Cardiology 2 Flashcards Preview

2A - Stuff i just cannot remember > Cardiology 2 > Flashcards

Flashcards in Cardiology 2 Deck (42)
Loading flashcards...
1

Management of COMPENSATED acute heart failure (pulmonary oedema)

Sit up
Oxygen if sats <94

IV Furosemide

SC Morphine

2

Advanced managemnt of acute heart failure

CPAP

IV Furosemide over 24hr

IV Dopamine over 24hr (inhibits SNS - increases myocardial contractility)

Intra-aortic balloon pump if in shock

Ultrafiltration if diuretics CI

3

Criteria for cardiac resynchronisation therapy

Symptomatic despite full medical management of ACEi, BB, Furosemide, Ivadbradine, Spironolactone, Hydralazine (if afro-carib)

1) LBBB on ECG
2) LVEF <30%
3) NYHA III

4) QRS >130ms

4

NYHA Classification of Heart Failure

I - no physical limitations

II - slight limitation, comfort at rest

III - marked limited activity, comfort at rest

IV - discomfort at rest

5

Pt is admitted with worsening SOB. RR 30, sats 91%, pulse 90bpm.

ECG shows normal sinus rhythym with a narrow QRS complex. LVEF 25%.

Current meds are Ramipril, bisoprolol, spironolactone, Bumetanide, Atorvastatin, Aspirin and Isosorbide Mononitrate.

She is treated with IV Furosemide. What intervention should she receive after her acute management? (+ other indications for this management)

Implantable cardioverter-defibrillation (ICD)

- LVEF <35%
- Good QoL
- Ventricular Fibrillation or Ventricular Tachycardia

6

Management of DECOMPENSATED acute heart failure (pulmonary oedema) secondary to Atrial Fibrillation

IV METOPROLOL (Beta-blockade, unless asthma/ COPD)

7

Pt presents with syncope and palpitations. ECG shows a long QT interval.

Congenital cause of Long QT Syndrome

Acquired cause of Long QT Syndrome

Treatment of Long QT?

Congenital: Jervell-Lange-Nielsen syndrome (mut. Cardiac Na/K channels)

Acquired: HypoK, HypoCa, amiodarone, TCAs, bradycardia, MI, diabetes

Tx:
Underlying
+ IV Isoprenaline if acquired

8

Pt presents with 2hrs of palpitations and malaise. Her pulse is 140bpm but other vitals are normal. She is haemodynamically stable.

ECG reveals regular tachycardia with QRS duration 80ms.

Diagnosis? 1L management? 2L Management?

What would the management be if she were haemodynamically unstable?

Narrow QRS = Supraventricular Tachycardia, haemodynamically stable

1L Vagal manoeuvre
- carotid sinus massage
- blowing into empty syringe

2L IV Adenosine

3L BB


If haemodynamically unstable: DC Cardioversion

9

Pt's ECG shows a series of broad QRS complexes and tachycardia. There are no abnormalities on examination.

What is the most appropriate management?

Broad QRS = Ventricular tachycardia

No abnormalities = stable

Tx: IV Amiodarone 300mg (Then 900mg over 24hrs)

10

Pt's ECG shows a series of broad QRS complexes and tachycardia. He has no pulse.

What is the most appropriate management?

= ventricular tachycardia but really bad

Chest compressions + unsynchronised shock

11

Pt's ECG shows a series of broad QRS complexes and tachycardia. He has a pulse but has experiences two episodes of syncope.

What is the most appropriate management?

= unstable ventricular tachycardia

DC Cardioversion (Synchronised)

12

Pt presents with palpitations. Their ECG has a corkscrew appearance. She recently has been taking clarithromycin and amoxicillin to treat CAP.

Likely diagnosis?

Torsades des pointes (Ventricular Tachycardia)

13

Pt presents with tachycardia and ECG shows broad QRS complexes. They have had palpitations for 5hrs. There are no signs of oedema or raised JVP.

Likely diagnosis? Management?

Haemodynamically stable Sustained Ventricular Tachycardia

IV Amiodarone

14

Asthmatic pt presents with SOB and palpitations. ECG shows supraventricular tachycardia of 180bpm.

How should we slow the rate to be able to identify the arrhythmia?

Asthmatic :. adenosine contraindicated

Therefore VERAPAMIL

15

Pt presents with SOB and palpitations. ECG shows supraventricular tachycardia of 180bpm.

How should we slow the rate to be able to identify the arrhythmia?

ADENOSINE

16

What is the most common ECG finding in pulmonary embolism?

Sinus tachycardia

17

Pt presents with a fast irregular pulse and muscle weakness. Their breathing is deep and slow (Kussmaul's). THeir ECG shows progresdive abnormalities, including tall T-waves.

Likely diagnosis? Investigations? What other ECG abnormalities might you expect? Treatment?

What are the complications of this?

Hyperkalaemia

Serum K+ >5.5mmol/L

ECG:
- progressive
- Tall T wave
- SMALL P-WAVE
- WIDE QRS

Non-urgent: stop offender (ACEi, spironolactone, NSAID) + POLYSTYRENE SULFONATE RESIN (binds K+ in gut)

Urgent: K>6.5
- IV CALCIUM GLUCONATE
- IV ACTRAPID + GLUCOSE
- IV SALBUTAMOL

Complications:
- Ventricular fibrillation
- heart failure

18

Wolf-Parkinson-White ECG

Pathophysiology

= Atrioventricular Re-entry Tachycardia
Wide QRS
Short PR
Delta Wave

Accessory pathway > re-entrant loop > supraventricular tachy

19

Types of Supraventricular Tachycardia

1, Atrioventricular Nodal Re-entrant: re-entry back through AVN

2. Atrioventricular Re-entrant: re-entry via accessory pathways (WPW)

3. Atrial tachycardia: signal originates in atria but not SAN

20

Normal PR interval

0.12-0.20s

21

PR depression

Pericarditis

22

Short PR in an arrhythmia

Wolf Parkinson White

23

Normal QRS range

0.08-0.12s

24

Wide QRS

RBBB/ LBBB
Hyperkalaemia (sine)
WPW
Ventricular rhythm
TCA poisoning

25

HASBLED

Risk of bleeding for patients on anticoagulants

26

Heart failure
- medications that improve prognosis
- medications that give symptomatic relief

Prognostic improvers
- ACEi
- BB
(start at different times!)

Symptomatic relief:
- Diuretics

27

Furosemide pharmacology

Loop Diuretic

Inhibits Na/K/Cl transporter on ASCENDING limb

28

K-sparing diuretics pharmacology

eg Amiloride, Spironolactone

Inhibit ENaC on DCT

29

Thiazide diuretics pharmacology

eg Bendroflumethiazide

Inhibit Na/Cl transporter in DCT

30

MI Complications

DARTH VADER

Death
Arrhythmia
Rupture (V.septum/papillary muscles)
Tamponade
Heart failure

Valve disease
Aneurysm of ventricle
Dressler's syndrome
Embolism
Regurgitation (mitral)/ recurrence