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Cardiology > Cardio II > Flashcards

Cardio II Flashcards

1
Q

Define cardiogenic shock

A

Inadequeate tissue perfusion primarily due to cardiac dysfunction

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2
Q

Causes of cardiogenic shock

A 
MI
Hyperkalaemia 
Endocarditis 
Aortic dissection 
Rhythm disturbance 
Tamponade
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3
Q

List three causes of aortic stenosis

A
  1. Senile calcification
  2. Congenital
  3. Rheumatic fever
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4
Q

A patient presents with angina, dyspnoea and syncope. . She also complains of coughing up a white frothy sputum and needing to sleep with three pillows at night.

O/E you note that she has a slow rising pulse with a narrow pulse pressure. The apex beat is forceful and not displaced.

What is a possible dx? What type of murmur is associated with this condition

A

Aortic Stenosis

Ejection systolic murmur which radiates to the carotids. Heard loudest at the 2nd ICS when the patient is sitting forward.

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5
Q

Outline the investigations you would do in a patient with suspected aortic stenosis.
What would you see on an ECG

A 
Bloods: FBC, U&E's, Glucose, Lipids 
ECG: 
- LVH
- LV strain
- Tall R waves 
- ST depression 
- T wave inversion
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6
Q

Outline the signs seen in patients presenting with aortic regurgitation

A

Collapsing pulse pressure, Corrigan’s pulse
Wide pulse pressure
Displaced apex beat
Soft/absent S2
Early diastolic murmur +/- Austin Flint murmur

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7
Q

Pathophysiological changes as a result of mitral stenosis

A
  1. Valve narrows, increase in LA pressure, loud S1 and atrial hypertrophy resulting in AF
  2. Pulmonary oedema, pulmonary HTN, Loud P2.
  3. RVH with a left parasternal heave
  4. Raised JVP, oedema and ascites
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8
Q

Clinical signs seen in patients presenting with mitral stenosis

A 
Low volume pulse pressure 
Af 
Raised JVP 
Tapping non displaced apex beat 
Rumbling mid diastolic murmur

**Gratham steel murmur: high pitched decrescendo murmur loudest on inspiration.

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9
Q

Causes of mitral regurgitation

A 
Mitral valve prolapse 
LV dilation
Post MI
Rheumatic fever 
Connective tissue disorders
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10
Q

Patient presents complaining of fatigue, breathlessness and palpations
O/E you note a loud P2 and a blowing pansystolic murmur which radiates to the axilla.
An ECG shows P mitrale
What is your diagnosis?
What is p mitrale?
What would the CXR findings be in this patient?

A

Mitral regurgitation

P mitrale is an ECG finding of a P wave shaped like an M. It is indicative of a bulky left atrium, most commonly in left atrial hypertrophy

CXR

  • LA and LV hypertrophy
  • Mitral valve calcification
  • Pulmonary oedema
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11
Q

Cardiac side effect of erythromycin

A

Prolongs the QT interval

Produces Torsades de Pointes

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12
Q

What are the contra indications for thrombolysis

A 
Pregnancy 
Bleeding 
Recent stroke 
Severe HTN 
GI malignancy
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13
Q

What are the features of tetralogy of fallot

A

VSD
Pulmonary stenosis
Over riding aorta
Right ventricular hypertrophy

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14
Q

List the ECG findings of digoxin toxicity

A

Results in ECG abnormalities
Reverse tick phenomen
ST segement depression
Accentuated U wave

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15
Q

List the causes of cardiomyopathy, classifying them under the following

  • dilated
  • restrictive
  • hypertrophic
A

Hypertrophic

  • Genetic
  • Sporadic mutations

Restrictive

  • Idiopathic
  • Amyloidosis
  • Sarcoidosis
  • Haemochromatosis

Dilated

  • Post viral
  • Alcohol
  • Pregnancy
  • Chagas disease
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16
Q

List the treatments for heart failure

A

1) ACEi, B blocker, diuretic (spiro) watch K+

2) Siagoxin/ ivabarine

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17
Q

List the treatments for angina

A

Aspirin
Statins
ACEi +/- B blockers
+/- GTN spray

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18
Q

List potential causes of HTN in young people

A

Endo

  • Cushing’s
  • Conn’s
  • Acromegaly

Renal

  • Renal artery stenosis
  • Polycystic kidney disease
  • Renal malignant tumours
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19
Q

ECG changes of pericarditis

A

Wide spread ST elevation (saddle shaped)
PR depression
Variable T wave ( flattening and inversion)

20
Q

Causes of 1st degree heart block

A

Increased vagal tone
Athletes
Inferior MI
Mitral valve disease

21
Q

Name four types of supraventricular tachycardia

A

Atrial Flutter
Atrial Fibrillation
Atrioventricular Reentry Tachy (AVRT)
Atrioventricular Nodal Reentry Tachy (AVNRT)

22
Q

Causes of atrial fibrillation

A 
Ischaemic heart disease
Hypertension
Valvular heart disease (esp. mitral stenosis / regurgitation)
Acute infections
Electrolyte disturbance (hypokalaemia, hypomagnesaemia)
Thyrotoxicosis
Drugs (e.g. sympathomimetics)
Pulmonary embolus
Pericardial disease
Acid-base disturbance
Pre-excitation syndromes
Cardiomyopathies: dilated, hypertrophic.
Phaeochromocytoma
23
Q

