18 November Flashcards
What is crescendo angina?
Comes on at rest/ with minimal exertion/increasing in frequency
What is variant angina?
Angina comes on at rest
What is decubitus angina?
Angina precipitated by lying flat
What is first line management of angina- in terms of symptom relief?
Beta blocker
CCB- if dual therapy them amlodipine
GTN
What other medication should be commenced in the presence of angina?
Statin
Aspirin
For secondary prevention
What does this ECG show?
Posterior MI
What vessel is affected in posterior MI?
Right coronary artery or left circumflex
What vessel is affected in anterior MI?
Left anterior descending artery
What vessel is affected in lateral MI?
Circumflex artery
What vessel is affected in inferior MI?
Right coronary atery
What vessel is affected in anterolateral MI?
Left coronary artery
What are causes of ejection systolic murmur?
Aortic stenosis
Pulmonary stenosis
Hypertrophic cardiomyopathy
Aortic sclerosis
Flow murmur
What is the screening for known AAA?
<3cm- no action
3-4.4cm- US every 12 months
4.5-5.4cm- Scan every 3 months
>5.5cm- 2 week referral for intervention
What is lights criteria for pleural effusion?
If protein content 25-35g/Dl- exudate is likely if one of the following met
1) Pleural fluid protein divided by serum protein >0/5
2_ Pleural fluid LDH divided by serum LDH >0/6
3) Pleural fluid LDS more than 2/3 upper limit of normal serum LDH
What is the CHADsVASc score?
Congestive Heart Failure- 1
Hypertension-1
Age >75 2 points
Diabetes mellitus 1 point
Stroke 2 points
Vascular disease 1 point
Age 65-74 1 point
Sex (female) 1 point
What are the ECG findings of hypertrophic cardiomyopathy?
Left ventricular hypertrophy
T wave inversion
Deep Q waves
AF can be seen
What are features of HCM?
Exertional dyspnoea
Syncope
Angina
Sudden death
Jerky pulse
Double apex beat- inappropriate filling during diastole
Ejection systolic murmur- worsens with Valsava
what is atrial myxoma?
Non cancerous tumour of the upper left or right of the heart
More common in women
What are features of atrial myxoma?
Weakness
Numbness
Chest pain
SoB
Leg swelling
Fever
Night sweats
What are causes of LBBB?
MI
HTN
Aortic stenosis
Cardiomyopathy
Idiopathic fibrosis
Digoxin toxicity
Hyperkalaemia
What are ECG signs of hyperkalaemia?
Tall tented T waves
Flat P waves
Widened QRS complex
What is the management of heart failure?
1) ACE inhibitor, betablocker
2) Aldosterone antagonist
3) Specialist- digoxin/ivabradine/hydralazine
What are side effects of amiodarone?
Grey/blue discolouration of skin
Hypo/hyperthyroidism
Hepatitis
Cough
Dyspnoea
Fibrosis
Peripheral neuropathy
Arrythmias
Conduction disorders
Hypotension
What are absolute contraindications for thrombolysis?
Previous intracranial bleed
Iscahemic stroke <6months
Cerebral neoplasm
AV malformation
Recent major trauma/surgery/head injury <3 weeks
Aortic dissection
Active bleeding/bleeding disorder
GI bleeding
Non compressible punctures <24 hours e.g. liver biopsy
what murmur is aortic regurg?
Early diastolic murmur
Heard best during expiration and patient sitting forward
