Cardiology Flashcards
How is atrial fibrillation management?
Management of Atrial Fibrillation;
1.Beta blockers
2. Calcium Channel blockers
3. Digoxin(Preferred in heart failure)
4. If haemodynamically unstable, do a cardioversion
Features of Heart block
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Mobitz type 1 block→Gradual prolongation of PR interval followed by a dropped beat.
1st degree heart block is a prolongation of the PR interval (beyond 0.2 seconds). It is a benign condition that does not require additional follow up or management. It is not usually associated with symptoms and
does not progress to other forms of heart block.
PR interval is measured from the beginning of the P wave to the beginning of the QRS complex.
Mobitz type 2 and complete heart block requires permanent pacemakers
Third heart block (Complete heart block): No connection between P waves and QRS complexes
Resuscitation
Steps;
1. Ring emergency bell
2. CPR(30:2)
3. Get a defibrillator
4. Commence ALS when team arrives
Contraindications of NSAIDs
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Non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided in patients with chronic kidney disese, heart failure or ischaemic heart disease.
Selective COX-2 inhibitors should also be avoided in these patients.
NSAIDs inhibit the synthesis of prostaglandins. This in turn can lead to a reduction in sodium excretion,
renal perfusion and glomerular filtration rate.
They can also reduce the effectiveness and increase the toxicity of ACE inhibitors and diuretics. This can result in an exacerbation of heart failure.
NSAIDs can cause the kidneys to retain more salt and water in the body which can increase your risk of
heart failure. They can also make some blood pressure-lowering medicines, such as ACE inhibitors and diuretics, less effective – and a rise in blood pressure is likely to worsen heart failure.
It is also worth noting that thiazide diuretics increase the risk of gout due to reduced clearance of uric
acid
ECG interpretation
The diagnosis here is atrial fibrillation. A completely irregular rhythm.
When looking at any ECG, try to use a stepwise approach
Step 1: Calculate rate
Step 2: Determine regularity
Step 3: Assess the P waves
Step 4: Determine PR interval
Step 5: Determine QRS duration
Step 6: Determine the axis
Step 7: Look at morphology
In this ECG, at step 2 (determine regularity), we can already see irregularity here just by looking at the RR intervals.
We will not discuss management here but the initial thoughts when seeing an ECG like this are:
1. Are they stable?
2. Is there rate control?
3. What is the patient’s CHA2DS2-VASc score?
Side effect hydrochlorothiazide
- Orthostatic hypotension
- Postural hypotension
Most appropriate diagnostic tool for patent foremen ovals
Transoesophageal echocardiography
Findings mitral valve stenosis
- Dyspnea on exertion
- Atrial fibrillation on ECG
- Straight left border of the heart -LAE on x-ray
Dressler syndrome
Post myocardial infarction.
ECG shows
ST elevation in leads V1, V2, V3, V4 and V5.
Complications MI
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The two closest options here are left ventricular aneurysm and Dressler’s syndrome.
One needs to understand them for the exam.
Left ventricular aneurysm is usually a complication resulting from a myocardial
infarction. When the cardiac muscle partially dies during a myocardial infarction, a layer of muscle may survive, and being severey weakened, start to become an aneurysm.
It usually presents four to six weeks post-myocardial infarction which fits this stem and ECG shows persistently raised ST segments.
Dressler’s syndrome is a secondary form of pericarditis that occurs post myocardial infarction.
It usually presents one week post myocardial infarction but may also occur
several months after a myocardial infarction.
Clinical features consist of fever, pleuritic pain, pericardial and pleural effusion. The pleuritic pain is usually the main complaint.
As we can see from the presenting symptoms of the patient, a left ventricular aneurysm fits best.
VENTRICULAR ANEURYSMS
Usually complications resulting from a myocardial infarction. When the cardiac muscle partially dies during a myocardial infarction, a layer of muscle may survive, and being severely
weakened, start to become an aneurysm.
ECG
• Persistently raised ST segments on ECG and left ventricular failure
Pericarditis findings
- saddle shaped ST elevation on ECG
- pericardial friction rub on auscultation
Cardiac tamponade
- large globular heart on x-ray
- distended neck veins
- muffled heart sounds
- hypotension
Ventricular septal defect
- fatigue and dyspnoea.
- left parasternal heave and systolic thrill with a harsh pan-systolic murmur at left
parasternal edge.
The guidelines for choice of antihypertensives based on age ?
Less than 55, caucasian- ACEI, CCB, Thiazides,
Greater than 55, black of any age- CCB, thiazide, ACEI
