3.0 Flashcards
what are you likely to see on an ABG in someone with a PE?
why?
respiratory alkalosis
PE –> hyperventilation / high RR
acute STEMI
drop in BP
high HR
increased RR / SOB
lung crackles
DDx?
congestive heart failure is taking place
progression of pulmonary oedema
mitral regurgitation
- common with infero-posterior infarction
- -> papillary muscle
- -> acute hypotension
- -> pulmonary oedema
- -> systolic murmur
left ventricular aneurysm
ischaemic damage –> resulting aneurysm formation
- persistent STEM
- left ventricular failure
how does a VSD present?
early weeks of life heart failure
pan-systolic murmur –> larger hole = louder
how does aortic regurg present?
AF LVF (pulmonary oedema) collapsing pulse displaced apex head bobbin (de musset's)
early diastolic
high pitched
which heart failure drugs reduce long-term mortality + slow disease progression?
ace -i
beta blockers
spironolactone
indapamide
thiazide-like diuretic
treatment options for stemi
percutaneous coronary intervention
thrombolysis
how often are troponins done?
every 4 hours
can peak at 24-48 hrs
staying high for up to 10 days
ECG abnormalities after MI
inverted T waves
pathological Q waves
hyperacute T waves
ST elevation
new onset LBBB
can you drive after MI?
can’t drive for 1 month after MI
no need to inform DVLA
complications after MI
PE DVT Stroke pericarditis (24-48 hrs) dressler's (2 weeks) Left ventricular failure LV aneurysm acute mitral regurg AV node block Cardiogenic shock Chronic heart failure
complications after MI
PE DVT Stroke pericarditis (24-48 hrs) dressler's (2 weeks) Left ventricular failure LV aneurysm acute mitral regurg AV node block Cardiogenic shock Chronic heart failure
aside from trops - what other bloods would you do in someone with query MI?
FBC - anaemia TFT - thyrotoxicosis Lipid profile - hypercholestaemia glucose - DM U&E - renal disease / considering ACE-i
how does aspirin reduce the risk of coronary events
- COX inhibition
- COX is then stopped from being made into prostaglandins + thromboxane
- Low levels of thromboxane - a precursor for platelets
- Hence inhibiting platelet aggregation for clots
for treatment of heart failure, what drug can cause hypokalaemia
furosemide
acts on channel (Na/K out, chloride in)
how would you increase his potassium levels?
oral (sando-k)
IV (KCL add to fluids)
what drugs are used in heart failure and why?
furosemide - to offload fluid
morphine / nitrates - reduce pre-load
inotropic support / increase contractility - adrenaline / noradrenaline / dopamine
what is a capture beat?
normal QRS complex between VT complexes
drugs used in cardiac arrest
adrenaline 1mg IV 1L 1:10,000
amiodarone 300mg IV
what are the reversible causes of cardiac arrest?
hypoxia
hypovolaemia
hyper/hypokaelamia - calcaemia - glycaemia
hypothermia
thrombosis
tension pnemothorax
tamponade
toxins
what classification is used for heart failure
new york heart association (NYHA)
how + where does furosemide act?
competitively inhibits Na-K-2Cl cotransport
at thick ascending loop of Henle
preventing reaborption by reducing osmotic gradient (Na, K out)
- hypovolaema
- hypokalaemia
- hypocalcaemia
side effects of ACE-i
1st dose hypotension
dry cough
angiodema
hyperkalaemia
complications of essential HTN
ischaemic heart disease peripheral vascular disease stroke hypertensive retinopathyf CKD
bedside signs of hypercholestraemia
xanthelasmata
tendon xanthoma
corneal arcus
common causes of AF
Pulmonary (PE/ COPD) Idiopathic Rheumatic disease (rheumatic fever, mitral REGurg) Anaemia / alcohol Thyrotoxicosis Electrolytes / endocarditis Sepsis
methods of AF conversion
medical - amiodarone / flecanide
electrical - DC cardioversion
ablation
where are microemboli likely to be found?
eyes - roth’s spots
urine dip - microhaemorrhages
nail beds - splinter haemorrhages
what criteria is used for endocarditis?
Duke’s
features of aortic regurg
early diastolic murmur high pitched collapsing pulse head bobbin (de musset's sign) wide pressure pulse
features of infective endocarditis
splinter haemorrhages
osler’s nodes
janeway lesions
clubbing
during cardiac arrest, when would you administer 3 successive shocks
if cardiac arrest was witnessed on monitor
Inferior STEMI - where would you find reciporcal ST depression?
anterior
lateral
(PAILS)
Mx for angina
beta blocker / CCB - 1st line
all angina patients should all have recieved aspirin + statin
Pt shows an inferior MI on ECG BP 85/60 HR 96 ECG ST depression
what drug is contraindication?
nitrates are CI in patients with hypotension systolic <90mmHg
vasoilator effects
- reducing revous return
- worsening hypotension
what abx can cause torsades de pointes
macrolides
pericarditis ecg features (3)
- PR depression
- saddle shape ST
- wide spread ST elevation
what is bifasicular block?
- RBBB
2. Left axis deviation
what is trifascular block?
- RBBB
- Left axis deviation
- 1st heart block
