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31 Cards in this Set
- Front
- Back
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Coarctation repair |
Late presenting recoarctation Needs trop +/- angiography |
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Digoxin toxicity |
ECG - Premature ventricular beats (most common) - sinus bradycardia - bigeminal/trigeminal rhythm - bidirectional VT Hyperkalemia Digifab Mg - suppresses ventricular arrhythmia Lidocaine/phenytoin - suppress ventricular automaticity, delay afterdepolarisation without depressing AV conduction |
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Long QT syndromes |
Treatment: beta blocker |
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Valve surgery |
Aortic stenosis: Valve gradient 50-60mmHg requires aortic valve replacement - bioprosthetic valve (no warfarin needed but wears out quickly) - metal valve (needs warfarin but lasts longer) - balloon valvuloplasty (reserved for patients unsuitable for surgery) - important to have cardiac catheter angiography (more accurate than CT coronary angiography which may overestimate the burden of atheroma in aortic stenosis)
Aortic regurgitation - if symptomatic or - if EF<50% + LVEDD>70mm/ LVESD>50mm |
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SVT with RBBB/LBBB |
How to differentiate? |
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Dresslers syndrome |
Pleural rub Cardiomegaly Pleural effusion Treat with Aspirin 650mg QDS |
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Xanthoma association |
Tendons - familial hypercholesterolemia Palmar - hyperlipoproteinaemia, biliary cirrhosis |
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Group 2 driver |
ACS - stop driving until exercise tolerance test in 6 weeks (after stopping anti-anginal eg nitrates, beta blockers or CCB) |
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Pericarditis |
Acute Chronic - a form known as constrictive pericarditis (tuberculous pericarditis is the commonest cause) Recurrent pericarditis - consider autoimmune screen |
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Ventricular pauses |
If >3 seconds will need referral for pacemaker |
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Bradycardia |
Atropine - use when patient is symptomatic or very low HR
Transcutaneous pacing - less effective and more painful than transvenous pacing, used as interim in symptomatic bradycardia if transvenous pacing is not immediately available
Transvenous pacing - should be considered if patient is asymptomatic while waiting for pacemaker |
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Primary pulmonary hypertension |
CCB - first line, use only if positive vasodilator test Endothelin antagonist eg bosentan PDE5 inhibitor eg sildenafil/ prostacyclin |
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Brugada syndrome |
ST elevation in V1-3 and RBBB Recurrent VT/VF at rest, heavy meals, during sleep, fever or alcohol ICD - treatment of choice Quinidine - if multiple firing of ICD in a day due to VF storm |
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Indication of Electrophysiology study |
To determine whether one would benefit from ablation or ICD |
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Anticoagulants post-cardioversion |
LMWH while warfarinised, rv warfarin in one month due to the risk of AF relapsing |
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Stress echo (exercise/dobutamine) |
Not useful if: - conduction abnormality eg WPW - resting ECG abnormal to begin with - on digoxin - ventricular paced |
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Carotid sinus hypersensitivity |
Type 1A causes bradycardia, needs dual chamber pacemaker Type 1B causes hypotension, no effective treatment but may try stockings, fludrocortisone, midodrine |
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Indication for permanent pacemaker |
- complete heart block - symptomatic 2nd deg HB - Type 2 2nd deg HB (even if asympt) - pauses >3sec |
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Indications for ICD |
- cardiac arrest due to VF or VT not due to a reversible cause - spontaneous sustained VT - unexplained syncope with VT inducible at EPS - non-sustained VT with prior MI |
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Flecainide Vs amiodarone for pharmacological cardioversion of AF |
Flecainide is more effective than amiodarone however flecainide is contraindicated in structural heart abnormalities eg heart failure |
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CRT indication |
- EF<35% - main indicator is QRS >120ms eg bundle branch block. Ie in a dys-synchronous LV - drug refractory symptoms |
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Cardiotoxic cardiomyopathy |
Especially anthracyclines Repeat ECHO |
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Lutembacher syndrome |
ASD + Mitral Stenosis leading to Eisenmenger syndrome Generally presents late |
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Bicuspid aortic valve |
Most common valve abnormality M>F Associated with calcification, Coarctation/aortic aneurysm, aortic stenosis Most observed cardiac defect in Turner's syndrome Needs annual CT/MRI to assess aortic diameter |
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Rheumatic fever major criteria |
Migrating polyarthritis Carditis Erythema marginatum Sydenham's chorea Subcutaneous nodules |
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Trifascicular/bifascicular block |
For pacemaker Bifascicular - RBBB + LAD Trifascicular - RBBB + LAD + heart block |
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AF - rate Vs rhythm control |
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Takotsubo cardiomyopathy |
ECG - ST elevation in anterior leads (mimic anterior MI) However NORMAL troponin Base of LV is normal but the remainder of LV is dyskinetic/akinetic |
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Angina regular meds |
Beta-blocker/CCB ISMN Nicorandil Ivabradine Ranolazine |
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Choice of pacemaker |
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S. Bovis group |
S. Gallolyticus S. Infantarius S. equinus UTI, endocarditis, Colorectal ca |
