ECG Flashcards
ECG - V2/V3 ST elevation (tombstoning)
anterior STEMI
ECG - II/III/AvF ST elevation with reciprical depression in I/AvL
inferior STEMI
ECG criteria to diagnose a posterior MI
ST segment depression v1-v4
R:S ratio in V1/V2 > 1
ECG differentiate LBBB and RBBB
Positive V1 = right
Positive V6 = left
Both = broad QRS complex!
Example of 1 loop and 1 thiazide diuretic
Loop - frusemide
Thiazide - hydrochlorothiazide
Diuretic monotherapy in treatment of heart failure…
Do not improve prognosis or mortality
Frusemide and loop diuretic action/outcome
increase excretion of sodium, water and potassium
What is spironolactone?
competitive antagonist of aldosterone
MOA spironolactone and a potential outcome
increases sodium and water excretion, decreases potassium excretion
may produce hyperkalaemia
Aldosterone receptors heart: normal vs pathological (3 effects)
Normal: low levels and minimal effect
Pathological: elevated aldosterone causes activation leading to detrimental effects on the heart - fibrosis, hypertrophy and dysrhythmias
What dosage of spironolactone has been shown to be beneficial in the treatment of severe systolic heart failure (improved survival)?
25mg daily
Combined therapy with what other drug and spironolactone should be taken with extreme caution? Why?
ACE inhibitors and angiotensin II antagonists
Severe hyperkalaemia and may lead to death
Findings of beta adrenergic antagonists (beta blockers) and systolic heart failure
reduced…
- total mortality
- sudden death
- hospitalisation
and improved QOL
List:
2: beta 1 blockers
1: beta 1 blocker with vasodilating properties
1: nonselective beta blocker with alpha 1 receptor blocking activity
b1
- bisoprolol
- metaprolol
b1 + vasodilating
- nebivolol
beta blocker + a1
- carvedilol
Possible MOA of beta blockers in systolic HF (3)
- reduced SNS activity
leading to reduced cardiac ischaemia and arrhythmias - reduced renin release
- apart from beta blockade, some vasodilate e.g. carvediol, nebivolol
Beta blocker treatment regime
- start low and go slow
- 4-8wks symptoms may worsen
- up to 4 months before benefit seen
- beta blocker therapy added to ACEi has additional mortality and morbidity benefits in HFrEF
What is a predictor of adverse outcomes in patients with HFrEF?
HR
- increased HR is associated with increased mortality
MOA of Ivabradine
Reduces HR by selectively inhibiting the current in the SA node responsible for spontaneous depolarisation - If current
What is the If current in the heart? Site? When is it activated? What regulates its activity? What ions are involved? Describe their movement through the channel?
Responsible for spontaneous depolarisation - helps regulate HR
SA node
Activated when the heart hyperpolarizaes
cAMP
K+ and Na+
Both move in to the cell - overall effect is depolarization
What is digoxin? Effect (2)? MOA (2)? Clinical impact on patients with HF?
naturally occurring cardiac glycoside found in the plant species Digitalis (foxglove)
1 Slows HR (increased parasympathetic activity)
2 Exerts +ve inotropic effect on heart (contractility)
1 increases vagal activity, decreased AV conduction = decreased HR
2 Inhibits Na+/K+ ATPase pump = increased intracellular Na+ = reduces Ca+ extrusion from the cell by the Na+/Ca+ pump = results in increased intracellular concentration of Ca+
Reduces hospitalisations but does not improve mortality + limited role in treatment
Outline characteristics of Digoxin that lead to toxicity? What increases its toxicity? ADRs?
Low TI - may produce significant toxicity and death
Long T1/2 - 36-48 hrs
Primarily excreted in urine as unchanged drug
Hypokalaemia increases toxicity
Nauseau, vomiting, diarrhoea, green/yellow vision, bradycardia, ectopic beats, dysrhythmias
Pharmacological treatment of systolic HF (HFrEF)? (8)
- ACEi / angiotensin II antagonists
- neprilysin inhibitors (breaks down BNP)
- diuretics (fluid overload)
- beta blockers
- aldosterone antagonists e.g. spironolactone
- ivabradine (I(f) current)
- digoxin (increased contractility)
- SGLT2 inhibitors
+ treatment of co-morbidities/disease states e.g. hypertension, IHD etc.
