Cardiology Flashcards
Side effects of ACEi
Cough
Angioedema
Hyperkalaemia
First dose hypertension
Cautions and contraindications to ACEi
Avoid in pregnancy and breastfeeding
Renovascular disease
Aortic stenosis
Concurrent high dose diuretic therapy
Poor prognostic factors for ACS
Age
Development of heart failure
Peripheral vascular disease
Reduced systolic blood pressure
Killip class
Initial serum creatinine concentration
Elevated cardiac markers
ST deviation
Causes of acute pericarditis
viral infections (Coxsackie)
tuberculosis
uraemia (causes ‘fibrinous’ pericarditis)
trauma
post-myocardial infarction, Dressler’s syndrome
connective tissue disease
hypothyroidism
malignancy
MOA of adenosine
causes transient heart block in the AV node
agonist of the A1 receptor in the atrioventricular node, which inhibits adenylyl cyclase thus reducing cAMP and causing hyperpolarization by increasing outward potassium flux
adenosine has a very short half-life of about 8-10 seconds
Adverse effects of adenosine
chest pain
bronchospasm
transient flushing
can enhance conduction down accessory pathways, resulting in increased ventricular rate (e.g. WPW syndrome)
Adverse effects of amioderone
thyroid dysfunction: both hypothyroidism and hyper-thyroidism
corneal deposits
pulmonary fibrosis/pneumonitis
liver fibrosis/hepatitis
peripheral neuropathy, myopathy
photosensitivity
‘slate-grey’ appearance
thrombophlebitis and injection site reactions
bradycardia
lengths QT interval
Monitoring for amioderone
TFT, LFT, U&E, CXR prior to treatment
TFT, LFT every 6 months
Treatment of angina
Aspirin and statin and GTN
beta blocker or CCB (verapamil or diltiazem)
Pathophysiology of aortic dissection
Tear in tunica intima
Associations with aortic dissection
Hypertension
Trauma
Bicuspid aortic valve
Marfans syndrome
Ehler Danlos syndrome
Turners and noonans syndrome
Pregnancy
Syphilis
Causes of aortic regurgitation
Rheumatic fever
Calcific valve disease
Infective endocarditis
RA/SLE
Bicuspid aortic valve
Aortic dissection
Spondylarthropathies
Hypertension
Syphilis
Features of aortic regurgitation
early diastolic murmur: intensity of the murmur is increased by the handgrip manoeuvre
collapsing pulse
wide pulse pressure
Quincke’s sign (nailbed pulsation)
De Musset’s sign (head bobbing)
mid-diastolic Austin-Flint murmur in severe AR - due to partial closure of the anterior mitral valve cusps caused by the regurgitation streams
Features of aortic stenosis
narrow pulse pressure
slow rising pulse
delayed ESM
soft/absent S2
S4
thrill
duration of murmur
left ventricular hypertrophy or failure
Causes of aortic stenosis
degenerative calcification (most common cause in older patients > 65 years)
bicuspid aortic valve (most common cause in younger patients < 65 years)
William’s syndrome (supravalvular aortic stenosis)
post-rheumatic disease
subvalvular: HOCM