Causes of 1st degree heart block

A 
Increased vagal tone
Athletic training
Inferior MI
Mitral valve surgery
Myocarditis (e.g. Lyme disease)
Electrolyte disturbances (e.g. Hyperkalaemia)
AV nodal blocking drugs (beta-blockers, calcium channel blockers, digoxin, amiodarone)
May be a normal variant
24
Q

Causes of Mobtiz II

A

Drugs: beta-blockers, calcium channel blockers, digoxin, amiodarone
Increased vagal tone (e.g. athletes)
Inferior MI
Myocarditis
Following cardiac surgery (mitral valve repair, Tetralogy of Fallot repair)

25
Q

Causes of Mobitz II

A

Anterior MI (due to septal infarction with necrosis of the bundle branches).
Idiopathic fibrosis of the conducting system (Lenegre’s or Lev’s disease).
Cardiac surgery (especially surgery occurring close to the septum, e.g. mitral valve repair)
Inflammatory conditions (rheumatic fever, myocarditis, Lyme disease).
Autoimmune (SLE, systemic sclerosis).
Infiltrative myocardial disease (amyloidosis, haemochromatosis, sarcoidosis).
Hyperkalaemia.
Drugs: beta-blockers, calcium channel blockers, digoxin, amiodarone.

26
Q

Causes of complete heart block

A

Inferior myocardial infarction
AV-nodal blocking drugs (e.g. calcium-channel blockers, beta-blockers, digoxin)
Idiopathic degeneration of the conducting system (Lenegre’s or Lev’s disease)

27
Q

Causes of aortic regurgitation

A

ACUTE

  • Rheumatic fever
  • Aortic dissection

CHRONIC

  • Congenital
  • Rheumatic heart disease
  • Connective tissue disease marfans
  • Autoimmune (Ank spon)
28
Q

Signs of aortic regurgitation

A 
Collapsing pulse 
Wide pulse pressure 
Displaced apex beat 
Early diastolic murmur 
(+/- Austin Flint murmur)
29
Q

Signs of aortic stenosis

A

Slow rising pulse
Narrow pulse pressure
Ejection systolic murmur
Forceful non dispalced apex beat

30
Q

Management of aortic stenosis

A

Medical

  • Monitor with f/up echo
  • Angina: Beta blockers
  • Rx HF (ACEi, diuretics)

Surgery

  • Valve replacement
  • TAVI
31
Q

Management of a HIGH risk NSTEMI

A 
Persistent ischaemia 
(ST depression, DM, +ve trop)
GPIIb/IIIa antagonist (tirofiban)
Angio within 96hrs
Clopidogrel 75mg/d
32
Q

Name the medications that are given to prevent clot formation in patients receiving PCI

A

Antiplatelet agents

  1. Ticagrelor: P2Y12 receptor antagonist
  2. Low dose aspirin for 12 months post

Anticoagulation
- Heparin

33
Q

Signs of mitral stenosis

A 
AF
Low volume pulse 
Malar flush 
Increased JVP 
Non displaced tapping apex beat 
Rubbing mid diastolic murmur (+/- Gratham steel murmur)
34
Q

Causes of mitral regurgitation

A 
Mitral valve prolapse 
LV dilatation 
Post MI (papillary muscle dysfunction)
Rheumatic fever 
Connective tissue disease
35
Q

Signs of mitral regurgitation

A

Blowing pansystolic murmur
Radiates to the axilla
Displaced apex beat
AF

36
Q

Signs of the tricuspid regurgitation

A 
Raised JVP 
RV Heave 
Pansystolic murmur 
Pulsitile HSM
Jaundice
37
Q

Management of sick sinus syndrome

A

Permanent atrial/dual chamber pacemaker

38
Q

General management of bradycardia

A

IV atropine

If poor response transcutaneous pacing

39
Q

Management of sinus tachycardia

A

Vagal manoeuvres (carotid massage)
Beta-blockers
Non-dihydropyridine CCB (verapamil)

40
Q

Management of AVNRT

A

Vagal manoeuvres
Adenosine
Prophylaxis: Digoxin, diltiazem, felcainide, BB
Curative: radiofrequency ablation

41
Q

Management of AVRT

A

Vagal manoeuvres + adenosine
Prophylaxis flecanide or sotalol
Curative : radiofrequency ablation
If it occurs with AF avoid using drugs that block the AV node

42
Q

Management of atrial flutter

A

Rhythm control
Cardioversion or medications
DC cardioversion
IV amiodarone, sotalol, flecanide

Recurrence
Radio frequency catheter ablation

43
Q

Management of broad complex tachycardia

A

UNSTABLE

  • synchronised DC up to 3 times
  • Amiodarone 300mg 10-20 mins, 900ng 24hours

STABLE/ IRREGULAR
- Magnesium 2g over 10 minutes

STABLE/REGULAR
- Amiodarone as above

Note VT is usually due to damage so will require maintenance anti- arrhythmias (BB/CBB) or consider implantable cardioversion defibrillator

44
Q

Mechanism of action of amiodarone

A

Blockade of Na/K/Ca channels
Antagonist alpha and beta adrenergic receptos
Slows conduction and increases refractory period (AV node)
Do not give in heart block or in thyroid disease

45
Q

Mechanism of action of adenosine

A

Adenosine receptor agonists on cell surface
Reduces automaticity and increases refractoiness
Slows sinus rate
Slows conduction and increases AV node refractoriness
Breaks the re entry circuit
Must monitor with a continuous ECG

46
Q

Mechanism of action of digoxin

A

Negatively chronotropic
Positively ionotropic
Reduces conduction at the AV node
Increases the contractile force

Cardiology (3 decks)

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