Cardiac Flashcards by katie louise

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

implantable cardioversion device ICD

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

GTN
opioid
aspirin
measure oxygen sats

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List two features of typical angina

pain/discomfort in chest/neck/shoulders/jaw/arm
Pain precipitated by exercise
pain relieved by rest or GTN spray within 5 mins

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Define atypical features

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

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List two drugs for symptomatic relief of angina

GTN and beta blockers

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List two drugs from secondary prevention in angina

aspirin
statin
ACEi

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

CT coronary angiogram
(NOT exercise tolerance test)

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What is the advice for using GTN spray?

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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What is the first line treatment in AF?

rate control
beta blocker OR rate limiting CCB

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When would you employ rhythm control?

younger patient
structurally normal heart?

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List two examples of rate limiting CCB

diltiazem or verapimil

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In which group of patients should CCB be avoided?

heart failure

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

paroxysmal- flecainide

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What are the components of CHA2DS2Vasc?

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

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What is the treatment for heart failure?

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

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

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

hyperkalaemia!

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

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

Is exercise recommended in those with heart failure?

no…

Which heart failure category must inform DVLA?

NYHA Class IV

What is classes as normotensive?

<140/90

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

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

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

standing!

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

stage 2- >150/95

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

Diabetes trumps everything. ACEi/ARB african- ARB due to lower angioedema risk

African origin stage 2 HTN patient. Which antihypertensive?

African/carribean ethnicity trumps everything EXCEPT diabetes CCB

Patient has heart failure. Which antihypertensive drug?

thiazide-like diuretic + ACEi (not CCB)

What is QRISK?

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.

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

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

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

CLOPIDOGREL

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

2 antiplatelets clopidogrel + aspirin

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

BP control statins ACEi

Which score is useful to determine whether to implement statin?

QRISK2 of 10% or more

List one case where statins are always recommended?

over 85 chronic kidney disease

List two side effects of statins

myalgia liver damage confusion increase BM or risk of T2DM

Which food item is said to interact with statins

grapefruit juice...very rare to have serious complication of rhabdo

What is the guidance for DVT investigation?

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

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

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

List three components of Well's score for PE

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

What is the treatment of DVT/PE?

anticoagulation- apixaban or rivaroxaban

List two factors that 'provoke' VTE

surgery trauma significant immobility pregnancy HRT or OCP

What is the best prophylaxis for VTE?

rivaroxaban