Cardio Flashcards
Pericarditis s/s? (5)
Fever, pleuritic chest pain relived by sitting up and leaning forward, cough, tachyopnoea, PERICARDIAL RUB
Ax pericarditis? (4)
Viral (coxsackie), TB, trauma, dresslers (post-MI)
ECG pericarditis?
Saddle-shaped ST elevation, PR depression
Ax endocarditis?
Strep viridans, HACEK, staph aureus
s/s endocarditis?
FROM JANE
Fever, roth spots, Osler’s nodes, murmur, janeway lesions, anaemia, nails (splinter haemorrhages), emboli
Dx endocarditis?
Blood culture, anaemia, CXR, ECHO, urinalysis for microscopic haematuria
Tx endocarditis?
- Native valves: amoxicillin + gentamicin
- Prosthetic valves: vancomycin, gentamicin + rifampacin
- IV drug: fluclox
- Staph aureus: fluclox
- MRSA: vancmycin, gentamicin + rifampacin
- Viridans strep: benzylpenicillin + gentamicin
- enterococcus: vancomycin + gentamicin
- staph epidermidis: vancomycin, gentamicin + rifampacin
S/s myocarditis? (4)
Fever, chest pains, SOB, palpitations
Ax myocarditis? (7)
Lymes, cocksakie, chaga’s disease, HIV, rheumatic fever, eosinophillic, SLE
Ax arhythmias? (5)
LVH, accessory pathway, drugs, inflammation, genetic
Dx arrhythmias?
ECG, electrophysiological study
Tx bradycardia?
- If asymptomatic and >40 bpm, no Tx required
* If <40 bpm or asymptomatic, IV atropine (if no response to atropine - temporary pacing wire)
SVT ECG?
Narrow complex tachy (QRS <0.12)
Tx SVT?
Vagotonic manouvres, IV adenosine/verapamil, DC shock
- Maintenance: BB/verapamil (NEVER together!!), radiofrequency ablation
ECG AF?
Irregularly irregular pulse, absent P waves, F waves
Ax AF?
Ectopic foci in pulmonary VEINS
Tx AF?
- Acute: emergency cardioversion, if unavailible = amiodarone + verapamil/bisoprolol
- Chronic: BB/CCB, if fails add amiodarone
ANTICOAGULATION if high risk of thomboembolism CHA2DS2-VAS
Maintenance of AF?
Catheter ablation of pulmonary vein focus
s/s AF? (6)
Palpitations, syncope, chest pain, breathlessness, fatigue, sweating
ECG VT?
Broad complex tachy
Tx VT?
Amiodarone/lidocaine, ICD, catheter ablation
Wolf Parkinson White syndrome?
Congenital accessory conduction pathway between atria and ventricles
ECG = delta waves
Tx WPW?
Ablation of accessory pathways
1st degree heart block? Tx?
PR interval longer than normal (>0.2)
Tx = none
2nd degree heart block? Tx?
- Mobitz 1 - progressive lengthening of PR interval eventually resulting in dropped beat
- Mobitz 2 - usually 2:1 or 3:1
- Tx = pacemaker
3rd degree heart block? Tx?
Heart stops (asystole) or enters escape rhythm
Tx ventricular fib?
Defib + CPR
Tx Long QT syndrome?
B-blockers (NOT SOTALOL)
Tx brugada syndrome?
ICD
ECG brugada syndrome?
ST elevation and RBBB
Drugs to avoid with brugada syndrome?
Analgesics, anti-arrhythmic drugs, psychotropics, anathetics
Collapsing pulse?
Aortic regurgitation
Radiofemoral delay?
Coarctation of aorta
s/s mitral stenosis?
Tapping apex, loud S1, rumbling mid-diastolic, malar flush
Aortic stenosis s/s?
Soft S2, ejection systolic (radiates), slow-rising pulse, heave
s/s aortic regurg?
Displaced apex, early diastolic, collapsing pulse
s/s mitral regurg?
Displaced apex, soft S1, pansystolic murmur (radiates to axilla)
Tricuspid regurg s/s?
JVP ‘v’ waves
Parasternal heave?
Cor pulmonale/pulmonary hypertension
JVP rising on inspiration?
Cardiac tamponade, constrictive pericarditis
Blurred yellowing vision + headache?
Digoxin toxicity
Tall tented T waves, prominent U waves?
Hyperkalaemia
Flattened T waves, prominent U waves?
Hypokalaemia
ST depression?
Myocardial ischaemia
ST elevation?
Acute MI
Saddle shaped ST elevation?
Constrictive pericarditis
S I, Q III, T III pattern?
PE
Dx AF?
ECG - absent P waves, irregular R-R intervals
Tx AF?
- Restore rate:BB, Ca+ antagonist, digoxin, amiodarone
- Restore rhythm: BB, cardioversion, amiodarone
- Anticoagulant: warfarin, apixiban, dabigatran, rivaroxiban
Tx MI?
Acute = MONAAB
Morphine, oxygen, nitrates, anti-platelet, antiemetic, BB, aspirin
Tx = PCI within 90 mins
s/s heart failure?
RHF - ankle oedema
LHF - pleural effusion, paroxysmal nocturnal dyspnea
Tx heart failure?
ACE/ARB, BBs, digoxin, furosemide, spironolactone
Ix heart failure?
Bloods, CXR (oedema), ECHO, ECG
Aneurysm?
Dilation of vessel by more than 50% its normal diameter
True aneurysm vs false aneurysm?
True: vessel wall is intact
False: breach in vessel wall
Ax AAA?
smoking, hypertension, diabetes
s/s AAA?
Pain can mimic renal colic
AAA rupture? (3)
- sudden onset epigastric pain
- Can radiate to back
- Collapse
Ix AAA?
- Duplex US
* CT angiogram - ONLY imaging that can identify ruptured AAA
Tx rupture AAA?
Open repair/EVAR
s/s acute limb ischaemia?
6 P’s
Pain, pallor, pulseless, perishingly cold, paraesthesia, paralysis
Tx diabetic foot sepsis?
SURGERY, wide spectrum antibiotics
(wound left open to encourage drainage)
- If patient very ill, GUILLOTINE PROCEDURE
Abdominal retroperitoneal structures?
SADPUCKER
- Suprarenal glands, aorta/IVC, duodenum (except 1st part), pancreas (not tail), ureters, colon (ascending + descending), kidneys, esophagus, rectum
Shockable rhythms?
Tx?
VF, pulseless VT
- 1 shock then continue CPR for 2 mins, shock again if necessary
- After 3rd shock, IV adrenaline and IV amiodarone 300 mg
Non-shockable rhythms?
Tx?
Pulseless electrical activity, asystole
* adrenaline 1mg IV immediately then every 2 CPR cycles