Cardiology Flashcards
1
Q
how long do troponin levels stay elevated for
A
7-10days
2
Q
3 ways you can try and rhythm control someone with AF
A
antiarrhythmic agents - sotalol, flecainide, amioderone
electrical cardioversion under anaesthetic
catheter ablation
3
Q
why is pregnancy associated with varicose veins
A
pelvic mass
hormones dilate blood vessels
hyperdynamic circulation
4
Q
4 main causes of heart failure with reduced EF
A
CAD
primary dilated cardiomyopathy
alcohol and thiamine def
HT
5
Q
what is 1st degree heart block
A
when PR interval is >0.2s
6
Q
treatment of tachy-brady syndrome
A
pacemaker then use blocking agents to control rapid heart rates (beta or calcium channel blockers)
7
Q
common causes of VT
A
cardiac ischaemia
cardiomyopathy
8
Q
explain the use of the score of the CHADS-VASC score
A
0 (male) or 1 (female) - no anticoagulant recommended
1 (male) - anticoagulant should be considered
2 - anticoagulant is recommended
9
Q
acute treatment of MI
A
MONASH
M - morphine
O- oxygen
N - Nitrites
A - aspirin
SH - streptokinase/heparin
10
Q
what things put the patient at risk of imminent asystole when they have 3rd degree conduction block
A
very slow rate pauses broad QRS
11
Q
what is lipodermadosclerosis
A
chronic inflammation involving the skin and subcutaneous tissue that tends to scar down (calf swelling and skinny ankle from scar)
12
Q
where is the common site of arterial ulcers
A
distal at toe tips or at pressure areas
13
Q
which heart blocks indicate to put in a pacemaker
A
sinus node dysfunction
symptomatic 2nd or 3rd degree AV block
intermittent 3rd degree AV block
14
Q
ECG pattern of WPW
A
delta waves and short PR interval
15
Q
what is wrong with having WPW
A
can lead to rapid regular tachycardias
16
Q
what ECG changes do you see in a NSTEMI
A
T wave changes ST depression or nothing
17
Q
what can cause unilateral oedema
A
DVT
compression of large veins by tumour or lymph nodes
18
Q
what is the difference between the length of time a patient has to take dual anti-platelet therapy for a bare metal stent vs a drug eluding stent
A
bare metal - 3 months
drug eluding - 1 year
19
Q
what is the effect on the heart of mitral regurg
A
LV eccentric hypertrophy
20
Q
treatment of superficial thrombophlebitis
A
low molecular weight heparin (clexane)
graduated compression stocking
aspirin
simple analgesia
21
Q
main cause of SVT
A
re-entrant circuits within the heart (most common are AV nodal re-entry tachy)
22
Q
what position do you put a patient in if you want to hear a aortic valve murmur better and a mitral valve murmur better
A
aortic - sitting forward and on full expiration
mitral - lateral left position
23
Q
management of a patient with ST elevation
A
urgent angiogram/thrombolysis or PCI
24
Q
what ECG pattern do you get with digoxin
A
AF with “reverse tick”
ST depression and T wave inversion in lateral leads
25
symptoms of aortic stenosis (only when severe)
SAD
S - Syncope
A - angina
D - dypnoea (on exertion)
26
which ECG leads are the inferior leads
II, III and aVF
27
explain murmur with mitral stenosis and what accentuates the murmur
diastolic low-pitched decrescendo murmur best heard at the cardiac apex
- accentuated by left lateral position or exercise
28
explain murmur with HOC and what accentuates the murmur
crescendo-decrescendo systolic murmur best heard at left lower sternal border or apex
- increased intensity during Valsalva
- softer during squatting
29
what are the ECG changes associated with pericarditis
widespread ST elevation - saddle shaped
also see widespread PR depression except for in aVR where you get PR elevation
no reciprocal changes
30
what does a single wave JVP point towards
AF
31
what is Buerger's angle
the angle at which the leg becomes white when elevating the leg (normal \>90 degrees) (severe ischaemia)
32
what does a tapping apex beat imply
mitral stenosis
33
what about the ECG points towards p pulmonale and p mitrale
pulmonale - increased p wave voltages (height)
mitrale - bifid and long p wave
34
in which patients is only fibrinolysis treatment of MI given
dont have PCI facilities when invasive strategies not an option patient has bleeding issues, eg. cerebral bleeds
35
what are the non cardiac causes of troponin rise
anaemia
pulmonary embolism
sepsis
chronic renal disease
36
what things are the most concerning if a patient has syncope
