CV disorders Flashcards
Examination
Pallor, signs of poor peripheral perfusion, overfilled or underfilled central veins, obvious places of losses, swelling of soft tissues, concealed haemorrhage evidence
Listen:
Confusion, faint, breathlessness on lying flat, chest pain, fever, cold
Feel for pulses (rapid thready pulse means low CO)
Rate, quality, regularity and equality
CRT always (inadequate fluid, continued bleeding, vasodilatation in sepsis, low cardiac output state)
High CVP (post fluid bolus, overload, RVF, cardiac failure, COPD, pericardial effusion with tamponade)
Early left sided failure may have basal creps or bronchial wheeze from cardiac asthma (small airway narrowing as result of interstitial pulmonary oedema)
QRS
R wave increases as LV thickness increases from V1-V6
S wave decreases towards V6
Q wave positive in V1-V3 but becomes slowly negative (due to rotation of heart about a near-vertical axis)
Hypertrophy or minimal adiposity can make QRS waves higher in amplitude
SVT
adenosine
Can also give verapamil, digoxin, beta-blockade
AF
PIRATESHIV
Flutter
Cardioversion, digoxin or verapamil
LVH
Tall R waves in I and AVL, S waves in III and aVF
RVH
Tall R wave V1 and deep S in V6
Bradycardia
Autonomic Pain ICP Drugs - beta Epidural
Non-autonomic MI Sepsis Hypoxia Drugs - digitalis toxicity Hypothyroidism Hypothermia
Contraindications to fibrinolytics
Peptic ulcer
Previous haemorrhage stroke
Recent head injury
Prolonged traumatic cardiopulmonary resuscitation
Causes of cardiac failure
Preload:
Hypovolaemia
Fluid overload
Pneumothorax / tamponade
Myocardial function: Ischaemia, infarction Dysrhythmias Heart failure and operative stress Hypocalcaemia and electrolytes Sepsis Pneumothorax and tamponade
Afterload Valve PE Pneumo/tamponade Aortic dissection
Flattening of starling curve –> reliance on HR –> reduced filling –> reduced perfusion –> relative ischaemia
Treat with ABVCDE Oxygen Stop IV infusions Diuretics, nitrates, diamorphine ECG Treat underlying CPAP Monitor CVP
Cardiogenic oedema
Fluid overload, dysrhtmia and MI most common causes
Dyspnoea, orthopnoea, tachypnoea
Tacycardic, sweaty and hypertensive, may have gallop rhythm
Fluid in horizontal fissure, peribronchial cuffing, upper lobe diversion, perihilar bat’s wing, Kerley B lines
Risk of disease in non-cardiac surgery
Recent MI Unstable angina Severe AS Decompensated heart failure Severe hypertension Cardiac arrhythmias
Lower: MI>6 months Stable angiuna Abnormal ECG Compensated heart failure Compensated valvular lesions Cardiomegaly
Re infarction is 60– 27 – 11 for 3 weeks, 34 months and 3-6 months
Pacemaker
Diathermy can inhibit demand type
Need pacemaker interrogation or turning it off
Place earthing pad away - thigh or buttocks
Short bursts rather than long bursts
Using bipolar rather than unipolar
Avoid use near pacemaker
Monitor ECG throughout
