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Year 5 notes > Cardio > Flashcards

Cardio Flashcards

1
Q

what electrolyte disturbance can be a poor prognostic factor in ACS

A

hyperglycaemia

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2
Q

when does troponin (T and I) increase, peak and decrease after MI

A
  • increases within 3-12 hours after MI
  • peaks at 24-48 hours
  • decreases at 5-14 days
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3
Q

type of MI which can cause hypotension vs hypertension

A
  • hypotension = inferior MI

- hypertension = anterior MI

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4
Q

dose of morphine in MI

A

2.5-10mg slow IV bolus

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5
Q

when is PCI given in STEMI

A

if on-going ischaemia and within 12 hours of onset

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6
Q

when is thrombolysis given in STEMI

A

if PCI can’t be delivered within 120 mins

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7
Q

examples of thrombolysis for STEMI

A
  • streptokinase/ tenecteplase/ reteplase
  • or LMWH, fondaparinux

do ECG 90 minutes after to assess if >50% resolution of ST elevation - if not might consider rescue PCI

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8
Q

when is CABG indicated in STEMI

A

if PCI fails

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9
Q

how is GRACE score used in STEMI

A

if >3% = undergo coronary angiography within 96 hours of admission
- otherwise will have at a lower date

also give fondaparinux - LMWH if angiography likely within 24 hours

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10
Q

ECG criteria for PCI

A
  • chest pain AND
  • ST elevation >1mm in 2 limb leads OR
  • ST elevation >2mm in 2 contiguous chest leads OR
  • new LBBB in presence of typical history of acute MI
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11
Q

artery for inferior MI

A

right coronary artery (II, III aVF)

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12
Q

artery for anterior MI

A

left anterior descending (V1-V4)

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13
Q

artery for lateral MI

A

left circumflex artery (I, V5, V6)

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14
Q

drugs to take after ACS

A
  • dual platelet therapy (aspirin plus clopidogrel/ticagrelor for up to 12 months)
  • beta blocker
  • statin
  • ACE inhibitor
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15
Q

when to NOT do ABPM/HBPM in diagnosis of HTN

A

if severe - >180/110

treat on day

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16
Q

definition of isolated systolic HTN

A

> 160/<90

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17
Q

how to do HBPM

A
  • twice a day for 7 days
  • each must be done twice at least 1 min apart
  • discard readings for day 1
  • take average of rest
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18
Q

electrolyte disturbances in thiazide-like diuretics (indapamide)

A
  • hyponatraemia

- hypokalaemia

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19
Q

when can you use spironolactone as a 4th line antihypertensive option

A

if K+ level <4.5mmol/l

if >4.5mmol/l = give higher dose thiazide-like diuretic or add alpha/beta blocker

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20
Q

ejection fraction in systolic vs diastolic heart failure

A
  • systolic = <40%

- diastolic = >50%

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21
Q

BNP results in heart failure

A

> 400 = high

<100 = consider alternative diagnosis

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22
Q

New York classification of heart failure

A

1 = heart disease, no undue dyspnoea from normal activity

2 = comfortable at rest, dyspnoea on normal activity

3 = less than ordinary activity causes dyspnoea

4 = dyspnoea at rest, all activity causes discomfort

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23
Q

when to use a beta blocker in heart failure

A

in all with a LVEF <40%

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24
Q

management of acute heart failure

A

PODMAN

  • position
  • O2
  • diuretics (furosemide)
  • morphine
  • antiemetic
  • nitrates (GTN infusion if SBP>110, 2 puffs spray if SBP>90)
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25
Q

first line management for chronic heart failure

A

ACEi and beta blocker

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26
Q

second line management for chronic heart failure

A

aldosterone antagonist

also ARB/hydralazine + nitrate if still having symptoms

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27
Q

when to consider implantable cardiac devices for chronic heart failure

A

if <35% EF

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28
Q

when to always do an USS doppler regardless of Wells score in DVT

A

pregnant

IVDU

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29
Q

what to do if DVT likely (Wells 2+)

A

USS within 4 hours

if can’t be carried out within 4 hours = D dimer and LMWH while waiting (within 24h)

if unlikely - do D dimer (if positive do USS)

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30
Q

surgery for acute limb ischaemia

A

must be within 6 hours

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31
Q

management for acute limb ischaemia

A
  • surgery/angioplasty within 6 hours
  • anticoagulation
  • atorvastatin 80mg
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32
Q

what drug increases risk of thrombophlebitis

A

amiodarone

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33
Q

management of superficial thrombophlebitis

A

compression stockings

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34
Q

first and second line medications for postural hypotension

A
  • 1st = fludrocortisone

- 2nd = milodrine (alpha receptor antagonist)

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35
Q

drugs which can cause postural hypotension

A
  • diuretics
  • antihypertensives
  • sedatives
  • vasodilators
  • anti-depressants
  • levodopa
36
Q

how often should QRisk2 be assessed in people age 40-85

A

every 5 years

37
Q

medication for stable angina

A

beta blocker/CCB

  • if CCB used alone = verapamil/diltiazem
  • if used with BB = nifedipine

also give:

  • anti platelet (low dose aspirin or clopidogrel)
  • atorvastatin 20mg
  • ACEi if also has diabetes
38
Q

when to give atorvastatin 80mg to people with stable angina (whereas usually is 20mg)

