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
What medication combined with verapamil is contraindicated
B-blockers
This can cause profound bradycardia and asystole
CHA2DS2VaSc score
Treat if males = 1
Females = 2
Congestive HF = 1
HTN = 1
Age >75=2 or >65=1
Diabetes = 1
Stroke/TIA/VTE = 2
Vascular disease = 1
Sex = 1
What score does the CHA2DS2VASc score need to be to consider/start anticoagulation
0 = no treatment
1 = males, consider anticoagulation
2 = offer anticoagulation
If a CHA2DS2VASc score suggests there is NO need for any anticoagulation, what investigation should be done to help
Transthoracic echo
To exclude vascular heart disease. This is an absolute indication for anticoagulation
What scoring system is used to assess bleeding risk
ORBIT system
ORBIT scoring system assesses bleeding risk (used to use HAS-BLED score). What are the 5 variables
- Hb <130 or Hct <40% for males; Hb <120 or Hct <36% for females = 2
- Age >74 yo= 1
- Bleeding Hx = 2
- Renal impairment eGFR <60 = 1
- Treatment with antiplatelets = 1
Statins should be given to patients with a 10-year cardiovascular risk QRISK score of
10% or more
Primary prevention for statins - what are the criteria and what is the dose of statin
QRISK score >10%
Or T1DM (if diagnosed over 10 years ago or older than 40)
Or CKD eGFR <60
Give 20mg atorvastatin OD
Secondary prevention for statins - what are the criteria and what is the dose of statin
Ischaemic heart disease
Cerebrovascular disease
Peripheral arterial disease
Give atorvastatin 80mg OD
TIA and stroke for lifelong maintenance antiplatelet choice
Clopidogrel
2nd line if not tolerated:
aspirin + dipyridamole
Peripheral arterial disease lifelong maintenance antiplatelet choice
Clopidogrel
2nd line if not tolerated:
aspirin ONLY
Acute antiplatelet management for TIA/ischaemic stroke
300mg aspirin
followed by 75mg clopidogrel OD (or 2nd line aspirin + dipyridamole)
Blood pressure target for <80 yrs in clinics
<140/90
Stage 1 hypertension
> 140/90
or home >135/85
Stage 2 hypertension
> 160/100
or home >150/95
Stage 3/severe hypertension
> 180 systolic; or
120 diastolic
Low salt diet for hypertension is advised. What grams of salt per day are recommended
Aim for less than 6g per day
Ideally 3g
Patients less than 55 years old or with T2DM with HTN are offered what drug first…
ACE inhibitor/ ARB
Patients greater than 55 years old or Afro-Carribbean are offered what drug first…
CCB
Angina patients are treated with what 4 main groups of medication
- Aspirin
- Statins
- CCBs
- B-blockers
(then can consider long-acting nitrates, ivabradine, nicorandil, ranolazine)
If a patient with angina is taking CCB + b-blockers, or not tolerating one and needs another medication/or needs another before PCI/CABG, what other 4 meds can be added on?
Long-acting nitrates
Ivabradine
Nicorandil
Ranolazine
What CCB is used in a patient with angina if they are taking:
(a) CCB monotherapy
(b) dual therapy of CCB with b-blockers
(a) Rate limiting CCB e.g. Verapamil
(b) Long-acting e.g. Amlodipine
NICE advises that patients who take STANDARD-release isosorbide mononitrate twice daily should use what dosing interval to prevent tolerance?
Asymmetric dosing interval
Ensures a daily nitrate-free time of 10-14 hours OVERNIGHT
ejection systolic murmur
Increases with Valsalva manoeuvre and decreases on squatting
what condition is this
Hypertrophic cardiomyopathy
n.b. sometimes there may be a pansystolic murmur
Echocardiogram findings for HOCM
Mitral regurg (MR)
Systolic anterior motion (SAM) of the anterior MV leaflet
Asymmetric hypertrophy (ASH)
MR SAM ASH
4 ECG findings with HOCM
LVH
Progressive T wave inversion
Deep Q waves
Atrial fib
Warfarin prevents activation of vitamin K by affecting with clotting factors
2, 7, 9, 10
Protein C
Which mechanical heart valve replacements need a higher INR for warfarin
Mitral valves > aortic valves
What are the target INR for VTE and AF with warfarin (n.b. DOACs are now first line)
VTE = 2.5
Recurrent VTE = 3.5
Atrial fib = 2.5
4 factors that may potentiate warfarin
- Liver disease
- P450 inhibitors
- Cranberry juice
- NSAIDs
B-blockers are now not used as much to reduce hypertension. What is the reason for this
Less likely to prevent stroke
Potential impairment of glucose tolerance
What is the inheritance pattern of HOCM
Autosomal dominant
If severe airway obstruction (unable to speak, SOB, wheezy) and is conscious, what should you do
5 back-blows
5 abdo thrusts
Repeat
If unconscious: call 999 and start CPR
Atrial fib in acute stroke patients - when should anticoagulation be started
Give antiplatelets for 2 weeks
Then start anticoagulation after
What medications are used to control the rate in atrial fib?
