Medicine - Cardiology Flashcards
Atrial Fibrillation Pathophysiology: Causes: ECG changes: Symptoms: Signs: Investigations: Management: Complications:
Pathophysiology: Multiple atrial foci firing at once
Causes: Myocardial infarction, Hypertension, Pericarditis, Congenital Heart Defects, Alcohol, Thyrotoxicosis, Electrolyte Imbalance
ECG changes: Loss of P waves, Irregularly Irregular
Symptoms: Breathlessness, Syncope, Palpitations, Reduced Exercise Tolerance
Signs: Irregular heart rate, Tachycardia
Investigations: 24-hour Holter monitor, CHADS-VASC, HAS BLED
Management: Haemodynamically unstable: Emergency Cardioversion
Rate: B-blocker (Atenolol), Ca channel blocker (Diltiazem), Digoxin
Rhythm: Amiodarone + Flecainide - chemical cardioversion
Clotting agents
Complications: Stroke and thromboembolism, HF, Cardiomyopathy
What are the indications for DC Cardioversion in AF? Contraindications?
Indications: Haemodynamically unstable (High HR, low BP)
Stable, but not recovering with medical treatment
Contraindications: Structural heart defects
Recall CHADS VASC
Congestive Heart Failure - 1 Hypertension - 1 Age - 2 - > 75 Diabetes - 1 Stroke/VTE - 2
Vascular history eg. MI/Peripheral artery disease - 1
Age - 1 - 65-74
Sex category - Female - 1
Murmur (Valvular Heart Disease): Signs of Aortic Stenosis: Signs of Mitral Regurgitation: Signs of Aortic Regurgitation: Signs of Mitral Stenosis:
AS: Syncope (exertional), SOB, Ejection Systolic Murmur, Radiation to Carotids
MR: Pansystolic Murmur, Non-pitting Peripheral Oedema, Radiates to Axilla, SOB
AR: Quinke’s sign, Diastolic Murmurs, Bounding Pulse
MS: Malar Flush, Diastolic Murmurs, Raised JVP
Name 5 causes of Murmurs:
Rheumatic fever Congenital Hypertension Endocarditis MI
Aortic Stenosis Pathophysiology: Causes: Symptoms: Signs: Investigations: Management: Complications:
Pathophysiology: Aortic Valve stenosed (!) - leads to right sided pump issues
Causes: Rheumatic fever, MI, Endocarditis, Hypertension
Symptoms: SAD - Syncope, Angina (chest pain), Dyspnoea, particularly if lying flat
Signs: Cyanosis, SOB, Carotid bruit
Investigations: Echocardiogram, ECG for hypertrophy
Management: TAVI (transcatheter aortic valve implantation through femoral artery), Anticoagulants
Complications: Heart failure, Haemolytic anaemia, Stroke
Endocarditis Pathophysiology: Causes: Symptoms: Signs: Risk factors: Investigations: Management:
Pathophysiology: Infection of the endocardium (inner lining) and valve(s) of the heart - most commonly mitral, then aortic valves
Causes: Staph aureus - most common, Staph epidermidis (replacement valves), Strep viridans (IVDU)
Symptoms: Fever (spiking), fatigue, weight loss
Signs: Osler’s nodes (painful, large), splinter haemorrhages (under nails), Janeway lesions (small, painless), clubbing of the fingers
Risk factors: IVDU, Valve replacement therapy, immunocompromise
Investigations: Blood cultures x2 done when temperature spikes, Echocardiogram, Eye test - Roth spot on retina
Management: Vancomycin or Gentamicin
ECGs: Signs for: - AF - Atrial flutter - Hyperkalaemia - Anterior STEMI - Inferior STEMI - Pericarditis - WPW - VF - RBBB - LBBB - Bifascicular Block - Trifascicular Block - PE - Right Axis Deviation - Left Axis Deviation - 1st degree HB - 2nd degree, MT1 - 2nd degree, MT2
- AF - loss of p waves, irregularly irregular
- Atrial flutter - sawtooth baseline, regular
- Hyperkalaemia - loss of p waves, tented T waves
