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1. 4th year > Cardio > Flashcards

Cardio Flashcards

1
Q

angina investigation

A

1st line - coronary angiography

also - ECG, exercise ECG, BP, bloods (FBC, U+E, glucose, lipid, TFT, LFT, troponins)

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2
Q

what 2 drugs should people with angina be put on unless contraindicated

A

aspirin and statin

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3
Q

angina 1st line symptom prophylaxis

A

Beta blocker or CCB

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4
Q

angina rapid symptom control

A

GTN

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5
Q

if no response to beta blocker or CCB in angina what do you do

A

switch to the other or use combination

- if using beta blocker use nifedipine as CCB

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6
Q

what drugs can be added to CCB + BB in angina treatment if not responding

A

long acting nitrate - isosorbide mononitrate
ivabradine
nicorandil
ranolazine

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7
Q

definitive treatment angina

A

CABG/PCI

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8
Q

what advice should be given regarding use of GTN

A

o When symptoms develop, stop activity and take GTN spray.
o If no symptom relief, take another spray after 5 minutes.
o If still no symptom relief 5 minutes after this, call 999.
o 8 hours per day nitrate free to avoid tolerance

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9
Q

acute management of suspected ACS

A 
MONA + T
morphine
oxygen
nitrates
aspirin
ticagrelor
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10
Q

when can PCI be given

A

if patient presents within 12 hours of symptom onset and PCI could be given in 120 mins from ECG diagnosis

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11
Q

what should be given prior to PCI

A

further dual antiplatelet therapy

Aspirin + prasugrel (60mg)

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12
Q

if PCI unavailable what can be done

A

thrombolysis

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13
Q

what drug is used in thrombolysis

A

alteplase

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14
Q

what drug is given to patients during PCI

A

heparin

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15
Q

what do you do if ECG 90 mins after thrombolysis fails to show resolution of ST elevation

A

PCI

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16
Q

Post ACS treatment

A 
statin lifelong 
ACEI 
BB
dual antiplatelet
- aspirin 75mg lifelong
- ticagrelor

GTN spray PRN
lifestyle advice
BP/glycaemic control

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17
Q

how long should dual antiplatelet treatment be given post ACS

A

aspirin lifelong

ticagrelor 3 months or 4 weeks if no PCI

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18
Q

drug for s/s of HF after ACS

A

spironolactone / eplerenone

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19
Q

acute treatment of NSTEMI

A

same as STEMI

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20
Q

treatment of NSTEMI if ischaemic ECG changes or elevated cardiac markers

A

immediate treatment with fondaparinaux or LMWH

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21
Q

treatment of NSTEMI following confirmation

A

BB

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22
Q

unstable angina treatment upon confirmation

A

BB and LMWH (same as nstemi)

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23
Q

unstable tachycardia treatment

A

1 - DC cardioversion up to 3 times (if applicable)

2 - amiodarone 300mg IV over 10-20 mins

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24
Q

1st line treatment stable SVT

A

1 - vagal manoeuvres

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25
Q

2nd line treatment stable SVT

A

IV adenosine

- if asthma IV verapamil

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26
Q

what is used instead of adenosine in 2nd line treatment stable SVT

A

IV verapamil

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27
Q

treatment stable VT

A

amiodarone loading dose followed by 24 hour infusion

or lidocaine

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28
Q

what drug should NOT be used in VT

A

verapamil

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29
Q

treatment irregular broad complex tachycardia

A

AF with BBB - treat same as unstable narrow/SVT

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30
Q

treatment polymorphic VT

A

IV mag sulf

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31
Q

treatment sinus tachycardia

A

beta blocker

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32
Q

definitive treatment of WPW

A

radioablation of extra pathway

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33
Q

acute AF treatment - heamodynamically unstable

A

emergency cardioversion (rhythm control) DCCV

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34
Q

rate control 1st line in AF

A

BB or CCB (diltiazem)

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35
Q

2nd line rate control in AF

A

digoxin e.g. if HF

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36
Q

what should always be given before rhythm control

A

antiplatelet

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37
Q

1st line rhythm control in AF if evidence of structural heart disease

A

amiodarone 900mg over 24 hours

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38
Q

1st line rhythm control in AF if no evidence of structural heart disease

A

flecainide

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39
Q

when is rhythm control indicated in AF

A

symptoms for < 48 hours or be anticoagulated

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40
Q

if AF > 48 hours how long must someone be taking heparin before cardioversion

A

3 weeks

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41
Q

treatment chronic AF

A

BB or CCB

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42
Q

3rd line treatment chronic AF if BB or CCB not worked

A

digoxin

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43
Q

when would rhythm control be used in chronic AF

A 
	Symptomatic. 
	CCF present. 
	Younger patient. 
	Presenting for the first time with lone AF. 
	Reversible cause
44
Q

what is the drug used in rhythm control in chronic AF

A

sotalol or amiodarone for 4 weeks

45
Q

anticoagulation in AF stroke risk score assessment

A

CHADVASC

46
Q

what drug is used as anticoagulation in chronic AF

A

noac - edoxaban, apixaban, rivaroxaban, dabigatran

47
Q

treatment atrial flutter

A

beta blocker

RFA

48
Q

treatment unstable VT

A

DCCV

49
Q

sustained VT

A

amiodarone central line

50
Q

treatment V fib

A

DCCV

51
Q

what drugs can cause TdP

A

macrolides - clarithromycin etc

52
Q

tx LQTS

A

low risk - lifestyle modifications and beta blockers

high risk- lifestyle + ICD +/- BB

53
Q

unstable bradycardia

A

atropine 500mcg IV repeat up to 3mg at 2-3 min intervals

54
Q

tx mobitz type 1

A

nothing unless associated with haemodynamic instability / collapse
- if so atropine, TC pacing

