cardiology Flashcards
1
Q
pathophysiology of TGA
A
ductus arterioles is closing/has closed so pulmonary circulation supplied systemic organs causing cyanosis
2
Q
CXR of TGA
A
egg shadow and increased pulmonary vascular markings with narrow pedicle
3
Q
treatment of TGA
A
prostaglandin E2 keep DA open until surgery (an arterial switch procedure)
4
Q
risk factors of coarctation of aorta
A
turners 45XO, male, bicuspid aorta, PKD, NFM-1
5
Q
what is coartation of aorta
A
congenital narrowing of the aorta usually just distal to origin of left subclavian around DA
6
Q
symptoms of coarctation of aorta
A
reduced blood pressure distal to coarctation and increased BP proximal
therefore HTN in upper limbs and weak femoral pulses so radiofemoral delay and higher BP in right arm compared to left
systolic murmur over left scapula
notching of inferior borders of ribs inn adults due to intercostal HTN
HF in infancy
7
Q
investigations of coarctation or aorta
A
4 limb BP CXR = rib notching ECG = LV strain CT angiogram ECHO and doppler
8
Q
treatment of coarctation of aorta in sick neonate
A
IV prostaglandins
fluids and furosemide
ventilation
9
Q
treatment of coarctation in adult
A
balloon dilation and stunting, BB for HTN
10
Q
symptoms of bicuspid aortic valve
A
no problems at birth but leads to stenosis and regurgitation and predisposed to IE
11
Q
causes of PDA
A
premature
12
Q
symptoms of PDA
A
machine like constant murmur at left subclavian due to shifting blood
wide pulse pressure with bounding and collapsing pulse
13
Q
treatment of PDA
A
NSAIDS or IV indomethacin which are cyclooxgenase inhibitors to promote PDA closure
if this doesn’t close, give prostaglandins and surgery by 6 months
14
Q
symptoms of VSD
A
small = LOUD pan systolic murmur at LSE large = quieter, and pulmonary HTN
can be asymptomatic or severe HF
15
Q
symptoms of HF in neonates
A
breathless, sweating, poor feeds, recurrent chest infections
16
Q
investigations in VSD
A
ECG
small = normal
large = RVH and LVH
CXR
small = mild pulmonary plethora
large = cardiomegaly and marked pulmonary plethora
17
Q
treatment of VSD
A
if symptomatic or large = surgical closure at 3-6 months
diuretics, ACE-I, high calorie diet, surgery
18
Q
definition of cyanosis
A
> 5g/L of deoxygenated Hb
19
Q
complication of VSD and AVSD
A
can lead to Eisenmeiger syndrome - a shunt reversal due to pulmonary HTN
20
Q
cyanotic heart disease in children
A
TGA and TOF due to right to left shunt so misses out the lung
21
Q
what is tetralogy of fallot
A
abnormal separation of trunks arterioles into aorta and pulmonary artery
pulmonary stenosis
VSD
overriding aorta
RVH
22
Q
causes of TOF
A
Di George
23
Q
symptoms of TOF
A
infant = cyanosis, squatting, clubbing
adult = asymptomatic, cyanosis
ejection systolic murmur a LLSE
24
Q
investigations in TOF
A
boot shaped heart
25
treatment of TOF
IV propranolol if cyanotic to reduce infundibular spasm and surgery to increase pulmonary arterials blood flow
26
symptoms of ASD
dyspnoea, PHTN, arrythmia, chest pain, AF, increased JVP, pulmonary ESM, fixed splitting
27
murmurs caused by PHTN
tricuspid regurgitation
| pulmonary regurgitation
28
investigations of ASD
ECG
CXR = pulmonary plethora, cardiomegaly, pulmonary arteries
ECHO = diagnostic
29
treatment of ASD
trans catheter close if not spontaneous
30
complications of ASD
RHF, arrhythmias, paradoxical embolus
31
symptoms of innocent murmur
asymptomatic, soft blowing, systolic, left sternal edge, positional
32
main heart defect in downs
avsd
33
symptoms of AVSD
no murmur
cyanotic @ birth
HF @ 2-3 weeks
apical pan systolic murmur from leaky valve
34
treatment of AVSD
surgery
35
when does eisenmerger syndrome occur
10-15years
36
causes of Ebstein's anomaly
lithium and benzodiazepines in pregnancy
37
what is ebstein's anomaly
unformed tricuspid valve (right side)
38
symptoms of tricuspid regurgitation
