Cardiology Flashcards
ASD Findings
- Fixed splitting of the second heart sound
- Left parasternal heave
- pulmonary ejection systolic murmur
interatrial septum is defective or absent allowing mixing of oxygenated and unoxygenated blood.
Outcome is increased pulmonary blood flow and overload of the right ventricle during diastole. Can worsen with age leading to Eisenmenger syndrome.
VT Management
Acutely:
Unstable VT (shock, syncope, MI Heart Failure): DC Cardioversion
Stable VT: Amiodarone
For Both:
Treat reversible causes eg replenish electrolytes
Secondary Prevention to improve long term outcomes:
Surgical Post-resuscitation consider ICD or catheter ablation for recurrent VT
SVT Mxt
1st: Vasovagal manoeuvres
2nd: adenosine 6, 12, 18 (CI in asthmatics)
Alternatives: Verapamil,
Beta-blocker (CI in asthmatics)
ECG Finding of HOCM
- Left ventricular hypertrophy with increased precordial voltages and non-specific ST segment and T-wave abnormalities
- Deep, narrow (“dagger-like”) Q waves in lateral (I, aVL, V5-6) +/- inferior (II, III, aVF) leads
1st degree HB ECG
PR >5 small squares (200ms/0.2s) as each small square is 40ms/0.04s
1st degree AV block is not technically a block but rather a delay in the conduction of atrial impulses to the ventricles, which results in a prolonged PR interval
2nd degree HB- Mobitz I
PR progressively lengthens until a QRS is dropped.
Mobitz I block (Wenckebach block phenomenon) is progressive
PR interval prolongation until a P wave fails to conduct. The PR
interval before the blocked P wave is much longer than the PR
interval after the blocked P wave.
2nd degree AV block, which can be further divided into Mobitz I and Mobitz II, occurs when some of the atrial impulses are fully conducted to the ventricles, whereas others are blocked along the way.
2nd degree HB- Mobitz II
PR constant then a QRS dropped.
Mobitz II block occurs when a dropped QRS complex is not
preceded by progressive PR interval prolongation. Usually, the
QRS complex is wide (>0.12 sec).
2nd degree AV block, which can be further divided into Mobitz I and Mobitz II, occurs when some of the atrial impulses are fully conducted to the ventricles, whereas others are blocked along the way.
In many cases, a ratio for the overall number of beats conducted to not-conducted can be seen, like 2:1 or 3:1 Mobitz II AV block.
3rd degree HB
No relationship between P waves and QRS complexes
P waves and QRS complexes are independent and ventricular rate is slower than atrial rate.
Narrow complex rapid tachycardia treatment
1st line- vagal maneouvour
2nd line- adenosine (CI in heart block and sick sinus syndrome)
3rd line (or 2nd line CI)- verapamil (CI in heart block or impaired left-ventricular function)
4th line (or above CI)- beta blocker
Adenosine contraindications
- heart block
- sick sinus syndrome.
-asthma
-decompensated heart failure
Heart transplant patients should be given a small dose (3 mg) as the donor AV node may be exquisitely sensitive to adenosine.
Verapamil contraindications
-heart block
-impaired left-ventricular function.
-avoid in patients who take beta-blockers as you risk asystole.
1st, 2nd and 3rd line treatment for angina
1st line- beta blocker or a calcium channel blocker
(based on comorbidities, contraindications and the person’s preference)
or if both CI monotherapy with other agents: a long-acting nitrate or ivabradine or nicorandil or ranolazine.
2nd line- CCB + BB or if CI then add another agent to CCB/BB eg
3rd line- 3 agents only if waiting revascularisation or revascularisation CI
Lines of Mxt for HTN
- CCB or ACE-i/ARB
- CCB + ACE-i/ARB (in black ARB preferred to ACE-i
- add Thiazide
- potassium less than 4.5 add spironolactone
potassium more than 4.5 increase thiazide diuretic
(consider alpha/beta blockers if intolerant to ACE-i/ARB)