B-blockers
CCB e.g. diltiazem
If one drug is not enough add on:
B-blocker
Diltiazem
Digoxin
Patients cannot drive after MI for 4 weeks but do not need to tell the DVLA. They can drive after 1 week if had PCI and which 3 criteria are met …
If PCI is done and:
- No other urgent PCI planned (within 4 weeks)
- LVEF >40%
- No other condition
Thiazide diuretics can cause what electrolyte disturbance
Hypercalcaemia
Hyponatraemia
Hypokalaemia
n.b. low levels of calcium in urine
5 causes of aortic stenosis
- Calcification
- Bicuspid aortic valve
- William’s syndrome
- Post-rheumatic disease
- HOCM
Patients with aortic stenosis, if they are asymptomatic then surgery is considered if they also have what 2 other criteria
Asymptomatic BUT:
Valvular gradient >40
LV systolic dysfunction
Three options for aortic valve replacement surgeries
Surgical AVR
Transcatheter AVR
Balloon valvuloplasty
If somebody with aortic stenosis ESM murmur, syncope etc - what is the most important initial investigation
ECHOCARDIOGRAM
Blood pressure target (> 80 years, clinic reading)
150/90
How long can patients not drive after CABG
4 weeks
Patients who are on antiplatelet and happen to get atrial fib and need anticoagulant, what happens to these meds
SWITCH antiplatelet to anticoagulant
(Patients with VTE and PCI have different options)
Patients who have PCI/post-ACS, what antiplatelet and anticoagulation dual therapy is given for atrial fib
- Triple therapy = 2 antiplatelets + 1 anticoagulant for 4 weeks to 6 months after the event
- Then decrease to dual therapy = 1 antiplatelet and 1 anticoagulant to complete 12 months
If a patient on antiplatelets develops a clot, what antiplatelet and anticoagulation therapy is given
Anticoagulants for 3-6 months
Then calculate ORBIT score - low risk of bleeding can continue antiplatelets
Intermediate or high risk can stop antiplatelets
What criteria are important for malignant hypertension same day specialist assessment
BP >180/120 and:
1. retinal haemorrhage
2. or papilloedema
3. or life threatening symptoms e.g. confusion, chest pain, AKI
What antithrombotic therapy is given for:
(a) bioprosthetic heart valves
(b) mechanical heart valves
(a) 3 months of warfarin; then life-long aspirin
(b) life-long warfarin + aspirin
When ACE inhibitors are not tolerated e.g. due to cough, what can be tried first line instead for HTN
Angiotensin receptor blockers
Shockable rhythms
Ventricular fib
Pulseless ventricular tachycardia
(VF/pulseless VT)
Non-shockable rhythms
Asystole
Pulseless electrical activity
(asystole/PEA)
A single shock for VF/pulseless VT followed by 2 mins of CPR should happen in defibrillation.
What about patients who are cardiac monitored?
Three shocks
Followed by CPR
How much adrenaline is given and when for non-shockable rhythms (asystole/PEA)
Adrenaline 1mg asap
Repeat every 3-5mins while ALS continues
How much adrenaline is given for shockable rhythms (VF/pulseless VT) and when
Adrenaline 1mg
Once chest compressions have restarted after the third shock
Repeat every 3-5 mins while ALS continues
How much amiodarone and when should it be given during shockable (VF/pulseless VT)
Amiodarone 300mg
After 3 shocks
Further 150mg
After 5 shocks
If pulmonary embolus is expected and thrombolytic drugs are given, CPR should be continued for how long
An extended period of 60-90mins
4 Hs and 4 Ts
Hypoxia
Hypovolaemia
Hyperkaelaemia (etc)
Hypothermia
Thrombosis
Tension pneumothorax
Tamponade
Toxins
Triad of pulmonary embolism
Pleuritic chest pain
SOB
Haemoptysis
The pulmonary embolism rule-out criteria (PERC) has criteria to rule out PE. If all of the criteria are absent (e.g. age >50, HR >100, SaO2 <94%, previous DVT, surgery, haemoptysis, leg swelling, COCP/HRT), what is the probability of PE
<2%
What 3 electrolyte disturbances can cause long QTc syndrome
HYPO-
magnesium
kalaemia
calcaemia
Immediate management of suspected acute coronary syndrome (ACS)
Aspirin 300mg
glyceryl trinitrate
Oxygen if sats <94%
do not give other antiplatelets e.g. clopidogrel, except aspirin outside of hospital settings
When to refer for chest pain?
