Cardio recap Flashcards
What drug should be prescribed to every patient with clinical syndrome of heart failure?
SGLT2i
(contraindicated in T1DM)
Patient factors favouring rhythm control in AF:
Symptomatic
Age <65
1st presentation
Indications for referral in HTN (5):
- > 160/100 despite 3 drug management
- Malignant HTN (urgent)
- eGFR <30
- Age <30, could be secondary cause
- proteinuria + haematuria
You should consider early dual therapy in a lot of patients when managing their hypertension. When should you consider monotherapy in the first instance?
Age >80 / frail patients
Grade I patients who are very low risk
BP treatment targets:
<140/90 in all patients
Patients <65 target should be 130/80 if patients are tolerating treatment well
Thresholds for grade I,II,III hypertension:
I = 140-159/90-99
II = 160-179/100-109
III = >180/>110
Common complications post MI:
Death
Arrhythmia
Rupture (free wall, septum, papillary muscle)
Tamponade
Heart failure
Valve disease
Aneurysm
Dressler’s
Embolus
Recurrence, mitral regurg
VSD, LV aneurysm, LV free wall rupture and acute mitral regurg features:
VSD = heart failure Sx with pansystolic murmur - echo to differentiate from mitral regurg.
LV aneurysm = due to weakness in myocardium. Persistent st elevation post MI. Risk of thrombus in the aneurysm, so anticoagulate.
LV free wall rupture = cardiac tamponade causing acute heart failure
Mitral regurg = pansystolic murmur
When is cardioversion considered in AF?
Adverse features
Contraindications to anticoagulant therapy:
Active bleeding, hepatic disease resulting in coagulopathy.
Relative - pregnancy, bleeding risk e.g. active peptic ulcer or recent head injury in last 12 months.
Essential investigations in AF:
FBC for anaemia
TFTs for hyperthyroidism
ECG
TOE to exclude mitral stenosis
LFTs if alcohol abuse suspected
HR targets in AF:
<110 all patients
<80 is still symptomatic
Difference between the chadsvasc score and orbit score:
chadvasc is risk of stroke, orbit is risk of bleeding
What type of murmur is seen in aortic stenosis? + symptoms
Ejection systolic radiating to carotids.
Chest pain, SOB, syncope.
Narrow pulse pressure, LVH
Causes of aortic stenosis:
Degenerative calcification (>65)
Bicuspid aortic valve (<65)
HOCM (subvalvular)
Classic cause of mitral stenosis:
Rheumatic fever
Mid to late diastolic murmur heard best on expiration.
Features of mitral stenosis:
Rheumatic fever
Mid to late diastolic murmur, snap S1 due to mitral leaflets still moving
SOB and haemoptysis due to pulmonary hypertension
AF secondary to LA enlargement
What is Kussmaul’s sign and what does it indicate?
JVP increase on inspiration - can be a sign of constrictive pericarditis.
(JVP should normally fall with inspiration due to reducing pressure in the thoracic cavity)
Discuss heart rate responses in causes of orthostatic hypotension.
Anaemia and hypovolaemia: will have a increased HR response to reduced blood pressure.
POTS: an excessive HR response to reduced BP - >30 or up to >120.
Diabetes / Parkinson’s: autonomic neuropathy causes minimal or flat heart rate response.
Features of aortic regurgitation:
Early diastolic murmur (hang grip manouevre)
Nail bed pulsation = Quincke’s sign
Wide pulse pressure
Causes of AR due to valve disease (acute and chronic):
Acute = IE
Chronic = rheumatic fever, calcification, CTD and bicuspid aortic valve
Causes of AR due to aortic root disease:
Acute = aortic dissection
Chronic = bicuspid aortic valve, Ank spond, syphilis, Marfan’s, ED
Cyanotic vs non cyanotic congenital heart defects:
Cyanotic includes:
TGA
Fallot
Tricuspid atresia
Non-cyanotic:
VSD
ASD
PDA
coarctation of the aorta
Aortic valve stenosis
Types of murmurs:
MR = pansystolic
AS = Ejection systolic radiating to carotids.
MS = mid to late diastolic
AR = early diastolic.
