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44 Cards in this Set
- Front
- Back
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Pulsus |
See text |
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JVP |
a, c, v, x, y Cannon a wave: complete heart block, VT, ectopic, nodal rhythm, single chamber ventricular pacing |
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S2, S3, S4 |
S1: MS S2: soft in AS S3: LVF, constrictive pericarditis, MR S4: AS, HCOM, hypertension |
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IE pathogens |
Staph aureus - most common nowadays Strep viridans - most common in developing countries (eg strep mitis, strep sanguinis) Staph epidermidis - <2mth post valve surgery Strep bovis - colorectal ca
Bacteroides fragilis - postcolonic resection, affects right>left heart as bacteria reach the heart through venous return. Treat with metronidazole
Culture negative (BP-CHB) - Brucella - Prior antibiotics - Coxiella burnetii - HACEK - bartonella
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IE prognostic markers |
Poor prognosis - Staph aureus - prosthetic valve - culture negative - low complement |
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LAD vs RAD |
Think logically Memorise only the following: LAD - hyperkalaemia, ostium PRIMUM ASD, obese ppl RAD - ostium SECUNDUM ASD, tall ppl, infant <1yo WPW is usually associated with right sided accessory pathway hence it causes LAD, but if it is specified left sided accessory pathway, it would cause RAD instead |
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Heart failure |
Improves prognosis - spironolactone Reduces mortality - all drugs except furosemide which only helps with symptom control Annual influenza vaccine Pneumococcal vaccine |
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Cardiac tamponade vs constrictive pericarditis |
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DVLA |
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Cardiac imaging |
Other imaging for myocardial perfusion - stress ECHO - first-pass contrast MR perfusion (with adenosine or dipyridamole) - MR for stress-induced wall motion abnormalities |
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Diagnosis of stable angina |
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Likelihood of CAD in deciding which investigation to use to diagnose stable angina |
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Recommended diagnostic testing according to likelihood of CAD |
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Unstable angina/NSTEMI |
300mg aspirin + lifelong aspirin Fondaparinux/UFH (the latter is chosen if likely PCI within 24h or creat >265)
Then calculate GRACE score (6mth mortality) and discuss with cardiologist re PCI/CABG
GRACE>1.5%: 300mg clopidogrel up to 12mth (but need to stop 5 days prior to PCI)
GRACE>3%: 3 options - add GPI (eptifibatide/tirofiban) - or abciximab (if offering PCI) - stop heparin, add bivalirudin PCI within 96hours of first admission |
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MOA |
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Verapamil + Beta blocker (no-no) |
Negative chronotropic, inotropic and dromotropic effects |
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Verapamil/Diltiazem Contraindicated in VT |
Verapamil and Diltiazem suppress SA and AV node May lead to VF if used in VT |
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Stable angina vs Prinzmetal angina |
Stable angina - bisoprolol/verapamil/diltiazem/nifedipine/ISMN/ivabradine Prinzmetal angina - amlodipine |
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Post MI heart failure Killips class |
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Restenosis vs thrombosis of stent |
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AF rate vs rhythm control |
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CHA2DS2VASc |
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Long QT causes |
Everything low Jervell-Lange-Nielsen: deafness RomaNO Ward: NO deafness |
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MAT |
Morphologically distinctive P waves Elderly COPD Treatment: correction of hypoxia and electrolyte disturbances, rate-limiting CCB |
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Long QT subtypes |
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ARVC |
Right ventricle - > fibro fatty tissue 2nd most common cause of sudden cardiac death in young after HCOM AUTOSOMAL DOMINANT V1-3 TWI Epsilon wave: terminal notch in QRS ECHO: enlarged hypo kinetic RV within a thin free wall First line: SOTALOL Catheter ablation ICD |
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Naxos disease |
Triad of: ARVC, palmoplantar keratosis, woolly hair AUTOSOMAL RECESSIVE |
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WPW associations |
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Catecholaminergic polymorphic VT (CPVT) |
AUTOSOMAL DOMINANT Ryanodine (RYR2) defect is the most common cause Cause of sudden death Exercise/emotion induced syncope
Treat with beta blockers ICD |
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HCOM |
ESM worse with Valsalva, less with squatting Ass: Freidriech's ataxia, WPW ECHO: MR SAM ASH MR: mitral regurg SAM: systolic anterior motion of the anterior mitral valve leaflet ASH: asymmetric hypertrophy Treatment: ABCDE Amiodarone Beta blockers/ccb (verapamil) Cardioverter defib Dual chamber ppm Endocarditis prophylaxis |
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Restrictive cardiomyopathy |
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Atrial myxoma |
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Valvular problems |
TR - Ebsteins anomaly, carcinoid |
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Risk factors for preeclampsia |
Smoking is not a risk factor |
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Takayasu arteritis |
Asian female Unequal BP in the upper limbs Carotid bruits Intermittent claudication Aortic regurgitation (around 20%) Renal artery stenosis Treatment: steroid |
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Centrally acting antihypertensives |
Methyldopa Moxonidine Clonidine |
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Lipid medications |
Statin - lowers LDL Fibrates - lowers triglyceride Niacin - increased HDL |
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Drugs causing long QT |
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AF + IHD |
If IHD is stable, can stop antiplatelet and stay on oral anticoagulant |
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Factors which alter BNP |
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Wellens syndrome |
Deep TWI in V1-2 Proximal LAD |
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PAH treatment |
If positive vasodilator test: Oral CCB If negative vasodilator test: iloprost/ bosentan/ sildenafil |
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Thick and thin filaments of myocardiocyte |
Thick: myosin Thin: trop, actin, tropomyosin |
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Ticagrelor + ivabradine side effects |
Ticagrelor: SOB? Ivabradine: Transient luminous phenomenon |