(a) Current chest pain or within 12 hours with abnormal ECG
(b) Chest pain 12-72 hours ago
(c) Chest pain >72 hours ago
(a) Current chest pain or within 12 hours with abnormal ECG - emergency admission
(b) Chest pain 12-72 hours ago - same day assessment
(c) Chest pain >72 hours ago - do ECG + trop then decide
Anginal pain is described with 3 criteria. What are the criteria and how do they separate into typical angina, atypical angina and non-anginal chest pain.
- Discomfort in front of chest or neck, jaw, arms
- Caused by exertion
- Relieved by rest or GTN in 5 mins
All three = typical angina
Two = atypical angina
One or none = non-anginal chest pain
For patients who you think may have typical/atypical angina or ECG changes, what threeinvestigations are recommended by NICE afterwards
- CT CA
- Non-invasive functional imaging e.g. MPS with SPECT, stress echo, MRI imaging
- Invasive coronary angio
DVLA advice following pacemaker insertion: cannot drive for…
1 week
xanthelasma (on the eyes) is usually seen in…
hypercholesterolaemia
accumulation of lipid deposits, can be seen in patients without abnormalities
palmar xanthoma and eruptive xamnthoma (on elbows and knees) can be seen in
hypertriglyceridaemia
also hyperlipidaemia
Absent limb pulse
Carotid bruit
Limb claudication on exertion
Aortic regurgitation
What vasculitis
Takayasu’s arteritis
Large vessel vasculitis
Occludes the aorta
Any patient in clinic with a blood pressure >= 140/90 mmHg is offered ideally what by NICE
ABPM/HBPM
Ambulatory blood pressure monitoring (ABPM) uses
at least 2 measurements per hour during what time of day, and then how many are averaged
At least 2 measurements per hour during the person’s usual WAKING hours
Use the average across at least 14 measurements
Home blood pressure monitoring (HBPM)
for each BP recording, two measurements are taken, at least 1 minute apart. BP is recorded in the morning and evening for how long
At least 4 days
Ideally for 7 days
Discard day 1
Use the average value of the rest of the measurements from day 2 to day 4-7
Moderate-severe aortic stenosis is a contraindication to which antihypertensives
ACE inhibitors
What combination of 2 types of anti hypertensive drugs should be avoided in diabetic patients
due to increased risk of hypertriglyceridaemia and hypoglycaemia in diabetic patients
B-blockers
Thiazides
How long do NICE recommend we wait following a myocardial infarction before prescribing a phosphodiesterase type 5 inhibitor (e.g. sildenafil /viagra)?
6 months
What tests is it important to ensure the patient has had prior to starting amiodarone treatment?
TFTs
LFTs
U&Es
chest x-ray
NICE recommends that people aged under what age with stage 1 hypertension and no evidence of target organ damage should be referred to exclude secondary causes of hypertension?
40 years
skin, mucosal, gastric (inc. anal) and eye ulceration can be caused by what anginal medication
nicorandil
Usually heart failure and COPD patients need pneumococcal vaccines one-off.
What 3 groups of patients need pneumococcal re-vaccination every 5 years?
Chronic kidney disease
Asplenia
Splenic dysfunction
patient with previous DVT on warfarin with inr target of 2.5 gets another DVT. what is the new INR target.
