Cardiology Flashcards
Pericarditis - define, presentation, ECG, treatment
Pericarditis - inflammation of pericardium, usually secondary to a viral infection
Presentation- produces characteristic retrosternal pleuritic chest pain worsened lying flat and relieved by sitting forward. Often associated with pericardial friction rub and/or pericardial effusion.
ECG - widespread ST elevation due to involvement of underlying epicardium (irritation) and can have some PR depression.
Treatment is symptomatic - NSAIDs with pericardiocentesis if underlying effusion. More severe cases may require steroid therapy
CHAD VASc
CHAD VASc - scoring system for commencing anticoagulant therapy
Dressler’s syndrome - definition and treatment
Definitions - autoimmune pericarditis presenting 4-6 weeks after an MI.
Treatment - NSAIDs and pericardiocentesis if required
Aortic dissection - definition and difference between Type A and Type B
Definition - separation of the layers within the aortic root
Type A - ascending dissection, surgical emergency
Type B - non-ascending dissections, conservative or surgical management
Myocardial hibernation - definition and investigation
Chronic but potentially reversible cardiac dysfunction (pump function) caused by chronic myocardial ischaemia, persists until blood flow is restored. The myocardium is still viable.
Stress echo (pharmacological - dobutamine) used to test hibernation and determine myocardial viability (on stimulation, ejection fraction will increase)
Myocardial stunning
Temporary cardiac dysfunction due to brief episode of ischaemia. Persists for a small period after but will regain function.
Unstable angina
Syndrome in which symptoms of coronary artery disease and ischaemia heart disease increase in frequency and occur with less physical activity or at rest, last longer and become more severe
NSTEMI
non-ST elevated myocardial infarction, same constellation of symptoms as unstable angina however will have RAISED TROPONIN T/I
STEMI
ST elevated myocardial infarction caused by complete occlusion of the coronary artery
ACS
Acute Coronary Syndrome, a collection of ischaemia conditions which occur through coronary plaque rapture. Includes: unstable angina and MI (STEMI and NSTEMI)
Filling pressure
the pressure needed to fill the chambers of the heart. Low filling pressures are better as it means the heart is correctly emptying during systole to allow low pressure filling in diastole
Properties of myocytes (4)
Contractility
Electrical conductivity
Pacemaker ability
Refractory period
Acute management of STEMI
1) ABC approach
2) O2 (15L non rebreather) if low sats
3) Aspirin 300mg P.O.
4) Morphine (5-10mg) IV with metoclopramide (10mg) IV
5) GTN spray
6) Primary PCI
Acute management of NSTEMI
1) ABC approach
2) O2 (15L non rebreather) if low sats
3) Aspirin 300mg P.O.
4) Morphine (5-10mg) IV with metoclopramide (10mg) IV
5) GTN spray
6) Clopidogrel (300 mg) PO and LMWH (enoxaparin) (1mg/kg) BD SC
7) b blocker (atenolol 5mg P.O.)
Acute management of LVF
1) ABC approach
2) O2 (15L non rebreather)
3) SIT PATIENT UP
4) Morphine (5-10mg) IV with metoclopramide (10mg) IV
5) GTN spray
6) Furosemide (40-80 mg) IV
Initial management of adult tachycardia
1) ABC approach
2) O2 (15L non rebreather) if low sats
3) IV access (2x large bore cannulae)
4) Monitor - ECG, BP, SpO2, 12-lead ECG
5) Identify and treat reversible causes
Acute management of stable broad complex adult tachycardia patient
1) Initiate basic management of tachycardia (ABC, O2, IV access, monitor)
2) Determine if regular or irregular rhythm
Irregular = AF with BBB or Polymorphic VT
A - seek expert help
B - if in AF, rate control (b-blocker or diltiazem)
B - if polymorphic, give magnesium (2g) IV
Regular = VT
A - amiodarone (300 mg) IV over 20 - 60 min
B - amiodarone (900 mg) IV over 24 hours
Acute management of stable narrow complex adult tachycardia patient
1) Initiate basic management of tachycardia (ABC, O2, IV access, monitor)
2) Determine if regular or irregular rhythm
Irregular rhythm = fast AF
A - rate control with b-blocker or diltiazem
