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Cardio Flashcards

1
Q

Suspected heart failure patients should have BNP levels. If BNP levels are high/raised, what should be arranged:

A

Specialist assessment and transthoracic echo (TTE) within:
1. 2 weeks - if BNP is HIGH
2. 6 weeks - if BNP is RAISED

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2
Q

New York Heart Association NYHA Heart failure classification
1. Class I
2. Class II
3. Class III
4. Class IV

A
  1. No symptoms - no limitation
  2. Mild symptoms - slight limitation on exercise
  3. Moderate symptoms - marked limitation on exercise
  4. Severe symptoms - symptoms at rest and unable to carry out exercise.
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3
Q

What 4 types of medication can exacerbate heart failure

A
  1. Pioglitazone (thiazolidinediones)
  2. Verapamil
  3. Flecainide (class I anti-arrhythmics)
  4. NSAIDs/steroids - except aspirin
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4
Q

Chronic heart failure mainstay of treatment

A
  1. ACE inhibitors and B-blockers
  2. Aldosterone antagonist - spironolactone or eplerenone
  3. SGLT-2 inhibitors (canagliflozin, dapagliflozin, empagliflozin) if reduced EF %
  4. Initiated by specialists: ivabradine, hydralazine with nitrate, sacubitril-valsartan, digoxin, cardiac resynchronisation therapy
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5
Q

COPD and heart failure patients have what vaccines

A
  • Annual influenza vaccine
  • One-off pneumococcal vaccine
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6
Q

Three cyanotic (right to left shunt) congenital heart diseases

A
  1. Tetralogy of fallot (VSD, pulmonary stenosis, RVH, overriding aorta) - 1-2 months
  2. Transposition of great arteries - at birth
  3. Tricuspid atresia
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7
Q

Turner’s syndrome is associated with which congenital heart defect

A

Coarctation of the aorta

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8
Q

People with what valvular disease should avoid ACE inhibitors

A

Aortic stenosis

  • can result in hypotension
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9
Q

What are 5 contraindications of ACE inhibitors

A
  1. Pregnancy/breastfeeding
  2. Hereditary angioedema
  3. Aortic stenosis
  4. Renovascular disease
  5. Hyperkalaemia >5.0
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10
Q

What are acceptable changes after increasing/starting ACE inhibitors in:
(a) % in serum creatinine
(b) potassium level

A

(a) 30% increase in serum Cr
(b) 5.5 potassium

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11
Q

2 common side effects of metformin

A

GI side effects
Lactic acidosis

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12
Q

4 common side effects of sulfonylureas e.g. glimepiride, glipizide

A

Hypoglycaemia
Increased appetite and weight gain
SIADH
Liver dysfunction (cholestatic)

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13
Q

4 common side effects of glitazones e.g. pioglitazone

A

Weight gain
Fluid retention
Liver dysfunction
Fractures

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14
Q

Rare but important side effect of DPP4 inhibitors (gliptins) e.g.

A

Pancreatitis

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15
Q

A 33-year-old woman is prescribed varenicline to help her quit smoking. What is the mechanism of action of varenicline?

A

Nicotinic receptor partial agonist

n.b. this is contraindicated in pregnancy + breastfeeding

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16
Q

Management of venous ulceration (typically seen above medial malleolus) if ABPI is normal (0.9-1.2)

A
  1. Compression bandages - 4 layer
  2. Oral pentoxifylline (peripheral vasodilator)

There is little evidence from hydrocolloid dressings, intermittent pneumatic compression, USS therapy, growth factors.
Small evidence supporting flavinoids

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17
Q

Which 6 medications can precipate digoxin toxicity

A

Amiodarone
Quinidine
Verapamil
Diltiazem
Spironolactone
Ciclosporin

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18
Q

PDE 5 inhibitors e.g. sildenafil is contraindicated by which 2 medications

A

Nitrates
Nicorandil

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19
Q

Causes of raised prolactin - the p’s

A

pregnancy
prolactinoma
physiological: stress, exercise, sleep
PCOS
primary hypothyroidism (and acromegaly)
phenothiazines, metoclopramide, domperidone

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20
Q

Patients after an MI are started on what 4 classes of drugs

A
  • Dual antiplatelet therapy
  • ACE inhibitors
  • B-blockers
  • Statins
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21
Q

Patients who have had ACS are started on dual antiplatelet therapy. What DAPT is given for those post-ACS who were medically managed?

