cardiology passmed Flashcards
VTE management
anticoagulate
> warfarin
>DOACs
when is it better to use LMWH?
antiphospholipid syndrome - triple positive
severe renal impairment <15/min
what score is useful for bleeding?
Orbit
Angina not controlled by beta block
dihydropyridine CCB - longer acting
ivabradine
reduces heart rate by inhibiting IF current
reducing oxygen demand
example of longer-acting dihydropyridine calcium channel blocker
Amlodipine
Nifedipine
Cardiac tamponade
Beck’s triad
hypotension
distended neck veins
muffled heart sounds
elevated JVP
persistent hypotension
tachycardia
pulsus paradoxus?
an abnormally large drop in BP during inspiration
Mx of cardiac tamponade?
urgent pericardiocentesis
Electrical cardioversion - Afib
synchronised to R wave to prevent delivery of shock in cardiac repolarisation > V fib can be induced
Cardioversion can happen in 2 eways in A fib
electrical DC cardiovert
Amiodarone
flecainade
Broad Complex Tachycardia
ventricular fibrillation
ventricular tachycardia
originate from the ventricles
> AMIODARONE acts on refractory period on the below
cardiac myocytes, AV node and SA node
good for ventricular arrhythmia
Narrow complex tachy’s
supraventricular - above ventricle
respond to adenosine
blocks transmission through AV node so abberrant SVT signals don’t reach ventricles
Unsynchronised cardioversion used in?
high energy shock
as soon as shock button pushed on a defibrillator
used in pulseless VT/VF
Synchronised DC cardioversion?
unstable atrial fib
atrial flutter
atrial tachy
vtach w a pulse
svt
Peri-arrest tachycardia
ABC assessment
Stable or unstable
QRS assessment > narrow or broad
Rhythm
> Regular
> Irregular
Peri-arrest
Stable assessment shows signs that it is unstable ?
shock - hypotensive <90
pallor, sweating, cold, clammy, confused
syncope
MI
HF
peri arrest, unstable
what next?
synchronised DC shock given upto 3
Tachycardia
Stable
QRS <0.12s
Regular QRS
vagal manouvres
> adenosine
6mg rapid IV blous
12mg
18mg
try CCB - verapamil
beta-block
Tachycardia
Stable
QRS Broad
Regular QRS
Amiodarone 300mg IV over 10-60 min
Stable tachycardia
narrow QRS
irregular
probable a fib
rate control : Beta blocker
consider : Digoxin / amiodarone
anticoagulate >48hours
broad QRS
stable tachycardia
Afib
bundle branch block
polymorphic VT torsades de pointes
magnesium 2g / 10 min
In suspected pulmonary embolism when would you use a ventilation-perfusion scan > CTPA?
eGFR significantly impaired V/Q scan preferred as contrast in CTPA is nephrotoxic
wolf-parkinson white?
accessory pathwya in electrical conduction of heart
most common causative agent for endocarditis
Staphylococcus aureus Staphylococcus epidermidis
if < 2 months post valve surgery
HTN
stage 2
BP >160/100
HBPM >150/95
stage 3 HTN?
clinic >180
clinic diastolic >120
<55 or T2DM
step 1 HTN management
ACEi
ARB
> 55 / no T2DM / black african / african- caribbean ethnicity
Caclium channel blocker
nifedipine / amlodipine
bradycardia and signs of shock mx?
500 micrograms of atropine
repeat upto max 3mg
Adenosine used in?
stable, narrow complex tachycardias
Amiodarone
Mx of ventricular fibrillation / vtachy
broad complex QRS
Bradycardia mx
2 step approach?
1) identify the presence of signs indicating haemodynamic compromise
2) identify potential risk of asystole
‘haemodynamic compromise’
shock:
Hypotension (systolic blood pressure < 90 mmHg),
pallor,
sweating,
cold,
clammy extremities, confusion or
impaired consciousness
syncope
Myocardial Ischaemia
heart failure
after atropine?
atropine 500mcg IV
transcutaneous pacing
isoprenaline / adrenaline
risk of asystole from bradycardia?
mobitz II AV block
complete heart block with broad QRS
ventricular pause >3s
using ABPM to confirm a diagnosis of hypertension
2 measurements every hour for every waking hour
average of at least 14 measurements used
Diagnosing HTN
measure both arms
record one from higher reading arm
if BP >180/120
admit for specialist
retinal haemorrhage or new onset confusion, chest pain, signs of heart failure, AKI
HBPM
2 consecutive measurements need to be taken at least 1 minute apart
twice daily in morning and evening
BP 4 days ideally for 7 days
when to treat stage 1 HTN?
<135/85
<80yrs and target organ damage, cardiovascular disease, renal disease DMT2
collapsing pulse, SOB, Cardiac murmurs
aortic regurgitation
Ivabradine role in angina?
lowers HR kinda when beta block cannot be used
targets sinus node to reduce HR w/o affecting BP
how does isosorbide mononitrate work?
decreases preload by vasodilation
decreases preload lowering the heart’s oxygen requirement for muscle contraction
effective in angina
contraindications to statin
macrolide
> erythromycin, clarithromycin
pregnancy
how much adrenaline in ALS?
1mg adrenaline 10mls of 1:10,000
20mls of NACL- 0.9% flush to aid entry into circulation
Left ventricular free wall rupture
within 48 hours
chest pain
Mitral valve prolapse
sudden shortness of breath
pulmoanry oedema
left ventricular aneurysm
ST elevation in V1-6
fibrosis and dead tissue not able to move properly
pulmonary oedema signs > bibasal crackles,
S3 sound > left ventricle is larger
S4 left ventricle is stiffer than normal
Hypocalcemia is a side effect of which antihypertensives?
loop diuretics
torsades de pointes mx?
IV magnesium sulfate
stabilises cardiac myocytes
reduces influx of calcium
hypercalcaemia ECG abnormality?
short QT interval
aortic dissection stanford B?
site of dissection is descending aorta
mx of uncomplicated?
medical : IV beta blockade and analgesia
aortic dissection stanford A
endovascular / open interventions
aortic dissection
DeBakey classification
type I - ascending aorta
type II - originates in and is confined to the ascending aorta
type III - originates in descending aorta, rarely extends proximally but will extend distally
candesartan
ARB
better for HTN addition step 2 in black patients
sacubitril-valsartan
a neprilysin inhibitor)
needs a 36 hour washout period to prevent accumulation of bradykinin
Digoxin
cardiac glycoside
slows down heart rate
