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SBA passmed Flashcards > cardio > Flashcards

cardio Flashcards

1
Q

what is the management of a STEMI if PCI is not possible in 120 mins

A

fibrinolysis

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2
Q

what is the conservative management of an NSTEMI

A

ticagrelor

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3
Q

which scoring system is used to estimate 6 month mortality of NSTEMI

A

GRACE score

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4
Q

what is the immediate management of NSTEMI

A

aspirin 300 mg followed by fondaparinux if no immediate PCI is planned

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5
Q

which medications are given alongside PCI ( STEMI)

A

Prasugrel
unfractionated heparin + bailout glycoprotein IIB/IIIA inhibitor

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6
Q

name a key difference in the presentation of a Type A aortic dissection vs a type B aortic dissection.

A

chest pain is more common in type A
upper back pain is more common in type B

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7
Q

which part of the aorta does
Type A dissection involve
Type B dissection involve

how are they managed

A

Type A : ascending aorta - IV labetalol + surgery
Type B : descending aorta - IV labetalol + medical management

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8
Q

most important RF for aortic dissection

A

HTN

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9
Q

classical symptoms of dresslers syndrome

A

central pleuritic chest pain
fever
Post MI ( 4 weeks)

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10
Q

main investigation for Dresslers syndrome

A

ESR - raised
widespread concave ST elevation + PR depression

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11
Q

first line management of SVT

A

Valsalva manouvre

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12
Q

what is the most common ECG finding in PE

A

Sinus tachycardia

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13
Q

most likely causative organism in Infective endocarditis

A

Staph. aureus

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14
Q

what class of drug is indapimide

A

thiazide like diuretic

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15
Q

which medication is used as anticoagulation in patients with mechanical heart valves

A

warfarin

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16
Q

first line treatment of patients with HF

A

ACEi + Beta blocker

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17
Q

which score measures risk of stroke in someone with AF

A

CHA2DS2VASc

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18
Q

how does aortic dissection present on CT angiography

A

false lumen of the aorta

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19
Q

at what CHADVASC score would you prescribe anticoagulation

A

men > = 1
women > = 2

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20
Q

which score is used to measure disease activity in RA

A

DAS28

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21
Q

which medications are offered 1st line for reducing stroke risk in AF

A

Rivaroxaban

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22
Q

when is thrombolysis indicated in the case of a PE

A

haemo-dynamic instability

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23
Q

what is atypical angina ?

A

atypical angina is described as chest pain that only meets 2 out of the 3 criteria for stable angina :
- sharp chest pain
- precipitated by exertion
- relieved by GTN spray

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24
Q

what is the 2nd line management of HTN in patient of afro-carribean origin ?

A

ARB

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25
Q

first line management of pericarditis

A

combination of NSAID’s and colchicine generally used first line

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26
Q

triad of symptoms seen in Takayasu’s arteritis

A

lethargy
dizzy spells
absent left radial pulse

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27
Q

which condition is takayasus arteritis associated with

A

renal artery stenosis

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28
Q

what is the management of major bleeding on warfarin

A

stop warfarin
give IV vitamin K 5 mg
and prothrombin complex concentrate

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29
Q

what is the management of minor bleeding ( INR > 8)

A

stop warfarin
giving IV vitamin K 1-3 mg
repeating dose of vitamin K if INR is still too high after 24h
restarting warfarin when INR < 5

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30
Q

what is the diagnostic test for an aortic dissection ? What is a key feature of it

A

CT angiogram chest abdo pelvis
false lumen

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31
Q

what sign is seen on chest xray in aortic dissection

A

widened mediastinum

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32
Q

what is dresslers syndrome and how and when does it present ?

A

It is pericarditis that tends to occur 2-6 weeks post MI . it is characterized by fever, pleuritic chest pain, pericardial effusion and raised ESR.

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33
Q

what are some complications of an MI

A

Cardiac arrest
cardiogenic shock
chronic HF
Pericarditis
left ventricular free wall rupture

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34
Q

what is the most common arrythmia post MI

A

V fibb

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35
Q

how does left ventricular free wall rupture present? How do you treat it ?

A

acute HF secondary to cardiac tamponade
raised JVP, Pulsus paradoxus, diminished heart sounds. Treat with pericardiocentesis and thoracotomy

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36
Q

what is the management of bradycardia with adverse features ?

A

Atropine up to a maximum of 3 mg

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37
Q

what are life threatening signs associated with bradycardia ?

A

shock
syncope
myocardial ischaemia
HF

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38
Q

what is the definitive management of WPW

A

accessory pathway ablation

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39
Q

what score is used in the diagnosis of infective endocarditis

A

Duke criteria

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40
Q

what is the major criteria needed for the diagnosis of IE

A

positive blood cultures
evidence of endocardial involvement ( +ve echo, new valve regurg))

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41
Q

what is the minor criteria needed for the diagnosis of IE

A

-predisposing heart condition or intravenous drug use
-microbiological evidence does not meet major criteria
-fever > 38ºC
-vascular phenomena: major emboli, splenomegaly, clubbing, splinter haemorrhages, Janeway lesions, petechiae or purpura
-immunological phenomena: -glomerulonephritis, Osler’s nodes, Roth spots

