GP Flashcards
What causes acne vulgaris?
It is caused by chronic inflammation with or without infection
- It results from increased production of Sebum that traps keratin and blocks the pilosebaceous unit.
- Androgenic hormones increase the production of sebum
What bacteria causes acne?
Propionibacterium acnes. Excessive growth of this bacteria can exacerbate acne
What are the different lesions that can occur in acne?
- Macules are flat marks on the skin
- Papules are small lumps on the skin
- Pustules are small lumps containing yellow pus
- Come domes are skin coloured papules representing blocked pilosebaceous units
- Blackheads are open comedones with black pigmentation in the centre
- Ice pick scars are small indentations in the skin that remain after acne lesions heal
- Hypertrophic scars are small lumps in the skin that remain after acne lesions heal
- Rolling scars are irregular wave-like irregularities of the skin that remain after acne lesions heal
What are the topical treatments for acne?
- Benzoyl peroxide reduces inflammation
- Topical retinoids (vitamin A) which slows the reduction of sebum
- Topical antibiotics : clindamycin
What are the oral treatments for acne?
- Lymecycline
- Oral contraceptive pill
- Oral retinoids: Isotretinoin
What is the most effective oral contraceptive pill for acne?
Co-cyprindiol (dianette): carries a high risk of thromboembolism
What are the side effects of Isotretinoin (Roaccutane)?
- Strongly teratogenic
- Dry skin and lips
- Photosensitivity
- Depression
- Stevens-Johnson syndrome (toxic epidermal necrolysis)
What is eczema?
A chronic atopic condition caused by defects of continuity of the skin barrier leading to inflammation in the skin.
What areas is eczema often found?
- Flexor surfaces
- Face and neck
- Flare periods
Describe the pathophysiology of eczem?
Tiny gaps in the skin barrier provide an entrance for irritants, microbes and allergens that create an immune response
What is the management of eczema?
- Use of emollients which create a barrier
- Soap substitutes
- Avoid using hot water and soaps which remove natural oils
What environmental factors effect eczema?
- Cold temperature
- Dietary products
- Washing and cleaning products
- Stress
How would you treat an eczema flare?
-Use of thicker emollients
- Wet wraps
- Steroid creams
- ## zinc impregnated bandages,topical tacrolimus,
- phototherapy
- systemic immunosuppressants, such as oral corticosteroids, methotrexate and azathioprine.
Steroid ladder for eczema?
Mild: Hydrocortisone 0.5%, 1% and 2.5%
Moderate: Eumovate (clobetasone butyrate 0.05%)
Potent: Betnovate (betamethasone 0.1%)
Very potent: Dermovate (clobetasol propionate 0.05%)
What is the most common bacterial infection in eczema and how would you treat it?
S.aureus and treat with flucloxacillin
What is eczema herpeticum?
Eczema herpeticum is a viral skin infection in patients with eczema caused by the herpes simplex virus (HSV) or varicella zoster virus (VZV).
How does eczema herpeticum present?
Someone with eczema that has a widespread painful, vesicular rash with systemic symptoms such as fever and lethargy
What is the treatment of eczema herpeticum?
Acyclovir
What is atrophic vaginitis?
- It refers to dryness and atrophy of the vaginal mucosa related to a lack of oestrogen .
- It occurs in women entering the menopause
What happens to the epithelial lining in atrophic vaginitis?
- The mucosa become thinner and less elastic
- This makes it more prone to inflammation and infection as there is a change in vaginal pH
What are the symptoms of AV?
- Itching
- Dryness
- Pain during sex
- Bleeding due to localised inflammation
What are the treatments for AV?
- Vaginal lubricants
- Topical oestrogen ( think estriol)
What are some presentations of AV in older patients?
- Recurrent UTIs
- Stress incontinence
- Pelvic organ prolapse
What will an examination of the vagina show in AV?
Pale mucosa
Thin skin
Reduced skin folds
Erythema and inflammation
Dryness
Sparse pubic hair
What are the contraindications of topical oestrogen?
