cardio Flashcards
conditions that increase the risk of atherosclerosis
DM
HTN
CKD
RA
atypical antipsychotics
what to do if QRISK score >/= 10%
atorvastatin 20mg
check LFTs 3m and 1yr
SE statins
myopathy
T2DM
haemorrhagic strokes
secondary prevention CVD
aspirin (+clopidogrel first 12m)
atorvastatin 80mg
atenolol (or bisoprolol)
ACE i - ramipril titrated to tolerated dose
gold standard ix for angina
CT coronary angiography
mx stable angina
refer to cardiology
immediate sx relief: GTN spray
long term sx relief: BB +/- CCB
secondary prevention: aspirin, atprvastatin, ACEi
surgery: PCI, CABG
what does right coronary artery supply
RA, RV, inf LV, post septal
what does circumflex artery supply
LA, post Lv
what does Left anterior descending supply
ant LV, ant septum
STEMI ECG
ST elevation MI or new LBBB
NSTEMI ECG
ST depression, deep T inversion, pathological Q
causes raised troponin
MI
chronic renal failure
sepsis
myocarditis
aortic dissection
PE
STEMI Mx
primary PCI (stented) within 2h presentation or thrombolysis (alteplase, streptokinase) if not
BB
aspirin 300mg
ticagrelor 180mg or clopidogrel 300mg
morphine
anticoag: LMWH
nitrates - GTN
oxygen if sats <95%
GRACE score
risk death/repeat MI within 6m NSTEMI
med=5-10%
high >10%
what to do if med/high GRACE scire
PCI within 4d
what is dresslers syndrome
2-3w post MI
localised immune response ->pericarditis
sx dresslers syndrome
pleuritic chest pain, fever, pericardial rub
can cause pericardial effusion and tamponade
ECG dresslers syndrome
global ST elevation
T inversion
mx dresslers syndrome
NSAIDs +/- steroids +/- pericardiocentesis
triggers acute LVF
iatrogenic (fluids)
sepsis
MI
arrhthmia
sx acute LVF
pulmonary oedema
SOB- T1RF
3rd HS
increased JVP
mx acute LVF
stop IV fluids
sit up
oxygen
diuretics (furosemide)
causes increaed BNP
HF
increased HR
sepsis
PE
renal impairment
COPD
when is BNP relerased
from ventricles when abnormally stretched
diagnosing chronic HF
presentation
BNP (NT-proBNP)
echo
ECG
causes chronic HF
IHD
aortic stenosis
HTN
AF
mx chronic HF
ACE i (ramipril 10mg), BB (bisoprolol 10mg)
if not controlled: aldosterone antagonist (spironolactone), loop diuretic (furosemide) for sx
what is cor pulmonale
RHF caused by resp disease
causes cor pulmonale
COPD
PE
ILD
CF
pulmonary HTN
sx cor pulmonale
SOB
oedema
increased JVP
3rd HS
hepatomegaly
mx cor pulmonale
tx cause
oxygen
poor prognosis
types HTN
essential/primary
secondary: renal, obesity, pregnancy, endocrine
stage 1 HTN
> 140/90 in hospital
135/85 at home
stage 2 HTN
> 160/100 hospital
150/95 at home
mx HTN
- <55=ACEi, >55 or afrocaribbean=CCB
- add CCB, if afrocaribbean + ARB
- thiazide like diuretic (indapamide)
target BP in HTN
> 80y <150/90
<80y <140/90
S1
closing AV valves
S2
closing semilunar valves
S3
due to rapid V filling
can be normal <40y
S4
before S1 - stiff ventricle
cause mitral stenosis
rheumatic heart disease
IE
features mitral stenosis
mid diastolic low pitched murmur
loud S1
malor flush
AF
features tricuspid regurg
pan systolic
split S2
thrill
increased JVP with giant CV waves (lancisis sign)
pulsatile liver
peripheral oedema
ascites
features pulmonary stenosis
ejection systolic murmur with deep inspiration
widely split S2
thrill
increased JVP with giant A waves
peripheral oedema
ascites
murmur grades
I = difficult to hear
VI = audible with stethoscope of chest