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42
Q

which antibiotic should be avoided in Long QT syndrome

A

Erythromycin

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43
Q

which is the preferred method of anticoagulation for those with heart valves

A

warfarin

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44
Q

which HF medications improve mortality

A

ACEi, BB’s , spironolactone

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45
Q

what is the first line medication offered to reduce stroke risk in AF

A

Rivaroxaban

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46
Q

which score is now used to assess Bleeding risk in patients with AF on anticoag

A

ORBIT

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47
Q

which are non shockable rhythm

A

Asytole, Pulseless electrical activity

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48
Q

which medications do you give in non shockable rhythm

A

IV Adrenaline

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49
Q

when would you give amiodarone in adult advanced life support

A

Amiodarone 300 mg in patients in VF/ pulseless VT after 3 shocks

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50
Q

what features of HTN would suggest specialist assessment

A

BP > 180/120
signs of retinal haemorrhage
life threatening symptoms - confusion, chest pain, AKI, HF

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51
Q

2 features of malingnant HTN

A

severe HTN
Bilateral retinal haemorrhages and exudate

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52
Q

when is a new LBBB normal

A

never, always pathalogical

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53
Q

what dose of adrenaline is given in advanced ALS

A

1mg

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54
Q

how does hypothermia present on an ECG

A

J-Waves

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55
Q

which angina medication requires an asymmetrical dosing regime

A

Isosorbide mononitrate

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56
Q

when would you add a third agent in the management of stable angina

A

if ccb and bb together fail

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57
Q

which vaccines are offered to HF Patients

A

annual influenza vaccine
one off pneumococcal vaccine

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58
Q

common signs of PE on ECG

A

Sinus tachycardia and in some cases S1Q3T3

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59
Q

which condition is associated with an early diastolic murmur

A

aortic regurgitation

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60
Q

what signs would you expect to see on a chest xray in heart failure

A

dilated upper lobe vessels
alveolar oedema
kerley b lines
cardiomegaly
pleural effusion

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61
Q

what is the most common cause of a pansystolic murmur in a patient with HF

A

Mitral regurgitation

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62
Q

how does left bundle branch block present on ECG

A

W in V1 and M in V6

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63
Q

how do you manage adult bradycardia with life threatening signs ?

A

atropine 500 mcg IV

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64
Q

give 4 risk factors for asystole

A

complete heart block with broad complex QRS
recent asystole
Mobitz type II AV block
Ventricular pause > 3 seconds

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65
Q

what signs are used to classify patients as unstable during tachycardia

A

-Shock : Hypotension ( Sbp < 90 mm Hg), pallor, sweating, cold, clammy extremities, confusion.
- Syncope
-MI
- HF

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66
Q

what is the management of unstable tachycardia

A

Synchronized DC shock ( up to 3)

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67
Q

what medication can be used to assist DC Cardioversion after 1st unsuccessful shock

A

Amiodarone 300 mg IV over 10-20 mins

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68
Q

How do you differentiate between broad complex and narrow complex tachycardia ?

A

Broad complex QRS > 0.12 seconds
Narrow complex QRS < 0.12 seconds

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69
Q

how do you manage polymorphic VT

A

magnesium 2 mg over 10 mins

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70
Q

how do you manage Regular ventricular tachycardia

A

Amiodarone 300 mg IV over 10-60 mins

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71
Q

how do you manage regular narrow complex tachycardia ( steps)

A
  • vagal manoeuvres
  • adenosine
  • verapamil / BB’s
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72
Q

how does hypercalcaemia present on ECG

A

shortened QT interval

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73
Q

what electrolyte abnormalities can loop diuretics cause ?

A

Hyponatraemia, hypokalaemia, hypomagnesaemia , hypocalcaemia

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74
Q

how do you manage major bleeding on warfarin ?

A

stop warfarin
give IV Vitamin K 5 mg and Prothrombin complex concentrate

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75
Q

how do you manage INR > 8 with minor bleeding on warfarin

A

stop warfarin
IV vitamin K 1-3 mg
repeat Vit K if INR still too high after 24h
restart warfarin when INR < 5

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76
Q

how do you manage INR > 8 no bleeding

A

stop warfarin
give Vit K 1-5 mg by mouth using IV preperation
repeat vit K if INR still too high after 24h
restart warfarin when INR < 5

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77
Q

How do you manage INR 5-8 minor bleeding

A

stop warfarin
IV vit K 1-3 mg
restart warfarin when INR < 5

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78
Q

how do you manage INR 5-8 no bleeding

A

withhold 1/2 doses of warfarin and reduce subsequent maintenance dose

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79
Q

what is the first line management of bradycardia with signs of shock

A

atropine 500 mcg IV to be repeated up to 3 times

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80
Q

what is the first line medication to control rate in AF

A

beta blocker / rate limiting calcium channel blocker

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81
Q

what is the most common cause of infective endocarditis ?

A

Staph. aureus

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82
Q

what is the first line management of pericarditis

A

Ibuprufen and colchicine

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83
Q

which anticoagulation is recommended for patients with mechanical heart valves

A

Warfarin

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84
Q

what sign is seen on echocardiography in Takotsubo cardiomyopathy?

