Cardiology

Front 1

Systematically thinking about pathophysiology, what factors influence automaticity of Cardiac Impulse formation? Under which cardiac pathology does this mechanism of change most likely present in?

Back 1

- neurohormonal
- abnormal metabolic conditions like hypoxia, hypothermia and acidosis
- drugs
- local ischemia
- other factors like infection/congenital prawlems

Typically presents as accelerated idioventricular rhythm and ventricular tachy cardia 24-72h post MI

Front 2

Systematically describe causes of sinus bradycardia, features, and management plan

Back 2

Causes:
increased vagal tone, vomiting, MI, sick sinus node, ICP, hypothyroid, hypothermia, drugs

Investiagtions:
vitals show BPM<60, ECG shows p wave positive in I and aVF

Treatment consists of removing offending pharmacological agent and using atropine during acute episodes, pacing for sic sinus node syndrome

Front 3

Describe Sick Sinus Syndrome and its management

Back 3

marked bradycardia, sinus pause/arrest, SA block, associated with tachy-brady sydnrome

management is a combo of pacemaker for bradycardia, beta blocker, CCB and or digoxin for tachy.

Front 4

Describe the ECG changes of 1st degree av block and its treatment

Back 4

P-R interval prolonged to > 200msec, frequently found in healthy folk, no treatment needed

Front 5

Describe 2nd degree AV Block

Back 5

Atrial impulses not always conducted to ventricles, and has a ration of P waves to QRS, higher ratio higher DANGER zomg
Divided into Type 1 and Type 2
Type 1: gradual prolongation of the Pr interval which then shows a dropped beat, usually caused by RCA infarct or increased vagal tone following surgery

Type 2 is PR constant with abrupt loss of conduction, happens distal to AV node, and increases risk of high grade 3rd degree block

Front 6

Describe 3rd degree AV block

Back 6

complete failure of conduction of AV stuff to the ventricles. Pr intervals vary because theres no correlation between P and QRS. Ventricular system pacemaker takes over

Front 7

Atrial flutter and its causes. Describe systematically

Back 7

Rapid regular atrial depolarization most commonly right atrium of around 250-350bpm. Presence of AV block is typical. ECG shows saw toothing in II, III and aVF.

Caused by: CAD, thyrotoxicosis, MV disease, cardiac surgery, COPD, PE, pericarditis

Front 8

MGMT of atrial flutter?

Back 8

Straight to cardioversion in acute setting where unstable.
If stable: Beta blockade, diltiazem, verapamil or digoxin, or use chemical cardioversion via sotalol, amiodarone, type I antiarrhythmics

In the long term, consider the use of RF ablation or anti arrhythmics

Front 9

Multifocal atrial tachycardia, describe and give etiology, systematically.

Back 9

Irregular rhythm caused by presence of 3 or more atrial foci. Can mimic Af at times. Usually faster at around 100-200 bpm. On ECG, at least 3 distinct p wave morphologies due to foci.

Occurs more commonly in COPD and hypoxemia, less so with HYPOKALEMIA, hypomagnesemia, sepsis, theophylline or digitalis toxicity

Front 10

Mgmt of Multifocal atrial tachycardia?

Back 10

treat the underlying cause, you may use CCBs. Thats the only thing you can really give

Front 11

How are patients stratified for anticoagulation therapy in AF and what are the risk factors that aid in stratification?

Back 11

CHADS2: CHF, Hypertension, Age>75, Diabetes, Stroke2

0-1 indicates low risk of 1.9-2.8% stroke risk oer year and is ASPIRIN ONLY
2-3 increases to 4-5.9 and 4-6 brings you to 8.5-18.2. Target INR 2-3, ideally 2.5

Front 12

What are ECG and PE findings of AF?

Back 12

Irreg/Irreg., no S4, no "A" wave seen in JVP.

Variable ventricular response, no organized P waves

Front 13

How would one approach the treatment of AF?

Back 13

RACE:
R - rate control with Beta blockers, CCBs. If pt has CHF, consider using digoxin and amiodarone

A - anticoagulation assessment with Chads any score 2 or higher gets warfarin, the rest get aspirin, target 2.5, acceptable 2-3

C - Cardioversion, new onset or risk factors of hypotension, angina due to tacyh, or HF, can proceed straight to cardioversion, if longer than 48 hours, anticoagulate for 3 weeks prior and 4 weeks after.

E - Etiology, treat underlying

Front 14

How would one treat recurrent AF?

Back 14

if they are brief and minimally symptomatic, use rate control and anticoag as opposed to antiarrhythmics.

If symptoms are bothersome, aseess for heart disease. If none, use either flecainide, propafenone, or sotalol. In LV dysfunction and CAD, use amiodarone(antiarrythmic)