A
  • previous MI/CHD
  • T2DM
  • current ACS symptoms
39
Q

how often to check LFTs when on a statin

A

before treatment, at 3 months and at 12 months

40
Q

what is usually curative of atrial flutter

A

radiofrequency ablation of tricuspid valve isthmus

41
Q

PR interval in first degree heart block

A

> 0.2 seconds

42
Q

most common cause of complete heart block

A

myocardial fibrosis

43
Q

ECG findings of proximal heart block

A

narrow QRS at around 50/min

44
Q

ECG findings of distal heart block

A

broad QRS at around 30/min

45
Q

drugs which can cause SVT

A 
alcohol
caffeine
salbutamol
amphetamines
digoxin
46
Q

most well-known type of AV re-entrant tachycardia (AVRT)

A

WPW syndrome

47
Q

dose of adenosine to give in SVT (after vagal manoeuvres)

A

IV adenosine 6mg, 12mg, 12mg

48
Q

what to give instead of adenosine in asthmatics

49
Q

what can be done to help prevent episodes of SVT

A
  • beta blockers
  • radio frequency ablation
  • valsalva manoeuvre can be taught to patients
50
Q

drugs which can cause polymorphic VT (torsades de pointes)

A
  • TCA
  • fluoxetine
  • amiodarone
  • erythromycin
51
Q

dose of amiodarone to give in VT

A

300mg IV over 60 mins

then 900mg over 24 hours

ideally give through a central line

52
Q

what to do in VT if drug therapy fails

A

implantable cardioverter-defibrillator

53
Q

murmur in mitral regurgitation

A

pansystolic murmur - best heard at apex and radiates to axilla

54
Q

what might be shown on ECG with mitral regurgitation and stenosis

A

bifid p waves - atrial enlargement

55
Q

autoimmune conditions which can cause mitral stenosis (but rheumatic fever and IE most common)

56
Q

murmur heard in mitral stenosis

A

mid-late rumbling DIASTOLIC murmur

57
Q

features of mitral stenosis

A
  • loud S1
  • malar flush
  • AF
  • raised JVP
  • laterally displaced apex beat
58
Q

when to do surgery in mitral stenosis

A

percutaneous mitral commissurotomy (PC)

for symptomatic patients with severe mitral stenosis/pulmonary hypertension - not if mitral valve area >1.5cm^2

59
Q

most common cause of aortic regurgitation

A

bicuspid aortic valve

other causes = rheumatic fever, infective endocarditis, RA/SLE, spondyloarthropathies, HTN, syphilis, Marfan’s, EDS

60
Q

murmur heard in aortic regurgitation

A

early diastolic murmur - high pitched and ‘blowing’

61
Q

pulse pressure in aortic regurgitation

A

wide pulse pressure

collapsing pulse

62
Q

what is Quinke’s sign

A

nailed pulsation - aortic regurgitation

63
Q

what is de Musset’s sign

A

head bobbing - aortic regurgitation

64
Q

most common cause of aortic stenosis in people age >65

A

degenerative calcification

65
Q

most common cause of aortic stenosis in people age <65

A

bicuspid aortic valve

66
Q

what does a S4 heart sound indicate

A

aortic stenosis

67
Q

modified Duke criteria for diagnosis of infective endocarditis

A
  • 2 major
  • 1 major and 3 minor
  • 5 minor
68
Q

difference between true aneurysm and pseudo aneurysm

A
  • true = all 3 layers of artery wall (intima, media and adventitia)
  • pseudo = collection of blood held around vessel by wall of connective tissue, doesn’t involve vessel wall
69
Q

infection which can cause an aneurysm

70
Q

most common site of peripheral aneurysms (outside of intracranial)

A

popliteal (70%)

femoral second most common peripheral

71
Q

type of ulcer associated with varicose veins

A

venous ulcers

72
Q

Fontaine classification of chronic lower limb ischaemia

A
  • stage 1 = asymptomatic
  • stage 2 = intermittent claudication
  • stage 3 = ischaemic rest pain
  • stage 4 = ulceration/gangrene or both
73
Q

type of ulcers associated with lower limb ischaemia

A

arterial ulcers

74
Q

what is Buerger’s test

A

angle at which limb with ischaemia goes pale

<20 degrees = severe ischaemia

75
Q

normal, mild, moderate and severe ABPI

A
  • normal >0.9
  • mild 0.8-0.9
  • moderate 0.5-0.8
  • severe <0.5
76
Q

what can you find on AXR in an AAA

A

calcium deposits where the AAA is (but do USS or CT for diagnosis)

77
Q

prophylactic antibiotics to give in ruptured AAA

A

IV cef and met

78
Q

scanning for stable AAA based on size

A

3-4.4cm = rescan annually

4.5-5.4cm = rescan every 3 months

> 5.5 = refer within 2 weeks to vascular surgery (endovascular stent repair EVAR)

79
Q

what is arrhythmogenic right ventricular dysplasia

A

type of cardiomyopathy - RV myocardium replaced by fatty tissue (AD genetic)

80
Q

what aortic complication can occur was a result of cardiac tamponade

A

ascending aortic dissection

81
Q

what to use to reduce BP in aortic dissection

A

IV labetalol

82
Q

artery usually with the embolus in mesenteric ischaemia

A

superior mesenteric artery - supplies small bowel

83
Q

investigation to do to diagnose mesenteric ischaemia

84
Q

conditions associated with Raynaud’s

A

SLE
RA
scleroderma

85
Q

medical management of Raynaud’s

A

CCB e.g. nifedipine

Year 5 notes (10 decks)

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