A

Apical ballooning of myocardium ( resembling an octopus pot)

takotsubo is a fat octopus with balloon tentacles

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85
Q

what is the action of dabigatran ?

A

Oral anticoagulant that works by being a direct thrombin inhibitor.

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86
Q

what use is Dabigatran licensed for ?

A

-Prophylaxis of VTE following hip / knee replacement surgery
-Prevention of stroke in patients with non-valvular atrial fibrillation

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87
Q

what medication can be used to reverse the effects of Dabigtran ?

A

Idarucizumab

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88
Q

what is the major adverse side effect of dabigatran ?

A

Haemorrhage

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89
Q

what is the commonest association for aortic dissection?

A

Hypertension

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90
Q

what type of pulse deficit is seen in aortic dissection

A

weak/ absent carotid brachial or femoral pulse + variation in arm BP

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91
Q

what 4 DOACs are recommended by NICE for reducing stroke risk in AF

A

Apixaban
Dabigatran
Edoxaban
Rivaroxaban

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92
Q

give 4 ECG features of Hypokalaemia

A

Small / absent T waves
Prolonged PR interval
ST depression
Long QT

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93
Q

does PE show up on CXR

A

No- normal

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94
Q

which condition presents with widespread ST elevation

A

Acute pericarditis

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95
Q

what is starlings law

A

It states that when the myocardium stretches due to blood pooling, the force of contraction increases to preserve the stroke volume and thus - cardiac output

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96
Q

what are important contraindications to thrombolysis

A

pregnancy
bleeding
recent stroke / surgery
uncontrolled severe HTN
GI malignancy
Prolonged CPR

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97
Q

what is the qrisk score at which a statin is prescribed

A

over or equal to 10%

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98
Q

what is the preferred statin for cardiovascular risk reduction

A

Atorvastatin

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99
Q

what medications should be prescribed in the management of stable angina

A

GTN spray
beta blocker or CCB ( verapamil / diltiazem) first line
aspirin
statin

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100
Q

what are the features of aortic regurgitation

A

early diastolic murmur, collapsing pulse and wide pulse pressure

Quincke’s sign ( nail bed pulsation) and de Musset’s sign ( head bobbing)

Mid diastolic Austin Flint murmur
( severe)

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101
Q

causes of Aortic regurgitation

A

bicuspid aortic valve
ankylosing spondylitis
marfans, Ehlers danlos

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102
Q

What is the most common cause of mitral stenosis

A

Rheumatic fever
Infective endocarditis

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103
Q

how do you manage suspected PE if D DImer negative

A

stop anticoagulation and consider alternative diagnosis

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104
Q

what ECG changes are considered normal in an athlete

A

sinus bradycardia
junctional rhythm
1st degree HB
Mobitz Type 1 Weckebach phenomenon

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105
Q

most common cause of mitral stenosis

A

rheumatic fever

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106
Q

first line therapy for chronic HF

A

ACEi
BB ( bisoprolol)

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107
Q

2nd line therapy for chronic HF

A

Aldosterone antagonist

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108
Q

what vaccines are offered to chronic HF patients

A

Annual influenza vaccine
one off pneumococcal vaccine

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109
Q

what medication can be used to reverse bleeding effects of dabigatran ?

A

Idarucizumab

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110
Q

how do you manage a patient with AF whos CHADVASC suggests no anticoagulation

A

transthoracic echo to exclude valvular heart disease

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111
Q

what type of murmur is seen in mitral stenosis

A

mid-diastolic low pitched rumbling murmur

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112
Q

give the step wise management of bradycardia with adverse signs

A

atropine 500 mcg IV

followed by

atropine up to a maximum of 3 mg
transcutaneous pacing
isoprenaline / adrenaline infusion

travsvenous pacing

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113
Q

which valve is most commonly affected in infective endocarditis

A

Mitral valve

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114
Q

infective endocarditis in IVDU most commonly affects which valve

A

tricuspid valve

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Perfectly
115
Q

which part of the renal tract does bumetanide act upon

A

inhibition of Na-K-Cl cotransporter in thick ascending limb of the loop of Henle

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116
Q

how do you interpret BNP

A

if levels are ‘high’ arrange specialist assessment (including transthoracic echocardiography) within 2 weeks
if levels are ‘raised’ arrange specialist assessment (including transthoracic echocardiography) echocardiogram within 6 weeks

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117
Q

what are the target values for INR when patient has mechanical valves

A

aortic -3
mitral 3.5

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118
Q

which score is used to assess bleeding risk in patients with AF who are anticoagulated

A

ORBIT

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119
Q

criteria for patient with AF to be cardioverted

A

must be anticoagulated
must have had symptoms for < 48 h

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120
Q

what is the NYHA classification

A

1 . no symptoms
2. mild symptoms / slight limitation of physical activities
3. moderate symptoms : marked limitation of physical activity ( comfortable at rest but ordinary activities cause discomfort)
4. severe - cant do anything without symptoms

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121
Q

at what CHADVASC score would you offer anticoagulation

A

2 - women
1.- men

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122
Q

what is takotsubo cardiomyopathy ? how does it present and what are its triggers?