occurred during sitting/lying
occurred during exercise
injury
37
name some causes of extreme right axis deviation
lead transposition
VT
emphysema
hyperkalaemia
paced rhythm
38
what is the ECG effect of hyperkalaemia
tall, peaked T waves with widening of QRS
39
symptoms of AF
- often asymptomatic
- may present with: palpitations, racing heart, irregular pulse, fatigue, light-headedness, increased urination, weakness, dyspnoea, angina, hypotension and presyncope
40
complaints of varicose veins
- cosmetic
- itch
- heaviness/aching
- swelling
- pigment changes
41
action of adenosine in AF
induces transient AV block
42
what xray sign points towards aortic dissection
widened mediastinum
43
what does a high JVP tell you
high RA pressure
44
acute Sx of HT
headache, blurred vision, dizziness, altered mental state, seizure
45
treatment for venous ulcers
elevation
compression
dressing changes
46
LBBB pattern on ECG
W in V1 (often not obvious)
M in V6
inverted T waves in V5-V6, I and aVL
47
what can you do with the patient if you hear a ejection systolic murmur and want to differentiate between HOCM and AS
HOCM - can get the patient to do a Valsalva manoeuvre and listen and left sternal edge
AS - full expiration and listen at the carotids for murmur
48
which type of type 2 conduction block requires immediate treatment
mobitz type 2
49
typical look of AF
irregular irregular rhythm no p waves
50
typical location of ischaemic ulcers
distal periphery over dorsum of foot or pretibia
51
what is the recommended drug combinations for treating HT in someone post MI
ACEI + BB
52
why do you get a patient to chew aspirin instead of swallow it in an acute presentation of MI
during stress --\> splanchnic circulation shuts down --\> absorption through stomach slows down. If you chew it is is absorbed straight away by the buccal mucosa
53
typical look for venous ulcers
- large and irregular edge
- shallow
- moist granulating base
- surrounded by zone of inflammation and stasis dermatitis
54
6 Ps of a threatened limb
pulseless
paraesthesia
paralysis
pallor
pain
poikliothermia - cold
55
symptoms and signs of pericarditis
- central or left side
- sharp, stabbing
- worse on movement
- worse on breathing
- eased by leaning forward!
56
what are the complications of infective endocarditis
mycotic aneurysms
heart failure
embolic complications - stroke, peripheral embolus, splenic infarcts, abscess, pulmonary infarcts, abscess
57
what is the definition of pulsus paradoxus
more than 10 mmHg rise in systolic blood pressure with expiration
58
at what EDP do you start to get pulmonary or systemic congestion
\>20-30mmHg
59
treatment of varicose veins
- reassurance
- compression stocking for relief of pain and swelling
- injection sclerotherapy (if small)
- surgery
- endo-venous methods
60
what are the X ray findings with someone in acute cardiac failure
ABCDE
A - alveolar opacity
B - Kerley B lines
C - cardiomegaly
D - dilated apical blood vessels
E - effusions
61
first line thearpy for infective endocarditis
benzylpenicillin + flucloxacillin + gentamicin
62
treatment of torsade de pointe
treat as VF - DC cardioversion
63
ECG criteria of a pathological Q wave
- \>25% height of the corresponding R wave
- \>40ms width and \>2mm depth
64
how is pericarditis diagnosed
clinical features:
- typical chest pain
- examination: pericardial friction rub, low grade fever, tachy
- suggestive ECG changes
- pericardial effusion
65
explain murmur with tricuspid stenosis
diastolic decrescendo murmur at the left lower sternal border
66
empirical drug treatment of HT
first choice: ACEI (or ARB) or CCB or low dose thiazide s
econd choice: ACEI + CCB or ACEI + thiazide
third choice: ACEI + CCB + thiazide
67
what is the most serious nerve injury that can happen with varicose vein surgery
common peroneal nerve = foot drop
68
two types of venous ultrasound
DVT study
incompetence study
69
management of narrow complex tachycardia
vagal manoeuvres
IV adenosine (warn patient)
IV verapamil
70
treatment of atrial flutter
pretty much the same as AF - easily amenable to ablation
71
What is the CHA2DS2-VASC score for and what does it stand for
to assess the risk of stroke in a patient with AF
C - congestive heart failure (1)
H - hypertension \>140/90 or on medication (1)
A - age \>75 (2)
D - diabetes mellitus (1)
