Pathology Flashcards
(187 cards)
1
Q
Familial hypercholestrolaemia
A
**Autosomal dominant condition
Increased LDL In the blood, leading to cardiovascular disease
Due to:
- Faulty LDL receptor and so LDL can’t enter cell form the blood
- Faulty Apo B-100 (name badge) - LDL cells can’t interact with the receptor, increasing in the blood
- Increased PCSK9 function - Destroys LDL receptors, LDL increases in the blood
- Leads to atherosclerosis
2
Q
Dysbetalipoproteinaemia
A
- Genetic defect leading to an increase in APO B containing lipoproteins
Cx - mutation in APO E gene
- Triggered by diabetes, hypothyroidism, obesity
Sx- Increased triglycerides and LDL, lipid deposits on skin, premature cardiovascular disease
3
Q
Familial chylomicronaeima
A
- Too many chylomicrons in the blood leading to pancreatitis
- Chylomicrons take fat from food
- Due to deficiency in lipoprotein lipase enzyme which normally promotes uptake of chylomicrons in cells, leading to increased triglyceride levels
4
Q
Hypocoagulation
A
- Reduced ability to clot (turn blood to gel)
Cx - thrombocytopenia, vonwilebrand disease, deficient in vitamin K, deficient in clotting factors
5
Q
Tricuspid regurgitation
A
Cx - rheumatic heart disease, right ventricular failure, pulmonary hypertension (COPD)
Sx - pulsatile hepatomegaly -back flow of blood into liver during cardiac cycle
Ix - pan systolic murmur
-
6
Q
Idiopathic intracranial hypetension
A
- Obese pregnant females
Sx - Papillodema and abducens nerve palsy
7
Q
Major bleeding
A
- Stop warfarin, give IV vit K 5mg, prothrombin complex concentrate
8
Q
V Fibb
A
- If witness arrest give 3 shock then 2 mins CPR
*If not witness, give 1 shock then CPR
9
Q
Dabigatran antidote
A
- Idirucizumab
10
Q
Normal INR range vs warfarin INR
A
<1.1 for healthy people
- Taking warfarin between 2-3
** If INR is high, skip 1/2 doses, then reduce warfarin dose
11
Q
Hypertension
A
*If <55 or T2DM
ACEorARB
ACE or ARB+CCB or ACE or ARB+thiazide like diuretic
ACE or ARB+CCB+thiazide like diuretic
If >55 and non T2DM or black
CCB
CCB+ACE or CCB+thiazide like diuretic
CCB, ACE, thiazide like diuretic
If K <4.5 - spironolactone
If K >4.5 - Beta blocker or alpha blocker
12
Q
Bleeding protocol
A
Minor bleeding with warfarin
- stop warfarin, give 3mg vitamin K
Major bleeding
- stop warfarin, give 5mg vitamin K, give prothrombin concentrate
13
Q
When do you give DC cardio version
A
- given ups to 3 shocks
- Altered consciousness, hypotension, heart failure, myocardial ischaemia
14
Q
Hypertension cut off
A
- 180/120 - same day treatment
Ix - 24 ambulatory monitory to aid diagnosis
- if >180/120 - urine dip for end organ damage first line
Mx -
15
Q
Constrictive pericarditis
A
- Kassumauls sign - JVP saying fixed on inspiration
- Favours constrictive pericarditis over cardiac tamponade
16
Q
Cardiorenal syndrome
A
- Wehn cardiac output drops due to poor renal function
Sx - fluid overload
Mx - IV loop diuretics - furosemide
17
Q
1st line Investigation for cardiovascular disease severity
A
*Contrast enhanced CT coronary angiogram 1st line
18
Q
LBBB
A
- Almost always pathological
Ix - W sign
Mx - PCI
19
Q
CHA2 DS2 VSC
A
- Need for anti coagulation in AF
Congestive HF - 1
Hypertension (can be treated) - 1
Age >75 - 2
Age > 65 - 1
Diabetes -1
Prior stroke, TIA or thrombosis - 2
Vascular disease -1
Sex - 1
Mx
score of 1 - consider anticoagulation in males
Score of 2 or more - offer anticoagulation
20
Q
What is pernicious anaemia
A
- Auto immune condition affection stomach, B12 can’t bind to intrinsic factor (allowing B12 to be absorbed) and parietal cells affected ***
21
Q
Sx of pernicious
A
- Tired all the time, confused, pins and needles often in feet
- neurological sx***
22
Q
Ix for pernicious anaemia
A
- Anti intrinsic factor (IFA) - most specific
- Anti parietal cell antibodies (PCA)
- microcytic anaemia
23
Q
Mx of pernicious anaemia
A
- Intramuscular B12 and oral B12
24
Q
What is the most common spot for abdominal aortic aneurysm
A
