MRCP Flashcards
(43 cards)
What is the dose of adrenaline given in cardiac arrest?
1mg of 1:10,000
What is the dose of adrenaline given in anaphylaxis?
<6 years: 150 mcg of 1:1,000
6-12 years: 300mch of 1:1,000
>12 years: 500mcg of 1:1,000
Causes of bradycardia
Physiological Hypothyroid AV block Sick sinus syndrome Drugs Vasovagal Electrolyte abnormalities
How do you treat broad complex tachycardia?
Irregular - seek help
Regular - Amiodarone 300mg
If adverse features - Amiodarone plus synchronised shock 120J
How do you treat a narrow complex tachycardia?
Irregular - as AF
Regular - vagal manoeuvres, adenosine 6mg
If adverse features, Amiodarone 300mg and synchronised shock 120J
Inheritance of HOCM
Autosomal Dominant
What is the pathophysiology of HOCM?
There is thickening of the interventricular septum which bulges out asymmetrically which narrows the outflow of LV
There is decreased pre load and excessive afterload
What murmur is heard in HOCM?
Ejection Systolic - therefore AS as Ddx
HOCM murmur increases in intensity with valsalva
Complications of ACS?
Septal rupture - pansystolic murmur
Ventricular rupture - tamponade
Papillary muscle rupture - mitral regurg
LV aneurysm - persistent ST elevation
Arrythmias
Pericarditis - 2-3 days post MI, pleuritic type pain
Dressler’s Syndrome - weeks after MI, fever, pericarditis and pleurisy
What is a Stokes-Adams attack?
Someone with known heart block who has episodes of transient asystole which causes syncope
They go grey/deathly pale and collapse
As soon as the attack is over they regain colour and consciousness quickly
What is decubitus angina?
Angina precipitated by lying flat
What is Pritzmetal’s angina?
There is ST elevation on ECG with no elevation in troponin
There are sporadic cycles of angina at rest due to coronary artery spasm
What is syndrome X?
ST depression and angina pain on exercise with no coronary artery abnormalities on angiography
Microvascular disease
Pulse description in heart failure?
Pulsus Alternans (Severe LVF)
Causes of Pulsus Paradoxus?
Severe asthma, Cardiac tamponade
Pulse description in aortic stenosis?
Slow rising
Causes of collapsing pulse?
Aortic regurgitation, PDA, Hyperdynamic states
Pulse description in HOCM?
Jerky
Causes of Bisferiens pulse?
Mixed aortic valve disease
Peripheral stigmata of infective endocarditis
Osler's Nodes Janeway Lesions Clubbing Splinter haemorrhages Fever Roth spots New murmur
Treatment of Wolff Parkinson White?
Non-AV Nodal blocking drugs (NO Verapamil) - risk of VF
Flecainide or Sotalol (if no AF)
Definitive treatment is RFA of accessory pathway
What is the pathophysiology of WPW?
Accessory conduction pathway - AVRT
As the conduction pathway doesn’t slow down conduction, if someone with WPW goes into AF they can rapidly go into VF
Differentiating between Type A and Type B WPW?
Type A: Left sided. Dominant R wave in V1
Type B: Right sided
What causes S2 heart sound?
Closure of aortic valve shortly followed by closure of the pulmonary valve
