Cardio Flashcards
hello everyone (JY), these flashcards are going to cover..
the management of: arrhythmia heart failure MI murmurs angina
in the bare minimum possible detail bc honestly I can hardly read let alone learn cardio <3
treatment for torsades de points
IV magnesium sulphate
treatment for pulseless VT/VF
immediate defibrillation
treatment for sustained VT in a conscious but deteriorating patient
synchronised direct current cardio version
treatment for sustained VT in a stable patient
IV amiodarone
rate control treatment for AF
beta blocker or rate limiting CCB (verapamil)
rhythm control drugs for AF
beta blocker
flecainide
amioderone
when do you use rhythm control as well as rate control in AF
if coexistent heart failure or
first onset of AF or
reversible cause to the AF
how do you treat acute AF in an unstable patient
emergency cardio version
how do you treat AF in a stable patient
rate +/- rhythm control
electrical or drug cardio version (drugs = felcainaide/amioderone)
when would you use electrical cardio version in a stable patient with AF
if they’ve been anti coagulated for at least 3 weeks
or
if the AF has been present for <48 hours (if its been there longer theres more likely to be clots in the atria which would be released by cardio version can cause a stroke)
treatment for paroxysmal SVT
1st line - vagal stimulation
2nd line - IV adenosine
if patient unstable - direct cardio version
what are vagal stimulation techniques
valsalva manoeuvre
immersing in cold water
carotid sinus massage
treatment for recurrent atrial flutter
catheter ablation
treatment for bradycardia in a patient with signs of shock
atropine
how does adenosine work
causes transient heart block - blocks SA node to terminate SVT
side effects of adenosine
flushing
chest pain
bronchospasm
how does hypothermia present on ECG
bradycardia + J waves
1st line treatment for chronic heart failure
ACEi and beta blocker
2nd line treatment for chronic heart failure
aldosterone antagonist (spironolactone)
3rd line treatment for chronic heart failure
needs to be initiated by a cardiologist - indicated if ejection systolic fraction <35%
ivabradine
digoxin
savubitril-valsartan
others
what vaccines should you offer people with heart failure
annual flu vaccine
one off pneumococcal vaccine
how does an MI present
u know the usual signs lol
central crushing chest pain
radiating to jaw/arm
feeling of impending doom
etc
what are the ECG indications for thrombolysis or PCI in MI
ST elevation >2mm in two or more consecutive chest leads
ST elevation of >1mm in >2 consecutive inferior leads
how do you manage a STEMI
MONAT
morphine oxygen nitrates aspirin tricagrelor
timings for giving PCI/fibrinolysis
PCI within 120 mins
if can’t give PCI in 120 mind give fibrinolysis within 12 hours
what are some common post-MI conditions
left ventricular free wall rupture pericarditis (Dressler syndrome) left ventricular aneurysm ventricular septal defect acute mitral regurgitation
how does left ventricular free wall rupture present
1-2 weeks after MI
patients present with acute heart failure secondary to tamponade
- treat with pericardiocentesis)
how can post-MI pericarditis present
commonly in first 48 hours
OR
2-6 weeks later as Dressler’s syndrome
when is a 3rd heart sound normal
in people <30
if >30 then its abnormal - can indicate heart failure
what causes a loud second heart sound
pulmonary hypertension
how do you treat an NSTEMI
beta blockers aspirin ticagrelor morphine anticoagulant nitrites
(BATMAN) can add in oxygen if stats are dropping
what is the first heart sound
closing of the tricuspid and mitral valves (after filling, getting ready for systole)
contraction happens between S1 and S2
what is the second heart sound
aortic and pulmonary valves closing after ventricular contraction
what extra heart sound is always abnormal
4th heart sound
comes before S1
indicates hypertrophic ventricle
systolic murmurs
MRS ASS
mitral regurgitation
aortic stenosis
diastolic murmurs - rarer
mitral stenosis
aortic regurgitation
what does mitral stenosis do to the heart
causes left atrial hypertrophy
much harder to get block through the valve so atria becomes thickkk
what does aortic stenosis do to the heart
causes left ventricular hypertrophy
what does mitral regurgitation do to the heart
causes left atrial dilation
- back flow of blood into left atria stretches it out
- presents as a bifid P wave on ECG (p mitrale)
what does aortic regurgitation do to the heart
causes left ventricular dilatation
what causes mitral stenosis
rheumatic heart disease
infective endocarditis
what does mitral stenosis sound like
mid-diastolic low pitched rumbling murmur
can present with malar flush
what does mitral regurgitation sound like
high pitched whistling murmur
how do tell what a murmur is going to sound like
stenosis - low pitched, blood moving slowly trying to get through stiff valve
regurgitation - high pitched, blood moving at high velocity backwards through the valve
where does mitral regurgitation radiate to
left axilla
where does aortic regurgitation radiate to
carotids
stable vs unstable angina
stable - on exertion - relieved by rest or GTN
unstable - at rest
gold standard investigation for angina
CT coronary angiogram
management of angina for immediate symptomatic relief
GTN spray
treatment for long term symptomatic relief for angina
beta blockers
CCBs
secondary prevention of angina/CVD
Aspirin - 75mg OD
atorvastatin 80mg OD
ACEi
beta blocker
surgical intervention for angina
PCI with coronary angioplasty
CABG is severe stenosis
