More Flashcards
Diagnosis of accelerated hypertension
Severe hypertension - associated grade 2-3 retinopathy
Malignant hypertension
Severe hypertension associate with grade 4 retinopathy - therefore papilloedema
Reducing BP in severe hypertension
Maximum by 20% in first hour Use continuous infusion of short-acing titratable anti-hypertensive with constant arterial monitoring - sodium nitroprusside - glyceryl trinitrate - labetalol - hydralazine
Glyceryl trinitrate contraindication medication
Tadalafil - used for erectile dysfunction
Also sildenafil and vardenafil
Cause circulatory collapse and severe hypotension
Onion skimming on microscopy
Accelerated hypertension
Aschoff nodule on microscopy
Myocarditis
4 signs of haemodynamic compromise in arrhythmias
Heart failure
Blood pressure 150bpm
Infective endocarditis vasculitis test
Urine dip for microscopic haematuria due to vasculitis
Pulsus alternans
Heart failure
What is an atrial myxoma
Benign tumour that grows in the atrial wall/septum
Where do majority of atrial myxomas occur?
In the left atrium
What can atrial myxomas lead to/be linked with?
Atrial fibrillation and tricuspid stenosis
Can also lead to obstruction, pulmonary embolism, peripheral emboli
Prevalence of atrial myxoma
More common in women
1 in 10 are familial - familial myxoma - often occur in more than one location in the heart at one time and give symptoms younger
What do signs and symptoms of atrial myxoma resemble?
Mitral stenosis - pulmonary oedema symptoms, breathlessness, faintness
Rate of atrial flutter
Atrial fate of 300 per min and ventricular rate of 150 per min - 2:1 heart block as atria conducts every 2nd beat
Reversal of atrial flutter
Vagal manoeuvres, IV adenosine or chemical cardioversion
What increases the risk of digoxin toxicity when treating AF
Hypokalaemia, hypomagnesaemia and hypercalcaemia - therefore do a baseline investigation before initiating treatment
Prognosis of Chronic AF in a diseased heart
Doesn’t usually return to sinus rhythm
3rd heart sound
dilated cardiomyopathy (left ventricular failure), MR and constrictive pericarditis
Words to remember RBBB and LBBB
WiLLiaM MaRRoW
Which BBB is never normal
LBBB
Can wenckebach phenomenon normal?
Yes
Can RBBB be normal?
Yes
Can LBBB be normal?
No
Can 1st degree AV block be normal?
Yes
Signs of ongoing acute MI vs past MI
Hyperacute T waves during acute MI whereas invert after 24hrs
Pathological Q waves develop after several hours to days
Driving post angioplasty and pacemaker insertion
1 week
Driving post ACS
4 weeks unless successfully treated with angioplasty (1 week)
Driving post CABG
4 weeks
Arrythmia catheter ablation and driving
2 days
Pulse in PDA
large volume, bounding collapsing pulse
Closure of PDA
Indomethacin
Signs of PDA
Subclavicular thrill
Heaving apex beat
Wide pulse pressure
Most common cause of death post MI
Cardiac arrest due to VF
What type of MI is more commonly associated with AV block
Inferior MI
Murmur in coarctation of aorta
mid systolic murmur
Loudest over back
PR depression
Pericarditis
Signs of LV hypertrophy on ECG
Deep S wave in v1-2 Tall R wave in V5-6 Left axis deviation LBBB Inverted T waves in I, AvL and V5-6
What are Stokes Adams attacks
Syncope caused by ventricular asystole eg. in heart block
Broad bifid p wave
p mitrale - mitral valve regurge causing left atria enlargement
Tall p wave
right atria hypertrophy due to triscupid regurge
QRS concordance with broad complex tachycardia
Ventricular tachycardia
Fixed splitting of second heart sound
Atrial septal defect