- Swelling in aorta running to stomach and and chest, usually just before bifurcation at L4 - loss of elastic fibres in tunica media
Rupture - extreme central abdominal pain, massive internal bleeding, 80% don’t survive
25
Sx of AAA
- severe, central abdominal pain radiating to the back
- Pulsatile, expansile mass in the abdomen
- Signs of shocked (hypotension, tachycardic)
- Collapse
26
Ix and Mx for AAA
Ix - CTA 1st line
- Screening offered to all men aged >65 - US
Mx - surgery for grafting
27
Cx of dissecting aortic aneurysm
* Most common in thoracic aorta
- Wall of the aorta (tunica intima) splits into 2 layers creating a cavity
- More common in men in 60s
Cx - hypertension, atherosclerosis, Marfan syndorme, aneurysms
28
Sx of dissecting aortic aneurysm
- Severe tearing chest pain, radiating to the back, - maximal onset
- Sweating
- Weak or absent carotid, brachial or femoral pulse
- Variation in systolic BP in both arms
- Aortic regurgitation
29
Ix and Mx of dissecting aortic aneurysm
Ix - CT thoracic aorta 1st line
- CXR, ECG, FBC, BP of both arms
Mx - Ascending - labetalol and surgery (aortic root replacement) (if murmur = AR)
- aortic root replacement as surg
Mx - Descending - lebatalol - non surgery unless complications
30
Sx of stable angina
-*Chest pain caused by artery stenosis
* Stable - brought on during exercise
* Unstable - brought on at rest
Sx - Chest pain that is tight or crushing and either central or left sided, shortness of breath, fatigue, sweating, dizziness
31
Ix for stable angina
- Coronary angiography 1st line
32
Prophylaxis for stable and unstable angina
**BB OR CCB 1st line to prevent attacks**
- If mono therapy use - rate liming CCB - verapamil or diltiazem
- If in combination with beta blocker - longer acting - amlodipine
If cannot tolerate addition of one of 2nd drug - give instead
- long-acting nitrate
- ivabradine
- nicorandil
* Patients can build up tolerance to standard release isosorbide mononitrate
33
Verapamil and beta blockers risk in combination
* CI due to risk of heart block
34
Mx of nitrate tolerance
* Only tolerance with standard release isosorbide nitrate*
Mx - give asymmetric dosing interval - 10-14hrs
- Switch to modified release
35
Unstable angina
Ix - Troponin and ECG 1st line
- angio, echo
* Sx of ACS, troponins normal, ECG normal or ST depression or T wave inversion
36
Heart failure sx
* More in, less out*
- Most commonly systolic failure of the left ventricle
- Oedema, dyspnoea, fatigue, tahcycardia
37
Ix of heart failure
- Reduced LVEF - normally between 50-70% (stroke volume/end diastolic volume) - HR needs to be low enough to calculate
- ANP and BNP levels increased due to high ventricular filling pressure
- ECG and echo
38
Mx of chronic heart failure
- ACEi/ARB or entresto (valsartan)
- Beta blocker
- Spironolactone
- SGLT2i
*All used in combination*
39
Mx of acute heart failure
- IV furosemide
* Meds not working use CPAP
40
Sx of MI
- Starts off mild then gets worse (most common)
- sudden chest pain radiating from left arm to neck
- shortness of breath, sweating, nausea, vomiting, abnormal heart rhythm (DULL HEAVY CHEST PAIN)
41
Ix for MI
- Positive torponin, ST elevation in ECG, increased resp rate (pain),
- RCA MI can cause arrhythmias
*Tropnin elevated for 10 days post
* CK MB elevated for 3-4 days post
Calculate GRACE score
42
Mx of MI
- Morphine, oxygen, nitroglycerin, aspirin (MONA)
If first attender - Give aspirin, place in W position and give nitrate if prescribed
Post MI - dual platelet, ACEi, BB and statin
* Ticagrelor and prasugrel 1stline
43
RF for infective endocarditis
RF - valve replacement surgery, a prosthetic valve, congenital heart disease, hypertrophic cardio myopathy, previous damaged valves, IV drug user, nipple piercing
44
Most common bacteria cx Infective endocarditis
* Infection in the inner lining of the heart (endocardium) caused by bacteria travelling in the blood
- Strep viridisans by mouth most common (strep sanguinis)
- Staph aureus from Injections.
