Cardiology Flashcards
5 causes of raised JVP
R sided heart disease
Tricuspid regurg
Complete Heart Block
CCF
Pericardial effusion
SVC Obstruction
Irregularly irregular pulse
ventricular ectopics
atrial flutter
sinus arrythmias
Austin Flint murmur
rumbling diastolic murmurs
severe AR
5th ICS MCL
mitral stenosis murmur
mid diastolic murmur
mitral regurg murmur
pan systolic murmur
cardioversion and anti-coagulation
3 weeks before
4 weeks after
or lifelong if CHADsVASc score
aspects of CHA2DSVASc score
CHF
HTN
Age > 75
DM
Stroke
Vascular disease
age 65-74
female
pulsus paradoxus
> 10mmHg fall in SBP during inspiration
varying strength of pulse with inspiration and expiration
causes: severe asthma, cardiac tamponade
pulsus alternans
regular alternation of force of arterial pulse
seen in severe LVF
Beurger’s disease
Raynaud’s syndrome
Intermittent Claudication
Finger ulceration
what is sacubitril with valsartan and indication
Entresto
improves LVF in patients already on other HF therapy
RBBB on ECG
complexes wide (>1.5 little squares) and upgoing in V1
LBBB on ECG
complexes wide (>1.5 little squares) and downgoing in V1
STEMI tx
activate primary PCI call
Aspirin 300mg and Ticagrelor (DAPT)
Morphine and Metoclopramide
Heparin
if delay in primary PCI = thrombolysis
what is normal/abnormal EF?
EF < 40-45% = abnormal
EF > 50% = normal
what post op care from MI is needed?
cardiac rehab
F/U in infarct clinic
smoking cessation
what are the 4 pillars to treating LV dysfunction?
beta blocker
ACEi
Eplerone
SCGLT-2 (start first)
what can you add if no improvement?
Sacubitril/Valsartan
what is CRT and how does it work?
special pacemaker
1 lead = R ventricle
1 lead = coronary sinus (paces L ventricle)
L and R ventricle out of sync in HF
CRT helps synchronize heart
what does patient need to have for CRT to work?
LBBB
NSTEMI treatment
- aspirin and clopi
- LMWH/Fondaparinux
- Morphine + Metaclopramide
- anti-anginal meds (GTN, beta blocker, Ca channel blockers)
after medical treatment for NSTEMI, what to consider?
- need for revascularization?
- find out LV function early on from echo
what do you need to hold 48 hours before and after angio?
LMWH
T wave inversion + chest pain?
ischaemia but not occlusionwhat
T wave inversion + chest pain?
ischaemia but not occlusion
what are the anti-anginal meds and MOA?
CCB: inc coronary blood flow, dec SVR
Beta blocker
Ivabradine: dec HR, sits on SAN, prolongs action potential
stable angina treatment
anti-platelet and statin
statin improves long term mortality
no benefit of PCI
how does nicorandil work?
anti-anginal
relaxes VSMC = inc blood flow = dec angina
no mortality benefit
diastolic HF pathology
stiff ventricles = poor filling = unable to relax
can result in AF
causes of AF
IHD
Sepsis
Electrolytes
Valvular disease
Endocrine causes
most common signs in IE
splenomegaly
microscopic haematuria
extras to add in cardio exam
BP
fundoscopy
peripheral pulses
AS heart sounds
soft S2 +/- S4
blood filling a non-compliant ventricles
AS symptoms
syncope, angina, dyspnoea
management of AS
MDT
1. RF modification = statin, anti-platelet
2. manage HTN, angina
3. Replace/valvuloplasty
AR symptoms
soft S2+/-S3
Blood filling against compliant ventricles
management of AR
reduce afterload
valve replacement (same for AS)
HF symptoms
ACEi + BB
+ spironolactone
+ SGLT2 inhibitors
Angina management
- GTN + BB or CCB
- GTN + BB + CCB
- Long acting nitrate, Ivabradine
Hypertension investigations
ABPM or home BP monitoring
Stage 1 HTN
clinic BP >140/90 mmHg AND AB BP >135/85
when do you treat stage 1?
