Cardiology Flashcards
Classical presentation of aortic stensosis
SAD
syncope (on exertion commonly)
Angina
Dyspnoea
ECG signs of aortic stenosis
LVH
P-Mitrale
AV block
Poor r wave progression
Signs of aortic stenosis
Ejection systolic murmur
Slow rising pulse - delayed through stiff ventricle
Narrow pulse pressure - reduced gap between systole/diastolic
Non-displaced but sustained/heaving apex
Aortic thrill
What constitutes severe aortic stenosis?
<1cm valve opening and symptoms
Valve gradient >40mmHg
Causes of aortic regurgitation
Congenital - bocuspid valve Aortic root dilatation- Marian's, ehlers Inflammatory- SLE, RA, rheumatic heart disease Infective endocarditis Aortic dissection
Signs and symptoms aortic regurg
LVF symptoms, dyspnoea, orthopnoea
Signs - early diastolic murmur
Collapsing pulse - rapid increase then collapse
Wide pulse pressure
Symptoms of AF
Palpitations
SOB
Angina (rate associated ischaemia)
Syncope
Symptoms of complications - HF and stroke
ECG findings of AF
Irregularly irregular R waves
Absent P waves
HR > 100 = FAST AF
Management of AF
Rate control - B-blocker or rate limiting calcium channel blocker. Consider dioxin if sedentary
Rhythm control - for acute new-onset <48 hours
- electrical cardioversion ideally - anticoagulation before (heparin). If elective, anticoag for 3 weeks prior
Pharm. Electrocardioversion - flecainide if no structural damage, otherwise amiodarone
Anticogaulte (assess chadsvasc and hasbled) - DOACs ideally
Ecg findings of broad complex tachycardia
Usually 150-250 bpm
QRS > 120ms
Can be monomorphic or polymorphic
Torsades de pointes is a complication of what and how is it treated?
Long QT syndrome
Manage with IV magnesium sulphate
Management of VT
ABCDE
Cardiac arrest = arrest protocol
Pulseless VT and VF - non-synchronised DC cardiovert
Is a pulse:
Synchronised DC cardiovert - up to 3 if unstable
Followed by 300 mg IV amiodarone over 20 mins
Another shock
Followed by 900 mg over 24 hr
If stable - straight to amiodarone, correct electrolyte abnormalities
Example of suoraventricular tachycardias
Sinus tachycardia Atrial tachycardia WPW Avrt AVNRT
Typical SVT ECG
HR > 100 bpm
Narrow QRS
Weird P wave morphology (different depending on type of SVT)
Management of SVF
Slow AV node via - vagal maneuvers (valsalva or carotid sinus massage)
IV drugs - 1st line - adenosine, verapamil 2nd line, 3rd line - b blocker
Synchronised DC if haempdynamically unstable
Prevention- teach valsalva
If no-pre-extiement - verapamil
If pre excitement (WPW) - flecainide (if no structural damage, if so then admiodarone)
ECG signs of WPW
Delta wave
Short PR
Broad QRS (if with delta wave)
Management of WPW
Svt treatment
Control rate - b blocker
Accessory pathway ablation
First line medications for hypertension
<55 or T2DM - ACEi
>55 or afro-carribean - calcium channel blocker
Commonest type of cardiomyopathy
Dilated cardiomyopathy
Inheritance pattern for HCM
Autosomal dominant (50%)
Signs and symptoms of HCM
SOB Angina Syncope Palpitations Asymptomatic Sudden cardiac death
ECG findings of HCM
Deep and narrow (dagger) Q waves
AF common complication
Non-specific ST segment and T wave abnormalities
Causes of bradycardia
Sick sinus syndrome Drugs- b-blocker, digoxin, amiodarone Cushing's response - to raised ICP Drugs to CNS - opioids Metabolic - hyperkalaemia, hypothermia, hypothyroidism Anorexia High level of fitness, pain
What is sick sinus syndrome, its causes
Basically sinus node dysfunction Usually caused by sinus node fibrosis Usually idiopathic But can be secondary to cardiomyopathy, sarcoidosis, infiltrative disease (amyloidosis, sarcoidosis) Drugs - b-blockers, digoxin
Management of severe bradycardia
ABCDE
Do ecg, correct electrolyte abnormalities or administer antidotes causing
IF ADVERSE SIGNS - ATROPINE 500mcg IV (unless transplanted hear. If unresponsive, can repeat every 3-5 mins
Consider - transcutaneous pacing, adrenaline
If a risk of asystole (recent asystole, AVN block mobitz 2 of complete heart block with broad QRS) - then will need specialist and possible transcutaneous pacing regardless of response to atropine or adverse signs
What is 1st degree av block
Prolonged PR interval (>0.2s)
Treatment for 1st degree heart block
No treatment needed
What is the normal PR interval?
