Cardiology Flashcards
Which areas does the RCA supply?
RV, RA
Which areas does the L circumflex supply?
LA, LV
Which areas does the L marginal supply?
LV
Which areas does the LAD supply?
LV, RV, IV septum
Which leads show lateral (Circumflex)
1, V5, V6
Which leads show inferior (RCA)
2, 3, aVF
Which leads show anterior (LAD)
V1-V4
Complications of MI
cardiac arrest
cardiogenic shock
HF
tachy/brady arrhythmias
pericarditis
Dresslers syndrome
LV aneurysm, LV free wall rupture
ventricular septal defect
acute mitral regurg
MI secondary prevention
lifestyle
DAPT
ACE I
B Blocker
Statin
What should be offered to Pts following MI showing signs of Heart failure
aldosterone antagonist
eplerenone
Thrombolytic agent examples
alteplase
tenecteplase
streptokinase
Anti anginal meds
1) Beta blocker / CCB
2) ISMN
3) ivabradine/nicorandil/ranolazine
Which CCB should be used as anti-anginal
If monotherapy use verapamil/diltiazem (rate controlling)
If with BB, amlodipine/nifedipine
Acute pericarditis causes
infection: viral, TB
Conditions: Uraemia, connective tissue disorder (SLE, RA), hypothyroid, trauma, malignancy (breast, lung)
Secondary: Post MI, radiotherapy
What would a trop rise in pericarditis indicate
myopericarditis
- 30%
ECG changes in pericarditis
widespread
saddle ST elevation, PR depression
Mangement of pericarditis
treat cause
NSAIDS + colchicine (taper once asymptomatic)
Complications of acute pericarditis
Pericardial effusion -> cardiac tamponade
Constrictive pericarditis
Pathophysiology of constrictive pericarditis
Persistent inflammation causes fibrosis of serous pericardium which becomes stiff. Heart cannot expand/relax as well, decreased stroke volume, increased HR
Signs of constrictive pericarditis
Right heart failure - Increased JVP, ascites, oedema
Loud S3
Kussmals sign (increased JVP with inspiration, due to impaired RVF)
Management of constrictive pericarditis
pericardiectomy
Signs of large pericardial effusion
Decreased heart sounds
SOB, low BP (due to decreased cardiac OP)
Pathophysiology of cardiac tamponade
Increased fluid in pericardial space, heart cannot expand/relax fully, chambers dont fill, decreased cardiac OP, hypotension, increased HR
Causes of acute cardiac tamponade
Trauma
Post MI (ventricular wall rupture)
Heart surgery (weakened muscle rupture)
Aortic dissection
Signs of cardiac tamponade
Becks triad
1) Raised JVP
2) Hypotension
3) Reduced HS
+ tachycardia and SOBE
ECG findings in cardiac tamponade
electrical alterans
Tachy, low QRS
Explain pulses paradoxus
During normal inspiration, negative pressure causes systemic venous return into RV which expands into pericardial space.
In cardiac tamponade RV is unable to expand into pericardial space so pushes into IV septum reducing the LV diastolic volume therefore reducing SV, and systolic BP
Decrease in systolic BP by 10 mmHg = pulses paradoxus
what are the layers of artery
1) tunica adventitia
2) tunica media
3) tunica intima
What is aortic dissection
tear in tunica intima of aorta
What is aortic dissection associated wtih
HTN
trauma
Connective tissue disorders
Aneursyms
Bicusipd aortic valve
How does aortic dissection present
Chest/back pain (severe, tearing)
Weak/absent lower pulses
>20mmHg diffence between arm sytolic BP (compression L subclavian)
What are the classification systems used for aortic dissection
Stanford and DeBakey
What is Standford classification
Used for aortic dissection
Type A: Ascending aorta (2/3)
Type B: Descending aorta
What is DeBakey classification
Used for aortic dissection
Type 1: Ascending aorta to aortic arch
Type 2: only ascending aorta
Type 3: descending aorta to distal
Investigations for aortic dissection
CXR: wide mediastinum
TOE
CT angio: false lumen
Management of aortic dissection
Type A: surgery
Type B: conservative B blockers, BP control
Complications of aortic dissection
Backward tear: aortic regurg, MI
Forward tear: unequal BP, stroke, renal failure
Rhythm control in AF
onset <48h
heparinise
DCCV
amiodarone
No anticoag needed if in AD <48h
onset >48h
3/52 anticoag -> DCCV
anti coag needed at least 4/52
Meds: BB, Amiodarone (in HF), flecanide
Rate controlling medications in AF
BB, CCB, digoxin
Symptoms of LV failure
Pulmonary oedema
- dyspnoea
- orthopnoea
- paroxysmal noctural dyspnoea
- bibasal fine crackles
Symptoms of RV failure
Peripheral oedema
Weight gain
Increased JVP
Hepatomegaly
Cardiac cachexia
Which classification system is used for HF
NYHA
Which tests are used to diagnose HF?