A

Aspirin
Ticagrelor - stop after 12 months

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22
Q

Patients who have had ACS are started on dual antiplatelet therapy. What DAPT is given for those post-ACS who had PCI?

A

Aspirin
Prasugrel or ticagrelor - stop after 12 months

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23
Q

Supraventricular tachycardia acute treatment

A
  1. Vagal manoeuvres - valsalva and carotid sinus massage
  2. IV adenosine
    6mg -> 12mg -> 18mg
  3. If asthmatic, give verapamil instead
  4. Electrical cardioversion
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24
Q

Prevention of supraventricular tachycardia episodes treatment

A

B-blockers
Radiofrequency ablation

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25
Q

What medication combined with verapamil is contraindicated

A

B-blockers

This can cause profound bradycardia and asystole

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26
Q

CHA2DS2VaSc score

Treat if males = 1
Females = 2

A

Congestive HF = 1
HTN = 1
Age >75=2 or >65=1
Diabetes = 1
Stroke/TIA/VTE = 2
Vascular disease = 1
Sex = 1

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27
Q

What score does the CHA2DS2VASc score need to be to consider/start anticoagulation

A

0 = no treatment
1 = males, consider anticoagulation
2 = offer anticoagulation

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28
Q

If a CHA2DS2VASc score suggests there is NO need for any anticoagulation, what investigation should be done to help

A

Transthoracic echo

To exclude vascular heart disease. This is an absolute indication for anticoagulation

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29
Q

What scoring system is used to assess bleeding risk

A

ORBIT system

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30
Q

ORBIT scoring system assesses bleeding risk (used to use HAS-BLED score). What are the 5 variables

A
  • 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
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31
Q

Statins should be given to patients with a 10-year cardiovascular risk QRISK score of

A

10% or more

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32
Q

Primary prevention for statins - what are the criteria and what is the dose of statin

A

QRISK score >10%
Or T1DM (if diagnosed over 10 years ago or older than 40)
Or CKD eGFR <60

Give 20mg atorvastatin OD

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33
Q

Secondary prevention for statins - what are the criteria and what is the dose of statin

A

Ischaemic heart disease
Cerebrovascular disease
Peripheral arterial disease

Give atorvastatin 80mg OD

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34
Q

TIA and stroke for lifelong maintenance antiplatelet choice

A

Clopidogrel

2nd line if not tolerated:
aspirin + dipyridamole

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35
Q

Peripheral arterial disease lifelong maintenance antiplatelet choice

A

Clopidogrel

2nd line if not tolerated:
aspirin ONLY

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36
Q

Acute antiplatelet management for TIA/ischaemic stroke

A

300mg aspirin

followed by 75mg clopidogrel OD (or 2nd line aspirin + dipyridamole)

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37
Q

Blood pressure target for <80 yrs in clinics

A

<140/90

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38
Q

Stage 1 hypertension

A

> 140/90
or home >135/85

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39
Q

Stage 2 hypertension

A

> 160/100
or home >150/95

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40
Q

Stage 3/severe hypertension

A

> 180 systolic; or
120 diastolic

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41
Q

Low salt diet for hypertension is advised. What grams of salt per day are recommended

A

Aim for less than 6g per day

Ideally 3g

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42
Q

Patients less than 55 years old or with T2DM with HTN are offered what drug first…

A

ACE inhibitor/ ARB

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43
Q

Patients greater than 55 years old or Afro-Carribbean are offered what drug first…

A

CCB

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44
Q

Angina patients are treated with what 4 main groups of medication

A
  1. Aspirin
  2. Statins
  3. CCBs
  4. B-blockers

(then can consider long-acting nitrates, ivabradine, nicorandil, ranolazine)

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45
Q

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?

