1st year cardio Flashcards
what is classed as hypertension?
-clinic BP 140/90
AND
-ABPM or HBPM 135/85
treatment for hypertension <55 or diabetic?
- ACEI/ARB
- ACEI/ARB + CCB OR ACEI/ARB + Diuretic
- ACEI/ARB + CCB + Diuretic
- A + C + D + further diuretic or alpha or beta blocker
treatment for hypertension > 55 or African or Carribean origin?
- CCB
- CCB + ARB/ ACEI OR CCB + Diuretic
- ACEI/ARB + CCB + Diuretic
- A + C + D + consider further diuretic or alpha or beta blocker
SE ACEI
dry cough
SE CCB
swollen ankles
CCB= cankles
what is Virchow’s triad?
-how thrombosis occurs
- stasis of blood flow
- endothelial injury
- hyper coagulability
management of VTE?
Direct oral anticoagulants
e.g. rivaroxaban
treatment stable angina?
acute= GTN spray
- BB
- +/- rate limiting CCB (diltriazem/veramapil)
inferior limb leads?
II, III and AVF
anterior limb leads?
V1-V6
anteroseptal limb leads?
V1-V4
anterolateral limb leads?
I, avL, V1-6
treatment for STEMI?
- PCI (if <120mins)
- Fibrinolysis (if PCI cannot be delivered in <120 mins)
MONAT Morphine IV Oxygen- if hypoxic Nitrate (GTN) Aspirin 300mg Tricagrelor 180mg
treatment NSTEMI?
-Aspirin and Fondaparinux (fibronylitic therapy to break up clot)
High risk= refer for angiography within 96 hours (+/- PCI)
Low risk= Aspirin and Ticagrelor
(use GRACE score to decide if high risk of low risk)
what occurs to cardiac output in heart failure?
-it decreases
presentation right sided HF?
- peripheral oedema
- raised JVP
- hepatosplenomegaly
- ascites
presentation left sided HF?
- exertional dyspnoea
- PND (wakes up at night breathless)
- orthopnea (how many pillows do they sleep with)
- fatigue
- cyanosis
- pulmonary congestion (pink, frothy sputum and crackles and wheezes)
how does HF present on CXR?
ABCDE
- Alveolar oedema
- Kerley B lines
- Cardiomegaly
- Dilated upper Lobe vessels
- Pleural Effusion
investigations for HF?
1st line= NT- pro- BNP (released when the heart is under strain)
echo- best way to assess cardiac function and structure
ECG + CXR may be useful
CXR: ABCDE
- alveolar bat wings
- Kerley B lines
- Cardiomegaly
- Dilated upper lobe vessels
- Pleural effusion
management of heart failure?
1st= ACEI + BB dual therapy (e.g. ramipril + bisoprolol)
2nd= spironolactone
Fluid overload= furesomide (loop diuretic)
what does S3 suggest?
- heart failure
- can be normal in younger adults and adolescents
what does S4 suggest?
(heard just before S1)
- always abnormal
- hypertrophic ventricle
what valve is heard at 2nd ICS, right of the sternum?
-aortic valve
what valve is heart 2nd intercostal space left of the sternum?
-pulmonary valve
what is heard at 5th intercostalspace left of the sternum?
Tricuspid valve
what is heard at the 5th intercostal space, mid clavicular line?
mitral valve/ apex beat
what murmurs are heard during systole?
MRS ASS
- mitral regurgitation
- atrial stenosis
infective endocarditis- IV drug user
- what bacteria?
- what valve is most commonly affected?
Staph aureus
Tricuspid valve most commonly affected
Infective endocarditis- prosthetic valve surgery
-What bacteria?
Staph epidermic
describe aortic stenosis
Aortic stenosis is hardening of aortic valve
- heard over the 2nd intercostal space, right of the sternum
- low volume, slow rising pulse
- ejection systolic murmur
- radiates to carotid
describe mitral regurgitation
Backflow of blood through the mitral valve due to floppy valves
- heard at the 5th intercostal space, mid clavicular line
- displaced apex
- pansystolic murmur
- maximal at the apex and radiates to the axilla
describe mitral stenosis
Hardening of mitral valves
- heard loudest at 5th intercostal space, mid clavicular line
- malar flush
- tapping apex beat
- mid diastolic murmur localised at the apex
