Cardio Flashcards
ECG findings PE (3)
Large S wave in lead I, a large Q wave in lead III and an inverted T wave in lead III - ‘S1Q3T3’
Right axis deviation/RBBB
Sinus tachycardia
Sacubitril (neprilysin inhibitor) MoA in heart failure
Inhibits degradation of BNP and ANP - thus promotes natriuresis and vasodilation
Stage 1 HTN
Clinic BP >140/90 and subsequent ABPM/HBPM >135/85
Stage 2 HTN
Clinic BP >160/100 and subsequent ABPM/HBPM >150/95
Stage 3 HTN
Clinic systolic >180 or diastolic >110
Indications for treating Stage 1 HTN
Target organ damage Established CVD Renal disease DM 10-year cardiac risk 10% or greater
Resistant HTN defintion
clinic BP >= 140/90 mmHg after step 3 treatment with optimal or best tolerated doses as resistant hypertension
Infective Endocarditis poor prognostic features (4)
Staph aureus
Low complements
Prosthetic valve (esp if soon after placement)
Culture negative
Mortality per IE organism - staph, bowel, strep
30%, 15%, 5%
Initial blind Rx for IE - native valve
Amoxicillin +/- gent low dose
Initial blind Rx for IE - native valve - pen allergic/MRSA/Severe sepsis
Vancomycin + low dose gent
Initial blind Rx for IE - prosthetic valve
Vanc + rifampicin + low dose gent
Native valve endocarditis caused by staphylococci
Flucloxacillin
Vanc + rifamp if pen allergic
Prosthetic valve endocarditis caused by staphylococci
Flucloxacillin + rifampicin + low-dose gentamicin
Pen allergic - vancomycin + rifampicin + low-dose gentamicin
Endocarditis caused by fully-sensitive streptococci (e.g. viridans)
Benzylpenicillin
Pen allergic - vanc + low dose gent
Endocarditis caused by less sensitive streptococci
Benpen + low dose gent
Pen allergic - Vanc + low dose gent
IE indications for Sx (5)
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
Indications for a temporary pacemaker (3)
Symptomatic/haemodynamically unstable bradycardia, not responding to atropine
Post-ANTERIOR MI - type 2 or complete heart block
Trifascicular block prior to surgery
Poor prognostic factors in HOCM (5)
Syncope Family Hx of sudden death Young age at Px Non-sustained ventricular tachycardia on 24 or 48h Holter monitoring Abnormal BP changes on exercise
Features suggesting VT rather than SVT with aberrant conduction (7)
AV dissociation Fusion or capture beats Positive QRS concordance in chest leads Marked left axis deviation Hx of IHD Lack of response to adenosine or carotid sinus massage QRS > 160ms
Cholesterol Embolisation characterisitics (4)
Eosinophilia
Purpura
Renal failure (common site of emboli)
Livedo reticularis
Aspirin antiplatelet effect MoA
Inhibits thromboxane A2 production
CLopidogrel MoA
Inhibits ADP binding to its plt receptor
Enoxaparin MoA
Activates anti-thrombin III, in turn potentiates the inhibition of coagulation factors Xa
Fondparinux MoA
Activates antithrombin III, in turn potentiates the inhibition of coagulation factors Xa§
Bivalirudin MoA
Reversible direct thrombin inhibitor
Abciximab, eptifibatide, tirofiban MoA
Glycoprotein IIb/IIIa receptor antagonists
Pulsus paradoxus - description, conditions
> 10mmHg fall in systolic BP during inspiration -> faint or absent pulse in inspiration
Severe asthma or cardiac tamponade
Slow rising/plateau condition
Aortic stenosis
Collapsing pulse
AR
Patent ductus arteriosus
Hyperkinetic - anaemia, thyrotoxicosis, fever, exercise/pregnancy
Pulsus alternans conditions
Regular allternation of the force of the arterial pulse
Severe LVF
Bisferiens pulse description, conditions
Double pulse - two systolic peaks
Mixed aortic valve disease
CHA2DS2-VaSc
Congestive heart failure HTN Age >75 (2), 65-74 (1) Diabetes Prior stroke/TIA (2) Vascular disease - inc IHD/PVD Sex (female)
HASBLED
HTN - uncontrolled (systolic >160)
Abnormal renal function (dialysis, Cr >200)
Abnormal Liver function - Cirrhosis, bili>x2 normal, AST/ALT/ALP x3 normal
Stroke
Bleeding Hx
Labile INRs - <60% of time in therapeutic range
Elderly >65
Drugs predisposing to bleeding (NSAIDs, antiplatelets) or alcohol use >8 drinks per week
ST elevation V1-4
Anteroseptal MI
LAD (proximal V1-2, distal V3-34)
ST elevation leads II, III, AvF
Inferior MI
Right coronary
ST elevation leads V4-6, I, aVL
Anterolateral
LAD or left circumflex
ST elevation I, aVL +/- V5-6
Lateral
Left circumflex
Tall R waves V1-2
Posterior MI
Usually left circumflex, also R coronary
LVEF calculation
Stroke volume/ end diastolic volume
Stroke volume calculation
end diastolic volume - end systolic volume
