Primary PCI within 2 hours of presentation Thrombolysis if PCI not available MONAC acronym is not longer accurate, instead: - IV morphine (plus anti-emetic) - Oxygen ONLY if sats <95% - GTN spray - Aspirin 300mg - Ticagrelor 180mg or Clopidogrel 75mg

- IV morphine (plus anti-emetic) - GTN spray - Aspirin 300mg - Clopidogrel 300mg - Fondaparinux - Angiography +/- PCI

Cardio Flashcards by S B

what are common narrow complex tachycardias

sinus tachycardia
AF
Atrial flutter

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common broad complex tachycardia

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what are causes of bradycardia

Sinus bradycardia

Sick sinus syndrome

AV block

1st degree
2nd degree: Mobitz type 1 or 2
3rd degree

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what is 1st degree heartblock

prolonged PR interval

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what is 2nd degree - mobitz type 1 heart block

progressive prolongation of the PR interval on consecutive beats followed by a blocked P wave (i.e., a dropped QRS complex)

It usually does not cause symptoms and rarely requires treatment.

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what is 2nd degree - mobitz type 2 heart block

P wave is blocked from initiating a QRS complex like type 1 but there is no pattern

constant PR interval
p wave without a QRS

needs intervention i.e. pacemaker

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how does left sided HF present, causes and examination findings

Presentation: dyspnoea, orthopnoea, pink/frothy sputum

Causes: IHD, valvular disease, cardiomyopathy

Examination: fine bibasal crackles, pleural effusions

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how does right sided HF present, causes and examination findings

Presentation: peripheral oedema

Causes: CHD, cor pulmonale, 2ndary to LVF

Examination: raised JVP, hepatomegaly, ascites

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how does acute LVF present and Ix

Presents as pulmonary oedema
- Dyspnoea, orthopnoea, pink frothy sputum

Ix =
Bloods (FBC, U&amp;E, CRP, trop)
ECG (ischaemia, LVH)
CXR (cardiomegaly)
Echo (LVSD)

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Mx for LVF

Sit upright, give high-flow oxygen
IV furosemide (monitor BP)
GTN (if sBP >100). If sBP <100 = GET HELP.
Morphine (but get help first)

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management for chronic heart failure

First line: ACE-inhibitor and β-blocker

Second line: mineralocorticoid antagonist (spironolactone)

Add-in ARB if ACI-inhibitor intolerant

Third line: Digoxin

If fluid overloaded: Furosemide

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what is definition of HTN

Blood pressure > 140/90

Ambulatory BP monitoring can aid diagnosis

Rules out white coat hypertension
Stage 1: ABPM >135/85 -> calculate CV risk, if >20% TREAT!
Stage 2: ABPM >150/95 -> treat

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what clinic BP should indicate immediate treatment

BP > 180/110

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treatment cascade for BP

Step 1:
If under 55
- start on ACEi (A)

If over 55
- start on CCB (C)

Step 2:
A + C

Step 3:
A + C + D

Step 4:
A + C + D = consider further diuretic or alpha/beta blocker
Consider seeking expert advice

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what is difference between unstable and stable angina

Stable angina = worse on exercise, relieved by rest

Unstable = occurs at rest, increasing frequency

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Mx of angina

Aspirin and statin for all (except if contraindicated)

GTN spray

Beta-blocker/calcium channel blocker monotherapy (then combine if needed)

If resistant: isosorbide mononitrate, ivabradine, nicroandil

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what are the 3 categories of ACS

Unstable angina: ECG changes, no corresponding trop rise

NSTEMI: ECG changes (ST depression, T wave inversion), trop rise

STEMI: ST elevation, trop rise
>2mm in 2 adjacent chest leads
>1mm in 2 adjacent limb leads
New LBBB

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STEMI Tx

Primary PCI within 2 hours of presentation

Thrombolysis if PCI not available

MONAC acronym is not longer accurate, instead:

