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finals > cardio > Flashcards

cardio Flashcards

1
Q

conditions that increase the risk of atherosclerosis

A

DM
HTN
CKD
RA
atypical antipsychotics

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2
Q

what to do if QRISK score >/= 10%

A

atorvastatin 20mg
check LFTs 3m and 1yr

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3
Q

SE statins

A

myopathy
T2DM
haemorrhagic strokes

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4
Q

secondary prevention CVD

A

aspirin (+clopidogrel first 12m)
atorvastatin 80mg
atenolol (or bisoprolol)
ACE i - ramipril titrated to tolerated dose

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5
Q

gold standard ix for angina

A

CT coronary angiography

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6
Q

mx stable angina

A

refer to cardiology
immediate sx relief: GTN spray
long term sx relief: BB +/- CCB
secondary prevention: aspirin, atprvastatin, ACEi
surgery: PCI, CABG

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7
Q

what does right coronary artery supply

A

RA, RV, inf LV, post septal

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8
Q

what does circumflex artery supply

A

LA, post Lv

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9
Q

what does Left anterior descending supply

A

ant LV, ant septum

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10
Q

STEMI ECG

A

ST elevation MI or new LBBB

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11
Q

NSTEMI ECG

A

ST depression, deep T inversion, pathological Q

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12
Q

causes raised troponin

A

MI
chronic renal failure
sepsis
myocarditis
aortic dissection
PE

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13
Q

STEMI Mx

A

primary PCI (stented) within 2h presentation or thrombolysis (alteplase, streptokinase) if not
BB
aspirin 300mg
ticagrelor 180mg or clopidogrel 300mg
morphine
anticoag: LMWH
nitrates - GTN
oxygen if sats <95%

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14
Q

GRACE score

A

risk death/repeat MI within 6m NSTEMI
med=5-10%
high >10%

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15
Q

what to do if med/high GRACE scire

A

PCI within 4d

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16
Q

what is dresslers syndrome

A

2-3w post MI
localised immune response ->pericarditis

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17
Q

sx dresslers syndrome

A

pleuritic chest pain, fever, pericardial rub
can cause pericardial effusion and tamponade

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18
Q

ECG dresslers syndrome

A

global ST elevation
T inversion

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19
Q

mx dresslers syndrome

A

NSAIDs +/- steroids +/- pericardiocentesis

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20
Q

triggers acute LVF

A

iatrogenic (fluids)
sepsis
MI
arrhthmia

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21
Q

sx acute LVF

A

pulmonary oedema
SOB- T1RF
3rd HS
increased JVP

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22
Q

mx acute LVF

A

stop IV fluids
sit up
oxygen
diuretics (furosemide)

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23
Q

causes increaed BNP

A

HF
increased HR
sepsis
PE
renal impairment
COPD

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24
Q

when is BNP relerased

A

from ventricles when abnormally stretched

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25
Q

diagnosing chronic HF

A

presentation
BNP (NT-proBNP)
echo
ECG

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26
Q

causes chronic HF

A

IHD
aortic stenosis
HTN
AF

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27
Q

mx chronic HF

A

ACE i (ramipril 10mg), BB (bisoprolol 10mg)
if not controlled: aldosterone antagonist (spironolactone), loop diuretic (furosemide) for sx

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28
Q

what is cor pulmonale

A

RHF caused by resp disease

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29
Q

causes cor pulmonale

A

COPD
PE
ILD
CF
pulmonary HTN

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30
Q

sx cor pulmonale

A

SOB
oedema
increased JVP
3rd HS
hepatomegaly

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31
Q

mx cor pulmonale

A

tx cause
oxygen
poor prognosis

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32
Q

types HTN

A

essential/primary
secondary: renal, obesity, pregnancy, endocrine

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33
Q

stage 1 HTN

A

> 140/90 in hospital
135/85 at home

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34
Q

stage 2 HTN

A

> 160/100 hospital
150/95 at home

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35
Q

mx HTN

A
  1. <55=ACEi, >55 or afrocaribbean=CCB
  2. add CCB, if afrocaribbean + ARB
    • thiazide like diuretic (indapamide)
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36
Q

target BP in HTN

A

> 80y <150/90
<80y <140/90

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37
Q

S1

A

closing AV valves

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38
Q

S2

A

closing semilunar valves

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39
Q

S3

A

due to rapid V filling
can be normal <40y

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40
Q

S4

A

before S1 - stiff ventricle

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41
Q

cause mitral stenosis

A

rheumatic heart disease
IE

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42
Q

features mitral stenosis

A

mid diastolic low pitched murmur
loud S1
malor flush
AF

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43
Q

features tricuspid regurg

A

pan systolic
split S2
thrill
increased JVP with giant CV waves (lancisis sign)
pulsatile liver
peripheral oedema
ascites

