cardio Flashcards
ASD
ESM louder on inspiration
MS
mid-late diastolic
loud S1, opening snap
soft S1
MR
loud S1
MS
soft S2
AS
when is S3 normal
<30 years
S3
LV failure (e.g. dilated cardiomyopathy) constrictive pericarditis (called a pericardial knock) mitral regurgitation
when is S4 normal
<40 years
S4
aortic stenosis, HOCM, hypertension
HF (chronic) mx
BASHeD Beta blocker + ACEi Spironolactone (Get specialist input) Hydralazine + Nitrates e Digoxin
STEMI PCI within 120 mins
Aspirin 300mg
PCI
Prasugrel
Unfractionated heparin + bailout glycoprotein IIb/IIIa inhibitor
STEMI PCI not possible within 120 mins
Aspirin 300mg Fibrinolysis Antithrombin Ticagrelor post-prodecure ECG 60-90 mins post-procedure Persistent MI - PCI
NSTEMI/unstable angina low risk mortality (<=3%)
Aspirin 300mg + Fondaparinux if no immediate PCI planned
Ticagrelor
NSTEMI/unstable angina high risk mortality (>3%)
Aspirin 300mg (+Fondaparinux if no immediate PCI)
PCI immediately if unstable, otherwise within 72h
Prasugrel or Ticagrelor
Unfractionated heparin
SVT ECG
narrow complex tachycardia (QRS<120ms)
SVT mx
vagal manoeuvres
adenosine (CI in asthma, use CCB)
P450 inducers (SCARS) what do they do to INR?
Smoking Chronic alcohol use Anti-epileptics (phenytoin and carbamazepine) Rifampicin St Johns Wort decrease INR
P450 inhibitors (ASS-ZOLES) what do they do to INR?
ABX (Ciprofloxacin, Macrolides, Isoniazid) SSRIs Sodium valproate -Zoles (Omeprazole, Ketoconazole) increase INR
ejection systolic murmur
AS + HOCM - louder on expiration
PS + ASD - louder on inspiration
pansystolic murmur
MR/TR (TR louder on inspiration)
VSD (‘harsh’)
late systolic murmur
mitral valve prolapse
early diastolic murmur
AR
mid-late diastolic
MS
hypercalcaemia ECG
shortened QT interval
hyperkalaemia ECG
tall tented T waves
flattened P waves
broad QRS
QT prolongation
hypokalaemia ECG
U waves
prolonged PR
ST depression
loud S2
systemic or pulmonary hypertension
PS
ESM
louder on inspiration
complete heart block
P waves and QRS complexes are not related
P wave may be in the QRS complex
first degree heart block
PR interval >0.2s
second degree heart block - type 1 (Mobitz I, Wenkebach)
progressive prolongation of PR until dropped beat
second degree heart block - type 2 (Mobitz II, Wenkebach)
intermittent non-conducted P waves without progressive prolongation of the PR interval
when P waves conduct the PR is constant
target INRs:
- normal
- VTE etc
- if VTE despite warfarin
normal = 0.8-1.2
VTE = 2-3
VTE despite warfarin = 3-4
what is Eisenmenger’s syndrome
reversal of a L->R shunt associated with VSD, ASD and PDA
pharmacological options for treatment of postural hypotension
fludrocortisone
ECG changes that indicate need for PCI or thrombolysis (3)
- ST elevation >2mm in 2 more more consecutive anterior leads
- ST elevation >1mm in >2 consecutive inferior leads
- new LBBB
medical mx of stable angina
beta-blocker or CCB first line
if beta-blocker used first and not controlled, add CCB (long-acting dihydropyridine such as - Amlodipine, Nifedipine)
CCB monotherapy - Verapamil or Diltiazem
adverse effects of ACE inhibitors
cough
hyperkalaemia
angioedema
ECG findings for acute pericarditis
saddle shaped ST elevation
PR depression
ECG changes caused by thiazides
thiazides can cause hypokalaemia leading to:
- prolonged PR
- U waves
- flattened T waves
mx of AF with CHA2DS2-VASc score of 0
no anticoagulation treatment
BP targets
<80 years - clinic BP 140/90, home BP 135/85
>80 years - clinic BP 150/90, hope BP 145/85