Cardiovascular Flashcards
65 year old woman being treated with large doses of loop diuretics requires add on for oedema refractory to treatment
Metolazone which is a thiazide diuretic
A 70 year old woman with a history of chronic heart failure presents with severe pulmonary oedema, what treatment?
100% O2, IV diamorphine, IV frusemide, sublingual GTN
Treatment of mild symptoms of shortness of breath and ankle oedema in a 65 year old man with left ventricular dysfunction caused by ischaemia heart disease, he is already taking an ACEi. What next?
Loop diuretic
Treatment of a 65 year old man with AF of longer than 48hrs before DC cardioversion
Digoxin and Warfarin for a month. Patient with AF of longer than 48hrs after cardioversion is at risk of thromboembolism after cardioversion. Ventricular rate should be controlled with digoxin
Initial therapy in a 60 year old woman presently severely compromised with acute persistent AF
Direct DC cardioversion and heparin because patient is severely immunocompromised
A 55 year old man admitted with acute MI develops a short run of VT. He requires treatment for prophylaxis against recurrent VT
IV Amiodarone -Amidarone works through class II action to prolong the plateau phase of cardiac action potential and prolongs the QT interval. Side effects in long term.
Drugs to aid diagnosis in a 50 year old man presenting with an unidentifiable, regular, narrow complex tachycardia
IV Adenosine
Prophylaxis of ventricular tachycardia in a patient with varying QRS axis and prolonged QT interval
IV Magnesium and ventricular pacing
-This is Torsades de Pointes which will often degenerate to ventricular fibrillation to cardiac arrest
63 year old man with a history of high blood pressure presents in A&E with sudden onset tearing chest pain radiating to the back
Aortic dissection
-The dissection can interrupt flow to the coronary arteries, resulting in myocardial ischaemia.
Type A involves the ascending aorta but type B does not.
Type A involves surgery whereas B aggressive reduction in blood pressure
40 year old woman develops sudden onset dyspnoea at rest following hip replacement surgery. On examination she is tachycardic and her ECG shows right axis deviation
PE
60 year old businessman complains of central crushing chest pain radiating to both arms after running to catch a bus. Pain was relived by rest and his ECG recording 1hr later was unremarkable
Angina
21 year old high jumper presents with acute onset dyspnoea and right sided pleuritic chest pain. Examination reveals increased resonance and reduced expansion on right side
Tension pnuemothorax
23 year old woman presents with localised left sided chest pain that is exacerbated by coughing and is particularly painful on light pressure to that area. Pain is relived by aspirin. ECG unremarkarble
Costochondritis
-2nd rib frequently affected in this condition
Slow rising pulse, narrow pulse pressure, heaving apex beat and fourth heart sound.
Aortic Stenosis
-Angina, SOB and syncope and common presenting symptoms
Collapsing pulse, wide pulse pressure, ‘pistol-shot’ sound heard over femoral arteries.
Aortic Regurgitation
-Other signs include Corrigan’s sign, de Musset’s sign and Quincke’s sign
Radiofemoral delay in a patient with hypertension.
Coarctation of aorta
- Involves narrowing of the aorta and is twice as common in men
- Assoc
Pulsus paradoxus, jugular venous pressure (JVP) rises on inspiration, heart sounds
muffled
Mixed aortic valve disease
Bounding pulse in a patient who is short of breath
acute CO2 retention
Radiofemoral delay in a patient with hypertension.
Coarctation of aorta
- Involves narrowing of the aorta and is twice as common in men
- Associated with Turner’s syndrome
- Can maybe see rib notching on CXR die to formation of collateral arterial circulation which can erode the undersurface of ribs
Bounding pulse in a patient who is short of breath
acute CO2 retention
-Can be felt in a patient with sepsis
Falling blood pressure, rising JVP on inspiration and muffled heart sounds
Beck’s Triad which is an indication of cardiac tamponade/constrictive pericarditis
Tapping apex beat, loud S1, mid diastolic murmur loudest at apex in expiration lying on the left side
Mitral Stenosis
Heaving undisplaced apex beat, absent A2 with ejection systolic murmur radiating to the carotids
Aortic stenosis
Pansystolic murmur heard best at lower left sternal edge during inspiration in a patient with pulsatile hepatomegaly
Tricuspid regurgitation