if <80 yo and end organ damage/CVD/renal disease/diabetes, Q-risk >10%
what is stage 2 HTN?
clinic BP >160/100mmHg AND >150/95
TREAT
most common form of ECG change in pericarditis
PR depression
cardiac causes of clubbing
atrial myxoma
cyanotic HD
IE
respiratory causes of clubbing
malignancy
ILD
empyema
CF
Bronchiectasis
abdominal causes of clubbing
malignancy
coeliac
IBD
cirrhosis
HS in mitral stenosis
loud S1
HS in mitral regurg
soft S1 +/- loud S2 (if pulmonary HTN)
cause of arrhythmogenic right ventricular dysplasia
R ventricular myocardium replaced by fatty/fibrous tissue
ECG changes in right ventricular dysplasia
V1-V3 T wave inversion
epsilon wave
drug causes of long QT
macrolides
SSRIs
TCAs
Haloperidol
cause of pulsus alternans
LVF
cause of bisferiens pulse
HOCM
Unipolar/bipolar
lead
indication
Lead: RA
Indication: SA node pathology
Dual chamber
lead
indication
Lead: RA, RV
allows synchronisation
Dual site atrial pacing
lead
indication
Leads: 2 x RA (SA node, coronary sinus), RV
indication: paroxysmal AF
Biventricular pacemakers
leads
indication
leads: RA, RV LV
indication: HF
what does an ICD treat?
treats tachyarrthmia
Axis:
I and II +ve
normal axis
Axis:
I +ve
II -ve (leaving)
Left axis deviation
Axis:
I -ve
II +ve (reaching)
Right axis deviation
RVH on ECG
dominant R wave in V1
deep S wave in V6
LVH on ECG
R wave in V6 >25mm
R wave in V5/V6 + S wave in V1 >35mm
which leads do you normally see T wave invertion?
aVR and V1
What are U waves?
occur after T waves
seen in hypokalaemia
what are J waves/Osborne waves?
between QRS and ST segment
causes of J waves?
hypothermia
SAH
hyperCa
RBBB on ECG
wide QRS
RSR pattern in V1
LBBB on ECG
wide QRS
notched top of QRS
ACS non-modifiable risk factors
age
male
FH
how much ST elevation is needed?
> 1mm in limb leads
2mm in chest leads
what drug should patients receive if they are not receiving any reperfusion therapy?
fondaprinaux
how long to take clopidogrel following STEMI?
1 yeat
continue aspirin indefinitely
what long term therapy in ACS?
ACEi
BB
Cardiac rehab
Statin
DAPT
angina secondary prevention
aspirin
ACEi
Statins
Anti-HTN
+ anti-anginals
causes of systolic HF
IHD/MI
dilated cardiomyopathy
HTN
causes of diastolic HF
pericardial effusion/tamponade
restrictive cardiomyopathy
Criteria for chronic HF
Framingham Criteria
which medications cause a decrease mortality in HF
ACEi
BB
Spirolactone
HTN classifications
- clinic BP >140/90
- clinic BP >160/100
- Severe >180/110
- Malignany >180/110 + papilloedema +/- retinal haemorrhages
BP targets
<80 yrs: <140/90 (<130/80 in DM)
>80 yrs: <150/90
which murmurs are in end expiration?
MS
AR
AS
what drug to avoid in AS?
nitrates
important treatments in all heart murmurs
optimise RFs
monitor: regular FU with echo
murmur in mitral valve prolapse
mid systolic click
+/- late systolic murmur
Criteria for infective endocarditis
Duke’s
what is Kussmaul’s sign? What is it seen in?
inc JVP with inspiration
- constrive pericarditis
signs of tamponade
Beck’s triad
Pulsus paradoxus
Kussmaul’s sign
pro of mechanical valve but…
mechanical valves last longer but need anticoagulants