pan systolic murmur in LLSA(carvellos sign), RV heave and increased JVP, jaundice, fatigue, hepatic pain on exertion
39
causes of tricuspid regurgitation
infective endocarditis in IVDU due to s.aureus, PHTN, carcinoid syndrome
40
murmur/examination in mitral regurgitation
pansystolic murmur at left side radiating to axilla with displaced apex beat due to LVH
best heard in left lateral position with bell
left parasternal heave due to RVH
soft S1
41
why is there a soft S1 in MR
incomplete closure of the valve before systolic
42
CXR in MR
LA/LV hypertrophy, double contour on right side
43
investigations in MR
ECHO, CXR, ECG (p-mitrale), bloods, cardiac catheterisation
44
treatment of MR
valve replacement
| statins, antihypertensives, DM Tx, antigcoag, AF Tx, diuretics
45
causes of mR
mitral valve prolapse
| LV dilation, post MI pupillary muscle dysfunction, previous childhood rheumatic fever, CTD
46
causes of mitral valve prolapse
MI, CTD (marfans/ehlers danlos), turners, PKD
47
complications of MVP
MR, embolic, arrhythmias
48
murmur/examination in Mitral stenosis
low pitched mid diastolic murmur at apex in left lateral position, radiates to axilla (non displaced apex)
s1 snap
malar flush
AF
raised JVP
49
symptoms of MS and why
back flow of blood leads to increased pressure in blood vessels so increased hydrostatic pressure causes fluid to shift from vascular to interstitial causing SOB and oedema, increased venous pressure caused RHF of raised JVP, oedema and ascites
50
why is there a left parasternal heave in MS
due to RVH causing it to be pushed forward
51
why is there AF in MS
LA beats rapidly as hypertrophy and increased LA pressure due to narrow valves
52
treatment of MS
statins, antihypertensives, DM Tx, anticoagulant, AF Tx, diuretic
percutaenous balloon valvuloplasty
valve replacement if repair not possible
53
what is starlings law
SV increases due to increased blood volume in ventricles before contraction (EDV) - CO can be a measure
54
starlings law on fluid shift
fluid movement across capillary walls is dependent on hydrostatic and oncotic pressure gradient
55
causes of mitral stenosis
rheumatic fever, congenital, prosthetic valve
56
causes of aortic regurgitation
IE, type A aortic dissection, bicuspid aortic valve, rheumatic heart disease, CTD, autoimmune (any soon, RA)
57
symptoms/murmur of AR
early diastolic murmur at LSE sitting forward, displaced apex
wide pulse pressure
collapsing water hammer pulse
LVF leads to exertion dyspnoea, PND, orthopnoea, demussets, austin flint
58
what is Demusset's and austin flints in AR
demussets = head nodding
| austin flints = rumbling mid diastolic murmur at apex due to regurgitation in severe
59
investigations in AR
```
bloods
ecg
echo
cxr
cardiac catheterisation
```
60
what is seen in echo on AR
LVH, reduced function, shows severity, shows vegetations
61
treatment of AR
statins, antihypertensives, tx dm, anticoagulants
valve replacement if HF sx or LV dysfunction
62
what should be screening for in AR
marfans and ehlers danlos via genetic testing
63
how to monitor AR
ECHO
64
what would an echo show in MR
LA/LV hypertrophy, mitral valve calcification
65
clinical features in severe aortic stenosis
angina, arrhythmias, dyspnoea, syncope, PND, orthopnoea, frothy sputum
66
murmur/examination in AS
ejection systolic murmur in right ICS sitting forward at the end of expiration and radiates to carotids
slow rising narrow pulse pressure, arrhythmias
apex forceful and non displaced
S4
audible click for ejection
67
investigations n AS
ECG, ECHO, doppler, cardiac catheterisation and angiography, CXR, bloods, exercise stress test
68
what will ECHO show in AS
LVH, thick calcified immobile valve cusps
69
which valve disorders have p mitral
the systolic ones - AS and MR
and MS
due to LAH
70
ECG in AS
LBBB, LVH, p mitrale
71
common causes of AS
degenerative calcification
bicuspid valve
rheumatic fever
72
symptoms of aortic sclerosis
