07/06 Flashcards
aortic vs pulmonary stenosis
pulmonary is louder on inspiration
posterior MI ECG changes
tall R waves in leads V1-3
CHADSVAC score
C- ongestive HF (1)
H- ypertension ( or treated hypertension) (1)
A2 age >75 (2)
age 65-74 (1)
D- iabetes (1)
S2- prior stroke or TIA (2)
V- ascular disease (IHD, PAD) (1)
S- ex (female) (1)
0 = no treatment
1= males- consider anticoag, females (no treatment)
2 or more = coagulation
how to differentiate between ascending/descending aortic dissection?
descending= normal heart sounds
ascending= aortic regurgitation
signs of right sided heart failure
raised JVP
ankle oedema
hepatomegaly
normal range LVEF
55-70%
when are regional wall abnormalities seen
infarction
acute management of SVT
vagal maneovures
IV adenosine 6, 12, 12 (verapamil in asthmatics)
cardioversion
MOA of statin
inhibit HMG-CoA reductase- the rate limiting enzyme in hepatic cholesterol synthesis
hypokalaemia ECG findingd
U waves
T waves have sine appearace
prolonged QTc
borderline PR
antihypertensives to be avoided in diabetes
thiazides
1st line anti-anginal for stable angine in a patient with known heart failure
atenolol
pulsus paradoxus
fall in systolic BP of >10mmHg during inspiration- asthma + cardiac tamponade
slow rising pulse
aortic stenosis
jerky pulse
HOCM
pulsus alterans
regular alteration of the force of the arterial pulse- left ventricular failure
management of dyspnoea and anxiety in acute exacerbation of HF
morphine
ECG in wpw
Possible ECG features include:
> short PR interval
> wide QRS complexes with a slurred upstroke - ‘delta wave’
> left axis deviation if right-sided accessory pathway*
> right axis deviation if left-sided accessory pathway*
medical treatment WPW
definitive treatment: radiofrequency ablation of the accessory pathway
medical therapy: sotalol, amiodarone, flecainide
sotalol should be avoided if there is coexistent atrial fibrillation
Complete heart block following an inferior MI is NOT an indication for ….
pacing, unlike with an anterior MI
NSAIDs ______ PDA and prostaglandins _____ PDA
close
open
management of asystole
ALS- CPR + check rhythm every two minutes + adrenaline every 3-5 minutes
Management of NSTEMI
aspirin 300mg
fondaparinux if no immediate PCI planned
estimate 6-month mortality
if low risk- give ticagrelor
if immediate/high risk - give prasugrel or tecagrelor and unfractionated heparinq
side effects of nitrates
hypotension
tachycardia
headaches
flushing
what should be used when ACEi cant be tolerated
<55 = ARB
NYHA classification
I= no symptoms, no limitation II= mild symptoms, slight limitation III= moderate symptoms, marked limitation (less than ordinary activity) IV= severe symptoms, pain at rest
hypothermia ECG
bradycardia J wave 1st degree HB long QT atrial and ventricular arrythmias
b blocker reducing mortality in HF
bisoprolol
glycoprotein IIb/IIIa receptor antagonist
abciximab
eptifibatide
tirofiban
adrenaline in ACS
non-shockable= ASAP, then alternate cycles
shockable= after 3rd shock, alternating cycles
amiodarone in ACS
given after third shock and considered after 5 shocks
_____ must be temporarily stopped when a macrolide antibiotic is started
statins
most common valve affected in encarditis
mitral valve
2) aortic
3) combined mitral + aortic
4) tricuspid
5) pulmonary
signs of neurally mediated syncope
prodrome- sweating, pallor, N&V
transient LOC
when should ACEi be stopped in patients with CKD
K >6
long term management post-MI
ABCDs ACEi Beta Blocker Cholesterol lowering agent (Statin) Dual antiplatelet therapy
pulse deficit in aortic dissection
In aortic dissection, a pulse deficit may be seen:
> weak or absent carotid, brachial, or femoral pulse
>variation in arm BP
STEMI management: if patient is having PCI then _____ is given in _____ __ _____. If patient is on an anticoagulant then ________ used instead
STEMI management: if patient is having PCI then aspirin is given in addition to aspirin. If patient is on an anticoagulant then clopidogrel used instead
de musset
head bobbing in aortic stenosis
