Cardio Flashcards
posterior MI ECG findings
which vessel
lead v1-3
Op of STEMI:
horizontal ST depression
Tall Broad R waves
upright T waves
dominent R wave in v2
Basically if st depression in leads V1-V4 = do 2 extra leads V&V9 bc something going on posterior
LCX or RCA
? PE investigation CKD or pregnant
V&Q scan
instead of CTPA
malignant hypertention
BP> 180/120
end organ damage
hypokal ECG
prolonged PR ( 1st degree Hb)
Prominent U waves
flateneed t wave and st depression
HOCM hart sound
s4
when to stop anticoag consider alternative diagnosis with PE
2-level PE Wells score </= 4
-ve d-dimer
NSTEMI scoring scale and Mx
GRACE SCORE
<3% = conservative management
> 3% = PCI in 72hrs
haem unstable = PCI now
Conservative management NSTEMI
aspirin fondaparinux ticagrelor
clopidgrel if high bleedinig risk (ie on anti coags)
pulmonary embolism abg
resp alkalosis
bc hypervent = low co2
criteria for infective endocarditis
duke criteria
risk of bleeding af and on anticoags
ORBIT score
PE with haemodynaic instability
thrombolysis
mitral stenosis
mc cause
path
sx
tx
rheumatic fever
(blood backflow in left atrium) heart failure sx and af bc atrial stretch
malar flush
haemoptysis
tx af w mitral stenosis = anticiag
ASx = monitor w echo every 6-12 mths
sx = baloon valvotomy or perc mitral commissurotomy
mitral stenosis sounds
mid diastolic rumble (best in exp)
at apex
loud s1
opening snap
pt w PE that can be managed as outpatients
PESI score
(pe severity index)
aortic regrug causes and presentation
infection - infective endocarditis, rheuamtic fever
infarction
aortic dissection
spondoarthrop
RA, SLE , marfans and ehler danlos
acute = cardiogenic shock
chronic = CHF and chest pain maybe
aortic regurg signs
early diastolic rumble (increase by handgrip)
collapsing pulse
wide pulse pressure
quincke
de mussets
severe = mid diastolic austin flint murmur
quinckes sign
nailbed pulsation in aortic regrug
de mussets sigm
head bobbing in aortic regurg
what is austin flint murmur
severe aortic regurg
due to partuial closure of anterior mitral valve cusps bc regurg stream
aortic stenosis sx
chestpain dysponea syncope (exertional dizziness)
aortic stenosis causes and tx
calcification
ie old pt w athersclerosis
process sped up if bicuspid valve = ypunger pt
williams syndrome (supravalv aotic sten)
post rheumatic disease
HOCM
Asx = monitor
Sx = valve replacement
aortic stenosis murmur
what if severe
ejection systolic
radiates to carotids
decreased by valsalva manouvre
crescendo descrescendo
severe =
soft absent s2
s4 sound
slow rising pulse
narrow pulse pressure
causes mitral regurg
Post MI/ ACS ( bc papillary muscles/chordea tendinae affected)
mitral valve proplapse
infective endo
rheumatic fever
congenital
mitral regurg sx
often stays asx unless gets too bad = present w failure of Left vent, arythmia, or pul htn
ie fatigue SOB oedema
mitral regrug murmir
what if severe
pansystolic mumur
hollow high pitched blowing sound
apex and radiates to axilla
widely split S2 if severe
medical mx acute mitral regurg
nirates duiretics inotropes intraaortic balloon pump
if in heart failure maybe ace inhibitors n bb m spirinolactone
severe = replacement
making murmurs worse/better
murmur louder bc more blood in the heart
therefore
valsalva = dec venous return = improve
leg lift and squatting = increased venous return therefore worsens murm
hocm genes and path
autosomal dominant
diastolic dyfxn
left v hypertrophy -> decreased compliance -> decreased cardiac output
hcm presentation
murmur
extertional sob
young
syncope post exercise
sudden death bc vent arythmia
ejection systolic murmur
(made worse by vals and better by squatting)
hocm echo MR SAM ASH
MR SAM ASH
mitrak regurg
systolic antieror motion (of ant mitral valve leaflet)
assymetic hypertophy
mitral valve prolapse causes features