ejection systolic murmur with no radiation, only valve thickening
73
treatment of AS
statins, anticoagulant, antihypertensive, DM Tx, angina/HF Tx
valve replacement
balloon valvuloplasty
TAVI
74
types of aortic valve replacement
mechanical - need anticoagulation
| bio prosthetic - doesn't last as long but also doesn't need anticoagulation
75
complications of AS
AF, IE, emboli, CHF, angina, death
76
symptoms of HOCM
angina, dyspnoea, palpitations, chest pain, exertion syncope, bisferens pulse, harsh ejection systolic murmur, sudden death
77
pulse in HOCM
bisferens pulse (2x systolic beats), jerky pulse
78
investigations of HOCM
ECG, CXR, ECHO, bloods, exercise stress with holder monitor, genetic testing
79
CXR in HOCM
atrial enlargement
80
ECHO in HOCM
atrial septal hypertrophy and left ventricular thickening
81
pathophysiology of HOCM
atrial septal thickening caused by AD mutation in B-myosin heavy chains leading to disorganised cardiomyocytes - leads to LVH, impaired diastolic filling so reduced SV
82
treatment of HOCM
```
ICD
negative inotropes (BB and verapamil)
amiodarone (rhythm control)
anticoagulants
septal myomectomy
```
83
what is an ICD
implantable cardio defibrillator
84
examples on negative inotropes
BB and verapamil
85
how do negative inotropes work
reduce ventricular contractility
86
risks of HOCM
sudden death from VT/VF
| AF and emboli due to blood stasis in the atria
87
rhythm control in HOCM
amiodarone
88
main cause of dilated cardiomyopathy
alcohol
89
other causes of dilated cardiomyopathy
```
DILATE
dystrophy (muscular)
infection (myocarditis)
late pregnancy (post partum)
SLE
toxins (alcohol, cyclophosphamide, cocaine)
endocrine (thyrotoxicosis)
```
90
CXR in dilated cardiomyopathy
pulmonary oedema
HF
cardiomegaly
91
ECHO in dilated cardiomyopathy
global dilation
92
ECG in dilated cardiomyopathy
T inversion
93
investigations in dilated cardiomyopathy
ECHO, ECG, CXR, catheter + biopsy
94
treatment of dilated cardiomyopathy
bed rest, diuretics, ACE-I, digoxin, anticoagulants
biventricular pacing, ICD, heart surgery
95
symptoms of dilated cardiomyopathy
```
LVF, RVF (HF Sx)
arrthymias
raised JVP
displaced apex
s3 gallop
MR/TR
```
96
causes of restrictive cardiomyopathy
```
miSSHAPEN
sarcoid
systemic sclerosis
haemochromatosis
amyloidosis
primary end-myocardial fibrosis
eosinophilia
neoplasia
```
97
sx of restrictive cardiomyopathy
same as constrictive pericarditis
98
diagnosis of restrictive cardiomyopathy
catheterisation
99
treatment of restrictive cardiomyopathy
treat the cause and symptoms
100
causes of myocarditis
```
viral - coxsackie B, flu, HIV
bacterial - s.aureus, syphilis
drugs - cyclophosphamide, perception, phenytoin
autoimmune giant cell myocarditis
electric shock
```
101
investigations in myocarditis
bloods (FBC, WCC, ESR) and culture
ecg
CK raised
+ve troponin
102
symptoms of myocarditis
flu prodrome
| dyspnoea, fatigue, fever, chest pain, arrhythmia
103
treatment of myocarditis
treat the cause
anticoagulation
antibiotics
+ve inotropes (increase ventricular contractility)
104
complication of myocarditis
dilated cardiomyopathy
| congestive heart failure
105
what is cardiac myxoma
rare, benign cardiac tumour
106
causes of pericarditis
```
viral (coxsackie B, flu, HIV)
bacterial (pneumonia, rheumatic fever, TB, staphs)
dresslers (post MI >2 weeks)
drugs - penicillin, isonazid
SLE
uraemia
cancer and radiotherapy
```
107
symptoms of pericarditis
pericardial friction rub - scratchy and louder on inspiration
pleuritic chest pain sharp and worse lying down and relieved sitting forwards, radiates to left shoulder
fever
signs of pleural effusion or cardiac tamponade
108
what is cardiac tamponade
accumulation of pericardial fluid which leads to poor ventricular fillin
109
symptoms of cardiac tamponade
BECKS TRIAD
muffled heart sounds
hypotension
raised JVP
PULSUS PARADOXUS - pulse fades on inspiration