3.5
In people with a significant postural drop or symptoms of postural hypotension, treat based on sitting or standing blood pressure
Standing blood pressure
Patients with diverticular disease are at particular risk of bowel perforation during what cardiovascular medication treatment
Nicorandil
Increased risk of ulcers
What cardiovascular drug has high risk of sexual/erectile dysfunction
Bisoprolol
People on larger doses of diuretics, when starting them on ACE inhibitors, how should you initiate this
REFER TO SECONDARY CARE when they are on larger doses of diuretics
what is the target INR for aortic mechanical valve
3.0
mitral = 3.5
what is the target INR for mitral mechanical valve
3.5
aortic = 3.0
what anti hypertensive drugs should be avoided if possible in gout patients
thiazide-type diuretics
Following BNF guidance, at what eGFR do thiazide diuretics become ineffective and hence should be avoided in patients with chronic kidney disease?
eGFR <30
The patient cannot drive a group 1 vehicle for how long after insertion of an ICD and also after an ICD shock.
6 months
Disqualified from HGV license for life
narrow pulse pressure
slow rising pulse
features of which valve disease
aortic stenosis
when should U&Es be measured when starting an ACE inhibitor
before starting
repeat 1-2 weeks after starting/dose increase
then at least annually
if renal impairment is severe (e.g. eGFR <15/min), what anticoagulants should be used for VTE
LMWH
Unfractionated heparin
or LMWH followed by vit K antagonist
if the patient has antiphospholipid syndrome (triple positive), what anticoagulants should be used for VTE
LMWH followed by vit K antagonist
Rheumatic fever develops following an immunological reaction to a recent (2-4 weeks ago) infection of which pathogen
Strep pyogenes
Diagnosis of rheumatic fever depends on how many criteria
Recent strep infection with:
2 major criteria
or 1 major, 2 minor
Major criteria in rheumatic fever diagnosing (CASES)
Carditis
Arthritis
Sydenham’s chorea
Erythema marginatum
Subcutaneous nodules
Minor criteria in rheumatic fever (PARP)
Pyrexia
Raised ESR/CRP
Arthralgia
Prolonged PR interval
Antibiotic management for rheumatic fever (strep pyogenes)
Oral penicillin V
What is the main reason for checking the urea and electrolytes prior to commencing a patient on amiodarone?
Detects hypokalaemia
HypoK+ increases risk of arrythmia with this med
statins and which antibiotic are contraindicated
clarithromycin/
erythromycin
BNP is related to the stretch in left ventricle. What disease leads to higher BNP levels
Chronic kidney disease
COPD
4 risk factors for statin-induced myopathy
Female gender
Low BMI
Age
Diabetes
NICE have produced guidelines on the management of patients following a myocardial infarction. What do they recommend in terms of exercise?
Physical activity for 20-30mins per day to point of slight breathlessness
BNP is related to the stretch in left ventricle. What 3 medications lead to lower BNP levels
ACE inhibitors
ARBs
Diuretics
what anti-hypertensive medication class can reduce hypoglycaemic awareness
b-blockers
At what size abdominal aortic aneurysm would disqualify patients from driving?
6.5cm
DVLA advice following angioplasty - cannot drive for ….
1 weekq
The most common investigation for investigating episodic arrhythmias/ palpitations
Holter ECG monitoring
What is the main mechanism of action of statins?
Inhibit HMG-CoA reductase, the enzyme in hepatic intrinsic cholesterol synthesis
Dabigatran should not be used in patients with…
mechanical heart valves
chronic kidney disease, CrCl <30
A patient with hypertension and heart failure -what is the best type of anti-HTN to start
ACE inhibitors
What is the most appropriate blood test monitoring for statins?
LFTs at baseline
3 months
12 months
For afro-carribbean patients, which anti-HTN should be avoided
ACE inhibitor
Aim for ARBs instead
What should you advise with regards to driving for a patient with STEMI, who had successul PCI and stent, LVEF 50%, no complications?
Stop driving for 1 week
No need to inform DVLA
If successfully treated by coronary angioplasty, driving may recommence after 1 week provided what 3 criteria
- No other urgent revascularisation is planned within 4 weeks
- LVEF >40%
- No other disqualifying condition.
