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1 General Practice > Cardiac > Flashcards

Cardiac Flashcards

1
Q

Which device is surgically implanted for prophylaxis of VT and VF?

A

implantable cardioversion device ICD

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2
Q

What is the immediate management for suspected ACS and in pain NOW

A

GTN
opioid
aspirin
measure oxygen sats

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3
Q

List two features of typical angina

A
  1. pain/discomfort in chest/neck/shoulders/jaw/arm
  2. Pain precipitated by exercise
  3. pain relieved by rest or GTN spray within 5 mins
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4
Q

Define atypical features

A

2/3 features of TYPICAL angina (GTN relief, exercise precipitation, chest discomfort)

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5
Q

List two drugs for symptomatic relief of angina

A

GTN and beta blockers

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6
Q

List two drugs from secondary prevention in angina

A

aspirin
statin
ACEi

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7
Q

If there is diagnostic uncertainty with chest pain/angina history, which test should be conducted?

A

CT coronary angiogram
(NOT exercise tolerance test)

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8
Q

What is the advice for using GTN spray?

A

one puff, if pain doesn’t resolve within 5 mins then take a second puff. If pain doesn’t go away in 5 mins then dial 999

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9
Q

What is the first line treatment in AF?

A

rate control
beta blocker OR rate limiting CCB

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10
Q

When would you employ rhythm control?

A

younger patient
structurally normal heart?

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11
Q

List two examples of rate limiting CCB

A

diltiazem or verapimil

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12
Q

In which group of patients should CCB be avoided?

A

heart failure

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13
Q

Pill in the pocket approach is used for which AF? What is the drug?

A

paroxysmal- flecainide

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14
Q

What are the components of CHA2DS2Vasc?

A

CHF
HTN
Age- 65-74=1, >75=2
Diabetes
Stroke/TIA= 2
Sex female
Vascular disease

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15
Q

What is the treatment for heart failure?

A

Step 1. ACEi/ARB
Beta blocker

+

Step 2. Mineralcorticoid receptor antagonist

Step 3. Gliflozin if symptoms persist

+ diuretic if fluid overloaded

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16
Q

Aside from drug therapy, list two other management options for heart failure

A

monitor depression + treat
stop smoking
immunisations- flu and pneumococcal
cardiac rehab
anaemia
anticoagulation

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17
Q

What is a serious complication of mineralcorticoid receptor antagonists? e.g. spironolactone, eplerenone

A

hyperkalaemia!

18
Q

At a 6 monthly GP review for heart failure, list three things you should cover?

A

screen for anxiety and depression
BP + fluid status
rhythm check- pulse
renal function
review medication and side effects

19
Q

Is exercise recommended in those with heart failure?

A

no…

20
Q

Which heart failure category must inform DVLA?

A

NYHA Class IV

21
Q

What is classes as normotensive?

A

<140/90

22
Q

Red flags that warrant same day referral for severe hypertension? >180/120

A

papilloedema/retinal haemorrhages
suspected phaeochromocytoma
chest pain, new confusion, AKI

23
Q

In a patient with postural hypotension, which BP reading should you used to monitor treatment- sitting or standing?

A

standing!

24
Q

In which stage of hypertension do you offer drugs regardless of age, diabetes etc

A

stage 2- >150/95

25
Q

Which antihypertensive to use in stage 2 HTN patient with diabetes?

A

Diabetes trumps everything.

ACEi/ARB

african- ARB due to lower angioedema risk

26
Q

African origin stage 2 HTN patient. Which antihypertensive?

A

African/carribean ethnicity trumps everything EXCEPT diabetes

CCB

27
Q

Patient has heart failure. Which antihypertensive drug?

A

thiazide-like diuretic + ACEi

(not CCB)

28
Q

What is QRISK?

A

QRISK3 (the most recent version of QRISK) is a prediction algorithm for cardiovascular disease (CVD) that uses traditional risk factors (age, systolic blood pressure, smoking status and ratio of total serum cholesterol to high-density lipoprotein cholesterol) together with body mass index, ethnicity, measures of deprivation, family history, chronic kidney disease, rheumatoid arthritis, atrial fibrillation, diabetes mellitus, and antihypertensive treatment.

29
Q

Antiplatelet used for heart related secondary prevention e.g. angina, IHD?

A

aspirin
(post-MI aspirin + another agent for 12 months)

30
Q

Antiplatelet agent used for non heart, cerebrovascular and vascular conditions? e.g. TIA, peripheral arterial disease

A

CLOPIDOGREL

31
Q

Antiplatelet agent used for multivascular disease e.g. stroke and IHD?

A

2 antiplatelets
clopidogrel + aspirin

32
Q

How to reduce secondary risk for stroke AND MI/angina…

A

BP control
statins
ACEi

33
Q

Which score is useful to determine whether to implement statin?

A

QRISK2 of 10% or more

34
Q

List one case where statins are always recommended?

A

over 85
chronic kidney disease

35
Q

List two side effects of statins

A

myalgia
liver damage
confusion
increase BM or risk of T2DM

36
Q

Which food item is said to interact with statins

A

grapefruit juice…very rare to have serious complication of rhabdo

37
Q

What is the guidance for DVT investigation?

A

Step 1: If Well’s score unlikely- D dimer

Step 2 : If D dimer positive, proximal leg USS

If DVT is likely (Well’s score >2) then do USS. If negative then do D dimer

38
Q

List three components that score on Well’s score for DVT (separate score for PE)

A

cancer
previous DVT/PE
immobility
bed bound >3days or surgery in last 12 weeks
entire leg swollen
pitting oedema confined to one leg
collateral superficial veins

39
Q

List three components of Well’s score for PE

A

immobilisation/surgery
cancer
previous DVT/PE
haemoptysis
clinical signs/symptoms of DVT

40
Q

What is the treatment of DVT/PE?

A

anticoagulation- apixaban or rivaroxaban

41
Q

List two factors that ‘provoke’ VTE

A

surgery
trauma
significant immobility
pregnancy
HRT or OCP

42
Q

What is the best prophylaxis for VTE?

A

rivaroxaban

1 General Practice (15 decks)

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