cardio Flashcards
markers for alchol in bloods
ALT
AST
GGT
high MCV
WHAT CAN CAUSE AF (NEED AT LEAST 6 )
infections
electolyte distrubances
ischemic heart disease
hypertension- lv hypetrophy hence more volume in left atrium (strecthes the wall)
PE
HYPERTHRYOIDISM
alchohol
diabetes
a person who has chronic AF Rate control
- bisoprolol
- ca 2+ blocker - diltiziam ( slows down heart)
how do we achieve rythm control
caridioversion
frine or flecainide sotolol
someone who has heart failure and A FIB first line
digoxin
fleicanide vs amidiorone
fleic :
younger pts with structurally normal hearts
amiodorone
bare side effects so older pts
whats the score for a fib
chadvasc
what does c in chadvasc
v stands for
congestive heart failure
vascuar disease
why do you sometims have to cover warfarin with heparin
because initially warfarin is prothromboric so need heparin as a cove
normal INR
2- 3
what dorm is enaxporin and what is in
its an injection
LMWH
indications for digozin
HF
AF
atrial flutter
moa digozin
whats important to know
side effects
reduces HR - chronocity
improved inotropic
not usually first resort tend to go for other drugs likee BB and ca channel blockers first
visual problems
can give you an arrythmia
if you already have low K+ it makes it worse
important is to monitor the kk levells of people on digoxin and also kidey function as thats how its excreted.
nomral EF
50-70
HEart failure EF
<40
SPIRONOLOLACTONE what is it and indications
diuretic used to treat edema and it also raises K+ levels
conns syndrome(too little potsium)
heart failure
a side effect of spironolcatone
hyperkalemia
tx for pulmonary edema
CPAP
diuretics
main key symptom for dissection
sudden onset tearing CP radiatiating to back
other signs of dissection
cp
back pain esp interscapulae
neck pain
paresthesia- t
murmour is possible as aortic regurg is a regonised complication of AD - so any new murmour could be susupicios(more common in type A)
rf dissection
hyperenstion
ct disease
cocain/amphetimine
age ?50
clinical signs dissection
blood pressure differences in each arm
radio radio delay
radio femoral delay
stanford
for type A - arch
type b - thoracic
how to asses radio radio delay
palpate both pulses, should be the same
are palpatiions dangerous
majority of them are benignn but you do need to rule out some causes
what to rule out in palpatiatiosn
- stress
- infection
- hyperthyroidism
- ARRYTHMIA !!!!
- CAN BE A SIGN OF MENOPAUSE
- CAFFEINE,
SMOKIG
ALCOHOL
how can alcohol affect the heart
it can be a cause of palpitations and hency tachycardia as it stimulates the sympatheitc nerbouse syndrome
holiday heart syndrome is a term coined for holiday goers who develop a fib, frequently from binge drinking.
alcohol is a cause of A FIB
ALCHOL AND ITS LINK TO THE HEART
- can cause hypertension
- increased risk of MI
- increased risk of strok
- palpitations
- cardiomyopathy
- weight gain
how mnay units a week
14 units
smoking and its effects
- makes arteries most sticky and increase artheroscleoris
- increase risk of thrombus
- MI, STROKE
- hypertension
- palpitations
ACS
UNTSABLE ANGINE
NSTEMI
STEMI
MOST IMPORTANT INVESTIGATIONS IN SOMEONE YOU SUSPECT HAS AC S
ECG
TROPONIN
difference between unstable angina and nstemi
troponin levels
post MI complications
arrythmias
aneurysm of wall
dresslers
tamponade
papilaary muscle rupture (mitral regurg)
becks
.veins
.hypo
muffled
post mi what meds will a pt may be on
aspirin
antiplatelets - usually will take for 1 year ater MI where risk is increased
statin
some bp meds like bb or ca2+ or ACE
DIFFERNECE BETWEEN NSTEMI AND STEMI
PARTIRAL/FULL OCCLUSION
WILL BOTH HAVE RAISED TROP
RF FOR HEART ATTACK
- smoking (damges endothelial lining more likey to have plaque)
- obesity (plaque)
3.diabtes (affects blood vessels due to sugar )
HYPERLIPIDEMIA
4.famiy history
- alcohol (strong link with BP, which also causes vessels to harden as LV becomes hypertrophic)
- hypertension
nonmodifiable(age, males, south asians, FH
unsatble angine ecg
ECG CAN BE NORMAL !!!!!!
or abnormal
unstable vs stable
rest vs excertion
whats the scary thing about heart attacks
sometimes we think you need the classic dramatic presentation you see on the tv when most people have a heart attack they don’t realize they are having it because the pain is not that severe.
atypical presentiaiton of MI
- NO PAIN (DIABTEICS, ELDERLY)
EPIGASTRIC PAIN
JUST BREATHLESSNESS
SYNCOPE
PALPITATIONS
HYPERGLYCEMIA CRISS
nstemi ecg
can be normal or abnormal
-0 st depression
ecg stemi
ST segment elevation >2mm in adjacent chest leads
ST segment elevation >1mm in adjacent limb leads
New left bundle branch block (LBBB) with chest pain or suspicion of MI
diagnosis of NSTEMI requires two of the following:
Cardiac chest pain
Newly abnormal ECG which does not demonstrate ST-elevation e.g. ST depression, T wave inversion or non-specific changes.