45
Sx of infective endocarditis
- High temperature, chills, headache, joint and muscle pain, possible chest pain when you breathe, SOB, night sweats...
46
Ix of infective endocarditis
**DUKE CRITERIA
- TTE 1st line , TOE preffered as 1st line if available
- Blood cultured x3 , ESR, CRP
- ECG, ultrasound for spleen
- splinter haemorrhages (association)
47
Mx of infective endocarditis
- IV antibiotics
- surgery to repair valves of heart if affected
48
Damaged heart valves due to endocarditis increase risk of...
STROKE
49
Cx of Pericarditis/Dressler's syndrome
- Swelling and irritation of the pericardium that surrounds the heart (pericarditis) - can be viral (few weeks post upper resp infection)
- 2 weeks to few months after MI = Dressler's syndrome
50
Sx of pericarditis
- Sharp or stabbing chest pain, a cough, fatigue, shortness of breath, cardiac tamponade , fever
- Spreads to left shoulder, gets worse when lying down, coughing or breathing in, alleviated when sitting forward
51
Ix of pericarditis
- Bloods: Bacteria cultured, ESR and CRP, troponin
- ECG - widespread saddle shaped ST elevation, PR depression
- Transthoracic echo given to all
52
Mx of pericarditis
- NSAIDs and colchicine 1st line
- antibiotics if caused by bacteria
53
Constricitve pericarditis sign
In constrictive pericarditis, JVP can rise on inspiration **Kassumals sign**
54
RF for pericarditis
SLE
55
Cx of HOCM
- Post MI, infection, injury, heart valve problems, high BNP
- Septum between ventricles can become thick, preventing the blood from exiting the heart - Obstructive cardio myopathy
* Autosomal dominant*
56
Clinical signs and complications of HOCM
- Asymptomatic, angina, fainting, sudden death, SOB
- ejection systolic murmur heard loudest after valsalva Manoeurvre
* Complications - Sudden death due to arrhythmia , HF, mitral valve problems, blocked BF, atrial fibrillation
57
Diagnosis of HOCM
- Transthoracic echo (TTE) diagnostic
58
Mx of HOCM
- BB 1st line meds
- implantable cardiodefib - most die of V arrhythmias
59
Cx of Cor pulmonale
*Right sided HF caused by respiratory disease
- COPD, PE, interstitial lung disease, cystic fibrosis, pulmonary hypertension
60
Sx of Cor pulmonale
- Main is SOB, peripheral oedema, syncope, cyanosis, raised JVP, hepatomegaly
**Treat as HF**
61
Bioprosthetic valves
Lifespan and medication
* Scar right down the midline of chest indicates a mitral or aortic valve replacement (also a CABG)
Bioprosthetic - limited lifespan of around 10 years
- low dose aspirin long term
62
Mechanical valve
lifespan and medication
Mechanical - long lifespan of >20 years but require lifelong anticoagulation with warfarin
complications - thrombus, infective endocarditis, haemolytic (blood gets churned up in valve)
63
INR targets for mechanical valves
Aortic and mitral
Aortic - 3.0 target
Mitral 3.5 target
64
Cx of Rheumatic fever and heart disease
- Inflammatory disease that can develop when strep throat or scarlet fever isn't properly managed - molecular mimicry of bacterial M protein from strep pyrogens
- most often in kids
- often effects connective tissues
- most often with mitral valve***
65
Sx of rheumatic heart disease
- Fever, painful, hot joints, chest pain, chorea, erythema margintum, murmur, SOB
* Strep throat will have been diagnosed 2-4 weeks prior to symptoms
66
Ix of rheumatic heart disease
- Bloods: CRP and ESR
- ECG and echo - showing vegitations/scarring of valve
