Cardio Flashcards
treatment for stable angina not controlled by beta blocker and GTN spray?
calcium channel blocker
ECG changes pericarditis?
-global wide spread changes
-Saddle shaped ST elevation
-PR depression most specific change
Condition that predisposes to pericarditis?
-auto-immune inflammatory conditions such as SLE, scleroderma and RA
Mitral stenosis - leaflets still have molbilty?
Loud opening snap - this indicates pateint would be suitable for balloon miitral valvuloplasty
What is the murmur heard in mitral stenosis?
-Mid-late diastolic murmur (heard expiration)
-Loud S1
Symptom of mitral stenosis?
haemoptyosis - increased pressures
Poorly controlled hypertension and already taking max dose of ACE inhibitor?
Calcium channel blocker or a thiazdie like diuretic
When is a thiazide like diuretic contraindicated?
Gout
What electrolyte imbalance do loop diuretics such as furosemide cause?
Hypokalaemia
What electrolyte imbalance does spironolactone cuse?
Hyperkalaemia
When are loop diuretics used?
-Heart failure
-Resistant hypertension, particularly with renal impairment
ECG findings PE?
-Sinus tachyvcardia
-Most specific chance is S1Q3T3 but this is rare
-RBBB and right axis deviation is also associated with PE
First line investigation for chronic heart failure?
NT-proBNP
WHat is BNP?
B-type natriuretic peptide - is a hormone produced by left vebtricular myocardium in response to strain
Levels of BNP and NTproBNP
If levels of NTproBNP are “high” what is the next step?
Specialist assessment within 2 weeks - transthoracic echocardiogrpahy
If levels of BNP are “raised’ what are the next step?
Arrange specialist assessment within 6 weeks
Warfarin PT and APTT
-PT is prolonged as main factor that is impacted is VII which is in the extrinsic pathway
Indication for warfarin?
-Mechanical heart valves
-Second line DOAC
If dose of warfarin was higher than therapeutic then could APTT increase?
yes
How is amiodarone given?
Central veins - can cause thrombophebitis
When is amiodarone used?
-Class III antiarrhythmic agent
-Blocks potassium channels which inhibit repolarisation
What ECG changes are seen in posterior MI?
ST depression not elevation
Acute presentation of AF hemodynamically unstable?
Electrically cardioverted
AF in stable patients?
-If <48 hours rate or rhythm control
->48 hours or uncertain rate control
Causes of dilated cardiomyopathy?
-Alcohol
-Coxsackie B virus
-Wet beri beri
-Doxorubicin
Causes of restrictive cardiomyopathy?
-AMyloidosis
-Post radiothepray
-Loefflers’ endocaridits
Clinical features of aortic stenosis?
-Chest pain dyspneoa
-Syncope/presyncope (feeling dizzy when exerted)
-Ejection systolic murmur us seen in aortic stenosis
-Radiates to carotids
-Valsalva manoeuvre decreases this
What is the Valsalve manoeurve?
You exhale forcefully with a closed mouth and nose, creating pressure in the chest. This maneuver increases pressure in the chest cavity
Features of severe aortic stenosis
-narrow pulse pressure
-slow rising pulse
-Left ventricular hypertrophy
management of aortic stenosis?
AVR is symptomatic otherwise cut off aortic valve gradient of 40
Cardiac arrest on monitor?
-Three shocks
-Amiodarone given
Triad of symptoms of PE?
Pleuritic chest pain, dyspnoea and haemoptysis
If PE is suspected what should be used?
2-level PE wells score
If wells score >4?
Immediate CTPA if delay anticoagulation until scan (DOAC)
What electrolyte imbalance do loop diuretics such as furosemide cause?
Hyponatremia
Viral pericarditis management?
NSAIDS and colchine - this is given until symptoms resolve and normla inflammatory markers (1-2 weeks ) then dose is tapered
What infection commonly causes pericarditis?
Coxsackie (viral)
Management of pericarditis bacterial infection such as high fever?
Manage as inpatients with antibicotics
Pulmonary embolism and renal impairemnt?
V/Q scan is investigation of choice
Nitrates and hypotension?
Contraindicated if <90mmHg
Symptoms of aortic dissection with aortic regurgitation symptoms where is false lumen seen on CT ?
-Ascending aorta
What are symptoms and signs of aortic reguritation?
diastolic murmur 2ICS, right sternal border
Heart sound if aortic dissection in descending aorta?
Normla heart sounds
Stanford classification of aortic dissection?
Type A- ascending aorta 2/3 acses
Type B - descending aorta
Type A management?
Surgical management
Type B management?
-Conservative and bed rest
-Reduce BP with IV labetalol
When should thrombolysis be considered for patients with massive PE?
If haemodynamically ustable - low BP
Over 80 with blood pressue <150/90?
Lifetsyle advise
Shockable rhythm but cardiac arrest not witnessed?
1 shock
What classes of antibiotics can cause torades de pintes?
