Cardio Flashcards
Suspected heart failure patients should have BNP levels. If BNP levels are high/raised, what should be arranged:
Specialist assessment and transthoracic echo (TTE) within:
1. 2 weeks - if BNP is HIGH
2. 6 weeks - if BNP is RAISED
New York Heart Association NYHA Heart failure classification
1. Class I
2. Class II
3. Class III
4. Class IV
- No symptoms - no limitation
- Mild symptoms - slight limitation on exercise
- Moderate symptoms - marked limitation on exercise
- Severe symptoms - symptoms at rest and unable to carry out exercise.
What 4 types of medication can exacerbate heart failure
- Pioglitazone (thiazolidinediones)
- Verapamil
- Flecainide (class I anti-arrhythmics)
- NSAIDs/steroids - except aspirin
Chronic heart failure mainstay of treatment
- ACE inhibitors and B-blockers
- Aldosterone antagonist - spironolactone or eplerenone
- SGLT-2 inhibitors (canagliflozin, dapagliflozin, empagliflozin) if reduced EF %
- Initiated by specialists: ivabradine, hydralazine with nitrate, sacubitril-valsartan, digoxin, cardiac resynchronisation therapy
COPD and heart failure patients have what vaccines
- Annual influenza vaccine
- One-off pneumococcal vaccine
Three cyanotic (right to left shunt) congenital heart diseases
- Tetralogy of fallot (VSD, pulmonary stenosis, RVH, overriding aorta) - 1-2 months
- Transposition of great arteries - at birth
- Tricuspid atresia
Turner’s syndrome is associated with which congenital heart defect
Coarctation of the aorta
People with what valvular disease should avoid ACE inhibitors
Aortic stenosis
- can result in hypotension
What are 5 contraindications of ACE inhibitors
- Pregnancy/breastfeeding
- Hereditary angioedema
- Aortic stenosis
- Renovascular disease
- Hyperkalaemia >5.0
What are acceptable changes after increasing/starting ACE inhibitors in:
(a) % in serum creatinine
(b) potassium level
(a) 30% increase in serum Cr
(b) 5.5 potassium
2 common side effects of metformin
GI side effects
Lactic acidosis
4 common side effects of sulfonylureas e.g. glimepiride, glipizide
Hypoglycaemia
Increased appetite and weight gain
SIADH
Liver dysfunction (cholestatic)
4 common side effects of glitazones e.g. pioglitazone
Weight gain
Fluid retention
Liver dysfunction
Fractures
Rare but important side effect of DPP4 inhibitors (gliptins) e.g.
Pancreatitis
A 33-year-old woman is prescribed varenicline to help her quit smoking. What is the mechanism of action of varenicline?
Nicotinic receptor partial agonist
n.b. this is contraindicated in pregnancy + breastfeeding
Management of venous ulceration (typically seen above medial malleolus) if ABPI is normal (0.9-1.2)
- Compression bandages - 4 layer
- Oral pentoxifylline (peripheral vasodilator)
There is little evidence from hydrocolloid dressings, intermittent pneumatic compression, USS therapy, growth factors.
Small evidence supporting flavinoids
Which 6 medications can precipate digoxin toxicity
Amiodarone
Quinidine
Verapamil
Diltiazem
Spironolactone
Ciclosporin
PDE 5 inhibitors e.g. sildenafil is contraindicated by which 2 medications
Nitrates
Nicorandil
Causes of raised prolactin - the p’s
pregnancy
prolactinoma
physiological: stress, exercise, sleep
PCOS
primary hypothyroidism (and acromegaly)
phenothiazines, metoclopramide, domperidone
Patients after an MI are started on what 4 classes of drugs
- Dual antiplatelet therapy
- ACE inhibitors
- B-blockers
- Statins
Patients who have had ACS are started on dual antiplatelet therapy. What DAPT is given for those post-ACS who were medically managed?
Aspirin
Ticagrelor - stop after 12 months
Patients who have had ACS are started on dual antiplatelet therapy. What DAPT is given for those post-ACS who had PCI?
Aspirin
Prasugrel or ticagrelor - stop after 12 months
Supraventricular tachycardia acute treatment
- Vagal manoeuvres - valsalva and carotid sinus massage
- IV adenosine
6mg -> 12mg -> 18mg - If asthmatic, give verapamil instead
- Electrical cardioversion
Prevention of supraventricular tachycardia episodes treatment
B-blockers
Radiofrequency ablation