Cardio/Resp/Cardiothoracic/AMIA/Vascular Flashcards
What are the features of the different types of heart block?
1st degree - prolonged PR interval that stays constant
2nd degree Type 1 - prolonged PR interval which increases until there is a dropped beat
2nd degree Type 2 - prolonged PR interval that remains constant and there are dropped beats
3rd degree - no relationship between P and QRS waves
What is INR and what does it measure?
International Normalised Ratio - it is a ratio of the patients prothrombrin time to a control samples prothrombin time
- Used to assess the pathway of coagulation and determine how well the blood is clotting
- Also used to monitor warfarin dosage
What is the target range for INR value in a patient on warfarin?
2-3
What can be the reasons for a raised INR (i.e. an increased prothrombin time)?
Vitamin K deficiency
Warfarin therapy
Malabsorption
In what patient group is a higher INR desirable?
Patients who have a mechanical heart valve
What is an ICD and what is it used for?
Implantable Cardiac Defibrilator
ICD’s are used to prevent sudden cardiac death in patients at risk of developing ventricular fibrilation
What is the general rule about syncope/blackouts and notifying the DVLA?
Vasovagal syncope with reliable prodrome = no driving restrictions
Syncope/TLOC with likely cardiovascular origin = License revoked for 6 months
Signs indicating likely cardiovascular origin:
- Abnormal ECG
- Evidence of structural heart disease
- Greater than 1 episode within 6 months
What medication can cause INR values to be raised and why does it happen?
Clarithromycin
It inhibits cytochrome P450 enzyme in the Liver and this causes warfarin metabolism to decrease and therefore the INR value to increase
If INR becomes very high, how can this be treated?
Give Vitamin K IM 20mg
If a patient has a bleed due to increased warfarin levels, what should the patient be given?
Vitamin K
Clotting factors
FFP
What are the different classes of antibiotics and give a few examples of each?
B-lactams - penicilins & cephalosporins
Glycopeptides (Gram +ve - Vancomycin
Aminoglycosides (Gram -ve) - Gentamicin
Macrolides (Gram +ve) - Erythromycin, Clarithromycin
What supplements need to be given to patients on loop diuretics and why?
Potassium supplements
Loop diuretics work by increasing the secretion of potassium (this draws water out of the body)
What is syncope and what are the different categories of disease that can cause syncope?
Syncope = transient loss of consciousness resulting in fainting
Vasovagal - neurologically induced drop of blood pressure usually preceded with an aura (sweating, seeing stars or ringing in ears)
Cardiac - Arrythmias, aortic stenosis & mitral stenosis, sick sinus syndrome
Blood pressure - postural hypotension
Metabolic - DKA, Hyper/hypokalaemia, Hyponatraemia
Neurological - Epilepsy or stroke
Respiratory - Massive PE
What does an ECG show in a patient with a PE?
S1 Q3 T3
S1 - Large s wave in lead I
Q3 - Q wave in lead III
T3 - Inverted T wave in lead III
What are the initial steps that you must take when assessing a patient who has suffered a syncope event?
ABCD
A - Airway (Is the patient speaking to you? If yes, then airway is clear. If patient not talking then look, listen and feel)
B - Breathing (Look, listen and feel for breathing - assess for 10 seconds)
C - Circulation (assess carotid pulse when checking for B)
D - Disability (Conscious level of patient and serious injuries)
