ECGs and Cardiology Flashcards
(185 cards)
1
Q
What does a tall P wave show?
A
P Pulmonale - RA hypertrophy
2
Q
What may RA hypertrophy be secondary to?
A
Pulmonary HTN and Tricuspid stenosis
3
Q
What is P Mitrale?
A
Bifid P wave, caused by LA hypertrophy, secondary to mitral stenosis
4
Q
Signs of RVH?
on ECG
A
RAD
P pulmonale
T wave inversion
5
Q
Causes of RVH?
A
1) Pulmonary hypertension
2) Chronic lung disease
3) Mitral stenosis
4) Congenital heart disease
6
Q
Classic acute right ventricular strain signs? e.g PE
A
S1Q3T3
7
Q
Sokolov Lyon Criteria for LVH diagnosis?
A
LVH present when combined total depth of S wave in V1 and height of R in V5/6 = Over 35mm
8
Q
What is a pathological Q wave?
A
1) Greater than 40ms
2) Over 2mm in depth
3) Over 25% of depth of QRS
9
Q
Causes of prolonged QT?
A
1) Long QT syndrome (inherited slow ventricular repolarisation)
2) ELectrolytes (hypokal, hypocalc, hypomag)
3) Medications (many..e.g antipsychotics, antiemetics)
4) Other (hypothyroid, intercranial disease)
10
Q
Medications to increase heart rate?
A
- Atropine (blocks action of vagus on SAN/AVN)
2. Isoprenaline
11
Q
Atrial flutter sign?
A
Sawtooth baseline
12
Q
Atrial tachycardia?
A
Abnormal P wave (inverted in inferior)
13
Q
AVNRT?
A
Absent P wave
14
Q
What is Wolff-Parkinson-White syndrome?
A
Pre-excitation syndrome - congenital accessory pathway named Bundle of Kent
15
Q
Signs of WPW?
A
Short PR Delta wave (slurred upstroke of QRS)
16
Q
Treatment of WPW?
A
Radiofrequency ablation of accessory pathway + Sotalol/ Amiodarone/ Flecainide
17
Q
Treatment to shorten QT?
A
IV Magnesium Sulphate
18
Q
What is Torsades De Pointes?
A
Polymorphic VT secondary to prolonged QT/ Myocardial Ischaemia
19
Q
STEMI ECG changes?
Minutes 0-12hrs 1-12hrs Days Weeks
A
Minutes = hyperacute T waves
0-12hrs = ST elevation
1-12hrs = Q wave development
Days = T wave inversion
Weeks = T wave normal + persistent Q waves
20
Q
Pericarditis signs?
A
ST elevation widespread and PR depression
21
Q
Causes of J waves? (notch just after QRS)
A
1) Early repolarisation
2) Hypothermia
3) Hypercalcaemia (short QT)
4) Brugada syndrome
22
Q
Signs of Digoxin on ECG?
A
Downsloping ST
Abnormal T
Short QT
23
Q
Hyperkalaemia signs?
A
Tall T
Long PR
WIde flat P
Broad QRS
24
Q
Risk factors for Coronary Artery Spasm (Prinzmetal Angina)
A
- Cocaine
- Mg deficiency
25
Diagnosis of Coronary Artery Spasm?
Angiogram (inject Acetylcholine, if vessel constricts - can dx vasospasm)
26
Tx of Coronary Artery Spasm?
CCB (Verapamil/ Diltiazem)
27
Angina Triad?
1) Constricted chest pain (radiating down neck/arm)
2) Precipitated by exercise
3) Relieved by rest/ GTN within 5 mins
28
ANGINA
| Anatomical non invasive tested for low risk?
CTCA
29
What is deemed obstructive CAD?
Over 70% stenosis of 1 major coronary artery segment or over 50% stenosis of left main coronary artery
30
ANGINA
Example of Non. Invasive Functional Testing?