- Systemic HRT
- Breast cancer
- Angina
- Venous thromboembolism
Can also cause endometrial hyperplasia and cancer
What is bacterial vaginosis?
- It refers to an overgrowth of bacteria in the vagina specifically anaerobic bacteria
- It is not Sexually transmitted
What causes BV?
Loss of lactobacilli which produce lactic acid and keep the vaginal pH low
What bacteria can cause BV?
Gardnerella vaginalis (most common)
Mycoplasma hominis
Prevotella species
What are the risk factors for BV?
- Multiple sexual partners
- Excessive vaginal cleaning
- Recent antibiotics
- Smoking
- Copper coil
What is the presentation of BV?
Fishy-smelling watery grey or white vaginal discharge. Half of women with BV are asymptomatic.
What are the investigations for BV?
- ## Test vaginal pH anything above 4.5 is badcharcoal vaginal swab can be taken for microscopy. This can be a high vaginal swab taken during a speculum examination or a self-taken low vaginal swab.
What cells are shown with BV?
Clue cells
What is treatment for BV?
Metronidazole
Or clindamycin but is less effective
What can’t you take with metronidazole?
Alcohol
What are the complications of BV?
It increases risk of STI
- Also can cause problems in pregnancy
Miscarriage
Preterm delivery
Premature rupture of membranes
Chorioamnionitis
Low birth weight
Postpartum endometritis
What is Bell’s palsy?
An idiopathic conditions which causes unilateral lower motor neuron facial nerve palsy
What is the treatment if a patient presents within 72 hours?
Prednisolone
50mg for 10 days
60mg for 5 days followed by a 5-day reducing regime of 10mg a day
They will also require lubricating eye drops to prevent it from drying out
What are the two types of breast abscesses?
Lactational abscess (associated with breastfeeding)
Non-lactational abscess (unrelated to breastfeeding)
What does mastitis refer to?
Inflammation of breast tissue often related to breastfeeding but can be caused by an infection
What is a key risk factor for infective mastitis?
- Smoking
- Damage to the nipple
- Underlying breast disease affecting the drainage of the breast
What are the causes of mastitis?
Staphylococcus aureus (the most common)
Streptococcal species
Enterococcal species
Anaerobic bacteria (such as Bacteroides species and anaerobic streptococci)
What are the symptoms of mastitis?
- Nipple changes
- Purulent nipple discharge (pus from the nipple)
- Localised pain
- Tenderness
- Warmth
- Erythema (redness)
- Hardening of the skin or breast tissue
Swelling
What is the key feature of a breast abscess?
- Swollen fluctuant (can move around on palpation) tender lump within the breast
What is the management of non-lactational mastitis?
- Analgesia
- Antibiotics - need to be broad spectrum
- Treatment for underlying cause
What are the antibiotics used to treat non-lactational mastitis?
Co-amoxiclav
Erythromycin/clarithromycin (macrolides) plus metronidazole (to cover anaerobes)
What is the treatment for Lactational mastitis?
Managed conservatively, with continued breastfeeding, expressing milk and breast massage.
Heat packs, warm showers and simple analgesia can help symptoms.
Antibiotics (flucloxacillin or erythromycin/clarithromycin where there is penicillin allergy) are required where infection is suspected or symptoms do not improve
What is Candidiasis?
Commonly referred to as thrush. It refers to a yeast infection most commonly candida albicans
What are the risk factors for thrush?
- Increased oestrogen: pregnancy
- Poorly controlled diabetes
- Immunosuppression
- Broad spectrum antibiotics
What are the symptoms of thrush?
- Thick, white discharge that does not typically smell
- Vulva and vaginal itching, irritation or discomfort
What can a severe thrush infection lead to?
Erythema
Fissures
Oedema
Pain during sex (dyspareunia)
Dysuria
Excoriation
What are the investigations for thrush?
- Testing vaginal pH often it is below 4.5 in thrush but will be higher with vaginosis
- Charcoal swab is gold standard
What is the treatment for thrush?
- A single dose of intravaginal clotrimazole cream
- A single clotrimazole pessary
- A single dose of fluconazole
What is conjunctivitis?
