Extra Flashcards by Clara Sage

Pain which is relieved on leaning forward

Pericarditic

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Chest pain with tenderness

Suggests musculoskeletal

Eg. Tietzes syndrome - costochondritis and costosternal joint swelling

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What lead is p wave normally inverted

AvR

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What leads do you normally see q waves?

V5, V6, AvL and I

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What leads do you normally have inverted t wave?

AvR, v1 and occasionally v2

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Order of ECG changes in MI

First t wave becomes peaked and St segments begin to rise
Within 24hour t wave inverts and St elevation begins to resolve
Within a few days pathological q waves begin to develop

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Leads affected in inferior infarct and the vessel

II, III, AvF

Right coronary

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Leads and vessel affected in anteroseptal infarct

V1-v4

Left anterior descending

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Anterolateral MI leads and vessel

V4-v6, I, AvL

Maybe Left circumflex left marginal

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Posterior infarct

Tall R and St depression in v1-v2

Circumflex artery

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What to do if patient has blood pressure >140/90

Offer abpm

Calculate cv risk and look for organ damage

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If abpm shows

Normotensive therefore no treatment unless clear end organ damage or high CV risk

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If abpm >135/85

Stage 1 hypertension

Therefore treat if cv >20%/10 years or end organ damage

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If abpm >150/95

Stage 2 hypertension

Therefore great

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If clinic blood pressure >180/110

Consider starting treatment immediately

Then do abpm

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Who is more commonly affected by malignant hypertension

Young people and black people

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Grading of hypertensive retinopathy

1) tortuous arteries with thick shiny walls - silver or copper wiring
2) AV nipping - narrowing where arteries cross veins
3) flame haemorrhages and cotton-wool spots
4) papilloedema

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Treatment bp goal in diabetics

130/80

Non-diabetics - 140/90

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Treatment BP if >80

150/90

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Treatment BP if proteinuria

125/75

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First BP medication if >55 or black or any age

calcium channel blocker eg. Amlodipine or nifidepine
or
thiazide diuretic eg,chlortalidone

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First med if

Ace inhibitor eg. Lisinopril
Or
ARB if acei intolerant (cough) - candesartan

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Dose of ace-I/arb

And of thiazide/calcium channel antagonist

Acei/arb - around 10-40

Thiazide or calcium around 25-60

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If need more than 1 med

Add the other first line drug

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If need 3 drugs or more

All 3 first line drugs | then add higher dose diuretic or another diuretic (spironolactone) or add b-blocker

When is beta blocker recommended -what do you add as 2nd for them?

Not first line for HTN Can consider if young person especially if intolerant of acei/arb or woman of child bearing potential If need second one then add calcium channel blocker not a thiazide

How long do blood pressure meds take to have effect

4-8 weeks

Treatment of malignant hypertension?

Unless there is encephalopathy or CCF - oral therapy - atenolol or long acting calcium antagonist Want to decrease BP over days not hours because cerebral auto regulation is poor

How to treat malignant HTN if encephalopathy

Want to reduce diastolic to 110 over 4 hours Furosemide 40-80mg IV Then either labetalol or sodium nitroprusside infusion

Pain of aortic dissection

Instantaneous, tearing and inter scapular | May be retrosternal

When do you get tapping non-displaced apex beat?

Mitral stenosis

When do you get a heaving non-displaced apex beat?

Aortic stenosis

When do you get hyper dynamic displaced apex beat

Mitral and aortic regurge

When do you get hoarseness, dysphasia and bronchial obstruction with heart murmur

Mitral stenosis because enlarged atrial pressing on structures

Murmur best heard with patient on left side

Mitral stenosis

Murmur radiates to axilla

Mitral regurge

Mid-systolic click

Mitral prolapse

Slow rising pulse or anacrotic pulse

Aortic stenosis

Bisferiens pulse

Mixed aortic stenosis and regurge

Bounding pulse

Co2 narcosis Sepsis Liver failure

Jerky pulse

HOCM | Also double apex beat

Collapsing pulse

Aortic regurge

Aortic thrill

Aortic stenosis

Murmur radiates to carotids

Aortic stenosis

Double apex beat

HOCM

Wide pulse pressure

Aortic regurge

Narrow pulse pressure

Aortic stenosis

Murmur best heard sitting forward

Aortic regurge

Murmur for inspiration

Muffles left heart murmurs - best for hearing right heart murmurs

Corrigans sign

Carotid pulsation | Aortic regurge

De Mussets sign

Head nodding with heart rhythm | Aortic regurge

Duroziezs sign

Groin with finger pressed over femoral artery

Traubes sign

Pistol shot over femoral arteries | Aortic regurge

Quinckes sign

Capillary pulsations in nail beds

S4 gallop

Acute myocarditis

S3 gallop

Dilated cardiomyopathy

Murmur in HOCM

Harsh ejection systolic murmur | Thrill over lower left sternal edge

Chest pain worse on lying flat - relief sitting up

Pericarditic

Saddle shaped/concave St elevation

Pericarditis

Pulsus paradoxus

Cardiac tamponade