67
Mx of rheumatic heart disease
- Antibiotics (usually penicillin for strep), anti inflammatory drugs,
- IM or oral Pen V
68
Valve most commonly affected with rheumatic heart disease
Mitral valve
69
vasovagal attack cx
*Most common cause of fainting usually In older adults
Mechanism - reduced contractility, reduced HR, reduced CO, peripheral vasodilation and venous pooling
70
Vasovagal sx
- Nausea, dizziness, pale skin, sweating, tinnitus, lightheaded (all prior to fainting)
71
Ix for vasovagal attack
- ECG, echo, stress test, bloods,
72
Mx of vasovagal attack
- unnecessary unless repeat event
73
What Cx Cardiac tamponade
* Trauma, infections, inflammation
- Pericardial fluid accumulation, heart put under pressure, preventing heart pumping
- Reversible cause of cardiac arrest (T)
** 7 days post MI complication
74
Sx of cardiac tamponade
- Becks triad: Hypotension, increased JVP, muffled heart sounds
- SOB, tachy, pulses paradoxus
** 7 days post MI
75
Ix for cardiac tamponade
- Echo 1st line
76
Mx of cardiac tamponade
- Pericardial needle aspiration (pericardiocentesis)
77
Cx of Malignant hyperthermia
*Dominant inheritance*
- Analgesia reaction - Suxamethonium and halothane- releases lots of calcium
78
Sx of malignant hyperthermia
- muscle rigidity, high bp, high HR,
79
Ix of malignant hyperthermia
- CK raised
80
Mx of malignant hyperthermia
- Dantrolene
81
What is Takayasu's arteritis
- Large vessels vasculitis associated with occlusion of the aorta
- Usually younger females and asians
82
Sx of takayasu's arteritis
- Systemic features, absent limb pulse, different BP in upper limbs, aortic regurgitation, bruits, pulseless
83
Ix for takayasu's arteritis
- Bloods - CRP and ESR raised, FBC
- MRA 1st line
- CTA if MRA CI
84
Mx of takayasu's arteritis
- Oral prednisolone 1st line
85
What is an Atrial myxoma
* Most common cardiac tumour of fossa ovalis
86
Sx of atrial myxoma
- Mitral valve obstruction, systemic embolism, AF
- Systemic symptoms - weightloss, sweats, SOB
- Mid diastolic murmur
87
Ix for atrial myxoma
Echo - pendunctulated heterogenous mass usually in septal area of LA
88
Most common area for a Atrial myxoma to occur
- Left atrium attached to fossa ovalis
- Usually females
89
Sx of a PE
- Sudden onset SOB, chest pain, calf pain, swollen calf
- Atypcial sx - lung crackles, fever...
90
RF for a PE
- Period of inactivity, surgery, combined pill, malignancy, steroids, pregnancy, high BMI, cancer treatment, varicose veins
91
Ix for a PE
- CTPA 1st line
- If not showing up, proximal venous US
- CXR to exclude other pathology
ECG - S1Q3T3 (20%)
- Usually sinus tachycardia
92
Well's Score cut off
Wells>4 - PE likely
93
Mx of a PE
- Apixaban or rivoroxban 1st line
- If DOAC not tolerated give heparin
**If massive PE and hypotension - Thrombolysis
**If repeat PE - IVC filter consideration
94
How long should a PE/DVT be treated for if provoked and unprovoked
- 3 months if provoked
- 6 months if unprovoked
95
DVT Ix
- 2 level DVT well's score
- Proximal leg vein US 1st line
- D dimer
96
DVT Mx
- Apixaban or rivoroxaban 1st line
- LMWH 2nd
97
2 level DVT Well's score criteria
Score 2 or more - DVT likely
Score of <2 - DVT unlikely
98
What is Takosubo cardiomyopathy
- Transient apical ballooning in times of stress
- Chest sx in periods of stress
- Broken heart syndrome
99
Sx of takosubo cardiomyopathy
- SOB, chest pain, dizzy, features of HF...