1) Dobutamine stress Echo
2) Stress/contrast MRI
3) SPECT
31
ANGINA
What is investigation of choice for high risk patients?
Invasive Coronary Angiography (for assessing stenosed arteries + provide revascularisation at the time of diagnosis)
32
ANGINA
Lifestyle advice?
WESAD
```
Weight Loss
Exercise 30-60mins
Smoking Cessation
Alcohol under 12 units weekly
Diet (limit sat fats to under 10% of total calorie intake)
```
33
ANGINA
Pharmacological management?
GTN +
1) BB / CCB (Amlodipine)
2) Long acting Nitrate
Ivabradine
Nicorandil
Ranolazine
34
What CCBs are contraindicated with beta blockers?
Non dihydropyridine CCBs such as Verapamil and Diltiazem due to the risk of AV block
35
Invasive Management of Angina?
PCI and CABG
36
What medication is given alongside PCI
Dual antiplatelet therapy (Aspirin + Clopidogrel) for 6 months
37
DIC treatment?
Tranexamic Acid
FFP
Cryoprecipitate
38
Treatment of GI bleed?
1. Ceftriaxone IV 1g
2. Octreotide 50 ug bolus + 50ug hourly
3. Erythromycin 250mg
4. PPI Pantaprazole 80mg IV bolus
39
Types of Shock?
```
Cardiogenic
Septic
Hypovolaemic
Neurogenic
Anaphylactic
```
40
What types of shock have warm peripheries?
Distributive
- neurogenic/ Septic/ Anaphylactic
41
3 in 3 out management of Septic Shock
3 in - Fluid Bolus, Tazocin (Abx), High flow O2
3 out - Blood cultures, lactate, measure urine output
42
Treatment of Neurogenic shock?
Vasopressors
43
What is Sepsis characterised by?
Temperature under 36 or over 38
HR >90
RR >20
WBC >12,000mm3 or <4000mm3
44
Famous Cause of Toxic Shock syndrome in the 80s?
Infected tampons , containing Staphylococcal Exotoxins
45
Symptoms of Toxic Shock Syndrome?
1. Fever >38.9
2. Hypotension
3. Sun burn like rash (desquamation of palms/soles)
4. 3+ organ involvement
46
Types of MI?
1. due to primary CA event e.g plaque rupture
2. due to oxygen supply demand mismatch
3 sudden expected cardiac death
4 Associated with PCI / stent complications
5 Associated with cardiac surgery
47
Chest Pain differentials?
Cardiac
Respiratory
GI
Other
C - Angina, ACS, Aortic Dissection, Pericarditis
R - PE, Pneumothorax, Pneumonia
GI - Oesophagitis, Peptic Ulcer, Oesophageal spasm
Other - Depression, MSK (rib fracture), herpes zoster
48
Immediate Management of ACS?
MONA (aspirin 300mg loading dose)
take morphine + anti-emetic (metoclopramide)
49
What should be done within 120 mins of STEMI
Primary PCI / Coronary Angiography
50
What should be done if action not completed within 120 minutes of STEMI?
Give fibrinolytic agent e.g alteplase
2. Clopidogrel + LMWH/UFH and PCI within 24hrs
51
what should be given prior to PCI
2nd antiplatelet (Prasugrel/ Clopidogrel/ Ticagrelor)
+ LMWH/ UFH
+ Glycoprotein IIb/IIIa inhibitor
52
What is GRACE score?
Estimates 6 month mortality risk in patients with NSTEMI/ UA
53
NSTEMI/UA Management Pathway?
1st - Consider risk using GRACE/HEART score
2. GIve antiplatelet + Fondaparinux or UFH if PCI <24hrs
3. do Angiography if under 96hrs of presentation and consider PCI/ CABG
IF pain free/ over 96hrs of presentation just do echo, if positive do angiography
54
Long term management after ACS?
Aspirin, ACE-I, Atorvastatin
BB
Cardiac Rehab, cessation of smoking
Driving, Diet/Alcohol, Dyspepsia (PPI!!)