A

Takotsubo cardiomyopathy is a type of non ischaemic cardiomyopathy associated with a transient apical ballooning of the myocardium
it is triggered by stress
features are chest pain, ECG showing widespread ST Elevation and features of HF

supportive management

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123
Q

which medications are contraindicated with statins

A

macrolides like erythromycin and clarithromycin - reduction in kidney function

pregnancy

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124
Q

give 3 features of left ventricular free wall rupture

A

raised JVP
Pulsus paradoxus
diminished heart sounds

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125
Q

what is the mechanism of action of statin

A

inhibits HMG-CoA reductase the rate limiting enzyme in hepatic cholesterol synthesis

126
Q

what are the features of hypokalaemia on ECG

A

U waves ( u have no pot)
small / absent T waves
prolonged PR
ST Depression
long QT

127
Q

what is the investigation of choice for aortic dissection

A

CT angiography

128
Q

For a patient with symptomatic stable angina on a calcium channel blocker but with a contraindication to a beta-blocker, the next line treatment should be _____________

A

isosorbide mononitrate ( long acting nitrate, ivabradine, nicorandil, ranolazine)

129
Q

what murmur is mitral stenosis associated with

A

mid diastolic murmur loudest over the apex

130
Q

which CCB should be prescribed in the management of stable angina ?

A

for monotherapy : rate limiting one such as verapamil or diltiazem
for combination with beta blocker : long acting like amlodipine or modified release nifedepine

131
Q

what are the indications for patient with NSTEMI to have coronary angiography

A

immediate : hemodynamically unstable
within 72 h : GRACE SCORE > 3%

132
Q

what type of murmur is seen in aortic stenosis

A

Ejection systolic murmur classically radiating to the carotids.

133
Q

when are nitrates contraindicated

A

Hypotension
aortic stenosis

134
Q

when would you stop beta blocker in HF

A

HR < 50 / Min
2nd / 3rd HB
Shock

135
Q

why does hypertrophic obstructive cardiomyopathy cause sudden death in young atheletes

A

ventricular arrythmia

136
Q

how to distinguish mitral from tricuspid regurgitation

A

tricuspid regurgitation : becomes louder during inspiration

137
Q

most common cause of infective endocarditis in patients who have undergone prosthetic valve surgery

A

Staph. Epidermis

138
Q

explain monitoring of fibrinolysis

A

give antithrombin drug
repeat ECG after 60-90 mins and perform PCI if myocardial ischaemia persists.

139
Q

what is the first line investigation for stable chest pain of suspected coronary artery disease

A

CT coronary angiogram with contrast

140
Q

what electrolyte imbalances do thiazide diuretics cause

A

hypokalaemia
hyponatraemia
hypercalcaemia
hypocalciuria in urine
impaired glucose tolerance

141
Q

what are the contraindications to ACEi

A

pregnancy and breastfeeding
renal disease
aortic stenosis

142
Q

what is the diagnostic test for cardiac tamponade

A

Echocardiogram

143
Q

MI due to first degree HB is generally seen in which leads

A

MI due to first degree HB is generally seen in which leads

144
Q

when would you consider a third heart sound to be normal

A

considered normal if < 30

145
Q

which conditions can present with a third heart sound

A

Left ventricular failure ( dilated cardiomyopathy)
Constrictive pericarditis
Mitral regurgitation

146
Q

what is becks triad

A

Hypotension
raised JVP
muffled heart sounds

147
Q

Explain the interpretation of a Wells score when PE is suspected.

A

PE likely : > 4 points
arrange immediate CTPA // interim therapeutic anticoagulation until the scan is performed
PE unlikely 4 points or less
arrange D Dimer
positive : CTPA with interim therapeutic anticoagulation
negative : Stop anticoagulation + consider alternative diagnosis

148
Q

what is S1Q3T3 classical of

149
Q

which pulse is most likely to be present in a patient with an early diastolic murmur louder on expiration

A

Collapsing pulse

150
Q

what is the most specific finding on ECG in acute pericarditis ?

A

PR depression

151
Q

which medication is preferred in patents with AF who have structura heart disease for rhythm control

A

amiodarone

152
Q

how long after a stroke should secondary prevention medication be started in a patient with AF? What medications suitable

A

2 weeks
Warfarin
Direct thrombin
factor Xa inhibitor

153
Q

to what wave is electrical cardioversion synchronized to

154
Q

what is the management of aortic stenosis ?

A

symptomatic : Valve replacement
asymptomatic but valvular gradient > 40 mm Hg : valve replacement
asymptomatic : observation

155
Q

what is Torsades de Pointes and how does it present ?

How is it managed

A

Polymorphic ventricular tachycardia with long QT
Managed with IV Magnesium sulphate

156
Q

how does a posterior MI present

A

ST depression
Tall, broad R-waves
Upright T-waves

157
Q

what is the conservative management of NSTEMI?

A

Aspirin 300 mg + Fondaparinux + ticagrelor

158
Q

what is the intermediate / high risk management of NSTEMI ?

A

aspirin + prasugrel / ticagrelor + unfractionated heparin + PCI

159
Q

what is the management of a STEMI when PCI is possible?

A

prasugrel + unfractionated heparin + bailout glycoprotein IIb / IIIa inhibitor

160
Q

what is the management of STEMI when Fibrinolysis is planned?

A

Antithrombin
ticagrelor

161
Q

what is the management of a shockable rhythm ?