A

Long-acting nitrates
Ivabradine
Nicorandil
Ranolazine

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46
Q

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

(a) Rate limiting CCB e.g. Verapamil
(b) Long-acting e.g. Amlodipine

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47
Q

NICE advises that patients who take STANDARD-release isosorbide mononitrate twice daily should use what dosing interval to prevent tolerance?

A

Asymmetric dosing interval

Ensures a daily nitrate-free time of 10-14 hours OVERNIGHT

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48
Q

ejection systolic murmur
Increases with Valsalva manoeuvre and decreases on squatting

what condition is this

A

Hypertrophic cardiomyopathy

n.b. sometimes there may be a pansystolic murmur

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49
Q

Echocardiogram findings for HOCM

A

Mitral regurg (MR)
Systolic anterior motion (SAM) of the anterior MV leaflet
Asymmetric hypertrophy (ASH)

MR SAM ASH

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50
Q

4 ECG findings with HOCM

A

LVH
Progressive T wave inversion
Deep Q waves
Atrial fib

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51
Q

Warfarin prevents activation of vitamin K by affecting with clotting factors

A

2, 7, 9, 10
Protein C

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52
Q

Which mechanical heart valve replacements need a higher INR for warfarin

A

Mitral valves > aortic valves

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53
Q

What are the target INR for VTE and AF with warfarin (n.b. DOACs are now first line)

A

VTE = 2.5
Recurrent VTE = 3.5
Atrial fib = 2.5

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54
Q

4 factors that may potentiate warfarin

A
  1. Liver disease
  2. P450 inhibitors
  3. Cranberry juice
  4. NSAIDs
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55
Q

B-blockers are now not used as much to reduce hypertension. What is the reason for this

A

Less likely to prevent stroke
Potential impairment of glucose tolerance

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56
Q

What is the inheritance pattern of HOCM

A

Autosomal dominant

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57
Q

If severe airway obstruction (unable to speak, SOB, wheezy) and is conscious, what should you do

A

5 back-blows
5 abdo thrusts
Repeat

If unconscious: call 999 and start CPR

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58
Q

Atrial fib in acute stroke patients - when should anticoagulation be started

A

Give antiplatelets for 2 weeks
Then start anticoagulation after

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59
Q

What medications are used to control the rate in atrial fib?

A

B-blockers
CCB e.g. diltiazem

If one drug is not enough add on:
B-blocker
Diltiazem
Digoxin

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60
Q

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 …

A

If PCI is done and:
- No other urgent PCI planned (within 4 weeks)
- LVEF >40%
- No other condition

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61
Q

Thiazide diuretics can cause what electrolyte disturbance

A

Hypercalcaemia
Hyponatraemia
Hypokalaemia

n.b. low levels of calcium in urine

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62
Q

5 causes of aortic stenosis

A
  1. Calcification
  2. Bicuspid aortic valve
  3. William’s syndrome
  4. Post-rheumatic disease
  5. HOCM
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63
Q

Patients with aortic stenosis, if they are asymptomatic then surgery is considered if they also have what 2 other criteria

A

Asymptomatic BUT:

Valvular gradient >40
LV systolic dysfunction

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64
Q

Three options for aortic valve replacement surgeries

A

Surgical AVR
Transcatheter AVR
Balloon valvuloplasty

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65
Q

If somebody with aortic stenosis ESM murmur, syncope etc - what is the most important initial investigation

A

ECHOCARDIOGRAM

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66
Q

Blood pressure target (> 80 years, clinic reading)

A

150/90

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67
Q

How long can patients not drive after CABG

A

4 weeks

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68
Q

Patients who are on antiplatelet and happen to get atrial fib and need anticoagulant, what happens to these meds

