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Emergency medicine > Cardiology > Flashcards

Cardiology Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards
1
Q

Causes of A fib

A

SMITH
- Sepsis
- Mitral stenosis or regurgitation
- Ischaemic heart disease
- Thyrotoxicosis
- Hypertension

*Alcohol, caffeine and age

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2
Q

DDx of irregularly irregular pulse

A
  • atrial fibrillation
  • ventricular ectopics (disappear at high rate and exertion)
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3
Q

A fib investigations

A
  • ECG
  • Echocardiogram - valvular disease, heart failure
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4
Q

Special types of A fib

A
  • Paroxysmal atrial fibrillation
  • Valvular atrial fibrillatioin (if due to mitra stenosis or mechanical heart valve)
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5
Q

Paroxysmal atrial fibrillation Ix

A

episodes of atrial fibrillation 30 sec - 48 hrs

24-hour ambulatory ECG recording (Holter monitor)

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6
Q

Paroxysmal atrial fibrillation Mx

A

Flecainide - Pill in pocket + anticoagulation
if:
- Patient able to recognize symptoms
- infrequent episodes
- no structural heart disease

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7
Q

Risk of flecainide in PAF

A

conversion to flutter with 1:1 AV conduction

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8
Q

Indications for rhythm control in AF

A
  • Acute presentation < 48hrs
  • Reversible cause of AF
  • Heart failure despite AF
  • Symptomatic despite rate control
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9
Q

How is rhythm control done in AF

A

Immediate (when < 48hrs or haemodynamically unstable)
- pharmacological cardioversion : Flecainide or amiodarone (if structural heart disease)
- Electrical cardioversion

Delayer (after 48hrs or hemodynamically unstable)
- Electrical: transesophageal echocardiography guided cardioversion (amiodarone before and after)

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10
Q

How is rate control achieved in AF?

A
  • Beta-blocker (bisoprolol) or non-DHP CCB (verapamil or diltiazem if asthmatic)
  • Digoxin
    *dont give BB and CCB together - risk of heart block
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11
Q

Long-term rhythm control

A
  • Beta blocker ie bisoprolol
  • Dronedarone
  • Amiodarone (if HF or ventricular dysfunction)
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12
Q

If AF not responding to anti-arithmetics

A

Catheter ablation

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13
Q

CHA2DS2VASc score

A
  • Congestive heart failure
  • Hypertension
  • Age >= 75 (2)
  • DM
  • Stroke or TIA (2)
  • Vascular disease
  • Age 65-74
  • Female

Consider DOAC if a score of 1 in males
Give DOAC if score > 2

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14
Q

ORBIT

A

risk of bleeding on anticoagulation
- Older age > 75
- Renal impairment eGFR < 60
- Bleeding hx
- Iron deficiency
- Taking anti-platelets

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15
Q

HF ejection fraction

A

< 40% is reduced HFrEF (issue with ventricular contraction)
>50% is preserved HFrEF (issue with ventricular filling)

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16
Q

HFrEF mx

A

ABAL
1. ACEi (or ARB if not tolerating or if afro-Caribbean)
2. Beta-blocker
3. Aldosterone antagonist e.g spironaloctone (mineralcorticoid receptor antagonist)
4. Loop diuretics

**Check potassium before spironolactone, K sparing

17
Q

HF presentation

A
  • Tachycardia and tachypnoea
  • Dyspnoea
  • Productive cough - pink and frothy
  • Orthopnoea
  • Bibasal crackles
  • Paroxysmal nocturnal dyspnoea
  • Peripheral oedema
  • Fatigue
18
Q

HF Ix

A

Bedside - ECG
Bloods - NT-proBNP, FBC, UE, LFT, TFT etc
Imaging - Echo, CXR (cardiothoracic index)

19
Q

New York Heart Association classification

A
  1. No symptoms
  2. No symptoms at rest, symptomatic with ordinary activities
  3. No symptoms at rest, symptomatic with any activity
  4. Symptomatic at rest
20
Q

Chronic HF mx

A

HFpEF - monitor and manage co-morbidities

HFrEF
- BB + ACEi (ARB if intolerant)
- spironaloctone
(3rd line in another flashcard)

*flu (annual) and pneumococcal vaccination (1),
cardiac rehabilitation,
smoking cessation
optimise co-morbidities
written care plan

21
Q

3rd line mx for chronic heart failure

A
  • Sacubitril-valsartan if EF < 35%
  • Ivabradine if EF < 35% + sinus rhythm > 75
  • Hydralazine and nitrate in afro-caribbean
  • Digoxin if HF
22
Q

AF and CHA2DS2VASc is 0

A

Do echo to rule out valvular disease

*AF + valvular disease = need anticoagulation

23
Q

Adult bradycardia guidelines

A

https://i0.wp.com/www.embeds.co.uk/wp-content/uploads/2021/09/Bradycardia-Algorithm-2021-scaled.jpg?w=1333&ssl=1

24
Q

AF cardioversion

A

If acute (<48hrs)
- unstable: electric cardioversion
- stable: decide between electric and pharmacological

if chronic (>48hrs)
- anticoagulation for 3 weeks, then electric cardioversion (↓ stroke)

25
Q

Broad complex tachycardia ddx

A
  • AF with bundle branch block
  • AF with ventricular pre-excitation
  • Torsades de pointes

*seek expert help

26
Q
A

Emergency medicine (5 decks)

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