Digoxin toxicity Flashcards
management of stable VT in digoxin toxicity
IV lidocaine
for unstable - synchronized cardioversion
young patient
apex best displaced laterally
ejection systolic murmur
diagnosis and ecg changes?
HOCM
ECG:
RBBB - anterior, anteroseptal and mid-septal myocardial fibrosis
- right or left axis deviation
- PR prolong
- non specific T wave abnormalities - usually anterior leads
indication of automated defibrillator
ventricular tachycardia post MI with left ventricular impairment
choice of statin therapy
hyperLDL
hyperTG
hyperLDL - atorvastatin +/- ezetimibe
atorvastatin»_space; pravastastin
hyper TG - fibrate (treatment of choice), nicotinic acid - modest rise in HDL, targest LDL, tolerability poor due to itching and facial flushing
pregnant lady with STEMI
treatment
angioplasty
thombolysis? - rTPA higher risks of maternal hghe, preterm delivery, fetal loss, abortion
left parasternal heave cause?
right ventricular volume overload
left parasternal heave
ECG: right axis deviation
cardiac catheterisation saturation - right atrium 78%
heart sound: splitting of S2
diagnosis?
ASD
Eisenmenger syndrome
drugs that prolong QT inverval
erythromycin
carbamazepine
ketonazole
TCA
Treatment of Torsades de pointes
IV magnesium
amiodarone (QT prolongation) , quinidine, flecainide - worsens the arrhythmia -
adenosine - ineffectve
WPW most appropriate long term management
radiofrequency ablation
pharmaco - amiodarone, flecainide
avoid drugs on AV node - verapamil, adenosine, bisoprolol
coronary vessels and supplies
1) right coronary artery
2) left anterior descending artery
3) left circumflex artery
1) RCA - right atrium, usually SA node, right ventricle, inferior wall of LV,
*in right dominant heart, give rise to Posterior descending artery (PDA) - suppl posterior interventricular septum and posterior wall
2) LAD - anterior wall of LV, anterior 2/3 of interventricular septum, apex of heart
3) LCX - lateral wall of LV
+/- posterior wall of LV, SA node
+/- give rise to PDA
Anterior/septal STEMI
vessel
ECG
complication
ECG: STE in V1 to 4
vessel: LAD
complication: LV dysfunction - heart failure, arrythmias, heart block (damage to septum)
Lateral STEMI
vessels
ecg
complication
ECG: STE over I, avL, v5, v6
vessel: LCX or diagonal branch of LAD
complication: LV dysfunction, arrhythmia
Inferior Stemi
ECG, vessel, complication
ECG: STE in II, III, avF
vessels: RCA +/- LCX
complication:
RV infarct - hypotension, clear lung sounds, STE in v4r
bradycardia and heart block (supply AV node)
use of nitroglycerine contraindicated in RV infarct - hypotension
Posterior STEMI
ECG: ST depression in V1-3, STE in posterior V7-9
vessels: RCA or LCX
complication: hemodynamic instability
when do consider ICD or CRT with heart failure patient
LV dysfunction with LVEF of less than 35%
Cardiac failure pharmacological treatment
Loops diuretics - frusemide - no change in mortality
ACEI or ARB - improve mortality and morbidity
Beta Blocker - improve mortality and morbidity
Aldosterone receptor antagonist - spironolactone
+/- anti platelet, statin
hydralazien and nitrates
Ivabradine - inhibit funny current in sinus node to slow SR
Digoxin - for worsening HF despite first line
