Laz Cardiology Flashcards
Left bundle branch block signs on ECG
Broad QRS (>0.12)
WiLLiaM MaRRoW
So will see W in V1 and M in V6
Definition of angina
Chest pain on exertion, relieved by rest
It’s because there is a mismatch in oxygen supply and demand to myocardium
Treatment of stable angina
Beta blockers (reduce the heart rate). This helps with the mismatch between oxygen and myocardium! Because not working as hard.
GTN spray
Risk factor modification
ACS is what?
Symptoms caused by a sudden reduced blood flow to the heart muscle
First line investigation in ACS
ECG
ACS Sx with no ST elevation, what do you do?
Troponin
ACS Sx, no ST elevation, raised troponin =>
NSTEMI
Ischaemic changes on ECG
Dynamic T wave inversion (a new finding, because can be normal). Try to find a previous ECG!
ST depression
Generic ACS management
Morphine 5-10mg
10mg metoclopramide to help with nausea from morphine
300mg aspirin
300mg clopidogrel
Or
180mg ticagrelor
GTN spray
How many medications do ACS patients get discharged on?
5
Discharge medications for MI
Aspirin 75mg Clopidogrel 75mg Bisoprolol (beta blocker) 2.5mg ACEi 2.5mg Statin 80mg
All once daily
Aim of STEMI Mx
Establish coronary repurfusion
STEMI Mx <12hr
PCI
Only if you can get PCI within 2hr of diagnosis
STEMI Mx >12hr
Angiography followed by PCI if necessary
If they have a STEMI <12hr but you cannot get PCI in less than 2 hours, what do you do?
Thrombolysis
Management of NSTEMI
Give 2.5mg SC fondaparinux
Do a GRACE score to determine risk
High risk -> angiography
Low risk -> medical management
All patients undergoing PCI should be on what medication to prevent the wire causing clotting?
IV unfractionated heparin
What type of drug is tacrolimus?
Calcineurin inhibitor
What is impregnated into a coronary stent?
Tacrolimus
Definition of heart failure
Inability of the heart to pump sufficiently to meet the demands of the body
Which side of the heart does the blood come from the body
Right side
Which side of the heart does blood come from the lungs?
Left side
ABCDE of pulmonary oedema
Alveolar oedema Kerly B lines Cardiomegaly Upper lobe diversion Pleural effusion
Causes of heart failure
IHD
Valvular disease
HTN
Sudden heart failure Ix
ECG Chest X-ray ABG Echo BNP
Management of acute heart failure
Sit the patient up
Oxygen 15/L non-rebreathe
Diuretics 40mg furosemide IV to clear some fluid
If already on diuretics (acute on chronic) go for higher dose of 80mg furosemide
GTN spray
5mg morphine IV
Long term heart failure management
Beta blocker
ACEi
Risk factor modification
Acute heart failure, you’ve sat them up, oxygen, GTN, morphine, furosemide 80mg, they are still bad, what do you do?
CPAP
Great explanation by Laz about oxygen therapy and ventilation. In a poorly functioning lung, there will be bits that are working ok and bits that aren’t working very well.
How does oxygen therapy work and how does ventilation work?
Oxygen therapy looks to help the bits that are already working, by increasing the diffusion gradient
Ventilation works by recruiting more of the dysfunctioning lung
Analogy for CPAP
Putting your head out of the car window, constant light pressure pushing air in and opening alveoli to aid ventilation
Summary of BiPAP using IPAP and EPAP
IPAP is higher than EPAP
I.e. air is pushed in
Why do we start someone on CPAP?
Say they are COPD, the airway is fragile and so when you try to breathe out, the airways collapse and lock off
CPAP keeps those alveoli open
Increases the surface area that is participating in gas exchange
Why do we start someone on BiPAP?
Keeps the alveoli open but then also aids in clearing the CO2!
So this is good for type 2 respiratory failure!
Causes of AF
Very common, loads of things can precipitate it Idiopathic Cold drinks Drugs Pneumonia PE Alcohol Hyperthyroidism IHD
What is AF
Irregularly irregular rhythm with no P waves
Cause of DVT, which aspect of Virchows does it influence, what do you give?
Stasis
Give anticoagulant
MI affects which part of virchows triad? What do you give?
Vessel wall injury (from plaque rupture)
Get platelet activation (because exposed tissue factor)
So need anti platelets
Examples of anticaogulants
Heparin
Rivoroxaban
Examples of anti platelets
Clopidogrel
Aspirin
A regular, narrow complex tachycardia is called
SVT
Supraventricular tachycardia
Remember that the QRS are narrow so it’s an atrial issue
Adenosine is contraindicated in which common condition?
Asthma
It can cause bronchoconstriction
Urine dip in endocarditis may show
Microscopic haematuria
Features of endocarditis
4 day fever Needle track marks Microscopic haematuria Splenomegaly Jane way lesions Oslers nodes Roth spots on retina
Causes of murmurs
Endocarditis
IHD
Senile calcification
Rheumatic heart disease
Why are murmurs on left side more likely?
Higher pressures
What usually causes RHS murmurs
Infection, because it’s the first valve it hits (tricuspid)
What is flecanide used for?
Dangerous arrhythmias
6 Ps of acute limb ischaemia
Pale Pulseless Parasthesia Perishingly cold Paralysis Painful
Analogy of acute limb ischaemia
MI of the leg, embolus going down aorta and getting stuck in leg arteries
Management of acute limb ischaemia
IV heparin
Refer to vascular surgeon
Vascular surgeon options for acute limb ischaemia
Embolectomy
Bypass
Amputation
Analogy of intermittent claudication
Stable angina!
Critical limb ischaemia analogy
Unstable angina
Features of critical limb ischaemia
Ulcers
Gangrene
Rest pain
Night pain
Ix for intermittent claudication
ABPI
Venous duplex USS
Small T waves
Prolonged PR interval
Symptoms of DKA
Electrolyte abnormality?
Hypokalaemia
Management of digoxin toxicity
Immediate digoxin level
IV fluids
Correct electrolyte abnormalities
Continuous cardiac monitoring
Ix for ischaemic stroke
CT head
Diffusion-weighted MRI
Look for causes = carotid artery doppler, ECG, echo
Causes of raised anion gap
MUDPILES Metformin Uraemia DKA Paracetamol Iron Lactic acidosis Eythyl Salicylate
Which antibiotic for penicillin allergic for strep throat?
Clarithromycin
Swollen gums
Anaemia
Easy bruising
Restricted diet
Vitamin C deficiency
Scurvy
What is tympanosclerosis
Tympanosclerosis is a condition characterised by chronic inflammation and scarring of the tympanic membrane leading to subsequent calcification of the tympanic membrane and associated structures.
Associated with long term otitis media and tympanostomy (grommet) insertion. Patients will normally present with significant hearing loss and on examination will present with chalky white patches on the tympanic membrane.
Hearing aids are a common treatment for hearing loss disorders. In cases refractory to hearing aids, excision of the sclerotic areas and repair of the ossicular chain may be considered.
Treatment of chronic otitis externa (episodes of painful ear with white discharge)
Aural toilet and topical antibiotic
What are the complications of otitis externa?
Mastoiditis
Labyrinthitis
