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3B > Cardiovascular 2 > Flashcards

Cardiovascular 2 Flashcards

(46 cards)

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1
Q

Ventricular tachycardias

A

Broad complex - VT and VF

Monomorphic - MI
Polymorphic - Torsades de Pointes - Precipitated by prolonged QT

Management if stable…

  1. IV amiodarone
  2. IV lidocaine
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2
Q

VF / Pulseless VT management

A

Shockable!

  1. DC cardioversion - 200, 300, 360
  2. Resume CPR for 2 minutes
  3. Assess rhythm
  4. Repeat shock
    + IV amiodarone after 3 shocks
    + IV adrenaline every 3-5 minutes

Prevention - BB or ICD

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3
Q

Torsades de Pointes

A

Twisting of peaks
Polymorphic VT with long QT

Management - IV magnesium sulphate

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4
Q

Long QT aetiology

A

Delayed ventricular repolarisation

Drugs

  • Antipsychotics
  • Amitriptyline
  • Ondansetron
  • SSRIs
  • Amiodarone
  • Erythromycin
  • Haloperidol

SAH
Electrolyte imbalance - HYPO-C/K/M
Acute MI / Myocarditis
Hypothermia

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5
Q

Brugada syndrome

A

Sodium channelopathy
AD inheritance
Young
South-East asian

Presentation - Syncope

ECG findings

  • J-point elevation in V1
  • ST elevation
  • RBBB

Management - ICD

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6
Q

Asystole

A

Non-shockable

CPR
Reassess rhythm every 2 minutes
IV adrenaline every 3-5 minutes

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7
Q

Long QT features

A 
Incidental finding - Routine ECG
Long QT1 - Exertional syncope - Swimming
Long QT2 - Emotional stress
Long QT3 - At night / at rest
Sudden cardiac death
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8
Q

Long QT management

A

BBs

ICD

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9
Q

Atrial flutter aetiology

A

Increasing age

Structural heart disease
Recent cardiothoracic surgery - Surgical / post-ablation scarring of atria
HF

Hyperthyroid

COPD
Asthma
Pneumonia

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10
Q

Atrial flutter clinical features

A 
Worsening HF
Pulmonary symptoms
Palpitations
Fatigue
Syncope
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11
Q

Atrial flutter ECG findings + investigations

A

Sawtooth appearance - II, III, aVF
2:1 block - 150bpm
Flutter waves visible following carotid sinus massage or adenosine

TFTs
Serum electrolytes

CXR

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12
Q

Atrial flutter management (acute)

A

Haemodynamically unstable - Synchronised cardioversion

Haemodynamically stable 
- Rate control - BB, CCB, Amiodarone
- Synchronised cardioversion
- Pharmacological cardioversion - Ibutilide
\+ Heparin
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13
Q

Atrial flutter management (ongoing)

A

Catheter ablation of cavotricuspid isthmus

Rate control - BB or CCB
Anticoagulation - Warfarin

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14
Q

Hypertrophic obstructive cardiomyopathy pathophysiology

A

AD - Disorder of muscle tissue

Mutation in B-myosin heavy chain protein
Predominantly diastolic dysfunction
LVH - Decreased compliance - Decreased CO
Myofibrillar hypertrophy with chaotic disorganised myocytes and fibrosis

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15
Q

HOCM clinical features

A

Asymptomatic

Exertional dyspnoea
Syncope - Following exercise
Sudden death - Ventricular arrhyhtmias

Jerky pulse
Large A waves
Double apex beat

Murmur - Ejection systolic

  • Increased with valsalva
  • Decreased on squatting
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16
Q

HOCM ECG findings

A

LVH
T-wave inversion
Deep Q waves
AF

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17
Q

HOCM echo findings

A

MR SAM ASH

MR - Mitral regurgitation
SAM - Systolic anterior motion of anterior mitral valve leaflet
ASH - Asymmetric hypertrophy

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18
Q

HOCM management

A

ABCDE

Amiodarone
BBs - Verapamil
Cardioverter defibrillator
Dual chamber pacemaker
Endocarditis prophylaxis
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19
Q

Contraindicated in HOCM

Study These Flashcards
A

Nitrates
ACE-I
Inotropes

20
Q

Dilated cardiomyopathy aetiology

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A

Autosomal dominant

Myocarditis
IHD
HTN

Drugs - Doxorubicin, Cocaine ± Alcohol

Peripartum

Haemochromatosis / Sarcoidosis

Hyperthyroid

Duchenne’s
Wet beri beri

21
Q

Dilated cardiomyopathy pathophysiology

Study These Flashcards
A

Dilated heart
Predominantly systolic function
All 4 chambers dilated - LV > RV
Eccentric hypertrophy - Sarcomeres added in series

