Cardio Flashcards
What medication do you need to give to individuals who have a prosthetic heart valve?
Lifelong anticoagulation with Warfarin
Target range = 2.5 - 3.5
What makes the S1 sound?
Tricuspid and mitral valve closure
What would you hear in aortic stenosis?
ejection systolic, high pitched murmur, crescendo decrescendo pattern
(will radiate to carotids)
- Narrow pulse pressure (pulse pressure = difference between systolic and diastolic blood pressure - narrow means low)
What is the most common cause of aortic stenosis?
- Age related calcification (> 65)
- Bicuspid aortic valve (< 65)
What would you hear in aortic regurgitation?
early diastolic, soft murmur
Collapsing pulse - carotids - blood flows right back into the heart
What would you hear in mitral stenosis?
mid-diastolic, low pitched rumbling, loud S1
What would you hear in mitral regurgitation?
pan systolic, high pitched whistling murmur
What is the most common cause of aortic regurgitation?
Age related weakness
What is the most common cause of mitral stenosis?
IE
RHD
What is the most common cause of mitral regurgitation?
Age related weakness
IE
RHD
Connective tissue disorders
What is the most common cause of infective endocarditis?
Staphyloccocus
used to be strep
What is the difference between valvular and non-valvular AF?
Valvular = mitral stenosis - assume that this has caused the AF
Non-valvular = No valve pathology / other valve pathologies
What would you see on the ECG of somebody with AF?
- Absent p waves
- Narrow QRS tachycardia
- Irregularly irregular ventricular beats (disorganised electrical activity in atria prevents regular conduction to the ventricles)
What are the ECG changes that you would see in someone with pericarditis?
- Saddle shaped ST elevation and PR depression across ALL LEADS
What is the treatment of pericarditis
- NSAIDs
- Colchicine
List 4 causes of AF
‘SMITH’
- sepsis
- mitral pathology
- ischaemic heart disease
- thyrotoxicosis
- hypertension
What scoring system is used to predict the risk of stroke of patients in AF?
CHADSVasc
Can you list the components of the CHADS2VASc scoring?
- CHF
- Hypertension
- Age >75
- Diabetes
- Stroke / TIA
- Vascular disease
- Age 65 - 74
- Sex (female)
What is the difficulty when giving anticoagulation to those with AF?
Anticoagulation = bleeding risk (HASBLED score).
However, bleeding is much easier to control, reversible, less long term concequences than having a stroke.
Useful to compare someones CHADS2VASc score to their HASBLED - often the risk of stroke outweighs that of bleeding.
What is the INR?
International Normalised Ratio
Prothrombin time of patient / prothrombin time of a normal healthy adult
Only used when a pt is on Warfarin
What is the action of Warfarin?
Vitamin K antagonist
When someone is in cardiac arrest, what are the two shockable rhythms?
- VT
- VF
When someone is in cardiac arrest, what are the two non-shockable rhythms?
- PEA
- asystole
What is WPW syndrome?
- Bundle of Kent = extra electrical pathway connecting the atrium and ventricles
What is a type 1 heart block?
- PR interval > 0.2
- Slowed conduction of impulse from atria - AV node - ventricles
What is a type 2, mobitz type 1 heart block?
- Increasing interval between p and QRS complex, and then dropped beat. Cycle starts again.
What is a type 2, mobitz type 2 heart block?
- 3 p waves to every 1 QRS complex
- Risk of asystole, needs to be treated
What is a type 3 heart block?
- No relationship between p and QRS complexes
- Risk of asystole, needs to be treated
What features can be seen on the ECG of someone with a PE?
- Sinus tachycardia
- S1Q3T3
- RBBB
What features can be seen on the ECG of someone with a PE?
- Sinus tachycardia - seen the most often
- RBBB
- S1Q3T3 (indicates R heart strain) - most diagnostic
What is the most common cause of pericarditis?
Coxsackie B
Other causes:
- Tb
- Trauma
- Post MI / Dresslers syndrome
List some causes of long QT syndrome
- Electrolyte disturbances (all LOW) - alcholics, malnutrition, D&V
- Medications - antipsychotics, antidepressants
- CNS lesions - stroke, etc
- Congenital
What beta blocker can actually exaccerbate long QT syndrome?
Solatol
What are the 4H’s and 4T’s (reversible causes) of cardiac arrest?
4 H’s:
- Hypoxia
- Hypothermia
- Hypovolaemia
- ^ Potassium, low everything else!
4 T’s:
- Tamponade
- Thrombosis
- Tension Pneumothorax
- Toxins
What is the name given to the triad of features that suggest cardiac tamponade?
Can you list the features?
Beck’s triad
- Hypotension
- Raised JVP
- Muffled heart sounds
What is the management of cardiac tamponade?
Urgent pericardiocentesis
What is the name of the criteria used for a definitive diagnosis of IE?
Duke criteria
What is Qrisk score used for?
Estimate the 10 year risk of cardiovascular disease
> 10% = statin
What is the most common cause of secondary hypertension?
Hyperaldosteroneism - treated with spironolactone