A

SWITCH antiplatelet to anticoagulant

(Patients with VTE and PCI have different options)

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69
Q

Patients who have PCI/post-ACS, what antiplatelet and anticoagulation dual therapy is given for atrial fib

A
  • 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
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70
Q

If a patient on antiplatelets develops a clot, what antiplatelet and anticoagulation therapy is given

A

Anticoagulants for 3-6 months
Then calculate ORBIT score - low risk of bleeding can continue antiplatelets
Intermediate or high risk can stop antiplatelets

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71
Q

What criteria are important for malignant hypertension same day specialist assessment

A

BP >180/120 and:
1. retinal haemorrhage
2. or papilloedema
3. or life threatening symptoms e.g. confusion, chest pain, AKI

72
Q

What antithrombotic therapy is given for:
(a) bioprosthetic heart valves
(b) mechanical heart valves

A

(a) 3 months of warfarin; then life-long aspirin
(b) life-long warfarin + aspirin

73
Q

When ACE inhibitors are not tolerated e.g. due to cough, what can be tried first line instead for HTN

A

Angiotensin receptor blockers

74
Q

Shockable rhythms

A

Ventricular fib
Pulseless ventricular tachycardia

(VF/pulseless VT)

75
Q

Non-shockable rhythms

A

Asystole
Pulseless electrical activity

(asystole/PEA)

76
Q

A single shock for VF/pulseless VT followed by 2 mins of CPR should happen in defibrillation.

What about patients who are cardiac monitored?

A

Three shocks
Followed by CPR

77
Q

How much adrenaline is given and when for non-shockable rhythms (asystole/PEA)

A

Adrenaline 1mg asap

Repeat every 3-5mins while ALS continues

78
Q

How much adrenaline is given for shockable rhythms (VF/pulseless VT) and when

A

Adrenaline 1mg
Once chest compressions have restarted after the third shock

Repeat every 3-5 mins while ALS continues

79
Q

How much amiodarone and when should it be given during shockable (VF/pulseless VT)

A

Amiodarone 300mg
After 3 shocks

Further 150mg
After 5 shocks

80
Q

If pulmonary embolus is expected and thrombolytic drugs are given, CPR should be continued for how long

A

An extended period of 60-90mins

81
Q

4 Hs and 4 Ts

A

Hypoxia
Hypovolaemia
Hyperkaelaemia (etc)
Hypothermia

Thrombosis
Tension pneumothorax
Tamponade
Toxins

82
Q

Triad of pulmonary embolism

A

Pleuritic chest pain
SOB
Haemoptysis

83
Q

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

A

<2%

84
Q

What 3 electrolyte disturbances can cause long QTc syndrome

A

HYPO-
magnesium
kalaemia
calcaemia

85
Q

Immediate management of suspected acute coronary syndrome (ACS)

A

Aspirin 300mg
glyceryl trinitrate
Oxygen if sats <94%

do not give other antiplatelets e.g. clopidogrel, except aspirin outside of hospital settings

86
Q

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

(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

87
Q

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.

A
  1. Discomfort in front of chest or neck, jaw, arms
  2. Caused by exertion
  3. Relieved by rest or GTN in 5 mins

All three = typical angina
Two = atypical angina
One or none = non-anginal chest pain

88
Q

For patients who you think may have typical/atypical angina or ECG changes, what threeinvestigations are recommended by NICE afterwards

A
  1. CT CA
  2. Non-invasive functional imaging e.g. MPS with SPECT, stress echo, MRI imaging
  3. Invasive coronary angio
89
Q

DVLA advice following pacemaker insertion: cannot drive for…

A

1 week

90
Q

xanthelasma (on the eyes) is usually seen in…

A

hypercholesterolaemia

accumulation of lipid deposits, can be seen in patients without abnormalities

91
Q

palmar xanthoma and eruptive xamnthoma (on elbows and knees) can be seen in

A

hypertriglyceridaemia
also hyperlipidaemia

92
Q

Absent limb pulse
Carotid bruit
Limb claudication on exertion
Aortic regurgitation

