Cardiology/general Ii

Front 1

Drugs for SVT (overview)

Back 1

ADENOSINE (for termination)
Verapamil
Betablocker
Other:
Amiodarone
Flecanaide
Quinidine
Digitalis

Front 2

ADENOSINE (ind, contraind, SE, dose)

Back 2

A2 receptor antagonist
termination of SVT
AV blocks
Asthma
Accessory conduction
dose: 6mg - 12mg

Front 3

ADENOSINE interaction

Back 3

DIPYRIDAMOLE
decreases re-uptake of adenosine.
-> reduce dose to 0.5 - 1mg

THEOPHYLLINE
competetive A2 agonist
-> use larger dose of adenosine to convert

Front 4

ADENOSINE practical use

Back 4

- 12 lead ECG before and after
- start with 6mg
- warn patient of "thump"
- give as bolus in large vein and flush with 10-20ml of NS
- increment dose after 1-2min if necessary
- stop increasing dose if AVB develops

Front 5

Classification of hypertension

Back 5

Grade I 140-149 90-99
Grade II 160-179 100-109
Grade III >180 >110

Front 6

Hypertension - aetiology

Back 6

primary
90% essential (primary)
secondary
renal (80%)
diabetic nephropathy
renovascular disease
GN
tubulointestinal nephritis
APCKD
endocrine
conn's syndrome
adrenal hyperplasia
phaeochromocytoma
Cushing's syndrome
Acromegaly
Coarcation of the aorta

Front 7

Malignant hypertension

Back 7

rapid rise, severe HTN
diastolic pressure >120
fibrinoid necrosis
renal failure, aortic dissection, heart failure, encephalopathy
1 year survival 20%

Front 8

Malignant hypertension - clinical presentation

Back 8

headache, nosebleed, visual disturbances, dyspnoe (LVH)
pointing towards cause:
attacks of sweating, headaches, palpitations (phaeo)
sx of IHD or peripheral arterial disease (renal artery stenosis)

Front 9

Malignant hypertension - clinical signs

Back 9

only BP elevated
signs of underlying cause:
- radial-femoral delay
- renal artery bruits
- signs of LVH/CCF
- fundoscopic signs

Front 10

Fundoscopy of hypertensive patient (Keith-Wagener classification)

Back 10

Grade 1: tortuosity of retinal arteries, silver wiring
Grade 2: nipping (where artery passes over vein)
Grade 3: flame shaped haemorrages, cotton wool spots
Grade 4: papilloedema

Front 11

Hypertension - basic screening investigations

Back 11

ECG
(signs of IHD/LVH -> further Ivx)
urine dipstick
(if protein/blood -> further Ivx)
U+E
(K low - Ivx for hyperaldosteronism - further Ivx)
fasting blood for glucose and lipids

Front 12

Hypertension - non-pharmacological treatment

Back 12

BMI reduction to <25
smoking cessation
low fat diet
low sodium diet <6g/day
increase fruit+veg
increase fish oil
limited EtOH <21M <14F
dynamic excercise >30min brisk walk per day

Front 13

Hypertension - when to commence pharmacotherapy

Back 13

BP >160/>100
after a periode of 6 months if
BP >140-150/90-99 if signs of end organ damage or >20% cardiovasc. 10 year risk
BP >140/>90 in diabetics

Front 14

Hypertension - treatment goals

Back 14

non-diabetic: <140/85

Front 15

Malignant hypertension - when to admit

Back 15

diastolic BP >140 or severe end-organ damage:
- grade 3-4 retinopathy
- CCF
- encephalopathy

Front 16

Malignant hypertension - how to manage in hospital

Back 16

slow reduction:
aim: diastolic 100-110 over 24-48 hours.
oral Ca-channel blocker
quick reduction (only if aortic dissection!)
IV nitroprussive or labetolol

Front 17

Management of hypertension in pregnancy

Back 17

mildly elevated: methyldopa or labetolol
pre-eclampsia same or nifedipine or delivery
eclampsia: IV hydralazine and TOP