NT-proBNP
BNP
ECHO
1st line management HF
ACE inhibitor and Beta Blocker
(dont affect mortality in p EF)
2nd line management HF
aldosterone antagonist (monitor K+)
e.g spiro, eplerenone
SGLT-2 inhibitors
e.g. dapagliflozin
3rd line management HF
ivabradine (HR >70 EF <35%)
sacubitril- valsartan (after ACE I/ARB Washout)
Digoxin
Hydralazine and nitrate (African-caribbean)
Meds to be avoided in HF
Verapamil
NSAIDS/glucocorticoids (retention)
Class I anti-arrhythmics
causes of atrial stenosis
- degen calcification
- bicuspid aortic valve
- rheumatic fever
- HOCM
pathophysiology and symptoms of AS
stenosed AV causes reduced blood flow and cardiac output
-SOB
- dizzy/syncope
- angina
normally on exertion
signs of AS
ESM
slow rising pulse
soft/ascent s2
sign of severe AS
S4
management of AS
if symptomatic - valve replacement (surgical AVR or TAVI)
causes of aortic regurg
-root dilatation (bicuspid valve, HTN)
- valvular damage (infective endocarditis, rheumatic fever)
signs of aortic regurg
-early diastolic murmur
- increased pulse pressure (systolic - diastolic)
-> collapsing pulse, nail bed pulsing, head bobbing
signs of severe aortic regurg
mid diastolic murmur - Austin Flint
What is Quinckes sign?
Nailbed pulsing, sign of increased pulse pressure such as in aortic regurg
What is De Mussets sign?
head bobbing, sign of increased pulse pressure such as in aortic regurg
When would you consider surgery in aortic regurg?
if severe or causing LV dysfunction
Pathophysiology of coarctation of aorta in infants
RV -> PA -> PDA -> Aorta (lower pressure due to narrowing)
Deoxygenated blood to lower extremities
cyanosis lower limbs
Pathophysiology of coarctation of aorta in adults
increased pressure before coartation
- increased pressure on aortic branches, increased BP to uper limbs and head (Berry aneursyms)
- increased risk of aortic dissection
Increased pressure after coarctation
- decreased pressure lower limbs, leg claudication, decreased renal perfusion
Signs of coarctation of aorta
radio-femoral delay
mid-systolic murmur
Management of coarctation of aorta
balloon dilatation or surgical removal of coarctation
Causes of Mitral stenosis
rheumatic fever
symptoms of mitral stenosis
SOB
haemoptysis
(Due to pulmonary venous HTN)
signs of mitral stenosis
mid-late diastolic murmur
loud S1
AF (LA enlargement)
Management of mitral stenosis
If AF - anti-coagulate with warfarin
if symptomatic - balloon valvotomy or valve replacement
Causes of Mitral regurg
mitral valve prolapse (associated with connective tissue disoders)
papillary muscle damage following MI
heart failure (dilated LV)
rheumatic fever
symptoms of mitral regurg
LV heart failure
Signs of mitral regurg
pansystolic murmur
quiet S1 (incomplete closing)
severe - split S2
causes of tricuspid regurg
- dilation of RA/RV (pulmonary hypertension, L->R shunt)
- rheumatic heart disease
- papillary muscle damage post MI
signs of tricuspid regurg
pansystolic murmur
louder on inspiration
symptoms of tricuspid regurg
RS HF
What is VSD associated with?
FAS
Downs
Edwards
post MI
pathophysiology of VSD
L->R shunt (pansystolic murmur)
increased volume R heart -> pulm HTN
Increased pressure so becomes R->L shunt which leads to cyanosis
post natal VSD symptoms
FTT
heart failure
two origins of ASD
ostium secondum (more common) and ostium primum
pathophysiology ASD
L->R shunt
Split S2 because PV takes longer to close than AV
systolic murmur
emboli to brain
pathophysiology of Tetralogy of fallot
1) RVOT stenosis
2) RV hypertrophy (boot shaped)
3) VSD (increased RV pressure due to RVOTO)
4) overiding aorta
TOF symptoms
cyanosis, clubbing, FTT, TET spellss, ESM
Management of TOF
surgery to RVOTO and VSD
what is PDA associated with
Maternal Rubella in 1st trimester
PDA murmur
pansystolic, machine like
pathophysiology of PDA
blood travels from aorta to pulmonary artery via PDA, causes pulmonary hypertension which then causes shunt to switch
Management of PDA
indomethacin (inhibits prostaglandin E2 synthesis)
Surgery: may need to give prostaglandin to keep open prior to surgery
What Is Eisenmenger syndrome
When L->R shunt becomes R->L shunt
e.g PDA, VSD
What is 1st degree heart block
PR interval >0.2s (4 small squares)
What is 2nd degree heart block
Mobitz 1 - increasing PR interval with dropped beat
Mobitz 2 - Constant increased PR but often no QRS
What is complete heart block
No relation between PR and QRS
Symptoms of CHB
syncope, SOB, dizziness, CP
Indications for temp pacemaker
-symptomatic/haemodynamically unstable bradycardia not responding to atropine
-post anterior MI type 2 or CHB
-trifascicular HB before surgery
Cardiology life threatening signs
shock, MI, HF, syncope
Management of bradycardia with life threatening signs
atropine 500mcg IV (up to 3mg)
isoprenaline 5mcg/min
adrenaline 2-10mcg/min
pacing
What features would increase risk of asystole in bradycardia
recent asystole
type 2 AV block
CHB with broad QRS
Ventricular pause >3 seconds
Treatment of tachycardia with life threatening signs
synchronised DC shock up to 3 times
amiodarone 300mcg IV
repeat DC shocks
treatment of non life threatening tachycardia broad QRS
regular: amiodarone 300mg IV
Iregular: AF with BBB or polymorphic - Mg 2mg
treatment of non life threatening tachycardia narrow QRS
regular: vagal manoeuvers, adenosine 6mg ->12mg -> 18mg
verapamil/BB -> DC shock
Irregular: AF, BB, Dig/amiodarone if HF
prevention of SVT
BB, radio-frequency ablation
Causes of ventricular tachy
Amiodarone, tricyclics
Low ca, K, Mg
MI, myocarditis
Treatment of ventricular tachy
if life threatening -> DC shocks
Amiodarone
ICD
