Flashcards in Passmedicine Deck (122):
U waves seen on ECG
J waves on ECG
In hypokalaemia, you have no T, but a long PR and a long QT
And you are depressed
Hypokalaemia - small or absent T waves,
Long PR interval
Who should you avoid giving adenosine to?
Don't give to asthmatics - could cause bronchospasm
Which drugs interact with adenosine?
Dipyridamoles - Enhance effect
Aminophylline - Reduces effect
Adenosine adverse effects
Can enhance conduction down accessory pathways, resulting in increased ventricular rate (e.g. wolff parkinson white)
Most common cause of aortic stenosis in younger patients (<65)
Bicuspid aortic valve
Most common cause of aortic stenosis in older patients (>65)
Calcification of the aortic valve
What does a narrow pulse pressure indicate?
Decreased cardiac output
Which syndromes are associated with VSD?
Fragile X is associated with, which heart problem?
Mitral valve prolapse
William's syndrome is associated with which heart problem?
Supravavlular aortic stenosis
First line treatment for hypertension in a diabetic
Investigation if you suspect a patient has aortic stenosis
Which common drug, may cause skin necrosis (rare)
Patients are particularly at risk if they are given warfarin without LMWH, and it is most likely to occur in the first 3-5 days of treatment
1972 and protein C
Chest pain relieved when sitting forward
ECG changes in pericarditis
Saddle shaped ST elevation
PR depression - most specific ECG marker for pericarditis
Acute management of SVT
Adenosine 6mg-12mg-12mg (UNLESS ASTHMATIC - give verapamil instead)
Xanthomata are seen in what
(eruptive xanthomata - due to high triglyceride levels and present as multiple red/yellow vesicles on extensor surfaces)
Does of adrenaline for baby - 6 years
150 micrograms, 0.15ml 1 in 1000
Does of adrenaline for 6 years to 12 years
300 micrograms, 0.3ml in 1 in 1000
Dose of adrenaline for adult and child >12 years
500 micrograms, 0.5ml 1 in 1000
Adverse effects of statins
Myopathy: includes myalgia, myositis, rhabdomyolysis and asymptomatic raised CK.
Risk factors for myopathy include advanced age, female sex, low BMI, presence of multisystem disease (e.g. diabetes)
ECG findings of Wolff parkinson white
Delta waves, short PR interval
Which drug are the most common cause of drug-induced angioedema
ACE inhibitor mechanism of action
Inhibit conversion of angiotensin I to angiotensin II
Side effects of ACEis
Angioedema (may occur up to a year after starting treatment)
First-dose hypotension: more common in patients taking diuretics
Antagonists of the P2Y12 adenosine disphosphate receptor
Statins interact with which drugs
The only shockable rhythms
Ventricular fibrillation and ventricular tachycardia
Where do thiazide diuretics work
Work at the beginning of the distal convoluted tubule (inhibit sodium reabsorption)
How long do thiazide diuretics take to work? And how long do they work for?
Begin to work after 1-2 hours, duration of action is 12-24 hours
Common adverse effects of thiazide diuretics
Hyponatremia, hypokalaemia, hypercalcemia
Impaired glucose tolerance
What QRISK should you offer statins for?
Offer if QRISK>10%
Side effects of GTN
How does GTN work?
Causes release of nitric oxide in smooth muscle, increasing cGMP, which leads to a fall in intracellular calcium levels
Management of aortic stenosis
Valve replacement if the patient is symptomatic
If not, then only replace when aortic valve gradient >36mmHg
When might you want to measure BNP levels in patients?
Measure in patients who you think have heart failure, but no history of myocardial infarction
>400 = poor prognosis
(If they have previous MI then they require urgent referral, echo and specialist assessment)
Describe BNP levels and heart failure
High levels = don't confirm heart failure, but likely
Low levels = rule out heart failure
(Highly sensitive but varying specificity)
When might BNP levels be elevated?
In heart failure
But also LVH, myocardial ischaemia, atrial fibrillation, pulmonary hypertension, hypoxia, pulmonary embolism, right ventricular strain, COPD, liver failure, sepsis, diabetes and renal impairment,
May also be high in women, and particularly in people older than 70
What is BNP?
A hormone produced by left ventricular myocardium in response to strain
Antiplatelet regimen following stroke?
check ct first lol
300mg aspirin for 2 weeks then 75mg clopidogrel for life
Adrenaline dose for cardiac arrest
When do you give adrenaline in cardiac arrest?
Give after third shock, and then every 3-5 minutes (during alternate cycles of CPR)
Pulseless electrical activity
Initial treatment of PEA and asystole
Patients should immediately receive 1mg IV adrenaline and high quality CPR
Pericardial knock - loud S3
JVP increases during inspiration
What is pulsus paradoxus?
When stroke volume and systolic BP decrease during inspiration
When might you see pulsus paradoxus?
Associated with cardiac tamponade - muffled heart sounds, distended veins, low arterial blood pressure
Causes long QT and deafness
Causes long QT but no deafness
Which electrolyte abnormalities can cause long QT?
Dietary advice for prevention of MI
Eat a mediterranean style diet - switch butter and cheese for plant based oils
Exercise advice for prevention of MI
20-30 minutes of exercise per day until patients are slightly breathless
When can you have sex after a heart attack?