cause mitral regurg
age
IHD
IE
connective tissue disorders
features mitral regurg
pan systolic high pitched
radiates to L axilla
leads to HF and S3
causes aortic stenosis
age
rheumatic heart disease
features aortic stenosis
most common murmur
ejection systolic high pitched crescendo decrescendo
radiates to carotids
slow rising pulse
narrow PP
exertional syncop
causes aortic regurg
age
connective tissue disorders
features aortic regurg
early diastolic soft murmur
collapsing pulse
austin flint murmur : at apex-early diastolic rumbling
AF ECG
absent P
narrow QRS
irregularly irregular
valvular AF
also have mod/sev mitral stenosis or mechanical valve
causes AF
sepsis
mitral valve
IHD
thyrotoxicosis
HTN
mx AF
rate=BB (atenolol) unless new onset or reversible
rhythm: if reversible/new onset then cardioversion (electrocal or flecanide/amiodarone)
long term BB
paroxysmal AF: flecanide during episode
anticoag: Chadvasc>1
HASBLED
bleeding risk
HTN
abnornal renal
stroke
bleeding
labile INR
elderly
alcohol
shockable rhythms
VT
VF
mx of a tachy rhythm in unstable patient
up to 3 syncronised shocks
amiodarone
narrow complex tachycardias
AF
atrial flutter
SVT
atrial flutter ECG
sawtooth
mx atrial flutter
BB
mx SVT
valsalva manoevre
carotid sinus massage
adenosine
DC cardioversion
what does adenosine do
slow conduction through AV node
when not to use adenosine
asthma
COPD
HF
heart block
severe hypotension
doses adenosine
6mg
then 12mg
then 12mg
as fast IV bolus
broad complex tachycardia
VT
SVT with BBB
mx VT
amiodarone infusion
wolf parkinson white
extra pathway - bundle of kent
ECG WPW
short PR
wide QRS
delta wave (slurred upstroke QRS)
definitive tx WPW
radiofreq ablation
malignant/accelerated HTN
BP >180/120 with retinal heamorrhage or papilloedema
mx malignant/accelerated HTN
IV: sodium nitroprusside, labetalol, GTN, nicardipine
torsades de points
polymorphic VT that occurs in prolonged QT
mx torsades de points
acute: magnesium infusion, defib if VT
long term: BB, pacemaker
causes prolonged QT
QT syndrome
medds: antipsychotics, citalopram flecainide, sotalol, amiodarone, macrolide abx
electrolytes: low K, low Mg, low Ca
first degree heart block
PR >0.2s
second degree heart block
mobitz type 1: increase PR until absent QRS and repeat
mobitz type 2: set ration no QRS - usually 3:1
2:1 block can be type 1 or 2
3rd degree heart block
complete
no relation between P and QRS
risk asystole
mx bradycardia and AV block
stable = observe
unstable= atropine 500mcg IV up to 6 doses, noradrenaline, transcutaneous cardiac pacing
pacemaker indications
bradycardia with sx
mobitz type 2 AV block
3rd degree heart block
severe HF
hypertrophic obstrictive cardiomyopathy
ECG changes with pacemaker
single chamber: 1 line before P or QRS
dual chamber: line before P and QRS
stable angina
sx come on with exertion and relieved by rest or GTN
unstable angina
sx at random at rest
cardiac chest pai
constricting/tight
may radiate to jaw or l arm
N+V
clammy
sweating
feeling of impending doom
SOB
palpitation
ACS
unstable angina
STEMI
NSTEMI
silent MI
typical chest pain not experienced
people woth DM at high risk
mx NSTEMI
BATMAN
base decision about angiography - PCI depending on GRACE score
aspirin 300mg
ticagrelor 180mg (clopidogrel if bleedin risk, prasugrel if having PCI)
morphine
antithrombin - fondaparineux
GTN
types MI
- due to ACS
