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Finals Revision - Last Min > Cardio > Flashcards

Cardio Flashcards

1
Q

When is a patient unstable in arrhythmia?

A
  • shock
  • syncope
  • MI
  • heart failure

-> DC cardiovert

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2
Q

Cardioversion if AF<48 hours?

A

Heparinise

Electrical - DC

OR

Amiodarone or Flecainide

(not flecainide if structural damage)

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3
Q

Factors favouring rate (2)/rhythm (4) control strategy in AF?

A

Rate - age >65, Hx of IHD

Rhythm - age <65, symptomatic, first presentation, CCF

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4
Q

What tests should be done before starting amiodarone?

Monitoring after this?

A

TFT, LFT, U&E, baseline CXR

TFT and LFT every 6 months

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5
Q

Blood pressure targets for clinic and ABPM for someone:
<80 y/o?
>80 y/o?

A

<80:
clinic - <140/90
ABPM - <135/85

> 80:
clinic - <150/90
ABPM - <145/85

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6
Q

Antihypertensive causing constipation and abdo pain?

A

Thiazides (hypercalcaemia)

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7
Q

3 criteria for angina?

What is atypical angina?

A
  1. Constricting discomfort in chest, neck, shoulders, jaw or arms
  2. Brought on by physical exertion
  3. Relieved within 5 mins by GTN spray

Atypical angina - 2/3 of these - e.g. if pain is ‘stabbing’ instead of ‘constricting’ (more common in women and diabetics)

If only 1/3 - non-anginal chest pain

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8
Q

Angina pectoris treatment ladder?

A

All patients should receive aspirin 75mg, a statin and GTN (unless CI)

  1. B-blocker or rate-limiting CCB
  2. Once at max dose, add second drug:
    B-blocker + dihydropyridine CCB
  3. If still symptomatic, refer for assessment for PCI/CABG and add a 3rd drug:
    - ivabradine (funny current HCN channel blocker)
    - long-acting nitrate
    - nicorandil (K channel opener/NO activity)
    - minoxidil (K channel opener/NO activity)
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9
Q

If thrombolysed MI, what is next management?

A

Re-check ECG for signs of improvement after 90 mins, if none then organise transfer for PCI

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10
Q

Which type of MI most commonly causes AV block?

A

Inferior

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11
Q

Sign of LV aneurysm?

A

Heart failure, persistent ST elevation

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12
Q

Sign of LV free wall rupture?

A

1-2 weeks after

Raised JVP
Pulsus paradoxus
Diminished heart sounds

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13
Q

What type of MI causes mitral regurg?

Signs

A

Infero-posterior

Acute hypotension and pulmonary oedema
Early-mid diastolic murmur

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14
Q

2 main causes of pulsus paradoxus?

A

Tamponade

Severe asthma

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15
Q

Treatment of pericarditis?

A

NSAID + colchicine

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16
Q

What is Kussmaul sign seen in constrictive pericarditis?

3 other signs?

A

Rise in JVP during inspiration

Pericardial knock (s3)
Signs of RV failure
CXR - pericardial calcification

17
Q

Typical presentation of myocarditis?
Bloods?
ECG?

A

Young person, acute chest pain, dyspnoea, may go into arrhythmia

Raised cardiac enzymes and BNP
Can cause ST elevation/T inversion

18
Q

Diagnosis of chronic heart failure?
What causes release of BNP?
What is its physiological effect? (4)
What to do if raised/high levels?

A

BNP and NT-proBNP

BNP:
Normal <100
Raised 100-400
High >400

NT-proBNP:
Normal <400
Raised 400-2000
High >2000

Released by LV myocardium in response to strain
- causes vasodilation, diuresis, natriuresis, and suppresses RAAS

Raised: specialist assessment within 6 weeks

High: specialist assessment within 2 weeks

19
Q

Treatment ladder of chronic heart failure?

Other treatments these patients should get?

