Cardiology 2 Flashcards
Wells score likely Ix
Wells score unlikely Ix
CTPA, if will be delayed then anticoagulate with a DOAC
If negative then consider US to r/o DVT
If unlikely - arrange d-dimer, if +ve then for CTPA
Wells score
Likely versus unlikely
> 4 PE likely
=<4 PE unlikely
PERC criteria (8)
> =50
Haemoptysis
Unilateral leg swelling
Recent surgery
HR >=100
Sats <=94%
Prev DVT use
Oestrogen use
What is the PERC rule?
Pulmonary embolism rule-out criteria (PERC)
all the criteria must be absent to have negative PERC result, i.e. rule-out PE
Acute hypotension and pulmonary oedema post MI?
Mitral regurg
Within 1 week post MI acute heart failure associated with a pan-systolic murmur =
ventricular septal defect
2-6 weeks post MI complication
48 hours
Dresslers syndrome
Pericarditis
Most common cause of death post MI
VF
Mitral stenosis features (7)
Dyspnoea
Haemoptysis
Mid- late diastolic murmur
Loud S1
Low volume pulse
Malar flush
AF
Mitral stenosis
Causes (3)
RhF, RhF, RhF
Mitral regurg murmur (4)
Pan systolic murmur
Blowing
Radiates to axilla
Quiet S1
Mitral regurg causes (5)
Collagen disorders
Mitral valve prolapse
Infective endocarditis
Post MI
Rh F
Minor Criteria (4)
Rheumatic fever
raised ESR or CRP
pyrexia
arthralgia (not if arthritis a major criteria)
prolonged PR interval
Rh Fever Dx criteria
Major Criteria (5)
1 major 2 minor or 2 major
Major
Erythema marginatum
Subcutaneous nodules
Sydenhams Chorea
Polyarthritis
Pancarditis
Rheumatic fever bacteria –>
Rx (2)
strep pyogenes
Rx NSAIDs, penicillin V
What is Kussmaul’s sign?
Seen in which condition?
paradoxical rise in JVP during inspiration seen in constrictive pericarditis
1st line management of isolated systolic hypertension
thiazides
Explain the heart sounds
S1 closure of which valves, soft and loud in which valvular disease
S2 closure of which valves, soft in which valvular disease
S3 name two conditions
S4 name three conditions
S1 closure of mitral and tricuspid
soft if mitral regurg
loud in mitral stenosis
S2 closure of aortic and pulmonary valves
soft in aortic stenosis
S3
Heard in dilated cardiomyopathy or constrictive pericarditis.
S4 aortic stenosis, HOCM, HTN
Causes of inverted T waves (6)
- MI
- Dig tox
- SAH
- Arrhythmogenic right ventricular hypertrophy
- PE
- Brugada syndrome
Causes of ST elevation (7)
- MI
- Pericarditis
- Normal variant (high take off)
- Left ventricular aneurysm
- Prinzmetal’s angina
- Takotsubo cardiomyopathy
- SAH
Causes of ST depression (3)
- Ischaemia
- Digoxin
- Hypokalaemia
Causes of prolonged PR (7)
IHD
Dig toxicity
Low K+
Rheumatic fever
Endocarditis
Lyme disease
Sarcoidosis
Increased P wave amplitude =
Bifid P waves
Two causes
Cor pulmonale
Mitral stenosis
Acute hypotension and pulmonary oedema post MI =
Mitral regurg
1st degree heart block
2nd Type 1, type 2 (mobitz I + II)
Third degree
Prolonged PR
Type 1 progressive prolongated PR with dropped QRS
Type 2 long PR, random QRS dropped
Third degree no association
Canon waves JVP in neck
Wide pulse pressure
Regular brady
Complete heart block
NYHA classification
NYHA Class I
no symptoms
no limitation: ordinary physical exercise does not cause undue fatigue, dyspnoea or palpitations
NYHA Class II
mild symptoms
slight limitation of physical activity: comfortable at rest but ordinary activity results in fatigue, palpitations or dyspnoea
NYHA Class III
moderate symptoms
marked limitation of physical activity: comfortable at rest but less than ordinary activity results in symptoms
NYHA Class IV
severe symptoms
unable to carry out any physical activity without discomfort: symptoms of heart failure are present even at rest with increased discomfort with any physical activity
Stress induced, family member dies then develops chest pain and features of heart failure.