Can have sex 4 weeks after an uncomplicated MI
A patient should avoid sildenafil if they are on which medications?
Avoid sildenafil if a patient is on nitrates or nicorandil
What is sildenafil used for?
Used to treat erectile dysfunction
If a patient has had an acute MI and has symptoms or signs of heart failure, which drug might you consider initiating?
An aldosteone antagonist (e.g. eplerenone)
Try to start 3-14 days after MI and after the ACE inhibitor
Best site for adrenaline injection?
Anterolateral aspect of middle third of thigh
The most important cause of ventricular tachycardia
Hypokalaemia (followed by hypomagnesaemia)
What precipitates Torsades de pointes?
Torsades de pointes is precipitate by elongation of the QT interval
Most common cause of monomorphic VT
Which condition may be worsened by bendroflumethazide?
Name 2 rate controlling drugs
Atenolol and diltiazem
Drugs used in pharmacological cardioversion of atrial fibrillation?
If no structural/ischaemic heart disease - flecainide/amiodarone
Structural/ischaemic heart disease - amiodarone
ECG shows elevation in leads V1-V4, with reciprocal changes in the inferior leads, which vessel has been occluded?
100% occlusion of the left anterior descending artery
What does an aortic regurgitation murmur sound like?
Early diastolic, heard best in the aortic area on end expiration, radiates to the 4th intercostal space
Investigation for aortic stenosis
What is Wenckebach phenomenon?
2nd degree atrioventricular block mobitz type 1 - seen in athletic individuals
Treatment of Dressler's syndrome
(or a prolonged course of colchicine or steroids)
What is Dressler's syndrome?
Pericarditis that occurs a couple of weeks after MI
Most common cause of death following MI?
Which beta blockers specifically reduce mortality in heart failure?
Carvedilol and bisoprolol
Which drugs improve mortality following heart failure?
Hydralazine with nitrates
Name 2 aldosterone antagonists
Which patients need a pneumococcal booster vaccine every five years?
Patients with asplenia, splenic dysfunction or chronic kidney disease
How do thrombolytic drugs work?
Activate plasminogen to form plasmin
Examples of drugs used in thrombolysis?
Side effects of thrombolysis?
Hypotension - more common with streptokinase
Allergic reactions - may occur with streptokinase
Why would you use a 24 hour holter ECG
To look for paroxysmal arrhythmia
Why would you use an electrophysiological study?
To trigger an arrhythmia so you can study it - also gives you the opportunity to treat the arrhythmia by delivering radiofrequency ablation to the extra pathway
Genetic idiopathic heart block, due to fibrosis and calcification of conduction system of heart
Investigation for cardiac tamponade
What is coarctation of the aorta associated with?
Associated with Turner's syndrome
Also associated with biscupid valve
Infection with what causes rheumatic disease?
Most common cause of infective endocarditis?
Strongest risk factor for developing endocarditis?
Used to determine the need to anticoagulate a patient in AF
Measure of disease activity in rheumatoid arthritis
Used in the assessment of suspected obstructive sleep apneoa
Prognostic score risk stratifying patients who've had a suspected TIA
Heart failure severity scale
A scoring system used to assess the severity of liver cirrhosis
What is pulsus paradoxus?
When there is a greater than normal fall in systolic BP during inspiration (means faint or absent pulse in inspiration)
Seen in severe asthma and cardiac tamponade
What is pulsus alterans and when is it seen?
Weak arterial pulse and then strong arterial pulse
- seen in severe left ventricular failure
If someone has complete heartblock following an MI, which vessel is likely to be affected?
Right coronary artery
Persistent ST elevation after MI, what is this most likely to be?
Left ventricular thromboembolism
Treatment of Dresslers syndrome
What is indapemide?
A thiazide-like diuretic
Why can you get hypertension in aortic dissection?
Because there is a catecholamine surge
Most common CXR finding of pulmonary embolism
Pulmonary embolism - normal CXR
Hypertrophic cadiomyopathy inheritance
Management of Torsades de Pointes
IV magnesium sulphate
When should you take a statin?
Last thing in the evening
What does the PHQ-9 score assess?
Can be used to evaluate the anxiety level of a patient?
Saddle shaped ST elevation
Foods high in vitamin K
Broccoli, spinach, kale and sprouts (so avoid if you're on warfarin)
Foods which might trigger migraines
Caffeine, cured meats, dark chocolate
Foods high in potassium
Dried apricots, banana, butternut squash, avacado
How are proximal aortic dissections managed?
Aortic root replacement
A 35-year-old Singaporean female attends a varicose vein pre operative clinic. On auscultation a mid diastolic murmur is noted at the apex. The murmur is enhanced when the patient lies in the left lateral position
Used in the assessment of suspected obstructive sleep apnoea
greater than the normal (10 mmHg) fall in systolic blood pressure during inspiration → faint or absent pulse in inspiration
severe asthma, cardiac tamponade
If you have complete heart block following an MI, which vessel has been occluded?
Right coronary artery
How does amiodarone work?
Blocks potassium channels, which inhibits repolarisation and prolongs the action potential (also blocks sodium channels)
Wedge shaped opacification on CXR
What could cause torsades de pointes
Post cardiac arrest
Raised ICP (subarachnoid haemorrhage)