- ischaemia secondary to increased demand or decreased O2 e.g. anaemia, tachy, low BP
- sudden death
- associated with procedures - PCI, CABG
CXR features HF
alveolar oedema
kerley B lines
cardiomegaly
dilated upper lobe vessels
pleural effusion
mx peripheral oedema HF
furosemide: IV if sev and pitting, otherwise oral
class of drug furosemide
loop diuretics
why is furosemide preferred in HF to spironolactone
spironolactone risk increased K
monitoring fluid overload HF
regular wt - should reduce
monitor fluid input and output
cause of murmur in HF
mitral regurg =pansystolic
criteria PPCI in STEMI
ST elevation over 2mm in 2 contiguous chest leads or >1mm in 2 contiguous limb leads
chest pain or other evidence ischaemia
what is the HEART score for
to see if admit or discharge with chest pain
hx, ecg, age, RF, trop
low risk=discharge
mod=observe
high=admit
non STE ACS mx in ED
cardiac monitoring
mx any arrhythmia or HF
P2Y12 i loading- ticagrelor 180mg or prasugrel 60mg (clopidogrel 2nd line)
anticoag-fondaparineux 2.5mg SC
NO BB or ACE i initially without specialist consultation
IV GTN if ongoin pain
inpatient mx non STE ACS
cardiac monitoring >/= 24h
medical vs invasive mx: usually angiogram and PCI
secondary prevention
stay approx 72h
physio
reduce RF
TTO post MI
aspirin 75mg OD
ticagrelor 90mg BD for 1y +/- PPI
bisoprolol 2.5mg OD - caution if asthma, bradycardia, conduction disorder
ramipril 2.5mg OD or ARB if wont tolerate
atorvastatin 80mg
others: GTN spray, poor LV funt=spironolactone, pericarditic pain=colchicine, HF=furosomide + dapagliflozin, non-revascularised=antianginal
follow up post MI
clinic in 1m
TOE
cardiac rehab programme
smoking cessation
GP uptitrate secondary prevention
advice post MI
no driving 1wk if PCI, 4 wks if none
gradual return activity
6w off work
stable angina meds
aspirin
statin
anti-anginal: BB, CCB, nitrates, nicorandil, ivabradine, rondazine
refer for intervention if failed 2 anti-anginals
interventions for stable angina
PCI: sx relief, need DAPT 6m
CABG favoured if 3 vessel disease, L main stem disease, valvular disease, sometimes diabetics
gold standard ix aortic dissection
CT aortogram
PESI score
decision to admit PE
rate control drugs AF
BB
CCB
digoxin
rhythm control drugs AF
flecanide
amiodarone
procedures
mx acute pulmonary oedema
sit forward
high flow oxygen
if shocked speak to critical care asap
vasodilate: diamorphine, GTN
diuretics: furosemide
+/- CPAP
rx cause
who is at risk VT/VF
severe LVSD
prev VT/VF
inherited cardiac conditions: HCM, brugada
prolonged QT ECG
> /= 2 large squares (440ms)
prolonged PR ECG
> /= 3-5 small squares (120-200ms)
usually first degree heart block
features postural tachycardia syndrome
young
F
dizziness, palpitations and chest pain after exercise/heat
fainting and feet go purple
conditions associated with postural tachcyardia syndrome
SLE
ehlers danlos
lyme disease
chronic fatigue syndrome
MS
sarcoidosis
diagnosis postural tachycardia syndrome
tilt table test
ms postural tachcyardia syndrome
lifestyle-avoid triggers
bisoprolol
CV causes collapse
prolonged QT
postural tachycardia syndrome
AAA dissection
bruasa syndrome
aortic stenosis
MI
heart blocks
postural hypotension
causes long QT
amiodarone
arithromycin
metoclopramide
citalopram
low K/Mg/Ca
genetic
associations with genetic long QT
deafness
increased HR
Fhx sudden deaths
