cardiology Flashcards
inidcation for ICD
symtomatic heart failure
EF<35%
no LBBB
QRS 120-149
risk of VT is high
myxoma
murmur, low grade fever, raised ESR and AF
leads to mitral stenosis
side effect of atypical antipsychotics
olanzapine/risperidone/clozapine have been associated with hyperglycaemia and insulin resistance
HOCM
ECG: TWI, Deep q waves, AF occasionally, LVO
Angina SOB heart failure Aortic stenosis jerky pulse double apex beat mitral regurg syncope following exercise Pulsus bisferiens
MR SAM ASH
Biopsy: myofibrillar hypertrophy, defect in B mysoin
Rx: ICD, amiodraone, beta-blockers/verapamil
Brugada syndrome
STE in V1-V3, partial RBBB
mutated Na channels, mutation of SCNSA gene, AD
Rx: ICD
ASD ECG
primum: LAD and RBBB
secundum: RAD & RBBB
cocaine and mI
Avoid beta-blockers
give GTN infusion or calcium cahnnel blocker
prolonged AT and torsades managment
If any adverse features are present, synchronised DCCV is the treatment of choice. In this case, the patient is stable and may need DCCV.
The initial management of torsade with no adverse features present is:
Stop all drugs which prolong QT
Correct any electrolyte abnormalities
Give IV magnesium (2 g IV over 10 minutes)
causes: hypokalemia, amiodarone
right sided failure, ascites and pericardial calcification on x ray
third/fourth heart sound
constrictive pericarditis.
The added sound is the pericardial ‘knock’ rather than a third/fourth heart sound.
causes of restrictive cardiomyopathy
Sarcoidosis would, like amyloidosis, be expected to cause a restrictive cardiomyopathy.
VSD with eisenmengers on cardiac catheterisation
RV systolic pressures exceeding LV systolic pressures is very suggestive of Eisenmenger’s syndrome in context of a VSD.
left ventricular oxygen saturation is low, which raises the possiblity of a right to left cardiac shunt mixing desaturated RV blood with LV saturated blood (due to right ventricular pressures exceeding left ventricular pressure).
Ebsteins anomaly
Ebsteins anomaly there should be elevated RA pressure due to significant tricuspid regurgitation.
2:1 AV block
two P waves for each QRS.
The conducted PR intervals are constant.
2:1 AV block cannot be classified as Mobitz type 1 or type 2 AV block since it would not be known whether the second P wave would be conducted with the same or a prolonged PR interval.
characteristic of aortic incompetence
: there is a wide pulse pressure in the aorta accompanied by a very high left ventricular end-diastolic pressure (LVEDP); a LVEDP greater than 20 mmHg is suggestive of irreversible LV dysfunction.
target BP
People aged under 80 years: lower than 135/85 mmHg
People aged over 80 years: lower than 145/85 mmHg
ventricular pre excitation
Ventricular pre-excitation (if there were a history of tachycardia it would be Wolff-Parkinson-White syndrome) commonly masquerades as other conditions, such as bundle branch block or ischaemia.
intracranial bleed ECG changes
Intracranial haemorrhage can cause changes in the ECG which are typically deep symmetrical T-wave inversion and prolonged QT interval.
HOCM and cardiac catherisation
Left ventricular pressures are high with a steep drop-off between the LV and aortic systolic pressures are suggestive of hypertrophic cardiomyopathy. pressure in LV is normally 150 could up to 250 = LVO
investigating for heart failure, NICE guidelines
ICE guidelines recommend that patients with previous myocardial infarction who have suspected heart failure should be referred for an echocardiogram and specialist review within two weeks.
Patients who do not have a history of infarction, but who have suspected heart failure, should be risk stratified using serum natriuretic peptides, such as BNP.
Patients with raised and high BNP concentrations should be referred for echo and specialist review within six weeks and two weeks respectively.
Patients with normal BNP concentrations should be investigated for other causes of their symptoms as a normal BNP makes heart failure unlikely.
BNP is also raised in the following:
Hypertension Atrial fibrillation (AF) Aortic stenosis Diastolic dysfunction Acute coronary syndromes Cor pulmonale, and Stable angina It is therefore a marker of structural heart disease rather than specifically a marker of systolic dysfunction.
Elevated BNP is also seen in:
Acute and chronic renal failure Liver cirrhosis Hyperaldosteronism, and Cushing's syndrome. Approximately 40% of patients with raised BNP will turn out to have left ventricular systolic dysfunction (LVSD) on echocardiographic assessment.
Many of the remaining patients with elevated BNP will be shown to have other significant cardiac abnormalities such as valvular heart disease, AF, left ventricular hypertrophy (LVH) or diastolic dysfunction.
BNP rises with age and is higher in women than men. ACE inhibitors and diuretics can reduce BNP levels, so ideally BNP testing should be carried out before instigating therapy with these drugs.
investigating for heart failure, NICE guidelines
ICE guidelines recommend that patients with previous myocardial infarction who have suspected heart failure should be referred for an echocardiogram and specialist review within two weeks.
Patients who do not have a history of infarction, but who have suspected heart failure, should be risk stratified using serum natriuretic peptides, such as BNP.
Patients with raised and high BNP concentrations should be referred for echo and specialist review within six weeks and two weeks respectively.
Patients with normal BNP concentrations should be investigated for other causes of their symptoms as a normal BNP makes heart failure unlikely.
BNP is also raised in the following:
Hypertension Atrial fibrillation (AF) Aortic stenosis Diastolic dysfunction Acute coronary syndromes Cor pulmonale, and Stable angina It is therefore a marker of structural heart disease rather than specifically a marker of systolic dysfunction.
Elevated BNP is also seen in:
Acute and chronic renal failure Liver cirrhosis Hyperaldosteronism, and Cushing's syndrome. Approximately 40% of patients with raised BNP will turn out to have left ventricular systolic dysfunction (LVSD) on echocardiographic assessment.
Many of the remaining patients with elevated BNP will be shown to have other significant cardiac abnormalities such as valvular heart disease, AF, left ventricular hypertrophy (LVH) or diastolic dysfunction.
BNP rises with age and is higher in women than men. ACE inhibitors and diuretics can reduce BNP levels, so ideally BNP testing should be carried out before instigating therapy with these drugs.
ablation indication
Modern guidance recommends moving to early ablation in patients who suffer from paroxysmal AF, because it is associated with a much greater chance of success when performed earlier.