S - previous stroke/TIA/thromboembolism (2)
V - vascular pathology (PAD, MI etc) (1)
A - age 65-74 (1)
SC - sex category (female) - (1)
72
symptoms and signs of pleuritic chest pain
- sharp, stabbing
- localised
- worse on inspiration, coughing
- may be worse on sitting up
- not related to exertion
- dyspnoea, cough, haemoptysis
73
pharmacological approach to CHF with reduced LVEF
diuretics - normalize volume
Start ACEI early
Beta blocks for chronic therapy (after initial stabilisation)
digoxin and nitrates for refractory Sx
74
what does an enlarged, distended and tender liver suggest
right heart failure
75
what causes stable angina
atheroscelrosis causing narrowing --\> ischaemia of the myocardium due to increased myocardial oxygen requirements during physical or emotional stress
76
treatment of pericarditis
NSAIDs
77
which symptoms and sign points towards aortic dissection
pain radiating to the back
sudden onset
BP difference \>20mmHg between arms
78
definition of metabolic syndrome
abdominal obesity + 2 or more of:
- elevated TG
- low HDL
- hypertension
- hyperglycaemia
79
explain murmur with tricuspid regurgitation and what accentuates the murmur
pan-systolic murmur at the left 4th costal cartilage with radiation to left upper sternal border
- accentuated by inspiration
80
how do you diagnose STEMI
chest pain PLUS
- 1mm ST elevation in II, III and aVF
- 2mm in precordial leads
- new LBBB (may be reciprocal ST depression in other leads)
81
RBBB pattern on ECG
M in V1
W in V6
inverted T waves in V2-3
slurred S wave in V6
82
what is the concern about long QT interval
can predispose to torsades de pointe
83
what does hameosiderin staining in the legs point to
chronic venous hypertension
84
what signs (if any) could you see on a normal ECG with a posterior infarct of the heart
V1-V3 ST depression
85
what are the class 1 indications for a pacemaker
- sinus node dysfunction
- symptomatic 2nd or 3rd degree AV block
- intermittent 3rd degree AV block
86
what does a pulsatile liver indicate
Tricuspid regurgitation
87
what does a large v wave of JVP suggest
tricuspid regurgitation
88
how does digoxin work
promotes the effects of vagal stimulation to the AV node
89
what is the ECG effect of hypokalaemia
flattening of T waves, with U waves
90
what does a palpable P2 imply
Pulmonary HT
91
which ECG signs do you see with right axis deviation
- R wave predominant in V1
- lead I predominantly negative
- lead III - predominantly positive
- inverted T waves in right praecordial leads
- deep S in V6 (peaked p waves may also occur in right atrial hypertrophy)
92
associated symptoms of AMI
dyspnoea, syncope, diaphoresis, nausea, vomiting, palpitations
93
what is the consequence of lipodermadosclerosis
prone to ulceration
94
what is the recommended drug combinations for treating HT in someone in heart failure or post stroke
ACEI + thiazide
95
clinical features of Rheumatic fever
fever
arthritis over large joints
rash - erythema marginatum
subcutaneous nodules over bones, tendons
murmur
sydenham's chorea
96
What is the HAS-BLED score used for and what does it stand for
to assess bleeding risk when considering putting patient on medication for AF
## Footnote
H - Hypertension (\>160/90 or on Rx) (1)
A - Abnormal renal and liver function (1 point each)
S - Stroke (previous)
B - Bleeding (prior major bleeding) (1)
L - Labile INRs (1)
E - elderly (\>65) (1)
D - drugs predisposing to bleeding or alcohol (\>8) (1 point each)
97
how do you distinguish between angina and a NSTEMI
NSTEMI - will show troponin rise ECG can show ST depression
98
treatment of 1st degree heart block
in isolation - doesnt need treatment
99
presentation of superficial thrombophlebitis
acutely localised tender ropey hard veins with localised erythema
100
why can you get chest pain with AF
due to subendocardial ischaemia (due to reduced diastolic filling time and reduced oxygen supply to myocardium)
101
explain murmur with pulmonary stenosis and what accentuates the murmur
crescendo-decrescendo murmur best heard at the left 2nd intercostal space with systolic ejection click
- accentuated by inspiration
102
what are the main types of complications after AMI
ischaemic
mechanical
arrhythmic
embolic
inflammatory
103
is infectious pericarditis most commonly caused by viruses, bacteria or mycobacteria?