55
Q

tx mobitz type 2

A

ventricular pacemaker

56
Q

tx 3rd degree heart block

A

ventricular pacing

57
Q

when is HTN treated

A 
stage 2 and above 
or stage one if
 	Diabetes. 
	Renal disease. 
	End organ damage. 
	Established cardiovascular disease. 
	10-year cardiovascular risk > 10%.
58
Q

tx HTN in diabetes

A

ACEI 1st line

59
Q

tx HTN in young patients with diabetes if ACEI not tolerated or may become pregnant or have clear sign of sympathetic drive i.e. sweating, palpitations

A

BB

60
Q

tx pathway HTN < 55 or T2DM

A

1) ACEI
2) ACEI + CCB or ACEI + thiazide
3) ACEI + CCB + thiazide
4) spironolactone (if K<4.5) or alpha or beta blocker if K >4.5

61
Q

tx pathway HTN non diabetics > 55 or afrocarribean

A

1) CCB
2) ACEI + CCB or ACEI + thiazide
3) ACEI + CCB + thiazide
4) spironolactone (if K<4.5) or alpha or beta blocker if K >4.5

62
Q

hypertensive crisis

A

no end organ damage - oral treatment
end organ damage but no LVF - labetolol
end organ damage with LVF - furosemide and hydralazine

63
Q

ix HF

A

raised BNP - 1st line

64
Q

non-pharmacological tx HF

A

weight loss
fluid restrict
salt restrict
exercise

65
Q

1st line tx heart failure

A

ACEI + BB

66
Q

2nd line tx HF

A

spironolactone

67
Q

risk of spironolactone + ACEI

A

hyperkalaemia - monitor

68
Q

3rd line HF

A

digoxin
ivabradine
hydralazine
sacubitril-valsartan

69
Q

acute tx HF

A 
sit up 
high flow O2
furosemide IV
diamorphine IV
nitrates IV 
CPAP

some others find dinner not crucial

70
Q

when should diamorphine not be used in HF

A

COPD

71
Q

ix endocarditis

A

blood cultures from 3 separate sites time and person

1st line imaging TTE

72
Q

imaging in endocarditis if prosthetic valve, vegetations or non-diagnostic image on TTE

A

TOE

73
Q

native valve endocarditis tx

A

amoxicillin and gent

74
Q

severe native valve endocarditis tx or penicillin allergy or MRSA

A

vanc and gent

75
Q

staph aureus endocarditis tx

A

flucloxicillin

76
Q

strep viridans endocarditis tx

A

benzylpenicillin

77
Q

prosthetic valve staph endocarditis tx

A

fluclox + rifampicin + gent

78
Q

prosthetic valve staph endocarditis treatment penicillin allergy

A

vanc + rifampicin + gent

79
Q

enterococcus endocarditis tx

A

amox/vanc + gent

80
Q

prosthetic valve blind endocarditis tx

A

vanc + gent + rifampicin

81
Q

symptom control HOCM

A

Bblockers / verapamil

82
Q

tx arrhythmic right ventricular cardiomyopathy

A

rhythm control - bb / amiodarone

ICD

83
Q

pericarditis tx

A

NSAID and colchicine

84
Q

pericardial effusion tx

A

pericardiocentesis

85
Q

cardiac tamponade tx

A

pericardiocentesis

86
Q

diagnostic ix aortic dissection

A

CT angio CAP

87
Q

tx aortic dissection

A

analgesia and bed rest
type A - open or endovascular repair and maintain BP between 100-120
type B - beta blockers

88
Q

AAA screening

A

all men > 65 - single ultrasound

89
Q

ruptured AAA investigation

A

US

90
Q

ruptured AAA treatment

A

open or endovascular repair

  • infrarenal EVAR
  • suprarenal TVAR
91
Q

AAA < 5.5cm

A

monitor

92
Q

how often do you scan AAA 3-4.4cm

A

yearly

93
Q

how often do you scan AAA 4.5-5.4cm

A

3 monthly

94
Q

first line investigation peripheral arterial disease

A

duplex US

95
Q

tx peripheral arterial disease

A

clopidogrel and statin
lifestyle - exercise beyond pain
surgical - stent, endartarectomy, BPG

96
Q

acute limb-threatening ischaemia investigation

A

hand held doppler examination + ABPI

97
Q

acute limb-threatening ischaemia treatment

A

IV opioid and IV unfractionated heparin

98
Q

superficial thrombophlebitis tx

A

LMWH for 30 days or fondaparinaux for 45

oral NSAID 2nd line

99
Q

DVT treatment 1st line

A

NOAC e.g. rivaroxaban

100
Q

DVT 2nd line treatment

A

LMWH + warfarin or LMWH + dabigatran/edoxaban

101
Q

how long should anticoagulation continue in unprovoked DVT

A

6 months

102
Q

how long should anticoagulation continue in provoked DVT

A

3 months

103
Q

PE treatment 1st line

A

rivaroxaban

104
Q

PE treatment 2nd line

A

LMWH + dabigatran or edoxaban

or LMWH + warfarin

105
Q

when would LMWH + warfarin be used in PE/DVT treatmetn

A

renal failure and APLS

106
Q

HTN treatment in patients with CKD and ACR > 30 regardless of age

A

ACEI / ARB

1. 4th year (23 decks)

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