Cardio 2 Flashcards
What is the difference between fast and slow AF
Fast AF = >100bpm
Slow AF = <60bpm
first line mx angina
aspirin + atorvastatin
beta blocker /non DHP CCB + GTN
what are non-DHP CCB
THE WEIRD NAMED ONES
e.g. diltaziem, verapamil
what is second line mx angina
beta blocker + DHP CCB + GTN
what are DHP CCB
the usual named ones
e.g. nifedipine
what typeof CCB must you never give with BB and why
never give NON DHP CCB with BETA BLOCK
because they can cause complete heart block
causes of secondary HTN
Renal - RAS, PKD, CKD, chronic glomerulonephritis
Endocrine - hyperthyroid, cushings, conn’s, phaeo, CAH
CV - aortic coarctation
when do you treat HTN
if >140/90 and UNDER 80yo and with end organ damage, CVD, renal disease, diabetes, Qrisk >10%
what is the target BP for <80yo with HTN
Target for <80yo: <140/90n
what is the target BP for >80yo with HTN
Target for over 80yo: <150/90
how do you manage resistant HTN (after ACEi/ARB + CCB+ TLD)
if K+<4.5: spironolactone
if K+>4.5: alpha/betablocker
what patients must you give ATORVASTATIN 80mg in
FOR SECONDARY PREVENTION
so if known IHD, CVD, PAD (not if just high Qrisk)
how is a pericardial rub audible
on left lower sternal edge, with patient leaning forward on inspiration
what do you need to monitor with unfractionated hepain
APTT
what does QRISK measure
your 10 year risk of developing cardiovasc disease
what should you be given if Qrisk <10%
lifestyle modification
what should you be given if Qrisk >10%
high dose statin (20mg atorvastatin)
causes of cardiac tampoinade
vascular: MI, rupture, aortic dissection
infection: pericarditis
trauma: includes iatrogenic
cancer…
cause a pericardial effusion
when is it appropriate to do a PCI after the reccomended time priod of 12h from sx onset?
when patients have persistent ischaemia following fibrinolysis (e.g. at a nonPCI centre)
which angina med do patients commonly develop resistance to
standard-release isosorbide mononitrate (not modified release)
investigations for suspected rheumatic fever
Throat swab)
Bloods (FBC, ESR, ASOT anti streptolysin O titre )
Blood cultures
ECG
CXR
Echo
what will Echo show in rheymatic fever
valve leaflet and chordal thickerning
mitral valve dilatation and collapse
what is the time pattern of rheumatic feber
rheumatic fever is RECURRENT > causes progressive cardiac damage
how long should patients with rheum fever keep taking antibioitics for as secondary prevention?
10 years or until age 40
lifetime prophylaxis may be needed if severe heart damage
what occurs in ECG in acute rhem fever
prolonged PR
Heart block
what is the timescale of the two disease patterns in Rheumatic fever
ACUTE»_space; immune response to strep pyogenes, 2-6 weeks from initial pharyngeal infection
CHRONIC»_space; recurrent through life
ix for pericarditis
ECG: widespreast PR depression and saddle shgaped ST elevation
Echo (TTE): to exclude pericardial effusion
Troponin: to check for PRIOR MISSED MI
viral serology (later, non-urgent) if suspecting viral cause
why is it important to do a troponin for pericarditis
because a prior silent MI may have caused it
what is the most common complication of pericardityis you must be weary of ?
PERICARDIAL EFFUSION > TAMPONADE
so get a CXR > it will show cardiomeg with normla pulm vassc
what causes WPW
presence of an accessory pathway conducting between atria and ventricles abnormally > premature ventricular contractions
ecg features of WPW
short PR interval
wide QRS complexes with a slurred upstroke - ‘delta wave’
left axis deviation if right-sided accessory pathway*
right axis deviation if left-sided accessory pathway*
what sets off WPW arrythmia?
HOCM
mitral valve prolapse
Ebstein’s anomaly
thyrotoxicosis
secundum ASD
mx of WPW
ablation of accessory pathway
OR
amiodarone / fleicanide
findings on ECG for pericarditis
Saddle shaped ST elevation
PR dePRession
absolute contraindications to thrombolysis
active internal bleeding
recent haemorrhage, trauma or surgery (including dental extraction)
coagulation and bleeding disorders
intracranial neoplasm
stroke < 3 months
aortic dissection
recent head injury
severe hypertension
what is first line is CHADS VASC high?
DOAC e.g. apixaban, rivaroxaban, dabigatran
what must you give if witnessed cardiac arrest while on monitor
3 SHOCKS (instead of just 1)
what kind of erythema do you get with rheumatic fever
erythema MARGINATUM
what must you synchronise DC cardioversion to?
synchronise to R wave
when do you NOT need to synchronise DC cardioversion
in defibrillation (VF, VT)
what drug reverses dabigatran effect
Idarucizumab
posterior MI on ECG
tall R waves in V1, V2
ECG change with HYPERCALCAEMIA
short QT
what must you not forget to give in AF if you can cardiovert <48 hours
GIVE RAPID ANTICOAG e.g.
causes of orthostatic hypotension (drop of BP >20/10 on standing)
- hypovolaemia
- autonomic dysfunction: diabetes, Parkinson’s
- drugs: diuretics, antihypertensives, L-dopa, phenothiazines, antidepressants, sedatives
- alcohol
which cardiac drug must be avoided in VT
VERAPAMIL – because it will inhibit heart contraction furter
electrolyte changes causing long QT
hypocalcaemia, hypokalaemia, hypomagnesaemia\
what is the second investigation type you must do in someone found to have a RAISED BP in clinic?
AMBULATORY BP MONITORING (this will confirm whether they actually have HTN - no need to call them back into clinic!)