usually idiopathuc ie congenital
midsystolic click (occurs later if pt standing)
late systolic murmur (longer if pt standing)
basically similar murmur to mitral regurg but improves with blood in the heart
angina tx
bb or ccb first line
if only ccb used = verpamil or diltazem
if on monotherapy still sx and cannot tolerate either bb or ccb = long acting nitreate. nicorandil, ivabradine
hyperaldoesteronism presentation
hypertension
hypokalaemia
metabolic alkalosis
hyperaldost 1stline investigtiion how to differentiate btween 1 and 2ndry
aldoesterone renin ratio
high = primary (in adrenals bc aldosterone being produced indepedant of renin)
low ratio = secondary (inc aldos bc renin raised ie problem in axis )
primary hyperaldosterone ix
1st aldosterone renin ratio (high ald = primary)
2nd high resolution ct abdo
(to see uni lat or bilat cause)
if normal/inconc = AVS
3rd adrenal venous sampling (AVS)
if aldos inc in both veins = bilateral cause
causes of primary hyperaldos
unilat adrenal adenoma
bilateral adrenal hyperplasia
Post MI complication pericarditis
2-3 days bc post transmural MI
Post Mi complications Dressler’s syndrome
2-6weeks post MI
autoimmune reactuion to proteins as myocardium recovers
fever pleuritic pain pericardial effusion
raised ESR
Tx - nsaids
after 5 days complications of post MI
RUPTURE ie
free wall = sx cardiac tamponade
VSD septal rupture = hf sx (pansystolic murm)
papllary muscle damage = mitral regurg and hf sx (early to mid systolic murm)
poorly controlled htn already on acei, ccb, and thiazide
if k<4.5 = add spironolactone
ccb SE gums
gingival hyperplasia = gum bleed
x ray findings heart failure
ABCDE
Alveolar oedema (bats wings)
Kerly B lines (intersitioal oedema)
Cardiomegaly
Dilated prominent upper lobe vessels
effusion (pleural)
ruptured AAA bloods
crossmatch blood 6 units
acute pericarditis 1st tx
nsaids and colchicine
fibronolysis given for ACS then what
repeat ecg after 60-90 mins if still st elevation = transfer for urgent PCI
ccb se
headache flushing ankle oedema
meseneteric ischaemia triad
cvd
hight lacate
sofy but tender abdo
unstable pe
thrombolysis ie alteplase
mesenteric ischaemia 1st ix
vbg - lactate
CT
nifedipine SE
reflex tachycardia
palpitations dizziness
bradycardia atropine CI
adrenaline infusion
mechanical valve target INR
aortic = 3
mitral = 3.5
AAA screening
all men aged 65 offered single abdo USS
infective endocarditis indications for surgery
severe valv incompetence
aortic abscess
infxn reistant to abx or fungal infections
cardiac failure refractory to standard medical therapy
recurrent emboli after abx therpay
isolated hemisensory loss stroke
lacunar infarct
lacunar infarct
unilateral weakness and or senrsory face arm and leg or all 3
pure sensory stroke
ataxic hemiparesis
dysarthria/clumsy hand syndrome
mx primary hyperaldoesterone
adrenal adenoma = laproscoopic adrenalenctomy
bilat adrenocortical hyperplasia = spironolactone
what does opening snap mean in mitral stenosis
leaflets still have some mobilty
new LBBB on ecg
wide QRS in precordial leads
normal shape but negative QRS in V1
mostly positive w slow upstroke R wave peak in lateral leads
anticoag post catheter ablation for AF
so still need anticoag base on chadvasc score
0 = 2mths anticoag
1+ = long term anticoag
risk factors for asystole in bradycardia
ie needs transvenous pacing
complete heart block w broad qrs complexes
recent asystole
mobitz type II av block
ventricular pause> 3 seconds
CCB constipation which one most likely
verapamil
acute limb ischaemie intial mx
abc
IV opiods
IV UFH
vascular review
acute limb ischaemia def mx
intra arterial thrombolysis
surgical embolectomy
angioplasty
bypass surg
amputation is irrevesible
MC cause infective endocarditis
Staph aureus
staph epidermidis if <2mths post valve surgery