A

All patients start on:
ACEI + B1-blocker

2nd line: aldosterone antagonist
(careful as these + ACEI can cause hyperkalaemia)

3rd line options - to be started by specialist:

  • Ivabradine
  • Digoxin
  • Hydralazine
  • Sacubitril-Valsartan
  • Cardiac resynchronisation therapy

Other things:
- annual influenza vaccine
- One off pneumococcal vaccine
(asplenic or CKD patients need booster every 5 years)

20
Q

What is subclavian steal syndrome?
Presentation? (2)
Rx? (1)

A

Subclavian stenosis proximal to the origin of the vertebral arteries - resulting in retrograde blood flow from the vertebral arteries to the arm during exercise

Presentation:

  • Dizziness/vertigo during exercise
  • Concurrent arm pain

(typically posterior circulation symptoms)

Rx: stent

21
Q

3 cyanotic heart defects?

A

Tetralogy of Fallot
Transposition of Great Arteries
Tricuspid atresia

TOF more common but usually present at 1-2 months
TGA more commonly recognised at birth

22
Q

How to determine if neonatal cyanosis is of cardiac origin?

What to do as initial supportive management if it is ductal dependent?

A

Nitrogen washout test - give 100% O2 for 10 mins then do ABG, pO2 <15kPa indicates cardiac cause

If duct-dependent give PGE2

23
Q

3 drugs to avoid in HOCM?

A

ACEI
Nitrates
Inotropes

24
Q

Presentation of aortic dissection?
Ix?
Type A management?
Type B management?

A

BP variation >20mmHg between arms
Hypertension
Aortic regurg if ascending aorta
TEARING pain

IX: CT angiography CAP
Trans-oesophageal echo if unsuitable/unstable

Type A - ascending - surgical management but maintain BP 100-120 systolic before

Type B - conservative, IV labetalol

25
Q

Which drug is assoc w GI ulcers and can cause perforation?

A

Nicorandil

26
Q

ECG changes and arteries for MI:

  • Anteroseptal?
  • inferior?
  • anterolateral?
  • lateral?
  • posterior?
A

anterolateral:
- V1-V4
- LAD

inferior:

  • II, III, aVF
  • RCA

anterolateral:

  • V4-V6, I, aVL
  • LAD or Left Circumflex

Lateral:

  • I, aVL +/- V5-V6
  • Left circumflex

Posterior:

  • Tall R waves V1-V2
  • May cause ST depression
  • Circumflex or Right Coronary

Isolated new onset LBBB may also point to MI

27
Q

What can raise and reduce BNP?

A

Raise - CKD (eGFR <60), and ACEI/ARB

Lower - Diuretics

28
Q

In VF/VT arrest, what is the shock:CPR ratio?
When is it changed?
When should adrenaline and amiodarone be given?
What is an alternative if amiodarone not available?
When should adrenaline be given for non-shockable rhythm?

A

Single shock followed by 2 mins CPR

If witnessed on a monitor e.g. in CCU - 3 quick shocks can be given in succession followed by 1 min CPR

Adrenaline: after the 3rd shock (not stacked) then every 3-5 mins after

Amiodarone also after 3 shocks and after 5 shocks

Lidocaine is alternative to amiodarone

In non-shockable rhythm, give adrenaline ASAP and every 3-5 mins after

29
Q

CI adenosine?

A

Asthma

30
Q

4 week old infant presents with poor feeding, on exam tachycardia, tachypnoea, hypertension and weak femoral pulses, no cyanosis. Systolic murmur best heard at left sternal edge?

A

Coarctation of aorta

31
Q

What is stage 1, stage 2 and severe HTN?
When to start medication?
What are BP targets?

A

Stage 1 - ABPM >135/85
Stage 2 - ABPM >150/95
Severe - clinic BP >180/110

Stage 1 - treat only if <80 y/o and Q-RISK >10%, or evidence of organ damage
Stage 2 - start medication for all

Targets: 135/85 if <80, 145/85 if >80

Finals Revision - Last Min (12 decks)

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