KUSSMAULS signs - raised JVP on inspiration
110
investigations in pericarditis
ECG, CXR, ECHO, bloods (FBC, WCC, CRP/ESR, cultures)
111
treatment of pericarditis
ABCDE
NSAIDs (+PPI cover)
steroids
112
ECG in pericarditis
saddle shaped ST elevation
| PR depression
113
ECHO in pericarditis and cardiac tamponade
globular heart, pericardial calcification, water bottle
114
what is constrictive pericarditis
heart encased in rigid pericardium
115
symptoms of constrictive pericarditis
```
kussmauls (raised JVP on inspiration)
RHF
HSM
ascites
oedema
```
116
investigations in constrictive pericarditis
ECG, ECHO, bloods, cultures, CXR
| cardiac catheterisation
117
treatment of constrictive pericarditis
urgent pericardiocentesis
send fluids for cytology, ziehl nelson stain and culture
O2
positive inotropes
118
causative organisms in rheumatic fever
group A beta haemolytic strep progenies
119
when does rheumatic fever occur
2-4 weeks post strep throat/skin infection
120
symptoms of rheumatic fever
```
JONES PEACE
joint arthritis
ocarditis (pericarditis)
nodules - subcutaneous on extensors
erthythema margitanum
sydenhams chorea
PR interval prolonged/depression as peri
ESR raised
arthralgia
riased CRP
elevated temp >39
```
valve disorders - MS mainly but can be all
121
investigations in rheumatic fever
```
bloods and cultures - FBC, WCC, ESR, CRP
ECG - pericarditis = saddle shape ST elevation and PR depression/prolongation
ECHO - valve disorders/pericarditis
throat culture - strep throat (pyogenes)
antistreptolysin O titre
DNAse B titre
```
122
treatment of rheumatic fever
```
bed rest
NSAIDs
eradicate strep
if chorea = haloperidol of diazepam
analegsia
```
123
Jones criteria
2 major or w/ antistreptolysin O titre/DNAse B titre
1 major and 2 minor
124
complications of rheumatic fever
```
valve disease
pericarditis
syndenhams chorea
nodules
joints
```
125
what is infective endocarditis
cardiac valves develop vegetations of bacteria and platelets to create fibrin thrombus
126
symptoms of infective endocarditis
FEVER and NEW MURMUR
```
from jane
fever
roth spots
osler nodes
murmur
janeway lesions
anaemia/arthritis
nail haemorrhages
emboli phenomena (haematuria and glomerulonephritis)
weight loss
```
127
risk factors of infective endocarditis
valve disease, prosthetic joint, cardiac heart disease, IVDU, infection, dental caries, rheumatic fever, previous IE, valve surgery
128
main valves affected in infective endocarditis
```
viridian's = mitral = normal
s.aureus = tricuspid = IVDU
```
129
main organsims in infective endocarditis
```
GRAM +ve
strep viridans
staph aureus
strep epididymus
pseudomonas
```
GRAM -ve
haemophilis
130
diagnosis of infective endocarditis
dukes criteria
2 major
1 major and 3 minor
5 minor
131
major dukes criteria
+ve blood culture in 2 sepatre cultures
endocardium involvement (+Ve ECHO from vegetation of abscess, or new valvular regurgitation)
132
minor dukes criteria
```
predisposition (cardiac lesion, IVDU)
fever >38
emboli
immune phenomenon
+ve blood culture
```
133
treatment of infective endocarditis
ABX - usually amoxicillin and gentamicin
134
causes of hypertension
PREDICTION
primary, renal artery stenosis, endocrine (cushings, conns, pheochromocytoma), drugs, raised ICP, Coarctation of aorta, toxaemia of pregnancy, increased viscosity, overload of fluid, neurogenic
135
investigations in HTN
```
BP - lying standing, both arms
ABPM 24hr if BP >140/90
urinalysis - haematuria, renin:angiotension, albumin:creatinine, free cortisol
fundoscopy
dexamethasone suppression test
blood - FBC, U+E, cr + u, eGFR, glucose, lipids, HbA1c
ECG
Q risk
```
136
when to do an ABPM
when BP >140/90 to confirm diagnosis before treatment, unless severe >180/100
137
aims of BP in HTN treatment
<80 years = <140/90
<80 years and EOD e.g. DM = <130/80
>80 years = <150/90
138
HTN Tx if <55, white, no DM
ACE-I
139
HTN Tx if >55, afro-carribean or DM
