cardio Flashcards
what is shockable Rhythm?
ventricular fibrillation / pulseless ventricular tachy
Vfib or pulseless VT
what do you do for non-shockable rhythms
1mg adrenaline asap
repeat every 3-5mins
Hs of cardiac arrest
hypothermia
hypovolaemia
hypoxia
hyper/hypo kalaemia, glycaemia,calcaemia, met disorders
T’s of cardiac arrest?
Thrombosis
Tension pneumothorax
Tamponade
Toxins
pleural rub on auscultation and chest pain relieved by sitting forward points to what diagnosis
what is the ECG finding for this condition?
pericarditis
saddle shaped ST elevation
PR depression - more common sign
atrial flutter
what are the complications?
signs/symptoms?
blood clots > stroke, ischaemia of bowel [mesenteric ischaemia]
tachycardia: ventricles decompemnsate > HF
if atrial flutter rate is high enough can cause ventricular tachy> which can cause symptoms like dizziness, nausea, chest pain
how do you manage atrial flutter?
rate control ; beta block, calcium channel blocker
anti-coagulate due to risk of clots
can do cardioversion to stop the reentrant
how do you define atrial fibrillation?
the sinus node signal is used differently by different myocytes in the atria so that the contraction of atria is happening in a disorganised way
once in a while the signal is sent to AV node to contract ventricles so you have QRS contraction but it is at irregular rates and not always following a p wave
Management of atrial flutter?
what do you first have to assess?
haemodynamic stability?
if yes then attempt rate control with a calcium channel blocker / beta blocker
also fluid resus can reverse if septic or dehydrated
second line is cardioversion
however is haemodynamic instability then attempt synchronised cardioversion first
causes of atrial flutter?
pulmonary disease COPD OSA PE Pulmonary htn
alcohol
sepsis
thyrotoxicosis
ihd
what is the cycle of atrial flutter?
why is this not the cycle of the ventricles?
300bpm AVN has long refractory period
degree of block so 2:1, 3:1
Ventricular rate which depends on the level of AV block: if 2:1 3:1 4:1 5:1
300 : 150bpm
300: 100bpm
300: 75bpm
300: 60bpm
what are signs of haemodynamic instability ? what shows end organ hypoperfusion brain hypoperfusion MI? HF ?
shock
syncope
chest pain
pulmonary oedema
CHA2DS2 VASc what is the criteria
congestive heart failure htn a2 75, a1 65-74 diabetes? s2- stroke,tia,mi or thromboembolism
vascular disease? IHD, peripheral arterial disease?
s- sex female
CHA2DS2 VASc
what score is relevant?
if score of 4?
0- treatment
1- if male offer anticoagulant
if female don’t as the 1 is due to gender
> 2 offer anticoagulant
CHA2DS2 VASc score is higher than 2 but anticoagulation is contraindicated?
why, what is the picture?
AF but with valvular disease is an ABSOLUTE CONTRAINDICATION
so a transthoracis echo has been done
if worried about risk of bleed vs anticoagulation what scoring system?
orbit
haemoglobin -2 AGE-1 bleeding Hx-2 GFR-1 treatment with antiplatelets -1
<130 M, <120 female
haematocrit <40%, 36%
age>74
GFR; renal impairment of <60mL/min/1.73m2
orbit score
low
medium
high
low 0-2 : 2.4 bleeds per 100 pt
medium 3 : 4.7 bleeds per 100 pt
high >4 : 8.1 bleeds per 100 pt
Mx of atrial fibrillation?
1st line
2nd line
DOACs apixaban, rivaroxaban
warfarin
how is AF classified?
management of each?
first time - self limiting
paroxysmal - recurrent but terminate spontaneously
persistent - lasting >7 days
permanent - clinically decided with pt - this we need to manage / treat w rate control and anticoagulant
irregularly irregular pulse
A fibrillation
when would you try to rhythm control Afib?
first time, HF coexistant and obvious cause
drugs to rhythm control?
if coexisting heart failure?
amiodrone
dronedrone post cardioversion
catheter ablation
when is the greater risk of thromboembolic / stroke in Afib pts?
just when you try to restore sinus rhythm via cardioversion as if a thrombus was formed or a clot then it would be flung out into arterial system
anticoagulate properly 4 weeks before attempting
or symptoms and AF lasting less than 48hours
if very healthy young patient with no PMHx gets atrial fibrillation first time whats should you do?
flecainide + amiodarone
irregularly irregular pulse single waveform JVP hyperthyroid features / alcohol/ sepsis HF signs >100bpm ventricular rate
atrial fibrillation
The ECG showed no discernible p waves and irregularly irregular rhythm. Otherwise, the heart rate was approximately 70 beats per minute, the QRS complexes were not broadened, and the QT interval were within normal limits. No saw-tooth baseline was seen.
atrial fibrillation
murmurs
‘mid systolic click followed by a late systolic murmur’
apical region
what causes this murmur?
what is this murmur called?
mitral prolapse
mitral regurgitation
JVP raised
soboe
cough
low pitched diastolic murmur
what is the most likely cause of this?
mitral stenosis
rheumatic fever > rheumatic heart disease
opening snap rumbling mid
diastolic murmur
irregularly irregular pulse
mitral stenosis
atrial fibrillation
what is rheumatic fever caused by?
inflammatory disease group A streptococci
strep throat
causes valve to thicken calcify and contract = stenosis
why is mitral stenosis associated with _____ ___ and a ____ pulse
a fibrillation and irregularly irregular pulse
as there is an increased atrial pressure due to inability fo blood to leave stenosed left ventricle
what conditions predispose to mitral valve prolapse?
ehlers danlos
marfans
osteogenesis imperfecta
turner syndrome
crescendo descendo murmur
ejection systolic
what valvular disease
what is the most common cause and where does it radiate to?
why is the nature of the murmur as such?
aortic stenosis
bicuspid valve congenital
carotids
why?
because when the pressure builds the initial LV pressure has to be so high to push open stenotic aortic valve so crescendo then as volume of blood / pressure decreases turbulance goes down so descendo murmur
early diastolic descendo murmur heard at left sternal border
most common cause?
aortic regurgitation
idiopathic most common
then after aortic dissection
aneurysm
syphilis
microangiopathic hemolytic anaemia is associated with which valvular disease?
aortic stenosis
RBC get damaged as pushed past stenosed valve
schistocytes on blood film
haemoglobinuria
heart block
second degree MObitz type 1
wenkebach - progressive elongation of PR interval until dropped beat
second degree heart block mobitz type 2
PR constant but p wave is not associated with qrs
first degree heart block
PR >0.2 seconds
third degree heart block
no association between p wave and qrs
cardiac causes of a raised JVP
right sided heart failure
tricupsid regurg
constrictive pericarditis
what does a positive hepatojugular result tell you?
what conditionS?
right ventricle is unable to accomodate the increased venous return
if it was normal it could increase it’s stroke volume
constrictive pericarditis
r ventricular failure
le
cardiomyopathy