100
Ix of takosubo cardiomyopathy
- ECG showing ST elevation
- Troponin raised
- Angiogram - normal
101
Mx of takosubo cardiomyopathy
Supportive treatment
102
Post MI complications
* Cardiogenic shock - LV wall can be damaged and reduced ejection fraction
* Cardiac arrest - usually due to V Fibb
* Chronic HF - Damage to LV
* Tachy and Brady - V fibb (most common) and V tach plus AV block if inferior MI
* Pericarditis and Dressler's syndrome - 2 hours weeks post MI or 2-6 weeks is Dressler's
*LV aneurysm - Damage to LV can weakened wall causing aneurysm - present with persistent ST elevation and LVF - at risk of thrombus so anti coagulated - 4 weeks post
* LV free wall rupture - 3% - Presents with acute HF 2nd to cardiac tamponade 1 week post - urgent pericardiocentesis and Thoracotomy
* Ventricular septal defect - Rupture of ventricular septum showing acute HF, pan systolic murmur
* Mitral regurgitation - Inferior-posterior MI - rupture of papillary muscle
103
What is Cardiogenic shock and Cx
- Heart isn't able to pump blood adequately
Cx - HF and MI
104
What is hypovolaemic shock and Cx
- Not enough circulating blood volume to maintain perfusion
Cx - Dehydration, burns, haemorrhage
105
What is obstructive shock and Cx
Physical blockage of blood flow from the heart
Cx - PE, tamponade, tension pneumothorax - compressing vessels
106
What are 3 types of distributive shock
Anaphylaxis - vasodilation and airway narrowing
Neurogenic - damage to spinal cord or brainstem interrupts signals causing widespread vasodilation (warm peripheries)
Septic - widespread infection causing vasodilation and low BP
107
Cx of myocarditis
**Viral infections**
- upper resp most likely
- GI
108
Sx of myocarditis
- Chest pain and pericarditis, fatigue, SOB, palpitations, tachycardia, collapse
- Signs of heart failure - oedema, JVP, SOB, pericardial friction rub
109
Ix of myocarditis
Bloods - CRP and ESR raised, WCC raised, Troponins and CK raised**
ECG - Pericarditis - ST elevation
Viral screen - cocksakies B, HIV, Hep...
Echo - exclude other pathologies
110
Mx of myocarditis
Supportive
111
What is Arryhtmogenic R ventricular cardiomyopathy
- Inherited cardiovascular disease that usually leads to syncope or sudden cardiac death
- RV myocardium replaced with fatty tissue
*Autosomal dominant*
112
Sx of Arryhtmogenic R ventricular cardiomyopathy
- SOB, Chest pain, palpitations, syncope
- VT episodes
- HF sx
**Sx brought on by exercise**
113
Ix of Arryhtmogenic R ventricular cardiomyopathy
ECG
Echo - enlarged RV and thin wall
MRI - fatty tissue
114
Mx of Arryhtmogenic R ventricular cardiomyopathy
- BB 1st line
- ICD, ablation...
115
Cx of Mitral stenosis
- Rheumatic heart disease (Most common), infective endocarditis, calcification,
116
Sx of Mitral stenosis
- Malar flush and AF
- mid diastolic, low pitched rumbling murmur, loud S1 and opening snap - loudest during expiration
117
Ix for Mitral stenosis
- TTE
118
Complications of mitral stenosis
- Can lead to LA hypertrophy which can compress the oesophagus and cause poor swallow
119
Cx of Mitral regurgitation
Weakening of the valve with age, rheumatic heart disease, infective endocarditis, CT tissue disorders such as Marfan's syndrome
120
Sx for mitral regurgitation
- Asymptomatic, Sx of HF
- Pan/holosystolic high pitched whistling murmur, quiet S1 - loudest with expiration
* AF
121
Ix for mitral regurgitation
- TTE
122
Cx of Aortic stenosis
Cx - Age related calcification, rheumatic heart disease, infective endocarditis
- Leads to left ventricular hypertrophy
123
Sx of aortic stenosis
- Ejection systolic high pitched murmur with a crescendo - decrescendo character
- Loudest with expiration and sitting forward
- Radiates to carotids
124
Ix for aortic stenosis
ECG - Large QRS
TTE
125
Mx of aortic stenosis
- Valve replacement
- TAVI if too frail^
126
Cx of aortic regurgitation
- Age related weakness, CT tissue disorders such as Marfan's syndrome, rheumatic heart disease, endocarditis
- Causes left ventricular dilation
Ix - Early diastolic soft/blowing murmur
- decrescendo
- collapsing pulse
* Can be heard over mitral area
127
Sx of aortic regurgitation
- Early diastolic soft/blowing murmur, loudest with expiration
- decrescendo
