Cardiology workbook Flashcards
What is the ECG diagnosis
Inferior STEMI, RCA
Immediate management of STEMI patient before cardiologist arrives and after
Before: MONA IV
Morphine, O2 if sats <94%, nitrates, Aspirin 300mg loading and anti nausea (ondansetron), secure IV access
A-E assessment
After: transfer to cath lab
What long term medications should be prescribed following MI, prior to hospital discharge, to improve outcomes
ATABS
Aspirin 75mg OD for life, Ticagrelor (or prasugrel or clopidogrel), ACEi/ARB (LV remodelling), B blocker, Statin
Features of CXR suggestive of heart failure
Cardiomegaly, alveolar oedema, perihilar shadowing
Why do patients with heart failure develop ankle oedema
Heart cannot pump effectively, blood backs up into veins, increased pressure pushes fluid out due to higher hydrostatic pressure,causes swelling
Treatment for acute presentation of heart failure vs chronic
Acute: loop diuretics, O2 or CPAP, nitrates
Long term: ACEi, B blocker, (aldosterone antagonist?)
What does this ECG show
A fib, irregularly irregular
Acute treatment for A fib
Cardio version (electrical or flecainide) + amiodarone
Example of indication for electrical DC cardioversion
Haemodynamic instability
3 commonest causes of A fib and investigation for that
Heart failure (e.g. post MI): ECG
Valvular disease: echo
Acute infection: FBC,CRP,blood cultures
What is WPW syndrome
Re entry loops
What drugs cannot be used in WPW
No rate control e.g. beta blockers, no adenosine, no CCB or digoxin
What drugs are used in long term treatment of permanent AF
Anticoagulation e.g warfarin/DOAC, rate control e.g. B blockers/CCB/digoxin, rhythm control e.g. cardioversion
What scoring systems are used to decide if a patient with AF should be taking long term anticoagulation
CHADSVASC and HAS-BLED
Clinical features of aortic stenosis
Slow rising pulse, narrow pulse pressure, heaving apex beat, ejection systolic 2nd ICS RHS heart murmur radiating to neck/carotids loudest on expiration, reduced or absent S2
What are common differentials for systolic murmur
Aortic stenosis!
Pulmonary stenosis, VSD, mitral regurgitation
Investigations relevant for murmur diagnosis
Echo and ECG
Common complications of severe aortic stenosis
Heart failure, stroke, blood clots
(Endocarditis, arrhythmia, haemolytic anaemia)
Symptoms of severe aortic stenosis
Syncope, chest pain, breathlessness
Management of aortic stenosis
Aortic valve replacement and anti coagulants
(TAVI via femoral artery more likely if elderly)
Common causes of valvular heart disease
Congenital heart disease, rheumatic fever, cardiomyopathy, heart attack
Clinical signs of aortic regurgitation
Diastolic murmur LHS sternal edge, collapsing pulse, head bobbing (De Musset’s sign)
Clinical signs of mitral stenosis
Murmur (low pitched mid diastolic)
irregularly irregular pulse
Malar flush
Loud SI
Clinical signs of mitral regurgitation
Holosytolic murmur (heard best at apex)
Radiation to axilla
Displaced apex beat
Clinical signs in infective endocarditis
Pyrexia, tachycardia, heart murmur new and regurgitating, splinter haemorrhages, clubbing, Jane way lesions, emboli, sepsis
(History of tiredness)
Common pathogens causing infective endocarditis
Viridans strep, Staph Aureus, enterococcal
How is a definitive diagnosis of infective endocarditis made
Blood cultures and TOE (echocardiogram)
What antibiotic therapy is indicated if infective endocarditis is expected
If strep/enterococci: Benzylpenicillin (vancomycin is penicillin allergic) and low dose gentamicin
If Staph: flucloxacillin and gentamicin
Clinical signs for high BP
None
Hypertensive retinopathy
Enlarged palpable kidneys
Renal artery stenosis causing bruits
Moon face, abdominal purple striae
Radiofemoral delay
Coarctation
Common secondary causes of high BP
Cushing’s syndrome, PCK disease, renal bruits, coarctation, radio-femoral delay, cocaine, oral contraceptive, pregnancy
investigations for hypertension
Test for protein in urine and haematuria
Plasma glucose, electrolytes, creatinine, eGFR, serum total cholesterol and HDL
12 lead ECG
Fundoscopy
Echocardiography
Pregnancy test
3 common drug classes used to treat hypertension and side effects
ACEi - dry cough headaches
ARB - dizziness, headaches, fatigue
CCB - ankle swelling, flushing, palpitations
Diuretic - dizziness, tiredness, headache, gout, ED, cramps
Common complications of untreated hypertension
Heart attack, stroke, TIA, heart failure, kidney failure, dementia
What is a feature of hypertensive retinopathy
Flame haemorrhages