- Inflammation of the conjunctiva which is the tissue that covers the inside of the eyelids and the sclera
What are the 3 causes of Conjunctivitis?
- Bacterial
- Allergic
- Viral
What are the symptoms of Conjunctivitis?
- Red, bloodshot eye
- Itchy or gritty sensation
- Discharge
It does not cause pain, photophobia or reduced visual activity
What are the differences between viral and bacterial Conjunctivitis?
- Bacterial often presents with a purulent discharge and worse in the morning also it is highly contagious
- Viral conjunctivitis is common and usually presents with a clear discharge. It is often associated with other symptoms of a viral infection, such as a dry cough, sore throat and blocked nose
What are the causes of a painful red eye?
Acute angle-closure glaucoma
Anterior uveitis
Scleritis
Corneal abrasions or ulceration
Keratitis
Foreign body
Traumatic or chemical injury
These tend to be more serious and require urgent intervention
How do you treat Conjunctivitis ?
- It usually resolves in 1-2 weeks with no need for treatment
- Chloramphenicol or fusidic acid eye drops are options for bacterial conjunctivitis if necessary.
- Neonates under one month with conjunctivitis need urgent ophthalmology assessment. Neonatal conjunctivitis may be caused by gonococcal infection
What is Allergic Conjunctivitis?
It causes swelling of the conjunctival sac and eyelid with itching and a watery discharge.
Antihistamines (oral or topical) can help symptoms.
What is croup?
- An acute infective respiratory disease affecting young children
- It typically affects children aged 6months to 2 years
What is dangerous about croup?
It causes oedema in the larynx
What is the most common cause of croup?
Parainfluenza
What are some other causes of croup?
Influenza
Adenovirus
Respiratory Syncytial Virus (RSV)
What used to cause croup?
It used to be caused by diphtheria. It leads to epiglottitis and has a high mortality.
What are the symptoms of croup?
- Increased work of breathing
- “Barking” cough, occurring in clusters of coughing episodes
- Hoarse voice
- Stridor
- Low grade fever
What is the treatment of croup?
Mainly can be conservative but dexamethasone is effective if needed
What is the stepwise management of croup?
Oral dexamethasone
Oxygen
Nebulised budesonide
Nebulised adrenalin
Intubation and ventilation
What is impetigio?
A superficial bacterial skin infection usually caused by S.aureus
What is the characteristic feature of a S.aureus skin infection?
A golden crust
What else can cause impetigio?
S.pyogenes
What are the two types of impetigo?
- Bullous
- Non-bullous
What is non bullous impetigo?
occurs around the nose or mouth. The exudate from the lesions dries to form a “golden crust”. They are often unsightly but do not usually cause systemic symptom
What is the treatment for non-bullous impetigo?
- Topical fusidic acid can be used to treat localised non-bullous impetigo
- antiseptic cream (hydrogen peroxide 1% cream) first line rather than antibiotics for localised non-bullous impetigo.
What is bullous impetigo?
- Always caused by S.aureus
- They produce epidermolysis toxins that break down proteins that hold skin cells together
Which group does bullous impetigo typically affect?
Neonates and children under 2
What can happen if the lesions are widespread and severe in bullous impetgio?
Can cause severe infection called staphylococcus scalded skin syndrome
- Treat with flucloxacillin
What are the complications of impetigo?
Cellulitis if the infection gets deeper in the skin
Sepsis
Scarring
Post streptococcal glomerulonephritis
Staphylococcus scalded skin syndrome
Scarlet fever
What is infectious mononucleosis (glandular fever)?
- A condition caused by infection with the EBV.
- Commonly known as the kissing disease or Mono
How can glandular fever spread?
- It is found in the saliva of infected individuals and is spread by kissing, or sharing cups and toothbrushes
When does an infection with EBV become classified as infectious mononucleosis?
- When symptoms present
What are the symptoms of infectious mononucleosis?
- Fever
- Sore throat
- Fatigue
- Lymphadenopathy
- Tonsillar enlargement
- Splenomegaly (can cause splenic rupture)
What happens if you treat a patient with infectious mononucleosis using amoxicillin?