55
what should be given alongside dual antiplatelet therapy?
PPI as increased. risk of peptic ulcer disease
56
What is Dresslers Syndrome?
Autoimmune pericarditis 2/3 weeks post MI.
Autoimmune reaction to myocardial antigens post infarction
57
3 functions of Pericardium?
Barrier - reduces external friction
Mechanical - limits cardiac dilation (maintains ventricular compliance and aids atrial filling)
Anatomical - fixes heart through ligamentous function
58
major risk factors of Pericarditis?
```
Fever over 38
Subacute onset
Large pericardial effusion
Cardiac tamponade
poor response to 1 week of tx
```
59
Describe Pericarditis pain?
Sharp pleuritic chest pain
BETTER - leaning forward / sitting up
WORSE - inspiration
60
How is Pericarditis Diagnosed?
2/4 of:
New/ worsening pericardial effusion
Classic chest pain
Pericardial friction rub (Squeaky sound heard over heart)
Characteristic ECG changes
61
ECG signs of PEricarditis?
ECG - widespread ST elevation + PR depression
62
Cardiac Tamponade features?
1. Muffled heart sounds
2. Distended JVP
3. Pulsus Paradoxus (BP drop >10mmHg on inspiration)
4. Hypotension
63
Tx of Pericarditis
NSAID + Colchicine
+ PPI
64
Tx of tamponade?
Urgent pericardial paracentesis
65
Management of Acute Pulmonary Oedema?
Furosemide (IV 40mg)
Oxygen (high flow)
Nitrates (sublingual infusion)
Diamorphine (IV)
may require CPAP if fails
66
What is a synonym of perihilar shadowing
Alveolar Oedema
67
Hypercalcaemia symptoms?
stones, bones, groans and psychic moans
bone pain, renal stones, abdo pain, low mood
short QT on ECG
68
Adenosine side effects?
chest pain
bronchospasm
transient flushing
can enhance conduction down accessory pathways, resulting in increased ventricular rate (e.g. WPW syndrome)
69
What is Adenosine mainly used for?
Termination of SVT
70
What enhances the effect of Adenosine and what blocks the effect of Adenosine?
Enhances - Dipyridamole (antiplatelet agent)
| Blocked - theophyllines
71
What should Adenosine be avoided in?
Asthmatics due to risk of bronchospasm
72
HEART FAILURE
Types of heart failure?
Vascular (HTN, IHD)
Muscular (Dilated Cardiomyopathies)
Valvular
Electrical
73
Definition of preload?
Stretching of cardiomyocytes at the end of diastole
74
Definition of afterload?
Pressure or load against which the ventricles must contract
75
Definition of Inotropy?
The force of muscular contraction
76
HEART FAILURE
Describe the basic pathophysiology
- ESV increases which reduces CO
- Body compensates by:
1) Increase preload (Increase EDV to maintain CO)
2) Increase heart rate
3) Activate RAAS (salt and water retention = oedema)
4) Baroreceptors activate sympathetic - vasoconstriction 1
77
HEART FAILURE
Symptoms?
```
SOB
Fatigue
Oedema
Paroxysmal nocturnal dyspnoea
Orthopnoea
```
78
HEART FAILURE
Signs?
```
S3/S4 HS
Ankle swelling
Wheeze
Pulsus Alternans
Ascites
Hepatomegaly
Increased JVP
Displaced apex beat
```
79
HEART FAILURE
Dx?
Echo + BNP
80
Causes of increased BNP?
- CKD
- Cirrhosis
- Heart failure
- Hypoxaemia
- Diabetes
- Old age
- Sepsis
81
HEART FAILURE
Management?
1st - ACE-I + BB + DIURETIC
2nd + MRA (Eplerenone)
3rd - Digoxin, Ivabradine, Hydralazine + Nitrate
82
Last line management of HF?
PCI
CRT
ICD
Heart transplant
83
What are MRAs / aldosterone receptor antagonists contraindicated in?
