Difficult Cardio Flashcards
Complications Post MI
ventricular septal defect presents with?
pansystolic murmur
acute HF signs
within 1 week
Left ventricular free wall rupture?
2 weeks post MI
cardiac tamponade features
blood is leaking into pericardial space
Becks: hypotension, raised JVP, muffled heart sounds
ECG: electrical alternans
left ventricular aneurysm
2 weeks post MI
persistent St elevation
lack of other MI features
Dressler’s syndrome
acute-onset pleuritic pain
ST elevation would be saddle shaped with PR depression
global across all leads
Ventricular septal defects in Downs
Hole in septum which separates R/L ventricles
blood flows from Left >Right
pan systolic murmur
why is warfarin INR target higher for a mitral valves
Mechanical heart valves have a high propensity for clot formation, particularly mitral valves
GRACE - poor prognostic factors?
HF
Age
reduced systolic BP
what drugs have shown to reduce mortality in patients with left ventricular failure?
ACEi
Beta-Block
ARB
aldosterone antagonist - spironolactone
hydralazine and nitrates
Holter monitor :
what is it?
what does it monitor?
continuous ECG for a period of 24, 48 or 72 hours
to assess for Atrial fibrillation
NICE recommends ___________ for someone presenting with non-cardiac chest pain with signs of ischaemia
NICE recommends contrast-enhanced CT coronary angiogram for someone presenting with non-cardiac chest pain but whose resting ECG shows signs of ischaemia
hypothermia ECG changes?
j waves
qt is long
irregular rhythm
bradycardia
first degree heart block
How to exclude valvular pathology?
transthoracic echocardiography
What is the normal range for a P-R interval?
120-200ms
PR interval of 200ms would be how many small boxes?
5 small sqaures
Takayasu is a vasculitis that affects the ?
aorta and its main branches
causes occlusion
absent limb pulse
how to investigate takayasu?
vascular imaging
magnetic resonance angiography
CT angiography
how long does Troponin remain elevated post MI?
10 days
creatine kinase CK-MB ?
3-4 so usrful when assessing reinfarction
cardiac enzymes and protein markers
myoglobin (1st(
CK-MB
Trop T - peaks at 12
AST
LDH
immediate treatment for bradycardia with adverse features
500 micrograms atropine IV
repeat upto 3mg
mitral stenosis
what suggests mobility of leaflets?
length of murmur suggests?
opening snap - pressure in left atrium is greater than the pressure in left ventricle
severity
loud S1
causes of mitral stenosis?
Rheumatic fever
mucopolysaccharidoses, carcinoid and endocardial fibroelastosis
Posterior MI
territory?
V1-V3 ST depression
tall borad R waves
uptight t waves
dominant r in V2
> circumflex or right coronary
Inferior MI
coronary artery?
territory?
Right coronary artery
II,II, aVF
