Cardiology 19/11 Flashcards
Pulsus paradoxus
large drop in BP during inspiration in cardiac tamponade
What is Dressler’s syndrome?
Autoimmune response by the body after an injury
Fever, pericarditis, pleuritic pain
2-3 weeks after
Left ventricular free all rupture
3% of MIs occurs around 1-2 weeks
acute heart failure 2 to cardiac tamponade
Bisoprolol as a beta blocker is contraindicated in asthmatics?
no Bisoprolol is cardioselective so okay
Dihydropyridine CCBs MOA
act on vascular smooth muscle leading to vasodilation
no effect on conduction system
reduce BP by decreasing vascular resistance
Cardioselective beta blockers
what does this mean?
act on beta 1 in heart
don’t cause vasoconstriction that beta 2 acting BB do
axis deviation on an ECG
lead 1 and 3 pointing away is LAD
pointing towrds is RAD
lead 1 is
0 degrees
lead aVF is
90 degrees
if lead 1 is + then?
if avf is +?
if normal axis is?
it’s between -90 to 90
0-180 degrees
0-90; Lead 1 and aVF ++
ticagrelor > clopidogrel
true
what ECG change is suggestive of cardiac tamponade?
electrical alternans
is a relatively specific but non-sensitive ECG sign of cardiac tamponade. Electrical alternans is characterised by beat to beat variation in QRS amplitude and morphology. This variability is due to the heart ‘swinging’ in the pericardial fluid
When would you offer rhythm control as a first line?
coexistent HF
first onset Af
reversible cause
acute pericarditis most specific ECG change?
PR depression
prolonged QT interval is due to?
Hypokalaemia
Hypothermia
S1Q3T3 pattern ECG
pulmonary embolism
sinus tachy
poorly controlled HTN already on ACEi, CCB and thiazide like diuretic
what next
if >4.5mmol/L K+ then add alpha or beta blocker
<4.5 Spironolactone
CCB - verapamil which is non hyrodropyrimidal
calcium-dependent conduction in the AV node
reduce contractility of the heart further
torsades de pointes
polymorphic ventricular tachycardia
prolonged corrected QT interval
caused by macrolides : eryhtromycin
Erythromycin causes change in QRS amplitude why?
inhibition if the delayed rectifier potassium channel
warfarin drug interactions
inducers
phenytoin
carbamazepine
barbiturates
phenobarbitone
Rimampicin
st johns wort
chronic alcohol intake
inhibitors of p450
Ciprofloxacin
macrolide
isoniazide
amiodarone
allopurinol
SSRIs
ritonavir
sodium valproate
acute alcohol intake
why are CCB contraindicated in HF?
depress heart function further
exacerbate symptoms
negative ionotropic effects
negative ionotropic effect means?
Negative inotropic agents reduce the influx or availability of calcium, leading to a weaker contraction
after fibrinolysis for ACS what needs to happen 60-90 mins after?
ECG to see if ST segment elevation has decreased
most common cause of death after an MI?
V fibrillation
preferred sit for insertion of catheter for PCI?
Radial artery, > femoral
complete heart block following MI?
right coronary artery lesion
supplies atrioventricular node
which artery supplies atrioventricular node?
right coronary artery
lateral or posterior MI
circumflex artery
What is takayasu arteritis?
large vessel vasculitis occluding aorta
associated with aortic regurgitation
wide pulse pressure
Bisferiens pulse
- mixed aortic valve disease
- double pulse
- caused by mixed aortic valve disease
De musset
head bobbing is a clinical sign fo aortic regurgitation
what is aortic regurgitation
leaking of aortic valve of the heart that cuases blood to flow in reverse direction during ventricular diastole
Score system recommended to help with PE identify where to manage
The Pulmonary Embolism Severity Index (PESI) score is recommended by BTS guidelines to be used to help identify patients with a pulmonary embolism that can be managed as outpatients
Rheumatic fever rash?
erythema marginatum
what are Aschoff bodies
granulomatous nodules found in rheumatic fever
Preference in angina symptom control between BB and CCB?
Diltiazem / verapamil
over Beta blocker
Normal ECG variants
sinus brady
first degree heart block
mobitz type 1 wenckebach
when are nitrates contraindicated in ACS Mx?
hypotension presence of
what is first degree heart block?
when PR interval is longer than 0.2s
Second degree heart block?
Progressive prolongation of PR interval until dropped beat occurs
hypercalcaemia ECG changes
shortening of the QT interval
2nd degree AV node block Mobitz type 1
Prolonged PR = AV node block
Increasing PR intervals
- non conducted p wave
mx of bradycardia?
Atropine 500mcg IV
transcutaneous pacing
isoprenaline /adrenaline infusion
transvenous pacing
what is a non shockable rhythm?
asystole/
pulseless-electrical activity (asystole/PEA)
