Cardiovascular System Flashcards
What is the 1st line management of Ventricular Tachycardia?
1st line- Amiodarone
What is the 1st line investigation for Brugada Syndrome?
1st line investigation- sodium challenge test
What is the 1st line management of Brugada Syndrome?
Management:
1st line- ICD
Long QT Syndrome:
a) What is the 1st line management?
b) What is the definitive management?
Long QT syndrome
1st line- beta blocker
definitive- ICD
What are the main X2 types of HF, and what causes them?
Reduced Ejection Fraction HF- this is when the heart does not contractt forceful enough during systole
Preserved Ejection Fraction HF:
The left ventricle is too stiff, so less blood fills overall resulting in reduced ejection fraction
What Classification system is used in HF?
NYHA classification
What are the abbreviations used for the management of these conditions?
a) Asthma Attack
b) COPD exacerbation
c) NSTEMI
d) HF
a) O SHIT MAN
b) ISOAP
c) BATMAN
d) LMNOP
What is the management of HF?
(*use abbreviation)
LMNOP
l-loop diuretic (furosemide)
m-morphine
n-nitrates
o-oxygen
-p-position (sit patient upwards, avoid lying on back)(
What is the acute management of Atrial Fibrillation?
Acute:
1st line- DC Cardioversion +/- Amiodarone
What is the long term management of Atrial Fibrillation?
a) long term
b) anti-coagulation therapy
1st line- beta blocker
2nd line- CCB
Anti-coagulation therapy
1st line- DOAC
2nd line- LMWH
(*SAME AS DVT/PE)
What is the management of Ventricular Tachycardia?
a) with pulse
b) pulseless
Acute:
1st line- IV Amiodarone
Pulseless Ventricular Tachycardia:
1st line- DC Cardioversion (shockable rhythm)
What is the management of Supra-Ventricular Tachycardia? (SVT)
(*spa)
1st line- valsalva manouver
2nd line- carotid sinus massage (s-spa)
3rd line- IV adenosine 6mg bolus > 12mg> 18mg
alternative if asthmatic
verapamil
What is the dosage of Adenosine in the management of SVT?
Dosage of Adenosine:
rd line- IV adenosine(6mg)- then 12 mg > 18mg
What is the alternative to adenosine in SVT when a patient is asthmatic?
asthmatic- verapamil
What is Malignant Hypertension?
acute rise in blood pressure defined as systolic >180 and diastolic >120
Infective Endocarditis
a) what is the 1st line investigation
b) what is the 1st line imaging?
1st line test- x3 sets of blood cultures (against Dukes Criteria)
1st line imaging- echocardiogram
What is GRACE score used for?
-determines short and long term risk in ACS
if >3% in an NSTEMI this indicates a coronary angiogram within 72hrs of admission
What GRACE score (%) in an NSTEMI indicates a coronary angiogram must be performed?
if >3% in an NSTEMI this indicates a coronary angiogram within 72hrs of admission
What is the management of an NSTEMI?
(*BATMAN)
BATMAN
- Base whether angiography should be carried out within 72hrs on the GRACE score is >3%
- Aspirin 300mg stat
- Ticagreor
- morphine
- anti-thrombin
- nitrates (GTN)
Where anatomically is a PCI carried out?
-radial access
What is Dresslers Syndrome and what are its clinical features?
This is a type of pericarditis (same clinical features) that occurs 4-6 weeks post MI
-better leaning forward, saddle ST elevation on an ECG
What is the main chamber effected in Chronic HF?
main chamber effected- left ventricle
Heart Failure:
a) what is the 1st line investigation?
b) what is the preferred imaging option?
Heart failure investigations:
1st line- BNP
2nd line -echocardiogram
What is the mutation in Long QT syndrome?
-base change in an exon nonsense mutation forming a premature stop codon
What is the genetic mutation in sickle cell syndrome?
Genetic - point mutation in codon 6 of the β globin gene that substitutes glutamine to valine producing βS
Hypertrophic Cardiomyopathy?
a) What is the 1st line management
b) what is the definitive management
Hypertrophic cardiomyopathy
1st line- beta blockers
definitive- ICD
What function is mainly impaired in hypertrophic cardiomyopathy?
reduced diastolic function
What is Frank Sterling Law?
