Cardiology Flashcards
For pharmacological cardioversion in atrial fibrillation what drugs do you use? for structural heart disease? No structural heart disease?
- flecainide or amiodarone if there is no evidence of structural or ischaemic heart disease or
- amiodarone if there is evidence of structural heart disease
Examples of thiazide diuretics
Chlorthalidone
Indapamide
Third heart sound (S3) what are the causes?
- caused by diastolic filling of the ventricle
- considered normal if < 30 years old (may persist in women up to 50 years old)
- heard in left ventricular failure (e.g. dilated cardiomyopathy), constrictive pericarditis (called a pericardial knock) and mitral regurgitation
how many days before surgery should warfarin be stopped?
5 days
What is ostium secundum? How would ECG present?
Atrial septal defect
associated with Holt-Oram syndrome (tri-phalangeal thumbs)
ECG: RBBB with RAD
ostium secundum in this patient has allowed passage of an embolus from the right-sided circulation to the left causing a stroke
Angina management
All patients must have:
1) all patients should receive aspirin and a statin
2) sublingual glyceryl trinitrate to abort angina attacks
Then:
1) either a beta-blocker or a calicum channel blocker first-line based on ‘comorbidities, contraindications and the person’s preference’
- if a calcium channel blocker is used as monotherapy a rate-limiting one such as verapamil or diltiazem should be used.
- If used in combination with a beta-blocker then use a long-acting dihydropyridine calcium-channel blocker (e.g. modified-release nifedipine).
Remember that beta-blockers should not be prescribed concurrently with verapamil (risk of complete heart block)
2) a long-acting nitrate, ivabradine, nicorandil or ranolazine
What are the 3 indications for urgent coronary thrombolysis or percutaneous intervention on ECG?
ECG changes for thrombolysis or percutaneous intervention:
ST elevation of > 2mm (2 small squares) in 2 or more consecutive anterior leads (V1-V6) OR
ST elevation of greater than 1mm (1 small square) in greater than 2 consecutive inferior leads (II, III, avF, avL) OR
New Left bundle branch block
A 32-year-old man presents with pain in his hands and feet which has been getting worse for the past few weeks. The pain is worse at night and also when he walks.
+ Smoker
Examination reveals cold hands and feet. There is an ulcer on the right foot at the distal phalanges. The dorsalis pedis, posterior tibial, radial and ulnar pulses are all absent.
Young male smoker with symptoms similar to limb ischaemia - think Buerger’s disease
Buerger’s disease (also known as thromboangiitis obliterans) is a small and medium vessel vasculitis that is strongly associated with smoking.
Features extremity ischaemia intermittent claudication ischaemic ulcers superficial thrombophlebitis Raynaud's phenomenon
1st line Ix of Heart failure
BNP
Patient with ventricular fibrillation - first course of action?
Use defibrillator at 150 Joules after charging with compressions
VF/pulseless VT should be treated with 1 shock as soon as identified
a single shock for VF/pulseless VT followed by 2 minutes of CPR, rather than a series of 3 shocks followed by 1 minute of CPR
What drug must you not take with non-dihydropyridine calcium channel blockers (verapamil, diltiazem)?
Beta blockers
A 52-year-old male presents with tearing central chest pain. On examination he has an aortic regurgitation murmur. An ECG shows ST elevation in leads II, III and aVF.
Proximal aortic dissection
An inferior myocardial infarction and AR murmur should raise suspicions of an ascending aorta dissection rather than an inferior myocardial infarction alone. Also the history is more suggestive of a dissection. Other features may include pericardial effusion, carotid dissection and absent subclavian pulse.
Boerhaave Syndrome
triad for Boerhaave syndrome: vomiting, thoracic pain, subcutaneous emphysema. It commonly presents in middle aged men with a background of alcohol abuse.
A patient with chronic kidney disease have suspected pulmonary embolism, what would be the investigation to exclude pulmonary embolism?
Pulmonary embolism and renal impairment → V/Q scan is the investigation of choice
as the contrast media used during CTPAs is nephrotoxic.
When to use rhythm control to treat AF?
if there is coexistent heart failure, first onset AF or an obvious reversible cause (e.g. pneumonia)