- A intensely itchy maculopapular rash will appear
What antibodies can be tested for to see if a patient has had infectious mononucleosis?
Heterophile antibodies
- Monospot test: this introduces the patient’s blood to red blood cells from horses. Heterophile antibodies (if present) will react to the horse red blood cells and give a positive result.
- Paul-Bunnell test: this is similar to the monospot test but uses red blood cells from sheep.
What is the management for infectious mononucleosis?
- Is usually self-limiting and lasts 2-3 weeks but can cause fatigue for several months
What is the advice given to patients with infectious mononucleosis?
- Avoid alcohol as EBV impacts the livers ability to process it
- Avoid contact sports due to risk of splenic rupture
What are the complications of infectious mononucleosis?
Splenic rupture
Glomerulonephritis
Haemolytic anaemia
Thrombocytopenia
Chronic fatigue
EBV infection is associated with certain cancers, notable Burkitt’s lymphoma.
What bacteria causes Lyme disease?
B burgdorferi
What are the symptoms of Lyme disease?
- Tick bite with rash called erythema migrans
- Fever
- Headache
- Myalgias
- Stiff neck
- Facial palsy
What is the treatment for Lyme disease?
Doxycycline, unless there is just a rash that can’t be distinguished from cellulitis then use amoxicillin
What are the complications of Lyme disease?
- Acute neurological complications
- Cardiac complications such as AV block and myocarditis
What is menopause?
- A retrospective diagnosis made after a woman has had no periods for 12 months
- It is defined as a permanent end to menstruation
- Menopause is the point at which menstruation stops
What is perimenopause, postmenopausal and premature menopause?
- Perimenopause refers to the time around the menopause, where the woman may be experiencing vasomotor symptoms and irregular periods.
- Postmenopausal describes the period from 12 months after the final menstrual period onwards.
- Premature menopause is menopause before the age of 40 years. It is the result of premature ovarian insufficiency.
What causes menopause?
- It is caused by a lack of ovarian follicular function, resulting in changes in the sex hormones associated with the menstrual cycle
- Oestrogen and progesterone levels are low
- LH and FSH levels are high in response to an absence of negative feedback from oestrogen
Describe how oestrogen is released during the menstrual cycle ?
- In the ovaries the process of primordial follicles maturing is into primary and secondary follicles is always occurring
- At the start of the menstrual cycle FSH stimulates the further development of secondary follicles
- As the follicles grow the granulosa cells that surround them secrete increasing amounts of oestrogen
How does the menopause begin?
- The menopause begins with a decline in the development of ovarian follicles
- Without the growth and development of the follicles there is reduced production of oestrogen
- This results in increasing levels of LH and FSH as oestrogen has a negative feedback on these hormones in the pituitary gland
How is the menstrual cycle affected in the menopause?
- Falling follicular development means ovulation does not occur (anovulation)
- Without oestrogen the endometrium does not develop leading to a lack of menstruation (Amenorrhoea)
- The low levels of oestrogen lead to the perimenopausal symptoms
What are the perimenopausal symptoms?
- Hot flushes
- Emotional lability or low mood
- Premenstrual syndrome
- Irregular periods
- Joint pains
- Heavier or lighter periods
- Vaginal dryness and atrophy
- Reduced libido
What does a lack of oestrogen increase the risks of?
- CVD
- Osteoporosis
- Pelvic organ collapse
- Urinary incontinence
How can menopause be diagnosed?
- Symptoms without blood test
- Use FSH blood test in women under 40 or aged 40-45 with menopausal symptoms
How long do women need to use contraception for after the menopause?
- Two years after the last menstrual period in women under 50
- One year after the last menstrual period in women over 50
What is the management of perimenopausal symptoms?
Hormone replacement therapy (HRT)
Tibolone, a synthetic steroid hormone that acts as continuous combined HRT (only after 12 months of amenorrhoea)
Clonidine, which act as agonists of alpha-adrenergic and imidazoline receptors
Testosterone can be used to treat reduced libido (usually as a gel or cream)
Vaginal oestrogen cream or tablets, to help with vaginal dryness and atrophy (can be used alongside systemic HRT)
Vaginal moisturisers, such as Sylk, Replens and YES
What is anaemia?