A

1 shock followed by resumption of CPR for 2 minutes

amiodarone 300 mg for patients who are in VF/ pulseless VT and 3 shocks have been administered.

adrenaline 1 mg once chest compressions have started after the third shock

162
Q

what is the management of a non-shockable rhythm?

A

CPR for 2 mins
adrenaline 1 mg as soon as possible for non shockable rhythms

163
Q

what is Buerger’s disease ? What is it associated with? What are it’s features?

A

Known as thrombo-angiitis obliterans and is a small + medium vessel vasculitis that is associated with smoking

Feature’s include :
extreme ischaemia
claudication and ulcers
raynauds
thrombophlebitis

164
Q

which medication is contra-indicated in ventricular tachycardia

165
Q

what are rules regarding combination antiplatelet and anticoagulation therapy

A

in stable cvd : anticoagulation monotherapy

post ACS / PCI : 2 platelets and 1 anticoagulant for 4-6 weeks after event and dual therapy 1 platelet 1 anticoagulant to complete 12 months

166
Q

what is the DVLA advice post MI

A

Cannot drive for 4 weeks

167
Q

how does ventricular septal defect present in a patient post MI

A

acute heart failure, new pan-systolic murmur

168
Q

what score helps identify patients with a PE that can be managed as an outpatient

A

PESI : Pulmonary embolism severity index

169
Q

what is the investigation choice in suspected PE when the patient has renal failure ?

170
Q

what is Kussmaul’s sign? What condition is it present in?

A

rise in JVP during inspiration
constrictive pericarditis

171
Q

how do you manage a choking patient depending on if they have mild / severe airway obstruction?

A

mild
ask patient to cough

severe and conscious

5 back blows
followed by 5 abdominal thrusts

continue cycle

unconscious

call for ambulance
start CPR

172
Q

how long is treatment continued in a patient with VTE

A

provoked : 3 months
unprovoked : 6 months in total

173
Q

what causes sudden death in Hypertrophic cardiomyopathy

A

ventricular arrythmias

174
Q

what is the first line investigation of episodic arrhythmias ?

A

Holter monitoring

175
Q

what type of an arrhythmia is svt ? How is it managed?

A

it is a narrow complex tachycardia.

management :
vagal manouvres such as valsalva manouvre.

IV adenosine

electrical cardioversion

176
Q

which beta blockers reduce mortality in stable HF ?

A

Bisoprolol and carvedilol

177
Q

what is the standard drugs offered to a patient post MI ?

A

Dual anti-platelet therapy ( aspirin + 1 more)
ACEi
BB
Statin

178
Q

which score can be used to assess anxiety in a patient?

179
Q

above what GRACE score should coronary angiography be considered?

180
Q

what biochemical marker is raised in Dressler’s syndrome?

181
Q

what abdo findings are seen in tricuspid regurgitation

A

pulsatile liver
ascites

182
Q

what is the most common cause of death post MI

A

ventricular fibrillation

183
Q

what type of MI precedes an AV block

A

inferior MI

184
Q

what is the investigation of choice in suspected pericarditis

A

transthoracic echo

185
Q

when is a carotid artery endarterectomy recommended in the management of TIA

A

if carotid stenosis 70 %

186
Q

what imaging is performed in the investigation of TIA

A

MRI preferred
urgent carotid doppler

187
Q

what is the immediate assessment and referral guidelines for suspected TIA

A

aspirin 300 mg - unless bleeding disorder/anticoagulation in which case admission is needed

in the last 7 days - immediate assessment by stroke physician

more than 7 days - refer for specialist assessment asap in 7 days

188
Q

what is the secondary prevention of TIA

A

clopidogrel
aspirin + dipyradamole if clopidogrel not tolerated

189
Q

which anti-anginal medication do patients commonly develop tolerance to? How do you prevent this ?

A

standard release isosorbide mononitrate

Assymetric dosing interval

190
Q

what are the three types of ischaemia to the lower GI tract ?

A

acute mesenteric ischaemia
chronic mesenteric ischaemia
ischaemic colitis

191
Q

what are the common features of bowel ischaemia ? what investigation is used for diagnosis ?

A

abdominal pain
rectal bleeding
diarrhoea
fever
bloods show lactic acidosis

investigation : CT

192
Q

what are the preceding factors, symptoms and management of acute mesenteric ischaemia

A

occlusion of artery such as superior mesenteric artery with a background of AF

presents with severe, sudden onset abdominal pain, required to be managed with urgent surgery

193
Q

what is ischaemic colitis ? what areas does it affect? what are its complications + investigations and management

A

acute + transient compromise in the blood flow to the large bowel leading to inflammation, ulceration and haemorrhage.

areas - watershed areas like splenic flexures
investigations - thumbprinting on abdo xray

management - supportive, surgery

194
Q

what medications are used in the management of shockable vs non shockable rhythms

A

adrenaline - 1mg asap for non- shockable rhythms
to be repeated every 3-5 mins whilst ALS continues

amiodarone - 300mg to be given to patients in VF/VT after 3 shocks

195
Q

what is the management of atrial flutter ? what is curative ?

