Extra Flashcards
Pain which is relieved on leaning forward
Pericarditic
Chest pain with tenderness
Suggests musculoskeletal
Eg. Tietzes syndrome - costochondritis and costosternal joint swelling
What lead is p wave normally inverted
AvR
What leads do you normally see q waves?
V5, V6, AvL and I
What leads do you normally have inverted t wave?
AvR, v1 and occasionally v2
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
Leads affected in inferior infarct and the vessel
II, III, AvF
Right coronary
Leads and vessel affected in anteroseptal infarct
V1-v4
Left anterior descending
Anterolateral MI leads and vessel
V4-v6, I, AvL
Maybe Left circumflex left marginal
Posterior infarct
Tall R and St depression in v1-v2
Circumflex artery
What to do if patient has blood pressure >140/90
Offer abpm
Calculate cv risk and look for organ damage
If abpm shows
Normotensive therefore no treatment unless clear end organ damage or high CV risk
If abpm >135/85
Stage 1 hypertension
Therefore treat if cv >20%/10 years or end organ damage
If abpm >150/95
Stage 2 hypertension
Therefore great
If clinic blood pressure >180/110
Consider starting treatment immediately
Then do abpm
Who is more commonly affected by malignant hypertension
Young people and black people
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
Treatment bp goal in diabetics
130/80
Non-diabetics - 140/90
Treatment BP if >80
150/90
Treatment BP if proteinuria
125/75
First BP medication if >55 or black or any age
calcium channel blocker eg. Amlodipine or nifidepine
or
thiazide diuretic eg,chlortalidone
First med if
Ace inhibitor eg. Lisinopril
Or
ARB if acei intolerant (cough) - candesartan
Dose of ace-I/arb
And of thiazide/calcium channel antagonist
Acei/arb - around 10-40
Thiazide or calcium around 25-60
If need more than 1 med
Add the other first line drug
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
