm with no P waves
36
Cause of DVT, which aspect of Virchows does it influence, what do you give?
Stasis | Give anticoagulant
37
MI affects which part of virchows triad? What do you give?
Vessel wall injury (from plaque rupture) Get platelet activation (because exposed tissue factor) So need anti platelets
38
Examples of anticaogulants
Heparin | Rivoroxaban
39
Examples of anti platelets
Clopidogrel | Aspirin
40
A regular, narrow complex tachycardia is called
SVT Supraventricular tachycardia Remember that the QRS are narrow so it’s an atrial issue
41
Adenosine is contraindicated in which common condition?
Asthma | It can cause bronchoconstriction
42
Urine dip in endocarditis may show
Microscopic haematuria
43
Features of endocarditis
``` 4 day fever Needle track marks Microscopic haematuria Splenomegaly Jane way lesions Oslers nodes Roth spots on retina ```
44
Causes of murmurs
Endocarditis IHD Senile calcification Rheumatic heart disease
45
Why are murmurs on left side more likely?
Higher pressures
46
What usually causes RHS murmurs
Infection, because it’s the first valve it hits (tricuspid)
47
What is flecanide used for?
Dangerous arrhythmias
48
6 Ps of acute limb ischaemia
``` Pale Pulseless Parasthesia Perishingly cold Paralysis Painful ```
49
Analogy of acute limb ischaemia
MI of the leg, embolus going down aorta and getting stuck in leg arteries
50
Management of acute limb ischaemia
IV heparin | Refer to vascular surgeon
51
Vascular surgeon options for acute limb ischaemia
Embolectomy Bypass Amputation
52
Analogy of intermittent claudication
Stable angina!
53
Critical limb ischaemia analogy
Unstable angina
54
Features of critical limb ischaemia
Ulcers Gangrene Rest pain Night pain
55
Ix for intermittent claudication
ABPI | Venous duplex USS
56
Small T waves Prolonged PR interval Symptoms of DKA Electrolyte abnormality?
Hypokalaemia
57
Management of digoxin toxicity
Immediate digoxin level IV fluids Correct electrolyte abnormalities Continuous cardiac monitoring
58
Ix for ischaemic stroke
CT head Diffusion-weighted MRI Look for causes = carotid artery doppler, ECG, echo
59
Causes of raised anion gap
``` MUDPILES Metformin Uraemia DKA Paracetamol Iron Lactic acidosis Eythyl Salicylate ```
60
Which antibiotic for penicillin allergic for strep throat?
Clarithromycin
61
Swollen gums Anaemia Easy bruising Restricted diet
Vitamin C deficiency | Scurvy
62
What is tympanosclerosis
Tympanosclerosis is a condition characterised by chronic inflammation and scarring of the tympanic membrane leading to subsequent calcification of the tympanic membrane and associated structures. Associated with long term otitis media and tympanostomy (grommet) insertion. Patients will normally present with significant hearing loss and on examination will present with chalky white patches on the tympanic membrane. Hearing aids are a common treatment for hearing loss disorders. In cases refractory to hearing aids, excision of the sclerotic areas and repair of the ossicular chain may be considered.
63
Treatment of chronic otitis externa (episodes of painful ear with white discharge)
Aural toilet and topical antibiotic
64
What are the complications of otitis externa?
Mastoiditis | Labyrinthitis

General Finals & SBA Review (8 decks)

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