Cardio Flashcards
What type of MI is known to have AV block as a complication?
INferior - ST elevation in II, III, AVF
When to use rhythm control to treat AF
If coexistent HF, first onset AF or obvious reversible cause
Intracranial haemorrhage on warfarin - what to do
Stop warfarin, give 5mg Vitamin K IV and PT complex concentrate
Polymorphic ventricular tachycardia (broad complex)- torsades de pointes - mx
Mg sulphate
Pulseless electrical activity mx
Non shockable so give adrenaline then CPR
What is the QT interval on an ECG
Time between the start of the Q wave and end of T wave
Ivabradine S/E
visual effects - luminous phenomena
Headache
Bradycardia, heart block
Young adult with HTN, systolic murmur heard best over back and LVH - dx
Coarctation aorta
What foods to avoid in warfarin
Broccoli, spinach, kale , sprouts = high vt k
ALS VF/Pulseless VT VS Non shockable
VF/Pulseless VT = shockable (up to 3 if monitored) - 2 mins cpr. Amiodarone 300mcg after 3 shocks and adrenaline 1mg (every 3-5mins). If 5 shocks then amidoarone/lidocaine also
Non shockable = Adrenaline 1mg + repeat. If thrombolyti drugs then 60-90mins CPR. If hypothermia only 3 shocks before >30 degrees
HTN Mx
Mx SVT
Vagal manoeuvres then IV adenosine - not in asthmatics 6-12-12
If unsuccessful then consider atrial flitter and control rate (BB)
CHADS VASC2
0 - no tx
1 males - consider antocga
1 female - no
2+ offer
still give if paroxysmal and high score
Unstable tachycardia mx
Hypotension, pallor, syncope, myocardial ischaemia, HF
Up to 3 synchronised shocks + amiodarone infusion
Angina step up Mx
Aspirin + GTN +
BB/CCB (verapamil)
BB+ CCB/Amlodipine
Long acting nitrate
Ejection systolic - Louder on expiration = high pitch, slow rising pulse, narrow PP, radiates to carotid
Dx and Mx
Aortic stenosis
Asymp + valvular gradient <40 = observe.
-Symp or >40 then replace with surgery or if frail (transcatheter).
-In children- balloon valvuloplasty
Ejection systolic murmur
Louder expiration = increased with valsalva. Quieter on squat.
Dx and Mx
HOCM
Need ICD (sudden death risk)
Causes diastolic dysfunction (HF with preserved ejection fraction)
ECHO
Ejection systolic murmur fixed splitting S2. Embolisms can pass and cause strokes/
what murmur is this
ASD
Early diastolic murmur
high pitch, blowing, corrigans collapsing pulse, wide pulse pressure, Quinke’s sign (nailbed pulsation), De musset’s sign (head bobbing)
Type murmur, IX, TX
aortic regurgitation
ECHO
Medical Mx HF, surgery (symptomatic with severe or asymp with severe and lV systolic dysfunction)
Pansystolic murmur -blowing, ass with collagen disorders, high pitch whistle, louder expiration
WHta murmur and Mx
mitral regurgitation
Nitrates, diuretics, positive inotropes, intr aortic balloon pump
If HF, can consider ACEi
In severe - surgery
Pansystolic murmur = blowing, high pitch, louder inspiration
Pulsatile herpaotmegaly, left parasternal heave
type murmur
tricuspid regard
Mid to late diastolic murmur
low pitch rumbling, ass with Atrial fibrillation. Tapping apex beat
Dx, cause, mx
Mitral stenosis - low pitch rumbling, ass with Atrial fibrillation. Tapping apex beat
Rheumatic fever is the cause!!
