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
Which drug is assoc w GI ulcers and can cause perforation?
Nicorandil
26
ECG changes and arteries for MI: - Anteroseptal? - inferior? - anterolateral? - lateral? - posterior?
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
What can raise and reduce BNP?
Raise - CKD (eGFR <60), and ACEI/ARB Lower - Diuretics
28
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?
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
CI adenosine?
Asthma
30
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?
Coarctation of aorta
31
What is stage 1, stage 2 and severe HTN? When to start medication? What are BP targets?
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