- Anterior STEMI - ST elevation in V3-V4
- Inferior STEMI - ST elevation in Leads 2, 3, AVL
- Pericarditis - PR depression, saddle ST elevation
- WPW - delta wave
- VF - polymorphic ventricular tachy
- RBBB - V1, V2, RSR pattern
- LBBB - V5, V6, M wave
- Bifascicular Block - RBBB, LAD
- Trifascicular Block - RBBB, LAD, 1st degree HB
- PE - tachycardia, S1Q3T3, RBBB, RV strain, RAD
- Right Axis Deviation - 1 and 3 pointing at eachother
- Left Axis Deviation - 1 and 3 pointing away
- 1st degree HB - >5 squares PR interval
- 2nd degree, MT1 - gradually increasing PR and then drop
- 3rd degree, MT2 - constant PR and then drop
Hypertension Pathophysiology: Causes: Signs: Investigations: Management: Complications:
Pathophysiology: High BP
Causes: Hyperthyroidism, Pre-eclampsia, Renal Artery Stenosis, OSA, Conn’s tumour
Signs: Haematuria, SOB, High BP
Investigations: Ambulatory Blood Pressure Monitoring (ABPM) or HBPM. Do same day assessment of organ function and eyes if >180.
Management: 1. Lifestyle 2. Only treat medically if QRISK>10%, diabetic, CKD, coronary disease 3. <55 or Diabetic - ACE, then Ca2+, then Thiazide-like diuretics (indapamide). > 55/Black and not diabetic - Ca2+, then indapamide, then ACE.
Complications: Heart failure, AF, MI, Stoke, Retinopathy (Flame Haemorrhages), Renal Failure
Name the ocular changes that occur in hypertension.
Copper and silver wiring
Flame haemorrhages, retinal oedema and Cotton wool spots
Papilloedema
Heart Failure Pathophysiology: Causes: Symptoms: Signs: Investigations: Management: Complications:
Pathophysiology: Drop in ventricular output leading to poor organ perfusion.
Causes: Coronary artery disease, Hypertension, AS, Pericarditis, Arrhythmias, Thyrotoxicosis and sepsis
Symptoms: SOB, PND, Orthopnoea, Dizziness/Syncope
Signs: Oedema, Tachycardia, Hypertension, Basal Pulmonary crackles, Liver congestion, Cardiomegaly
Investigations: BNP (care ACE), ECG, Echocardiogram, CXR (batwing + cardiomegaly + maybe pleural effusion)
Management:
Acute: Oxygen, Morphine, Loop diuretic IV (furosemide or add indapamide), GTN spray
Not responding: CPAP
Chronic: ACE (Ramipril) + B-blocker, (bisoprolol) add spironolactone if struggling, sleep study + lifestyle modification
Complications: AF, depression, cachexia, CKD
Myocardial Infarction Pathophysiology: Risk factors: Investigations: Management: Complications:
Pathophysiology: Coronary artery occlusion leading to ischaemia.
Risk factors: High cholesterol diet, Obesity, Smoking, Hypercholesterolaemia, Hypertension
Investigations: Troponin, but only changes after 4 hours, ECG
Management: ROMANCE immediately + PCI
Long-term: ACE + B-blocker (atenolol) + dual anti-platelet (aspirin + clopidogrel) + statin
Complications: Must tell DVLA and stop for 4 weeks, sudden pulmonary oedema, pericarditis leading to tamponade
Angina
Pathophysiology:
Investigations:
Management:
Pathophysiology: Partial Occlusion - stable if only during exercise, unstable if at rest.
Investigations: ECG + Troponin
Management: Nitrates + Aspirin + Statin + B-blocker
Name the ECG leads for the corresponding and the artery supplied: Anterior Inferior Septal Lateral
Anterior - V3-V4 - Right coronary artery
Lateral - 1, V5, V6 - Circumflex artery
Inferior - 2,3,AVL - Right coronary artery
Septal - V1, V2 - LAD
Describe the management of VT/VF
Shockable
Start CPR, shock three times, give adrenaline 1mg 1:10000, give amiodarone, continue