cardio deck 1 Flashcards
most common ECG change in PE is
sinus tachycardia
78 y/o female, sudden onset, severe shortness of breath. CTPA likely to show
pulmonary embolism
what murmur is heard in aortic stenosis and when is it loudest
ejection systolic murmur
louder in expiration
what murmur is heard in mitral stenosis
mid-late diastolic murmur
louder in expiration
murmur heard in pulmonary stenosis and when is it loudest?
ejection systolic
louder on inspiration
murmur louder on expiration
aortic stenosis
hypertrophic obstructive cardiomyopathy
murmur louder on inspiration
pulmonary stenosis
atrial septal defect
is tricuspid regurgitation louder on inspiration or on expiration?
- holosystolic (high-pitched, blowing)
- louder on inspiration
- during inspiration, venous bf to RA & RV increase
- increases stroke volume of RV during systole
late systolic murmur heard it
mitral valve prolapse
coarctation of aorta
describe typical presentation of Dressler’s syndrome
- tends to occur 2-6 weeks post MI
- thought to be autoimmune reaction against antigenic proteins formed as myocardium recovers
- characterised by combo of fever, pleuritic pain, pericardial effusion and raised ESR.
management of Dressler’s syndrome
NSAIDS
when may protamine sulphate be used?
- as a reversal agent in patients bleeding on
- heparin, enoxaparin or dalteparin
what is dabigatran ?
- oral anticoagulant
- works as direct thrombin inhibitor
action of statins
- inhibit action of HMG-CoA reductase
- rate limiting enzyme in hepatic cholesterol synthesis
Wolff-Parkinson White syndrome
- caused by congenital accessory conducting pathway between atria and ventricles
- leads to atrioventricular re-entry tachycardia (AVRT)
common ECG change in wolff-parkinson white syndrome?
- short PR interval
- wide QRS complexes with slurred upstroke ‘delta wave’
75 y/o female.
PC: fatigue, dysponea, anklee swelling
PMH: HT, OA, gout, T2DM
Ex: cheeks erythematous, irregular pulse, raised JVP, peripheral oedema to knees bilaterally
1st heart sound loud, added low, rumbling diastolic murmur
diagnosis, likely cause ?
mitral stenosis!
rhemautic fever most common cause of mitral stenosis
libman-sacks endocarditis
- non-bacterial endocarditis seen in association with SLE
potential biochemical side effect of ACE inhibitor
hyperkalaemia
78 y/o female
- worsening SOB over past 4 months
- LHS pain
- lightheadedness on exertion
OE
- ejection systolic murmur radiating to carotids
what findings may you also find one examination?
classic aortic stenosis
- Syncope
- Angina
- Dyspnoea on exertion
narrow pulse pressure
slow rising pulse
thrill over cardiac apex
what does Corrigan’s sign refer to?
- rapid upstroke and collapse of carotid artery pulse
- seen in aortic regurgitation
describe the three main points associated with an aortic stenosis murmur?
- Ejection sytolic murmur
- classically radiates to carotids
- decreased during the valsalva manoeuver
management for patient over 55 years of age with
- stage 2 hypertension
- QRisk > 10%
- calcium channel blocker (amlodipine)
- atorvastatin
- lifestyle advice as first line
if patient is still experiencing angina symptoms despite being on a beta blocker which has been titrated to maximum dose, what is the next step?
add on calcium channel blocker such as nifedipine.
why is verapamil not prescribed alongside a beta blocker?
due to risk of complete heart block
in a patient who is already taking a calcium channel blocker and has poorly controlled hypertension. what additional treatment can be added?
- ACE inhibitor
- angiotensin receptor blocker
- thiazide like diuretic
what is an important side effect to note of thiazide like diuretics such as indapamide?
- sexual dysfunction
- patients should be made aware
thiazides can worsen glucose tolerance
thiazides can worsen glucose tolerance
what is a recognised side effect of loop diuretics such as furosemide?
- ototoxicity
- hypotension
- hyponatraemia
- hypokalaemia
- hypomagnesaemia
- hypochloraemic alkalosis
- renal impairment
- hyperglycaemia
- gout
21 y/o student
- 1 month hx of episodic, retrosternal chest pain
- each episode lasts 30 mins
- accompanied by dizziness and SOB
- exacerbated by lying down
OE
- 12 lead ECG , ST elevation in all leads
potential diagnosis?
acute pericarditis
- chest pain (often relieved by sitting forwards)
- non-productive cough, dyspnoea, and flu like symptoms
- pericardial rub
- tachypnoea
- tachycardia
first line investigation for suspected pulmonary embolism
CTPA
does tricuspid regurgitation get louder during inspiration or expiration?
gets louder during inspiration
what drug is important to avoid in patient with long QT syndrome?
- erythromycin
which coronary artery supplies the inferior aspect of the left ventricle?
- right coronary arteries
what valvular pathology would cause a murmur that radiates to the carotids?
- aortic stenosis
What blood test is most important in a patient who is starting an ACE inhibitor?
- U&Es
- check renal function
what investigation will be most helpful in diagnosing chronic heart failure?
b-type natriuretic peptide
- released from heart ventricles in response to muscle strethc
which artery supplies the left atrium?
- circumflex artery
acute NSTEMI treatment
BATMAN
B- beta blockers A- aspirin (330mg) T- ticagrelor (180mg stat) M- morphine titrated to control pain A- anticoagulant LMWH (enoxaparin) N- nitrates
