Cardio 4 Flashcards
pulmonary stenosis
heard loudest?
second intercostal space on the left sternal border
> right sided heart failure
Triad of symptoms for right sided heart failure?
JVP
hepatomegaly
ankle oedema
amiodarone IV has one common injection side effect?
thrombophlebitis
> ensure given into ventral veins
amiodarone is a class?
class III anti arrhythmic agent
blocks potassium channels
amiodarone interaction with which commonly used anticoagulant ?
decreases metabolism of warfarin
what are u waves?
u waves appear as small + deflections after t wave
lead V2 and V3
caused by hypokalaemia
short QT interval?
QT interval prolongation
J waves are what?
osborn waves
hypotrhermia
hypercalcaemia
junction between QRS and ST segment
Raynauds with extremity ischaemia?
buerger’s disease
other name for buergers disease?
thromboangitis obliterans
how to differentiate between myocarditis and pericarditis
Myocarditis is more likely to show a focal ECG changes
> also more likely to show acute congestive HF signs / Left ventricular failure signs
pericarditis is widespread
why does myocarditis present with left ventricular dysfunction signs?
inflammation reducing contractile strength of the heart
causes of myocarditis?
viral : coxsackie
bacterial : diphtheria, clostridia
fungal : toxoplasmosis
mx of angina?
First line : beta blocker
or if not tolerated / contraindicated
first line : CCB NDHP - verapamil / diltiazem
2nd line: Beta blocker and Dihydropyridine CCB - amlodipine / nifedipine
3rd line - add 3rd drug but awaiting PCI / CABG
other angina medications?
a long-acting nitrate
ivabradine
nicorandil
ranolazine
Stage III HF
pain on less vigorous studd
like daily activities impacted
but no pain at rest
stage 1 HF?
Stage I - No limitation on ordinary physical activity (incorrect)
PKD is associated with what valve abnormality?
mitral valve prolapse
management of cardiac tamponade?
pericardiocentesis
when should you take statins?
at night- increases efficacy
beta blockers licensed for HF?
bisoprolol, carvedilol, and nebivolol.
2nd line HF?
with reduced ejection fraction
beta blocker, ACEi, + mineralocorticioid receptor antagonist
> be wary of hyperkalaemia
role of SGLT-2 drugs inhibitors
SGLT-2 inhibitors
reduce glucose reabsorption and increase urinary glucose excretion
dapagliflozin
sacubitril-valsartan
criteria?
3rd line
left ventricular fraction < 35%
reduced ejection fraction who are symptomatic on ACE inhibitors or ARBs
initiated after a washout period
role of digoxin
very helpful w symptoms
t is strongly indicated if there is coexistent atrial fibrillation
major bleed and on warfarin mx?
stop warfarin
IV vitamin K 5mg and prothrombin concentrate complex
Ivabradine is used in?
MOA?
S/E?
inhibition of IF channels
I current
F = funny
mixed na+/K+ in heart like Sinoatrial node
angina management
transient luminous phenomenon
what is the MOA of ivabradine?
inhibits channels
= delay in depolarisation
= slows down heart rate
HTN management?
when should you start antihypertensives?
if more than 150/95
stage 2
> 135/85 on
ABPM / HBPM
when to start anti hypertensives?
<80
+ target organ damage
CVD disease
renal disease
DM
QRISK >105
black african or african-caribbean ethnicity first line anti hypertensives?
second line?
CCB
> CCB + ACEi / ARB
CCB +thiazide like diuretic (indapamide)
<55 or T2DM
first line antihypertensive?
ACEi / ARB
acute HF management
with hypotension?
high dependency unit
inotropes considered for reversible cardiogenic shock
HF acute management?
IV loop diuretic - furosemide
O2 - if needed
Vasodilate
> contraindicated if hypotensive
Respiratory support
CPAP
Inotropic agent
vasopressor agent
mechanical circulatory assistance
Acute mx of HF summarised
if hypotensive?
IV furosemide
O2
Vasodilation
CPAP
Iv furosemide
O2
HDU with inotropic support
vasopressor
> norepinephrine
Mechanical circulatory support
breathing problems with a clear chest ?
pulmonary embolism
differentials for acute breathlessness?
COPD exarcebations : wheeze and crackles
Pneumothorax : absent breath sounds
astham attack - wheeze
which murmur gets louder during inspiration
lower left sternal edge
tricuspid regurgitation
venous blood flow into right atrium and ventricle are increased
> stroke volume of right ventricle during systole
murmurs at lower left sternal edge?
Tricuspid regurgitation / mitral regurgitation
HOCM
VSD
HOCM murmur?
harsh
ejection systolic
loudest on expiration
side effect of indapamide
hypokalaemia
erectile dysfunction
dehydration
hyponatraemia
hypercalcaemia
impaired flucose tolerance
gout
antihypertensives which cause hyperkalaemia
spironolactone
ACEi
angina pectoris triad
chest discomfort
triggered by exertion
alleviated with rest
angina pectoris first line mx?
beta blocker
CCB - rate limiting one
> diltiazem / verapamil
s/e of beta blockers?
bronchospasm
cold peripheries
fatigue
sleep disturbances
erectile dysfunction
tachyarrhythmia management
if not stable
narrow complex
signs of shock
DC cardioversion
1) Midazolam large bore IV - sedate
2) pads places ; synchronised
take blood at same time
potassium
magnesium
calcium
irregular broad complex tachycardia management?
seek expert help
atrial fibrillation with bundle branch block
> ventricular pre excitation
torsades de pointes
loop diuretic
mechanism of action?
inhibition of Na-K-Cl transporter in the thick ascending limb of the loop of henle
mx post ischaemic stroke?
300mg aspirin for 2 weeks
75mg clopidogrel for life