A

similiar to AF - medications less effective
more sensitive to cardioversion
radiofrequency ablation of tricuspid isthmus is curative

196
Q

what is the management of Torsades de pointes?

A

IV Magnesium sulphate

197
Q

what medications cause long QT

A

antibiotics- macrolides
antipsychotics - clozapine, haloperidol
antidepressants - TCAs
antiemetics- ondansetron

198
Q

what diseases can cause torsades de pointes

A

myocarditis
hypothermia
sah
electrolyte imbalance - hypocalcaemia, hypokalaemia, hypomagnesaemia
subarachnoid haemorrhage

199
Q

what is the referral guidelines for AAA

A

asymptomatic and aortic diameter < 5.5 cm - low rupture risk, so abdominal ultrasound surveillance depending on size.

if the aneurysm is symptomatic or the aortic diameter > 5.5 cm or rapidly enlarging : refer within 2 weeks to vascular surgery for probable intervention, and management with elective endovascular repair.

200
Q

how often is an abdominal aortic aneurysm scanned

A

3-4.4 cm = every 12 months
4.5-5.4 = 3 months
5.5 - referral within 2 weeks for probable intervention

201
Q

explain acute mitral regurgitation post MI

A

infero-posterior infarction may be due to ischaemia or rupture of the papillary muscle leading to acute hypotension and pulmonary oedema

202
Q

what is the management of ischaemic stroke ?

A

aspirin 300 mg rectally or orally if haemorrhagic stroke has been excluded
thrombolysis if patient has presented within 4.5 hours of onset + haemorrhage has been definitely excluded

thrombectomy - offer with thrombolysis within 4.5 hours .or just thrombectomy within 6 hours. Extended target time upto 24h considered if there is potential to salvage brain tissue - CT/ MRI showing limited core infarct core volume

203
Q

what is the secondary prevention of stroke

A

clopidogrel
aspirin + mr dipyradimole - if clopidogrel c/i

204
Q

what is the most specific finding on ecg in acute pericarditis

A

pr depression

205
Q

what are the most common causes of endocarditis

A

staph aureus
staph epidermis if < 2 months post valve surgery

206
Q

mx of irregular broad complex tachy

A

seek cardiology input

207
Q

post mi drugs

A

dual antiplatelet therapy (aspirin plus a second antiplatelet agent)
ACE inhibitor
beta-blocker
statin

208
Q

ptn of myocarditis

A

young patient with acute history
chest pain
dyspnoea
arrhythmias
ST elevation and acute pulmonary oedema
recent flu like illness

209
Q

how does left ventricular aneurysm post MI present

A

persistent ST elevation in anterior leads
pulmonary oedema

features of acute heart failure such as -
SOB
Cough
crackles on auscultation

occuring 2 weeks post MI

210
Q

when do you offer pharmacological management of hypertension to those over 80

A

if ABPM > 150/95 mmHg

211
Q

what is the guidelines surrounding anticoagulation in patient with AF who has had a stroke

A

aspirin daily, start anticoagulation after 2 weeks

212
Q

what are poor prognostic features for ACS ?

A

age
development of HF
peripheral vascular diseases
reduced systolic BP
cardiac arrest
ST segment deviation
Killip class - crackles, pulmonary oedema, cardiogenic shock

213
Q

what indicates mobility of mitral valves

A

opening snap

214
Q

what are the features of post MI ventricular septal defect

A

acute HF associated with a pan-systolic murmur
usually seen in the first week after an MI

215
Q

what is the management of a cardiac arrest witnessed on monitor

A

3 successive shocks before CPR

216
Q

what is a side effect of the following medications ?

Nicorandil
Isosorbide mononitrate
beta blockers

A

Nicorandil - ulcers , risk of bowel perforation during diverticular disease
isosorbide mononitrate - development of tolerance
bisoprolol- sexual dysfunction

217
Q

what type of disease is a pansystolic murmur associated with

A

tricuspid and mitral regurg- murmur louder on inspiration in tricuspid

218
Q

what is the biggest cause of mitral stenosis

A

rheumatic fever

219
Q

what are features of severe MS ?

A

length of murmur increases
opening snap becomes closer to S2

220
Q

what is the management of mitral stenosis

A

asymptomatic - regular echos
symptomatic - Percutaneous mitral balloon valvotomy

221
Q

whats the very first thing u do in stroke suspected

A

hypoglycaemia
ROSIER

222
Q

what is the first line investigation for stroke? what is a characteristic sign of :

acute ischaemic stroke
acute haemorrhagic stroke

A

CT head - non contraaat
acute - hyperdense artery sign and may show areas of low density in the grey and white matter

acute haemorrhagic - hyperdense material surrounded by low density

223
Q

what tests are used to investigate cause of stroke in young ppl

A

thrombophilia
autoimmune
under 55 with no cause of stroke

224
Q

what is the ABPM definition of stage 1 HTN

225
Q

what is the definition of stage 2 htn
what is the definition of severe htn

A

stage 2- clinical bp >=160/100 mmHg and subsequent ABPM >= 150/95
stage 3 = clinic systolic BP >= 180 mmHg , clinic diastolic BP > 120 mmHg

226
Q

what are the dietart modifications recommended for the management of HTN

A

low salt diet - aiming for < 6 g / day , ideally 3 g a day

227
Q

which artery is the preferred site for insetion of a catheter for PCI

A

radial artery

228
Q

what medication causes reflex tachycardia

A

nifedipine

229
Q

how and when is amiodarone administered in management of VF/ pulseless VT ?
What is an alternative ?

