Cardio Flashcards
HF
Ix first line ?
definative
B type natriuretic peptide BNP
NT-proBNP if high then arrange specialist assessment
within 2 weeks
echo
if NT-proBNP is raised?
echo within 6 weeks
ACS Ix
troponin
ECG
MI mx
nstemi and unstable angina
calculate GRACE
>3 within 72 hours PCI
give fondaparinux and tricelogpr
post MI mx?
aspirin 75mg OM and clopidogrel /tricagrelor 90
beta blocj
acei
high dose statin - 80mg
echo
and cardiac rehab
inferior MI ecg
ii , iii and avf
lateral MI
V5,v6
lead 1
when can you interpret a Troponin for Mi
> 3 hours
then repeat in 6-12 if raising or raised then MI confirmed
if falling no Mi
ECG findings WPW
delta waves - slurred upstroke in the QRS
short PR interval <120
broad QRS
narrow complex tachycardia
how do you diagnose WPW
ecg 24 hour TFTs routine bloods echo - ventricular function intracardiac electrophysiological studies to map the location of the accessory pathway
Mx of WPW
Radiofrequency ablation of the accessory pathway Drug treatment (such as amiodarone or sotalol) to avoid further tachyarrhthmias. These are contraindicated in structural heart disease.
cause of HF in central and south america?
Chagas
The NYHA Classification system
Class I - no limitation in physical activity, and activity does not cause undue fatigue, palpitation or dyspnoea.
Class II - slight limitation of physical activity, and comfort at rest. Ordinary physical activity causes fatigue, palpitation and/or dyspnoea.
Class III - marked limitation in physical activity, but comfort at rest. Minimal physical activity causes fatigue (less than ordinary).
Class IV - inability to carry on any physical activity without discomfort, with symptoms occurring at rest. If any activity takes place, discomfort increases
what is the echo findings for Heart failure with preserved ejection fraction
EF >40% but raised BNP
Mx of HF
NyHAclass 3/4 what medication do you consider?
if in sinus rhythm but impaired EF
those with AF?
spironoloactone /epelerone - improves mortality
if afro-caribbean ?
hrdralazine and nitrate
ivabradine
ARB
Digoxin - worsens mortality
ICDs are indicated if the following criteria are fulfilled: HF
QRS interval <120ms, high risk sudden cardiac death, NYHA class I-III QRS interval 120-149ms without LBBB, NYHA class I-III QRS interval 120-149ms with LBBB, NYHA class I
Mx of mitral stenosis if asymptomatic?
if pliable and non calcified?
no treatment just review
balloon valvuloplasty
moderate disease= percutaneous mitral valvotomy
Open valve repair/replacement - for patients with severe disease who are not too high risk for surgery but are not candidates for percutaneous intervention, due to valve morphology or otherwise. Valves are more likely to be metal than bioprosthetic.
cannon A waves on JVP are a sign of?
complete heart block
WPW ECG findings
pr interval is shortened
rapid ventricular rate
and DELTA wave which is pathogenomic
what is a delta wave and what is it associated with?
slurring if the upstroke of QRS - due to early depolarisation of myocardium
pathogenomic of WPW
how does acute myocarditis differ to pericarditis
myocarditis causes a much bigger rise in troponin and presents with a more MI type presentation
when does cardiac resynchronisation therapy device indicated in HF
if EF <35 and QRS is wide
management of type B stanford aortic dissection
IV labetalol
most appropriate diagnostic tool for aortic dissection?
trans oesophageal echocardiography
best diagnostic investigation for infective endocarditis?
3 sets of blood cultures from 3 different sites
stanford type A mx?
IV labetalol
IV morphine and open surgery
stanford type b surgical option?
endovascular repair if unstable
aortic stenosis Mx?
TAVI is favoured with patients with severe comorbidities, previous heart surgery, frailty, restricted mobility, and those older than 75 years of age.
SAVR is favoured for patients who are low risk and less than 75 years of age.
when is an aortic balloon pump utilised?
acute mitral regurgitation
ECG findings in Hypertrophic cardiomyopathy
Abnormal Q waves
Deeply inverted T waves
Left ventricular hypertrophy
HOCM which gene
echo finding
mutation in gene encoding b myosin
Mitral regurgitation
what is the most common type of cardiomyopathy
what are the causes
dilated
most common cause; idiopathic
Inflammation; sarcoidosis, haemochromatosis
infection; coxsackie virus, HIV myocarditis
toxins; alcohol, cocaine
inherited; duchene muscular dystrophy
dilated cardiomyopathy on xray
balloon
dilated cardiomyopathy ix findings?
heart failure signs
systolic murmur - mitral / tricuspid regurg
S3
cxr balloon apppearance
HOCM manahgement?
amiodarone beta block/verapamil cardioverter defib dual chamber pacemaker endocarditis prophylaxis
what is the most common cause of restrictive cardiomyopathy
amyloidosis
