Cardio 2 Flashcards by Owen Vineall

Management of aortic stenosis

Asymptomatic= observe unless valvular gradient >40mmHg or LVF dysfunction
Symptomatic= valve replacement

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What are different types of valve replacement in AS

Transcatheter or surgical
Choice depends on patient risk

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What is soft/absent S2 seen in

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If someone has HF, low BP and poor U&Es, what do

Increase furosemide dose to ensure their is sufficienct concentration of drug in kidneys

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What treat cardiac tamponade with if neoplastic cause

Percutaneous balloon pericardiotomy

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If not giving opiod for ACS, what use instead

Paracetamol
Avoid NSAIDs

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What is a pedunculated heterogenous mass on echo attached to atrial septum

Atrial myxomaA

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Atrial myxoma presentation

B symptoms
AF
Mid-diastolic murmur

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Murmur in ASD

Fixed splitting of S2
ESM

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If someone has had AF for over 48 hours but need to electrically anticoagulate, what can do beforehand

Echo to look for thrombus

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First line anti-anginal if known HF

Bisoprolol

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If using a standard release nitrate, how prevent tolerance

Asymmetric dosing where take 1 in evening and 1 in morning

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How differentiate aortic sclerosis from aortic stenosis on examination

Aortic stenosis will radiate to carotids but sclerosis won’t

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Cardiac causes of stroke

Aortic dissection
ASD
Infective endocarditis
Ventricular thrombus

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How investigate if having recurrent episodes of syncope but a normal ECG

Holter monitoring

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What causes radial pulse to disappear on inspiration

Pulsus paradoxus- cardiac tamponade

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Side effects of amiodarone

thyroid dysfunction
corneal deposits
pulmonary fibrosis
liver fibrosis
peripheral neuropathy myopathy
photosensitivity
‘slate-grey’ appearance
thrombophlebitis
bradycardia
lengths QT interval

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What investigations need to do before starting on amiodarone

TFT, LFT, U&E, CXR

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What tests need to do while on amiodarone

LFT
TFT every 6 months

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What does prolonged PR interval suggest in IE

Aortic abscess

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When prioritise rhythm control over rate in acute AF

HF
First onset AF
Obvious reversible cause

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What surgery is done for stanford A

Aortic root replacement

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What do if someone post PCI starts reinfarcting or has haemodynamic instability

Urgent CABG

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What cardiac drug can cause GI ulceration and sometimes perforation

Nicorandil

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What drug is strictly CI in VT

Verapamil

Management of irregular broad complex tachycardia

Seek expert help

How differentiate between pericarditis from tamponade

Kussmauls sign positive in pericarditis where JVP does not fall on inspiration

What vessel use for venous cutdown

Long saphenous vein

What investigation do all pericarditis patients need

TTE

What drugs can be given for VT

Amiodarone Lidocaine Procainmide

What do if drug therapy fails for VT

Electrical cardioversion

What do if someone on dual antiplatelet therapy for CVD presents now requires DOAC for AF

If stable - stop antiplatelets Commence DOAC

What test is needed pre digoxin

Hypokalaemia needs to be excluded as predisposed to toxicity

How know when to treat HTN

Treat all stage 2 and 3 Only treat 1 if age <80 and 1 of - renal disease - DM - CVD - Q-RISK>10%

What is first line anti-hypertensive use guideline

Under 55 or T2DM -ACEi or ARB Over 55 or black - CCB

What is second line anti hypertensive for a black person

ARB not ACEi

Second line management of HTN

If taking ACE i or ARB, add CCB or thiazide like diuretic If taking CCB, add ACEi, ARB or thiazide like diuretic (ARB if black)

Third line for HTN

Add whatever missing of ACEi/ARB, CCB or thiazide like diuretic

What do 4th line for HTN

Either seek expert help or add 4th line drug - if potassium>4.5 then add beta blocker - if potassium 4.5 and lower then add spironolactone

Metabolic side effects of thiazide diuretics

Hyperglycaemia High lipids High uric acid

Target BP for HTN

Clinic - Under 80 BP<140/90 - Over 80 BP<145/85 ABPM - Under 80 BP<135/85 - Over 80 BP<150/90

What cardiac drug would cause marked tongue and facial swelling after starting

ACEi from angioedema

Why are thiazide like diuretics preferred nowadays

Poor metabolic SEs - high lipids, glucose and uric acid

How do ventricular premature beats appear on ECG

Wide QRS complexes between normal P wave- QRS

How differentiate between RBBB and LBBB

RBBB- MaRRoW= M in V1 and W in V6 LBBB- WiLLiaM- W in V1 and W in V6

Causes of RBBB

Normal variant- particularly common as become older RVH Cor pulmonale PE MI Cardiomyopathy

