Cardiology Flashcards
Stage I HTN
- Criteria
- Mangement
> 135/85
Treat if QRISK >20%
Accelerated idioventricular rhythm
P waves not always associated with QRS
Wide QRS
50-100bpm
Often seen following reperfusion, if in this context needs no intervention
What is sinus arrest?
No p waves for >3 seconds
What is sick sinus syndrome?
Management of symptomatic bradycardia
Bradycardia + sinus arrest
Need AAIR pacemaker
(single lead, atrial sensing and pacing lead, not suitable if there is atrial fibrillation)
Management of sustained slow AF in sick sinus syndrome
VVIR pacemaker
Management of Angina
- BB or CCB
- BB + CCB
- Ivabradine OR Nicorandil OR Ranolazine OR long acting nitrate
Diarrhoea
New tricuspid regurgitation
- diagnosis
- pathological findings
= carcinoid syndrome
Endocardial plaques of the firbous tissue with often involve the tricuspid valve
- May then develop signs of RHF
Management of ARVC
Sotalol
(superior to other BBs)
Treatments licensed for rate control in heart failure
Ivabradine
Carvedilol
Nebivolol
Skin sign seen in acute rheumatic fever
Erythema marginatum
= red circular lesions, sharp borders, faint central clearing
ST Elevation
No reciprocal depression
Recent MI
- diagnosis?
Left ventricular aneurysm
RV involvement of MI pathophysiology of presentation
Immediate management
- V4 usually best lead to see in
- Associated with inferior infarction, rare to happen alone
- Poor contraction of RV results in peripheral oedema and right atrial dilation
- Poor flow of blood into pulmonary artery
- Reduced blood delivery to LV
Fluid resuscitation - want to increase the LV preload to improve hypotension
Then consider noradrenaline/dobutamine
Suspected endocarditis
- lymphocytosis
- middle east
- culture negative
Consider brucellosis
Features of constrictive pericarditis (5)
Right heart failure
Rapid x/y descent (kussmaul’s)
Septal shift on inspiration
Relative equalisation of diastolic pressures on cardiac catheterisation
Dip/plateau pattern
Location ASD secundum vs primum
Secundum = mid septum
Primum = lower in septum
ACS + already on anticoagulation
Usually triple therapy 4 weeks-6 months after
THEN
DAPT to complete 12/12 of treatment
Prognostic benefit in heart failure (beyond 4 pillars)
In afro-caribbean - ISMN and hydralazine shown to have benefit
Management of severe non-calcific MR
Percutaneous balloon mitral commissurotomy
Medication not useful in cocaine overdose
Beta blockers
Get unopposed alpha stimulation, enhances vasospasm and raises BP
Fabry’s Disease
- features (4)
Black-blue papules
MV prolapse
Stroke/TIA
Distal paraesthesia
Type A WPW
Left sided pathway
Dominant R wave in V1
Type B WPW
- target for ablation
Right sided pathway
Dominant S wave in V1
= right atria/ventricular area
Coronary artery vasospasm
- features
Intermittent STE
Occurs at rest
Normal coronary arteries
Management of Kawasaki Disease
Aspirin
IV immunoglobulin
(can add steroids in with high risk cases)
Defect on stress and rest MRI
Fixed defect
= transmural defect
Indications for valve intervention in MR (3)
EF <60%
LVES diameter >40
New AF
Contra-indications in sick sinus
Calcium channel blockers
Ivabradine
CI for ranolazine
Liver dysfunction
Severe renal dysfunction
SVT with aberrancy VS VT
- what makes VT more likely?
Absence of LBBB/RBBB
Extreme axis deviation
Very broad complex
Positive or negative concordance in the chest leads
Choice of heparin if angio < 24 hours
Unfractionated heparin