0.2 secs
What is 2nd degree heart block?
Intermittent conduction of P waves to the ventricles
What is Mobitz type 1 heart block
Progressive PR prolongation until a QRS drops (there isn’t one)
What is mobitz type 2 heart block?
No progressive PR prolongation but intermittent failure to transmit to the ventricles (high risk of becoming 3rd degree)
What is 3rd degree heart block and its management?
No association of P waves and QRS (no transmission of P waves to the ventricles with ventricular escape rhythm taking over)
Needs pacemaker
Causes of acute pericarditis
Usually idiopathic or viral
Bacteria - TB
Fungi
Acute MI or post-MI (dresslers syndrome)
Drugs
Autoimmune (SLE, RA, sarcoidosis)
Other - uraemia, chest trauma, hypothyroidism, cancer
Signs and symptoms of pericarditis
Chest pain - worse on lying down and inspiration, relieved by sitting forward
Pericardial friction rub
Fever
ECG findings of pericarditis
Widespread saddle shaped ST elevation
Management of acute pericarditis
NSAIDs
Analgesia
Oxygen if hypoxic
Add colchicine if viral or idiopathic - continue for 3 months as prevents recurrence
What is cardiac tamponade and its signs and symptoms
Fluid in the pericardial sac that increases the pressure so much it prevents ventricular filling, reducing cardiac output
Beck’s triad - decreased BP, reduced heart sounds, raised JVP
Increased HR
Pulses paradoxes
What is pulses paradoxus and what is it a sign of?
Reduced BP with inspiration
Sign of cardiac tamponade
Causes of cardiac tamponade
Trauma
Aortix dissection
Medical procedure - carherisation, heart surgery
Pericardial effusion causes - cancer, infection
Management of cardiac tamponade
Urgent pericardiocentesis
What medication should never be given in VT?
Verapamil
ECG findings of hypokalaemia
U waves Prolonged PR Small or absent T waves ST depression Long QT
ECG signs of hyperkalaemia
Peaked or tall T waves
Loss of P waves
Broad QRS
Ventricular fibrillation
What are the stockade rhythms?
Pulseless VT
VF
What are U waves
Small deflection immediately following T wave
Sign of hypokalaemia
Inheritance pattern of long QT syndrome
Autosomal dominant
Causes of long QT syndrome
Congenital Drugs - amiodarone Tricyclic antidepressants Erythromycin Electrolytes - htpokalaemia, hypomagnesia Myocarditis Acute MI
Presentation of long QT
Syncope
Palpitations
SCD
Triggers - stress, exercise
Management of long QT
Avoid triggers including drugs
B-blocker
ICD
Aortic stenosis murmur
Ejection systolic
Narrow, tough valve - harder to get blood out during ventricular systole
Mitral regurgitation mumur
Pansystolic murmur
Backflow of blood into the atria during ventricular systole
Therefore occurs throught systole
Aortic regurg murmur
Early diastolic murmur
When ventricles relax during diastole, aortic valves are shut but leaky so blood flows back into the atria during diastole
Mitral stenosis murmur
Low-pitched, mid-diastolic murmur
Blood flowing through mitral valve during diastole into the ventricles but is tough because of stenosis (later in diastole due to increased filling as atria contract)
Pulmonary stenosis murmur
Ejection systolic
Tricuspid regurgitation murmur
Pansystolic murmur
Return of blood when ventricles contract
Tricuspid stenosis murmur
Mid diastolic murmur
Important differentials of broad complex tachy
VT
SVT with altered conduction to ventricles (BBB or WPW)
E.g. Aflutter with BBB
Drug treatments in chronic heart failure
ACEi / ARB If not tolerated - hydralazone and nitrates B-blocker Entresto Mineralocorticoid receptor antagonists
Diuretics- for symptomatic relief
Other - Digoxin
Entresto (never put ACEi with this as has ARB in)
Ivabradine
Dapagliflozin