Dyspnea, haemotpysis, loud S1, opening snap, low vol pulse, malar flush
Ass AF need anticoag
Asymp patients- monitored with reg ECHO
Symp - percutaneous mitrla balloon valvotomy, mitral valve surgery
Murmur:
Late systolic, decrease fem pulses, ass with turners, maximal over back (scapulae between), notching of inferior border of ribs
Coarctation aorta
Continuous machine like murmur
PDA
Quiet S1 cause
Mitral regurgitation
Loud S1
Mitral stenosis
Loud S2 cause
HTN
AV blocks - types and mx
Mx for STEMI
Mx NSTEMI
V1-V4 leads: which artery
Anterior (septal) = V1-4 = LAD
Which view of the heart and artery for II, III, AVF
Inferior
Right coronary artery
II,III,AVF
Which view of the heart and artery for I, V5-6
Lateral
left circumflex
Which view of heart and artery for v1-3
Posterior = V1-3 (tall broad R waves,upright T waves, horizontal ST depression on 12 lead. Usually left circumflex, alo righ coronary. Confirmed by ST elevation and Q waves in posterior leads V7-9
MI CX - <48hr, 1-2 weeks, 2-6 weeks
Pericarditis (<48HR)
2-6 weeks = Dressler’s - fever, pleuritic pain, pericarditis (NSAIDs)
1-2 weeks = LV Free wall rupture - cardiac tamponade (muffled heart sounds, Increased JVP, pulsus paradoxus, electrical alternans on ECG)
AAA: The 3 categories and when to re scan or refer
3-4.4cm = rescan 12m
4.5-5.4cm = every 3m
>5.5 = refer <2 weeks
TIA - what medications afterwards
Clopidogrel life or 2. Aspirin + dipyridamole
Warfarin rules and what to give:
INR >8 minor bleeding
INR >8 no bleeding
INR 5-8 minor bleeding
INR 5-8 no bleeding
Major bleeding - stop warfarin, IV VK, PT
INR >8 minor bleeding - stop warfarin, IV VK (+/- repeat 24hr), restart warfarin when INR <5
INR >8 no bleeding - stop warfarin, PO VK, restrat when INR<5
INR 5-8 minor bleeding - stop warfarin, IV VK, restrat when INR<5
INR 5-8 no bleeding - withhold ½ warfarin, reduce subsequent maintenance dose
Posterior circulation symptoms like dizziness and vertigo duing exertion of an arm. There is subclavian artery steno-occlusive disease proximal to the origin of vertebral artery and associated with flow reversal in vertebral artery. Management - percutaneous transluminal angioplasty or a stent.
Subclavian steal syndrome
Ix and mx in aortic dissection (severe sharp chest/back pain, maximal at onset, pulse def, aortic regurgitation)
Depending on arteries - angina, paraplegia,limb ischaemia
CXR - widened mediastinu.
CTA is best - false lumen. If unstable then Transoesophageal ECHO
TA = ascending = surg x but bP controlled 100-120 whilst waiting
TB = conservative, bed rest, reduce BP with iV labetolol to prevent progression
Polymorphic ventricular tachycardia ass with long QT interval
WHta is this and Mx
Torsades de pointes
IV MGS04-
ATLS - shockable vs not shockable
CPR 30:2 and attach defib/monitor
Assess rhythm
Shockable = VF/Pulseless VT = 1 shock then CPR (if witnessed and monitored then up to 3 shocks)
Adrenaline 1mg once chest compressions restarted after 3rd shock. Then repeat every 3-5mins
Amiodarone 300mg if VF/pulseless VT after 3 shocks
Further dose amiodaorne 150mg after 5 shocks. Alternative is lidocaine
Non shockable = PEA/ASystole = immediately resume CPR 2mins.
