Cardiology Flashcards
diagnostic criteria for acute MI
rise in troponin or CK-MB
with at least one of the following:
1. typical MI symptoms (retrosternal/arm pain, diaphoresis, SOB etc)
2. development of pathological Q waves on ECG
3. ECG changes indicative of ischaemia (ST-elevation of depression)
4. coronary artery intervention
OR pathological findings of an acute MI
when do you do troponins to rule out acute MI
one at presentation and one 6 hours after presentation, if pain/symptoms started within 2 hours of presentation.
how long does troponin T stay elevated for?
10-14 days (so if someone comes in with chest pain 6 days after an MI, dont bother doing troponin T, do CK-MB)
how long does CK-MB stay elevated for after acute MI
2-3days
acute management of MI
aspirin
oxygen?
if not hypotensive give metoprolol (decrease myocardial oxygen demand)
GTN and IV morphine as required
transfer to regional centre for PCI if not already there
continuous cardiac monitoring/telemetry/serial ECGs
acceptable time for PCI to be administered
90min since presentation as long as onset of symptoms within 2 hours of presentation.
if not possible: benefit might > risk up to 12 hours from symptom onset.
what troponin forms are used for determining myocardial ischaemia
I and T
man comes in with sx of acute MI, he has a positive troponin T, at what time is it appropriate to repeat the troponin.
never. don’t repeat if positive result –> organise PCI
when is CK-MB more useful than troponin T
when recent MI (3-10 days ago)
what ECG features confirm STEMI
>1mm ST-segment elevation in > or = 2 anatomically contiguous LIMB leads or >2mm " contiguous chest leads or new LBBB
when would you do CABG instead of PCI/thrombolysis in patients with STEMI
- not suitable for PCI/thrombolysis
- cardiogenic shock
- in conjunction with mechanical repair (e.g. ruptured papillary muscle or ventricular septal defect)
what complications of MI cause the highest mortality
VF or sustained VT
ventricular free wall rupture –> tamponade has high mortality within seconds but is far less common
if someone has an ACS and present to hospital. what meds should you discharge them with?
aspirin +/- clopidogrel betablocker (metoprolol) ACEi Statin GTN spray PRN
medical mx for pulmonary oedema
morphine
loop diuretics
nitrates
mechanical mx for pulmonary oedema
BiPAP/CPAP
intubation
definition of systolic heart failure
LVEF <40 %
Definition of diastolic heart failure
impaired LV relaxation and normal/preserved LV function (>40% LVEF)
which Beta-blockers have been shown to prolong survival in patients with CHF?
carvedilol
bisoprolol
extended-release metoprolol
standard medical long-term therapy for CHF
ACEi
Beta blocker
Loop diuretic (frusemide)
if someone is unable to do EST because they cannot run on a treadmill, what other test can you do?
dobutamine stress test
when would you expect to find pulsus paradoxus
severe asthma
pericardial constriction
cardiac tamponade
what is pulsus paradoxus
systolic pressure weakening in inspiration by >10mmHg
when do you get a slow rising pulse
aortic stenosis
when do you get a waterhammer or collapsing pulse
aortic incompetence, AV malformations and patent ductus arteriosus
when do you get a bounding pulse
CO2 retention, liver failure and sepsis
what characteristic of a pulse could you expect in HCM?
jerky pulses