What happens in Mobitz T1 HB

Progressive prolongation of PR before missing a beat

What happens in Mobitz T2 HB

PR interval constant but not always followed by a QRS

How describe a Mobitz T2 HB

Ratio of QRS to p waves

Which cardiac drugs can prolong the QT

Sotalol Amiodarone

Which diuretic most likely to cause hypocalcaemia

Loop diuretics

On which cardiac drug do you see bright spots in vision

Ivabradine

Presentation of left ventricular aneurysm post MI

Persistent ST elevation in absence of chest pain Left ventricular failure

What is wenkenbach phenomena

T1 HB Progressive PR elongation before skipping a QRS

Which HB/'s can be normal

T1 Mobitz T1

What can consider 3rd line for black people with HF

After ACEi, beta blocker and spironolactone Can consider hydralazine and nitrate

Patient presents with sudden onset chest pain worse on breathing in, with RBBB

When starting an ACEi, how manage a rise in creatinine

If less than 30% acceptable, repeat bloods

Where calculate QT to and from

Start of Q to end of T

If has HF and has HTN, which drugs should avoid

CCB ideally as exacerbates oedema but can give amlodipine if thiazides CI like in goût and diabetes

What determines what length of time holter give

Depends on the frequency of palpitations Eg- if get 2-3 x a week then want to have a 72 hour tape as opposed to 24 hour

What is seen in gallop rhythm

S3 from HF

In what lead it T wave inversion normal

aVR and III

What is in trifasicular block

RBBB with left axis deviation PLUS 1st degree HB

Presentation of stokes adams attacks

Get complete heart block and episodes of syncope

What wave is electrical cardioversion synchronised to

R wave

What is combined alpha and beta blocker

Labetalol

What rise in troponin is concerning from baseline

When can be confident not having an MI based off troponin

4 hours between first and final measurement

Loading clopidogrel dose

300mg

Loading ticagrelor dose

180mg

Daily ticagrelor and clopidogrel dose

Tic- 90 Clopi- 75

On top of meds, what is given part of managementfor MI

Cardio rehab

Who are silent MIs seen in

DM Elderly females CKD stage 5

Why is echo important in MI

To see if regional wall abnormalities- akinesia, dyskinesia

What need to check daily on furosemide

U&Es for hypokalaemia

How manage furosemide hypokalaemia

Options include adding spironolactone or SandoK

What valves shut in S1

Mitral and tricuspid

What valves shut in S2

Aortic and pulmonary

Causes of mitral regurg

Mitral vavle prolapse IHD- regional wall abnormalities Dilated cardiomyopathy Marfans IE and rheum fever

What worsens progression of valve disease

CKD as calcification Hyperlipidaemia and DM

What is the most common cause of secondary htn

Primary hyperaldosteronism

What do if someone presents with new onset AF within last 48 hours

Cardiovert, options include - DC cardioversion - medical with flecainide or amiodarone if structural heart disease

What medication affects effectiveness of clopidogrel

Omeprazole

When see bisferiens pulse

Mixed aortic disease

Which CCB use for angina

If monotherapy use verapamil or diltiazem If in combination with beta blocker use longer release

Lung crackles with normal CXR

How manage DM after a MI

Dose adjusted insulin infusion with regular monitoring of glucose to ensure under 11

MOA of clopidogrel, prasugrel and ticagrelor

P2Y12 receptor antagonist

What do with results of BNP in GP

If over 2,000 then cardio referral in 2 weeks 400-2000 cardio referral in 6 weeks Under 400- consider other diagnoses

Management of preserved EF HF

Loop diuretic Manage rfx and supportive

Typically if echo not preferred what use

Cardiac MRI

Which valve replacement operation is preferred

Open as TAVI new and only do in people with lots of rfx

Severe aortic stenosis signs

Absent S2 Narrow pulse pressure S4

Most common presenting aortic stenosis symptom

Exertional dyspnoea

What can be done for palliative patients with severe aortic stenosis

Percutaneous balloon valvulotomy

Long term complications of valve replacements

Endocarditis Thrombus formation Haemolysis

When operate on asymptomatic aortic valve disease (regurg and stenosis)

Reduced LVF

Investigations for IE

3 blood cultures TTE often first line but if available to TOE as more sensitive

What is most common presenting symptom of right sided endocarditis

Pulmonary septic emboli

Where get septic emboli from IE

Lungs Brain Eyes Spleen Kidney

Complications of IE

HF Aortic abscess Septic emboli- stroke, PE, kidneys Osteomyelitis Discitis Psoas abscess Valvular dysunction

Post prosthetic valve replacement what is most common cause of IE

Within 2 months= s epidermis After= s aureus

How tell if axis deviation

Look at leads 1 and AVF - if both positive then normal - if both away from eachother then LAD - if towards then RAD - if both negative then extreme deviation

Where does PR interval run from

Start of p wave to start of q wave

Where is ST segment between

End of S to start of T

What equation use for corrected QT

Bazzett- which estimates using HR of 60BPM QT/RR^-2