06/06/2021 Flashcards
Investigation for pulmonary embolism in patient with renal impairment
V/Q scan
Infective endocarditis valve in IVDU
tricuspid valve
what does the management of bradycardia depend on
- identifying presence of ‘adverse signs’
2. identifying the potential risk of asystole
what indicates haemodynamic compromise in bradycardia
- shock
- syncope
- myocardial ischaemia
- heart failure
management of bradycardia with adverse signs
atropine 500mcg IV
what are the risk factors for asystole
- complete heart block with broad complex QRS
- recent asystole
- mobitz type II AV block
- ventricular pause > 3 seconds
management of AF with collapse
immediate DC cardioversion followed by thromboprophylaxis
sign of pulmonary hypertension
loud second heart sound
splitting of first heart sound
mitral valve closes significantly before the tricuspid, inspiration is a cause of this
soft second heart sound
aortic stenosis
reversal of dabigatran
idarucizumab
reversal of warfarin
vit K
reverse unfractionated heparin
protamine sulphate
eisenmeger
reversal of a left to right shunt
Aortic stenosis management: ____ if symptomatic, otherwise cut-off is gradient of __ mmHg
AVR
40
pharmacological managment of orthostatic hypotension
Fludrocortisone and midodrine are pharmacological options for treatment of orthostatic hypotension
ECG changes for thrombolysis or percutaneous intervention:
> ST elevation of > 2mm (2 small squares) in 2 or more consecutive anterior leads (V1-V6)
OR
ST elevation of greater than 1mm (1 small square) in greater than 2 consecutive inferior leads (II, III, avF, avL) OR
New Left bundle branch block
Poorly controlled hypertension, already taking an ACE inhibitor and a thiazide diuretic
add a CCB
The long saphenous vein passes anterior to the ————- and is commonly used for _______ ________
The long saphenous vein passes anterior to the medial malleolus- and is commonly used for venous cutdown
management of angina
1) aspirin + statin
2) sublingual GTN
3) beta blocker or CCB (verapamil or diltiazem if monotherapy, long acting dihydropyridine CCB (nifedipine) if used with bblocker)
4) if dual therapy not adequaate then PCI or CABG
ST elevation + PR depression
pericarditis
what foods should those on warfarin avoid
broccoli, sprouts, spinach, kale (high Vit K)
inferior MI plus aortic regurg murmur
ascending aorta dissection
what is contraindicated in ventricular tachycardia
verapamil- precipitate cardiac arrest
anti-anginal causing GI ulceration
nicorandil
secondary prevention of MI
dual antiplatelet therapy (aspirin + second antiplatelet)
ACE inhibitor
beta-blocker
statin
coarctation of the aorta presentation
acute circulatory collapse at 2 days of age when duct closes- heart failure & absent femoral pulses
systolic murmur under left clavice and over back
types of aortic dissection
Type A- ascending aorta- control BP (IV labetaolol + surgery)
Type B- descending aorta- control BP (IV labetalol)
long-term management of unprovoked pulmonary embolisms
6 months apixaban
investigating aortic dissection in clinically unstable patients
transoesophageal echogardiography
which antibiotic can cause long QT syndrome
erythromycin
system used in the assessment of suspected obstructive sleep apnoea
epworth scale
system used to determine the need to anticoagulate a patient in atrial fibrillation
CHA2DS2-VASc
system used to measure disease activity in rheumatoid arthritis
DAS28
acute pulmonary oedema management
IV diuretics- furosemide
Poorly controlled hypertension, already taking an ACE inhibitor, calcium channel blocker and a standard-dose thiazide diuretic. K+ > 4.5mmol/l
Add an alpha or beta blocker
when should treatment with statins be discontinued?
if serum transaminase concentrations rise to and persist at 3 times the upper limit of reference range
persistent ST elevation following recent MI, no chest pain-
left ventricular aneurysm
management of major bleeding in warfarinised patients
stop warfarin, give IV vit K 5mg, prothrombin complex concentrate
For patients of black African or African–Caribbean origin taking a calcium channel blocker for hypertension, if they require a second agent consider
angiotensin receptor blocker in preference to an ACE inhibitor
risk factors for silent MI
diabetes
elderly
massive PE + _______ = thrombolyse
hypotension
standford B
site of the dissection is the descending aorta.
Management of stanford B dissection
Appropriate first line medical management is IV beta blockade and analgesia.
If blood pressure and heart rate remain raised then vasodilators may be considered
drugs that reduce mortality in patients with LVF
>ACE-inhibitors >Beta-blockers >Angiotensin receptor blockers >Aldosterone antagonists >Hydralazine and nitrates
management of torsades des pointes
IV magnesium sulphate
Anteroseptal
V1-V4
Left anterior descending
Inferior
II, III, aVF
Right coronary
Anterolateral
V4-6, I, aVL
Left anterior descending or left circumflex
Lateral
I, aVL +/- V5-6
Left circumflex
Posterior
Tall R waves V1-2
Usually left circumflex, also right coronary
when is 3rd heart sound considered normal?
<30
MOA of bumetanide
Furosemide - inhibits the Na-K-Cl cotransporter in the thick ascending limb of the loop of Henle
signs and symptoms of malignant hypertension
> Papilloedema
Retinal bleeding
Increased cranial pressure causing headache and nausea
Chest pain due to increased workload on the heart
Haematuria due to kidney failure
Nosebleeds which are difficult to stop
patients who require anticoagulation but do not want regular monitoring
NOACs
HOCM is associated with sudden death in young athletes due to …..
ventricular arrythmia
dabigatran reversal
idarucizumab
offer both …. ….. as licensed first line treatment for heart failure
ACE inhibitor + beta blocker
if symptoms of HF persist after 1st line treatment then consider;
aldosterone antagonist
angiotensin receptor blocker
hydralazine + nitrate
if symptoms of HF persist despite 1st and 2nd line treatment consider
cardiac resynchronisation therapy
digoxin
A patient with AF + an acute stroke (not haemorrhagic) should have anticoagulation therapy started….
two weeks after the event
when are nitrates contraindicated
aortic stenosis- risk of profound hypotension
pulmonary embolism ABGs
hyperventilation, causing a drop in arterial carbonic dioxide partial pressure and thus alkalosis
warfarin ___ be used in breastfeeding
can
target of INR
- 5
- DVT, PR, APS, A FIB, Cardioversion etc - 5
- recurrent DVT or PE
