Cardio Flashcards
AF is likely indicated in which valve problem?
Mitral problems
most common cause of mitral stenosis?
rheumatic fever
signs on examination of mitral stenosis
tapping apex beat (palpable and loud first sound) low rumbling mid-diastolic murmur Malar rash AF low volume pulse
signs of mitral stenosis on ECG
bifid P waves (P mitrale, left atrial enlargement) or no P waves
ECG changes in hypokalaemia
U waves
flattened/inverted T waves
tall p waves
ST depression
ECG changes in WPW
Delta waves
Management of viral pericarditis
NSAIDs (aspirin or ibuprofen)
PPI
Colchicine
Bed rest
where is the needle inserted for pericardiocentesis
subcostally in midline aiming for left shoulder
what % of acute pericarditis recurs
15-30%
signs of aortic stenosis
slow rising pulse
narrow pulse pressure
ES murmur radiating to neck
treatment of choice for severe aortic stenosis
valve replacement
valvuloplasty/transcatheter aortic valve implantation may be attempted if pt unfit for open surgery
long term Abx
most common cause of aortic stenosis in <60
bicuspid valve
management for post-MI VSD
analgesia
inotropes
balloon pump (counterpulsation inside aorta to augment BP during diastole)
Closure of defect (percutaneous or can be surgery)
structural abnormalities associated with WPW
ventricular hypertrophy
Ebstein’s anomaly
what bloods is most important in WPW
thyroid function
medical management of WPW
flecainide
Amiodarone
avoid drugs that block AV node alone (digoxin, verapamil, bblockers etc)
if a patient has heart failure leading to pulmonary oedema and low blood pressure, how do you manage?
CPAP - allows lung fluid to be pushed back into vasculature
can’t use furosemide due to low BP
can’t give fluids due to pulmonary oedema
what medicines should patients be on post-MI
aspirin + clopi
bisoprolol
statin
ramipril
most common branches of aorta affected in dissection
renal, spinal, coronary or iliac arteries
can also dissect back into aortic valve causing regurg
what is the cause of death in HOCM
arrhythmia due to increased metabolic demand of muscle and reduced blood supply
also obstruction to aortic outflow
inheritance pattern of HOCM
AD
Management of HOCM
beta blockers + CCB to reduce load on left ventricle
amiodarone to reduce chance of arrhythmia
ICD in high risk patients
Cardiac surgery if aortic outflow obstruction severe
symptoms of HOCM
mostly symptomless angina dyspnoea syncope systolic murmur (thickened septum leads to mitral valve problems and obstructed aortic outflow)
3 investigations for DVT diagnosis
couler USS doppler
D-dimer
Venometry
INR range for uncomplicated DVT
2-3
INR range for prosthetic heart valve
3.5-4.5
infections that can cause sinus bradycardia
Legionnaire’s
typhoid
lyme disease
investigations for infective endocarditis
ECG - heart block TTE - valvular vegetations mid-stream urine MC&S USS abdo - splenic infarcts 3 sets of blood cultures may do serology for atypical organism
major criteria for infective endocarditis
typical organism from 2 BC OR persistent positive blood culture
Evidence of endocardial involvement
culture NOT to be taken from indwelling line
minor criteria for infective endocarditis
fever risk factors vascular phenomena (stroke etc.) immunological phenomena (RhF, glomerulonephritis, osler nodes etc.) micro evidence echo
complications of infective endocarditis
heart block TIA AKI HF vertebral osteomyelitis
ECG changes in digoxin
downsloping ST depression in V5/6
flattened, inverted or biphasic T waves
short QT itnerval
frequent premature ventricualr contractions, sinus brady, av block in toxicity
Symptoms of digoxin toxicity
altered bowel function visual disturbance headache dizziness confusion
how to confirm digoxin toxicity
measure 6h post dose blood level
how long can you not drive for post-infarct with deranged LVEF/symptomatic heart failure
4w
how long can you not drive for post-infarct with normal LVEF
1w
management of type B aortic dissection
conservative (pain and blood pressure management) if stable
urgent surgery if unstable
management of type A aortic dissection
urgent surgery
heart failure drugs
beta blocker acei/arb spironolactone statin SGLT2i ezetimibe PCSK9i dual antiplatelet if MI PPI
which leads are the high lateral vessels
I and aVL
management of NSTEMI
aspirin + ticagrelor
LMWH/fondaparinux
morphine and metoclopramide
anti-anginal medication (GTN beta blocker amlodipine)
revascularisation doesn’t necessarily need to be done immediately
echo
what drug held for 48h before and 48h after angio
metformin, fucks kidneys
symptom control in stable angina
1:GTN
2: add bisoprolol
OR rate limiting CCB (verapamil, dilt)
3: add GTN + BB + NON-rate limiting CCB (amlod)
4: Add ivabradine OR nicorandil OR ranolazine
Also get atorvastatin for long-term mortality
contraindication for ivabradine
AF, as it disrupts If
contraindication to adenosine
asthma, so give verapamil if SVT
management of SVT
1) vagal manoeuvres
2) adenosine or verapamil
3) DC cardiovert if unstable
if first presentation and treated, give conservative mx
svt ablation if recurrent or bisoprolol
what drugs can cause extremis
flecainide
what is the pill in the pocket
carry around fleicainide for paroxysmal AF
management for VT
magnesium
amiodarone
dc cardiovert
NOT FLECAINIDE
causes of raised JVP
RHF fluid overload SVC compression - non-pulsatile pericardial effusion Tricuspid regurg complete heart block
complications of prosthetic heart valves
endocarditis PE infection bleeding anaemia failure
causes of irregularly irregular pulse
ventricular ectopics
flutter with variable block
describe mitral stenosis
low pitched rumbling mid-diastolic murmur best heard in left lateral position on expiration
complications of mitral stenosis
pulmonary hypertension
AF
signs of pulmonary hypertension
loud p2
left parasternal heave
graham steel murmur (early diastolic)