What vasculitis

A

Takayasu’s arteritis

Large vessel vasculitis
Occludes the aorta

93
Q

Any patient in clinic with a blood pressure >= 140/90 mmHg is offered ideally what by NICE

A

ABPM/HBPM

94
Q

Ambulatory blood pressure monitoring (ABPM) uses
at least 2 measurements per hour during what time of day, and then how many are averaged

A

At least 2 measurements per hour during the person’s usual WAKING hours

Use the average across at least 14 measurements

95
Q

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

A

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

96
Q

Moderate-severe aortic stenosis is a contraindication to which antihypertensives

A

ACE inhibitors

97
Q

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

A

B-blockers
Thiazides

98
Q

How long do NICE recommend we wait following a myocardial infarction before prescribing a phosphodiesterase type 5 inhibitor (e.g. sildenafil /viagra)?

A

6 months

99
Q

What tests is it important to ensure the patient has had prior to starting amiodarone treatment?

A

TFTs
LFTs
U&Es
chest x-ray

100
Q

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?

A

40 years

101
Q

skin, mucosal, gastric (inc. anal) and eye ulceration can be caused by what anginal medication

A

nicorandil

102
Q

Usually heart failure and COPD patients need pneumococcal vaccines one-off.

What 3 groups of patients need pneumococcal re-vaccination every 5 years?

A

Chronic kidney disease
Asplenia
Splenic dysfunction

103
Q

patient with previous DVT on warfarin with inr target of 2.5 gets another DVT. what is the new INR target.

A

3.5

104
Q

In people with a significant postural drop or symptoms of postural hypotension, treat based on sitting or standing blood pressure

A

Standing blood pressure

105
Q

Patients with diverticular disease are at particular risk of bowel perforation during what cardiovascular medication treatment

A

Nicorandil

Increased risk of ulcers

106
Q

What cardiovascular drug has high risk of sexual/erectile dysfunction

A

Bisoprolol

107
Q

People on larger doses of diuretics, when starting them on ACE inhibitors, how should you initiate this

A

REFER TO SECONDARY CARE when they are on larger doses of diuretics

108
Q

what is the target INR for aortic mechanical valve

A

3.0

mitral = 3.5

109
Q

what is the target INR for mitral mechanical valve

A

3.5

aortic = 3.0

110
Q

what anti hypertensive drugs should be avoided if possible in gout patients

A

thiazide-type diuretics

111
Q

Following BNF guidance, at what eGFR do thiazide diuretics become ineffective and hence should be avoided in patients with chronic kidney disease?

A

eGFR <30

112
Q

The patient cannot drive a group 1 vehicle for how long after insertion of an ICD and also after an ICD shock.

A

6 months

Disqualified from HGV license for life

113
Q

narrow pulse pressure
slow rising pulse

features of which valve disease

A

aortic stenosis

114
Q

when should U&Es be measured when starting an ACE inhibitor

A

before starting

repeat 1-2 weeks after starting/dose increase

then at least annually

115
Q

if renal impairment is severe (e.g. eGFR <15/min), what anticoagulants should be used for VTE

A

LMWH
Unfractionated heparin
or LMWH followed by vit K antagonist

116
Q

if the patient has antiphospholipid syndrome (triple positive), what anticoagulants should be used for VTE

A

LMWH followed by vit K antagonist

117
Q

Rheumatic fever develops following an immunological reaction to a recent (2-4 weeks ago) infection of which pathogen

A

Strep pyogenes

118
Q

Diagnosis of rheumatic fever depends on how many criteria

A

Recent strep infection with:
2 major criteria
or 1 major, 2 minor

119
Q

Major criteria in rheumatic fever diagnosing (CASES)

A

Carditis
Arthritis
Sydenham’s chorea
Erythema marginatum
Subcutaneous nodules

120
Q

Minor criteria in rheumatic fever (PARP)

A

Pyrexia
Raised ESR/CRP
Arthralgia
Prolonged PR interval

121
Q

Antibiotic management for rheumatic fever (strep pyogenes)

A

Oral penicillin V

122
Q

What is the main reason for checking the urea and electrolytes prior to commencing a patient on amiodarone?

