Cardiology Flashcards
(38 cards)
3 Is, 4 Ps, DTU
Causes of pericarditis
Infectious - usually viral (80% are viral or idiopathic)(coxsackie, COVID), can be bacterial, fungal, TB (poorer prognosis)
Immunological - SLE, rheumatic fever, vasculitis
Idiopathic
Post MI (Dressler’s syndrome)
Post cardiac surgery
Post RTx
Paraneoplastic
Trauma
Drug induced (isoniazid, cyclosporin)
Uraemia
ECG changes in pericarditis
Widespread concave STE (esp inferior and precordial) with reciprocal STD in aVR and V1
Widespread PR depression with reciprocal PR elevation in aVR and V1
Sinus tachycardia
Spodick’s sign
Differences between ECG for BER and pericarditis
Pericarditis:
-STE widespread in limb and precordial leads (BER pre cordial only)
-no “fish-hook” J point pattern (best seen in V4 in BER)
-ST/T wave ratio >0.25 (BER <0.25)
-presence of PR depression
-normal T wave amplitude
-dynamic ECG changes that evolve over time
Differences between ECG for STEMI and pericarditis
STEMI has reciprocal changes (pericarditis reciprocal only in aVR and V1)
Only STEMI causes convex or horizontal STE
STEMI causes STE > in III than II
PR depression in multiple leads is more likely pericarditis
Diagnosis of pericarditis
At least two of:
Chest pain (retrosternal, sharp, pleuritic, can radiate to L shoulder, better with leaning forward)
Pleural rub
Pericardial effusion
ECG changes of widespread STE and PR depression (<60% of patients)
NZ Criteria for Rheumatic Fever
2 major OR 1 major and 2 minor OR several minor
AND
Evidence of recent GAS infection (2-3 weeks)
Major:
Carditis (echo/new murmur)
Chorea (can be standalone diagnostic)
Polyarthritis (or aseptic mono arthritis)
Erythema marginatum
Subcutaneous nodules
Minor:
Fever
Raised ESR/CRP
Polyarthralgia
Prolonged PR interval on ECG
What is the OR of acute rheumatic fever in Maori and Pasifika cf other ethnicities?
> 20x more likely in Maori
40x more likely in Pasifika
Describe some key features of HFpEF
-EF >50%, LV normal volume
-usually females, older adults
-LV wall is thickened/stiff
-poorer prognosis/less amenable to drugs
List some causes of high output cardiac failure
Thyrotoxicosis
Obesity
Pregnancy
Anaemia
Shunting
Vit B1 deficiency
Describe the NYHA levels of HF
Class I - no limitation
Class II - ordinary activity causes SOB
Class III - less than ordinary activity causes SOB
Class IV - SOBAR
Hx and exam in HF
Hx:
Cough
SOB
Wheeze
Collapse
Palpitations
Decreased exercise tolerance
Orthopnoea/PND
Chest pain
Lethargy
Exam:
Elevated JVP
Tachycardia
Tachypnoea
Sweaty/clammy
Hypoxia
Hepatomegaly
Gallop rhythm/abnormal rhythm
Crackles
Oedema
Cyanosis
Treatment for acute HF
Oxygen
SL nitrates
Diuretics
Morphine
B blocker
ACE inhibiter/ARB
Aspirin
Risk factors for HF
IHD
Arrythmia
Smoking
HTN
High cholesterol
Increased age
Male
FHx heart disease
Treatment for chronic HF
If overloaded start with frusemide, add thiazide if required
Start ACE-i/ARB
Start B-blocker once fluid overload settled
If insufficient add spironolactone
If insufficient add entresto
If insufficient refer cardiology
Add SGLT2 inhibitor if diabetic
Digoxin if AF + consider anticoagulation
High risk features of syncope
Age >65
ANY ECG changes (esp ST/T changes, any conduction abnormalities, any QT prolongation or shortening, delta waves, brugada syndrome, LVH, RVH, bradycardia, abnormal Q waves, arrhythmia)
Palpitations
Dyspnoea
HCT <30
Abdo pain/back pain
Headache
Chest pain
SOB
Occurred while supine or exercising
No prodrome
Heart failure/IHD/structural heart disease/new murmur
Hypotension
Evidence of haemorrhage (malena)
Male
FHx sudden cardiac death <50yo
Low risk features of syncope
Provoking factors eg emotional stress/pain medical procedure
Postural
Prodrome
Age <40
Triggered by micturation/cough/defecation
Triggered by nausea/vomiting
Only while standing
ECG changes in STEMI
STE 1mm or greater in 2 or more limb leads
STE 2mm or greater in 2 or more precordial leads
STE 0.5mm or greater in posterior leads (if sig STD in V1-3) - always check for this in inferior or lateral STEMIs
New LBBB
Sgarbossa criteria
Fibrinolysis in STEMI
Tenecteplase:
<60kg = 30mg
60-69kg = 35mg
70-79kg = 40mg
80-89kg = 45mg
90kg+ = 50mg
Clexane 30mg IV (unless >75yo)
Clexane IM 1mg/kg (max 100mg) (unless >75yo then 0.75mg/kg, max 75mg)
Clopidogrel 300mg
Contraindications to fibrinolysis in STEMI
Dementia
Uncontrolled HTN
Non-compressible bleeding
Head trauma/brain surgery <6/12
Cerebral AVM/neoplasm/aneurysm
Possible aortic dissection
Ischaemic stroke <1 year
Non-compressible vascular punctures <24 hours
GI bleeding <1 year
Other internal bleeding <1 year
CPR <3 weeks
Infective Endocarditis diagnostic criteria
Dukes criteria:
Pathological Criteria:
+ve micro culture from vegetation or histology from vegetation indicating IE
OR
2 major OR
1 major, 3 minor OR
5 minor required
Major:
2x +ve BCs at least 12 hours apart (or 1x +ve coxiella burnetii culture)
New murmur/echo shows endocarditis
Minor
Vasc phenom eg Janeways lesions, emboli
Immunological phenom eg Oslers nodes/Roths spots/GMN
Predisposition eg IVDU/prev IE
Fever >38
Micro evidence not meeting major criteria
Risk factors for IE
IVDU
Unrepaired cyanotic congenital heart disease
Immunosuppressed
Prosthetic valves
Rheumatic heart disease
Prev IE
Surgical repair congenital heart disease <6 months
Bacterial causes of IE
Staph aureus
Coxiella burnetii
Strep viridans
GAS
Enterococcus
HACEK
-haemophilus
-aggregatibacter sp
-cardiobacterium hominis
-eikenella corrodes
-kingella sp
Strep gallolyticus/bovis
Risk factors/causes myocarditis
Viral illness
Peripartum or postpartum
HIV
Autoimmune disease
Hypersensitivity reactions
Toxins
ECG changes in myocarditis
QRS prolongation (poor prognosis)
ST/T diffuse elevation
AV block