Frank Sterling Law:
* relationship between stroke volume and end diastolic volume
What does J waves indicate?
-eat JELLYBABIES when hypothermic
-hypothermia
What medications are known to reduce the mortality rates of HF?
(*must know! in MLA exam last year)
(beta blockers)-carvedilol and bisoprolol
What are the X4 main types of Syncope?
-reflex
-orthostatic hypotension
-carotid sinus reflex
-cardiac syncope
What is reflex syncope?
reflex- brief loss of consicousness due to a neurologically induced drop in blood pressure
What is Carotid Sinus Reflex?
activation of the baro-recpetors in the neck due to exertion of pressure- e.g tight collars or shaving
What is the main triad of symptoms in cor pulmonale?
pulmonary oedema
elevated JVP
hepatosplenomegaly- inc pressure on the hepatic vein
What vessel layer is damaged in:
- aortic dissection
- AAA
What vessel layer is damaged in:
- aortic dissection- tunica intima
- AAA- tunica media
what condition is associated with:
Different blood pressure measurements in each arm, and tearing chest pain radiating to the back is associated with?
Aortic Dissection
What are the X2 main types of aortic dissection and associated symptom?
b) what part of the aorta is damaged?
- Aortic Dissection type A (*More common- ascending aorta- common ascend in life-chest pain
- Aortic Dissection type B (*less common in descending aorta)- back pain
What is the ‘diagnostic’ investigation for Aortic Dissection?
Diagnostic Investigation = CT angiography (*false lumen is the positive finding)
What is the 1st line investigation for suspected AAA?
B) what is the gold standard diagnostic investigation?
(***same gold standard as aortic dissection)
a) US
b) gold standard diagnostic- CT Angiogram
What isBoerhaaves Syndrome?
- spontaneous rupture of the full layers of oesophagus due to repeated episodes of vomiting
- associated with alcoholics
- bloody vomiting
- more severe than mallory weiss tear, malory weiss is NOT Painful only superficial tea
What is the main area damaged in Boerhaaves Syndrome?
(*Must know- very painful full rupture)
- usuallyDISTAL aorta
What is the diagnostic investigation for boerhaaves Syndrome?
- Diagnostic Investigation > CT contrast Swallow (*as associated with vomiting and rupture of oesophagus)
What function is reduced in hypertrophic cardiomyopathy?
-diastolic function is reduces- reduced filling of blood in the heart
How long does medication need to be given for a PE?
a) unprovoked
b) provoked
a) unprovoked - 6 months
b) provoked (e.g plane, in hospital )- 3 months
Prosthetic heart valves/metallic - mechanical valves requires what anti-coagulation?
warfarin
What is the main antibiotic that causes Long QT Syndrome?
erythromycin
(*other meds- citalopram and haloperidol triggers it)
QRS complex (> 120 ms) means what leads should be looked at?
V1 and V6- bundle branch block
Right- MarroW
Left- William
Absent radial pulse in one arm indicates?
Takyasu
(*also has different blood pressure in each arm)
(*Aortic dissection also presents with different blood pressures in each arm)
How do you calculate CHA2DS2-VASc?
a) What do the scores mean and when should an anti-coagulant be started?
Risk factor Points
C Congestive heart failure 1
H Hypertension (or treated hypertension) 1
A2 Age >= 75 years 2
Age 65-74 years 1
D Diabetes 1
S2 Prior Stroke, TIA or thromboembolism 2
V Vascular disease (including ischaemic heart disease and peripheral arterial disease) 1
S Sex (female) 1
> 2- male means anti-coagulate, if woman do not
3- females and males- start anti-coagulant
Electrical alternans is associated with?
Cardiac Tamponade
What is the most common heart valve effected in infective endocarditis?
b) most common valve effected in iV drug users?
most common- mitral valve (m-most common)
IV drug user- tricuspid
What blood vessel is most likely to be effected in an MI?
right coronary artery
> 55 years old or afro-carribean is given CCB
b) what is the add on treatment if hypertension is uncontrolled
C + A or C + D
(ACEI/ARB or diuretic added)