- collapsing pulse
128
Ix for aortic regurgitation
- TTE
129
Mx of aortic regurgitation
- Valve replacement
130
Sx of AF
- Shortness of breath, palpations, syncope
- Irregularly irregular pulse
131
Ix for AF
ECG - absence of P waves
TTE - structural defects
132
Mx of AF
- CHADSVASC SCORE
- DOAC 1st line
- If <48hrs - Beta blocker 1st line rate control - then CCB or digoxin
- If >48hrs - 3 weeks anticoagulation and rate control then shock
- Ablation if not responding or wanting to avoid drugs
133
Mx of unstable AF patient
- Cardioversion
134
Cx of Atrial flutter
Prior cardiac surgery or prior ablation or heart disease
135
Ix for atrial flutter
ECG - sawtooth baseline
136
Mx of atrial flutter
- CCB, beta blocker, digoxin
- electrical cardio version (if unstable)
137
Cx of tricuspid regurgitation
- Rheumatic heart disease, endocarditis, right ventricular failure *pulmonary hypertension (COPD)
138
Sx of tricuspid regurgitation
- Pulsatile hepatomegaly, LV heave, pan systolic murmur - loudest during inspiration
139
Ix of tricuspid regurgitation
TTE
140
What is the definition of SVT
*Narrow complex tachycardia (QRS less than 3 small squares/120ms)
*Shockable
*no p wave
141
Sx of SVT
- Recurrent episodes of palpitations (95%)
- Dizziness (75%)
- Dyspnoea
- Chest pain or tightness
- Progressive fatigue
* Episodes tend to last 10-15minutes*
*Syncope very uncommon*
142
Ix for SVT
ECG - narrow complex tachycardia - <3 small squares
Echo - congenital defects
143
Preventative Mx of SVT
BB or CCB 1st line
Radio ablation definitive 1st line
144
Acute Mx of SVT
Stable
- vagal manœuvres (carotid massage - CI if disease, valsalva), cold stimulus
- IV adenosine 6mg, then 12mg, then 18mg, (if asthmatic give verapamil)
Unstable
- DC cardio version - if unstable
145
What is VT
* Broad complex tachycardia, greater than 3 small squares - potential to become V fibb
*Shockable
Sx - SOB, palpitations, fainting, sweating
Mx - If unstable (systolic <90, chest pain, HF) DC cardio version
- if stable give amiodarone
**If amiodarone not available, lidocaine can be used
146
Sx of VT
- Chest pain, SOB, syncope
- Instability
- weak or rapid pulse
- clammy...
147
Ix of VT
Bloods - K and Mg, elevated troponin
ECG - Broad QRS, more than 3 small squares
Echo
148
Mx of VT
Stable
- Amiodarone 150mg 1st line
- Lidocaine can also be used
*If unsuccessful, DC cardio version can be given
Unstable
- DC cardio version followed by 300mg amiodarone
149
Acute Mx of STEMI
STEMI identified and symptoms present for less than 12 hrs
1st - 300mg Aspirin
If PCI available within 2 hrs -
- Prior to PCI - Dual platelet, if not on Anti coagulant - give praugrel, if on anticoagulant give clopidogrel - During PCI - Unfraxtioned heparin with glycoprotein IIbi
- Drug eluting stents used
If PCI unavailable within 2 hrs - Fibrinolysis - Give an antithrombin at the same time - repeat ECG in 60-90 min then urgent PCI if not resolved
- post procedure give ticagrelor
* For ongoing ischaemia, consider PCI
150
Acute Mx of NSTEMI
- Morphine, oxygen, nitrate, aspirin 300mg - initial
*Base PCI and angioplasty on grace score, aspirin 300mg, ticagrelor or clopidogrel (low risk or high risk of bleeding respectively) 180mg, morphine, antithrombin with fondaparinux, nitrate
*Grace score>3% offer coronary angiography within 72hrs
151
Ix for NSTEMI
- ECG - normal or ST depression or T wave inversion
- Echo and angio
Bloods
- Troponins will be raised - up to 10 days
- CK MB - remains elevated for 3-4 days post MI
152
Mx of STEMI - PCI available within 2 hrs
If PCI available within 2 hrs:
- Aspirin 300mg 1st line+ticagrelor+unfractioned heparin
- PCI
*Glycoprotein IIb/IIIa inhibitor (e.g. abciximab) can be added if high burden
153
Mx of STEMI - PCI not available within 2 hrs
If PCI unavailable within 2 hrs:
- Aspirin 300mg, ticagrelor
- Thrombolysis - tenectaplase given + enoxaprin or fondaparinux
- ECG after 90 mins - PCI if not resolved
post procedure give ticagrelor
- For ongoing ischaemia, consider PCI
154
Long term medication post STEMI
Aspirin lifelong
Clopidogrel or ticagrelor 12 months
ACE, BB, statin
155
Cx of Torsades de pointes
* V tach with long QT interval that can become v fibb
- Quinolones - ciprofolaxacin...
