Cardiology Flashcards
Antiplatelet mechanisms
- Thromboxane A2i - Aspirin
- Antithrombin III activator - Heparins
- Coronary vasodilator - Nitrates
- Glycoprotein IIb/IIIa receptor antagonist - Abciximab, Tirofiban
- P2Y12 i - Clopidigrel, Ticagrelor
- Reversible direct thrombin i - Bivalirudin
- Increases effect of adenosine and non specific phosphodiesterase i - Dipyridamole
HOCM
- Beta myosin heavy chain
- Diastolic dysfunction
- Myofibrillar hypertrophy with disorganized fashion myocytes and fibrosis on biopsy
HOCM clinical features
- Syncope
- Sudden death
- Jerky pulse
- Large a waves
- ESM due to LVOT obstruction
- PSM due to MR
HOCM echo findings
- MR
- SAM of anterior mitral valve leaflet
- asymmetric hypertrophy
Variable intensity S1
Complete heart block
(also has cannon waves in JVP)
Associations for Coarctation of Aorta
- Bicuspid aortic valve
- Turner’s syndrome
- Neurofibromatosis (NF1)
- Berry aneurysms
Buy Two New Berries for aorta
ECG in hypokalemia
U waves, ST depression, T-wave inversion
Nicorandil
Potassium channel activator
Adverse effects
1. Headache
2. Flushing
3. GI ulceration anywhere including anal ulcers
Contraindicated in LV failure
S3
Diastolic rapid filling of ventricles
Normal in <30 years of age
- LV failure like dilated cardiomyopathy
- Constrictive pericarditis (pericardial knock)
- MR
S4
Atrial contraction against stiff ventricles
- AS
- HOCM with double apical impulse
- HTN
Collapsing Pulse
- AR
- PDA
- Hyperkinetic states
Slow rising pulse
AS
Pulsus alternans
Severe LV failure
Pulsus paradoxus
- Severe asthma
- Cardiac tamponade
Pulsus bisferiens
Mixed aortic valve disease
Jerky pulse
HOCM
Syndrome X
Angina like chest pain on exertion
- ST depression on stress ecg
- Normal Coronary angio
Ebstein’s anomaly
Low insertion of tricuspid valve leading to large RA and small RV
- cyanosis
- hepatomegaly
- TR
- RBBB with WPW
Important Cardiac genes
- SCN5A - Brugada
- MYBPC3 & MYH7 - HCM
- CAV3 - Hereditary long QT syndrome
- TTR - Transthyretin amyloidosis
Adenosine interactions
- Dipyridamole - enhances action
- Aminophylline - reduces effect
WPW associations
HOCM
MVP
Ebstein’s anomaly
Thyrotoxicosis
Secundum ASD
Indications for stopping ETT
- ST elevation >2 mm
- ST depression >3 mm
- SBP > 230 mm Hg
- SBP falling more than 20 mm Hg
- HR falling more than 20% of starting HR
Causes of ST depression
- Syndrome X
- Ischaemia
- Abnormal QRS
- Digoxin
- Hypokalemia
Remember SIADH
Management of severe MS
Percutaneous mitral commisurotomy (PMC)
If fails, then valve replacement
Difference between cardiac tamponade and constrictive pericarditis
Absent y descent on JVP for Tamponade
Nicorandil important side effect
Ulcerations anywhere in the GI tract
JVP Canon waves
Regular Canon waves:
- VT with 1:1 ventricular-atrial conduction
- AVNRT
Irregular Canon waves: Complete heart block
Cardiac resynchronisation therapy (biventricular pacing) candidates
- ECG: LBBB
- TTE: LVeF<35%
Prinzmetal Angina Management
Dihydropyridine CCB (Amlo or felodipine)
Persistent ST elevation post MI and no CP
LV aneurysm
Associations of MVP
M - Marfan
V - (V) Wolff Parkinson White $
P - Pseudoxanthoma elasticum
P - PDA
R - tuRneR’s syndrome
O - Osteogenesis imperfecta
L - Long QT syndrome
A - ASD
P - PCKD
S - Severe cardiomyopathy
E - Ehler Danlos
Causes of DCM
THIAMIN
T - Thiamine deficiency
H - HTN
I - IHD
A - Alcohol and cocaine
M - Myocarditis
I - Infiltrative (hemochromatosis and Sarcoidosis)
N - no cause (idiopathic)
Associations of WpW
HoT As ME
Ho - HOCM
T - Thyrotoxicosis
As - ASD Secundum
M - MVP
E - Ebstein’s anomaly
Drugs with serious contraindications
Verapamil in VT
Nitrates in RV MI
ACEi, Nitrates and Inotropes in HOCM