Macrolides - clarithromycin, erythromycin and ciprofloaxacin
Most common cause of mitral stenosis?
rheumatic fever
What can 24-hour holter monitor be used to find?
sinus pulses, abnormal bradycardia, supraventricular tachycardia or non-sustained
Losing consciousness occuring at rest and on exertion?
Abnormal arrhytmias
AF findings
-irregularly irregular pulse with absent P waves
young patient with AF, no TIA or risk factors?
arrange transthoracic echo to exclude valvular disease
Acute pulmonary oedmea?
IV loop diuretic such as furosemide
How does loop diuretic help with pulmonary edema caused by heart failure ?
Decreased ventricular filling pressures therefore improving symptoms
What antiplatelet do you give to patients with NSTEMI (managed with PCI)?
-If no oral anticoagulant prasugrel or ticagrelor
-If oral anticoagulant clopidogrel
-This is taken along with aspirin
side effect of GTN spray?
Hypotension, tachycardia and headache
What kind of haemorrhage can cause torsdeas de pointes?
Subarachnoid haemorrhage
Hypothermia and rapid re warming?
Rapid rewarming can lead to peripheral vasodilation and shock
Regular broad complex tachycardia no adverse features?
IV amiodarone
Renovascular disease what antihypertensive to avoid?
ACE inhibitors are contraindicated - calcium channel blocker perfered
Medication used for AF
-Beta blockers atenolol or bisoprolol
-Calcium channel blockers such as ditiazem or verapamil however not in heart failure
-Digoxin - if sendentary and persistent AF
Severe hypertension no symptoms (>180/120)
Urgent referral for end organ damage - same day ophthalmology assessment
NSTEMI management
Grace score - angio and PCI
-If grace score>3 then PCI and angio
-if < 3
Dose of asprin in NSTEMI
300mg
what drug is not prescirbed with verapamil?
Beta blockers risk of complete heart block
How does acute mitral regurgitation occur after MI?
There can be rupture of papillary muscle due to MI this causes rupture of papillary muscle leading to acute mitral regugitation
What are the symptoms of of acute mitral regurgitation?
-early-to-miud systolic murmur
-hypotension and pulmonary oedema
How is acute mitral regurgitation treated after MI?
Vasodilators but often surgical repair is required
What is the most common MI that causes rupture of the papillary muscle and therefore acute mitral regugritaion?
infero-posterior infarction
why is BNP used?
helpful test to rule out heart failure
When else may there be increased BNP?
In patients with chronic kidney disease
Mechanical valve anticoagulation?
Warfarin with INR range 2.5-3
Mechanical valve INR target with warfarin?
Aortic: 3
Mitral : 3.5
What drug is bendroflumethiazie?
Thiazide diuretics - inhibit sodium reabsorption
-Potassium loosing
common adverse effects of thiazide diuretics - bendroflumethiazie?
-hyponatremia
-hypokalameia
-hypercalciemia and hypocalcuria
Narrow QRS complex tachycardia? (SVT)
-Sinus tachycardia
-Atrial fibrillation
-Atrial flutter
-SVT
ECG of sinus tachycardia?
-Narrow complex tachycardia
-P waves, QRS complex and T waves normal pattern
Atrial fibrillation ECG?
-P waves absent
-Narrow QRS complex tachycardia
-Irregularly irregular ventricular rhythm
Atrial flutter ECG
-Narrow QRS complex tachycardia - normal regular intervals
-Atrial rate is around 300bpm - saw tooth pattern
-Often two atrial contractions for everyone ventricular contraction
Ventricular rate 150bpm
SVT ECG?
-Narrow complex tachycardia
-Immediately followed by T wave
-P waves are present but buried in P waves
-Regular rhythm
How to distinguish between SVT and sinus tachycardia?
-SVT more abrupt and regular pattern
-Sinus tachycardia gradual onset and more variabilty in rate
Beta blockers and diabetes?
Can reduce hypoglycaemic awarness
Ventricular septal defect after MI?
-Features of acute heart failure with pan-systolic murmur
-Occurs within the first week
-Surgical repair
PCI not available within 2 hours with STMEI?
Thrombolysis inject fibrinolytic agent
DVLA Post MI advice
Dont drive for 4 weeks
How are proximal aortic dissection managed?
Aortic root replacment
Aortic regurguation murmur
Early diastolic murmur
Mamnagement of PE score?
PESI - pulmomnaruy embolsim
abosolute contrindication for thrombolysis?
known intracranial neoiplasm
Electrolyte imbalances and ECG
Hypercalcaemia -short QT interval
Hyperkalemia - large T waves
Hypokalemia - small T waves
Neurological complaints in aortic dissection?
Horners syndrome (ptosis, miosis and anihidrosis) due to compression of sympathetic trunk by expanding aortic dissection
NSTEMI Grace score >3% how soon to get coronary angio?
within 72 hours
What medication should be avoided in patient with HOCM?
ACE inhibitors
Stable angina not controlled with beta blocker what should be added?
Longer acting dihydropyridine caclium channel blocker
Becks triad for cardiac tamponade?
hypotension, distended neck veins, and muffled/difficult-to-auscultate heart sounds
What is cardiac tamponade?
accumulation of pericardial fluid under pressure
