Cards Flashcards
Complications of pulmonary vein ablation for AF
1-2 percent Aorto-oesophageal fistula Valve damage Femoral vascular complications Thromboembolic events Tamponade Phrenic or gastric nerve injury Pulmonary vein stenosis
What is actually abated in AF? In flutter?
Complete electrical isolation of the pulmonary veins in AF
In flutter need to ablate the cavotricuspid isthmus also
What is the best indication for AF ablation? Other indications accepted?
Symptomatic AF that is resistant to at least one class 1 or 3 antiarrhythmic
Best patients are young with paroxysmal AF, small atria and no underlying heart disease
Discontinuation of warfarin is not a good sole indicator
After procedure, anticoaguate for 1-3 months. Don’t discontinue if CHADS2 is 2 or more
12 causes of pericarditis
Idiopathic Infective- coxsackie, hep, adeno/ histoplasma, aspergillus, candida/tb/ strep, staph, pneumo,haemoph Uraemia Autoimmune- rheumatic (sle sarcoid ra) and non rheum (uc, pan, gca) Traumatic Aortic disease related MI related Radio frequency AF ablation Neoplastic Radiation Recovery phase takotsubo Medications- amiodarone, penicillin, hydralazine
If effusion - all of the above plus hypothyroidism plus cirrhosis
4 Hs
Hypo/hyperthermia
Hypo/hyperkalaemia
Hypovolaemia
Hypoxia
4Ts
Toxins
Tamponade
Thrombosis
Tension pneumothorax
Causes of short QT
digoxin and hypercalcaemia
Causes of long QT
hypokalaemia hypomagnesaemia hypocalcaemia hypothermia myocarditis myocardial ischaemia Drugs including class one and three antiarrhythmics
SURGERIES where dual antiplatelet risk of bleeding is unacceptable- even aspiring alone might be bad
Intracranial Spinal TURP extra-ocular Plastic reconstructive
Asthmatic person with SVT?
Give verapamil
Not adenosine
Most common cardiac issue in Turners syndrome
Bicuspid AV
Also coarctation of aorta
Name three indications for temporary pacemaker insertion
- symptomatic/haemodynamically unstable bradycardia, not responding to atropine
- post-ANTERIOR MI: type 2 or complete heart block*
- trifascicular block prior to surgery
*post-INFERIOR MI complete heart block is common and can be managed conservatively if asymptomatic and haemodynamically stable
Poor prognostic markers in HOCM (6)
Syncope FH sudden cardiac death Young age at presentation NSVT on holter Fall in SBP on exercise Increase in septal thickness
Five groups of pulmonary hypertension
Group 1: Pulmonary arterial hypertension (PAH)
- idiopathic*
- familial
- associated conditions: collagen vascular disease, congenital heart disease with systemic to pulmonary shunts, HIV**, drugs and toxins, sickle cell disease
- persistent pulmonary hypertension of the newborn
Group 2: Pulmonary hypertension with left heart disease
- left-sided atrial, ventricular or valvular disease such as left ventricular systolic and diastolic dysfunction, mitral stenosis and mitral regurgitation
Group 3: Pulmonary hypertension secondary to lung disease/hypoxia
- COPD
- interstitial lung disease
- sleep apnoea
- high altitude
Group 4: Pulmonary hypertension due to thromboembolic disease
Group 5: Miscellaneous conditions
- lymphangiomatosis e.g. secondary to carcinomatosis or sarcoidosis
Components of TIMI risk score
Each of the following criteria constitutes one point for TIMI scoring :
Age ≥65 years Three or more risk factors for coronary artery disease (CAD) (family history of CAD, hypertension, hypercholesterolemia, diabetes mellitus, tobacco use) Known CAD (stenosis >50%) Aspirin use in the past 7 days Severe angina (≥2 episodes in 24 hours) ST deviation ≥0.5 mm Elevated cardiac marker level
Score Risk of Death/MI/Urgent revascularization by Day 14
0-1 5% 2 8% 3 13% 4 20% 5 26% 6-7 41%
TIMI risk score- what is the use?
The Thrombolysis in Myocardial Infarction (TIMI) Score is used to determine the likelihood of ischemic events or mortality in patients with unstable angina or non–ST-segment elevation myocardial infarction (NSTEMI)
Causes of hypertriglyceridaemia? (You can think of at least 10!)
Obesity (often with increase cholesterol too)
Diabetes mellitus with poor glycaemic control
Alcohol excess
Nephrotic syndrome
Hypothyroidism
High oestrogen states (except transdermal HRT)
Beta blockers except carvedilol
Thiazides and frusemide
Immunosupressives (steroid, cyclosp, sirolimus)
HIV antiretrov
Retinoids
Bile acid sequestrants
Second gen antipsychotics
How does BNP break down?
ventricle releases pro-BNP which is cleaved to BNP and NT-proBNP
In normal people, fractions will be about the same.
In heart failure, proBNP goes up more than BNP
900 of NT-pro is about the same as the 100 for BNP
What increases and decreases your BNP?
old women renal failure PE cor pulmonale
Reduce in obese, duretics, ACE
Cut offs for BNP in normal renal function and in AF
over 100 in normal PPV 83%
If AF use 200 as cutoff as lower specificity
NTproBNP under 300 has NPV 98%
What do you do about SVT in asthmatics?
DONT give adenosine
Give verapamil
Tako stubo want to diagnose?
GREAT! But need a normal angio
Also GET OFF INOTROPES- makes worse
What is the earliest sign of anthracycline induced cardiac dysfunction?
Lack of significant increase in EF during stress echo
Diastolic dysfunction
before systolic dysfunction
Which chemo gives you heart failure>
Anthracyclines (doxorubicin, danorubicin, epirubicin)
Mitoxantrone
Alkylating agents (cyclophosphamide, cisplatin)
5-FU can give you MI during treatment
Trastuzumab
IL-2 or IFN gamma- HF during treatment
