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Step 2 Flashcards

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1
Q

right vs left axis deviation on ecg

A

left axis deviation; positive QRS lead I but negative in aVF

right axis deviation: negative QRS lead II and positive aVF

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2
Q

extreme axis on ECG and what does this indicate

A

negative QRS aVF and lead II
- misplaced leads, ventricular arrythmias, ventricular pacing

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3
Q

smith-modified Sgarbossa criteria

A

criteria for diagnosis of MI in the presence of new LBBB

  • concordant ST elevation >1mm in >1 lead
  • concordant ST depression >1mm in > 1 lead V1-V3
  • disconcord ST elevation >1mm in >1 lead (QRS amplitude ratio >25%
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4
Q

most common congenital cause of long QT syndrome and inheritance pattern

A

Romano ward syndrome
autosomal dominant
present spurely as cardiac phenotype (no deafness)

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5
Q

child with sensorineural deafness, syncope on exercise, found to have prolonged QT interval ?diagnosis ?treatment

A

Jarvel and Lange-Neilson syndrome

defect in K channel conduction
autosomal recessive
treat with beta blockers and ICD or pacemaker

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6
Q

ECG findings after STEMI
- seconds after
- mins to hours
- <24 hrs
- days to weeks
- months to years

A

seconds after: hyperacute T waves

mins - hrs: ST elevation, Q waves

< 24 hrs: T wave inversion, deeper Q wave

days - weeks: normal ST segment, T wave inversion

months-yrs: normal T wave, persistent Q wave

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7
Q

when is T wave inversion found on ECG post MI

A

< 24 hours after MI

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8
Q

when are Q waves first found after MI

A

mins-hrs
deeper Q waves < 24 hrs

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9
Q

feature on ECG found seconds after STEMI

A

hyperacute T waves

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10
Q

cause of peaked P waves

A

pulmonary causes of right atrial enlargement i.e. pul HTN, COPD

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11
Q

murmur that increases with expiration

A

left sided murmurs
(right sided murmurs increase with inspiration)

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12
Q

causes of a collapsing pulse

A

aortic regurgitation
severe anaemia
thyrotoxicosis
PDA
AV malformations

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13
Q

pulsus parvus et tardus

A

weak and delayed pulse
found in aortic stenosis

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14
Q

pulse found in HOCM

A

jerky
pulsus biferiens

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15
Q

pulsus biferiens

A

bifid pulse/twice beating

aortic regurgitation, aortic stenosis, or combo of both
HOCM

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16
Q

difference between paroxysmal, persistent, long standing and permanent AF

A

paroxysmal - self resolving
persistent > 7 days
long standing > 12 months
permenant - not looking to restore normal rythmn

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17
Q

patient bradycardic and fails to respond to atropine. ?next step

A

transcutaneous pacing or dopamine/epinephrine infusion

3rd line: temporary transvenous pacing

definitive: permanent pacemaker implantation

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18
Q

definitive treatment for bradycardia unresponsive to treatment /persistent

A

permanent pacemaker

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19
Q

treatment for mobitz type I vs type II heart block

A

mobitz type 1;
- if asymptomatic then no tx
- if symptomatic: atropine

mobitz type 2;
- pacemaker (even if symptomatic)

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20
Q

sick sinus rythmn on ECG

A

SA pause - no P wave suggesting no activation of SA node)
followed by junctional escape QRS without preceeding P wave
followed by reactivation of SA node with P wave followed by QRS

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21
Q

contraindications to carotid sinus massage in AVNRT (SVT)

A

MI/TIA/stroke previous 3 months
atheroma/carotid stenosis
VF/VT
previous adverse reaction to CSM

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22
Q

acute therapy for WPW syndrome

A

procanamide (IA) or amiodarone (III)

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23
Q

definitive treatment for WPW syndrome

A

radiofrequency catheter ablation

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24
Q

what medication is contraindicated in the acute management of WPW syndrome

A

nodal blockers such as adenosine (AV node block), betablockers + CCB
- makes SVT worse