- Macrolides - erythromycin... causing long QT
- Amiodarone
- hypocalcaemia, hypokalaemia, hypomagnesia
156
Mx of torsadoes de pointes
IV Mg Sulphate
157
Bradycardia Mx
- Atropine 3mg, transcutaneous pacing, adrenaline, transvenous pacing
Signs of shock - 500ug IV - up to 3mg atropine
158
Mitral valve prolapse Px
- Atypical chest pain, tachy, SOB...
Axs - PKD
159
Mitral valve prolapse Ix
- Mid systolic click
160
Complications of rapid rewarming in hypothermia
- Peripheral vasodilation and shock
161
Hypothermia sx
- Altered mental status, Tachycardia, hypotonia, seizures
162
Hypothermia on ECG
J waves - notch after QRS complex
163
Postereolateral MI ECG
I, aVL, V6 - ST elevation
V1-V3 - ST depression
164
What is Buerger's Disease and Px
- Vascultitis associated with smoking in young patients
Px - Limb ischaemia, ulcers, thrombophelbitis, high pack years
165
When should statins be given during the day
Last thing in the evening
166
When is anticoagulation started after a stroke
*Aspirin daily the anticoagulation 2 weeks after
167
Critera for aortic stenosis mx
Symptomatoly of patient determines
>40 valvular gradient is cutoff otherwise
168
Statins and macrolides interaction
CI due to risk of hepatotoxicity
169
CI top CTPA
Renal impairment
*V/Q scan 1st line
170
Normal ECG variants
Bradycardia
1st degree heart block
Mobitz type 1
Junctional rhythm
171
What is Borhaeves syndrome
Full thickness rupture of the oesophagus cx by vomiting
172
Sx of borhaeves
- sudden severe chest pain, vomting subcutaneous emphysema
173
Ix for borhaves
CT with contrast
174
Mx of borheaves
Surgical emergency
175
What is a Mallory wise tear
Partial thickness tear of gastrosophaegal junction cx by vomiting or coughing
176
Sx of mallory wise tear
bright red vomting, mild chest pain
177
Ix for mallory wise tear
Endoscopy
178
Mx of mallory wise tear
conservative
179
How does an ACEi cx renal impairment
Bilateral renal artery stenosis cx significant AKI
Dilation of efferent arterioles
180
Indicationa for AVR
- LVEF <55%
- If symptomatic
- If asymptomatic but valve gradient >40 with features of
181
When is fluid challenge used
Shock, sepsis, trauma
182
Coarctation of aorta px
- high BP, notching of ribs**
- difference in limb BP
183
AAA mx
3-4.4 - anual US
4.5 - 5.5 - 3 month US
>5.5 - surgery
184
ABI cut off
<0.9 = PVD
>0.8 compression bandage
185
Side effects of amiodarone
- thyroid toxicity due to high iodine levels
186
PAD mx
- Statin
- clopidogrel (80mg)
- exercise regime
Severe PAD
Endovascular revascularisation - stent /angioplasty - <10cm lesions
Surgical revascularisation/bypass - common femoral artery or >10cm
187
Dx after a heart attack
Dual platelet - Aspirin and ticagrelor - stop T after 12 months
ACEi
BB
Statin