Rx apical ballooning of the myocardium
What is Takotsubo cardiomyopathy?
Name four causes of dilated cardiomyopathy
- Cocksackie virus B
- ETOH
- wet Beri Beri
- Doxorubicin
HOCM ECHO findings (3)
- MR
- Systolic anterior motion of the anterior mitral valve (SAM)
- Asymmetrical septal hypertrophy
Which two types of cardiomyopathies are AD?
Mx
HOCM and arrhythmic right ventricular dysplasia
ICD
Statins - when do you increase the dose in the context of primary prevention?
increase the dose if non-HDL has not reduced by >= 40%
Long QT1
Long QT2
Long QT3
Syncope following:
Long QT1 exertional syncope e.g swimming
Long QT2 emotional stress, exercise or auditory stimuli
Long QT3 often at night or at rest
Cause of long QT
SSRIs
TCAs/ terfenadine
Ondansetron
Methadone/ MI/ myocarditis/ macrolides
Amiodarone
Chloroquine, ciprofloxacin
Hypothermia/ haloperidol
Low K, Mg, Ca
Erythromycin
SAH
Sotalol
STOMACHLESS
Long QT can lead to?
Mx (2)
VT or torsade de pintes
BB
ICD if high risk
Choking
First question to ask
How to differentiate between mild and severe
3 steps for mild
If unconscious (2)
- Are you choking? (if responds - mild, otherwise severe)
If mild
1. Encourage patient to cough
2. Five back blows
3. Five abdominal thrusts
Then repeat
If unconscious
1. Call for an ambulance
2. CPR
Stable angina investigations (3)
1st line CT coronary angiography
2nd line myocardial perfusion scan, OR stress ECHO
3rd line invasive coronary angiography
When do you give oxygen with CP?
Sats <94% who are not at risk of hypercapnia
OR
COPD patient aiming sats 88-92%
CP referral
CP within 12 hours with an abnormal ECG
CP 12-72 hours ago
CP >72 hours ago
ED
Refer to hospital for same day assessment
Perform full ECG and troponin
Hypokalaemia ECG findings (5)
U have no Pot and no T, but a long PR and a long QT
And ST depression
U waves, small or absent T waves, long PR, long QT
Digoxin toxicity findings on ECG (4)
Down sloping ST depression
Flattened/ inverted T waves
Short QT
Long PR
Causes of LAD (6)
Left bundle branch block
MI (inferior)
Wolff-Parkinson-White syndrome - right-sided accessory pathway
Hyperkalaemia
Congenital: ostium primum ASD, tricuspid atresia
Obesity
RAD causes (8)
RVH
MI lateral
Chronic lung disease → cor pulmonale
PE
Congenital ostium secundum ASD
Wolff-Parkinson-White syndrome* - left-sided accessory pathway
Normal in infant < 1 years old
Tall people
Coronary territories
Anteroseptal ECG and artery
Anterolateral
Lateral
Inferior
Posterior
V1-V4 LAD
V4-V6, I, aVL LAD or left circumflex
I, aVL +/- V5-V6 Left circumflex
II, III, aVF right coronary
V1-V3 Left circumflex
What can decrease BNP? (5)
Obesity
Diuretics
ACE inhibitors/ ARBs
BB
Aldosterone antag
BNP, NTproBNP
Values of high, raised and normal
High >400, >2000
100-400, 400-2000
<100, <400
Chronic heart failure 1st line investigation
NTproBNP