When there is a decrease in haemoglobin.
What two things cause low haemoglobin levels?
Reduction in cell mass
Increased plasma volume
What element is key for making Hb?
Iron
What is the normal mean cell volume?
80-100 femtolitres
What are the 3 main subtypes of anaemia?
Microcytic- low MCV indicating small sized RBC
Normocytic- normal MCV indicating normal sized RBC
Macrocytic- high MCV indicating large sized RBC
What are the 5 causes of microcytic anaemia?
T- Thalassaemia
A- Anaemia of chronic disease
I- Iron deficiency
L- Lead poisoning
S- Sideroblastic anaemia
TAILS
What are 5 causes of normocytic anaemia?
A- anaemia of chronic disease
A- Acute blood loss
A- Aplastic
H- haemolytic
H- Hypothyroidism
3 As and 2 Hs
What are the two subtypes of macrocytic anaemia?
Megaloblastic
Normoblastic
What is megaloblastic anaemia and what causes it?
Problem in DNA synthesis caused by vitamin deficiency
Folate
B12
What causes normoblastic anaemia?
Alcohol
Hypothyroidism
Liver disease
Drugs such as azathioprine
What are the generic signs of anaemia?
Pale skin
Conjunctivital pallor
Tachycardia
Raised respiratory rate
How common is iron deficiency anaemia?
Most common cause in the world
What can cause iron deficiency anaemia?
Vegetarian diet
H. pylori infection
Pregnancy and breastfeeding
IBS
Coeliac
PPI’s
Increased iron loss through bleeding (this is the principal cause if Fe deficiency)
Why does iron loss cause microcytic anaemia?
Iron is needed for the formation of haemoglobin and when there is a lack of iron not enough haemoglobin is made to make normal sized RBC’s.
Therefore smaller RBC’s are produced by the bone marrow which can’t carry enough oxygen to meet the bodies demand hence hypoxia
Where is Iron mainly absorbed in the body?
Duodenum and jejunum
Why are women more prone than men to iron deficiency?
Women lose about 2mg daily when menstruating where as men will only on average lose 1mg a day
How can pregnancy cause anaemia?
Pregnancy results in net loss of 580mg of iron, due to expansion of RBC mass and growth of the foetus and placenta. Most occurs in the third trimester
Why does H.Pylori cause iron deficiency?
It traps Fe itself in the stomach preventing it from reaching the duodenum
How do PPI’s cause iron deficiency?
Iron requires acid from the stomach to stay in it’s soluble form fe2+ where as without acid it becomes insoluble Fe3+. Therefore PPI’s as they reduce amount of stomach acid can lead to Fe deficiency
Why can hair and nails be affected by Iron deficiency?
As iron is required for enzymes in the mitochondria, and as hair and nails are fast growing they are most affected by this deficit
What are the signs of Iron deficiency?
- Conjunctivital pallor
- Koilonychia (spoon shaped nails)
- Angular stomatitis (redness around mouth)
- Glossitis
What are the symptoms of iron deficiency?
- Fatigue
-Dyspnoea on exertion - Dizziness
- Headache
- Nausea
- bowel disturbance
- Hair loss
What investigations would you perform for a patient with suspected iron deficiency?
FBC- would have low Hb, low MCV
- Iron studies would measure the: serum iron, serum ferritin and total iron binding capacity
If ferritin in the blood is low it is highly suggestive of iron deficiency. If ferritin is high then this is difficult to interpret and is likely to be related to inflammation rather than iron overload. A patient with a normal ferritin can still have iron deficiency anaemia, particularly if they have reasons to have a raised ferritin such as infection.
transferrin levels increase in iron deficiency and decrease in iron overload.
How would you treat iron deficiency?
- Treat underlying cause
- Oral iron supplements ferrous sulphate/fumarate
- Iron infusion e.g., cosmofer
- Blood transfusion in severe cases
What are the complications associated with iron deficiency?