If not successfully treated by coronary angioplasty, driving may recommence after 4 weeks provided that…
there are no other conditions
Do patients who’ve had a catheter ablation for atrial fibrillation still require anticoagulation
YES
long-term as per cha2ds2-vasc score
short PR interval
wide QRS complexes with a slurred upstroke (delta wave)
axis deviation
what condition
Wolff-Parkinson white
For primary prevention of statins, when should the dose be increased (from 20mg atorvastatin)
if non-HDL has not reduced by 40% after starting statins
For statins, checking LFTs at baseline, 3 months and 12 months happens. Treatment should be discontinued if serum transaminase concentrations rise to and persist at how many times the ULN
3 times the upper limit
first line Ix for suspected angina
CT coronary angiogram
pulmonary embolism ECG changes
S1Q3T3
large S wave in lead 1
Q wave in lead 3
inverted T wave in lead 3
management of warfarin
INR 5.0-8.0
no bleeding
Withhold 1 or 2 doses of warfarin
Reduce subsequent maintenance dose
management of warfarin
INR 5.0-8.0
minor bleeding
Stop warfarin
Give intravenous vitamin K 1-3mg
Restart when INR < 5.0
management of warfarin
INR >8.0
no bleeding
Stop warfarin
Give vitamin K 1-5mg orally
Repeat dose of vitamin K if INR still too high after 24 hours
Restart when INR < 5.0
management of warfarin
INR >8.0
minor bleeding
Stop warfarin
Give intravenous vitamin K 1-3mg
Repeat dose of vitamin K if INR still too high after 24 hours
Restart warfarin when INR < 5.0
management of warfarin
major bleeding
Stop warfarin
Give intravenous vitamin K 5mg
Prothrombin complex concentrate - if not available then FFP*
what medication has been shown to improve mortality in patients with NYHA class 3 or 4 heart failure, already taking an ACEi
spironolactone
what 2 medications should be given first-line in patients with stable impaired LV function
ACE inhibitor
B-blocker
patients 60-80years with stage 1 HTN and no end-organ failure and QRISK <10% - management
lifestyle changes only
(if below 60 years can consider starting anti-HTN)
weakened femoral pulses
what congenital cardiovascular disease
coarctation of aorta
4 associations (diseases) with coarctation of aorta
- Turners syndrome
- Bicuspid aortic valve
- Berry aneurysms
- Neurofibromatosis
Child heart failure
Radio-femoral delay
Mid systolic murmur with apical click
Notching of ribs
Weak femoral pulses
what congenital heart disease
coarctation of aorta
in a woman who is planning to get pregnant with hypertension, what should she be referred for
refer to secondary care for routine review
for preconception advice
what medication can be used to reverse dabigatran (direct thrombin inhibitor)
idarucizumab
right bundle branch block seen on ECG in asymptomatic older patient, what is the appropriate next step
no investigation needed
usually normal variant.
Three main side effects of GTN spray
Hypotension
Tachycardia
Headache
if a patient with angina needs a third anti-anginal medication (e.g. nitrates after b-blockers and CCB), what investigations/interventions should be considered
Refer to cardio
For PCI or CABG
effect of furosemide on electrolytes
HypoNa+
HypoK+
HypoMg+
HypoCa2+
Hypochloraemic alkalosis
Blood pressure targets for:
1. T2DM
2. T1DM
3. T1DM with albuminuria or metabolic syndrome
- T2DM - 140/90
- T1DM - 135/85
- T1DM with albuminuria or metabolic syndrome - 130/80
Hypertension with heart failure or T2DM of any age.. likely first anti-hypertensive medication to start
ACE inhibitor
VTE prophylaxis for moderate-high risk patients going on flights
Compression stockings
VERY high risk - consider LMWH
3 options for rate control in atrial fibrillation
- b-blockers - avoid in asthma
- CCBs - e.g. diltiazem
- digoxin - useful if HF too
3 options for rhythm control in atrial fibrillation
- b-blockres
- dronedarone - following cardioversion
- amiodarone - useful if HF too
Aschoff bodies are granulomatous nodules found in which disease
Rheumatic heart fever
(usually caused by strep pyogenes)
Which heart failure medications have NO EFFECT ON MORTALITY in patients with PRESERVED ejection fraction
Ace inhibitors + B-blockers
Diltiazem and verapamil should be avoided in which patients
HEART FAILURE
In a patient with angina who already takes b-blockers, what examples of CCBs should be added on?
Amlodipine
Felodipine
Nifidepine MR
- these are long-acting dihydropyridine CCBs
(avoid diltiazem and verapamil)
What is a normal QTc interval in males and females
<430ms in males
<450ms in females
There are 3 types of long QTc syndrome. What are the differences in presentation
Long QT1 - exertional syncope
Long QT2 - syncope after stress or exercise
Long QT3 - during night or at rest
Management of long QTc syndrome
- avoid the triggers /drugs
- b-blockersca
- ICD in high risk cases
can warfarin be used during breastfeeding
yes
