4th Year Extra bits Flashcards
what is the QRISK2 score?
scoring system used to assess risk of CVD
who should get their QRISK2 score done?
84 years and younger
diabetics
renal disease?
hypertension management pathway
- ACEI/ ARB or CCB
- ACEI/ARB + CCB
- ACEI/ARB + CCB + thiazide-like diuretic
- K+ >4.5mmol/l beta or alpha blocker, if K+ <4.5mmol/L spironolactone
lifestyle management in hypertension
low salt diet reduce caffeine stop smoking reduce alcohol diet exercise weight loss
management of malignant hypertension
IV labetalol/ GTN
presentation of malignant hypertension
men in 5th decade HA vomiting visual disturbance convulsions papilloedema
in hypertension and diabetes what is first line management for all regardless of age?
ACEI/ ARB
what QRISK2 score should atorvastatin 20mg be started?
10% or greater
what dose of atorvastatin should be started in QRISK 10% or greater in those with CVD?
80mg
monitoring when starting statins?
recheck lipid level at 3 months to check for >40% reduction
what to do if >40% reduction not achieved?
check compliance
diet advice/ lifestyle
increase dose (80mg is max)
what is normal lipid level?
<10mmol/L
who should be offered atorvastatin 20mg?
type 1 diabetics
CKD
CVD
check QRISK2 in type 2
warnings to give when starting statins?
grapefruit juice interaction
muscle pain prior to starting
if muscle pains develop seek medical advice
when are statins CI?
pregnancy
what are Osler’s nodes?
tender on ends of fingers and toes
what are Janeway lesions?
non-tender lesions on palms and soles
Duke’s criteria for endocardtiis diagnosis
2 major, 1 major + 3 minor, or 5 minor for diagnosis
Major= blood culture positive for typical organism or persistently positive and evidence of endocardial involvement
Minor= fever, previous heart condition or IVDU, immunological phenomena, vascular phenomena or positive blood culture with atypical bacteria.
immunological phenomena in endocarditis
Osler’s Roth GN clubbing petechiae arthralgia
vascular phenomena in endocarditis
mycotic aneurysms janeway septic emboli intracranial haemorrhage visceral infarct splinter haemorrhages
grading angina
I = angina on strenuous or prolonged exertion II = slight limitation in ordinary activity, angina in moderate activity III = marked limitation of ordinary, angina on mild IV = unable to carry out activities without angina, may occur at rest
what is decubitus angina?
precipitated by lying flat
what is variant/prinzmental angina?
coronary artery spasm
management of ischaemic stroke
thrombolysis within 4.5 hours of onset
thrombectomy within 6 hours (or 24 if limited infarct core volume)
aspirin 300mg for 2 weeks (+ PPI if needed)
dosage of aspirin in MI
300mg
management of MI
MONA +C/T (clopidogrel if high risk of bleeding, ticagrelor if no risk)
PCI within 12 hours + 120 minutes (72 hours if NSTEMI or unstable angina)
thrombolysis if >120 minutes
long-term management post-MI
aspirin (lifelong+ PPI if needed, if sensitivity give clopidogrel) beta blocker (12 months, unless reduce LVEF then lifelong) ACEI/ ARB (check renal function before and 1-2 weeks after) statin (life-long, started within 48 hours)
what is Beck’s triad?
muffled heart sounds
low BP
raised JVP
seen in pericardial effusion
who always gets ACEI first line for BP no matter ethnicity or age?
diabetics
management of acute heart failure
IV loop
additions= oxygen, nitrates, CPAP, dobutamine, NE
management of chronic heart failure
first line= ACEI + beta blocker
2nd= spironolactone
3rd= digoxin/ ivabradine/ enestero
bradycardia management
atropine 500mcg IV
pacing
a wave in JVP
atrial contraction
x waves in JVP
relaxation of atria
c wave in JVP
systolic contraction
v wave in JVP
right atrium fills with blood
y wave in JVP
tricuspid valve opens
indications for CABG
severe angina unresponsive to medical therapy marked ST depression on exercise ECG left main stem stenosis severe triple vessel disease angina with left ventricular dysfunction
indications for temporary pacing
unstable bradycardia not responding to atropine
post-anterior MI with heart block
trifascicular block prior to surgery
management of warfarin in bleeding
- Major bleeding= stop warfarin, give vit K 5mg IV and prothrombin complex concentrate
- INR >8.0 minor bleeding/ no bleeding= stop warfarin, give IV vit K 1-3mg, repeat if still high after 24 hours. Restart warfarin when INR <5
- INR 5-8 minor bleeding= stop warfarin, give IV vit K 1-3mg and restart when <5.0
- INR 5-8 no bleeding= withhold 1 or 2 doses, reduce maintenance dose
when is valve replacement indicated?
symptomatic
gradient >40mmHg
constrictive pericarditis sign?
Kussmaul’s sign (raised JVP that does not fall with inspiration
what to do if the cardiac arrest if witnessed on monitor?
3 successive shocks then CPR
MI medically treatment instead of PCI/ thrombolysis
aspirin + ticagrelor + fondaparinux (+ nitrates if BP good)
who should be offered atorvastatin 20mg?
QRISK2 score >10%
if already CVD give 80mg
when to recheck lipids after starting a statin?
3 months later aiming for >40% reduction (if not chat about lifestyle and consider dose increase - max is 80mg)
who should be considered for 20mg statins without lipid check?
diabetics
CKD
warnings in statin use?
grapefruit juice
muscle pain - doctor + check CK
what are statins CI in?
pregnancy
timing for PCI
2hours
long-term management of MI
aspirin (+ PPI - if cannot tolerate use clopidogrel) beta blocker (metoprolol) for 12 months, if LVEF then lifelong ACEI/ARB (check renal function before and 1-2 weeks later) statin lifelong
rate control CCB (dipyramindaole??)
verapamil
nifedipine
