Cardio 4 Flashcards
What should be done in a patient with symptomatic (incl. haemodynamically unstable) bradycardia which is not responding to atropine
insert temporary pacemaker
NOTE: this is also management of choice if type 2/3 heart block post anterior MI or prior to surgery for trifasicular block
Bradycardia
- a) when is management indicated?
b) how is it managed? - When is there and increased risk of asystole (and therefore need specialist help)
- a)
- shock: hypotension (sys. <90), pallor, sweating, cold, confusion
- syncope
- heart ischaemia / failure
b)
500mcg atropine IV
if insufficient response:
- atropine up to 3mg
- transcutaneous pacing
- adrenaline
- complete heart block with wide QRS or type 2 heart block
- ventricular pause >3s
- recent asystole
Tachycardia
- a) when is the patient seen as unstable?
b) what is done if this is the case? - Broad-complex tachycardia (VT) - what should be done if
a) regular
b) irregular - Narrow-complex tachycardia (SVT) - what should be done if
a) regular
b) irregular
1.
a)
- shock: hypotension (sys. <90), pallor, sweating, cold, confusion
- syncope
- heart ischaemia / failure
b) 3 DC shocks
- a) loading dose of amiodarone followed by 24hr infusion (alternatively lidocaine or procainamide)
NOTE: verapamil contraindicated in VT
b) seek expert help
- a)
- vagal manœuvres
- IV adenosine
(verapamil if asthmatic) - electrical cardioversion
b) likely AF (follow guidance of that)
- <48hrs can cardiovert
- rate control (beta blockers)
Pulmonary Artery Occlusion Pressure
- What is this an indirect measure of?
- What should you suspect if
a) low
b) low + pulmonary oedema
c) high
- left atrial pressure
- a) hypovolaemia
b) ARDS
c) fluid overload
What is the most common cause of SVT?
AV nodal re-entry tachycardia
-> 2 separate conduction pathways within the AV node
(will see 2 different QRS complexes one wider than the other)
-> P wave will follow QRS as conduction originates in AV node
Rheumatic Fever
- What is it?
- How is it diagnosed?
- What is the management?
- an immune reaction (2-6 weeks after) to recent strep progenies infection
- evidence of recent strep infection (strep antibodies, antigens or positive throat swab)
AND
2 major / 1 major+2 minor criteria
Major sydenham's chorea erythema marginatum endocarditis (pancarditis) poly arthritis subcutaneous nodules
mnemonic: myosin SEEPS into range immune attack against protein M of strep pyogenes
minor:
- raised ESR / CRP
- fever
- prolonged PR interval
- penicillin V
- NSAIDs
Prosthetic heart valves
- Biological valves (from cow or pig)
a) What is the disadvantage?
b) What drugs are required post op? - Mechanical Valves
a) What is the disadvantage?
b) Lifelong warfarin indicated. What is the target INR in
i) mitral
ii) aortic
- a) calcification / degeneration of valve
b)
- life-long aspirin
+/- 3 months warfarin depending on risk
2.
a) risk of thrombosis
b)
i) 3.5
ii) 3.0
THINK: higher INR for mitral as blood more likely to pool in atrium than ventricle
State the vein which
- originates at the first digit and passes up the medial aspect of the leg draining into the femoral vein at the femoral triangle
- originates at the fifth digit and passes up the lateral aspect of the foot and posterior aspect of leg to drain into popliteal vein at knee
- great / long saphenous vein
2. short saphenous vein
Takayasu’s arteritis
- Who is it more common in?
- What clinical features are seen?
- What is it associated with?
1.
- 10-40
- females
- asian people
2. typically causes occlusion of aorta - unequal BP in upper limb - limb claudication - absent / weak lower limb pulses - carotid bruit / tenderness
- renal artery stenosis
Additionally to VT management, what should be given in torsades de pointes?
IV magnesium sulphate
Wolff-Parkinson White
- What is it?
- What clinical features can be seen on ECG?
- How would you differentiate between types A and B?
- How is it managed?
- congenital accessory pathway between the atria and ventricles causing an atrioventricular re-entry tachycardia
- > accessory pathway cannot slow conduction in AF and therefore AF can rapidly progress to VF - wide QRS complex with slurred upstroke ‘delta wave’
- short PR interval
- type A - left accessory pathway: RAD and prominent R wave in V1
type B - right accessory pathway: LAD and NO prominent R wave
- radio frequency ablation of accessory pathway
What NSAID is contraindicated in CV disease?
diclofenac
