mmore bits Flashcards
notching of the inferior border of ribs sign of
coarctation of the aorta - this is due to dilatation of intercostal arteries, superior vena caval obstruction, arteriovenous fistula, or following a Blalock Taussig shunt.
The itnerocstals are dilated as it allows sufficient blood flow to reach the descending aorta. The pressure of these vessels erodes the inferior margin of the ribs.
Coarctation explains this patients refractory hypertension too.
what congential condition can cause refractory hypertension and why
coaractation - this cause increased afterload for the left ventricle resulting in an increased systolic pressure in the lV and upper part of the body
in what other condition can you see rib notching - but mainly in the upper proportion of the ribs.
marfans syndrome
iNR high - minor bleed tx
stop warfarin adn IV vit k
INH high and over 8 but a major bleed
stop warfarin , IV vit k and prothrombin complex
after atropine what can you give in bradycardiac event
external pacing via transcutaneous pacing then transvenous
first thing you do when someone reports someone unresponsive and not witnessed
1 shock 2 min cpr
first thing you do if you witness someone go into cardiac arrest
3 shocks intially given then cpr
angina pt already tried verampamil and asthmatic what is next on the list that can be given if still having exacerbations
isosobide mononitrate- long acting nitrate
what is the problem with combining ivabradine with a rate limiting CCB like verapamil
could lead to severe bradycardia
tx of type a aortic dissection - ascending aorta
Intravenous labetalol and immediately refer for aortic root replacement
tx of type b - descending
type B - descending aorta - control BP(IV labetalol)
aortic regurgitation sign of which aortic dissecton
type a - aortic dissection
side effect of ramipril
angioedema - marked toungue and facial swelling
what is secondary hypertension
high blood pressure caused by another medical condition
what is the most common cause of secondary hypertension
primary hyperaldonsteronism
This patient has hypokalaemia and hypernatraemia, which combined with hypertension suggests either
primary hyperaldosteronism, Cushing’s syndrome or renal artery stenosis.
To distinguish between these causes, you can perform a plasma renin: aldosterone ratio and a low-dose dexamethasone suppression test. It is important to note that although primary hyperaldosteronism often presents with hypokalaemia, this may not always be the case. It is most commonly caused by idiopathic bilateral adrenal hyperplasia, followed by an aldosterone-secreting adenoma of the adrenal gland (Conn’s syndrome).
Renal artery stenosis is incorrect. This is more likely to occur in older male smokers with atherosclerotic risk factors such as hypercholesterolaemia or, more rarely, younger women due to fibromuscular dysplasia. In renal artery stenosis, renal bruits may be heard on examination and there may be hypokalaemia and hypernatraemia due to hyperreninaemic hyperaldosteronism (high renin activating the renin-angiotensin-aldosterone system). Although this patient had hypertension with hypokalaemia and hypernatraemia, primary hyperaldosteronism is a much more common cause of this.
HF need annual what vaccination
influenza vaccination
when in HF do people ned vaccination
normally one off
every 5 years if asplenia, CKD - booster every 5 years
mitral valve most affected in IE but hwat about in IE in IVDU
tricuspid valve
what medication commonly used in blood pressure and af causes cold perpipheries and night terrors
beta blockers
A patient develops acute heart failure 10 days following a myocardial infarction. On examination he has a raised JVP, pulsus paradoxus and diminished heart sounds -
left ventricular free wall rupture
The ischaemic damage sustained may weaken the myocardium resulting in aneurysm formation. This is typically associated with persistent ST elevation and left ventricular failure. Thrombus may form within the aneurysm increasing the risk of stroke. Patients are therefore anticoagulated.
left ventricular aneurysm
dose of statin given when Qrisk over 10% for hyperlipideamia
20mg
what are the HOCM murmur findings
HOCM may present with ejection systolic murmur, louder on performing Valsalva and quieter on squatting
u waves and QT prolonging seen in what
hypokalamia
what ppi should you prescribe with clopidogrel
lansoprazole
ix of choice for aortic dissection
CTA -CAP
antiplatelet choice in Nstemi
aspirin, plus either:
ticagrelor, if not high bleeding risk
clopidogrel, if high bleeding risk
positive Kussmaul’s sign (the raised JVP that doesn’t fall with inspiration
Kussmaul’s sign can be used to differentiate cardiac tamponade and constrictive pericarditis
s. Another factor that indicates constrictive pericarditis is his recent history of cardiac catheterisation for his coronary angiogram. Recent cardiac surgery (including cardiac catheterisation) is a common cause for constrictive pericarditis.
dyspnoea and peripheral oedema
Orthostatic hypotension may be exacerbated by venous pooling during exercise (exercise-induced), after meals (postprandial hypotension) and after prolonged bed rest (deconditioning)
most important risk factor for aortic dissection
hypertension
rhythm control for af 3 conditions
managing atrial fibrillation can be divided into rate control and rhythm control. Patient factors favouring rhythm control include:
Age <65 years
First presentation of AF
Symptomatic.
long qt due to hwat
usually due to loss-of-function/blockage of K+ channels
In cardiac tamponade, there will be an abnormally large drop in BP during inspiration, known as
pulsus paraodoxus
Tricuspid regurgitation becomes louder during inspiration, unlike mitral regurgitation
Systolic murmur.
2- Loudest in the 4th intercostal left parasternal region.
3- Louder on inspiration.
4- The patient has chronic obstructive pulmonary disease and is developing signs of core pulmonale.
statin LFTs checked when
LFTs at baseline, 3 months and 12 months
what drug that could interact with clopidogrel makes it less effective
Concurrent use of clopidogrel and omeprazole/esomeprazole can make clopidogrel less effective
Thiazide diuretics can cause hypercalcaemia and what levels of calcium in the urine whihc may be useful in reducing the incidence of renal stones
hypocalcuria
Nitrates are contraindicated in patients with
hypotension
A 78-year-old woman is admitted to hospital with nausea, abdominal pain, constipation and low mood with generalised musculoskeletal pain and weakness. On examination she appears dehydrated.
what problem and what ecg
hypocalcaemia
shortened QT
causes of torsades electroltes
hypothermai
low k ca and mg
ventricular tachycardia (VT
hypos as above in torsades
what is the main important cause of VT
hypokalamia
bisoprolo or verampil in angina mx with heart failure
BB as verapamil avoided - as has a negative iontrophic affect
