Cardiovascular Flashcards
What is a normal ejection fraction?
50-70%
What factors influence preload?
Atrial contraction, venous tone, total blood volume
What is afterload and what influences it?
Afterload is the pressure the ventricle needs to generate to eject blood from the ventricles. This is influenced by the total peripheral resistance.
What landmark designates where to look for JVP?
Between the two heads of sternocleidomastoid.
How do we differentiate between the (JVP) venous and arterial pulsation?
Mnemonic = POLICE (not palpable, occludable, location, inspiration (decrease), contour/waveform, erection (position of body). Can also use hepatojugular reflex.
What is Kussmaul’s sign?
Kussmaul sign describes an increase in JVP on inspiration. Therefore atrial pressure is higher on inspiration, when it should be lower. Could point to constrictive pericarditis, RHF, restrictive cardiomyopathy
Outline the blood supply of the heart
RCA and LCA come off the root of the aorta. RCA gives rise to PDA (right-dominance, most common), LCA gives off LAD and left circumflex.
What are the bradyarrythmias?
First degree, second degree (I + II), third degree AV blocks, sick sinus syndrome (note SSS has periods of both brady and tachy cardia)
What medications can cause bradyarrtyhmias?
B-blockers, Calcium-channel blockers, digoxin, amiodarone – which we also use to treat tachyarrhythmias!
What are the features of ‘typical’ angina?
<20 minutes, dull substernal chest pain, worsened by stress/exertion and relieved by rest/nitrates. Can radiate, can have SOB, nausea, sweating or lightheadedness.
How do you use your GTN?
use immediately when pain comes on, use at 5 mins again if the pain does not ease, then if the pain has not eased after another 5 mins call an ambulance immediately
What is atypical angina?
Occurs at rest. Worsening e.g. getting longer, more severe, less responsive to GTN.
What differentiates cardiac syncope from other syncope?
past hx of cardiac/coronary artery/valvular disease
- Associated with exertion
- Accompanied by palpitations or chest pain
- Lack of prior vagal symptoms (sweating, nausea, lightheadedness before syncope)
What are some common causes of cardiac syncope?
- Structural (valvular, ischaemic cardiomyopathy, dilated cardiomyopathy)
- Tachyarrythmias
- Bradyarrythmias
- Drug induced
JVP main wave features
A
X(1)
C
X(2)
V
Y
Atrial contraction
Atrial RelaXation
C(systole) as ventricle contracts
Atrial relaXation as ventricle is very small so lots of room for RA to expand
Villing of atria and IJV
EmptYing of RA
Name 2 causes of systolic murmur and how to differentiate the two.
Aortic stenosis - radiates to carotids. Harsh ejection murmur.
Mitral regurg - pansystolic and radiates to axilla.
What is a third heart sound a feature of?
acute heart failure
How do you manage acute AF > 48 hours + stable?
Beta blocker + anticoag. DO NOT CARDIOVERT FOR >3 WEEKS - THROMBI RISK
How to manage acute AF unstable?
Electrical cardioversion
What are the drugs we give in AF?
‘RACE’
Rate control: B-blocker or CCB (add digoxin if in heart failure)
Anticoagulation: dabigatrin or rivoroxaban
Cardioversion? (consider in new AF)
Etiology (treat underlying cause)
+ rhythm control (cardiologist review(
- amiodarone or B-blocker
What are the causes of acute AF?
Pulmonary disease (not asthma). ischaemia, RHD, anaemia, thyrotoxicosis, ethanol. sepsis
How do you reverse warfarin? INR >8 and bleeding
IV vitamin K 5mg and prothrombin complex concentrate (contains Vit-K dependent clotting factors)
Oral if not bleeding
In which scenario do we give atropine?
Block + low heart rates (bradyarrythmias)
6 doses then temp pacemarker if not responding. If haemodynamically unstable just do the pacemaker.
When should we administer adenosine?
Tachycardias originating at the AV junction (AVNRT, WPW, AVRT)
Note: give after valvasalva manevure + carotid massage