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44
Q

features pulmonary stenosis

A

ejection systolic murmur with deep inspiration
widely split S2
thrill
increased JVP with giant A waves
peripheral oedema
ascites

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45
Q

murmur grades

A

I = difficult to hear
VI = audible with stethoscope of chest

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46
Q

cause mitral regurg

A

age
IHD
IE
connective tissue disorders

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47
Q

features mitral regurg

A

pan systolic high pitched
radiates to L axilla
leads to HF and S3

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48
Q

causes aortic stenosis

A

age
rheumatic heart disease

49
Q

features aortic stenosis

A

most common murmur
ejection systolic high pitched crescendo decrescendo
radiates to carotids
slow rising pulse
narrow PP
exertional syncop

50
Q

causes aortic regurg

A

age
connective tissue disorders

51
Q

features aortic regurg

A

early diastolic soft murmur
collapsing pulse
austin flint murmur : at apex-early diastolic rumbling

52
Q

AF ECG

A

absent P
narrow QRS
irregularly irregular

53
Q

valvular AF

A

also have mod/sev mitral stenosis or mechanical valve

54
Q

causes AF

A

sepsis
mitral valve
IHD
thyrotoxicosis
HTN

55
Q

mx AF

A

rate=BB (atenolol) unless new onset or reversible
rhythm: if reversible/new onset then cardioversion (electrocal or flecanide/amiodarone)
long term BB
paroxysmal AF: flecanide during episode
anticoag: Chadvasc>1

56
Q

HASBLED

A

bleeding risk
HTN
abnornal renal
stroke
bleeding
labile INR
elderly
alcohol

57
Q

shockable rhythms

A

VT
VF

58
Q

mx of a tachy rhythm in unstable patient

A

up to 3 syncronised shocks
amiodarone

59
Q

narrow complex tachycardias

A

AF
atrial flutter
SVT

60
Q

atrial flutter ECG

A

sawtooth

61
Q

mx atrial flutter

A

BB

62
Q

mx SVT

A

valsalva manoevre
carotid sinus massage
adenosine
DC cardioversion

63
Q

what does adenosine do

A

slow conduction through AV node

64
Q

when not to use adenosine

A

asthma
COPD
HF
heart block
severe hypotension

65
Q

doses adenosine

A

6mg
then 12mg
then 12mg
as fast IV bolus

66
Q

broad complex tachycardia

A

VT
SVT with BBB

67
Q

mx VT

A

amiodarone infusion

68
Q

wolf parkinson white

A

extra pathway - bundle of kent

69
Q

ECG WPW

A

short PR
wide QRS
delta wave (slurred upstroke QRS)

70
Q

definitive tx WPW

A

radiofreq ablation

71
Q

malignant/accelerated HTN

A

BP >180/120 with retinal heamorrhage or papilloedema

72
Q

mx malignant/accelerated HTN

A

IV: sodium nitroprusside, labetalol, GTN, nicardipine

73
Q

torsades de points

A

polymorphic VT that occurs in prolonged QT

74
Q

mx torsades de points

A

acute: magnesium infusion, defib if VT
long term: BB, pacemaker

75
Q

causes prolonged QT

A

QT syndrome
medds: antipsychotics, citalopram flecainide, sotalol, amiodarone, macrolide abx
electrolytes: low K, low Mg, low Ca

76
Q

first degree heart block

A

PR >0.2s

77
Q

second degree heart block

A

mobitz type 1: increase PR until absent QRS and repeat
mobitz type 2: set ration no QRS - usually 3:1

2:1 block can be type 1 or 2

78
Q

3rd degree heart block

A

complete
no relation between P and QRS
risk asystole

79
Q

mx bradycardia and AV block

A

stable = observe
unstable= atropine 500mcg IV up to 6 doses, noradrenaline, transcutaneous cardiac pacing

80
Q

pacemaker indications

A

bradycardia with sx
mobitz type 2 AV block
3rd degree heart block
severe HF
hypertrophic obstrictive cardiomyopathy

81
Q

ECG changes with pacemaker

A

single chamber: 1 line before P or QRS
dual chamber: line before P and QRS

82
Q

stable angina

A

sx come on with exertion and relieved by rest or GTN

83
Q

unstable angina

A

sx at random at rest

84
Q

cardiac chest pai

A

constricting/tight
may radiate to jaw or l arm
N+V
clammy
sweating
feeling of impending doom
SOB
palpitation