viruses
104
normal EF
50%
105
what ECG signs do you get in someone with a past MI
q waves
t wave inversion
sometimes persistent ST elevation
106
difference between stable and unstable angina
stable - pain only comes on with exercise/stress and relieved by rest unstable - new onset pain or pain at rest, or pain at lower levels of exercise
107
what are some peripheral signs of infective endocarditis
splinter haemorrhages
Osler's nodes
Janeway lesions
108
signs of Aortic regurgitation
collapsing pulse (Waterhammer pulse)
wide pulse pressure
early diastolic murmur
Corrigans pulsation (carotid)
fingernail capillary pulsation
LVH - displaced apex beat
109
suspect infective endocarditis in which clinical presentation
new regurgitant murmur
embolic events of unknown origin
sepsis of unknown origin
fever
110
which two conditions other than VT can prolong the QRS interval
hyperkalaemia
BBB
111
what is a positive Beurger's sign
dependent rubor when dropping the leg down below side of bed
112
what causes Rheumatic heart disease
immune response to Strep pyogenes (group A beta haemolytic strep) - antibody cross-reactivity (type 2 HS)
113
what causes the pigment changes with varicose veins
red cells leaking out of the blood vessels due to venous stasis --\> into the tissues --\> breakdown --\> haemosiderin deposition
114
major Duke criteria for infective endocarditis
positive blood cultures
evidence of IE on echo
115
what causes atrial flutter
large re-entrant pathway in the atrium
116
when should you think to test for adrenal causes of HT
- unprovoked, unexplained hypokalaemia
- diuretic induced hypokalaemia, resistent to correction
- family Hx of aldosteronism
- reistant HT
117
what is superficial thrombophlebitis
thrombosis in the superficial veins
118
where is the typical area for ulceration with varicose veins
in the gaiter area (lower half of the calf, typically on the medial aspect down towards the medial malleolus)
119
Tx for STEMI vs NSTEMI
both get MONA
STEMI --\> PCI or thrombolysis, 2nd antiplatelet agent and anticoagulate til PCI
NSTEMI --\> thrombolysis is contraindicated! Load 2nd antiplatelet agent, anticoagulate and ?PCI in a few days
120
typical look of ischaemic ulcers
- punch out edges
- base shows poorly developed gray granulation tissue
- surrounding skin is pale or mottled with no signs of inflammation
- little bleeding when debrided
121
risk factors for PE
travel
OCP
malignancy
surgery
long periods of immobility
steroids
family history of coagulopathy
factor 5 leiden deficiency
122
4 causes of oedema
increased venous pressure
decreased osmotic pressure
blocked lymphatics
increased capillary permeability
123
which 6 things can precipitate heart failure
anaemia
thyroid problems
infection
arrhythmia
non-compliance ischaemia
124
symptoms of venous insufficiency
leg ache, heaviness, fatigue at the end of the day leg elevation helps
125
what can cause non-pitting oedema
hypothyroidism
lymphoedema
126
definition of AMI
requires 2 out of the 3:
- symptoms of MI
- elevation of cardiac markers (troponin or CK)
- typical ECG pattern
127
what is the Adson's test
elevation, abduction and external rotation of the left and and turning head to opposite side - causes disappearance of the radial pulse
128
if AF is slow (50-60) what does it point to
significant conduction problems
129
normal atrial flutter "rate"
300bpm
130
examination findings in someone with coarctation of the aorta
high BP in upper body and low BP in lower body
radio-femoral delay
absent femoral pulses
loud systolic murmur heard over back
131
other causes of ST segment changes other than MI/ischaemia
pericarditis
LV hypertrophy with "strain" pattern
Drugs
132
which type of murmur will inspiration make louder
pulmonary and tricuspid (right sided murmurs)
133
treatment for vasovagal syncope
increase fluid intake (\>2L/day)
avoid predisposing factors
dynamic manoeuvres
increase salt intake
134
what is the cut off points for abdominal obesity
europoids:
- M: \>94cm
- F: \>80cm
south asia and chinese