22
Q

Dilated cardiomyopathy presentation

Study These Flashcards
A

HF symptoms

Arrhythmias
Emboli
Mitral regurgitation

23
Q

Dilated cardiomyopathy examination

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A

S3 gallop
Systolic murmur

JV distension
Peripheral oedema
Bibasal crackles
Hepatomegaly

24
Q

Dilated cardiomyopathy investigations

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A

ECG

  • LVH
  • Wide QRS
  • LBBB
  • P-wave abnormalities - Atrial enlargement

CXR - Balloon appearance

Echo

  • Decreased wall thickness
  • LV dilatation
  • Poor systolic function

FBC - Anaemia
BNP ^^^

25
Dilated cardiomyopathy management
Lifestyle - Same as HF! ACE-I / ARB BB Diuretics Digoxin Aspirin Warfarin LVAD Pacemaker ICD Heart transplant
26
Takotsubo cardiomyopathy
Broken heart syndrome Non-ischaemic cardiomyopathy Transient apical ballooning of myocardium - Octopus pot Presentation - Triggered by stress - Chest pain - HF symptoms - ST elevation Management - Supportive
27
Peripartum cardiomyopathy
Last month of pregnancy to 5 months post-partum More common in older women Increased risk with greater parity and multiple pregnancies
28
Cardiac conditions considered severe risk in pregnancy
Pulmonary HTN Systemic left heart obstruction Systemic ventricular impairment - Ejection fraction < 30% Marfan's syndrome with aortic root diameter > 47mm
29
Aortic aneurysm aetiology
True - All 3 layers False - 1 layer Arterial disease - HTN, DM, smokers, etc. Connective tissue disease Age ^ Male - Increased prevalence Female - Increased risk of rupture
30
Aortic aneurysm clinical features
Palpable pulsatile mass Abdo/back/groin pain Hypotension - Rupture?
31
Aortic aneurysm investigations and management
Abdominal USS Ruptured or symptomatic - Urgent surgical repair
32
Aortic aneurysm screening
< 3cm - Normal width 3-4.4cm - Small - Rescan every 12 months 4.5-5.4cm - Medium - Rescan every 3 months > 5.5cm - Large - Referral < 2 weeks + Endovascular repair
33
Aortic dissection aetiology
Smoking Family history Atherosclerosis HTN Connective tissue disorder Bicuspid aortic valve CoA
34
Aortic dissection presentation
``` Marfan's / ED Acute severe chest pain = Tearing, radiates to the back Left/right BP differential Pulse deficit Diastolic murmur ```
35
Aortic dissection investigations
ECG - ST depression or elevation CXR - Widened mediastinum Cardiac enzymes - Negative CT angiography - Intimal flap TOE if unstable
36
Aortic dissection management
Analgesia Control BP! - Labetalol - Nitroprusside Type A - Surgical repair Type B - Conservative On discharge - Anti-HTN
37
PVD aetiology
Age > 40 Smoking Sedentary lifestyle DM HTN Hyperlipidaemia Atherosclerosis
38
PVD clinical features
Asymptomatic? Intermittent claudication Thigh or buttock pain on exertion - Relieved at rest Diminished or absent pulse Erectile dysfunction?
39
6 Ps of acute limb ischaemia
``` Pale Pulseless Painful Paralysed Paraesthesia Perishingly cold ```
40
PVD investigations and management
Ankle/Brachial pressure index < 0.9 Antiplatelet therapy - Aspirin/Clopidogrel Analgesia - Opioid Anticoagulation - Heparin CV risk factor management Endovascular or surgical revascularisation
41
Shock
Life-threatening Acute circulatory failure Inadequate oxygen delivery to cells
42
Shock risk factors
History of sepsis Recent MI Surgery, trauma, haemorrhage Exposure to known allergens Change in medication Significant comorbidities
43
Shock clinical features
Hypotension Tachycardia Skin changes - Cyanosis Oliguria < 0.5ml/kg/hr Altered mental state - GCS
44
Shock investigations
ABG - Metabolic acidosis with raised lactate ``` Glucose ^ FBC - Anaemia WCC - Infection? Urea - GI bleed? Clotting screen - DIC - Septic shock CRP - Inflammation - Sepsis? ECG - Cardiogenic cause? ```
45
Shock complications
Multiple organ dysfunction End-organ damage Death
46
Reversible causes of cardiac arrest
4 Hs - Hypoxia - Hypovolaemia - Hypo/hyperkalaemia - Hypothermia 4 Ts - Thrombosis - Coronary or pulmonary - Tension pneumothorax - Tamponade - Toxins

3B (23 decks)

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