85
Q

ACS

A

unstable angina
STEMI
NSTEMI

86
Q

silent MI

A

typical chest pain not experienced
people woth DM at high risk

87
Q

mx NSTEMI

A

BATMAN
base decision about angiography - PCI depending on GRACE score
aspirin 300mg
ticagrelor 180mg (clopidogrel if bleedin risk, prasugrel if having PCI)
morphine
antithrombin - fondaparineux
GTN

88
Q

types MI

A
  1. due to ACS
  2. ischaemia secondary to increased demand or decreased O2 e.g. anaemia, tachy, low BP
  3. sudden death
  4. associated with procedures - PCI, CABG
89
Q

CXR features HF

A

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

90
Q

mx peripheral oedema HF

A

furosemide: IV if sev and pitting, otherwise oral

91
Q

class of drug furosemide

A

loop diuretics

92
Q

why is furosemide preferred in HF to spironolactone

A

spironolactone risk increased K

93
Q

monitoring fluid overload HF

A

regular wt - should reduce
monitor fluid input and output

94
Q

cause of murmur in HF

A

mitral regurg =pansystolic

95
Q

criteria PPCI in STEMI

A

ST elevation over 2mm in 2 contiguous chest leads or >1mm in 2 contiguous limb leads
chest pain or other evidence ischaemia

96
Q

what is the HEART score for

A

to see if admit or discharge with chest pain
hx, ecg, age, RF, trop
low risk=discharge
mod=observe
high=admit

97
Q

non STE ACS mx in ED

A

cardiac monitoring
mx any arrhythmia or HF
P2Y12 i loading- ticagrelor 180mg or prasugrel 60mg (clopidogrel 2nd line)
anticoag-fondaparineux 2.5mg SC
NO BB or ACE i initially without specialist consultation
IV GTN if ongoin pain

98
Q

inpatient mx non STE ACS

A

cardiac monitoring >/= 24h
medical vs invasive mx: usually angiogram and PCI
secondary prevention
stay approx 72h
physio
reduce RF

99
Q

TTO post MI

A

aspirin 75mg OD
ticagrelor 90mg BD for 1y +/- PPI
bisoprolol 2.5mg OD - caution if asthma, bradycardia, conduction disorder
ramipril 2.5mg OD or ARB if wont tolerate
atorvastatin 80mg

others: GTN spray, poor LV funt=spironolactone, pericarditic pain=colchicine, HF=furosomide + dapagliflozin, non-revascularised=antianginal

100
Q

follow up post MI

A

clinic in 1m
TOE
cardiac rehab programme
smoking cessation
GP uptitrate secondary prevention

101
Q

advice post MI

A

no driving 1wk if PCI, 4 wks if none
gradual return activity
6w off work

102
Q

stable angina meds

A

aspirin
statin
anti-anginal: BB, CCB, nitrates, nicorandil, ivabradine, rondazine
refer for intervention if failed 2 anti-anginals

103
Q

interventions for stable angina

A

PCI: sx relief, need DAPT 6m
CABG favoured if 3 vessel disease, L main stem disease, valvular disease, sometimes diabetics

104
Q

gold standard ix aortic dissection

A

CT aortogram

105
Q

PESI score

A

decision to admit PE

106
Q

rate control drugs AF

A

BB
CCB
digoxin

107
Q

rhythm control drugs AF

A

flecanide
amiodarone
procedures

108
Q

mx acute pulmonary oedema

A

sit forward
high flow oxygen
if shocked speak to critical care asap
vasodilate: diamorphine, GTN
diuretics: furosemide
+/- CPAP
rx cause

109
Q

who is at risk VT/VF

A

severe LVSD
prev VT/VF
inherited cardiac conditions: HCM, brugada

110
Q

prolonged QT ECG

A

> /= 2 large squares (440ms)

111
Q

prolonged PR ECG

A

> /= 3-5 small squares (120-200ms)
usually first degree heart block

112
Q

features postural tachycardia syndrome

A

young
F
dizziness, palpitations and chest pain after exercise/heat
fainting and feet go purple

113
Q

conditions associated with postural tachcyardia syndrome

A

SLE
ehlers danlos
lyme disease
chronic fatigue syndrome
MS
sarcoidosis

114
Q

diagnosis postural tachycardia syndrome

A

tilt table test

115
Q

ms postural tachcyardia syndrome

A

lifestyle-avoid triggers
bisoprolol

116
Q

CV causes collapse

A

prolonged QT
postural tachycardia syndrome
AAA dissection
bruasa syndrome
aortic stenosis
MI
heart blocks
postural hypotension

117
Q

causes long QT

A

amiodarone
arithromycin
metoclopramide
citalopram
low K/Mg/Ca
genetic

118
Q

associations with genetic long QT

A

deafness
increased HR
Fhx sudden deaths

finals (31 decks)

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