CVS Flashcards
Hypotension Muffled heart sound raised JVP tachycardia dyspnoea
Cardiac tamponade
ECG = electrical alternans
cardiac tamponade
Management of Cardiac tamponade
Urgent pericardiocentesis
splinter haemorrhages roth spots janeway lesions new murmur (regurg) osler's nodes fever
Infective endocarditis
RFs for infective endocarditis
valvular disease
prosthetic valve
IV drug use
diagnostic investigations for infective endocarditis:
multiple +ve blood cultures (staph aureus) and ECHO (check valves)
management for infective endocarditis:
penicillin (amoxicillin/flucloxacillin) and gentamicin
penicillin allergy/severe case = + vancomycin
HF signs - urgent valve replacement/surgery
severe tearing chest pain - sometime radiation of pain to back pulse deficit/wide pulse pressure aortic regurg dyspnoea hypotension
widened mediastinum, false lumen on CT CAP/TOE
Aortic dissection
ascending/type A = radiate to thoracic region
descending type B = radiates to back
type A aortic dissection mx
surgical repair and IV labetalol (aim for SBP - 100-120mmHg)
Type B aortic dissection mx
IV labetalol
bed rest
analgesia
ejection systolic (crescendo-decrescendo) murmur radiating to carotids
aortic stenosis
early diastolic (decrescendo) murmur de mussets = head bobbing de quincke's = nailbed pulsation
aortic regurgitation
dizziness, less exercise tolerance/dyspnoea, palpitations,
irregularly irregular pulse
absent p waves
Atrial fibrillation
management of Atrial fibrillation
<48hr = heparin and cardiovert >48hr = anticoagulate (DOAC) for 3wks and cardiovert
CHA2DS2VASC = 2+ = anticoagulate HASBLED = 3+ = high bleeding risk
beta blocker/diltiazem/verapamil
palpitations, dyspnoea, fatigue, syncope, SOB
ventricular rate above 300/min/very tachycardic
sawtooth appearance on ECG
Atrial flutter
management of Atrial flutter
cardiovert
radiofrequency ablation of tricuspid valve
ejection systolic murmur + split S2, louder on inspiration
heard in the left sternal edge
Acyanotic
symptomatic in adulthood
atrial septal defect
what is the management of ASD
surgery
mid-late diastolic murmur, loud S1 and opening snap best on expiration rheumatic fever hx malar flush atrial fibrillation
mitral stenosis
pansystolic ‘blowing’ murmur, best @ apec and radiates to axilla
marfans/ehlers-danhlos hx
mitral regurgitation
erythema marginatum subcuatneous nodules fever polyarthritis carditis/valvulitis = chest pain, SOB, regurg murmur chorea hx or sore throat a couple week back
acute rheumatic fever
diagnose rheumatic fever
+ve throat swabs
raised ESR/CRP
ECHO = HF signs
management of acute rheumatic fever
oral penicillin V + NSAIDs
treat HF
usually asymptomatic
may present with headaches, visual changes or seizures in severe cases
hypertension
HTN diagnosis and checks
a clinic reading persistently above >= 140/90 mmHg, or:
a 24 hour blood pressure average reading >= 135/85 mmHg
fundoscopy: to check for hypertensive retinopathy
urine dipstick: to check for renal disease, either as a cause or consequence of hypertension
ECG: to check for left ventricular hypertrophy or ischaemic heart disease
breathlessness, oedema, reduced exercise tolerance/fatigue raised JVP displaced apex beat bibasal crackles
acute heart failure
dyspnoea cough (frothy sputum) orthopnoea PND weight loss bibasal crackles ankle oedema raised JVP hepatomegaly
chronic heart failure
heart failure Ix
CXR = cardiomegaly and interstitial oedema BNP = >100mg/L ECHO = pericardial effusion - definitive
management of heart failure
first line = ACEi + Beta blocker
second line = spironolactone
specialist care with hydralazine and ivabradine, nitrates and digoxin
offer annual influenza vaccine
offer pneumococcal vaccine every 5 years
heavy constricting chest pain
relieved by rest or GTN spray
~10-15mins
Stable angina
Management of stable angina
beta-blocker or CCB
Ivabradine, nicorandil or ranolazine if contraindicated
chest pain typically at rest
very short lived
radiated to the back
SOB
transient ST elevation in ECG
prinzmetal angina
management of prinzmetal angina
GTN spray
CCB
Isosorbide mononitrate
heavy constricting chest pain
radiation to left arm, jaw, or neck
not releievd by rest/GTN
unstable angina
management of unstable angina
If on BB - switch or add to a long acting dihydropyridine CCB e.g. amlodipine
in intolerance/contraindication = consider addition of nitrate
if on CCB - switch or add a Beta block
avoid use of non-dihydropyridine CCB
in intolerance/contraindication = consider addition of nitrate
continued symptoms = add on third anti-anginal and reefer to cardiac specialist
central/left-sided chest pain, heavy and constricting radiation to the left jaw, neck and arm dyspnoea sweating palpitations
Acute myocardial infarction