cardio Flashcards
Contraindications of ACE inhibitors?
What condition is ACE inhibs good for?
- renal aa stenosis, hyperkalaemia, pregnancy, severe aortic stenosis, severe AKI
- diabetic nephropathy
Side effect of B blockers
bronchospasm, cold hands, fatigue, low blood pressure, masking hypos in DM
What ABG findings do you get in pulmonary oedema
Initially type 1 RF due to hyperventilation
Later type 2 RF due to impaired gas exchange
Causes of pulmonary oedema
Fluid overload
LVF/ valve disease/cardiomyopathy
ARDS (infection, DIC, toxins)
Hypoalbuminaemia
What is the management of acute heart failure causing pulmonary oedema
Sit the patient upright 100% O2 IV diamorphine IV furusomide 40-80mg GTN puffs or buccal
If not improving
- Nitrate IV if >100sbp
- SBP <100 cardiogenic shock and ?ICU
Causes of ARDS
Direct inhalation: smoke, drowning, aspiration
Indirect: sepsis, pancreatitis, transfusion reactions, anaphylaxis
MI in which artery corresponds to this STEMI pattern:
- I, avL, V5, V6
- V1-4
- II, III and avF
- = Circumflex
- = LAD
- = right coronary artery
Why is identifying VSD/ ASD early crucial
Once Eisenmengers syndrome in place cant do structural reversal surgery on heart.
Only treatment is heart and lung transplant
Symptoms if infective endocarditis
- Fever, new murmur
- Malaise, lethargy, anorexia
- Haematuria, splenomegaly
- Oslers nodes, Janeway, Clubbing, Splinter, digital infarcts
- Roth spots
What investigations would you do for infective endocarditis?
- FBC, U+E, CRP
- 3 cultures 3 diff types
- Urinalysis
- ECG
- CXR
- Transthoracic echo
What is DUKES criteria for endocarditis
MAJOR:
+ve cultures (2), endocardial involvement on echo
MINOR:
predisposition (valve disease, congenital defects), fever >38, vascular/immunological signs, culture/ echo not good enough for major,
Need 2 maj OR 1 minor + 3 minor
What signs are indicative of infective endocarditis on echo
- New regurgitation
- Vegetations
- Abscess
Causes of bradycardia
- b blockers
- prev MI
- OD
- medications
- endocrine e.g. hypothyroid
- hypoxia
- hypothermia
Name causes of an inverted T wave
- BBB
- MI
- PE
- raised ICP
- normal in children!!!
What are the causes of AF
- hypertension
- valvular heart disease
- CCF
- IHD
- PE
- thyrotoxicosis
- excess alcohol intake
Post MI compliations
ACUTE
- Acute HF: cardiogenic shock or pulmonary oedema
- Chorda tendon rupture > MR
- VSD > ejection systolic rupture
- Ventricle rupture
- Pericarditis
- Cardiac arrest
LONG TERM
- CCF
- Dresslers syndrome
- Arrthymias: VF/ bradycardias
- Ventricular aneurysm
What is CHADsVASC
CHF 1 point Hypertension 1 point Age >75 2 points 65-74 1 point Dm 1 point Stroke/ VTE prev 2 points Vascular disease e.g. peripheral aa or angina 1 point Sex female 1 point
what is HASBLED
Hypertension 1 Abnormal liver function 1 Abnormal renal function 1 Stroke 1 Bleeding 1 Labile INRs 1 Elderly (Age >65) 1 Drugs 1 Alcohol Alcohol use ≥ 8u / week 1
Difference between 3rd and 4th heart sounds? Name the causes
3rd after S1 - ventricles fill to fast.
- CHF, post MI, mitral regurg, VSD
4th before S1 - ventricle walls stiff.
- LVH
WHat causes torsade de pointes
how do you treat it?
Low magnesium, low potassium. common in alcoholics or malnurished
2mg Mg IV
Describe the treatment of IHD - angina
- GTN
- Lifestyle modification
- Statins
- Aspirin
- BP control if high e.g. ACE
- B blocker OR calcium channel blocker (not verapamil and b blocker)
Last line > Nicurandil or Ivabradine
Describe the treatment of heart failure
- Lifestyle
- Patient education
- ACE inhibitors + Beta blocker
- If cough switch to ARTI
If kidney failure hydralazine + nitrite
These are also second line after Ace+B’s - Last line digoxin or ivabradine
NB//
- Diuretic for symptomatic relief (thiazide if elderly or mild, loop if acute or severe) if fluid overload
- Influenza and pneumococcal vaccine
What are the three main causes of heart failure?
Name other causes
IHD, cardiomyopathy, hypertension
Other causes: valvular disease, Cor pulmonale, alcohol, anaemia, AF
Describe the pathophysiology of heart failure
- Decreased output
- RAAS stimulated
- increasing volume and pre load (good), increasing vasoconstriction and afterload (bad, increases blood pressure and cardiac work) - SNS stimulated > causes myocyte apoptosis and necrosis (desensitisation to SNS, contract less efficiently)
- ANP released by heart - antags RAAS
What makes up starlings law
Preload, afterload and myocardial contractility
Features of ARDS
- History of relevant injury
- Increasing SOB
- Cyanosis, increased resp rate, tachycardia
- Bilateral fine inspiratory crackles
What is the New York heart associated classification for heart failure
- No activity limitation
- SOB during normal activity
- SOB during minimal activity
- SOB at rest
What investigations would you do for a patient with suspected heart failure?
FBC, LFT, U+E, cardiac enzymes in acute failure BNP CXR ECG Echo (eject fract <45% diagnostic)
What are the signs + symptoms of:
- left heart failure
- right heart failure
- Symptoms: exertional SOB, paroxysmal SOB, orthopnea, cough
Signs: Bilateral course crackles, displaced apex beat, 3rd heart sound + gallop rhythm if tachycardic - S+ Signs: JVP, hepatomegaly, peripheral oedema, sacral oedema, ascites
Common to both: fatigue
Describe why the following first line medications are given in these diseases:
- CHF
- IHD
- ACE inhib, stop RAAS. B blocker, chill SNS
2. Ca channel and B blockers slow the heart rate allowing longer diastole, increasing coronary flow
Which cardiac meds shouldnt be used in heart block?
Ca channel blockers, b blockers, digoxin
What are the symptoms of digoxin toxicity
visual disturbances, nausea, anorexia, diarrhoea
What are the complications of infective endocarditis
glomerulonephritis, CCF, valvular incompetence, systemic emboli
What are the long term medications post ACS
- B blocker
- Clopidogrel one year
- Aspirin for like 75mg
- Statin
- ACE
RF mod
Isosorbide mononitrate if angina