B - if HF + digoxin or amiodarone
Regular rhythm
A - vagal manoeuvres
B - adenosine (6mg) IV bolus (repeat 2x if nec with 12 mg)
C - continuous ECG monitoring
Acute management of the unstable adult tachycardia patient (i.e. presence of shock / syncope / myocardial ischaemia / HF)
1) Initiate basic management of tachycardia (ABC, O2, IV access, monitor)
2) Synchronised DC shock - up to 3 attempts
3) Amiodarone (300 mg) IV over 10-20 mins
4) Repeat shock
5) Amiodarone (900 mg) IV over 24 hours
Outline the hypertension management guidelines in patients < 55 years old
1) ACEi (or ARB if not tolerated) - eg: lisinopril 10mg OD (or candesartan 8mg)
2) + CCB - eg: nifedipine 30 mg OD
3) + Diuretic (thiazide-like) - eg: indapmide
4) Refer to expert - can add b-blocker
Outline the hypertension management guidelines in patients > 55 years old (or afro-carribean)
1) CCB (or thiazide-like if not tolerated) - eg: nifedipine 30 mg OD (or indapimide)
2) + ACEi (or ARB if not tolerated) - eg: lisinopril 10mg OD (or candesartan 8mg)
3) + Diuretic (thiazide-like) - eg: indapimide
4) Refer to expert - can add b-blocker
Outline the stepwise management of chronic heart failure
1) ACEi (lisinopril 2.5mg) + B-blocker (bisoprolol 2.5mg)
2) + ARB (candesartan 4mg)
3) + Hydralazine (25 mg 8-hourly) + isosorbide mononitrate (20 mg 8-hourly)
4) + Spironolactone (25 mg)
5) Digoxin
6) Surgical intervention
In the management of AF, which patients should be anticogulated and with which drug?
AF + CHAD VASc 0 = nil or aspirin 75 mg OD
AF + CHAD VASc 1 = aspirin (75 mg) or warfarin (INR 2.5)
AF + CHAD VASc 2 = warfarin (INR 2.5)
What are the two methods of rhythm control in AF patients?
Electrical - synchronised cardioversion
Pharmacological - amiodarone 5mg/kg IV over 20-120 mins
What are the drugs used to rate control AF patients?
1) B-blocker (propranolol 10mg 6-hourly)
OR
1) CCB (diltiazem 120mg)
2) Digoxin (if required or both above are CI)
At what HR should AF patients be rate controlled?
90 bpm
Outline the stepwise management of stable angina?
1) GTN spray PRN
2) Secondary prevention: aspirin, statin, lifestyle modification
3) B-blocker (or CCB if CI)
4) + CCB (or nitrate - ISMN)
5) Refer for CABG
List some of the cardiac conditions that can be treated with ACEi (or ARBs)
HF
HTN
Post-MI
Angina
List some of the cardiac conditions that can be treated with B-blockers
Angina HF (not severe) Acute MI Arrhythmias HTN Long QT
List some of the Duckett Jones criteria for the diagnosis acute rheumatic fever diagnosis (HINT: think CASES)
Carditis Arthritis Subcutaneous nodules Erythema marginatum Sydenhams chorea
What is erythema marginatum?
A rash that appears, usually in young people, following a sore throat (6 weeks previously)
It is associated with acute rheumatic fever
What signs would you expect to see in a patient with mitral stenosis?
Pulse: irregularly irregular pulse (AF)
Face: malar rash
Chest: loud S1, mid diastolic murmur (mitral stenosis)
List some of the causes of AF (HINT: think PIRATES)
Pulmonary (PE, COPD)
Idiopathic/ Iatrogenic/Infarction/Infection
Rheumatic heart disease and mitRal Regurgitation
Alcohol / Anaemia
Thyrotoxicosis
Electrolytes/Endocarditits
Sepsis/Stimulants
What are the signs of PE on ECG? (HINT: think S1Q3T3)
The most common finding is an NORMAL ECG
Otherwise -
• Sinus tachycardia
• Right ventricular strain – Q waves (V3) inverted T waves (V3)
Define bradycardia
HR < 60 bpm
List the causes of bradycardia (HINT: think DIVISIONS)
Drugs
Ischaemia
Vagal hypotonoia (eg: syncope, athletes)
Infection (eg: infective endocarditis, rheumatic fever)
Sick sinus syndrome
Infiltration (amyloid, autoimmume, sarcoid)
O - hypOthyroid, hypOkalaemia, hypOthermia
Neurology - increased ICP
Surgery (catheterisation)
Name some of the drugs that can cause bradycardia (HINT: think ABCD)
Antiarrhythmics (amiodarone)
B-blockers
CCB (verapamil)
Digoxin
List some of the symptoms / presentations of rheumatic fever (HINT: think PASES)
Pancarditis - pericarditis, myocarditis, endocarditis Arthritis Subcutaneous nodules Erythema marginatum Sydenham's chorea
