Cardiology 🫀 Flashcards
What are 1st line anti-hypertensives?
ACE-i (Eg Ramipril) if under 55 or diabetic. Calcium channel blockers (Eg Amlodipine) if over 55 and not diabetic or black/Afro-Caribbean
Chest XR findings in Heart Failure
A - Alveolar oedema (bat’s wings)
B - kerley’s B lines (interstitial oedema)
C - Cardiomegaly
D - Dilated prominent upper lobe vessels
E - Effusion (pleural)
Causes of Pericardial Effusion
Right-sided heart failure
Bacterial/fungal infection
Mesothelioma
Pericardial cyst
Adenocarcinoma (MOC-31 +ve)
How do you treat ventricular septal defects (VSDs)?
Diuretics
If associated with aortic regurgitation then a high caloric diet
Follow this with closure of the defect
Why does valve replacement worsen symptoms of dementia?
Use of cardio-pulmonary bypass
What would you see on examination of atrial septal defects?
Right ventricular impulse (heave)
Wide split fixed 2nd heart sound
Soft systolic ejection murmur
ECG may show right axis deviation
In heart block, will the heart rate be fast or slow?
Slow
How do you manage VT?
Electrocardioversion
Bolus of amiodarone or lidocaine if stable and unsure of cause
How do you test for and treat postural hypotension?
Tilt test -> Attempt to provoke episode of postural hypotension (usually fainting)
Treat with high salt diet
Can give salt in tablets but don’t usually work
What are the ECG findings in PE?
S1Q3T3 or Sinus Tachycardia
What are the causes of high-output heart failure?
AAPPTT
Anaemia
Arteriovenous malformation
Paget’s dx
Pregnancy
Thyrotoxicosis
Thiamine deficiency (wet beri beri)
What medications cause hypertension as a SE?
NSAIDs, COCP, ciclosporin, carbenoloxone
What are the endocrine causes of secondary HTN?
Conn’s syndrome
Pheochromocytoma
Cushing’s
Acromegaly (too much growth hormone)
Hyperthyroidism
If a pt has resistant HTN, what is the management?
ACE-i, Ca-channel blocker + a diuretic.
If K+ >4.5 then Thiazide diuretic.
If K+ <4.5 then spironolactone.
What is classed as severe HTN?
180/120mmHg
What is the 1st line anyi-hypertensive in pregnancy?
Labetolol
Can also use Methyldopa and MR nifedipine
Target BP in pregnancy?
<140/90
The BP in a pregnant lady is over 160/110, how do we treat this medical emergency?
IV labetolol or hydralazine or MR nifedipine
What % of clotting factors is sufficient for clotting and what % is insufficient?
Sufficient = >30% (Borderline haemostasis)
Insufficient = <20% (Established haemostatic failure)
What is the most common cardiomyopathy seen in heart transplant?
Dilated cardiomyopathy
Cardiomyopathy Px?
Heart failure symptoms (high JVP, pulmonary oedema, dyspnoea)
Palpitations
Syncope and pre-syncope
Chest pain
HCM: can show signs of hypertrophy or Q waves (replacement fibrosis)
Diagnosis of cardiomyopathy?
MRI or echo to assess myocardial structure
Heart failure diagnostic factors (Eg NT pro-BNP)
Exclude other causes (CAD, HTN, valvular dx or congenital heart dx)
HCM: wall thickness >15mm
Management of cardiomyopathies?
Symptoms relief (HF or arrhythmia therapy —> ACE-i, b-blockers and diuretics)
Can do ICD implantation (to reduce the chance of sudden cardiac death)
Lifestyle modifications
In some cases, can treat the underlying cause Eg iron overload
What are the complications of cardiomyopathies?
Heart failure
Stroke
Sudden cardiac death (due to arrhythmias) - most common in ACM and HCM
What is Hypertrophic Cardiomyopathy?
Increased ventricular wall thickness or mass without loading conditions sufficient to cause the observed abnormality (Eg CAD, valvular dx, congenital heart dx or HTN)
Mainly genetic cause
What is Dilated Cardiomyopathy?
