Term
| Possible causes of atrial fibrillation |
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Definition
* Ischaemia/coronary artery disease
* Valvular heart disease (mitral stenosis/regurg etc.)
* Left atrial enlargement
* Thyroid disease (hyperthyroidism)
* Cardiomyopathy
* Congenital defects
* Stimulants (caffeine, alcohol, tobacco, medications)
* Infections |
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Term
| Complications of atrial fibrillation |
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Definition
* Ischaemia/angina/AMI
* Embolism
* Stroke/CVA
* Hypotension
* CCF/LV failure |
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Term
| Therapy for atrial fibrillation |
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Definition
Need to slow/control ventricular rate:
* Digoxin
* Beta-blocker
Other:
* Anticoagulation (warfarin)
* DC reversion/cardioversion |
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Term
| Cardioversion: what needs to be considered? |
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Definition
* DC reversion reasonable if AF onset is <12 hrs
* Pt <65 yrs
* No Hx cardiac disease
* No risks thromboembolism
* No LA thrombus |
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Term
| What conditions other than Afib may cause an irregularly irregular pulse rhythm? |
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Definition
* Multiple ventricular premature beats
* Multiple atrial premature beats
* Atrial flutter w/ variable block
* Multifocal atrial tachycardia |
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Term
| Location of leads & likely coronary artery supplying II, III, aVF |
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Definition
| Inferior, right coronary artery (RCA) |
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Term
| Location of leads & likely coronary artery supplying I, aVL, V5, V6 |
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Definition
| Lateral, circumflex artery |
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Term
| Location of leads & likely coronary artery supplying V1, V2 |
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Definition
| Septal, left anterior descending artery (LAD) |
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Term
| Location of leads & likely coronary artery supplying V3, V4 |
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Definition
| Anterior, left anterior descending artery (LAD) |
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Term
| What are the indications for thrombolysis? |
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Definition
* Ischaemic chest pain >1/2 hr duration
* ST elevation >2mm in 2 contiguous chest leads
* ST elevation >1mm in 2 contiguous limb leads
* New onset LBBB
* Evidence of acute post. MI |
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Term
| Risk factors for ischemic heart disease |
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Definition
Top 6 = most important
* Smoking
* Male
* HTN
* Hypercholesterolaemia
* FHx
* Previous ischaemic heart episode
* Diabetes
* Arrhythmias
* Anaemia
* Thyroid disease |
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Term
| What tests might you suggest if a patient has angina? |
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Definition
* Stress test ECG
* Stress echocardiogram
* Coronary angiogram |
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Term
| What are the contraindications for performing a stress test? |
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Definition
* Acute AMI
* Unstable angina
* Severe aortic stenosis |
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Term
|
Definition
* Systolic or diastolic
* Ejection or pansystolic
* Maximum intensity location
* Radiation |
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Term
| Clinical features which suggest presence of significant aortic stenosis |
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Definition
* Slow rising carotid pulse
* Systolic thrill in aortic area
* Transmission of murmur to carotids
* Narrow pulse pressure
* LV hypertrophy on ECG |
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Term
| Fundi changes on ophthalmoscopy with hypertension |
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Definition
* Haemorrhages
* Exudates
* Papilloedema |
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Term
| Causes of secondary hypertension |
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Definition
* Chronic kidney disease
* Renal a. stenosis
* Coarctation of the aorta
* Thyroid dysfunction (Cushing's disease)
* Pregnancy |
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Term
| Investigations for underlying cause of hypertension |
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Definition
* Urine dipstick & MCS
* Renal function tests (UECs, 24 hr urinary catecholamines etc.)
* Renal a. imaging (Doppler etc.)
* Urinary or plasma aldosterone or aldosterone-renin ratio
* Electrolytes looking for hypokalaemia |
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Term
| Lifestyle management of essential hypertension |
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Definition
* Avoid added salt
* Physical exercise
* Moderate alcohol intake
* Weight control
* Smoking cessation
* Relaxation/stress management |
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Term
| Investigations for palpitations |
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Definition
* ECG
* FBE, UEC, LFT, CRP
* Cardiac enzymes (troponins)
* TFTs
* CXR
* Echocardiogram |
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|
Term
Diagnosis of ECG:
Raised ST segments, concave upwards in all leads |
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Definition
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Term
Diagnosis of ECG:
Saw-tooth pattern (particularly in inf. leads), tachycardia |
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Definition
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Term
| Definition of 1st degree heart block |
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Definition
| PR interval >200 ms (5 small squares) |
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Term
| Definition of 2nd degree heart block, Mobitz 1 |
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Definition
| Progressive prolongation of PR interval culminating in a non-conducted P-wave |
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|
Term
| Definition of 2nd degree heart block, Mobitz 2 |
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Definition
| Intermittent non-conducted P-waves WITHOUT progressive prolongation of the PR interval |
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|
Term
| Definition of 3rd degree (complete) heart block |
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Definition
Complete absence of AV conduction (P-waves are present, but not associated w/ QRS complexes)
Perfusing rhythm is maintained by a junctional or ventricular escape rhythm |
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