Cardiology Flashcards
What are the causes of ST elevation?
Myocardial infarction
Pericarditis (saddle-shaped)
Normal variant (high take off)
Left ventricular aneurysm (persistent after MI)
Prinzmetal’s angina (Coronary artery spasm)
Rarely: Subarachnoid Haemorrhage
What are the causes of peaked T waves?
Myocardial ischaemia (Acute ischaemic change) Hyperkalaemia
What are some causes of inverted T waves?
Myocardial ischaemia Digoxin toxicity Subarachnoid haemorrhage (Deep) Arrhymogenic right ventricular cardiomopathy Brugada syndrome.
Causes of a prolonged PR interval?
Idiopathic (athletes) Ischaemic heart disease Digoxin toxicity Hypokalaemia Rheumatic fever Aortic root pathology Lyme disease Sarcoidosis Myotonic dystrophy
What is the criteria defining Stage 1 hypertension?
Clinic BP >140/90mmHg and subsequent ABPM or HBPM average BP >135/85mmHg
What is the criteria defining Stage 2 hypertension?
Clinc BP >160/100mmHg and subsequent ABPM or HBPM average BP >150/95mmHg
What is the criteria defining severe hypertension?
Clinic systolic BP>180mmHg or Clinic diastolic >110mmHg
Describe Atrial Fibrillation, it’s causes, signs and tests, and management
A chaotic irregular atrial rhythm with variable AV response causing an irregularly irregular pulse. May be split into fast and slow AF, Fast AF more than 100bpm, Slow considered less than 60bpm.
Causes: heart failure/ischaemia, IHD, MI, PE, Mitral Valve disease, pneumonia, hyperthyroidism, caffeine, alcohol, hypokalaemia, hypomagnesia
Symptoms: may be none or chest pain, palpitations, dyspnoea, faintness. May be acute, chronic or paroxysmal
Tests: ECG shows absent p waves and irregular QRS complexes. Blood tests; U+E, Troponin, TFTs to look for underlying cause, CXR
Management:
- haemodynamically unstable AF requires immediate DC cardioversion, if prolonged AF (more than 48h) TOE is needed to confirm that there is no evidence of left atrium thrombus.
- Haemodynamically stable, can be rate or rhythm controlled, younger patients or reversible causes should opt for rhythm control, elderly patients with chronic AF should opt for rate control
- Rate control includes beta-blocker (metoprolol, bisoprolol), or rate-limiting Ca-blocker e.g. Verapamil, diltiazem failing this digoxin can be used
- rhythm control, try amiodarone, or sotalol, if persisting for more than 48hr anticoagulation 3wks and cardioversion,
- paroxysmal AF can be dealt with pill in the pocket with flecainide or sotalol.
- Anticoagulation should be initiated in chronic and paroxysmal AF
Describe the CHADS-VASc score
Score of 1 or more consider oral anticoagulation, 2 or more warfarin.
C ongestive cardiac failure H ypertension A ge >75 (2 points) D iabetes S troke (2 points) V ascular disease A ge >65 Sc - Sex catergory female
Describe the HAAS-BLED score
Score of 3 or more indicates high risk of bleeding and alternatives to anticoagulation should be considered
H ypertension A lcohol abuse A bnormal renal or liver function S troke B leeding disorder or previous major bleed L abile INR E lderly >65 D rug abuse
What is a bounding pulse a sign of?
CO2 Retention, liver failure, sepsis
What is a small volume pulse a sign of?
Aortic stenosis, shock, pericardial effusion
What is a collapsing pulse a sign of?
Aortic regurgitation, AV malformation, patent ductus arteriosus
What is a slow rising pulse a sign of?
Aortic stenosis
What is a bisferiens pulse a sign of?
Combined Aortic stenosis and regurgitation
What is pulsus alternans a sign of?
suggests LVF, cardiomyopathy or aortic stenosis
What is a jerky pulse a sign of?
HOCM
What is pulsus paradoxus and what is it a sign of?
Systolic pressure drop in inspiration >10mmHg occurs in severe asthma, constrictive pericarditis or cardiac tamponade.
Describe the 1st heart sound (S1)
S1 represents the closure or mitral (M1) and tricuspid (T1) valves. splitting in inspiration may be heard and is normal.
What is a loud S1 a sign of?
Mitral stenosis
What is a soft S1 a sign of?
occurs if PR interval prolonged or mitral valve incompetent e.g. mitral regurgitation
Describe the 2nd heart sound S2
S2 represents the closure of the aortic (A2) and pulmonary (P2) valves.
What is a soft A2 a sign of?
aortic stenosis
What is a loud P2 a sign of?
Pulmonary hypertension