CCB (Thiazide diuretic)
140
further HTN treat
ACE-I, CCB, TD then add either spironolactone, a-blocker, BB
141
when could you use BB in HTN treatment
in the young who can't have ACE-I/ARB
142
example of ARB
candesartan
143
what is a HTN crisis
malignant/accelerated
200/130
evidence of end organ damage
144
treatment of HTN crisis
reduce BP to avoid stroke with atenolol or long acting CCB
145
types of EOD in HTN
```
retinpathy
nephropathy
neuropathy
HF
eclampsia
encephalopathy
```
146
what would be seen in fundoscopy of HTN
retinopathy, AV nipping, flame haemorrhages, cotton wool spots, papilloedema, silver wiring
147
lifestyle changes in HTN
quit smoking, reduce alcohol, healthy weight, reduce salt, reduce stress, exercise, reduce caffeine
148
what is qrisk
QRISK is an algorithm for predicting cardiovascular risk. It estimates the risk of a person developing cardiovascular disease (CVD) over the next 10 years - >20% consider statin
149
other medications to consider in HTN treatment
statins, aspirin
150
treatment of encephalopathy in HTN
furosemide and nitroprusside/labetolol IV
aim to reduce BP to 110 over 4 hours
need intra arterial monitoring
151
what is cariogenic shock
inadequate tissue perfusion leading to cardiogenic dysfunction
152
management of cariogenic shcok
```
ABCDE
O2, IV access
diamorphine, metaclopramide
correct arrhymias, electrolyte disturbances, acid base abnormalities
dobutamine (inotrope)
```
153
right heart failure symptoms
ascites, oedema, raised JVP, HSM, TR, neck vein dilation, facial engorgement
154
left heart failure symptoms
dyspnoea, syncope, pink frothy sputum, PND, pulses alterus, orthopnoea, PND
155
what is pluses alterus
one weak beat then one strong beat
156
heart failure symptoms
weight loss, pulmonary oedema, tender hepatomegaly, SOBOE, pleural effusion, bibasal creps, cardiomegaly
157
what is BNP
secreted from ventricles in response to increased pressure/stretch in the heart, leading to increased GFR, reduced renal absorption, reduced pre load
158
investigations in HF
BNP, ECHO, CXR, ECG, bloods (WCC, ESR/CRP, culture), NYHA, ABG
159
CXR is HF
```
alveolar oedema
kersey b lines
cardiomegaly
dilated pulmonary vessels
pleural effusion
```
160
ECHO in HF
hypertrophy
| valve lesions
161
what is the NYHA
1 - no limitation of activity
2 - mild limitation, none at rest
3 - limitation
4 - dyspnoea at rest
162
what do BNP readings mean
<100 no HF
100-400 - do 6ww ECHO
>400 - 2ww for ECHO and doppler
163
what does BNP correlate to
LV dysfunction and mortality
164
what is starlings law and an equation to show this
stroke volume is directly proportional to end diastolic volume, therefore increased pre load, increased SV
SV = EDV-ESV
165
how does ventricle dilation effect diastolic volume
ventricle dilation causes increase diastolic volume due to stretch of myocardial fibres
166
how does RAAS affect the heart
causes salt and water retention to maintain SV
167
how does SNS affect the heart
increases the HR and increases heart contraction
168
acute HF treatment
```
NOMF
nitrates - isoboride mononitrate IV
O2
diamorphine IV
furosemide IV
```
vasodilators (hydralazine), inotropes, CPAP
169
medications to improve prognosis in HF
ACE-I, spironolactone, BB
170
medications to improve symptoms in HF
furosemide
vasodilators
thiazide diuretic
digoxin
171
things to monitor in HF treatment
BP, weight, potassium, renal function, inform DVLA
172
surgical options in HF
cardiac resychronisation +ICD
| transplant
173
pathophsyiology of acute coronary syndrome
plaque rupture, thrombosis and inflammation
| coronary spasm
174
symptoms of ACS
```
acute central chest pain which radiates to jaw and down left arm
sweating
nausea
anxiety
dyspnoea
palpitations
raised pulse and BP
```
175
Ddx of ACS
angina, STEMI, NSTEMI, costochondritis, pericarditis, PE, pneumothorax, GORD, anxiety
176
investigations in ACS
```
ECG
troponin
CK/CKMB
LDH