A

Detects hypokalaemia

HypoK+ increases risk of arrythmia with this med

123
Q

statins and which antibiotic are contraindicated

A

clarithromycin/
erythromycin

124
Q

BNP is related to the stretch in left ventricle. What disease leads to higher BNP levels

A

Chronic kidney disease
COPD

125
Q

4 risk factors for statin-induced myopathy

A

Female gender
Low BMI
Age
Diabetes

125
Q

NICE have produced guidelines on the management of patients following a myocardial infarction. What do they recommend in terms of exercise?

A

Physical activity for 20-30mins per day to point of slight breathlessness

126
Q

BNP is related to the stretch in left ventricle. What 3 medications lead to lower BNP levels

A

ACE inhibitors
ARBs
Diuretics

127
Q

what anti-hypertensive medication class can reduce hypoglycaemic awareness

A

b-blockers

128
Q

At what size abdominal aortic aneurysm would disqualify patients from driving?

A

6.5cm

129
Q

DVLA advice following angioplasty - cannot drive for ….

A

1 weekq

130
Q

The most common investigation for investigating episodic arrhythmias/ palpitations

A

Holter ECG monitoring

131
Q

What is the main mechanism of action of statins?

A

Inhibit HMG-CoA reductase, the enzyme in hepatic intrinsic cholesterol synthesis

132
Q

Dabigatran should not be used in patients with…

A

mechanical heart valves

chronic kidney disease, CrCl <30

133
Q

A patient with hypertension and heart failure -what is the best type of anti-HTN to start

A

ACE inhibitors

134
Q

What is the most appropriate blood test monitoring for statins?

A

LFTs at baseline
3 months
12 months

135
Q

For afro-carribbean patients, which anti-HTN should be avoided

A

ACE inhibitor

Aim for ARBs instead

136
Q

What should you advise with regards to driving for a patient with STEMI, who had successul PCI and stent, LVEF 50%, no complications?

A

Stop driving for 1 week
No need to inform DVLA

137
Q

If successfully treated by coronary angioplasty, driving may recommence after 1 week provided what 3 criteria

A
  1. No other urgent revascularisation is planned within 4 weeks
  2. LVEF >40%
  3. No other disqualifying condition.
138
Q

If not successfully treated by coronary angioplasty, driving may recommence after 4 weeks provided that…

A

there are no other conditions

139
Q

Do patients who’ve had a catheter ablation for atrial fibrillation still require anticoagulation

A

YES

long-term as per cha2ds2-vasc score

140
Q

short PR interval
wide QRS complexes with a slurred upstroke (delta wave)
axis deviation

what condition

A

Wolff-Parkinson white

141
Q

For primary prevention of statins, when should the dose be increased (from 20mg atorvastatin)

A

if non-HDL has not reduced by 40% after starting statins

142
Q

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

A

3 times the upper limit

143
Q

first line Ix for suspected angina

A

CT coronary angiogram

144
Q

pulmonary embolism ECG changes

A

S1Q3T3

large S wave in lead 1
Q wave in lead 3
inverted T wave in lead 3

145
Q

management of warfarin
INR 5.0-8.0
no bleeding

A

Withhold 1 or 2 doses of warfarin
Reduce subsequent maintenance dose

146
Q

management of warfarin
INR 5.0-8.0
minor bleeding

A

Stop warfarin
Give intravenous vitamin K 1-3mg
Restart when INR < 5.0

147
Q

management of warfarin
INR >8.0
no bleeding

A

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

148
Q

management of warfarin
INR >8.0
minor bleeding

A

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

149
Q

management of warfarin
major bleeding

A

Stop warfarin
Give intravenous vitamin K 5mg
Prothrombin complex concentrate - if not available then FFP*

