Cardiology Flashcards
RBBB +left anterior or posterior hemiblock + 1st-degree heart block = –
trifasicular block
Aspirin
Antiplatelet - inhibits the production of –
Clopidogrel
Antiplatelet - inhibits – binding to its –
Enoxaparin
Activates—, which in turn potentiates the inhibition of coagulation factors —
Fondaparinux
Activates – which in turn potentiates the inhibition of coagulation factors –
Bivalirudin
Reversible —- inhibitor
Abciximab, eptifibatide, tirofiban
— receptor antagonists
Aspirin Antiplatelet - inhibits the production of thromboxane A2
Clopidogrel Antiplatelet - inhibits ADP binding to its platelet receptor
Enoxaparin Activates antithrombin III, which in turn potentiates the inhibition of coagulation factors Xa
Fondaparinux Activates antithrombin III, which in turn potentiates the inhibition of coagulation factors Xa
Bivalirudin Reversible direct thrombin inhibitor
Abciximab, eptifibatide, tirofiban Glycoprotein IIb/IIIa receptor antagonists
Ventral septal defect - classically associated with a – murmur
heard best at the – sternal border. Paradoxically, the larger the defect, the quieter the murmur.
Other clinical findings might including a heaving – beat, a split S– and signs of – hypertension and —heart failure.
Ventral septal defect - classically associated with a pansystolic murmur
heard best at the lower left sternal border. Paradoxically, the larger the defect, the quieter the murmur.
Other clinical findings might including a heaving apex beat, a split S2 and signs of pulmonary hypertension and right heart failure.
ECG features of hypokalaemia -- waves small or absent -- waves (occasionally inversion) prolong -- interval ST -- long --
ECG features of hypokalaemia U waves small or absent T waves (occasionally inversion) prolong PR interval ST depression long QT
P Mitrale represents left — hypertrophy/strain e.g. in mitral —
P Mitrale represents left atrial hypertrophy/strain e.g. in mitral stenosis
The following ECG changes are considered normal variants in an athlete: sinus -- -- rhythm -- heart block -- phenomenon
The following ECG changes are considered normal variants in an athlete: sinus bradycardia junctional rhythm first degree heart block Wenckebach phenomenon
If a patient with AF has a stroke or TIA, the anticoagulant of choice should be – or a direct – or factor– inhibitor
If a patient with AF has a stroke or TIA, the anticoagulant of choice should be warfarin or a direct thrombin or factor Xa inhibitor
Massive PE + hypotension -
Massive PE + hypotension - thrombolyse
PE
Choice of anticoagulant
– or – (both —) should be offered first-line following the diagnosis of a PE
Choice of anticoagulant
the big change in the 2020 guidelines was the increased use of DOACs
apixaban or rivaroxaban (both DOACs) should be offered first-line following the diagnosis of a PE
A – is an essential investigation when investigating a PE
A chest xray is an essential investigation when investigating a PE
If a PE is ‘likely’ (more than 4 points) arrange an immediate —
If there is a delay in getting the — then interim therapeutic — should be given until the scan is performed.
interim therapeutic anticoagulation used to mean giving low-molecular weight heparin
NICE updated their guidance in 2020. They now recommend using an anticoagulant that can be continued if the result is positive.
this means normally a–such as – or –
If a PE is ‘unlikely’ (4 points or less) arranged a –
if positive arrange an immediate–
if there is a delay in getting the— then give interim – until the scan is performed
if negative then PE is unlikely - consider an alternative diagnosis
If a PE is ‘likely’ (more than 4 points) arrange an immediate computed tomography pulmonary angiogram (CTPA). If there is a delay in getting the CTPA then interim therapeutic anticoagulation should be given until the scan is performed.
interim therapeutic anticoagulation used to mean giving low-molecular weight heparin
NICE updated their guidance in 2020. They now recommend using an anticoagulant that can be continued if the result is positive.
this means normally a direct oral anticoagulant (DOAC) such as apixaban or rivaroxaban
If a PE is ‘unlikely’ (4 points or less) arranged a D-dimer test
if positive arrange an immediate computed tomography pulmonary angiogram (CTPA)
if there is a delay in getting the CTPA then give interim therapeutic anticoagulation until the scan is performed
if negative then PE is unlikely - consider an alternative diagnosis
ECG
the classic ECG changes seen in PE are:
1. a large S wave in lead –,
2. a large Q wave in lead - and an inverted T wave in lead – -
‘S-Q-T-‘. However, this change is seen in no more than 20% of patients
right bundle branch block and right axis deviation are also associated with PE
sinus tachycardia may also be seen
ECG
the classic ECG changes seen in PE are a large S wave in lead I, a large Q wave in lead III and an inverted T wave in lead III - ‘S1Q3T3’. However, this change is seen in no more than 20% of patients
right bundle branch block and right axis deviation are also associated with PE
sinus tachycardia may also be seen
In the context of a tachyarrhythmia, a systolic BP < 90 mmHg →
DC cardioversion
Hypertrophic obstructive cardiomyopathy - is associated with sudden death in young athletes due to–
ventricular arrhythmia
For a person < 80, with stage 1 hypertension, only treat medically if:
For a person < 80, with stage 1 hypertension, only treat medically if: diabetic, renal disease, QRISK2 >10%, established coronary vascular disease, or end organ damage
ABPM/HBPM >= –/– mmHg (i.e. stage 1 hypertension)
treat if < – years of age AND any of the following apply; target organ damage, established cardiovascular disease, renal disease, diabetes or a 10-year cardiovascular risk equivalent to –% or greater
ABPM/HBPM >= 135/85 mmHg (i.e. stage 1 hypertension)
treat if < 80 years of age AND any of the following apply; target organ damage, established cardiovascular disease, renal disease, diabetes or a 10-year cardiovascular risk equivalent to 10% or greater
in 2019, NICE made a further recommendation, suggesting that we should ‘consider antihypertensive drug treatment in addition to lifestyle advice for adults aged under 60 with stage 1 hypertension and an estimated 10-year risk below 10%. ‘. This seems to be due to evidence that QRISK may underestimate the lifetime probability of developing cardiovascular disease
Blood pressure targets
Clinic BP ABPM / HBPM Age < 80 years 1--/-- mmHg --5/-5 mmHg Age > 80 years 1--/-- mmHg 1--/-- mmHg
Blood pressure targets
Clinic BP ABPM / HBPM
Age < 80 years 140/90 mmHg 135/85 mmHg
Age > 80 years 150/90 mmHg 145/85 mmHg
New onset AF is considered for electrical cardioversion if :
New onset AF is considered for electrical cardioversion if it presents within 48 hours of presentation
Medication
Agents used to control rate in patients with atrial fibrillation:
x3
Agents used to maintain sinus rhythm in patients with a history of atrial fibrillation:
Medication
Agents used to control rate in patients with atrial fibrillation
beta-blockers
a common contraindication for beta-blockers is asthma
calcium channel blockers
digoxin
not considered first-line anymore as they are less effective at controlling the heart rate during exercise
however, they are the preferred choice if the patient has coexistent heart failure
Agents used to maintain sinus rhythm in patients with a history of atrial fibrillation
sotalol
amiodarone
flecainide
others (less commonly used in UK): disopyramide, dofetilide, procainamide, propafenone, quinidine
