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Cardiology (Complications of MI (Tamponade (Low CO, pulses paradoxes,…
Cardiology
Complications of MI
Cardiac arrest - VF
Heart block - if SAN involved
Right ventricular failure - low CO and raised JVP
Tamponade
Low CO, pulses paradoxes, raised JVP, muffled heart sounds
Papillary muscle rupture
New murmur after MI - consider valve replacement
Ventricular septal defect
Pansystolic murmur, raised JVP, heart failure
Dressler's syndrome
1-3 weeks post MI, recurrent pericarditis, pleural effusions, fever, anaemia and raised ESR - treat with NSAIDs
Left Ventricular Aneurysm
4-6 weeks post MI, persistent ST elevation, LVF, recurrent VT, systemic embolism - anticoagulant and remove
Heart Failure
RHF = Pleural effusion
LHF = Pulmonary oedema
1st line: ACEi + beta-blockers + Diuretics
2nd line: Add Spironolactone or Hydralazine + isorbide dinitrate
3rd line: Digoxine or cardiac resin therapy
Acute heart failure: Loop diuretic (furosemide), morphine, GTN, O2, sit up - POD MAN
Mitral regurgitation
Asymptomatic - monitor
If fast AF - beta blocker
Diuretic - improve symptoms
Abx if IE
Replace valve if a) Acute, b)Evidence of LV remodelling
Aortic Stenosis
Asymptomatic and valvular gradient <40mmHg
Review regularly
Asymptomatic but gradient >40mmHg
Plus feature of left ventricular dysfunction - consider surgery
Symptomatic
Valve replacement
Ballon valvuloplasty limited to patients with critical AS not fit for replacement
NSTEMI
MONA + fondaparinux 2.5mg SC
High risk - GPIIb/IIIa infusion refer for PCI in 72h (in 24h if score >140)
Low risk - Discharge if repeat trop -ve, start secondary prevention drugs, arrange stress test and angio
Heart muscle disease
Myocarditis
idiopathic, infection or drugs
flu-like prodrome followed by chest pain, fever, palpitations, tachypnoea
ECG looks like MI with AV block
+ve trop
Supportive treatment
Pt recover or get crashing HF
HOCM
FH of sudden death young
Jerky pulse, double apex beat, ESM
Can present with death (VT) or syncope
Don't
exercise test
Beta-blocker,calcium channel blocker, anticoagulant, Septal myomectopy or transplant
Pericarditis
Secondary to infection
Pericardial Rub
Chest pain relieved on sitting forward
NSAIDs + colchicine
STEMI
Urgent PCI if available - fibrinolysis of PCI not available and transfer to PCI centre ASAP
CABG
Left main stem disease
Triple vessel disease
Unsucessful = angioplasty
Cardiomyopathies
Dilated
Most common (flabby dilated heart - get systolic dys); alcohol, postpartum, viral, autoimmune associated; heart failure signs, S3; bed rest, digoxin, anticoags, ACEi, pacing - transplant
Restrictive
Stiff heart - diastolic days; amyloidosis, haemochromotosis, sarcoidosis, scleroderma, feature of RVF (raised JVP, hepatomegaly, oedema ascites, S4) - Treat cause
CHA2DS2 VASc
1 - Consider anticoagulant if male; 2 or more - Anticoag