Hyperkalaemia
Hyponatraemia
AKI
84
What would an echo show if a person had Hypertrophic Obstructive Cardiomyopathy>
- Mitral regurgitation
- Systolic anterior motion (SAM) of anterior mitral valve
- Asymmetrical septal hypertrophy
85
Classic ECG sign in Arrhythmogenic right ventricular dysplasia?
inverted T V1-3 and EPSILON wave (terminal notch in QRS)
86
Describe flow murmurs? (7 S's)
- Slow
- Short
- Systolic
- Symptomless
- Sounds (normal S1 and S2)
- Standing/ sitting (positional)
- Special tests normal (Echo/ECG)
87
Causes of dilated cardiomyopathies?
```
ABCD
Alcohol
Beri Beri (Thiamine B1 deficiency)
Coxsackie B virus
Doxorubicin
```
88
What is Becks Triad?
S3 signs of Acute Cardiac Tamponade?
1) Raised JVP
2) Hypotension
3) Muffled heart sounds
89
What is Aortic Dissection
When the medial aortic layers separate
1) Intimal tear allowed blood to enter intima-media space
2) false lumen fills with blood it may propagate proximally/distally
3) This results in either:
Rupture through adventitia
OR
Reentry to true lumen via 2nd intimal tear
90
AORTIC DISSECTION
Describe Stanford Classification
Type A - ascending aorta involved
Type B - Ascending aorta not involved
91
AORTIC DISSECTION
Describe DeBakey classification
Type 1 Involves ascending, extends into arch and beyond
Type 2 Limited to ascending
Type 3a Involves descending thoracic (proximal to coeliac artery)
Type 3b Involves descending aorta and abdominal aorta
92
AORTIC DISSECTION
Congenital risks?
```
Noonans
Turners
Marfans
Ehlos Danlos
Osteogenesis Imperfecta
```
93
AORTIC DISSECTION
Acquired risk?
```
Cocaine
HTN
Pregnancy
Syphillitic arthritis
Iatrogenic (cannulation)
```
94
AORTIC DISSECTION
Symptoms?
Tearing chest pain
Back and abdo pain
Dyspnoea
Syncope/ colllapse
95
AORTIC DISSECTION
Signs?
Horners syndrome
Arm BP differential
Neuro deficit
Absent peripheral pulses
96
AORTIC DISSECTION
Acute complications?
Cardiac Tamponade and Aortic Regurgitation
97
Aortic Regurgitation signs
Diastolic murmur
Wide pulse pressure
Heart failure signs
98
AORTIC DISSECTION
Gold standard imaging?
CT angiogram
Echo - good if ascending and to assess complications - tamponade/ AR
99
AORTIC DISSECTION
Management of Stanford Type A/B?
Type A = surgery! (50% mortality in first 48hrs)
Type B = Analgesia and BP control (Labetolol)
100
How big is a AAA?
Over 3cm
101
AAA are more likely in males. Screening is available to those aged 65, whart are the pathways based on the size of the AAA on screening?
3-4.4cm = Annual USS + seen in 12 weeks
4.5-5.4cm = 3 montly USS + seen in 12 weeks
>5.4cm = 2 week wait
102
RIsk factors for AAA?
```
Family history 12x
Male 6x
Smokers
Hypertensive
Diabetics
Connective tissue disorders (Marfans)
```
103
Marfans complications?
```
Mitral valve prolapse
Aortic Dissection
Retinal detachment
Fibrillin - 1 - mutation
Arachnodactyly
Near sighted
Sclerosis
```
104
Commonest causes of aortic Regurgitation
Congential (bicuspid valve) + degenerative (calcification)
105
Aortic Regurgitation murmur?
Early diastolic + water hammer pulse
106
Aortic Stenosis clinical features?
Syncope (exertional)
Angina
Dyspnoea
107
Murmur heard in Aortic Stenosis?