150
Q

what medication has been shown to improve mortality in patients with NYHA class 3 or 4 heart failure, already taking an ACEi

A

spironolactone

151
Q

what 2 medications should be given first-line in patients with stable impaired LV function

A

ACE inhibitor
B-blocker

152
Q

patients 60-80years with stage 1 HTN and no end-organ failure and QRISK <10% - management

A

lifestyle changes only

(if below 60 years can consider starting anti-HTN)

153
Q

weakened femoral pulses
what congenital cardiovascular disease

A

coarctation of aorta

154
Q

4 associations (diseases) with coarctation of aorta

A
  1. Turners syndrome
  2. Bicuspid aortic valve
  3. Berry aneurysms
  4. Neurofibromatosis
155
Q

Child heart failure
Radio-femoral delay
Mid systolic murmur with apical click
Notching of ribs
Weak femoral pulses

what congenital heart disease

A

coarctation of aorta

156
Q

in a woman who is planning to get pregnant with hypertension, what should she be referred for

A

refer to secondary care for routine review

for preconception advice

157
Q

what medication can be used to reverse dabigatran (direct thrombin inhibitor)

A

idarucizumab

158
Q

right bundle branch block seen on ECG in asymptomatic older patient, what is the appropriate next step

A

no investigation needed

usually normal variant.

159
Q

Three main side effects of GTN spray

A

Hypotension
Tachycardia
Headache

160
Q

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

A

Refer to cardio
For PCI or CABG

161
Q

effect of furosemide on electrolytes

A

HypoNa+
HypoK+
HypoMg+
HypoCa2+

Hypochloraemic alkalosis

162
Q

Blood pressure targets for:
1. T2DM
2. T1DM
3. T1DM with albuminuria or metabolic syndrome

A
  1. T2DM - 140/90
  2. T1DM - 135/85
  3. T1DM with albuminuria or metabolic syndrome - 130/80
163
Q

Hypertension with heart failure or T2DM of any age.. likely first anti-hypertensive medication to start

A

ACE inhibitor

164
Q

VTE prophylaxis for moderate-high risk patients going on flights

A

Compression stockings

VERY high risk - consider LMWH

165
Q

3 options for rate control in atrial fibrillation

A
  1. b-blockers - avoid in asthma
  2. CCBs - e.g. diltiazem
  3. digoxin - useful if HF too
166
Q

3 options for rhythm control in atrial fibrillation

A
  1. b-blockres
  2. dronedarone - following cardioversion
  3. amiodarone - useful if HF too
167
Q

Aschoff bodies are granulomatous nodules found in which disease

A

Rheumatic heart fever
(usually caused by strep pyogenes)

168
Q

Which heart failure medications have NO EFFECT ON MORTALITY in patients with PRESERVED ejection fraction

A

Ace inhibitors + B-blockers

169
Q

Diltiazem and verapamil should be avoided in which patients

A

HEART FAILURE

170
Q

In a patient with angina who already takes b-blockers, what examples of CCBs should be added on?

A

Amlodipine
Felodipine
Nifidepine MR

  • these are long-acting dihydropyridine CCBs

(avoid diltiazem and verapamil)

171
Q

What is a normal QTc interval in males and females

A

<430ms in males
<450ms in females

172
Q

There are 3 types of long QTc syndrome. What are the differences in presentation

A

Long QT1 - exertional syncope
Long QT2 - syncope after stress or exercise
Long QT3 - during night or at rest

173
Q

Management of long QTc syndrome

A
  1. avoid the triggers /drugs
  2. b-blockersca
  3. ICD in high risk cases
174
Q

can warfarin be used during breastfeeding

A

yes

AKT (25 decks)

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