CARDIORESPIRATORY Flashcards
Complications of an MI
Immediate:
- cardiac arrest
- cardiogenic shock
- acute mitral regurgitation (more common with inferio-posterior infarction)
- arrhythmias
-Pericarditis (within 48hrs or Dresslers 2-6weeks after)
-large ventricular free wall rupture (1-2 weeks post)
- ventricular septal defect (within first week)
- chronic heart failure
Mining occupation, upper zone fibrosis, egg-shell calcification of hilar nodes
Silicosis
X ray findings in asbestosis
lower zone fibrosis and pleural thickening, and there is not commonly hilar calcification.
clinical examination findings for a collapsed right upper zone
Trachea deviated to the right
reduced breath sounds
dullness to percuss
causes a cavitating mass on chest radiograph?
squamous cell carcinoma
pulmonary infarct
granulomatosis with polyangiitis
bacterial lung abscess
mycetoma
causes of a loud S1
hyperdynamic states
- exercise
- pregnancy
- fever/ sepsis
- anaemia
reduced PR interval- WPW syndrome
mitral stenosis
what makes the sound of:
S1
S2
S3
S4
S1- closure of MV and TV
S2- closure of AV and PV
S3- Excess ventricular filling
S4- increased arterial ‘kick’ during diastole
causes of a soft S1
hypodynamic states
- HF
increased PR interval (increased ventricular filling and pushing valve leaflets closer together)
- heart block
Mitral regurg
causes of a loud S2
systemic hypertension
pulmonary hypertension
causes of a soft S2
aortic stenosis and aortic regurg
causes of a split S2
physiological during inspiration
wide split S2-
- delayed RV ejection: RBBB, pulmonary hypertension,pulmonary stenosis, PE
- increased LV ejection: WPW
Fixed split S2 (same in insp and expiration)
- ASD
causes of pitting oedema
HF
liver cirrhosis
nephrotic syndrome
casues of non pitting oedema
lymphoedema
pretibial myxedema
cuases of constrictive pericarditis
idiopathic
TB
systemic inflammatory conditions- RA, SLE, sarcoid
Signs and symptoms of constrictive pericarditis
SOB
chest pain
Kussmal breathing - raised JVP on inspiration
signs of right HF - pulmonary oedema
what is constrictive pericarditis
formation of granulation tissue within the pericardium resulting in loss of stretch and cardiac filling
causes of restrictive cardiomyopathy
amyloidosis
sarcoidosis
myeloma (deposition of AL amylois)
presents similarly to constrictive pericarditis
what is brugada syndrome?
AD inherited heart condition
predisposes to fatal arrhythmias
RBBB and ST elevation in V1-3
strong FHx of unexplained cardiac death or syncope
sparkling sign on echocardiogram sign of
amyloid deposition in the myocardium
anti hypertensive drugs safe to use in pregnancy
labetelol
nifedipine
methyldopa
hydralazine
treatment for oligogyric crisis
procyclidine
what conditions are a contraindication for beta blockers
asthma
COPD
raynauds
peripheral vascular disease
bradycardia
prinzmatal angina
causes of haemoptysis
resp:
PE
lung cancer
TB
Cardio
RHF
Mitral stenosis
systemic
GPA
goodpastures syndrome
causes of pericarditis
infections
- coxackie B, EBV, mumps
infaarct
- ost MI dresslers
inlammation
- RA, SLE, sarcoid
antibiotics that cause long QTc
macrolides (azithro, erythro, clarythromycin)
quinolones (ciproflox, levofloxacin)
aortic regurgitiation signs
wide pulse pressure
collapsing pulse
De musset’s sign- head bobbing with pilse
rare:
Quinckes sign- nail bed pulsation
corrigans sign: carotid pulseation
pistol shot sign heard over the femorals
long term management of mechanical valve replacement
warfarin sodium
now have home INR testing kits
discharge management following asthma attack
non-pharm:
personalised asthma management plan
pharm:
salbutamol
betamethasone and slmaterol inhaler
oral pred
causes of clubbing
resp:
bronchiectaasis
lung carcinoma
lung abscess
extrinsic allergic alveolitis
cycstic fibrosis
Idiopathic pulmonary fibrosis
cardio
cyanotic heard disease
gastro
ulccerative colitis
neuro
neurogenic tumors
management of moderate acute exacerbation of COPD
increase frequency of bronchodilator/ nebulised
30mg oral pred for 5 days
signs of infection:
antibiotix: amoxicillin/ clarythromycin/ doxycycline
management of severe exacerbation of COPD
oxygen: caustion of CO2 retention, ABG, check Hx, 88-92% target if retainer
venturi mask 28%
NIV if retention
salbutamol/ ipratroprium nebs
IV steroids (hydrocortisone)
management for ABPA
oral steroids
Management of STEMI
ACUTE
supportive:
- analgaesia (IV morphine)
- metocopromide
- oxygen if required
- nitrates if SBP >110
medical
- STAT dose aspirin (300mg)
- loading dose of ticagrelor (180mg)
interventional:
- call cardiology and arrange for a primary PCI ASAP (within 2hrs of presentation)
- if not possible within 2 hrs then thrombolyse with alteplase
LONGTERM
- address CVD RFs: smoking cessation, DM control, statin
Management of NSTEMI
Supportive:
- analgaesia + metoclopromide
- oxygen
- GTN, bblocker, CCB
medical
- Aspirin 300mg + ticagrelor 180mg
- fondaparinux or LMWH
calculate GRACE score (6 month mortality)
> 3%
Intervention:
- revascularisation within 72hrs
- ticagrelor + unfractionated heparin
<3%
conservative:
- ticagrelor
Important investigations
- Echo to establish LV funtion
Management od unstable angina
Management of stable angina
Symptom control
vasodilators:
-GTN spray
- CCBs (amlodipine)
rate slowing:
- beta blockers
- ivabridine (acts on SAN)
Management of AS
asymptomatic:
- annual f/u in clinic and echocardiogram
- safety netting
symptomatic
- TAVI
-iopen AV surgery
Management of MR
Management of acute symptoms:
- A-E
-oxygen
-IV frusomide if overloaded
- manage ACS if appropriate
MR
- TOE
- mitral valve repair or replacement
- biologic or metallic
what AV pressure gradient should prompt AV replacement
> 50mmHg
causes of 3rd decree heart block
ischaemia (esp inferior MI)
medication (CCB, digoxin, bblockers, amiodarone, donepazil)
fibrosis
becks triad
hypotension
raised JVP
muffled heart sounds
which lung cancer is associated with cavitating lesions?
squamous cell
