Cardio Flashcards
1) What makes up stroke volume
2) What is the frank starling law in relation to the heart
3) Criteria for reduced and preserved ejection fraction in HF
1) Preload, after load, contractility
2) Increase in stretch (preload) increases the contractility.
3) Reduced = <40% Preserved = >50%
1) 4 symptoms you would expect to see in a pt with HF
2) Following examination how would you initially inx a patient with HF
3) Specific blood tests you would do in a patient with HF. Criteria for urgent and routine referral.
4) Follow up investigation in patients with suspected HF
1) Pitting ankle/sacral oedema. Orthopnea. Paroxysmal nocturnal dyspnoea. Frothy pink sputum. SOB
2) BP. Sats. FBC, U/E. ECG. Trop.
3) BNP >400 = routine (6 weeks). >2000 = urgent referral
4) Echocardiogram
1) 3 stages of management in HF
2) When do you avoid giving ACEI
3) What monitoring and precaution is required in patients on loop diuretics of Aldosterone ant.
1) ACEI (ramipril) or ARB (candesartan). B-clocker (bisoprolol). Aldosterone antagonist Loop diuretics (Furosemide). diuretics only provide symptomatic relief.
2) In patients with valvular heart disease. Until specialist review
3) U/E. They can effect electrolytes. Causing hyponatraemia and Hyperkalaemia
1) Causes of broad complex tachycardias
2) Causes of narrow complex tachycardia
3) Pathology and ECG changes in wolf-parkinson white syndrome
1) Ventricular tachycardia. V-fib. Torsardes de pointes.
2) SVT, Sinus tachycardia, Atrial tachycardia. AF, Atrial flutter.
3) Accessory pathway into ventricles (bundle of kent). Abnormal P waves and delta wave sloped R wave)
1) Management of SVT
2) What do you have to warn the patient of dying before medical management
3) Management of AF in a) Unstable patient. b) Stable patient, with symptoms <48h. C) Stable patient symptoms >48h
1) Valsalva manœuvres. Carotid sinus management. Adenosine (6,12,12,18mg)
2) Warn them of impending doom, about to die feeling. Extreme bradycardia. But short half life so doesn’t last.
3a) DC cardioversion. Sedate patient before hand if needed.
b) pharmacological cardioversion with flecainide or amiodarone. DC cardioversion
c) Rate controle. Atenolol 50mg.Or cardioselective CCB - diltiazem or verapamil.
Management of broad complex tachycardia
A-E assessment. Attach pads - assess trace Treat reversible causes Amiodarone 300mg IV over 10-50min If torsades de point 2g of IV Mg DC shocks. Give adrenaline 1mg IV after 3rd shock and then every 3-5 minutes after.
additional drug given in Torsades de point
IV magnesium 2g
Patient presents with crushing chest pain radiating to jaw and left arm.
1) 3 other symptoms you might expect.
2) Initial inx to do.
3) The initial troponin comes back at 22. What do you do?
4) 2 features on an ECG of an STEMI
5) 3 features on an ECG of an NSTEMI
1) Nausea, sweating clammy. SOB
2) ECG and serial troponin
3) Repeat Trop in 3 hours is ECG normal. ECG changes likely to be an MI.
4) New LBBB. ST elevation
5) ST depression. T wave inversion. Pathological Q waves
Management of STEMI
1) Drugs to give
2) Time frame for PCI - what to do if this is not met
3) 3 anticoagulation measures
1) Morphine titrated to manage pain. Nitrates (GTN). Aspirin 300mg.
2) 2 hours. If not met consider thrombolysis. Alteplase or streptokinase .
3) Aspirin 300mg and tricagrelor 180mg.
The LMWH prior to PCI. Then glycoprotein IIa/IIIb may be given at time of PCI
1) Management of NSTEMI
2) How to determine risk of mortality and need for PCI in NSTEMI patients
B - beta blocker A - aspirin (300mg) T - tricagrelor 180mg M - Morphine A - Anticoagulate - Fondaparinux N - Nitrates
2) GRACE score
Long term medical management post MI
6 As
Atorvastatin Atenolol (or another B blocker) Aspirin (75mg) Another antiplatelet (clopidogrel 75mg for 12/12) ACEI Aldesterone antagonist (if clinical HF)
Complications of MI
D - death R - rupture E - heart failure (oedema) A - arrhythmia/aneurysm D - dresslers syndrome
Medical management for stable angina
Risk control:
Aspirin 75mg
Statin
ACE-I
Symptom control:
Beta blocker (bisoprolol) or and CCB (amlodipine)
GNT spray
Patient presents with sudden acute pleuritic chest pain and SOB.
1) one cardiac and one resp DD. How would you expect position of the patient to affect the pain in the cardiac DD.
2) 4 causes of likely cardiac diagnosis
3) 3 inx and results. 2 signs you would expect to see.
4) Complication of disease
5) Management
1) resp = PE. Cardiac = pericarditis. pe would have low sats, pericarditis has ECG changes.
2) Autoimmune (RA, SLE). Uraemic. Dresslers syndrome, Infection (Coxsackie B, TB).
3) ECG = ST elevation across all leads. Raised WCC and CRP.
4) Cardiac tamponade - fluid build up in pericardial space. Restriction of heart pumping. Cardiac failure and arrest.
5) NSAIDs - ibuprofen 600mg TDS + ppi
colchicine 2-3mg loading dose then 0.5mg BD
you are bleeped to see 87yo lady has sudden onset SOB + low sats. On examination you note a 3rd HS.
1) What other signs would you expect to see on examination given the likely diagnosis
2) 4 causes
3) 4 investigations
4) 3 things seen on x ray
5) Management
1) Acute LV failure. Bibasal crackles. Dull percussion at bases. R failure would lead to peripheral oedema and raised JVP as well.
2) Iatrogenic (too much fluids). Sepsis. MI, Arrhythmias
3) ECG - look for ischemic changes. ABG - T1RF. BNP raised. Trop if MI suspected. CXR.
4) Kerly B lines. Costophrenic blunting bilaterally. fluid in interlobular fissures
5) Stop fluids. Fluid balance and fluid restriction. O2 if sats <95%. IV furosemide 40mg stat dose then titrate.
1) Cause of cor pulmonale. Pathophysiology and diseases.
2) 4 signs of cor pulmonale
1) R sided heart failure due to pulmonary hypertension. COPD most common cause. Other interstitial lung diseases and PPH.
2) oedema, low sats, cyanosis, 3rd HS, hepatomegaly, mitral-regurg causes a pan systolic murmur.
