cards Flashcards
(31 cards)
chronic heart failure mng
https://d32xxyeh8kfs8k.cloudfront.net/images_Passmedicine/pdd975b.png
If vagal manoeuvres and adenosine ineffective for SVT →?
verapamil or beta-blocker
first-line to prevent angina attacks
A beta-blocker or a calcium channel blocker (verapamil, diltiazem)
when to start doac in AF
Based on CHADSVASC score - No treatment
1 Males: Consider anticoagulation
Females: No treatment (this is because their score of 1 is only reached due to their gender)
2 or more Offer anticoagulation
In AF, if a CHA2DS2-VASc score suggests no need for anticoagulation- next step
echo to exclude valvular heart disease
The most specific ECG finding in acute pericarditis
PR depression
mng of bleding and on warfarin
Major bleeding (e.g. variceal haemorrhage, intracranial haemorrhage)- Stop warfarin
Give intravenous vitamin K 5mg
Prothrombin complex concentrate - if not available then FFP*
INR > 8.0 & Minor bleeding-Stop warfarin
Give intravenous vitamin K 1-3mg
Repeat dose of vitamin K if INR still too high after 24 hours
Restart warfarin when INR < 5.0
INR > 8.0 & No bleeding-Stop warfarin
Give vitamin K 1-5mg by mouth, using the intravenous preparation orally
Repeat dose of vitamin K if INR still too high after 24 hours
Restart when INR < 5.0
INR 5.0-8.0 &Minor bleeding- Stop warfarin
Give intravenous vitamin K 1-3mg
Restart when INR < 5.0
INR 5.0-8.0 & No bleeding- Withhold 1 or 2 doses of warfarin
Reduce subsequent maintenance dose
causes of acute pericarditis
Aetiology
viral infections (Coxsackie)
tuberculosis
uraemia
post-myocardial infarction
early (1-3 days): fibrinous pericarditis
late (weeks to months): autoimmune pericarditis (Dressler’s syndrome)
radiotherapy
connective tissue disease
systemic lupus erythematosus
rheumatoid arthritis
hypothyroidism
malignancy
lung cancer
breast cancer
trauma
what ix should all pts with acute pericarditis have
TTE
https://d32xxyeh8kfs8k.cloudfront.net/images_Passmedicine/ecg062b.jpg
widespread ST elevation and PR depression - acute pericarditis
https://d32xxyeh8kfs8k.cloudfront.net/images_Passmedicine/ecg083b.png
Widespread ST ELEVATION WITHOUR RECIPROCAL changes . Marked PR depression
- acute pericarditis
CHADSVASC score
which medications can cause torsades
macrolides - azithromycin, erythromycin
https://d32xxyeh8kfs8k.cloudfront.net/images_Passmedicine/ecg069.png
torsades
what ECG finding can SAH cause
TORSADES
ORBIT score
Causes of torsades
Causes of long QT interval
congenital
Jervell-Lange-Nielsen syndrome
Romano-Ward syndrome
antiarrhythmics: amiodarone, sotalol, class 1a antiarrhythmic drugs
tricyclic antidepressants
antipsychotics
chloroquine
terfenadine
erythromycin
electrolyte: hypocalcaemia, hypokalaemia, hypomagnesaemia
myocarditis
hypothermia
subarachnoid haemorrhage
mng of torsades
IV magnesium sulphate
what findings would increase consideration of starting antihypertensives irregardless of the BP reading
signs of end organ damage
Based on CHADSVASC score, when is anticoagulation considered for patients:
Men: CHA2DS2-VASC >= 1
Women CHA2DS2-VASC >= 2
if have a TIA and AF, when should anticoagulation for AF be started
immediately, once imaging has excluded hemorrhage
what is Takayasu’s arteritis
Takayasu’s arteritis is a large vessel vasculitis. It typically causes occlusion of the aorta and questions commonly refer to an absent limb pulse. It is more common in younger females (e.g. 10-40 years) and Asian people.
features of Takayasu’s arteritis
Features
systemic features of a vasculitis e.g. malaise, headache
unequal blood pressure in the upper limbs
carotid bruit and tenderness
absent or weak peripheral pulses
upper and lower limb claudication on exertion
aortic regurgitation (around 20%)
ix for Takayasu’s arteriti
vascular imaging of the arterial tree is required to make a diagnosis of Takayasu’s arteritis
either magnetic resonance angiography (MRA) or CT angiography (CTA)