A

300 mg amiodarone after 3 shocks
further 150 mg after 5 shocks have been given

alternative : Lidocaine

230
Q

when is adrenaline given in an VF/VT cardiac arrest

A

once chest compressions have restarted after the third shock - to be repeated every 3 - 5 mins

231
Q

what heart murmur can present with haemoptysis

A

mitral stenosis

232
Q

what are the surgical options for aortic stenosis

A

surgical AVR for low/medium operative risk patients
transcatheter AVR for high operative risk patients

233
Q

when is balloon valvuloplasty used in the management of aortic stenosis

A

may be used in children with no aortic valve calcification
in adults limited to patients with critical aortic stenosis who are not fit for valve replacement

234
Q

when does anticoagulation start after a TIA in patients with atrial fibrillation ?
how does this differ in acute stroke ?

A

anticoagulation should start immediately once a haemorrhage has been excluded
in acute stroke - anticoagulation should be commenced in 2 weeks once haemorrhage has been ruled out

235
Q

what is the first line investigation for acute mesenteric ischaemia ?

A

raised lactate

236
Q

broad complex tachy following MI is always

A

ventricular tachy

237
Q

what is the time frame within which pericarditis and dresslers syndrome occur post mi

A

pericarditis - 1st 48 h
dresslers- 2-6 weeks post Mi

238
Q

How does a Pontine haemorrhage present ? What is it a complication of ?

A

complication secondary to chronic HTN

reduced GCS
Quadriplegia
miosis
absent horizontal eye movements

239
Q

what arteries does a Lacunar infarct involve ? how can it present

A

perforating arteries around internal capsule, thalamus and basal ganglia and one of -

unilateral weakness and or sensory deficit of face and arm, arm and leg or all 3
pure sensory stroke
ataxic hemiparesis

240
Q

which arteries does a posterior circulation infarct involve

A

vertebrobasilar arteries presenting with one of -
cerebellar or brainstem syndromes
loc
isolated homonymous hemianopia

241
Q

how does a posterior cerebral artery stroke present

A

contralateral homonymous hemianopia with macular sparing and visual agnosia

242
Q

what heart condition can conditions like ankylosing spondylitis and connective tissue disorders pre-dispose you to

A

aortic regurgitation

243
Q

what is the first line medication used in the management of PAD

A

clopidogrel

244
Q

what lifestyle factor has significant benefit in PAD

A

exercise training

245
Q

what makes an aortic stenosis murmur quieter

A

left ventricular systolic dysfunction

246
Q

what medication is given along with fibrinolysis

A

antithrombin - fondaparinaux

247
Q

what is the criteria for open bypass graft in PAD A

A

critical limb ischaemia - for long segment lesion > 10 cm

248
Q

what is the criteria for admitting patient in htn

A

bp > 180/120
signs of retinal haemorrhage + papilloedema
life threatening symptoms such as new onset confusion , chest pain, signs of HF, aki

249
Q

what is the first line investigation for suspected acute limb threatening ischaemia

A

handhend arterial doppler

250
Q

what is the investigation of choice in clinically unstable patients with suspected aortic dissection

A

transoesophageal echo

251
Q

what is the management of patients anticoagulation when they have had catheter ablation

A

continue anticoagulation because stroke risk remains the same

252
Q

summarise the management of broad complex tachycardias

A

any adverse signs : synchronized DC shocks ( upto , before asking for specialist input)
regular - ventricular tachy
loading dose of amiodarone followed by 24h infusion
irregular -specialist input

253
Q

how long should CPR continue when thrombolytic drugs are given

254
Q

which 2 medications should a patient take post ischaemic stroke and discharge

A

clopidogrel and statin

255
Q

what are the most common clinical causes of ventricular tachycardia

A

Hypokalaemia

256
Q

give the stepwise management of supraventricular tachycardias

A

vagal manouvres - valsalva ( blowing into an empty plastic syringe)
carotid sinus massage
iv adenosine
rapid IV bolus of 6 mg - if unsuccessful give 12 mg – if further unsuccessful give further 18 mg

electrical cardioversion

257
Q

what can be used in the prevention of supraventricular tachycardias

A

beta blockers
radiofrequency ablatiin

258
Q

summarise the stepwise management of heart failure

A

ACEi and Beta blocker
2nd line -aldosterone antagonist, SGLT2 can be used in management with reduced ejection fraction
3rd line =
digoxin = symptoms / co-existing AF
hydralazine w nitrate = black ppl
cardiac resynchronized therapy- widened QRS ( LBBB)
ivabradie = LVF< 35, sinus rhythm > 75 / min
sacubitral-valssartan LVF< 35% ; symptomatic on ACEI. ARB and symptomatic ( initiated following ACEi or ARB wash out period)

259
Q

when do u use unsynchronized DC cardioversion?