Ejection systolic murmur + slow rising pulse
108
INR aim in patients with aortic mechanical valve replacement ?
3.0 - long term anti-coagulation required
| warfarin, if ischaemic add aspirin
109
murmur heard in MR?
Pansystolic + S3 due to rapid filling of dilated ventricle
110
signs on ECG if MR?
LVH and P Mitrale (bifid P wave)
111
Murmur heard in. MS?
Mid diastolic (lie on left side while holding expiration)
112
What is Ortner Syndrome
left recurrent laryngeal palsy (hoarse voice)
can be caused by left atrial enlargement
113
Management of MR?
Nitrates, Diuretics + Inotropes
114
INR aim in mechanical mitral valve replacement?
3.5.
115
If degenerative regurgitation, what should be the surgical treatment?
REPAIR over replace
116
What can left atrial enlargement cause
```
Ortner Syndrome
Right heart failure (Oedema, raised JVP, hepatomegaly)
Pulmonary HTN
Mitral facies
AF
```
117
IF a patient has mitral stenosis and persistent AF, which anticoagulation should they be on
VKA not NOACs
118
ATRIAL FIBRILLATION
Signs?
```
Irregularly irregular pulse
Palpitations
SOB
Angina
Presyncope
```
119
What does HASBLED stand for
```
Hypertension
Abnormal liver/renal func
Stroke
Bleeding (prior)
Labile INR
Elderly >65
Drugs/ alcohol
```
120
What does CHA2DS2VASc stand for
```
CCF
HTN
Age >75 +2
Diabetes
Stroke/TIA +2
Vascular disease
Age 65-74
Sc- Female
```
121
ATRIAL FIBRILLATION
IF pt has paroxysmal AF with no co-morbidities what is the treatment?
Flecainide
122
ATRIAL FIBRILLATION
Management of rate?
1st - BB Metoprolol
Rate limiting CCB - Verapamil
2nd - Digoxin
123
ATRIAL FIBRILLATION
Rhythm control?
Cardioversion
if onset <48hrs = immediate
if >48hrs = 3-6 weeks of anticoagulation then cardioversion
Electrical
Pharmacological (amiodarone, sotalol)
124
ATRIAL FIBRILLATION
Anticoagulation management?
If 1st line contraindicated?
DOACs - Rivaroxaban /Dabigatran
if DOAC contraindicated = Aspirin + Clopidogrel (dual ap treatment)
125
Rivaroxaban mode of action?
Xa inhibitor
126
Dabigatran mode of action?
Direct thrombin inhibitor
127
ATRIAL FIBRILLATION
If drug therapy fails what is final treatment>
ABLATION
128
ATRIAL FIBRILLATION
When should anticoagulation be used?
If CHADSVASC 2 or more
129
Treatment of SVT
- electrical cardioversion
- vagal manoeuvres (carotid sinus massage / valsalva)
2nd IV Adenosine 6mg-12mg-12mg
130
What is Adenosine contraindicated in and what is the preferred treatment
Asthmatics - prefer verapamil
131
1st line medication in VT
Amiodarone
132
Drugs that can prolong QT?
```
Methadone
Ondansetron
Sotalol
Citalopram
Haloperidol
Amiodarone
Terfenadine
Erythromycin
```
133
electrolyte causes of prolonged QT?
HYPO cal, kal, mag
134
Management of prolonged QT syndrome
Beta blockers plus avoid exacerbating drug/ strenuous exercise
implantable cardioverter defibs in high risk cases
135
What is Sodium Nitroprusside?
potent vasodilator (hypertensive crisis)
136
Acute NSTEMI treatment?
B – Beta blockers unless contraindicated
A – Aspirin 300mg stat dose
T – Ticagrelor 180mg stat dose
M – Morphine titrated to control pain
A – Anticoagulant: Low Molecular Weight Heparin (LMWH) at treatment dose (e.g. enoxaparin 1mg/kg twice daily for 2-8 days)
N – Nitrates (e.g. GTN) to relieve coronary artery spasm
137
Treatment of Regular Broad complex Tachycardia?