- Cognitive impairment
- Impaired muscular performance
- Preterm delivery
- High output heart failure
What are the investigations for anaemia?
- New born screening with heel prick happens at day 5
- FBC:normocytic anaemia with reticulocytotic
- Blood film:sickled RBCs, target cells, Howell-Jolly bodies (RBC nuclear remnants seen later in the disease due to hyposplenism)
- Hb electrophoresis and solubility: diagnosticinvestigation, demonstrating**increased HbS (2 alpha chains and 2 abnormal beta chains) and reduced/absent HbA (α2β2)
What is aplastic anaemia?
A stem cell disorder. It is characterised by anaemia, leukopenia and thrombocytopenia
What causes aplastic anaemia?
- Idiopathic
- radiation and toxins
- Drugs
- Infections HIV
What is B12 deficiency anaemia?
Anaemia caused by B12 deficiency it is a macrocytic megaloblastic anaemia
What causes B12 deficiency?
- Inadequate intake (vegans and vegetarians as it is found in animal products)
- Inadequate secretion of intrinsic factor
- Malabsorption (crohn’s, patients who have had a gastric bypass)
- Inadequate release of B12 from food (alcohol abuse and gastritis)
- Can also be caused by pernicious anaemia which is where there is autoimmune destruction of the gastric epithelium
What are the signs of B12 deficiency?
- Pallor
- Signs of neurological defect
What are the symptoms of B12 deficiency?
- SOB
- Palpitations
- Headaches
- Fatigue
- Glossitis
- CNS involvement - Personality change
- Depression
- Memory loss
- Visual disturbances
- Numbness, weakness and paraesthesia affecting the lower extremities
- Ataxia
- Loss of vibration sense or proprioception
- Autonomic dysfunction (e.g. bladder/bowel dysfunction)
How long does folate deficiency take to occur compared to B12?
folate= a few months
B12= A few years
What can cause folate deficiency?
- Inadequate intake
- Malabsorption
- Increased requirement (malignancy and pregnancy)
- Increased loss (chronic liver disease)
- Alcohol abuse
What are the symptoms if folate deficiency?
- Fatigue
- Dyspnoea
- Palpitations
- Headache
- Glossitis
- Features of pancytopenia e.g. excessive bleeding and bruising due to thrombocytopenia, recurrent infections due to leukopenia
-
Symptoms of underlying cause e.g.
- Coeliac disease: diarrhoea, bloating, dyspepsia and abdominal discomfort.
What is Anaemia of chronic disease?
- A chronic disease due to chronic inflammation process from underlying infection, malignancy or systemic disease
- Normally normocytic but can be microcytic
What two processes are the main cause of ACD?
- Decreased lifespan as a result direct cellular destruction via toxins from cancers, viruses and bacteria
- Decreased production of RBC- inflammation inhibits iron metabolism and cytokines inhibit erythropoietin production in the kidney
What is the treatment for ACD?
- Treatment of underlying cause
- EPO injections
- Parenteral iron
- Transfusions
What is an atrial flutter?
is a macro re-entrant atrial tachycardia with atrial rates usually above 250 bpm up to 320 bpm.
What can cause an atrial flutter?
Results from either structural or conduction abnormalities.
Structural= atrial dilation, incisional scars and fibrosis of the atrium.
Can also occur as a result of taking drugs for atrial fibrillation
What are the key presentations of an atrial flutter?
Presence of the risk factors and worsening heart failure or pulmonary symptoms. Leads to a atrial HR of 300.
2:1 (most common)= 150 heart rate in ventricles
What will an ECG show of a patient with an atrial flutter?
Sawtooth P waves with fast heart rate
What are symptoms of an atrial flutter?
Palpitations and fatigue, racing pulse
How would you manage an atrial flutter?
If haemodynamically unstable then cardiovert either electrically or chemically
Use beta-blockers and CCB’s if not. Treat underlying cause
What are complications associated with atrial flutter?
Acute stroke, myocardial ischaemia, then lots of medication related.
What is AF?
