Revision Powerpoint Cardio Flashcards
general rules for endocarditis antibiotics?
needs high dose (IV)
long course (4-6 weeks)
bactericidal
synergistic effect of combination
what organisms cause native valve endocarditis?
staph aureus (most common)
strep viridans
enterococcus
staph epidermidis
what organisms cause endocarditis in IV drug users?
staph aureus
what organisms cause prosthetic valve endocarditis?
staph epidermidis
staph aureus
endocarditis after dentist?
strep viridans
endocarditis after line insertion?
staph epidermidis
treatment for prosthetic valve endocarditis?
vancomycin
rifampicin
gentamicin
valve replacement usually needed
normal P wave?
0.0-0.1 secs
normal QRS?
<0.1
PR interval?
AV node delay
0.12-0.2 secs
QT interval?
diastole
0.36-0.44 secs)
where is angiotensinogen produced?
liver
where is renin produced?
kidney
where is ACE produced?
lung surface
how do thiazide diuretics work?
reduce blood volume by increasing Na, Cl and H2O excretion
side effects of thiazide diuretics?
hypokalaemia
electrolyte disturbance
how do beta blockers work?
reduce sympathetic activity, reducing CO, reducing renin release from kidney
beta blocker side effects?
cold peripheries
asthma
fatigue
how do CCBs work?
block L type calcium channels, reducing Ca2+ entry into vascular smooth muscle, reducing contraction
side effects of CCBs?
ankle oedema
how do alpha blockers work?
block alpha 1 adrenoceptors causing vasodilation
reduces sympathetic transmission
side effects of alpha blockers?
dizziness
confusion
what is stage 1 hypertension?
BP > 14/90 in clinic
OR
ABPM average of 135/85
what is stage 2 hypertension?
clinic BP > 160/100
OR
ABPM average >150/95
causes of left sided heart failure?
ischaemid heart disease
cardiomyopathy
valvular disease
symptoms of left sided heart failure
dyspnoea on exertion/rest
orthopnoea
paroxysmal nocturnal dyspnoea
pink frothy sputum
signs of left heart failure?
tachycardia
fine crepatations
pleural effusion
S3 (gallop rhythm - S3 + tachycardia)
heart failure on CXR?
cardiomegaly
bat wing shadows (esp. lower zones)
interstitial fluid
right heart failure is usually 2ndary to left, true or false?
true
what can cause primary right heart failure?
cor pulmonale
congenital heart disease
symptoms of right heart failure?
body oedema
signs of right heart failure?
oedema elevated JVP hepatomegaly ascites CXR
when are thiazide diuretics used for heart failure?
mild CCF only
loop diuretics more commonly used (furosemide)
what is the main side effect of furosemide and how is this counteracted?
hypokalaemia coincidental drugs (ACE and spironolactone) help retain and normalise K
what drugs are used in heart failure?
diuretics spironolactone ACE inhibitors Beta blockers Ivabradine Digoxin
what are the initial risks of Beta blockers in HF?
hypotension
worsening dyspnoea
what kind of drug is spironolactone?
aldosterone receptor antagonist
side effects of spironolactone?
hyperkalaemia
renal dysfunction
gynaecomastia
what does ivabradine do and when is it used for HF?
slows HR
only used if HR fast despite B blockers
what is the sign of digoxin poisoning?
yellow vision
signs of patent foramen ovale?
machine like murmur
how is a patent foramen ovale diagnosed and treated?
ECHO, Doppler US
treated with surgery
signs of patent ductus arteriosus?
laboured breathing
how is a PDA treated?
NSAIDs
signs of persistant pulmonary hypertension of the newborn?
sick at birth or in hrs following cyanosis tachycardia low blood sats on high flow O2 pre and post ductal saturations
how is persistent pulmonary hypertension of the newborn treated?
nitric oxide
what are the signs of duct dependant circulation (DDC-also known as patent ductus arteriosus)?
present at 3-5 days
suddenly pale, tachypnoeic and distressed
how is DDC treated?
IVPGE2
prostaglandin E2 - keeps duct open until surgery as baby is dependant on open duct
what is the main use for antiplatelets?
arterial thrombosis
how does aspirin work?
irreversibly blocks COX in platelets preventing TXA2 synthesis
also blocks COX in endothelial cells inhibiting production of antithrombotic prostaglandin I2
side effect of aspirin?
GI bleeding
ulceration
how does clopidogrel work?
links to P2Y12 receptor via disulphide bridge producing irreversible inhibition
(usually used when aspirin allergic or alongside aspirin)
how does tirofiban work?
binds to factor IIb/IIIa
prevents MI in high risk unstable angina
what are anticoagulants mainly used for?
venous thrombosis
how does warfarin work?
inhibits Vit K reductase preventing conversion of epoxide to active hydroquinone
inactivates factors II, Vii, IX and X
how does rivaroxiban work?
direct thrombin inhibitor
factor Xa inhibitor
how does LMWH work?
inhibits Xa
not thrombin IIa
4 Hs and 4 Ts of reversible causes of cardiac arrest?
Hypothermia Hyperkalaemia/hypokalaemia Hypovolaemia Hypoxia Tamponade Tension pneumothorax Thromboembolism Toxin
saddle shaped ST elevation?
pericarditis
continuous machine like murmur?
PDA
diminished or absent lower limb pulses?
coarctation of aorta
radio-femoral delay?
coarctation of aorta
slow rising pulse?
aortic stenosis
collapsing pulse?
aortic regurgitation
JVP rising on inspiration?
cardiac tamponade or constrictive pericarditis
tapping apex beat, loud S1?
mitral stenosis
drug causing gout?
thiazide diuretics