- M: \>90cm
- F: \>80cm
135
what is a "significant" drop in BP with standing
\>20mmHg
136
management of aortic regurgitation
echo every 6-12 months for severe AR
- when echo indicates early LV decompensation --\> operation for valve replacement/repair
137
in which leads are inverted t waves normal
avR, V1 (sometimes V-12), III
138
what does a double impulse apex beat imply
hypertrophic obstructive cardiomyopathy (HOCM)
139
treatment of pericarditis
pain relief - NSAIDs, steroids, opiods
colchicine if recurrent episodes
treatment of underlying condiiton
140
route of short saphenous vein
lateral dorsal venous arch --\> posterior calf --\> popliteal vein
141
examination findings for atrial flutter
- regular pulse/heart sounds
- often tachycardia
- higher degree of conduction block at the AV node
142
signs of Mitral regurg
pansystolic murmur radiating to the axilla
louder on full expiration
143
what does a parasternal heave imply
RV volume enlargement
144
2 main superficial veins of the eleg
great saphenous vein
short saphenous vein
145
what is the advantage of CK levels over troponin
levels fall quickly - so can pick up subsequent MI after initial one (unlike troponins which will still be elevated)
146
explain what the precordial leads look at
V1, V2 = anterior RV
V3, V4 = anterior septum
V5, V6 = anterior LV
147
in which subset of people is rheumatic fever common in
children aged 6-15 years
148
complications of aortic dissection
vascular - stroke, tamponade, dissection of coronaries (STEMI)
149
what is 3rd degree heart block
where there is complete dissociation of the QRS from the p wave
150
a pathological Q wave is a marker of
established full thickness death of myocardium (needs to be in more than 1 adjacent lead)
151
cause of S3
turbulence during early filling of the ventricle
152
what is the most effective drug treatment for HT in people with diabetes or lipid abnormalities
ACEI + CCB
153
what is Mobitz II heart block
intermittently block P waves
154
how can you tell there is LVH on ECG
- sum of S waves in V1/V2 and R in V5 or V6 \> 35mm
- R in aVL \>11mm
155
consequences of varicose veins
ulceration
lipodermadosclerosis
superficial thrombophlebitis
bleeding
156
AF is associated with increased risk of...
embolic stroke
157
which valvular diseases cause volume loads and which cause pressure loads
volume - aortic and mitral regurg
pressure - aortic and mitral stenosis
158
main mechanical complications of AMI
- heart failure
- cardiogenic shock
- mitral valve dysfunction
- aneurysms
- cardiac rupture
159
what are the signs of venous insufficiency
haemosiderin deposits
venous eczema
venous ulceration and healed scars
lipodermatosclerosis
varicosities
brawny oedema - skin look tight and thick
160
what is WPW
where there is an accessory pathway that bypasses the AV node leading to earlier excitation of the ventricle
161
normal SV
70ml
162
common community drugs that can elevate blood pressure
NSAIDs
OCP
oral decongenstants
163
what is Mobitz type 1 /Wenckbach heart block
when there is progressive lengthening of the PR interval until there is no QRS complex and then cycle restarts
164
tests for heart failure
ECG
Chest xray
transthoracic echo
BNP
165
heart failure Sx
SOB - on exertion,
orthopnoea,
PND
peripheral oedema
ascites
fatigue
cachexia
166
treatment of heart failure with preserved LVEF
no proven therapies
- treat underlying conditions
- diuretics for Sx
167
what is the ECG sign of cardiac tamponade
electrical alternans - small voltage then large voltage alternating
168
treatment of acute heart failure
LMNOP
Lasix (frusemide)
morphine
nitrates
oxygen
positioning (done in reverse order)
169
what tests are useful to assess valvular disease
TTE
trans-oesophageal echo - particularly good at assessing posterior structures
coronary angiogram/right heart catheter
170
symptoms of abdominal aorta and iliac arterial vascular disease
pain in buttocks, legs and impotence
171
When do you start anti-HT Rx straight away (without further confirmatory tests)?