Assume VT - loading dose amiodarone (after DC)
138
Cause of irregular broad complex tachycardia?
AF with BBB
AF with ventricular pre excitation
torsades de pointes
139
Treatment of regular narrow complex tachycardia
Vagal manoeuvres followed by IV adenosine
IF above unsuccesful consider flutter dx and control rate
140
Cause of irregular narrow complex tachycardia?
Probable AF! if onset <48hrs then cardioversion
control rate with BB
141
Secondary causes of Hypertension
Endocrine - Aldosteronism, Cushings, Phaeochromocytoma, Acromegaly
Renal - Renovascular disease, Intrinsic disease (CKD, AKI, glomerulonephritis)
Drugs - Glucocorticoids, oral contraceptive, SSRIs, NSAIDs
Coarctation of the Aorta
142
Signs of hypertension
Cardiomegaly, Arrhythmias, Retinopathy, Proteinuria
143
What can Nicorandil cause?
Ulceration in GI tract
144
when can you not give Nicorandil
Patients with LVF
145
What is Conn's Syndrome?
Adrenal adenoma causing hyperaldosteronism
146
What electrolyte disturbances does Conn's Syndrome cause?
Hypokalaemia
Hypernatraemia
147
BP targets for under 80 and over 80s with hypertension?
Under = 135/85
Over = 145/85
148
Give an example of hypertensive emergency
Papilloedema + Retinal Haemorrhage
149
Treatment of hypertensive crisis
IV Nitroprusside, Labetolol and GTN
150
Treatment of Pheochromocytoma crisis?
Phentolamine
151
What is Phaeochromocytoma?
Catecholamine secreting tumour
152
Pheochromocytoma investigation?
25hr urine collection of metanephrines
153
treatment of Pheochromocytoma
```
Surgery definitive
but pt must first be stabilised with:
1) Alpha blocker (phenoxybenzamine)
MUST BE GIVEN BEFORE
2) beta blocker (propanolol)
```
154
What is Metanephrine
Metanephrine is a metabolite of epinephrine created by action of catechol-O-methyl transferase on epinephrine
155
What are the main Catecholamines
The main catecholamines are epinephrine (adrenaline), norepinephrine (noradrenaline), and dopamine.
156
What antiplatelet is given for conservatively managed NSTEMI
aspirin, plus either:
ticagrelor, if not high bleeding risk
clopidogrel, if high bleeding risk
157
What is a common interaction with statins
Macrolides (cause increase CK)
158
Aortic stenosis - most common cause:
younger patients < 65 years: bicuspid aortic valve
| older patients > 65 years: calcification
159
INFECTIVE ENDOCARDITIS
Types of endocarditis and their incidence %?
Native Valve Endocarditis
Prosthetic Valve Endocarditis (10-20%)
IV Drug Abuse Endocarditis (50%)
TYPICALLY MITRAL VALVE THEN AORTIC
160
INFECTIVE ENDOCARDITIS
Risks?
Cardiac Risks?
Age >60
Male
IVDU
Poor dental hygiene
```
Cardiac:
Structural/ valvular HD
Congenital HD
Prosthetic valves
Intravascular devices
```
161
INFECTIVE ENDOCARDITIS
Typical bacterial cause of NVE?
Alpha - haemolytic Strep Bovis (70%)
S.aureus (25%)
162
INFECTIVE ENDOCARDITIS
What is Strep Bovis linked to?
Colorectal cancer
163
INFECTIVE ENDOCARDITIS
What bacteria accounts for 30% of PVE infections?
Likely Bacterial cause within 1 year of prosthetic?
Over 1 year?
Coagulase - negative staphylococcus (CoNS)
such as Staphylococcus epidermidis
<1 year = staph
>1 year = strep
164
INFECTIVE ENDOCARDITIS
What is vegetation made up of?