Most commonly seen cardiomyopathy in transplant
Progressive left ventricular wall thinning and dilating accompanied by gradual functional impairment (Eg functional mitral/tricuspid regurgitation)
Can be post-myocarditis or due to alcohol
What is ARVC (Arrhythmogenic Right Ventricular Cardiomyopathy)?
A genetic dx characterised my fibrofatty infiltration of the myocardium as a mechanism of repair.
Unlike DCM, there is a RV predominance due to thinner RV walls (+ :. Higher susceptibility to stresses)
Which cardiomyopathy is most likely to arise from chronic alcohol-use disorder?
Dilated cardiomyopathy
What is the initial/most common direction of shunt blood flow in a septal defect and why?
Left –> Right.
This is because there is a higher pressure in the left side of the heart due to it having to pump blood around the whole body, whereas right only has to fill the lungs.
A left to right shunt means blood still travels to the lungs and gets oxygenated, so the patient does not become cyanotic.
How does a right –> left shunt come about?
Initially there is a left –> right shunt due to left having higher pressure, but when the extra blood increases pulmonary pressure so much it exceeds systemic pressure the direction of shunt blood flow reverses and a right –> left shunt is formed.
This causes deoxygenated blood to bypass the lungs and enter the body. This causes cyanosis.
What is the drug Sildenafil used for?
Pulmonary arterial HTN +/or Erectile dysfunction
What is the treatment for regular narrow complex tachycardias e.g. supraentricular tachycardia (SVT) if vagal manoeuvres fail?
IV adenosine
What is the Rx for a polymorphic VT such as Torsade de Pointes?
IV Magnesium
What is the treatment for regular broad complex tachycardias such as VT if adverse features are not present?
IV Amiodarone
Loading dose of 300mg over 10-12 mins, followed by an infusion of 900mg her 24hrs
What is the initial management for narrow complex tachycardias like SVT?
Vagal manoeuvres
When does a pt require DC Cardioversion?
If a patient with a tachyarrhythmia has adverse features (shock, syncope, myocardial ischaemia or heart failure)
What are the most common causative organisms bacterial endocarditis?
Gram +ve cocci
Eg streptococcus viridans, Staphylococcus aureus (IVDU or prosthetic valves), and staphylococcus epidermis (prosthetic valves).
In what cardiological condition do you see notching of the inferior border of the ribs on CXR?
Coarctation of the aorta
Due to increased pressure + :. dilated intercostal vessels and the vessels erode the inferior ribs.
What conditions are associated with coarctation of the aorta?
- Turners syndrome
- Bicuspid aortic alvve
- Berry aneurysms
- Neurofibromatosis
What are the features of coarctation of the aorta?
- Infancy: Heart failure
- Adult: HTN
-Radio-femoral delay
-Mid systolic murmur, loudest over back - Apical click
- Notching of the inferior border of the ribs (not seeing young people)
What drugs used in heart failure are known to worsen glucose tolerance?
Thiazide diuretics Eg Indapamide
NB: They also cause erectile dysfunction, gout and postural hypotension
What is the classic Px of aortic dissection?
- Tearing chest pain
- Diastolic murmur heard loudest over 2nd intercostal space, right sternal border (suggesting aortic regurg)
- A widened mediastinum on CXR
- Male over 50yrs
What is the treatment for an acute NSTEMI?
BATMAN!
B -Beta blockers (unless contraindicated)
A - Aspirin 300mg stat dose
T -Ticagrelor 180mg stat dose (clopidogrel 300mg is alternative if higher bleeding risk)
M -Morphine
A - Anticoagulant:Fondaparinex (unless high bleed risk)
N - Nitrates e.g. GTN to relieve coronary artery spasm
What are the complications of MI?
DREAD
D-Death
R - Rupture of the heart septum or papillary muscles
E - Edema (Heart failure)
A - Arrhythmia and Aneurysm
D - Dressler’s syndrome
What are the causes of AF?
SMITH
Sepsis
Mitral valve pathologies
Ischaemic heart disease
Thyrotoxicosis
Hypertension
How can you tell if a patient is de compensating? (HISS)
HISS
H- heart failure
I - ischaemia
S - systolic less than 90
S - systole