Raised troponin (with no other reasonable explanatio
conditions for PCI
came witin 12 hours of onset of pain and PCI can be given within 120 mins
CABG VS PCI
PCI IS MORE URGERNT WHEREAS CABG MORE ELECTIVE
both treating the sam problem clot but cabg is open surgery , more risks , the heart has to be stopped
lateral stemi
1, avl 5+6
what is the most common arrythmia an MI can lead to
VF
whats the most common reason for someone to die of a heart attack
VF
inferior MI corrosponds to which artery
RIGHT
DRESSLERS MANAGEMENT
high dose apsirin 300?
left circumflex supplies
posterior lateral
signs of a previous MI
q waves (deep and wide)
digoxin toxicity
signs of a fib
chest pain
palpitations
dizzines
syncope
investigations for AF
ECG
BLOODS - need to figutr out a cause as a lot of times theres a reason, infection, alcohol,
what constitutes unstable AF
- signs of shock
- syncope
- heart failure
- myocardial ischemiaa
how to treat unstable AF
cardioversion
try 3 rounds if unstable 300mg of IV amiodarone should be given followed by another DC shock, then a 24 hour infusion of 900mg amiodarone.
when would you not want to cardiovert somone for AF
if theyve presented longer than 48 hours as the risk of stroke increases
EXAMPLS OF ANTIPLATELETS
ASPIRIN
CLOPIDOGREL
PRASIGRUEL
why is AF so tricky
so many people have it undiagnosed as its a silent arrythmia not everyone feels the palpitations etc
tachycardia with adverse features
- shock
- myocaridal ischemia
- syncope
- heart failure
if you have tachy with adverse features what do you do
cardioversion up to 3 times and after give 300 mg of amiodorone over 10-20 mins
Repeat shock
Then give amiodarone 900 mg over 24 h
EXAMPLES OF VAGAL MANEOUVEOURS
- cold water
- blow through blcoked mouth
- carotid masaage (check for bruits before)
- bear down as if bowel movement
when do we give adenosine
we give in SVT, where you have normal qrs complexes (like AF, but the difference here is its sinus so its regular).
you use after vagal maenouveres have failed.
6mg adenosine IV bolus
12 if no response
12 again if no response
all together up to 3 cycles
amiodorone vs adenonis when to use
both antiarrhythmic drugs
AMIODORONE - antiarrhythmic (AF)
adenosine (SVT)
when you give you warn the patient before hand as its going to stop the heart and hopefully that resets the Sa node
metallic tase in mouth
impending doom
why to perform valasave
to slow down HR
someone who has SVT
AF increases risk of
- stroke (ischemic)
- heart failure
- dementia (chronic hypoperfusion)
IF YOU WANT TO CARDIOVERT SOMEONE BUT ITS DEFINITELY BEEN >48 H what are your options
- get them stablised with other methods and do an elective cardioversion in3 weeks
- do a TEE before hand to visualise a clot if there
- do pharmacological cardioversion with amidorone or fleicanide
can adults get rheumatic fever
yes but very rare its mainly kids and teensn
criteria for rheumatici fever
jONES
what imaging can be used for AORITC DISESCTION
- ct angio
- CXR- widened mediastinum,loss of aortic knob
- TEE
for a difference in bp measurments how signifcant does it need to be ?
> 20 mmhg
AAA vs AD
AAA- more so features of shock, you can feel a pulsatile mass and its more so abdomninal pain/back as opposed to chest pain
AD- more so chest pain,
syncope during excercise
BIG RED FLAG !
HYPERTOPHIC CARDOMYOPATHY - young athleates due to lv obsruction no perfusion to brain
ASS - poor CO as steonic valve
palpitations history
how long its been going on
1st time
anything that triggers is
any chest pain associated with it
does it come and go
any particular time when its worse or better
anything that relieves it
have you tried vagal maneuvers to reduce it (holding ur breath, blowing out, holding nose)
triggers, coffee , energy drinks, stress, alochol, drug use
FH -
pmh- any history of heart problems in the past
rule out anxiety
adverse signs associated with : sweating, extreme fatigue, inability to carry out activites, chest pain, s.o.b, syncope, dizziness, (pre- synccpe, triggered by excercise
which drugs can cayse tachy
amphetamines
cocaine
ecstasy
cannabis at low doses (at high causes brady )
MAIN SYMPTOMS OF AF
PALPITATIONS
SYNCOPE
LIGHT HEADED
MAYBE A LITTLE CHEST PAIN
algorithm for unsatble a fib
dc cardiovert
up to 3 x
if not then 300 mg of amiodarone
then shock again
then IV 900mg amiodorone
target hr in AF
110 Hr
