Cardio Flashcards
Hypertrophic obstructive cardiomyopathy symptoms and echo + gene
Sudden cardiac death in athletes
Beta myosin heavy chain mutation
Mitral regurg, systolic anterior motion of mitral valve and asymetric septal hypertrophy
Arrythmogenic RV dysplasia pathogenesis, ECG
RV myocardium replaced by fatty and fibrous tissue
V1-3 abnormalities (t wave inversion) and epsilon wave (notch in QRS)
Causes of dilated cardiomyopathy
Alcohol
Coxswckie B virus
Wet beri beri
Docorubicin
Causes of restrictive cardiomyopathy
Amyloidosid
Post RT
Loefflers endocarditis
Peripartum cardiomyopathy
Between final month of pregnancy and 5 months post
Older women multiparous multigravid
Takotsubo cardiomyopathy
Stress induced
Secondary cardiomyopathies (types)
Infective (coxsackie B, Chagas) Infiltrative (amyloidosis) Storage (haemochromatosis) Toxic (doxorubicin, alcoholic) Inflamm (sarcoid granulomas) Endocrine (DM, thyrotoxicosis, acromegaly) NM (Friedrichs, DMD, myotonic dystrophy) Nutrition (beri beri = thiamine) AI (SLE)
Reversible causes of cardiac arrest
Hypoxia Hypovolaemia Hypothermia Hypo- kal/ glycaemia/ calc Hyperkalaemia
Toxin
Thrombus
Tension PT
Tamponade
Types of calcium antagonist and what to use/not use with them
Dihydropyridines (nicedipine amlodopine). Peripheral vasodilators. Use with beta blocker as they cause reflex tachy. Treat HT and angina.
Non digydropyridines
Verapamil diltiazam. Slow conduction through AV and SA. DO NOT USE BB risk of Brady.
Hypetkalaenia
Tall tended T
Flat P
Tachy
Sinusoidal
NSTEMI
RMANCE / ticag 180mg
Look atT wave inversion (where is it) ie lateral circumflex
Inferior RCA
Anterior LAD
Angiography
Secondary PCI
Ccx of septal anterior infarct
Papillary rupture
Mitral regurgitation
Score for Nstemi
GRACE score
2ary cardiac prevention
dapt
Statin
Losartan
AT2 block
Brady andST depress
Posterior stemj/ STEMI
Septal ischaemia
When to not give GTN
Low BP
Posterior
RCA
Branches of L circumflex
PE ecg
Tachycardia Right axis RBBB T wave inversion S wave in lead 1 Deep Q S1Q3T3
Broad QRS
> 120ms or 3 small
S1Q3T3
Cor pulmonale
Provoked PE prevention post
Disc
ThromboLYs PE
Haemodtnamically unstable
New LBBB and chest pain
Treat for STEMI
Check old ECGs
NSTEMI
Raised trop with chest pain
Not another reason ie CKD chronic hypertensive
Scarbossa criteria
For LBBB
Left main stem partial block
Global ST and AVR
CT angio before intervention
Unfit
Ix before CABG
Cxr Ecg Echo (EF >55 normal) Bloods Angiogram for stenosis
CABG vs stent
cabg if multiple vessels triple vessel
Already stented (diabetics get stent failure)
>50% stenosis of left main steno = critical main stem disease
LV failure
CP bypass
Heparinise
1 venous (SVC/RA) 1 arterial (aortic arch)
Oxygenate warm filter cool blood
Reverse heparin with protamine
Cardioplegia
Stop heart
K+ rich crystaloid
Arrest and prevent ischaemia
CABG scar
Saphenous graft and midline sternotomy
L Internal mammary
Internal thoracic
Post op CCX CABG
Infection. (Wound) Bleed Poor cardiac function Stroke Mortality 2-3%
Hook to telemetry for AF / VT / tachy
Cautious for fluid so inotropic support ie dobutamine and NA
Triad for Aortic stenosis
Chest pain
Syncope
Breathless
Aortic stenosis findings
Brady
Pulse changes eg slow rising
Ejection systolic to carotid
Echo showing trileaflet calcified valve stenosis.
Classify aortic stenosis
Area
Gradient
Velocity
Causes of valve disease
Bicuspid/unileaflet aortic Calcified Infective (rheumatic/BE) Connective tissue Ischaemia Degenerative
Indication for aortic valve replacement
Severe Symptomatic / reduced exercise tolerance
EF <50%
Replacement of aortic valve choice
TAVI- life expectancy over a year
OPen - fit
Lifelong anticoag
Metal vs tissue valve
Metal vs tissue
Mechanical with warfarin as INR needs to be higher as higher risk of vegetation’s. Hear it. Lifelong?
Tissue 10-15y, degeneration, risk of reop. No lifelong anti coagulation (ie could get pregnant).
Pan systolic murmur
Mitral regurgitation
Indication for mitral valve
Severity of MR
Symptoms
Repair vs replacement mitral valve
Repair- reduce systolic dysfunction. Annuloplasty.
Common valves needing replacement
Mitral and aortic ie left heart
Symptoms of constructive pericarditis
Dyspnoea JVP that doesn’t fall on inspiration = Kussmalls sign Peripheral oedema Pericardial knock (S3) RH failure (JVP ascites oedema hepatomeg)
CXR- pericardial calcification
Common valve defect following rheumatic disease
Mitral stenosis heard as diastolic murmur with opening snap and low pitch rumble
ECG changes in trifascicular block
RBBB
Left anterior or posterior HEMi block + first degree heart block
ECG in wpw
Short PR
Delta wave
QRS prolongation