```
fibrin
platelets
WBCs
RBCs
Clusters of bacteria
```
165
INFECTIVE ENDOCARDITIS
Symptoms and signs?
```
Symptoms:
Fever (90%)
Malaise
weight loss
cardiac symptoms
```
Signs:
regurgitant murmurs (MR and AR)
features of HF
166
INFECTIVE ENDOCARDITIS
classic signs
Janeway lesions (macules on palms/soles)
Osler Nodes (nodules on pads of finger/toes)
Roth spots (lesion on retina with pale centre)
splinter haemorrhages (under nails)
167
INFECTIVE ENDOCARDITIS
Investigations of choice?
Echo
Blood cultures (3 sets with 30 min intervals)
168
INFECTIVE ENDOCARDITIS
Major criteria?
Endocardial involvement with
Typical organisms from two separate blood cultures or persistently positive BCs 12hrs apart
169
INFECTIVE ENDOCARDITIS
Management of Methicillin sensitive staph?
Methicillin resistant?
Sensitive = Flucloxacillin
Resistant = Vancomycin
170
INFECTIVE ENDOCARDITIS
Management of prosthetic?
Add rifampicin and gentamicin
171
INFECTIVE ENDOCARDITIS
Management of strep?
Penicillin G
Amoxicillin
Ceftriaxone or vancomycin
172
INFECTIVE ENDOCARDITIS
Prophylactic for dental procedures
Amoxicillin 2g orally / clindamycin
173
Empirical Abx for NVE or late PVE?
Ampicillin, Fluclox and Gent
OR
Vancomycin, Gent and rifampicin
174
Reversible causes of Cardiac Arrest?
Hypoxia
Hypovolaemia
Hyperkal, hypokal, hypogly, hypocalc
Hypothermia
Thrombosis
Tamponade
Tension pneumothorax
Toxins
175
1st line antiplatelet for following dx:
ACS
PCI
TIA
Ischaemic stroke
PAD
ACS - Aspirin + Ticagrelor
PCI - Aspirin + Ticagrelor or Prasugrel
TIA - Clopidogrel
Ischaemic stroke - Clopidogrel
PAD - Clopidogrel
176
Digoxin monitoring rules?
digoxin level is not monitored routinely, except in suspected toxicity
HOWEVER
if toxicity is suspected, digoxin concentrations should be measured within 8 to 12 hours of the last dose
177
Method of action of Digoxin?
- decreases conduction through the atrioventricular node which slows the ventricular rate in atrial fibrillation and flutter
- increases the force of cardiac muscle contraction due to inhibition of the Na+/K+ ATPase pump.
Also stimulates vagus nerve
178
Which drugs might precipitate Digoxin toxicity?
```
Amiodarone
Diltiazem & Verapamil
Spironolactone
Thiazides and loop diuretics
Ciclosporin
```
179
Management of Digoxin toxicity?
Digibind
180
What electrolyte imbalance causes Digoxin toxicity and why?
- classically: hypokalaemia
digoxin normally binds to the ATPase pump on the same site as potassium.
Hypokalaemia → digoxin more easily bind to the ATPase pump → increased inhibitory effects
181
Digoxin features?
generally unwell, lethargy, nausea & vomiting, anorexia, confusion,
yellow-green vision
arrhythmias (e.g. AV block, bradycardia)
gynaecomastia
182
Side effects of beta blockers?
```
bronchospasm
cold peripheries
fatigue
sleep disturbances, including nightmares
erectile dysfunction
```
183
Side effects of CCBs?
Headache
Flushing
Ankle oedema
184
Side effects of Bendroflumethiazide?
Gout
Hypokalaemia
Hyponatraemia
Impaired glucose tolerance
185
How to distinguish between mitral and tricuspid regurgitation murmur?
Both pansystolic
BUT
tricuspid regurgitation becomes louder during inspiration, unlike mitral which is louder on expiration
aortic is also louder on expiration
