Cardio 5 Flashcards
In african / caribbean patients when initiating second line antihypertenisve
should you start a ACEi / ARB?
ARB - losartan
biggest risk factor for aortic dissection?
HTN
bicuspid aortic valve
collagens: Marfan’s syndrome, Ehlers-Danlos syndrome
Turner’s and Noonan’s syndrome
pregnancy
what is aortic dissection?
tear in the tunica intima of the wall of the aorta
INR 5.0-8.0 (no bleeding)
withhold warfarin 2 doses maybe
INR >8 and not bleeding
oral vitamin K
stop warfarin
holosystolic murmur
no change with inspiration
high pitched and blowing in character?
mitral regurgitatiopn
Beta-blockers should only be stopped in acute heart failure?
HR <50
2/3 degree heart block
shock
All patients with suspected chronic heart failure should have
NT-proBNP test
what are the indications for emergency valve surgery in infective endocarditis?
severe valvular incompetence
aortic abscess (often indicated by a lengthening PR interval)
infections resistant to antibiotics/fungal infections
cardiac failure refractory to standard medical treatment
recurrent emboli after antibiotic therapy
why does MI cause acute mitral valve regurgitation?
rupture of the tendinous cords that usually hold the valve in place
subclavian steel syndrome
posterior circulation symptoms
dizziness and vertigo
percutaneous transluminal angioplasty / stent
reversal agent for dabigtran?
Idarucizumab
reversible of apixaban / rivaroxaban
andexanet alfa
Phytomenadione
vitamin K
> warfrain
HOCM
louder on valsalva
quieter on?
squatting
preload increases
increased amount of blood within the ventricles reducing the proximity of the mitral valve
prosthetic heart valves antithrombotic therapy?
bi prosthetic
aspirin
> reduces platelet aggregation
>adequate protection against thromboembolism
mechanical heart valve antithrombotic?
warfarin and aspirin
Target INR
aortic:
mitral:
aortic: 3.0
mitral: 3.5
what leads categorise a posterior MI?
leads V1-V3
V2- dominant R wave
> st segment depression
inferolateral MI?
leads II
III
aVF
persistent ST elevation following an MI with no chest pain?
left ventricular aneurysm
ventricular septal defect post MI
acute heart failure associated with a pan-systolic murmur
Pulseless ventricular tachycardia
high rate of electrical activity, leading to the heart being an ineffective pump, and not being able to support circulation
wide complex tachycardia
difference between myoglobin and CK-MB as MI markers?
myoglobin first to rise but
CK -MB more accurate
Prosthetic heart valves
how to decide which type of valve to give
> aortic stenosis?
mechanical in younger patients
as they last longer
biprosthetic in older pts
no postural drop
what is postural drop?
symptomatic fall of >20
diastolic drop of >10
or fall to <90
how many sets of blood cultures recommened in infective endo?
3 sets
patient treated with PCI post procedure complaining of intense pain
haemodynamic instability
urgent CABG
suggests PCI was ineffective
conservative management of an nstemi
aspirin and
Ticragrelor if low bleeding risk
Clopidogrel if high bleeding risk
In ALS if drugs cannot be given IV how to give?
intraosseous route (IO)
proximal tibia
However, aldosterone antagonists, ACE inhibitors, angiotensin-II receptor antagonists, beta-blockers and diuretics can all falsely lower ____
BNP
HF
Dobutamine
ionotropic agent
severe left ventricular dysfunction
when starting medication for reduced ejection fraction HF
how to initiate the meds?
start ACEi / beta blocker
but one at a time
Jones criteria
rheumatic fever post strep
people who have had PCI should be given what antiplatelets?
DAPT
aspirin
> prasugrel
ticragrelor
clopidogrel
SVT
if adminstering adenosine ?
6mg
12mg
18mg
then consider DC cardiovert
what is first line anti statin?
atorvastatin
> simvastatin
which antihypertensives are assocuated with ototoxicity?
loop diuretics
