Cardiology Flashcards
Give two causes of a midline sternotomy scar
Open valve replacement CABG
What are the two causes of an irregularly irregular heartbeat and how can you differentiate between them?
AF and multiple ventricular ectopics Ventricular ectopics disappear with exercise
How can you assess whether AF is well controlled?
Time apical rate,
What is a pulse deficit?
As rate increases diastolic filling time is reduced, so may be insufficient cardiac output but enough blood to move valve (heart sound) “loss of diastolic filling times with fast ventricular rates”
What are the dangers of AF?
Loss of atrial contraction reduces cardiac output - can trigger heart failure Stagnation of blood can cause thrombus formation causing stroke
What INR do you aim for in someone with AF?
2-3
What INR do you aim for in someone with a mechanical valve?
3-4
CHADS2VASC Score - use and management
Stroke Age 65-74 Diabetes Cardiac Failure Hypertension Age 75 or over Vascular History Sex female 1 = moderate, 2 or above = high
How do you differentiate between an MI and angina?
Pain is less severe and
What do Q waves on an ECG showing MI suggest?
Full thickness transmural infarct
Complications of an MI?
Sudden death Pump failure Aneurysm/arrhythmia Rupture of papillary muscle Embolism Dresslers
ECG changes in hyperkalaemia
flat P wave broad bizarre QRS slurring into ST segment tall tented T waves
What does this ECG suggest and why?
A posterior MI due to :
Horizontal ST depression in V1-3
Tall, broad R waves (> 30ms) in V2-3
Dominant R wave (R/S ratio > 1) in V2
Upright T waves in V2-3
When do you rhythm control in AF?
New onset
<65
no structural heart disease - lone AF
underlying causes resolved
heart failure/angina/heart disease worsened by AF
Contraindications to rhythm control in AF
structural heart disease
previously failed and keep reverting back into AF
AF >12 months
What does CHADSVASc actually calculate?
The risk of having a stroke if you have AF
Offer anticoagulation if 2 or above
What does HASBLED actually calculate?
Your risk of having a bleed if you’re anticoagulated
When can you D/C cardiovert people in AF without anticoagulating first?
<48h
If not need 3w anticoagulation
If someone in AF has structural heart disease, what should you use to cardiovert them?
Amiodarone
What do you use for cardioversion/ rhythm control for someone in AF w/ NO structural heart disease?
Amiodarone or Flecanide
Innocent murmurs
Soft
Systolic
LSE
ASymptomatic
Stills
Post MI, what medication should you be on?
ACEi
Beta
Clopi + aspirin
Statin
