Cardiology Flashcards
Aortic stenosis findings
- narrow pulse pressure
- slow rising pulse
- thrill at apex
- fourth heart sound in hypertrophy
- soft or absent S2
Atorvastatin
If QRISK greater that 10% consider giving atorvastatin
Amlodipine
IF older than 55 or Afro-Caribbean give calcium channel blocker
Heart failure- longer life
ACE inhibitors, beta blockers and spironolactone
Nifedipine
If angina is not controlled with a beta-blocker then add calcium channel blocker
PE
- pleuritic chest pain
- dyspnoea
- haemoptysis
- tachycardia
- S1Q3T3
Losartan
Angiotensin receptor blocker that can be added second line in hypertension treatment
Fibrinolysis
Needs to be given within 12 hrs if primary PCI cannot be given in under 120 mins
Heart block in heart failure
If left bundle branch block seen after ACE inhibitor, beta blocker and aldosterone therapy consider cardiac resynchronisation therapy
Thiazide-like diuretics
Include indapamide and can cause erectile dysfunction
Thiazide diuretics
Can worsen glucose tolerance
Furosemide
Loop diuretics can cause ototoxicity
PCI
If MI persists post fibrinolysis then consider PCI
Thiazide diuretics
Can cause hyponatraemia
HOCM
- asymmetric septal hypertrophy and systolic anterior movement (SAM)
- autosomal dominant inheritance
INR
In cases of recurrent VTE or PE then aim for INR of 3.5
S3
- normal in those under 30
- suggestive of dilated cardiomyopathy
Hypertension and diabetes
ACE inhibitor is first line
Rhythm control
Treatment of AF that is coexistent with heart failure, first onset or an obvious reversible cause is found
Stable suspected CAD
CT angiography
Beta blockers
Reduce hypoglycaemic awareness
Ivabradine
Long acting vasodilator used in treatment of angina if verapamil not tolerated
Thiazides
Can cause hypokalaemia
Aortic dissection
If patient is clinically unstable transoesophageal echo can be used
Spironolactone
Mineralocorticoid receptor agonist given in heart failure with reduced ejection fraction
ACE inhibitor and renal function
Increase in creatinine of up 30% from baseline is accepted
1 shock defib
Used to manage VF and pulseless VT as soon as identified
INR 5-8 (no bleeding)
Withhold 1 or 2 doses and reduce subsequent maintenance dose
Thiazide diuretics
Can cause hypercalcaemia and hypocalciuria
Hypokalaemia
- tiredness
- constipation
- cramping
- u waves on ECG and prolonged QT interval
Posterior MI
ECG with tall R waves in V1-2
Symptomatic bradycardia
First with 3mg IV atropine then with external pacing
Ventricular septal defect
Classically associated with a pansystolic murmur
Acute pulmonary oedema
Complication of MI
- SOB
- productive cough
- sweaty
- raised JVP
- end-inspiratory crackles
- manage with IV diuretics
PE investigation
If Wells score less than 4 and D-dimer negative then stop anticoagulation and consider alternative diagnosis
Acute pericarditis
- suspect in cases of retrosternal chest pain, worse on lying down with signs of raised WBCs
- investigate with transthoracic echo
PE
CTPA is first line investigation
Diabetes in cardiac ward care
If high dependency stop medications and start IV insulin infusion
Acute pericarditis ECG
Widespread ST elevation and PR depression
Bumetanide
A loop diuretic that acts on the Na-K-Cl cotransporter in the ascending limb of the loop of Henle
Atorvastatin
-primary prevention of MI 20mg
-secondary prevention of MI
40mg
LBBB
New LBBB is significant in the presence of chest pain and indicates the need for thrombolysis or PCI
Thiazides
Can cause hypokalaemia and heart block
Bradycardia
500 micrograms of IV atropine
Tachyarrhythmia
Systolic BP less than 90 needs DC cardioversion
Massive PE and hypotension
Thrombolyse
Posterior STEMI
- ST depression in leads V1-V3
- tall R waves in V1-2
Hypercalcaemia
- bone pain
- rental stones
- abdominal groans
- psychic moans
Nifedipine
A Ca channel blocker that can be used in angina uncontrolled by a beta blocker
Electrical alternans
Suggestive of cardiac tamponade
Constrictive pericarditis
- Kussmauls sign negative so JVP does not fall with inspiration
- pericardial knock
AF
Begin with Ca channel blocker or beta blocker then add digoxin
Adenosine
Used to treat SVT when Valsalva manoeuvres fail
-can cause warmth and flushing
Hypertension
BP greater than 140
Atrial fibrillation
Offer direct oral anticoagulant
BP>180/120
In the presence of confusion, chest pain, signs of heart failure or AKI then admit for specialist assessment
Heart failure vaccination
Offered yearly influenza and one off pneumococcal vaccination
Spironolactone
A mineralocorticoid receptor antagonist offered in heart failure alongside ACEi and beta blocker
Hypothermia
Presents with bradycardia and J waves on ECG
Hypertension (black or afro-caribbean)
First line with Ca channel blocker then add angiotensin receptor blocker
Hyperacute T waves
Big T waves that come before a myocardial infarction
Rheumatic fever
Develops following reaction to streptococcus pyogenes infection
- recent strep infection
- erythema marginatum
- twitching or chorea
- polyarthritis
- carditis and valvulitis
- subcutaneous nodules
Decompensated AF
Manage with DC cardioversion
Aortic stenosis
Late presentation with exertional syncope
Hypokalaemia
Can lead to long QT syndrome
Acute pericarditis
One risk factor is SLE
Constrictive pericarditis
Positive Kussmaul’s sign with JVP rising on inspiration
-chest pain worse on inspiration
Bendroflumethiazide
Can cause hypercalcaemia
Aortic dissection
- tearing pain into back
- sinus tachycardia
- weak brachial pulse
- variation in arm bp
Bradycardia
If patients show signs of shock give 500 micrograms of IV atropine repeated up to 3mg
Lateral MI
- ST elevation in I and aVL with slight V5+V6
- left circumflex
HOCM
Give an implantable cardioverter defibrillator
Broad complex tachycardia
If no adverse features give IV amiodarone
Acute pericarditis ECG
Often show saddle-shaped ST elevation
Quincke’s sign
Nailbed pulsation seen in aortic regurg