Front 18

DDx of sudden death in a young marathon runner

Back 18

HOCM
ARVD
Long QT syndrome
Brugada syndrome

Front 19

DDx of SVT

Back 19

Sinus tachycardia
Atrial tachycardia
Atrial fibrillation
Atrial flutter
MFAT
AVNRT
AVRT
Accelerated junctional tachycardia

Front 20

definition of normal sinus rythm

Back 20

p wave that is positive in I, II and negative in aVR and V1

Front 21

infective endocarditis - organisms by origin

Back 21

dental (strep viridans) 50%
infected cannula, IV drug user, soft tissue infection (staph aureus)
UTI (enterococcus)
colon Ca (strep bovis)

Front 22

infective endocarditis in pt with valve replacement

Back 22

early <60 days: staph aureus/epididermidis

late: strep viridans, staph aureus (25%) - like normal population.

Front 23

rare causes of infective endocarditis

Back 23

HACEK
haemophilus, actinobacillus, cardiobacter, cardiobacterium, eikenella, kingella

Front 24

culture negative endocarditis

Back 24

5-10%
previous abx or coxiella burnetii, chlamydia, bartonella, legionella

Front 25

infective endocarditis - ECG

Back 25

AVB (abscess)
ischaemia (emboli)

Front 26

infective endocarditis - CXR

Back 26

multiple septic emboli/abscesses

Front 27

infective endocarditis - echo

Back 27

TTE - sensitivity vegitations 60-75%, root abscess
TOE higher sensitivity

Front 28

infective endocarditis - antibiotics while culture result awaited (if pt unstable or very unwell)

Back 28

no suspicion of staph:
penicillin 1.2g 4hrl, gentamycin BD
suspected staph aureus:
vancomycin 1g, gentamycin TDS

Front 29

Duke's criteria

Back 29

diagnosis if 2 major or 1 major and 5 minor

Front 30

Duke's major criteria

Back 30

1. Positive blood culture
2. evidence of endocardial envolvement

Front 31

Duke's criteria - minor

Back 31

1. fever >38
2. predisposition
3. echo (not major)
4. immunological phenomena
5. vascular phenomena
6. microbiology (not major)

Front 32

atrial myxoma

Back 32

tumor plop
murmur that changes with position
clubbing, constitutional signs.

Front 33

Mitral valve prolapse (MVP) - associations/aetiology

Back 33

young females, familial
?normal variant (so common)
associate with:
Marfan's
HOCM
rheumatic/IHD

Front 34

MVP - clinical presentation

Back 34

atypical chest pain, submamillary, stabbing (most common)
palpitations
cerebral emboli

Front 35

MVP - clinical signs

Back 35

mid-systolic click
may be followed by a late systolic m

Front 36

MVP - CXR

Back 36

usually normal

Front 37

MVP - ECG

Back 37

usually normal

Front 38

MVP - echo

Back 38

diagnostic - posterior movement of one of the two cusps

Front 39

MVP - treatment

Back 39

if only atypical chest pain: BB
in pt <75 who have LVF +/- AF or significant regurgitation: mitral valve repair

Front 40

DVLA regulations post-MI

Back 40

stop driving, inform the DVLA and return for ETT in 6/52 after he has stopped anti-anginal meds for 48 h

Front 41

Brugada syndrome

Back 41

SUDS (sudden unexpected death syndrome) - there is no warning!!
RBBB
>2mm ST-elevation in V1-V3

Front 42

Brugada syndrome - managment

Back 42

ICD
if frequent shocks ("VF storm") consider quinine (no RCT)

Front 43

HOCM management

Back 43

betablockers once symptoms
if outflow gradient >50 consider mymectomy
if arrythmias: ICD

Front 44

Lutembacher's syndrome

Back 44

congenital ASD + MS
F>M
presents with fategue and AF

Front 45

ECG: tall R wave in V1 DDx

Back 45

WpW Type A
dextrocardia
posterior MI
RBBB

Front 46

most common paroxysmal SVT

Back 46

AVNRT
retrograde p waves!

Front 47

first line treatment in stable pt

Back 47

vagal manoevre
if unsuccessful, adenosine
if unsuccessfull, DC cardioversion