CARDIORESPIRATORY Flashcards by Isobel Elliott

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

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Mining occupation, upper zone fibrosis, egg-shell calcification of hilar nodes

Silicosis

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X ray findings in asbestosis

lower zone fibrosis and pleural thickening, and there is not commonly hilar calcification.

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clinical examination findings for a collapsed right upper zone

Trachea deviated to the right
reduced breath sounds
dullness to percuss

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causes a cavitating mass on chest radiograph?

squamous cell carcinoma
pulmonary infarct
granulomatosis with polyangiitis
bacterial lung abscess
mycetoma

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causes of a loud S1

hyperdynamic states
- exercise
- pregnancy
- fever/ sepsis
- anaemia

reduced PR interval- WPW syndrome

mitral stenosis

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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

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causes of a soft S1

hypodynamic states
- HF

increased PR interval (increased ventricular filling and pushing valve leaflets closer together)
- heart block

Mitral regurg

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causes of a loud S2

systemic hypertension
pulmonary hypertension

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causes of a soft S2

aortic stenosis and aortic regurg

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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

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causes of pitting oedema

HF
liver cirrhosis
nephrotic syndrome

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casues of non pitting oedema

lymphoedema
pretibial myxedema

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cuases of constrictive pericarditis

idiopathic
TB
systemic inflammatory conditions- RA, SLE, sarcoid

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Signs and symptoms of constrictive pericarditis

SOB
chest pain

Kussmal breathing - raised JVP on inspiration

signs of right HF - pulmonary oedema

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what is constrictive pericarditis

formation of granulation tissue within the pericardium resulting in loss of stretch and cardiac filling

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causes of restrictive cardiomyopathy

amyloidosis
sarcoidosis
myeloma (deposition of AL amylois)

presents similarly to constrictive pericarditis

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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