Atrial fibrillation (AF) is a common tachycardia. It can be caused by many other underlying illness, especially in the acutely unwell patient (such as sepsis, pneumonia, hyperthyroidism or other illness). It may be reversible by treating the underlying cause.
Is also very common idiopathic
What are the different types of AF?
Paroxysmal: episodes last >30 seconds but <7 days and are self-terminating but recurrent
* Persistent: episodes last less than or more than seven days but require electrical or chemical cardioversion
* Permanent: episodes fail to terminate with cardioversion OR a terminated episode that relapses within 24 hours OR long-standing AF (usually >1 year) in which cardioversion has not been indicated or attempted
What are the key presentations of AF?
Irregularly irregular pulse
Palpitations
Chest pain
Dyspnoea
Dizziness / syncope (particularly in paroxysmal)
ECG
What would an AF ECG look like?
No p wave
Fluttering baseline
What are the two principles for managing AF?
Two principles for treating AF:
Rate or rhythm control
Anticoagulation to prevent stroke
What are some rate control medications for AF?
Beta blocker bisoprolol , CCB amlodipine
How would you do rhythm control of AF?
Rhythm control can be achieved by either electrical or chemical cardioversion
Chemical cardioversion=
Flecainide
Amiodarone
What would be the long term treatment for AF?
Left atrial ablation
How would you determine anti-coagulant control?
Use CHAD-VASc score to determine anti-coagulant.
Used to be more warfarin now DOAC more commonly used e.g., apixaban/rivaroxaban
Complications of AF?
Acute stroke (most common) due to blood pooling and coagulating in the atrium
MI
Congestive heart failure
Amiodarone related pulmonary toxicity/thyroid dysfunction
Hypotension
What are the 2 shockable rhythms for a cardiac arrest?
Ventricular tachycardia
Ventricular fibrillation
What are the two non-shockable rhythms?
Asystole- when there is no electrical activity
Pulseless electrical activity
What are the different types of supraventricular tachycardia?
A sinus tachycardia
Focal atrial tachycardia
Atrioventricular re-entry tachycardia
AV nodal re-entry tachycardia
What is focal atria tachycardia?
A group of cells in the atria act as the pacemaker going quicker than the SAN node often seen in patients with chronic lung disease. Normal P wave
What is atrioventricular re-entry tachycardia (AVRT)?
Atrioventricular re-entry tachycardia- when there is an accessory pathway
ANTEGRADE (atria to ventricles) which is shown as pre-excitation on the resting ECG (the mythical DELTA wave) Wolf-Parkinson-White syndrome
RETROGRADE (ventricle to atria) which is not seen on a resting ECG
What is a AV nodal re-entry tachycardia (AVNRT)?
This is where re-entry circuits form within the AV node, or anatomically adjacent similar tissue.
Most common type and more common in women. Can be caused by drugs and lifestyle. Usually sudden onset and can cause shortness of breath.
How would you manage a haemodynamically unstable patient with a supraventricular tachycardia?
Cardiovert them either chemically or electrically
How would you manage a haemodynamically stable patient with a supraventricular tachycardia?
use vagal manoeuvres if that doesn’t work then can use adenosine which interrupts the AV node
Do supraventricular tachycardias have wide or narrow QRS complexes?
Narrow unless present with bundle branch block
What are the wide-complex QRS tachycardias?
Ventricular tachycardia,
Ventricular fibrillation
Torsades de pointes
What is ventricular tachycardia?
Usually observed in the setting of ischaemic heart disease. IHD and CAD are the most common. Things such as Chagas disease can also cause.
Other forms of structural heart disease, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, and anomalous coronary arteries are also associated with ventricular arrhythmias.
What causes ventricular tachycardia?
Areas previously scarred are the substrate for re-entry causing rapid ventricular depolarisation
What are the symptoms of VF?
Hypotension and syncope. Along with racing pulse and dyspnoea
How would you treat a patient with VF?
Treatment if they are haemodynamically unstable with a pulse- do a cardioversion and look for underlying cause try and solve.
Consider using antiarrhythmic medication amiodarone
If stable then use adenosine/amiodarone then cardiovert if not successful