questions i got wrong Flashcards
what is a pericardial knock and what is it indicative of?
- commonly caused by constrictive pericarditis
- high pitched sound made by heart during early diastole
murmurs on which side of the heart get louder on expiration
- left side + vice versa
which murmurs are louder with valsalva manouvre?
HOCM + mitral valve regurg
acute management for a patient in AF who is haemodynamically unstable
DC cardioversion
ECG changes in pericarditis
- PR depression
- saddle ST elevation
management of VT with pulse
- amiodarone 300mg IV over 20-60 mins
- 900mg over 24 hours
management SVT in stable patients with a regular rhythm
- vagal manouvres
- IV adenosine 6mg
rheumatic fever management
- oral benzylpenicillin
- NSAIDs
management of STEMI if PCI not available within 2 hours
- fibrinolysis - with tPA
- give a heparin at same time
management of patient if ECG still shows ST-elevation 90 mins after fibrinolysis
PCI - persisting ischaemia on ECG following fibrinolysis demonstrates failure of intervention
what cha2ds2-vasc score indicates anticoagulation?
1 - men
2 - women
what do each of the letters mean in cha2ds2vasc
c - congestive heart failure
h - hypertension
a2 - age>75 =2, age>65 = 1
d - diabetes
s2- stroke, TIA, thromboembolism
v - vascular disease
s - sex (female)
features of aortic regurgitation
- early diastolic murmur
- intensity increased by handgrip manoeuvre
- intensity increased with exhalation
- widened pulse pressure
management 3 vessel disease
CABG
management type A and B aortic dissection
type A - surgery
type B - conservative + bed rest - reduce blood pressure with IV labetalol
signs aortic stenosis
narrow pulse pressure
ejection systolic murmur - transmitted to carotids
soft s2
ejection click
ecg findings aortic stenosis
increased QRS
LAD
LBBB
poor R wave progression
definition severe aortic stenosis
- peak gradient > 40 mmHg
- aortic jet velocity >4m/s
when to give SAVR vs TAVI in aortic stenosis
SAVR = surgical aortic valve replacement - if patient low risk and <75
TAVI = trans-catheter aortic valve implantation - if patient has co-morbidities, >75
causes LAD
shortness
obesity
inferior MI
LBBB
causes RAD
tall + lean
PE
RBBB
features aortic regurg
early diastolic murmur, best heard on exhalation
wide pulse pressure
head bobbing (de musset’s sign)
nailbed pulsation
collapsing pulse
features left ventricular free wall rupture post-MI
- acute heart failure secondary to cardiac tamponade-raised JVP
- pulsus paradoxus (drop in blood pressure >10mmHg on inspiration)
- diminished heart sounds
features left ventricular aneurysm post-MI
- persistent ST elevation
- risk of thrombus, must be anti-coagulated
features ventricular septal defect
acute heart failure + pan-systolic murmur
features acute mitral regurg post-MI
- due to ischaemia of papillary muscle
- hypotension and pulmonary oedema
- pan-systolic murmur
acceptable blood changes after commencing ACE-inhibitor
<30% increase in creatinine
<25% decrease in eGFR
- don’t modify dose, recheck levels in 1-2 weeks
which hypertensive medication causes ototoxicity
loop diuretics
‘non-shockable’ rhythms
asystole/pulseless-electrical activity (asystole/PEA)
target INR for patient with aortic metallic heart valve
INR 3.0
target INR for patient with mitral metallic valve
3.5
ECG findings posterior MI
V1-V3
Reciprocal changes of STEMI are typically seen:
horizontal ST depression
tall, broad R waves
upright T waves
dominant R wave in V2
Posterior infarction is confirmed by ST elevation and Q waves in posterior leads (V7-9)
medication to avoid in ventricular tachycardia
verapamil
