Cardiology Flashcards
What is acute left ventricular failure?
Acute left ventricular failure occurs when the left ventricle of the heart is unable to move blood efficiently through the left side of the heart and into the systemic circulation due to an acute event.
What is cardiac output?
Stroke volume x heart rate
What is pulmonary oedema?
Pulmonary oedema is where the lung tissue and alveoli are filled with interstitial fluid, which interferes with normal gas exchange in the lungs and causes shortness of breath and reduced oxygen saturation.
What are common triggers of acute left ventricular heart failure?
Acute left ventricular failure is often the result of decompensated chronic heart failure, but other triggers can include myocardial infarction, arrhythmias, sepsis, and hypertensive emergency.
Over-prescribing fluids.
What are some symptoms of acute LVF?
Symptoms of acute LVF include shortness of breath, feeling unwell, and cough with frothy white or pink sputum.
Signs specific to right sided heart failure:
- Raised jugular venous pressure (JVP), caused by a backlog on the right side of the heart, leading to an engorged internal jugular vein in the neck
- Peripheral oedema of the ankles, legs and sacrum
Investigations and assessment for someone with acute LVF?
- A to E
- ECG for ischaemia and arrhythmias
- Bloods for anaemia, infection, kidney function, BNP, and consider troponin if suspecting myocardial infarction
- ABG
- Chest x-ray
- Echocardiogram
What are the chest x-ray findings in someone with acute LVF?
Cardiomegaly on a chest x-ray is classified as a cardiothoracic ratio of more than 0.5. Upper lobe venous diversion may also be seen. Fluid leaking from oedematous lung tissue causes additional x-ray findings of bilateral pleural effusions, fluid in interlobar fissures (between the lung lobes), and fluid in the septal lines (Kerley lines).
Mnemonic for treating acute LVF?
SODIUM
- S–Sit-up
- O–Oxygen
- D–Diuretics
- I–Intravenous fluids should be stopped
- U–Underlying causes need to be identified and treated (e.g., myocardial infarction)
- M–Monitor fluid balance
NSTEMI management: patients with a GRACE score > 3% should be managed how?
Coronary angiography within 72 hours of admission.
Ejection systolic murmur, louder on performing Valsalva and quieter on squatting
HOCM
Treatment of a VT accompanied by chest pain?
Synchronised DC cardioversion
Patients with tachycardia and signs of shock, syncope, myocardial ischaemia or heart failure should receive up to 3 synchronised DC shocks.
HYPOkalaemia causes what ECG change?
U waves
Long Q
What is a U wave?
The U-wave on electrocardiogram (ECG) is a small deflection FOLLOWING the T-wave
Broad complex tachycardia with a systolic BP <90
- treatment?
DC cardioversion
If a patient with a tachyarrhythmia has adverse features (shock, syncope, myocardial ischaemia or heart failure), they require DC cardioversion to terminate the arrhythmia.
Tall R waves V1-2 in a patient with chest pain on ECG.
Where is the MI?
Posterior MI
ST elevation in II, III, AVF on ECG
Inferior STEMI, due to obstructed right coronary artery.
Patient with AF has a stroke anticoagulate with…?
Warfarin or direct thrombin
Wide pulse pressure and nail bed pulsation (Quinckes sign)
Aortic regurge
Aortic regurge presents with what symptoms?
Can present with symptoms including dyspnoea, orthopnoea, and paroxysmal nocturnal dyspnoea.
When to cardiovert new onset AF?
New onset AF is considered for electrical cardioversion if it presents within 48 hours of presentation
Poorly controlled hypertension, already taking an ACE inhibitor, calcium channel blocker and a standard-dose thiazide diuretic. K+ > 4.5mmol/l - add what?
Alpha or beta blocker
Complete heart block following a MI? - Which coronary artery is affected?
Complete heart block following a MI = right coronary artery lesion
ECG changes for thrombolysis or percutaneous intervention:
ST elevation of > 2mm (2 small squares) in 2 or more consecutive anterior leads (V1-V6) OR
ST elevation of greater than 1mm (1 small square) in greater than 2 consecutive inferior leads (II, III, avF, avL) OR
Persistent ST elevation following recent MI, no chest pain = ?
Left ventricular aneurysm.
STEMI management if PCI is not available within 120mins?