A

pulseless VT/AF
unstable polymorphic VT

260
Q

what is the management of AF if there is co-existent HF, first onset HF, or reversible case

A

rhythm control

261
Q

what patterns of presentation may be present in PAD

A

intermittent claudication
critical limb ischaemia
acute limb threatening ischaemia

262
Q

features of acute limb threatening ischaemia

A

pale
pulseless
painful
paralysed
paraesthetic
‘perishing with cold’

263
Q

management of acute limb threatening ischaemia

A

ABCDE
IV opioids used
vascular review

264
Q

main causes of acute limb threatening ischaemia

A

thrombus
embolus due to AF

265
Q

Chronic vs acute limb threatening ischaemia

A

chronic - symptoms have to be present for 2 weeks

266
Q

most common cause of congenital heart disease

A

ventricular septal defect

267
Q

classical signs of VSD

A

failure to thrive, pan-systolic murmur

268
Q

what can cause orthostatic hypotension

A

venous pooling, post meal, prolonged bed rest, pregnancy

primary autonomic failure - Parkinsons and Lewy body
secondary - diabetic neuropathy, amyloidosis and uraemia
drug induced - diuretics, alcohol, vasodilators
volume depletion - haemorrhage, diarrhoea

269
Q

which is a useful marker to detect re-infarction

270
Q

coarctation of the aorta

A

mid systolic murmur, radio-femoral delay

271
Q

definition of orthostatic hypotension

A

drop in SBP of at least 20 mmHg or drop in DBP of at least 10 mmHg after 3mins of standing

272
Q

which conditions can cause a raised BNP ( apart from hf)

A

CKD
MI
valvular disease

273
Q

what ECG changes suggest ischaemia

A

Q wave abnormality
T wave changes

274
Q

ventricular septal defect on cardiac catheterisation

A

jump in oxygen from right atrium to right ventricle

275
Q

main cause of rheumatic fever

A

Streptococcus pyogenes

276
Q

features of rheumatic fever

A

erythema marginatum
Sydenham’s chorea
polyarthritis
carditis and valvulitis

277
Q

management of rheumatic fever

A

antibiotics - oral Penicillin V
NSAID’s

278
Q

what can be a cause of global T wave inversion

A

Head injury

279
Q

causes of inverted T waves

A

MI
Digoxin toxicity
SAH
PE
brugada

280
Q

early sound of HF

281
Q

which condition is hypertrophic cardiomyopathy likely to have

282
Q

features of digoxin toxicity

A

unwell, lethargy, nausea and vomiting, anorexia, confusion
gynaecomastia

283
Q

what precipitates digoxin toxicity

A

hypokalaemia
age
renal failure
drugs like amiodarone, verapamil, diltiazem, ciclosporin, diuretics

284
Q

mx of digoxin toxicity

285
Q

ECG: digoxin

A

down sloping ST depression
flattened / inverted T waves

286
Q

what heart sound is hypertrophic cardiomyopathy associated with

A

S4
ejection systolic murmur that increases with valsalva manouvre and decreases on squatting

287
Q

Notching of the inferior border of the ribs

A

coarctation of the aorta

288
Q

pathophysiological cause of long QT

A

loss of function of K+

289
Q

3 key side effects of GTN spray

A

hypotension, tachycardia, headache

290
Q

wellen’s syndrome

A

ECG pattern caused by high grade stenosis in LAD
minimal ST elevation and deep T wave inversion

291
Q

atrial septal defect

A

ejection systolic murmur louder on inspiration

292
Q

late systolic murmur

A

mitral valve prolapse
coarctation of the aorta

293
Q

pulmonary stenosis

A

ejection systolic murmur louder on inspiration

294
Q

what sign favours cardiac resynchronisation therapy

A

widened QRS

295
Q

Signs of hypertrophic cardiomyopathy on Echo

A

mitral regurgitation ( MR)
systolic anterior motion of anterior mitral valve leaflet ( SAM)
asymmetric hypertrophy ( ASH)

296
Q

Ccauses of loud S2

A

pulmonary HTN

297
Q

which vein is used for venous cut down in cases where vascular access is difficult

A

long saphenous vein

298
Q

which meds should be avoided in patients with HOCM

299
Q

coarctation of the aorta murmur

A

mid systolic , maximal over the back

300
Q

key side effect of nicorandil

A

gastrointestinal ulcers

301
Q

lifestyle cause of dilated cardiomyopathy

A

chronic alcoholism

302
Q

how should hyperglycaemia be managed in ACS

A

low dose insulin infusion with regular monitoring of blood glucose levels to glucose below 11 mmol/l

303
Q

what happens to pulmonary pressure in cardiogenic shock

304
Q

what happens to cardiac output in septic shock

A

high cardiac output and low systemic vascular resistance

305
Q

where are right sided and left sided murmurs heard best

A

right - inspiration
left side -expiration
RILE

306
Q

causes of S3

A

dilated cardiomyopathy
constrictive pericarditis
mitral regurgitation

307
Q

causes of S4

A

aortic stenosis
HOCM
HTN

308
Q

which condition causes a bisferiens pulse

A

mixed aortic valve disease

309
Q

key sign of digoxin therapy on ECG

A

scooped ST depression in leads II,III, aVF v5,v6

310
Q

what wave represents strain in mitral stenosis

311
Q

ECG changes associated with bradycardia

SBA passmed Flashcards (30 decks)

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