symptomatic aortic stenosis tx
surgical AVR for low/med risk op pts
transcatheter AV for high risk
driving post MI
4 weeks
dont tell dvla
useful cardiac enzyme to look for reinfarction
ck-mb
returns to normal after 2-3 days
complications after coronary anggiography
bleeding
infection
allergy to contrast
mi
stroke
angina triggers
cold weather
amotionie anger/excitement
vivid dreams
lying down
blood tests and why for pt w angina
fbc - anaemia
tft - thyrotox
blood glucose - d
u&e if considering acei
how does aspirin work
Cox inhib
prevents thromboxine production
inhibits platelets aggregation
what is an aneurysm
abnormal dilation of vessal wall >150% of orgininal diameter due to weakness in vessel wall
true aneurysm
dilatation of vessel involving all 3 layers of vessel
false aneurysm,
collection of blood in a dilatation only secured by adventitia (outermost layer) due to damage to other two layers
aneurysm screening <3cm
no further action
AAA screening dilation found
3-4.4cm = rescan every 12 mths
4.5-5.4 = rescan every 3mths
AAA screening found aneur >5.5cm
refer 2 weks for vascular surgery for repair
either EVAR (Eelective endovasc repair)
or open surgery if unsuitable
causes AAA and RF
marfans/ehlers
atheromatous degeneration
smoking
fhx
dm
htn
male
inc age
hyperlipidemia
reasons why EVAR for aaa may be prefered over open surg
comorbidties = open surgery too much risk
morphology of AAA = evar suitable
position of renal arteries
-ve of EVAR for aaa repaire
long term follow up needed
not suitable for every aneurysm
high reintervention rate (endo leak)
ruptured aaa ix if stable
abdo ct with contrast
Trash foot
cholesterol embolism
atheromatous debris shed during vasc surgery, lodges in distal vessel = local ischaemia
mottled skin and darekened segments on toes
4 layers of vessel
endothelium/intima
tunica media
tunica externa
serosa/adventitia
capture beat
normal qrs complex inbetween broad VT complexes
VT or VF shockable ?
VF yes
VT yes if no palpable pulse
VT mx
oxygen
adrenaline
amiodarone
lidocaine
vt vs vf
vt more regular and uniform than vf
severity of HF
NYHA
acute left heart failure path and sx
LV cant pump blood out to SVS, back log= pulmonary oedema= acute SOB, reduce sats, worse lying down. T1RF.
unwell, cough pink frothy sputum, wheeze cough
raised RR, tachyC, 3rd HS, bibasal crackles, hypotension. RSHF?
right heart failure sx
peripheral oedema, facial engorgement and distension o f the abdomen.
raised jvp
hepatomegaly
how does furesimide work
competitively inhibits na/k/cl cotransporter in thick ascending loop of henle
removes osmotic water gradient for water to reabsorb
reverse tick pattern on ecg
down sloping st depression
t wave inversion/flat
short qt
bc DIGOXIN
ACEi side effects
cough
first drop hypotension
angioedeema
hyperkalemia
renal impairement
hypertensive retinopathy classification
Keith-Wagener
signs of hypertensive retinopathy
silver wiring
AV nipping
flame haemorrhages
cotton wool exudates
flame and blot haemorhages (may collect around mac = macular star)
papilloedema
complications of essential hypertension
HF
IHD
CKD
Stroke
PVD
hypertensive retinopathy
causes of AF
pneumonia
MI
PE
HF
hyperthyroid
alocohol excess
endocarditis
af ecg
ireggular qrs
absent p wave
AF cardioversion
medcal = amiodarine flecanide
electrical DC cardioversion
ablation
complications of AF
stroke
tia
HF
systemic emboli
falls
why check urine sample in infective endocarditis
microscopic haematuria
bc
immune complex glomerulonephritis
septic emboli
renal cortical necrosis
infective endocarditis eyes
roth spots on retina
white centered haemorrhages
infecttive endo ix
3 blood cultures 3 seperate times 3 sep places
echo
cxr
ecg
urine dip
infective endo RF
prev episode
IDVU
prosthestic valves
rheumatic valve disease
congen heart defects ie PDA VSD
recent piercings