Adrenaline asap 1mg then repeat every 3-5mins
Thrombolytic drugs - if PE suspected and if given then CPR extended 60-90mins
Angina Tx
Aspirin + statin + sublingual glyceryl trinitrate (tolerance so asymmetric dosing)
BB/CCB (verapamil or diltiazam)
BB + CCB (amlodipine or MR nifedipine as the CCB)
If on CCB and cant tolerate addition of other then consider long acting nitrate, ivabradine, nicorandil, ranolazine
Only add third drug if waiting assessment for PCI/CABG
Causes dilated cardiomyopathies
Causes - alcohol, Coxsackie, wet beri beri, doxorubicin
restive cardiomyopathy causes
Causes - amyloidosis, post-radiotherapy, Loeffler’s endocarditis
Systolic vs diastolic dysfunction HF in relation to ejection fraction and causes
By ejection fraction:
Systolic dysfunction - Reduced ejection fraction - IHD, dilated cardiomyopathy, myocarditis, arrhythmias
Diastolic - Preserved EF - HOCM, restrictive cardiomyopathy, cardiac tamponade, constrictive pericarditis
LHF VS RHF symptoms
RHF = caused by increased RV afterload (Pulm HTN) or increased RV preload (tricuspid regurg)
Lvf = pulmonary oedema
RVF = peripheral oedema, raised JVP, hepatomegaly
High output HF - what is this and what are the causes
High output HF:
Normal heart is unable to unable to pump enough blood to meet metabolic needs of body
Causes - Anaemia AV malformation, Pagets disease, pregnancy, thyrotoxicosis, thiamine def
Features of Chronic Heart failure
Dyspnea, cough, orthopnea, paroxysmal nocturnal dyspnoea, wheeze, weight loss, bibasal crackles, signs RHF (raised JVP, ankle oedema, hepatomegaly)
Management Chronic HF - first line medications
- ACEi + BB
- Aldosterone antagonist (monitor K+). SGLT-2 inhibitors used more in reduced ejection fraction.
- Specialist - ivabradie, sacubitril valsartan, digoxin, hydralazine in combo with nitrate, cardiac resynchronisation therapy
Annual flu and one off pneumococcal
NYHA 1 - no symp - NYHA IV - severe symp = rest pain
Features of acute HF
Sudden onset or worsening of symptoms
Breathless, reduced exercise tolerance, oedema, fatigue
Cyanosis, tachy, elevated JVP, displaced apex beat, chest signs (bibasal crackles), S3 heart sound
Ix in Acute HF
Bloods - anaemia. Abnormal electrolytes check
CXR - pulm venous congestion, interstitial oedema,c ardiomegaly
ECHO - if new onset or suspected change in function
BT NP
Bones stones groan psychic moan
Shortened QT interval
HTN
electrolyte abnormality
Hypercalcaemia
Organisms for infective endocarditis (most common)
Mostly mitral valve
Mostly staph aureus (esp in acute/IVDUs) - others include: strep viridans (dentl hygiene), staph epidermis (indwelling lines), strep bovis (CRC)
management of postural hypotension - some medication options
Midodrine and fludrocortisone
Perri arrest for bradycardia - mx
Need for Tx signs = shock, syncope, MI, HF
Atorpine 500mcg
Up to max 3mg atropgine, trascutaneous pacing, isoprenaline/adrenaline infusion titrated to respoinse
Peri arrest tacky
Unstable is shock, syncope, MI, HF
Synchronised DC shock - up to 3
raynauds with extremity ischaemia, male, smoker.
DX
Beurgers disease - thromboangiits obliterans
Which angina drug can cause ulceration in GIT
Nicorandil
first line anginal prophylaxis
BB
What is brugada syndrome
inherited CVD which may present with udden cardiac death. Autosomal dominant. Partial RBBB, convex ST elevation, ECG changes more apparent after flecainide. ICD needed
Mx rheumatic fever
IM Benzylpenicillin/oral penicillin V
First line mx to pericarditis
ibuprofen and colchicine
When to stop warfarin before surgery and what if you need to bridge it
5 day sbefore
If bridge it then o with LMWH until 3 days before
Important interaction between statin and an ABx - which Abx and why
Can’t have statin and macrloife abx (clarithromycin) die to risk rhabdomyolysis
Patient with AF and acute stroke (to hemorrhagic) - when to start anticoagulant tx and medication in between
Aspirin daily and start anticoagulant after 2 weeks
Pedunculated heterogenous mass on ECHO
Atrial myxoma
What is a non sensitive ECG sign of cardiac tamponade
Electrical alternans - beat to beat variation in QRS amplitude and morphology due to swinging in pericardial fluid.
What WELLs score indicates a CTPA should be done
> 4
If a pt with reduced ejection fraction HF still have symptoms despite being on ACE inhibitor, BB blocker then what medication to add
Spironolactone - mineralcorticodid receptor antagonist
Target INR normally and when you suffer form recurrent pulmonary embolisms
Normally 2-3
Recurrent PEs = 3.5 (so may have to increase dose anticoags)
