Cardiology Flashcards
Heart failure medication having no improvement on mortality
Digoxin
4th line heart failure
- Switch ACEi for sacubitril valsartan if HF EF <35%
- Add hydralazine if Afro-Carribean
- Add ivabradine if HF EF <35% and HR >75
Clopidogrel MOA
Blocks ADP
Aortic stenosis heart sounds
Quiet S2
V5-V6 ST elevation
Lateral MI (Left Cx)
V1-4 ST elevation
Anterior (LAD)
II, III, aVF ST elevation
Inferior (RCA)
Define ejection fraction
The difference in volume of blood at diastole and systole
EF: (EDV - ESV)/EDV
Splitting of the first heart sound, where does this correspond with the ECG
R wave
What is S1
Closure of mitral and tricuspid valves
What is S2
Closure of the aortic and pulmonary valves
Soft S1
immobile mitral stenosis
mitral regurgitation
Split S1
RBBB
LBBB
VT
Ebsteins anomaly
Variable S1
AF
Complete heart block
Loud S2
Hypertension
Tachycardia
ASD
Soft/absent S2
Severe aortic stenosis
Fixed S2
ASD
Wide split S2
RBBB, pulmonary stenosis
Reversed split S2
LBBB
PDA
AS
S3
Caused by rapid filling
MR
VSD
S4
Filling of a stiff LV
LVH
HOCM
Warfarin therapy
- small operation e.g. tooth extraction
Can continue as long as INR not above 2.0
HOCM
Ejection systolic murmur that improves on squatting
Signs of VT rather than sVT on ECG
- AV dissociation
- QRS complex >160ms
- fusion beats
- RSR complex
Coarctation of the aorta, why would the RHS blood pressure be higher than the LHS
If the coarctation is proximal to the left subclavian artery origin
If pressure in the RV > LV after MI, what is the cause
RV failure
Carotid sinus syndrome
Can cause black outs, asystole momentarily, need to have a pacemaker
Drug that shortens QT interval
Digoxin
What is the dicrotic notch
Timed with aortic valve closure
Co-arctation of the aorta BP in limbs
Legs will be much lower than arms
Prominent X and Y waves on JVP
Restrictive cardiomyopathy
Marfans murmur
Aortic regurgitaiton
Electrolyte imbalance causing prolonged QT
Hypomagnesia
Medication to avoid in AS
bisoprolol
MOA tirofiban
Glycoprotein IIb/IIIa inhibitor
- used in unatable angina/NSTEMI
HOCM pulse
Jerky
HOCM symptoms
double apex beat
jerky pulse
mid-systolic murmur
HOCM management
Primary ICD
HOCM genetic cause
Defect in the B myosin
autosomal dominant
Pulmonary oedema, hypotensive on a background of HF management
IV diuretics
IV opiate
O2
If remains hypotensive could consider dobutamine for BP support
Poor prognostic indicator HOCM
Septal wall thickness >3cm
Patent foramen ovale investigation
TOE with bubble study
- note likely to present with DVT and stroke like symptoms
WPW management
Radiofrequency ablation
Pericarditis ECG post 1- 2 weeks
T wave flattening
LHS or RHS murmurs heard best on inspiration
RHS heard best on inspiration
LHS heard best on expiration
Gradient of AS that you can observe if asymptomatic that will mean you have to surgically intervene
40mmHg
AR
De Mussets sign: head bobbing
Quinckes sign: nail pulse beating
Histology of rheumatic fever
Aschoff bodies