cardiovascular Flashcards
CXR in aortic dissection
Widened mediastinum
Double aortic contour
Irregular aortic contour
Inward displacement of atherosclerotic calcification
CT angiography aortic dissection
False lumen
ix for aortic dissection
CXR
CT angiography is the initial ix - diagnostic
Transoesophageal echocardiography (TOE) - espesh if unstable
types of aortic dissection
type A - ascending aorta, 2/3 of cases - worse prog
type B - descending aorta, distal to left subclavian origin, 1/3 of cases
mx aortic dissection for type A + B
Type A
surgical management - control BP to a target systolic of 100-120 mmHg whilst waiting
Type B
conservative management
- bed rest
reduce blood pressure IV labetalol
murmur for aortic stenosis
ejection systolic
(louder on expiration)
murmur for mitral regurgitation
pan-systolic
presentation of aortic dissection
50+ men
sudden onset tearing chest pain radiating to the back
radio-radial delay
radio-femoral delay
BP diff between arms
RF aortic dissection
Hypertension
Connective tissue disease e.g. Marfan’s syndrome
Valvular heart disease
Cocaine/amphetamine use
who is at risk of having a silent MI
px w DM
ECG changes for hypercalcaemia
shorted QT interval
J waves if severe
what is Wellen’s syndrome and what are the signs of it
characterised by biphasic or deeply inverted T waves in V2-3
history of recent chest pain now resolved (cardiac ischaemia in the setting of unstable angina)
highly specific for critical stenosis of the left anterior descending artery (LAD)
- high risk needing further ix
Troponin normal at this stage
immediate ACS drug therapy
- aspirin 300mg
- oxygen should only be given if the patient has oxygen saturations < 94%
- morphine should only be given for patients with severe pain
- nitrates,useful if the patient has ongoing chest pain or hypertension, should be used in caution if patient hypotensive
mx of STEMI
PCI - if the presentation is within 12 hours of the onset of symptoms AND can be delivered within 120 minutes of the time when fibrinolysis could have been given (i.e. consider fibrinolysis if there is a significant delay in being able to provide PCI)
fibrinolysis (w/ eg alteplase) - should be offered within 12 hours of the onset of symptoms if primary PCI cannot be delivered within 120 minutes of the time when fibrinolysis could have been given
further drug therapy before PCI
or if not taking an anticoag
if taking an anticoag
‘dual antiplatelet therapy’, i.e. aspirin + another drug
if the patient is not taking an oral anticoagulant: prasugrel
if taking an oral anticoagulant: clopidogrel
fibrinolysis/thrombolysis what to do before and after
give another antithrombin drug
An ECG should be repeated after 60-90 minutes to see if the ECG changes have resolved. If patients have persistent myocardial ischaemia following fibrinolysis then PCI should be considered.
when to give heparin in NSTEMI/unstable angina
if immediate angiography is planned or a patients creatinine is > 265 µmol/L then unfractionated heparin should be given
which px w NSTEMI get angiography? (w follow on PCI if needed)
immediate: patient who are clinically unstable (e.g. hypotensive)
within 72 hours: patients with a GRACE score > 3% i.e. those at intermediate, high or highest risk
coronary angiography should also be considered for patients if ischaemia is subsequently experienced after admission
Risk assessment tool for ACS
GRACE
age
heart rate, blood pressure
cardiac (Killip class) and renal function (serum creatinine)
cardiac arrest on presentation
ECG findings
troponin levels
how to terminate supraventricular tachycardias
vasovagal maneuvers if haemodynamically stable
12mg adenosine via large bore cannula (as they are narrow complex)
what are the ECG changes in a posterior MI?
reciprocal changes to STEMI
changes in V1-3
- horizontal ST depression
- tall, broad R waves
- upright T waves
- dominant R wave in V2
see tall R waves? Right behind you!
what artery is affected in posterior MI?
left circumflex
(sometimes right coronary)
where is the lesion if someone gets complete heart block after an MI
right coronary artery (as it supplies the AV node)
triad for cardiac tamponade (pericardial tamponade)
Beck’s triad
- hypotension
- muffled/distant heart sounds
- elevated JVP