Cardio 6 Flashcards
pulmonary stenosis murmur heard best where?
second left intercostal space
radiates to shoulder
ejection systolic
Left ventricular free wall rupture
is associated with?
cardiac tamponade and acute HF due to
pericardium to rapidly fill with blood
when investigating aortic dissection
after Xray what do you look at?
if patients are unstable?
CT angiography
transoesophageal echocardiography
what type of antibiotic can cause torsades desn pointes?
macrolide
azithromycin
unstable angina is at rest
T/F?
true
Aortic Dissection
management
Ascending aorta?
IV labetolol to control BP
> theatre
> surgery
what is broad complex QRS?
how many small squares?
> 0.12 milliseconds
3 small squares
common causes of broad complex?
Stable broad complex tachycardia
is VT unless proven otherwise
Diagnosing bundle branch block
step 1
what would QRS show?
wide QRS > 3 small squares / >0.12 ms
Dx BBB
left
which leads to look at?
1) wide QRS
2) Lead V1 / V6/ lead 1
cominant negative QRS in v1
broad slurred R in V6 / lead 1
which antibiotic class reacts with statins?
what is the interaction?
macrolide such as erythromycin
increase risk of hepatotoxicity and rhabdomyolysis
pedunculated heterogeneous mass on echocardiogram
atrial myxoma
Atrial myxoma is a
benign tumour
left atrium (most likely)
atrial myxoma presents with triad of?
mitral valve obstruction, systemic embolisation + constitutional symptoms
following a TIA if a patient has Afib how to manage?
anticoagulate immediately once imaging has ruled out haemorrhage
acyanotic congenital cardiac abnormality?
vetricular septal defect - pansystolic murmur
congenital cardiac murmurs
patent ductus arteriosus
continuous machinery murmur
congenital cardiac murmur
murmur which is more prominent at beginning of systole?
ejection systolic
atrial septal defect
A murmur which is more prominent at the start of diastole
early diastolic
aortic and pulmonary regurg
A murmur more prominent towards the end of systole
coarctation of the aorta / mitral valve prolapse
coarctation of aorta?
aortic clicks
radio-femoral delay
bisferiens pulse
mixed aortic valve disease
2 distinct systolic peaks
statin monitoring
LFTs
baseline
3 months and
12 months
Streptococcus sanguinis
group of viridans group of streptococci
a-hemolytic
commensal in mouth / dental disease
ALT can be raised in statin use on LFT but what is the limit?
upto 3 times the upper limit of normal
Management for complete heartblock?
pacemaker
for pts with IHD history with a new onset AF how should antithrombotic medication be given?
they would be on a antiplatelet
but if stable say MI was 20 years ago
causes of AS
> 65
<65
degenerative calcification most common in older
bicuspid aortic valve
pt high bleeding risk
NSTEMI mx?
aspirin and clopidogrel
1st degree heart block post MI
inferior leads affected
II, III, aVF
af and anticoagulation
female, 64 and healthy?
do not offer anticoagulant <65 if no RF other than sex
symptomatic bradycardia is managed with?
IV atropine
<60bpm
Potential risk of asystole
bradycardic pt
complete heart block with broad complex QRS
recent asystole
Mobitz type II AV block
ventricular pause > 3 seconds
Mitral regurgitation
pansystolic
high pitched
blowing
pericarditis cardinal features on ECG
causes?
widespread ST elevation w PR depression
infection: viral coxsackie, TB,
inflammation : SLE/ RA
malignancy
complications post MI
pansystolic murmur
acute HF
ventricular septal defect
rupture of the interventricular septum
echo needed to confirm
corrective surgery required
complications post MI
acute onset shortness of breath, bibasal crackles, raised jugular venous pressure, muffled heart sounds
left ventricular free wall rupture
Urgent pericardiocentesis and thoracotomy
acute heart failure clinical signs
raised JVP
wheeze
bibasal crackles
displaced apex beat
S3
when should warfarin be stopped before surgery?
5 days
INR <1.5
current chest pain and abnormal ECG at a GP?
<12 hours chest pain
emergency admission to secondary care - ambulance w aspirin given
patients on warfarin having emergency surgery:
25-50 units/kg four-factor prothrombin complex
if 5-6 hours to surgery give IV vitamin K
heart failure with fluid overload
severe anaemia from a big bleed can cause this
inadequate perfusion of blood
hypothermia VF?
rewarmed to 30 degrees
then shock
Moderate-severe aortic stenosis is a contraindication to ACE-i
why?
vasodilator effect of an ACE inhibitor might lead to a reduction in the coronary perfusion pressure
cardiac ischaemia
