6/5 Flashcards
What is Dressler’s syndrome?
Post-ACS pericarditis - 2-6wks after the event
Chest pain and fever
Management of STEMI
MONAT AND ANTI-EMETIC
IV morphine
Oxygen
Nitrates - GTN spray
Aspirin - 300mg PO + tricagerlor
Explain the differences in management pre and post 12hrs since onset in STEMI
<12hrs since onset
<2hrs to PCI - angiograph + PCI
>2hrs to PCI - thrombolysis with alteplase etc.
Management of NSTEMI
- MONA+T and ANTI-EMETIC
+ - Anti-thrombin e.g. LWMH/fondaparinux
If high risk - angiogram in <96hrs of symptom onset
Complications post MI
How can you tell the difference between rupture of papillary muscles/free wall and septal wall
DREAD
Death
Rupture of papillary muscles + septal wall
Embolism/ oEdema (= heart failure)
Anersym and arrythmias
Dressler’s syndrome
Papillary muscles/free wall = tamponade like picture - lots of bleeding into the pericardium
Septal wall = pansystolic murmur and clear heart soudns
What is a normal ejection fraction?
60-65%
What is high output HF?
What are the causes?
HF caused by the heart working very fast but not getting adequate oxygen to the tissues
Causes - AAPPTT
Anaemia (most common cause - always manage anaemia in HF)
Arteriovenous malformation
Pregnancy
Paget’s disease
Thyrotoxicosis
Thiamine deficency
Management of narrow complex tachycardia
- Regular or irregular?
Regular
- vagal manouevers
- adenosine up to 30mg
- if not fixed - get expert help
Irregular (likely AF)
- b-blockers OR dilitazem (if can’t have b-blockers) to control rate
- if heart failure ~amiodarone/digoxin
How can you reverse a B-blocker OD (would cause bradycardia)
IV glucagon
How does digoxin work?
Blocks the AV node and reduces HR
What are the vagal maoeuvers?
Put syringe in someones mouth and ask to blow
In infective endocarditis, what valve is most commonly affected in:
- PWID
- everyone else
PWID = tricuspid valve
Everyone else = mitral valve
