Cardiology Flashcards
Pulsus paradoxus (>10mmHg fall in SBP during inspiration) -
severe asthma, cardiac tamponade
SLow rising/ plateau pulse
Aortic stenosis
Collapsing pulse (3)
Aortic regurgitation, patent ductus arteriosus, hyperkinesis (anaemia, thrytotoxic, fever, exercise, pregnancy)
Pulsus alternans
severe LVF
Bisferiens pulse (double pulse)
Mixed aortic valve disease
jerky pulse
HOCM
BNP actions (3)
vasodilator
diuretic and natriuretic
supress sympathetic tone and RAAS
Cause of loud S2 (2)
hypertension (systemic A2, pulmonary P2)
ASD
Cause of soft S2
aortic stenosis
Cause of split S2 (5)
ASD (fixed split S2) deep inspiration RBBB pul stenosis Mitral regurg
warfarin MOA
inhibit epoxide reductase therefore preventing reduction of vit K. Acts as cofactor for clotting factor II, VII, IX, X and protein C
Causes of Endocarditis (5)
Staph aureus (most common) - IVDU
Strep viridans (eg mitis/ sanguinis) - associated poor dentition
Staph Epidermidis (coag neg) - perioperative, valve surgery, indwelling lines
Staph bovis - colorectal Ca
non infective - SLE, malignancy
Target INR
VTE
Mechanical Aortic
Mechanical Mitral
VTE - 2.5, if recurrent 3.5
Aortic 3.0
Mitral 3.5
Wold parkinson white ECG features (3)
short PR
wide QRD + slurred upstroke (delta)
left axis deviation (if right side accessory pathway)
Wolf parkinson white Mx (2)
definitive: radiofrequency ablation
Medical: sotalol (avoid in AF), amiodarone, flecainide
Angina Mx
1st aspirin + statin (all patients)
2nd B blocker/ CCB (verapamil or diltiazem) - maximise monotherapy before adding another
3rd add B block or CCB (nifedipine if dual therapy)
JVP: Prominent V Cannon A Absent A Prominent X Absent X
Prominent V - Tricuspid regurg Cannon A - complete heart block Absent A - AF Prominent X - cardiac tamponade/ constrictive pericarditis Absent X - AF
Clopidogrel MOA
P2Y12 ADP receptor antagonist, inhibiting platelet activation
HOCM Mx (5)
Amiodarone B blocker/ CCB Cardioverter defibrillator Dual chamber pacemaker Endocarditis prophylaxis
S3 heart sound
a) caused by
b) found in
diastolic filling of ventricle
normal if <30 years old
found in LVF (dilated CM), constrictive pericarditis, Mitral regurg
S4 heart sound
atrial contraction against stiff ventricle (coincide with P wave on ECG)
found in aortic stenosis, HOCM, HTN
Torsade de pointes Mx
IV Magnesium sulfate
Warfarin and emergency surgery
a) surgery in 6-8 hours - give?
b) surgery immediately - give?
a) IV Vit K 5mg
b) four factor prothombin complex
Multifocal atiral tachycardia Mx
CCB - verapamil
Major bleeding + warfarin Mx
Cease warfarin
Vit K 5mg IV
Prothrombin complex
Post Inferior MI complication (1)
Atrioventricular block (bradycardia)
HOCM gene mutation
HOCM due to a mutation in the gene encoding β-myosin heavy chain protein or myosin binding protein C
Chronic Heart Failure Mx (3)
1st: ACEi + B Blocker
2nd: Spriniolactone
3rd: Ivabradine/ Digoxin/ Sacubitril-Valsartan/ Hydralazine/ Cardiac resynchronisation
Digoxin ECG changes (4)
down-sloping ST depression (‘reverse tick’, ‘scooped out’)
flattened/inverted T waves
short QT interval
arrhythmias e.g. AV block, bradycardia
pansystolic murmur cause
inspiration
expiration
inspiration - tricuspid regurg
expiration - mitral regurg
Ejection systolic murmur causes
expiration (2)
inspiration (2)
expiration: aortic stenosis, HOCM
inspiration: ASD, pulmonary stenosis
SUpraventricular arrhythmia Mx
1st - vagal manoeuvers
2nd - IV Adenosine 6mg, 12mg, 18mg (contraindicated in asthmatics, give verapamil)
3rs - DC cardioversion
Infective endocarditis antibiotics
a) Generic
b) prosthetic valve
a) Amoxicillin + Gent
b) Vancomycin + Rifampicin + Gent
Cannon a wave
regular
irregular
a) regular - AVNRT, VT
b) irregular - complete heart block
wolf parkinson white Mx
accessory pathway ablation
Moa Heparin Clopidogrel Abciximab Dabigatran Rivaroxaban
Drug name MOA Heparin activates anti-thrombin III Clopidogrel P2Y12 inhibitor Abciximab glycoprotein IIb/IIIa inhibitor Dabigatran direct thrombin inhibitor Rivaroxaban direct factor X inhibitor
Complete heart block heart sound
Variable s1
Eisenmenger’s syndrome describes…
the reversal of a left-to-right shunt in a congenital heart defect due to pulmonary hypertension.
Reversal agents:
a) Dabigatran
b) Heparin
a) idarucizumab
b) Protamine sulphate
Congenital heart disease Most common
cyanotic: (2)
acyanotic: (1)
cyanotic: TGA most common at birth, Fallot’s most common overall
acyanotic: VSD most common cause
Amiodarone - MOA:
blocks potassium channels
Mitral stenosis definitive Mx (2)
1st: Percutaneous mitral commissurotomy
2nd (if surgery contraindicated): Transcatheter mitral valve repair
Brugada ECG changes
convex ST elevation in V1-V3 with a partial right bundle branch block
