Cardiovascular pathology 2 Flashcards
What are some indications in claudication to referral to a specialist:
impacting on lifestyle
impacting on walking distance
What two things would very suggestive of a person NOT having critical limb ischemia?
Being able to walk
- even a couple of yards
Being able to sleep through the night without being woken up by pain
What clinical sign is particularly worrying in limb ischemia and should motivate further treatment?
Muscle tenderness
Outline the immediate management for a critically ischemic limb:
Imaging:
- CT
- MRI
- arteriogram
*arteriogram may be useful if there is going to immediate invasive intervention
Viable limb:
- Aspirin/ Clopidogrel
- Morphine
- Alteplase
- Surgical revascularization
Non Viable Limb:
- Surgical amputation
+
Morphine
Prior to treatment for limb ischemia, what must one consider?
Do the symptoms justify investigation? majority don’t need intervention
What treatment is available?
- bypass
- stenting
Is there evidence of muscle necrosis?
- if so no delay can be left
What drugs should be avoided in PVD?
Beta blockers
In acute MI when do you give oxygen?
If stats are <94%
If there is ST depression inferior, where will the reciprocal changes take place?
Lateral leads
If PCI can’t be done - what is the treatment?
IV tenecteplase
IV heparin
\+ Aspirin Ticagrelor Metoclopramide Morphine \+/- Oxygen
In order to have 1st degree heart block, what must be present?
P-Q interval of >0.2seconds
one large box
What tests should be done following a PCI?
Troponins
Cholesterol levels
Glucose
X-ray
Echocardiogram
How long is tricagerlor prescribed for following the MI?
6 months
How long after an MI, until someone can,
Drive
Have sex
Return to work
Drive - least 1 week, and 4 weeks if evidence of LVHF
Sex - briskly walk two flights of stairs without being breathless
~2-3 weeks
Return to work:
- 1-2 months
In the setting of unstable Angina, what tests should be done?
Coronary angiogram
Exercise testing
What are some absolute contraindications for thrombolytic therapy?
History of intracranial bleeds
Recent surgery <3 weeks
Ischemic stroke <6months
Bleeding disorders
Pancreatitis
Suspected aortic dissection
Active internal bleeding <1 month
What is the criteria for LVH? and what is it often associated with?
> 35mm QRS wave
Aortic stenosis
Hypertension
Name a medication that can be used as a positive inotrope in cardiac failure:
Dobutamine
*also used to stress the heart
What shape is the normal aortic valve?
Mercedes Benz
If you want to see the four chambers of the heart, where do you place the probe?
Apex
What is the most common cause of valvular disease?
and what is the most common cause of non-cyanotic congenital heart defect?
Wear and tear, leading to calcification
Most common non - cyanotic heart defect is Bicuspid Aortic valves
What tests are done to establish aortic stenosis?
Transthoracic echo
- apical view
- parasternal view
- doppler use
ECG
Chest x-ray
- may seen enlarged ventricle
Stress test
- exercise test
- dobutamine
Cardiac Catheterisation
If someone presented with acute limb ischemia and didn’t have previous history of claudication (which would be suggestive of atheroma rupture), what would the most likely etiology be?
Embolism
- most likely cause from AF
If there is atheroma present in the lowering limb - where else is likely to have them?
Coronary artery
carotids
Renal
Mesenteric
Whats the immediate treatment for Severe ischemic limb?
Heparin
Analgesics
Rest
angiogram - after which arterial thrombolysis
with possible angioplasty and stenting
In a patient presenting with AF for the first time, what would be the considering factors to carry out cardioversion? what other factors need to be considered?
If they were symptomatic
There good chance cardioversion could be achieved
if it has occurred >48hrs. if so then anti-coagulation is needed
Which patients may be suitable for catheter ablation of AF? and where is it typically done?
Those who have recurrent paroxysmal AF with symptoms.
The pulmonary vessels
In someone with permanent AF, what would your management be?
Rate control
- Beta blockers
- Verapamil (not HF patients)
- digoxin
Anti-coagulation
