Cardio Flashcards
what is first line for bradycardia?
if fails?
atropine
then external pacing
what is radio-femoral delay associated with?
coarctation of the aorta
what rhythms are shockable? what drug is given with them
VT and VF
give amiodorone 300mg after 3 shocks
CPR 30:2 for 2 minutes between shocks
Give adrenaline 1mg after compressions have restarted after 3rd shock if no response
what rhythms are non-shockable? how do you manage
asystole/pulseless electrical activity
CPR 30:2
give adrenaline 1mg asap then every 3-5 minutes
management for SVT
vagal manoevres then adenosine - 6mg then 12mg then 18mg escalating if unsuccessful
if still uncontrolled cardioversion
note adenoids contraindicated in asthmatics
what is the most common cause of mitral stenosis
rheumatic fever
what ECG abnoramlity can hypokalaemia cause?
broad complex ventricular tachycardia
management of an unstable tachyarrhythmia
DC cardioversion if systolic BP <90mmHg
acute HF treatment
oral then IV furosemide
if not responding then CPAP
reversible causes of cardiac arrest
Hypothermia
Hypoxia
Hypovolaemia
Hypokalaemia/hyperkalaemia/hypoglycaemia
Tension pneumothorax
Tamponade
Toxins
Thrombosis
CHADSVASC
CHF
Hypertension
Age (1 for >65, 2 for> 75)
Diabetes
Stroke/TIA/thromboembolism (2)
Vascular disease
Sex (1 for female)
treatment of pericarditis
NSAIDs
aspirin
cardiac tamponade signs
becks triad
raised JVP
low BP
muffled heart sounds
What precipitates digoxin toxicity
Hypokalaemia
Other factors; age, renal failure, myocardial ischaemia, other electrolyte abnormalities
Statins
- contraindications
- when to take
- doses
Contraindicated in pregnancy and if taking a macro life antibiotic (clarithromycin, erythromycin)
Take in the evening if od
Atorvastatin 20mg for primary prevention
Atorvastatin 80mg for secondary prevention
When is aspirin used in IHD
All patients without contraindications
how does bifasicular block appear on ECG
RBBB with left axis deviation
how does wolf Parkinson white appear on ECG
re-entry tachycardia caused by the presence of an accessory pathway- commonly presents supraventricular tachycardia.
ECG changes include a short PR interval along with wide QRS complexes with a slurred upstroke (delta wave)
Hypertrophic Obstructive CardioMyopathy
an inherited cardiac condition which is a cause of sudden death in young people
symptoms if present:
exertional dyspnoea
angina
syncope
signs:
ejection systolic murmur
S4 heart sound
LVH on ECG
coarctation of the aorta + features
congenital narrowing of the descending aorta
infancy: heart failure
adult: hypertension
radio-femoral delay
mid systolic murmur, maximal over back
apical click from the aortic valve
notching of the inferior border of the ribs
associated conditions of coarctation of the aorta
Turner’s syndrome
bicuspid aortic valve
berry aneurysms
neurofibromatosis
what valve does infective endocarditis most likely affect
tricuspid valve
Arrhythmogenic right ventricular cardiomyopathy
inherited CVD that may present with syncope or sudden cardiac death
second most common after HOCM
causes T wave inversion v1-v3
what is the main cause of mitral stenosis
rheumatic fever
mitral stenosis symptoms
dyspnoea
haemoptysis
mid late diastolic murmur
malar flush
AF secondary to increased left atrial pressure
adrenaline in ALS
adrenaline 1 mg as soon as possible for non-shockable rhythms
during a VF/VT cardiac arrest, adrenaline 1 mg is given once chest compressions have restarted after the third shock
repeat adrenaline 1mg every 3-5 minutes whilst ALS continues
amiodarone in ALS
amiodarone 300 mg should be given to patients who are in VF/pulseless VT after 3 shocks have been administered
a further dose of amiodarone 150 mg should be given to patients who are in VF/pulseless VT after 5 shocks have been administered
tachyarrhythmia; systolic BP<90mmHg
DC cardio version
antiplatelet therapy before PCI
dual antiplatelet therapy prior to PCI (aspirin + another)
Prasugrel is offered if the patient is not taking an oral anticoagulant, whereas clopidogrel is offered if they are
persistent ST elevation with no chest pain after an MI
left ventricular aneurysm
statin major drug interaction
erythromycin/clarithromycin - contraindicated together
note statins also contraindicated in pregnancy
drug treatment of a VT
amiodarone ideally via a central line
Kussmaul’s sign
JVP rise on inspiration
associated with constrictive pericarditis
secondary prevention after developing cardiovascular disease
4As
Aspirin
Atorvastatin
Atenolol or other beta-blocker
ACEi
PCI in STEMI
within 120 minutes symptom onset
dual anti-platelet before - aspirin + prasguel/clopidogrel if already anti-coagulated
unfractioned heparin during PCI
fibrinolysis in STEMI
done if >120 minutes
add another anti-thrombin drug
NSTEMI management
Aspirin 300mg
Fondaparinux if no immediate PCI planned
Low risk GRACE score - give ticagrelor
High risk GRACE score - offer immediately if unstable, within 24 hours if not
give unfractioned heparin + ticagrelor/prasugrel
also consider coronary angiography
heart failure first line drug management - reduced ejection fraction
ACE inhibitor + beta blocker
generally one started at a time
2nd line HF treatment
add aldosterone antagonist e.g. spironolactone
note ACEi + spironolactone has risk of hyperkalaemia
vaccinations HF
one off pneumococcal
annual flu
treatment torsades de point
IV magnesium sulphate
antiplatelets in medically treated ACS
aspirin lifelong and ticagrelor 12 months
if aspirin contraindicated, clopidogrel lifelong
antiplatelets if PCI was used for ACS
aspirin lifelong + prasurgrel/ticagrelor 12 months
if aspirin contraindicated, clopidogrel lifelong
antiplatelets TIA / stroke
clopidogrel lifelong
2nd line aspirin +dipyridamole
antiplatelets peripheral artery disease
clopidogrel lifelong
2nd line aspirin lifelong
management cardiac tamponade
urgent pericardiocentesis
atrial septal defect murmur
ejection systolic
hypercalcaemia main abnormality on ECG
shortening of QT interval