evidence of:
- end organ damage
- associated conditions (CV disease, diabetes, renal disease)
- High CV risk
- Grade 3 HT
- isolated systolic HT
172
complications of surgery for varicose veins and how to prevent
DVT - give clexane for 24 hours
infection - give prophylactic AB
nerve injury
recurrent varicose veins
173
explain the look of venous ulcers
in the "gaiter area" tend to bleed especially if traumatised dark haemosiderin staining
174
explain the look of ischaemic ulcers (arterial insufficiency)
punched out, well defined borders little erythema unless infected located in toes
175
normal PR interval
less than 0.2 s
176
when should you suspect phaeochromocytoma
markedly variable BP
paroxysmal symptoms
177
cause of S4
turbulence during atrial contraction caused by stiff ventricle
178
minor criteria for Duke's criteria of infective endocarditis
predisposing conditions (abnormal heart valve, IVDU etc)
fever
vascular phenomenon
immunological phenomenon
positive blood culture but not meeting major criteria
179
name some causes of right axis deviation
- normal in children and tall thin adults
- RV volume/pressure overload (ASD, VSD, pulm embolus, RV hypertrophy)
- lung pathology
- WPW
- dextrocardia
180
what else can you do to treat AF if pharmacological Tx not working
DC cardioversion
ablation
181
explain murmur and pulse with patent ductus arteriosus
continuous murmur radiating to the back with collapsing pulse
182
what examination signs will you get with aortic stenosis
plateau pulse of carotids
heaving apex beat
thrill over upper R sternal edge
crescendo-decrescendo murmur heard loudest in full expiration at the RUSE and radiating to the carotids
183
signs of mitral stenosis
in severe:
- mitral facies
- tapping apex beat
- loud S1
- diastolic rumbling murmur
184
what does a JVP that rises with inspiration point towards
constrictive pericarditis (Kussmaul's sign)
185
pharmacological treatment for rate or rhythm control for AF
rate - beta blockers, CCB, digoxin
rhythm - amiodarone, flecainide
186
mneumonia for infective endocarditis
FROM JANE
F - fever
R - Roth's spots
O - Osler's nodes
M - murmur
J - Janeway lesions
A - Anaemia
N - nail bed haemorrhages
E - Emboli
187
are pharmacological or lifestyle changes more effective in preventing diabetes
LIFESTYLE
188
which leads are left looking
I, II, avL
189
associated JVP with tricuspid stenosis
dominant a wave with slow y descent of JVP
190
associated clinical signs of tricuspid regurgitation
dominant v wave of JVP
pulsatile liver
191
in which lead is a Q wave normal
III
192
what is the "strain" pattern with LVH
ST segment depression with T wave inversion in V5-6 and 1 and avL
193
you do the hepatojugular reflex and the JVP stays elevated... what does this suggest
heart failure
194
what do you think of if you find elevated creatinine in someone taking ACEI
bilateral renal stenosis
195
what are the cardiac, vascular and respiratory causes of chest pain
cardiac - AMI, unstable angina, percarditis
vascular - aortic dissection
respiratory - PE, pneumonia, pneumothorax, pleurisy
196
signs of arterial insufficiency
atrophic muscle, skin (shiny, dry, red) punched out ulcers/gangrene
197
management of rheumatic fever
ABs
NSAIDs long term
AB prophylaxis
198
what is the average rate of depolarisation of the AV node (not depolarised by the SA node)
50-60bpm
199
treatment for bleeding varicose veis
ELEVATION then pressure bandage compression stocking
200
what ECG pattern do you get with pericarditis
ST elevation in all precordial leads and Lead 1 also can get PR depression
201
what is the difference between primary and secondary varicose veins
primary = affecting superficial veins or perforators in the absence of deep incompetence
secondary = associated with deep venous incompetence from recanalization of previous DVT. Or venous obstruction
202
typical location of neuropathic ulcerrs
pressure points or calluses
203
what should you do if you hear a murmur in the aortic area
sit the patient forward and get the patient to expire and hold their breath
- listen at the left sternal edge (aortic regurg) and then aortic area (aortic stenosis)
204
end organ damage caused by hypertension
stroke, intracerebral haemorrhage LVH, CHF, CAD Renal failure, proteinuria peripheral vascular disease, retinopathy
205
what is the effect on the heart of mitral stenosis
LA enlargement
206
when do you use dobutamine stress echo
in patients who cannot exercise
207
what is the echo sign of cardiac tamponade
ventricular interdependence
208
treatment of VT
DC reversion in unconscious
can try amiodarone as a bolus if conscious
209
you cannot perform a stress ECG on a patient with which ECG signs
LBBB
WPW
paced rhythm - less reliable with LVH, digitalis effect
210
clinical signs of HOCM
diffuse, foceful apex beat
Ejection systolic murmur best heard at the left sternal edge/apex that increases with the Valsalva manoeuvre
211
management of mitral regurg
echo every 6-12 months if severe surgery for replacement/repair when:
- echo shows decompensation of LV
- pulmonary hypertension
212
causes of secondary hypertension
renal artery stenosis
adrenal - Cushings, hyperaldosteronism phaeochromocytoma
coarctation of the aorta
sleep apnoea
213
what does a diffuse and hyperkinetic apex beat suggest
volume overloaded heart
214
management of aortic stenosis
mild-moderate with no symptoms = observe
severe AS + symptoms = replace valve
215
do not use a CV risk calculator in patients with:
existing CVD
strong family history of premature cardiovascular disease
patients with renal disease (should be treated)
