Cardiology 2 Flashcards
Management of COMPENSATED acute heart failure (pulmonary oedema)
Sit up
Oxygen if sats <94
IV Furosemide
SC Morphine
Advanced managemnt of acute heart failure
CPAP
IV Furosemide over 24hr
IV Dopamine over 24hr (inhibits SNS - increases myocardial contractility)
Intra-aortic balloon pump if in shock
Ultrafiltration if diuretics CI
Criteria for cardiac resynchronisation therapy
Symptomatic despite full medical management of ACEi, BB, Furosemide, Ivadbradine, Spironolactone, Hydralazine (if afro-carib)
1) LBBB on ECG
2) LVEF <30%
3) NYHA III
4) QRS >130ms
NYHA Classification of Heart Failure
I - no physical limitations
II - slight limitation, comfort at rest
III - marked limited activity, comfort at rest
IV - discomfort at rest
Pt is admitted with worsening SOB. RR 30, sats 91%, pulse 90bpm.
ECG shows normal sinus rhythym with a narrow QRS complex. LVEF 25%.
Current meds are Ramipril, bisoprolol, spironolactone, Bumetanide, Atorvastatin, Aspirin and Isosorbide Mononitrate.
She is treated with IV Furosemide. What intervention should she receive after her acute management? (+ other indications for this management)
Implantable cardioverter-defibrillation (ICD)
- LVEF <35%
- Good QoL
- Ventricular Fibrillation or Ventricular Tachycardia
Management of DECOMPENSATED acute heart failure (pulmonary oedema) secondary to Atrial Fibrillation
IV METOPROLOL (Beta-blockade, unless asthma/ COPD)
Pt presents with syncope and palpitations. ECG shows a long QT interval.
Congenital cause of Long QT Syndrome
Acquired cause of Long QT Syndrome
Treatment of Long QT?
Congenital: Jervell-Lange-Nielsen syndrome (mut. Cardiac Na/K channels)
Acquired: HypoK, HypoCa, amiodarone, TCAs, bradycardia, MI, diabetes
Tx:
Underlying
+ IV Isoprenaline if acquired
Pt presents with 2hrs of palpitations and malaise. Her pulse is 140bpm but other vitals are normal. She is haemodynamically stable.
ECG reveals regular tachycardia with QRS duration 80ms.
Diagnosis? 1L management? 2L Management?
What would the management be if she were haemodynamically unstable?
Narrow QRS = Supraventricular Tachycardia, haemodynamically stable
1L Vagal manoeuvre
- carotid sinus massage
- blowing into empty syringe
2L IV Adenosine
3L BB
If haemodynamically unstable: DC Cardioversion
Pt’s ECG shows a series of broad QRS complexes and tachycardia. There are no abnormalities on examination.
What is the most appropriate management?
Broad QRS = Ventricular tachycardia
No abnormalities = stable
Tx: IV Amiodarone 300mg (Then 900mg over 24hrs)
Pt’s ECG shows a series of broad QRS complexes and tachycardia. He has no pulse.
What is the most appropriate management?
= ventricular tachycardia but really bad
Chest compressions + unsynchronised shock
Pt’s ECG shows a series of broad QRS complexes and tachycardia. He has a pulse but has experiences two episodes of syncope.
What is the most appropriate management?
= unstable ventricular tachycardia
DC Cardioversion (Synchronised)
Pt presents with palpitations. Their ECG has a corkscrew appearance. She recently has been taking clarithromycin and amoxicillin to treat CAP.
Likely diagnosis?
Torsades des pointes (Ventricular Tachycardia)
Pt presents with tachycardia and ECG shows broad QRS complexes. They have had palpitations for 5hrs. There are no signs of oedema or raised JVP.
Likely diagnosis? Management?
Haemodynamically stable Sustained Ventricular Tachycardia
IV Amiodarone
Asthmatic pt presents with SOB and palpitations. ECG shows supraventricular tachycardia of 180bpm.
How should we slow the rate to be able to identify the arrhythmia?
Asthmatic :. adenosine contraindicated
Therefore VERAPAMIL
Pt presents with SOB and palpitations. ECG shows supraventricular tachycardia of 180bpm.
How should we slow the rate to be able to identify the arrhythmia?
ADENOSINE
What is the most common ECG finding in pulmonary embolism?
Sinus tachycardia
