Cardiology Flashcards
Blood pressure causes for elevations (8)
- Non compliance
- Whitecoat
- Recent weight gain
- drugs (methamphetamines)
- Renal failure
- Anxiety
- Wrong cuff size
- Smoking
- OSA
- Sedentary lifestyle
HOCM major symptom
Exertional Dyspnoea
ECG findings in HOCM
High voltage QRS
ST changes and T wave repolarisation abnormalities
May be hard to distinguish from athletic young person
HOCM ECHO findings (and what they are assessing for)
- LV thickness >11mm raises concern
Looking for
- LV function
- LVOT
- Pattern and degree of LVH
- Presence and degree of mitral regurg
Investigations for HOCM
- ECHO
- Stress ECHO (looking for exercise induced LVOT)
- ECG
- 24 hour holter monitor
- Cardiac MRI
Investigations for HOCM
- ECHO
- Stress ECHO (looking for exercise induced LVOT)
- ECG
- 24 hour holter monitor
- Cardiac MRI
Diagnosis of CCF
Transthoracic ECHO
BNP
CCF management (general)
- ACEi low dose (perindo 2.5-5mg)
- Spironolactone (25mg)
- Frusemide (up to 40mg)
- Cardio-selective beta blocker (bisoprolol 1.25mg) (NOT in decompensated HF)
- Low salt diet (<5g)
- Fluid restrict 1-1.5L
- Daily weights
- Review 48 hours
- Cardiac rehab
How much exercise per week
150-300 mintues moderate intensity/week
Angina episodic treatment
GTN spray 400mcg
Repeat every 5 min up to 3 doses
(note: if pain persists >10mins despite 2 doses –> ED)
Pharmacological management to prevent angina (broad categories)
USE TWO FROM DIFFERENT CLASSES
-Beta blocker (Metoprolol tartrate)
-Long acting nitrate (GTN 14 hour patch)
-Nondihydropyridine CCB (Diltiazem, verapamil)
-Dihydropyridine CCB (Amlodipine, nifedipine)
Pharmacological management to prevent angina: Betablocker dose.
Beta blocker:
Metoprolol tartrate 25mg BD (max 100mg BD)
(HFREF: use bisoprolol or metoprolol succinate)
Pharmacological management to prevent angina: Non-dihydropyridine calcium channel blocker
Diltiazem MR 180mg daily (up to 360mg)
OR
Verapamil MR 120mg daily ( up to 480mg)
Cautions with nondihydropyridine calcium channel blocker
Do not use with beta blocker (severe bradycardia and HF)
Avoid with ejection fraction <40 %
Do not use with dihydropyridine CCB (amlodipine or nifedipine)
Pharmacological management to prevent angina: Dihydropyridine calcium channel blocker
Amlodipine 2.5mg (up to 10mg)
Nifedipine MR 30mg (up to 60mg)
Pharmacological management to prevent angina: Long acting nitrate
Glyceryl trinitrate 5mg patch (14 hours/day)
max dose 15mg
Pharmacological management to prevent angina - refractory angina
Nicorandil 5mg BD
Max dose 20mg BD
History for HOCM
- Exertional dyspnoea
- non- exertional dyspnoea
- Chest pain
- palpitations
- Presyncope
Rule out differentials
- Wheeze
- Cough or coryzal symptoms
- Fever
- VTE: immobilisation, calf pain
HOCM management following diagnosis
- URGENT referral to cardiologist
- Stop competitive sport (high intensity) until cardiology review
- Any chest pain, presyncope to attend ED
- Family will need testing
Metabolic syndrome diagnostic criteria
- Waist circumference >88
(>80 for asian, african, mediterranean) - Triglycerides >1.7
- HDL-C <1
(1.3 in women) - HTN: >130 or >85
- Fasting glucose >5.5
Most common cause of Mitral Stenosis
Rheumatic heart disease
Clinical features of MITRAL STENOSIS (general and murmur findings)
- Mitral Facies: flushed cheeks
- Crackles due to pulmonary oedema
- Advanced: RHF
Murmur:
- Opening snap
- Low pitched diastolic rumble
- At APEX
- Best heard with bell with patient lying on left side (held expiration)