Cardio Flashcards
what are common narrow complex tachycardias
sinus tachycardia
AF
Atrial flutter
common broad complex tachycardia
VT
VF
what are causes of bradycardia
Sinus bradycardia
Sick sinus syndrome
AV block
- 1st degree
- 2nd degree: Mobitz type 1 or 2
- 3rd degree
what is 1st degree heartblock
prolonged PR interval
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.
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
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
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
how does acute LVF present and Ix
Presents as pulmonary oedema
- Dyspnoea, orthopnoea, pink frothy sputum
Ix = Bloods (FBC, U&E, CRP, trop) ECG (ischaemia, LVH) CXR (cardiomegaly) Echo (LVSD)
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)
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
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
what clinic BP should indicate immediate treatment
BP > 180/110
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
what is difference between unstable and stable angina
Stable angina = worse on exercise, relieved by rest
Unstable = occurs at rest, increasing frequency
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
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
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
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
