Cardiology Flashcards
How to Tx STEMI?
If within 12hrs -> transfer to PCI centre (within 2hrs)
If not, offer alteplase -> if not >50% ECG resolution at 90 mins, transfer for PCI
If >12hrs -> consider angiography first, then PCI
Give all DAPT
How to Tx NSTEMI?
Fondaparinux and DAPT, refer for angio
Calculate GRACE score
What medications should be prescribed in stable angina?
Aspirin
Statin
GTN spray
Then consider adding:
- B blocker/CCB or both
- then nitrates/nicorandil
(Do not give B blocker with verapamil -> risk of CHB)
Investigation of choice in stable angina?
CT coronary angiography, then noninvasive functional imaging if required (MR perfusion etc), then invasive angiogram
Complications after ACS?
Acute:
1) Cardiac arrest
2) Cardiogenic shock
3) Brady/tachyarrhthmias
Subacute/chronic:
1) Heart failure
2) Dressler’s syndrome (occurs 2-6 wks after, AI reaction)
3) LV aneurysm
4) LV free wall rupture (occurs 1-2 weeks after)
5) VSD (occurs in first week)
6) Acute MR (pap muscle rupture)
Investigations in a patient with suspected Marfan’s, with regards to aortic dissection?
1) Hx (particularly FH) + obs
2) Bloods
3) ECG - check for signs of MI if chest pain
4) CXR - widened mediastinum
5) CT CAP
How to manage acute aortic dissections?
Get IV access
Give morphine
Urgent HTN management
IV B-blockers
Stanford A: ASS (systolic Mx + surgery)
Stanford B: BooBs (B-blockers and bed rest)
CXR findings in heart failure?
Alveolar oedema
Kerley B lines
Cardiomegaly
Dilated prominent upper lobe vessels
Pleural effusions
4 pillars of heart failure management?
ACEi, BB, MRA, SGLT2
What is the NY classification for heart failure?
1) No symptoms/limitations
2) Mild symptoms/limitation on daily activities
3) Moderate symptoms/limitations
4) Severe, dyspnoea at rest
Adjuvant therapy for heart failure? (devices)
Consider implantation of a CRT-P, CRT-D or ICD based on QRS length, evidence of LBBB and NYHA class
Treatment options for PAH?
Acute vasodilator testing
Positive result: CCB
Negative result:
Endothelin receptor antagonists - bosartan
Phosphodiesterase inhibitors - sildenafil
Prostacyclin analogues - iloprost (SEVERE CASES)
What is Brugada syndrome? ECG findings?
Rare inherited (AD) sodium or calcium channelopathy
ECG - RBBB, persistent ST elevation in V1-V3
Mx - may require ICD
What is included in the ORBIT score?
Haemoglobin/haematocrit levels
Age
Bleeding history
Renal impairment
Treatment with anti-platelet drugs
What are common causes of myocarditis?
Idiopathic (~50%)
Infectious:
Viral - coxsackie, HIV
Bacterial - lyme disease
Non-infectious:
Autoimmune - sarcoid, lupus
Drugs - doxorubicin
Radiation
What two conditions if HOCM associated with?
Friedrich’s Ataxia
WPW syndrome
What is arrhythmogenic right ventricular cardiomyopathy?
AD condition, second most (c) cause of sudden cardiac death in the young
R vent myocardium is replaced with fatty/fibrofatty tissue
ECG findings and treatment in arrhythmogenic right ventricular cardiomyopathy?
ECG - TWI in V1-V3, epsilon wave in 50% (extra notch after QRS)
Mx - sotalol, catheter ablation to prevent VT, ICD
Investigations for pericarditis?
Usual bloods
Pericarditis screen - includes viral serology, blood cultures, autoAbs, fungal precipitins
CXR
May need echo
Management of pericarditis?
Analgesia
Avoid strenuous activity for 3 months
Treat underlying cause
Consider NSAIDs + colchicine
Steroids if relapse/unresolved
Why should you avoid strenuous activity in pericarditis?
To reduce the risk of progression to myocarditis, pericardial effusion, cardiac tamponade + constrictive pericarditis
What causes constrictive pericarditis?
Often unknown, or after any pericarditis
Can be TB or radiotherapy
What is the most common cause of restrictive cardiomyopathy in the UK?
Amyloidosis
Diagnostic triad in cardiac tamponade?
Beck’s triad: muffled heart sounds, rising JVP, hypotension
Indications for surgery in IE?
Infection resistant to medical therapy
Cardiac failure refractory to medical therapy
Recurrent emboli (esp risk to CNS)
Severe valvular incompetence
Aortic abscess (lengthening PR interval)
Poor prognostic factors in IE?
Staph aureus
Prosthetic valve
Culture negative endocarditis
Low complement levels
Indications for permanent pacemaker?
Persistent symptomatic bradycardia
Mobitz T2 / CHB
Persistent AV block after MI