IV morphine (plus anti-emetic)
Oxygen ONLY if sats <95%
GTN spray
Aspirin 300mg
Ticagrelor 180mg or Clopidogrel 75mg

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Tx for NSTEMI

IV morphine (plus anti-emetic)
GTN spray
Aspirin 300mg
Clopidogrel 300mg
Fondaparinux
Angiography +/- PCI

side effects of ACE-i

Dry cough

[switch to ARB]

side effects of GTN spray

headaches

side effects of bisoprolol

Dizziness/postural hypotension/collapse

Stop if this occurs – the risk of harm outweighs benefit

what drugs cause Long QT syndrome

Antibiotics (Erythromycin, Clarithromycin, anti-fungals)

Antipsychotics (Haloperidol, Quetiapine, Risperidone)

Antiarrhythmics (Amiodarone)

Antidepressants (Citalopram, Amitriptyline, Clomipramime)

Antiemetics (Ondansetron, Domperidone)

Others (Methadone, antimalarials, antiretrovirals)

A 55 year-old man presents to his GP for a routine health check. He is found to have BP 160/105 in clinic. He has a strong family history of cardiac disease, and a personal history of type 2 diabetes. He is a current smoker. What is the most appropriate management?

Start lisinopril and encourage smoking cessation

Diabetic = ACE-inhibitor is first line

how is pericarditis treated

high-dose ibuprofen (or any NSAIDs)

An 80 year old inpatient in a surgical ward develops acute shortness of breath, with RR 28 and SpO2 85%. They are tachycardic and normotensive. Temperature is 38.4. They are day 2 post-op for bowel obstruction. Past medical history includes a STEMI 6 months previously, and 3 months of worsening shortness of breath on exertion at home before admission. What is the most appropriate initial management?

High-flow oxygen This could be acute pulmonary oedema, PE or chest infection. No matter which, if a patient has low sats -> give O2!

treatment for SVT

Adenosine

A 69 year-old is reviewed in the heart failure clinic. They have increasing shortness of breath on exertion, and reduced exercise tolerance. Currently they can walk 20m before having to stop to catch their breath; 6 months ago they could walk half a mile. Past medical history includes 2 previous MIs, angina, moderate LVSD (confirmed on echocardiogram 2 months ago), T2DM, and benign prostatic hyperplasia. They are on bisoprolol, ramipril and tamsulosin. What is the most appropriate next management step?

Start spironolactone After BB and ACE-inhibitor, adding MRA is the next step in chronic LVF

ST elevation in V1 - V4 - type of MI and artery affected

anteroseptal Left anterior descending

ST elevation in II, III, aVF - type of MI and artery affected

inferior Right Coronary Artery

ST elevation in V4-6, I, aVL - type of MI and artery affected

anterolateral Left anterior descending or left circumflex

ST elevation in I, aVL +/- V5-6 - type of MI and artery affected

lateral left circumflex

Tall R waves V1-2 - type of MI and artery affected

posterior left circumflex or right coronary

ECG changes - hypercalcaemia

shorted QT interval

ECG changes - hypocalcaemia

prolonged QT interval

ECG changes - hyperkalaemia

tall tented T waves loss of P waves broad QRS complexes VF

ECG changes - hypokalaemia

U waves Small or absent T waves Prolonged PR interval ST depression

drug that cause ankle oedema

CCB

drugs that causes Gout and diabetes and hyponatraemia

Thiazide diuretics

drug that cause cold peripheries

beta blocker

drug that cause fluid retention

NSAIDs

drug that causes Muscle weakness raised CK

statin

drug that causes Increased eye pigmentation

prostagladin

when can postural hypotension be diagnosed

a drop in SBP of at least 20 mmHg and/or a drop in DBP of at least 10 mmHg within 3 minutes of standing

Ix for AAA

abdo USS

Ix for aortic dissection

CT angiography