Passmedicine Flashcards
What vessel is affected in anterior MI
LAD
What vessel is affected in inferior MI
RCA
What vessel is affected in anterolateral MI
LAD or left circumflex
What vessel is affected in lateral MI
left circumflex
What vessel is affected in posterior MI
left circumflex or RCA
Angina pain, worse in morning, no CVS risk factors, normal exercise tolerance
Prinzmetal angina - due to coronary artery spasm
cardiac complication of TB
constrictive pericarditis
dose of adrenaline in anaphalaxis in adults
500mcgs (0.5ml of 1 unit in 1000)
what cardiac drug should be withheld in an MI
ACE/ARB
j waves on ecg
hypothermia
u waves on ecg
hypokalaemia
delta waves on wcg
WPW
what is bumetanide
loop diurectic
mechanism of action of amioderone
blocks potassium channels
post MI treatment
dual antiplatelet
ace
beta blocker
statin
slow rising pulse
aortic stenosis
most common cause of aortic stenosis
older - calcification
younger - bicuspid valve
common side effect/problem with amioderone
thrombophlebitis - should be given into central veins
what should you not prescribe with verapamil
beta blockers
what is an absolute contraindication to thrombolysis
intracranial neoplasm
ejection systolic murmur radiating to carotids
aortic stenosis
when would you give a mechanical heart valve vs bioprosthetic valve
mechanical valve given to younger patients as they last longer
What is the advantage if biiprosthetic valve replacement
do not need anticoagulated
how should type 2 diabetics glycemic control be managed post MI
stop all diabetic med
start iv insulin whilst in hospital
when can you offer statins to type 1 diabetics
older than 40
had diabetes for over 10 years
risk factor eg obese
nephropathy
what drug interacts with statin
clarythromycin - causes statin induced myopathy
side effects of GTN
headache, tachycardia, hypotension
early diastolic murmur
aortic regurg
most common complication of MI causing death
v fib
intial dose of amioderone during cardiac arrest
300mg
treatment of symptomatic bradycardia
IV atropine
treatment of symptomatic bradycardia if atropine fails
external pacing
how soon can you give a second adrenaline dose in analylaxis
five minutes
ECG features of WPW
short PR
slurred upstroke, wide QRS = delta wave
axis deviation
side effect of ivabradine
transient luminous phenominon
bright spots of light in vision
occurs after sore throat, arthritis, rash (erythema marginatum), sydenhams chorea, can cause carditis
rheumatic fever
dose of adrenaline in children 6-12 for analphylaxis
300mcgs
how do u decide when to replace aortic valve in aortic stenosis
symptomatic
valvular gradient more than 40mmHg
how long can you not drive post MI
4 weeks
where do thiazide diuretics work
proximal part of distal convoluted tubule
investigation of heartfailure
no MI - BNP naturietc peptides, if high echo in 2 weeks, if ‘raised’ echo in 6 weeks
if had previous MI - echo within 2 weeks
absent limb pulse
Takayasu
kussmauls’s sign
JVP increases on inspiration/fails to decrease
sign of constrictive pericarditis
ejection systolic, radiating to carotids, aortic area
aortic stenosis
Pansystolic, tricuspid area, radiating to 4th intercostal space
tricuspid regurg
Pansystolic, mitral area, radiating to axilla
mitral regurge
Mid diastolic, mitral area, radiating to axilla
mitral stenosis
what is coartication of the aorta
congenital narrowing of the descending aorta
what murmur is heard in coartication of the aorta
mid systolic maximal over back
who is at risk of silent MI
diabetics
pulsus paradoxicus
cardiac tamponade
bifasicular block
RBBB and left axis deviation
trifasicular block
bifasicular block + first degree heaet block
what leads do you look at for axis deviation
I and avF
third heart sound
normal in under 40s LVF - dilated cardiomyopathy constrictive pericarditis mitral regurg caused by ventricle filling in diastole
fourth heart sound
may be heard in aortic stenosis, HOCM, hypertension
caused by atrial contraction against a stiff ventricle
in HOCM a double apical impulse may be felt as a result of a palpable S$
mechanism of action of thrombolytic drugs
activates plasminogen to form plasmin
heart block and MI
RCA lesion - branch of RCA supplies AV node
pharmacological cardioversion in AF in patient with structural heart disease
amioderone
what should u be worried about if u see inferior MI on ECG + aortic regurg
aortic dissection
name medications that can cause long QT
amiodarone, sotalol, class 1a antiarrhythmic drugs
tricyclic antidepressants, selective serotonin reuptake inhibitors (especially citalopram)
methadone
chloroquine
terfenadine**
erythromycin
haloperidol
signs of heart failure on a chest x ray (pulmonary oedema)
A -alveolar oedema (batswing) B - Kerley B - interstitial oedema C- cardiomegaly D - dilated prominent upper lobe vessels E - effusion
trx of acute heart left venticular failure
sit up
oxygen
iv diuretic
iv diamorphine
what is important finding on echo in heart failue
left ventricular ejection fraction - whether this is reduced or normal
normal is above 50 percent
pulse in patients with heart failure
pulsus artenans - upstroke of pulse alternated between strong and weak
most useful test to confirm if someone has had analphylaxis
tryptase - remains elevated for 12 hours after an attach
becks triad
falling BP, enlarged neck veins/raised JVP, muffled heart sounds = cardiac tamponade
what test to diagnose cardiac tamponade
echocardiogram
adverse effects of amioderone
thyroid dysfunction corneal deposits pulmonary fibrosis/pneumonitis liver fibrosis/hepatitis peripheral neuropathy, myopathy photosensitivity 'slate-grey' appearance thrombophlebitis and injection site reactions bradycardia
monitoring required on amioderone
TFT UE LFT chest x ray all prior to treatment just TFTs and LFTs 6 monthly thereafter
which is the ‘bad’ cholesterol
LDL
murmur associated with rheumatic heart disease
mitral stenosis
when is malar flush seen
seen in mitral stenosis
blood transfusion threshold
70
blood transfusion threshold in ACS
80
wedge shaped opacification of cxr
PE
threshold for platelets prior to surgery or invasive proceudre
more than 50 x10(9)
what cardio drug needs to be stopped in pregnancy
statins
signs associated with aortic regurg
Corrigan's - exaggerated carotid pulse Quinke's - nailed pulsation De Musset's - head nodding Duroziez's - diastolic femoral murmur Traube's - 'pistol shot' femorals
pericardial rub is a sign of
pericarditis
collapsing pulse
aortic regurg
rumbling mid diastolic murmur, opening snap
mitral stenosis
slow rising pusle
aortic stenosis
diagnostic test for cardiac tamponade
echocardiogram
heyde’s sydnrome
triad of aortic stenosis, an acquired von Willebrand disease and anaemia due to angiodysplasia
monitoring for statins
lfrs at baseline, at 3 months and 12 months
ecg change in hypercalcaemia
shortening of the QT interval
