Core Flashcards
AF - Mx post DC cardioversion
- High risk of stroke (raised CHADSVASC) - continue lifelong anticoagulation
- Low risk of stroke - continue anticogaulation for 4 weeks the stop
Third degree HB
- P waves not related to QRS
- Ventricular escape rhythm : 35-40 bpm
GRACE score
Helps to decide mx of Unstable angina and STEMI
<3% : Low
Conservative mx
Dual antiplatelet therapy for 12 months
aspirin, plus either:
ticagrelor, if not high bleeding risk
clopidogrel, if high bleeding risk
3-6% : Intermediate
>6% : High
- Clinically unstable - Immediate PCI
- Grace score >3% - Coronary angiogram with PCI withi 72 hours
* 300mg asprin - then give Fondaparinux, prasugrel or ticagrelor, and refer for coronary angiography within 72 hours
Ace inhibitors SE
Used in hypertension and HF
1. Cough
2. Angio-odema
3. Hyperkalaemia
4. U+Es checked before starting - baseline increase of creatinine up to 30% from baseline
4. Avoid in ;
* Pregnancy and breast feeding
* Renovascular disease - bilateral renal artery stenosisa
PEA
- Start Chest compressions before starting IV adrenaline
Amiodone ALS
Amiodarone should be given to patients in ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT).
Hypokalaemia
U waves
small or absent T waves (occasionally inversion)
prolong PR interval
ST depression
long QT
Hypertrophic obstructive cardiomyopathy : Genes
(HOCM) is an autosomal dominant disorder of muscle tissue caused by defects in the genes encoding contractile proteins.
most common cause of sudden cardiac death in the young.most commonly due to ventricular arrhythmias
hypertrophic obstructive cardiomyopathy (HOCM) : Mx
Management
Amiodarone
Beta-blockers or verapamil for symptoms
Cardioverter defibrillator
Dual chamber pacemaker
Endocarditis prophylaxis*
hypertrophic obstructive cardiomyopathy (HOCM) : CI drugs
- Angiotensin-converting enzyme (ACE) : educe afterload which may worsen the LVOT gradient.
- nitrates
- inotropes
BP classification
Hypertension - When to treat
First-degree heart block is a normal variant in an athlete. It does not require intervention
Anal ulceration may be caused by nicorandil
Statin - interactions
Clarithromycin inhibits CYP3A4, an enzyme involved in the metabolism of many drugs including simvastatin. When CYP3A4 is inhibited by clarithromycin, it can lead to increased levels of simvastatin in the body,
Ventricular Tachycardia : CI
Verapamil is contraindicated in VT as intravenous administration of a calcium channel blocker can precipitate cardiac arrest.
PE - OP mx
The Pulmonary Embolism Severity Index (PESI) score is recommended by BTS guidelines to be used to help identify patients with a pulmonary embolism that can be managed as outpatients
Heart failure : Drugs which reduce mortality in LV Heart failure
The following drugs have all been shown to reduce mortality in patients with left ventricular failure:
ACE-inhibitors
Beta-blockers
Angiotensin receptor blockers
Aldosterone antagonists
Hydralazine and nitrates
Heart failure : Use of digoxin
- Heart failure with AF
- Worse ing heart failure despite first or second line treatments
AF : Anticoaulation
ONLY COMMENCED IF INDICATED BY CHADSVASC SCORE - IF ZERO, ONLY CONTROL RATE/RHYM WITHOUT ANTICOAGULATION
3. 1. DOAC
2. Warfarin : poor renal function
Posterior MI
Changes in V1-3
Reciprocal changes of STEMI are typically seen:
horizontal ST depression
tall, broad R waves
upright T waves
dominant R wave in V2
Mx of HF with reduced Ejection fraction
Newly diagnosed patient with hypertension who has a background of type 2 diabetes mellitus - add an ACE inhibitor or an angiotensin receptor blocker regardless of age
Warfarin : lifelong anticoagulant therapy in
1. valvularr heart disease
2. Second episode of AF and risk factors for stroke
AF - TRANSOESOPHAGEAL ECHO for thrombus
CHADSVASC SCORE
Digoxin reduces hospitalisation but not mortality in heart failure.
Heart failure : Intervention therapy
Cardiac resynchronisation therapy is indicated in patients with
* left ventricular dysfunction
* ejection fracture <35%
* QRS duration >120ms.
Implantable cardiac defibrillator (ICD) is indicated in patients with
* previous sustained ventricular tachycardia
* ejection fraction <35%
* symptoms no worse than class III of of the New York Heart Association functional classification.
Anterior MI complication
Anterospectal MI - complicated by Ventricular septam defect
1. Ejection systolic murmur
2. Left parasthernal edge
2. Thrill
Exercise ECG testing : CI
- Pulomonary oedema 2nd to HF
- MI within 2-7 days
- Electrolyte disturbance
- Aortic stenosis
- Heart failure
- Not sutiable for angina
Ambulatory ECG monitoring : Indications
- Chest pain
- Palpitations
- Syncope
Digoxin toxicity
- N+V, Diarrhea
- Bradycardia/Potentiated by hypokalaemia
- Arrythmia
- Tx - withold drug, correct electrolyte - Digibind antibodies if very severe
Cardiac catheterisation - Comaplications
- Haemorrhage
- Contrast - renal dysfunction
- Angina/MI/Pericardial effusion
Aortic dissection - Ix
Transoesophageal echo -
Mycocardial ischaemia - Ix
- CT angiography
- Non invasive - Single photol emmission computed tomorhraphy (MPS with Spect)
- Stress Echocardiography
- First pass contransed enhanse MR perfusion
VT
1. Polymorphic VT - normal QT and beat to beat variability
2. Torsade de Pointes : Q-T elongated, and beat to beat variablity
CABG - complications
- Loss of memory
- Renal failure
- MI/Stroke
- Brain damage
Mx of aortic stenosis
- Balloon angioplasty
- Second line : Surgical valve replacement