STEMI management: fibrinolysis should be offered within 12 hours of onset of symptoms if primary PCI cannot be delivered within 120 minutes
1st line for HTN in a non-diabetic over 55
Ca2+ channel blocker
A 52-year-old male presents with tearing central chest pain. On examination he has an aortic regurgitation murmur. An ECG shows ST elevation in leads II, III and aVF.
Diagnosis?
Proximal aortic dissection
An inferior myocardial infarction and AR murmur should raise suspicions of an ascending aorta dissection rather than an inferior myocardial infarction alone. Also the history is more suggestive of a dissection. Other features may include pericardial effusion, carotid dissection and absent subclavian pulse.
The Mackler triad for Boerhaave syndrome:
Vomiting, thoracic pain, subcutaneous emphysema. It commonly presents in middle aged men with a background of alcohol abuse.
What vaccinations should be given in chronic heart failure?
One off pneumococcal vaccine
Yearly influenza vaccine
Inferior MI can lead to acute mitral regurge, how can this present?
Rupture of the papillary muscle due to a myocardial infarction → acute mitral regurgitation → widespread systolic murmur, hypotension, pulmonary oedema
Mid systolic murmur that radiates to the axilla
Mitral regurge.
Stroke management for patients presenting within 4.5hrs:
Thrombolysis + THROMBECTOMY
A combination of thrombolysis AND thrombectomy is recommend for patients with an acute ischaemic stroke who present within 4.5 hours
Diagnosis of malnutrition:
Unintentional weight loss greater than 10% within the last 3-6 months is diagnostic of malnutrition.
1st line to prevent angina attacks:
A beta-blocker or a calcium channel blocker is used first-line to prevent angina attacks.
E.g atenolol, verapamil etc
A patient develops acute heart failure 10 days following a myocardial infarction. On examination he has a raised JVP, pulsus paradoxus and diminished heart sounds. What’s the cause?
Left ventricular wall rupture
Diarrhoea causes what finding on ABG?
Diarrhoea can cause a normal anion gap acidosis
Treatment for aortic dissection (for both types)
Aortic dissection
type A - ascending aorta - control BP (IV labetalol) + surgery
type B - descending aorta - control BP(IV labetalol)
STEMI but to slow for PCI then…
Fibrinolysis
Electrolyte deficiency that causes long QT?
Hypokalaemia can lead to long QT syndrome
NSTEMI management: patients with a GRACE score more than what should have coronary angiography within 72 hours of admission
GRACE score >3%
Kussmaul’s sign
In constrictive pericarditis, the JVP will rise on inspiration; this is known as Kussmaul’s sign
Colles fracture - what nerve is injured?
Median nerve
Colles fracture - what nerve is injured?
Median nerve
Unable to abduct thumb, what nerve is injured?
Median nerve
Management of stable torsades de pointes?
IV magnesium sulfate is used to treat torsades de pointes
Explain doses of statins and how they differ:
Cardiovascular disease: Atorvastatin 20mg for primary prevention, 80mg for secondary prevention.
What is considered low risk on a GRACE score?
6 month mortality of equal to or less than 3%
NSTEMI management (from the start) for someone with a GRACE score of 2%
- Aspirin 300mg
- Fondaparinux
- Grace score =/<3% give ticagrelor
Managment of NSTEMI with a grace score of more than 3%
PCI within 72hours
(immediately if unstable)
Conservative management for patients with NSTEMI/unstable angina
- Further antiplatelet (‘dual antiplatelet therapy’, i.e. aspirin + another drug)
- If the patient is not at a high risk of bleeding: ticagrelor
- If the patient is at a high risk of bleeding: clopidogrel
How to calculate MAP:
Diastolic + (1/3(systolic - diastolic))
What is pulsus paradoxus and what’s it seen in?
In cardiac tamponade, there will be an abnormally large drop in BP during inspiration, known as pulsus paradoxus.
Cushing’s reflex findings
Bradycardic, hypertensive, wide pulse pressure
ACE inhibitors - contraindicated in patients with renovascular disease
ACE inhibitors - contraindicated in patients with renovascular disease
When to shock tachycardia?
Patients with tachycardia and signs of shock, syncope, myocardial ischaemia or heart failure should receive up to 3 synchronised DC shocks
On examination, there is a mid-diastolic murmur present and a loud S1 opening snap consistent with
Mitral stenosis
Mitral stenosis - most common cause?
Rheumatic fever
What is contraindicated in Vtachy?
Ventricular tachycardia - verapamil is contraindicated
