Cardiovascular Flashcards
post MI drugs
Dual antiplatelet therapy (tecagrelor and aspirin) for 12 months antithrombotic (fondaparinux) bisoprolol (beta blocker) high dose statin (atorvo 80mg) (AB(see)D)
examination findings in aortic stenosis
ejection systolic murmur (time with radial pulse)
loudest over aortic region, radiating to carotids
loudest on expiration (lean forward and hold breath in expiration)
slow rising pulse
narrow pulse pressure
examination findings in mitral regurgitation
pansystolic murmur best heard at apex (time with radial pulse)
radiates to left axilla
listen in left lateral position on expiration
HF symptoms
examination findings in aortic regurgitation
early diastolic murmur at aortic area best heard sitting forward on expiration waterhammer pulse wide pulse pressure corrigans sign (carotid pulsation) de mussets sign
examination findings in mitral stenosis
mid diastoloc murmur best heard at apex in left lateral position on full expiration malar flush RV failure raised JVP
describe the trend of troponins in ACS and when to measure
detectable 3-6 hours after infarct
peak at 12-24 hours
test at 6 and 12 hours (should be increasing in ACS)
- can also test immediately and then after 3 hours
list complications of MI
bradyarrhythmias (heart block and BBB) tachyarrhythmias (SVT - AF, AFl. VT/VF) pericarditis tamponade MR dresslers (pericarditis, pleural effusion, fever, anaemia- treat with NSAIDS)
explain the grading or murmurs
grades 1-6 (1-3 = no thrill, grades 4-6 = thrill)
1: faint not heard in all positions
2: soft heard in all positions
3: loud, no thrill
4: loud , palpable thrill
5: loud with edge of stethoscope tilted off chest, thrill
6: heard with stethoscope completely off chest , thrill
acute management of ACS
Morphine (analgesia), O2 if sats low, GTN, Aspirin and tecagrelor (DAPT), Antiemetic
management of angina
risk factor management, symptoms relief, 1st line, 2nd line, 3rd line, surgical
risk factors: smoking cessation, diet and exercise, statin, manage HTN and diabetes, aspirin
symptoms: GTN
1st line: beta blockers - bisoprolol
2nd line: isosorbide
3rd line: dihydropiridine CCB - amlodipine
surgical: if not controlled by >2 meds -stent
classification of AA and management
Abdo USS
standford classification
A: involves AA - surgical graft ASAP
B: doesn’t involve AA - endovascular repair
>5.5cm = surgery, under 5.5 = surveillance
criteria used for diagnosis of HF and investigations
framingham criteria
if previous MI do echo
if no MI do BNP and ECG then echo
New york heart association of severity of HF
1: no symptoms
2: slight limitation
3: symptoms at rest
4: unable to do any activity
acute management of HF (oedema)
O2 and analgesia furosemide slow IV GTN isosorbide (nitrate) IV fluid restrict and daily weights and U&E's avoid NSAIDs
long term management of HF
ACEi (in all LVEF <40%. cant use in renal disease/AS/COPD - give candesartan). titrate slowly, monitor kidney function
diuretic - furosemide +/- spironolactone/eplerone
Beta blocker if already on ACEi and diuretic
main pathogens responsible for IE
staph aureus in immunosuppression
strep viridans in abnormal valves and IVDU
staph epidermis if post surgery
investigation of IE and criteria
dukes criteria
3 different blood cultures at different times and locations
TOE
ECG changes in pericarditis
widespread saddle shaped ST elevation
stages of HTN
1: >140/90
2: >160/100
3: >180/110
malignant: >200/>130 AND end organ damage
BP targets
<140/80 - diabetics
<140/90 if <80 years old
<150/90 if >80
management of bradycardia with adverse signs/risk of asystole (heart block and broad QRS, recent asystole, ventricular pauses)
IV atropine (repeat 3mg every 3-5 mins) Pacing with transcutaneous wire
causes of sick sinus syndrome, ECG changes and management
fibrosis, digoxin, ischaemia
P-P pauses and junctional escape rhythms from AVN
pacing
causes of heart block
ischaemia, lymes disease, SLE, inflammation, digoxin, CCB, Beta blockers
describe 1st degree heart block
prolonged PR (>0.2 seconds) QRS after every P
