cardiology Flashcards
learning (38 cards)
pericarditis acute includes sub/retrosternal chest pain, pt presented with coughing orthopnea and fever so the ECG changes will be
ST elevation saddle shaped
initially could be ST depression
later stages are T wave flattening and inversion, troponins will be increased later in some, NSAIDS mainstay Rx and colchicine for prevention
17 year old collapsed after swimming, after CPR brought to the hospital and he was in VF ECG showed long QT interval what’s the likely defect
slow delayed rectifier potassium channel mutation LQT1 is the most common type its gene is KCNQ1 isolated to chromosome 11. This codes for potassium gated channel KvLQT1 which is slow delayed rectifier potassium channel mutation.
ECG shows narrow regular complex tachycardia, palpitation and dizziness with HR 180bpm
supraventricular tachycardia
Rx- Adenosine - rapid acting short half life- helps by blocking AV nodal conduction temporarily its the first line Rx in stable SVT
46 yr old with palpitations and prev wolf parkinson syndrome with broad complex irregular tachycardia, HR - 180
procainamide agent of choice in atrial fibrillation with preexcitation stage
prolonged QT interval
Hypomagnesemia may cause torse de pointe , hypocalcemia also can cause long QT
bp medicine in pregnancy with asthma which is preferred
first line is oral labetalol but it is CI in asthma
Nifidipine is second option
ACI and ARB’s are CI in pregnancy
Thiazides too
first line are - labetalol and methyldopa
second line- nifidipine, hydralazine and prazosin
mechanism of action of clopidogrel
blocks ADP receptors
aspirin blocks thromboxane production
heparin potentiates antithrombin 3 action
pt faint and light headed AF is diagnosed which drug is suited
flecanide in a structurally noemal heart with no ischemia this is used alternatives are sotalol and propafenone
adenosine in SVT
amiadrone in LVH
chest pain at rest, ST depression in lateral leads and troponin elevated
Rx of NSTEMI is 2 antiplatelets like aspirin and clopidogrel, prasugrel, ticagrelor and an anticoagulant like LMWH along with a b- blocker, diltiazam and verapamil can be used if b blocker is CI. this is the mainstay treatmnt of unstable angina
69yr old came with syncope, feels hot. nausea and faints ECG is normal and is bro has epilepsy history which test to perform next
Tilt test - strapped and tilted to 70 degrees for upto 45min
BP and cardiac rythm monitored throughout pt maintains BP initially then suuden onset of syncope,then severe hypotension and brady preceeded by tachy and they resolve on coming back to supine position
A man collapsed suddenly while walking his dog for first time
ECG performed with carotid sinus massage showed 5 sec pause
carotid massage is CI in pt with carotid vascular disease
absolute CI for sinus massage are - MI
TIA ( in last 3 months)
CVA( same)
previous ventricular arrythmias
carotid artery occlusion
wolf parkinson white syndrome
short PR interval - < 0.12s
slurring of QRS complexes leading to delta wave
paroxysmal tachys and carotid sinus massage or IV adenosine can terminate this episode
wide fixed split second sound with ejection systolic murmur
atrial septal defect - doesnt change with respiration
ostrium primum septal defect - left axis deviation
ostium secondary- right axis deviation
Atrial Fibrillation
Rx - best DC cardioversion in presence of heart failure and prev structural abnormality in heart like infarct
Bisoprolol can also be used
Digoxin- preferred in heart failure with reduced ejection fraction not indicated in hemodynamically unstable or pt with normal ejection fraction or structurally defect heart comdition
Flecanaide can be used without structural heart disease or in unstable patients its not used
Malignant hypertension with systemic sclerosis and asthma
high blood pressures with bilateral retinal hemorraghes or cotton wool spots without need for papilloedema
Rx - IV sodium nitroprusside
IV labetalol too can be used if not for asthma
Tricuspid regurgitation wave prominent
V wave is prominent
a wave is absent in A Fib
cannon waves seen in AV dissociation
Hypothermia significance
J waves
criteria for severe Aortic stenosis
aortic jet velocity >4 m/s
mean gradient across the aortic valve > 50mmhg
aortic valve area <1cm2
velocity ration < 0.25
indexed aortic valve area <0.6cm2/m2
regular broad complex tachycardia with poor left ventricular function with capture and fusion beats
VT - Amiadarone
pan systolic murmur at left sternal edge, fluid overload bilateral crackles, childhood murmur, cyanosed and clubbing at rest
MR,TR,
VSD-essiengmers syndrome
systolic murmur at left interscapular region
PDA- continous machinary murmur below the left clavicle
coarctation of aorta
atrial myxoma
benign tumour of heart, common in women,10% inherited, intracardiac obstruction- exertional dyspnoea, paroxysmal dysponea and platypea- uprght dyspneo ablates on supine position
it originates in left atrium, stalk like appearance TOE has more resolution, mri or ct can be done it in doubt.
Pericarditis ECG changes Four stages
stage1- diffuse concave ST segment elevation with concordance of T waves and ST segment depression in aVR OR V1 , PR segement depression, low voltage, abscence of reciprocal ST segment changes
stage2- ST segments return to baseline and T wave flatenning,
stage3- T wave inversion
stage4-gradual resolution of T wave inversion
carcinoid syndrome
flushing of face and neck, abdominal pain, watery diarreohea,fatigue, breathlessness, anorexia,and nausea jvp distension with V waves, hepatomegaly and odema on auscultation- blowing pan systolic murmur at lower left sternal edge
ausculatory findinds show- Tricuspid incompetence
may also have pulmonary stenosis