FBC
glucose
lipids
clotting
U+E
CXR
```
177
when should troponin be tested in ACS
on admission and 3 hours later to see if doubles
| ideally 6hours post symptom onset
178
when is troponin raised
MI, CKD, infections, sepsis, trauma, PE
179
Cxr in ACS
cardiomegaly, pulmonary oedema, widened mediastinum, aortic rupture
180
what is the GRACE score
assesses severity of NSTEMI
181
acute management of STEMI
```
ABCDE - o2, ecg, iv fluids, bloods, arg
MONA - morphine, o2 if sats <94%, nitrates (GTN), aspirin and clopidogrel (dual antiplatelet)
metaclopromide
anticoagulant
inform cardiac catheterisation lab
PCI or thrombolysis
```
182
when should you PCI in STEMI
if <12 hours - ideally <90 mins
183
what is a PCI
insert wire into groin artery and thread unto the heart to insert some dye to assess where is blocked and then use balloon to blow up a stent to open veseel
184
complications of PCI
failure, bleed, infection, emboli, arrhythmia
185
when to thrombolysis in STEMI
12-24hours
186
what is used for thrombolysis in STEMI
streptokinase/alteplase
187
complications of thrombolysis
bleed, stroke, failure, allergic, arrhythmia
188
contraindications of thrombolysis
aortic dissection, GI bleed, allergic, recent surgery, severe HTN >200/120, trauma
189
longterm treatment of STEMI
```
aspirin indefinitely
ACE-I
BB
cardiac rehab
DVT prophylaxis for 3 months
statins
```
190
lifestyle advice for post MI
anxiety is normal
bath and shower as normal
no driving for 4 weeks (6 and inform DVLA id HGV or carrying vehicle and will need to have successful exercise test) contact car insurnace
light housework/garndeing when feel ready
4 weeks until sex, may have trouble first few attempts
limit alcohol, can interfere with medications
3-4 until work
6 weeks for heavy work
no fly for 3 months
stop smoking
improve diet
191
Ddx of chest pain
GOD, MI, pericarditis, PE, MSK, pneumonia, pneumothorax, endocarditis, dissecting aorta
192
types on anticoagulant treatment in STEMI
fondaparinux (if no CTPA in 24 hours)
| heparin if <24 hours CTPA
193
reversible causes of arrests
4Hs - hypothermia, hypovolaemia, hypoxia, hyperkalaemia
| 4Ts - tension pneumothorax, thrombosis, tamponade, toxins
194
pathophysiology of angina
atherosclerosis leads to ischaemia + LVH leading to increased resistance and decreased blood flow due to stenosis and reduced O2 binding capacity due to anaemia and increased demand
195
types of angina
stable - induced by effort
unstable - occurs at rest/minimal exertion
decubitus - induced by lying down
prize mental - induced at rest due to coronary artery spasm
196
investigations in angina
```
ECHO
CXR
ECG
bloods
ABG
TFTs
exercise test
perfusion scan
angiography
```
197
treatment of angina
```
lifetsyle
GTN spray
BB or CCB
aspirin
HTN meds
statins
PCI/CABG
```
198
difference between inotropic and chronotropic
inotropic affects contractility of the heart
| chronotropic affects rhythm of the heart
199
how do BB affect the heart
decrease O2 demand and decrease sympathy action on the heart
200
how do CCB affect the heart
dilate peripheral vessels
201
how do nitrates affect the heart
reduce venous return via venous dilation and increasing diastolic filling time
202
pathophysiology of AF
left atrium lose refractioness before end of atrial systole leading to recurrent uncoordinated contraction - leads to HF and stasis of blood in atria and reduced CO
203
causes of AF
```
PIRATES
PE
ischaemia
resp
atrial enalagrment (valves)
thryoid
ethanol
sepsis
```
204
investigations in AF
```
ECG
TFTs
toxicology screen
CXR
ECHO
bloods
cardiac enzymes
U+Es
```
205
symptoms of AF
```
irregularly irregular pulse
tachycardia
dyspnoea
palpitaitons
arrhythmia
chest pain
faintness
```
206
acute management of unstable AF
emergency cardioversion via DC cardioverion, IV amiodarone, IV flecainide
LMWH
rate control via BB or CCB
207
types of AF
paroxysmal = <7days
persistant >7days
