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
describe second degree heart block mobitz type 1/wenckebach
PR progressively lengthens then QRS drops
describe mobitz type 2 second degree heart block
normal PR but some not conducted to ventricles so some dropped QRS
describe 3rd degree heart block
no association between p waves and QRS
which heart blocks are worrying/ need pacing
mobitz type 2 and complete
what is a 2:1 AV block suggestive of?
digoxin toxicity (reverse tick sign) and ischaemia
examples of narrow complex tachycardias
SVT - atrial fib/flutter, AVN reentry, junctional, sinus
examples of broad complex tachycardia
VT, VF, torsades des pointes, ectopics
examples of shockable rhythms - and treatment
VT/VF
CPR 30:2
shock x 3
give IV adrenaline 1mg every 3-5 mins
examples of non shockable rhythms and treatment
PEA, asystole
CPR, 1mg adrenaline, repeat every 3-5 mins, get airway and do continuous CPR, 2 min rhythm checks
treat reversible causes
management of AF
rate control: beta blockers/ CCB - verapamil
rhythm control: amioderone (not tolerated well)/ flecanide (can cause broad complex tachycardia)
anticoagulation: CHADS2VASC (>2 = warfarin)
ECG changes in wolff-parkinson white
Prolonged PR, wide QRS, delta wave, ST changes
<0.9 ABPI means..?
arterial disease
do a doppler
investigation of DVT
wells score >1 - D-dimer and USS
wells score <2 - D-dimer (if positive do USS)
initial management of VTE
LMWH/ fondaparinux for 5-7 days or until INR is >2
management of VTE in cancer
continue LMWH for 6 months and reassess
management of provoked VTE
warfarin/ NOAC for 3 months and reassess
management of unprovoked VTE
look for thrombophillia in <40 and cancer in >40
warfarin/NOAC for at least 3 months and reassess
management of PAD
risk factors ACE inhibitors to reduce CV risk peripheral vasodilators antiplatelets - clopidogrel/ aspirin angioplasty
describe an arterial ulcer
well defined borders
necrotic
small and painful
occur at pressure areas
describe an venous ulcer
occurs on medial malleolus
exudative
large, not well defined
little pain
describe a neuropathic ulcer
painless ulcers on pressure points
punched out appearance
what is becks triad
cardiac tamponade
1: low BP
2: raised JVP
3: muffled heart sounds
what are the cyanotic structural heart defects?
tetralogy of fallot
transposition of the great vessels
what does tetralogy of fallot consist of
pulmonary stenosis
RVH
over-riding aorta
VSD
how does tetralogy of fallot present and management
loud ejection systolic murmur
child squats down
presents with cyanosis and breathlessness at 6 months
insert a shunt
how does transposition of great vessels present and what is it and management
pulmonary artery and aorta are switched so oxygenated blood from lungs goes back to the lungs and not around the body
only compatible with life if co-exisitng septal defect
keep defect open using prostaglandins
what is PDA, presentation and management
duct between aorta and pulmonary artery so oxygenated and deoxygenated blood gets mixed
machinery murmur
breathlessness, pulmonary hypertension, HF
close with indometacin (NSAID) / catheter
murmur in ASD and presentation
ejection systolic and left sternal edge
can be asymptomatic or breathlessness/pulmonary hypertension
dilated cardiomyopathy
how does a VSD present
breathlessness, heart enlargement, prominent apex beat pansystolic murmur (loud = small defect, quiet = large defect)
what is eisenmenger’s syndrome
long standing left - right shunt causes pulmonary hypertension and reverses the shunt causing cyanosis
drugs causing heart block
ABCD(E) adenosine beta blockers CCB digoxin excitation of vagus
causes of clubbing
lung fibrosis lung cancer cystic fibrosis cyanotic heart disease infective endocarditis IBD coeliac GI cancer liver cirrhosis thyroid acropachy
reversible causes of cardiac arrest
4 H's, 4 T's Hypothermia Hypovolaemia Hypoxia hyper/hypokalaemia
Thrombus
Tamponade
Tension pneumothorax
Toxins