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25
initial management for torsades de pointes if unstable vs stable
unstable; - defibrillation if pulseless - synchronised cardioversion if hamodynamically unstable stable; - magnesium sulphate - correct hypokalaemia
26
CHA2DS2-VASc score
CHF Hypertension age >75 = 2 points diabetes stroke = 2 points vascular disease age 65-74 = 1 point sex category (female = 1 point)
27
when do you consider anticoagulation for AF
chadsvasc score 2 or more in male and 3 or more in female if low risk of bleeding when consider anticoagulation if score 1 or more in men or 2 or more in women
28
stroke prevention measure for a patient who cannot tolerate anticoagulation
left atrial appendage occlusion (minimally invasive or surgical closure)
29
best initial rate control medication for AF
betablockers digoxin (digitalis) sometimes used as an adjunct
30
Options for rhythm control management in AF
haemodynamically unstable: immediate electrical cardioversion stable: elective electrical cardioversion - if AF < 48 hrs then low risk for thrombus so no anticoagulation required - if AF >48 hrs then anticoagulants for 3 weeks prior to cardioversion, alternatively echo to rule out LA thrombus stable: medical cardioversion - amiodarone, flecainide, dofetilide, IV ibutilide Catheter ablation of pulmonary veins
31
rate vs rythmn control for AF - what improves mortality
rate control improves mortality rythmn control is beneficial for symptom control
32
hypovolaemic shock management - what is 1st line management: - vasopressors i.e. noradrenaline - IV fluids
IV fluid resuscitation using vasopressors on a patient who is hypovolaemic doesnt work as well. they decrease blood flow to tissues that undergo vasoconstriction. autoregulation reduces the effects of vasopressin on vital organs to maintain their pressure.
33
treatment for atrial flutter
same as AF
34
treatment for unstable AF / atrial flutter
synchronised electrical cardioversion at 120-200 J
35
indications for unsynchronised cardioversion (defibrillation)
pulsless VT VF
36
what can precipitate an arythmia with use of synchronised cardioversion
if shocking occurs at T wave (during repolarisation) instead of R wave
37
causes of PEA
5 H's and 5 T's hypoxia hypovolaemia hydrogen ion acidosis hypo/hyperkalaemia hypothermia toxins tension pneumothorax tamponade thrombosis (cardiac) thrombosis (PE)
38
HFrEF vs HFpEF dysfunction
HFrEF systolic dysfunction HFpEF diastolic dysfunction
39
S3 vs S4 in HFrEF and HFpEF
HFrEJ (systolic dysfunction) - S3 HFpEF (diastolic dysfunction) - S4
40
NYHA functional classification of HF
I - no limitation of activity, no symptoms II - slight limitation, comfortable at rest or with mild exertion III - limitations of activity , comfortable at rest IV - symptoms at rest, severe limitations to activity
41
1st line for management in a patient with acute congestive HF with hypotension
'wet and cold' congested with hypoperfusion (BP < 90) treat hypoperfusion first before you treat the overload 1st line: ionotropic agent 2nd line: vasopressor if refractory once stabalised start diuretic therapy
42
1st line management for patient with heart failure and hypotension without signs of overload
BP <90mmHg but euvolaemic 1st line: consider fluid challenge 2nd line: inotropic agent
43
CXR findings in congestive heart failure
Alevolar oedema ('bats wings') kerley B lines Cardiomegaly Diffuse upper lobe vessels Effusion (pleural)
44
side effects of acetazolamide
carbonic anhydrase inhibitor - hyperchloraemic metabolic acidosis - neuropathy - NH3 toxicity - sulpha allergy
45
side effects of K sparing diuretics
hyperkalaemia anti-androgen effects i.e. gynaecomastia, sexual dysfunction note: eplernone doesnt have antiadrogenic effects
46
best initial treatment for patient with congestive heart failure who is normotensive
'warm and wet' loop diuretic + vasodilators
47
examples of inotropic agents
milrinone dobutamine dopamine
48
what heart failure medication is contraindicated during acute decompensation
beta blockers if previously on them then continuation can be considered
49
what medication is indicated in HFrEF + pulse >70bpm
Ivabradine (reduces heart rate through SA node inhibition of funny If channels)
50
medications shown to reduce mortality in patients with HFrEF
spironolactone, eplerenone ACE inhibitors / ARB's Betablockers SGLT-2 inhibitors hydralazine - isosorbide dinitrate (black americans)
51
indication for ICD in heart failure and time after MI they can be inserted
symptomatic with EF < 35% - 40 days post MI - 3 months post revascularisation asymptomatic with EF < 30% - 40 days post MI - 3 months post revascularisation
52
indication for cardiac resychronisation therapy in heart failure
LVEF < 35%, sinus rythm, LBBB, QRS >150msec, on optimal therapy
53
what is the only drug to improve mortality in HFpEF
SGLT-2 inhibitor
54
ejection fraction in dilated, hypertrophic and restrictive cardiomyopathy
dilated - reduced hypertrophic - increased restrictive - normal
55
best initial treatment for HOCM
betablockers 2nd line: CCB, ventricular pacemakers
56
medications contraindicated in HOCM
ACE/ARB's nitrates hydralazine digoxin diuretics i.e. spironolactone
57
patients born to mothers with diabetes are at risk of what heart disease
hypertrophic cardiomyopathy due to foetal hyperinsulinaemia in response to maternal hyperglycaemia most infants asymptomatic and condition regresses by age 1 yrs may require betablockers and IV fluids
58
2nd most common cause of sudden cardiac death in young people (after HOCM)
arrythmogenic right ventricular dyspalasia
59
arrythmogenic right ventricular dysplasia mode of inheritance
autosomal dominant (myocytes are replaced with fibrofatty tissue causing RV dilatation resulting in ventricular arrythmias)
60
1st line treatment for arrythmogenic right ventricular dysplasia
betablockers
61
advice given in the management of HOCM and arrythmogenic ventricular dysplasia
avoidance of physical activity
62
treatment of cardiac amyloidosis
treatment of HF: diuretics (betablcokers + ACEI not beneficial) treatment of underlying amyloidosis if persistent bradyarrythmia: pacemaker
63
most common arrythmia found in cardiac sarcoidosis
AV block
64
treatment for peripartum cardiomyopathy
Treat as CHF but avoid teratogens i.e. ACEI, ARB's, sacubitril valsatran, aldosterone antagonists suitable drugs; - hydralazine - betablockers - loop diuretics - digoxin - isosorbide dinitrate - dopamine - dobutamine echo biannually avoid future pregnancy if ef < 50%, esp if < 20%
65
whats an appropriate first line treatment for a patient with hypertension and hx gout
Losartan only anti-hypertensive medication that has uricosuric symptoms CCB's should be avoided in patients with gout as it causes oedema therefore causing fluid depletion = worsening uric acid levels

Cardiology (7 decks)

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