permanent >1 year and not terminated by DC
208
management of paroxysmal AF
rhythm control = flecanide
prevention = BB, stall or amiodarone
anticoag assessment via CHADS2VASC
209
treatment of AF if persistant
rhythm control
| rate control
210
rhythm control for AF
```
ECHO first to look for structural abnormalities
anticoagulation
sotalol
BB
amiodarone
```
211
rate control for AF
BB or rate limiting CCB
add digoxin (not as mono therapy)
amiodarone
212
what happens if BB and CCB togtehr
bradycardia
213
invasive options for AF tx
radio frequency ablation, maze procedure, pacing
214
anticoagulant options in AF
warfarin or NOAC if >1 CHADS
215
what is cha2ds2vasc
```
congestive heart failure
HTN
age >75
DM
stroke/vte/TIA
vascular disease
>65
female
```
216
what is hasbled
used to assess bleed risk in those on anticogulants in AF
217
contraindications of flecainde
strutural defects in the heart
218
management of flutter
like AF
| amiodraone to restore sinus
219
examples of narrow complex tachycardias
AF, flutter, atrial tachycardia, AVRT, AVNRT
220
medications to avoids in WPW
BB, CCB, adenosine, digoxin as leads to VF
221
what is WPW
congenital accessory conducting pathway between atria and ventricles
222
treatment of WPW
radio frequency ablation of the accessory pathway
amiodarone
sotalol
NOT DIGOXIN
223
acute management in narrow complex tachycardia (supraventricular tachycardia) with no regular rhythm
treat like AF
224
acute management in narrow complex tachycardia (supraventricular tachycardia) with regular rhythm
ECG
vagal manoeuvres
adenosine 6mg IV, then 12mg then 12mg
if no relief, and no adverse signs then give digoxin, amiodarone, verapamil or atenolol, if no relied, DC
225
why not digoxin in WPW
as reduces ventricular rate but increasing conduction through bundle of his
226
treatment of VT with pulse and no adverse signs
correct electrolytes
regular = amiodarone
irregular = AF tx
failure = DC
227
treatment of VT with pulse and adverse signs
DC x 3 then amiodarone then ICD
228
cause of VT
recent MI
229
treatment of VF
```
dc
dc
adrenaline
dc
amiodarone
```
longterm = BB +ICD
if witness = 3xDC then CPR
230
treatment of tornadoes de pointes
mgso4
| then BB and ICD
231
complication of tornadoes de pointes
can lead to VF
232
what is brugada
ad inheritance
| defective sodium channel leading to restricted movement of sodium channel
233
treatment of brugada
if abnormal ECG - defibrillator
234
what should be avoided in brugada
phenytoin, TCAs, illicit drugs, high temp, low K+
235
how to enhance ECG change in brugade
give flecanide as it is a sodium channel blocker
236
management of pulseless electrical activity
```
CPR
airway monitor
adrenaline 1ml in 10,000 Iv central line every 3-5 minutes
CPR
once shockable rhythm DC
CPR
adrenaline
DC
amiodarone
```
237
causes of bradycardia
```
sinus
heart block
drugs
vagal hypertonia
hypothyroidism
dilated cardiomyopathy
```
238
treatment of bradycardia
atropine IV
adrenaline
external pacing
permanent pacing
239
management of AAA
```
O2
large bore cannula
major haemorrhage protocol
vascular surgeon before rupture
analgesic
```
if <5.5 then monitor via US
240
symptoms of ruptured AAA
sudden onset severe abdo pain
collapse and shcok
expansible abdo mass
241
investigations of AAA
AXR
abdo US
CT/MRI
angiography
242
stages of limb ischaemia
intermittent claudication
critical limb ischaemia
leinches syndrome
burgers disease
243
6ps of peripheral vascular disease
pain, pulseless, perishingling cold, paraestheisa, paralysis, pale
244
symptoms of limb ischaemia
raised CRT, ulcers, nail dystrophy, skin 6ps, venous guttering, burgers angle/sign
245
what is the fontaine classification
asymptomatic
intermittent claudication
ischaemia rest pain
ulceration and gangrene
246
investigations in critical limb ischaemia
```
doppler waveforms
ABPI
walk test
bloods
imaging - colour duplex US, CT/MR angiogram contrast
```
