cardio Flashcards
1
Q
conditions that increase the risk of atherosclerosis
A
DM
HTN
CKD
RA
atypical antipsychotics
2
Q
what to do if QRISK score >/= 10%
A
atorvastatin 20mg
check LFTs 3m and 1yr
3
Q
SE statins
A
myopathy
T2DM
haemorrhagic strokes
4
Q
secondary prevention CVD
A
aspirin (+clopidogrel first 12m)
atorvastatin 80mg
atenolol (or bisoprolol)
ACE i - ramipril titrated to tolerated dose
5
Q
gold standard ix for angina
A
CT coronary angiography
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
7
Q
what does right coronary artery supply
A
RA, RV, inf LV, post septal
8
Q
what does circumflex artery supply
A
LA, post Lv
9
Q
what does Left anterior descending supply
A
ant LV, ant septum
10
Q
STEMI ECG
A
ST elevation MI or new LBBB
11
Q
NSTEMI ECG
A
ST depression, deep T inversion, pathological Q
12
Q
causes raised troponin
A
MI
chronic renal failure
sepsis
myocarditis
aortic dissection
PE
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%
14
Q
GRACE score
A
risk death/repeat MI within 6m NSTEMI
med=5-10%
high >10%
15
Q
what to do if med/high GRACE scire
A
PCI within 4d
16
Q
what is dresslers syndrome
A
2-3w post MI
localised immune response ->pericarditis
17
Q
sx dresslers syndrome
A
pleuritic chest pain, fever, pericardial rub
can cause pericardial effusion and tamponade
18
Q
ECG dresslers syndrome
A
global ST elevation
T inversion
19
Q
mx dresslers syndrome
A
NSAIDs +/- steroids +/- pericardiocentesis
20
Q
triggers acute LVF
A
iatrogenic (fluids)
sepsis
MI
arrhthmia
21
Q
sx acute LVF
A
pulmonary oedema
SOB- T1RF
3rd HS
increased JVP
22
Q
mx acute LVF
A
stop IV fluids
sit up
oxygen
diuretics (furosemide)
23
Q
causes increaed BNP
A
HF
increased HR
sepsis
PE
renal impairment
COPD
24
Q
when is BNP relerased
A
from ventricles when abnormally stretched
25
diagnosing chronic HF
presentation
BNP (NT-proBNP)
echo
ECG
26
causes chronic HF
IHD
aortic stenosis
HTN
AF
27
mx chronic HF
ACE i (ramipril 10mg), BB (bisoprolol 10mg)
if not controlled: aldosterone antagonist (spironolactone), loop diuretic (furosemide) for sx
28
what is cor pulmonale
RHF caused by resp disease
29
causes cor pulmonale
COPD
PE
ILD
CF
pulmonary HTN
30
sx cor pulmonale
SOB
oedema
increased JVP
3rd HS
hepatomegaly
31
mx cor pulmonale
tx cause
oxygen
poor prognosis
32
types HTN
essential/primary
secondary: renal, obesity, pregnancy, endocrine
33
stage 1 HTN
>140/90 in hospital
>135/85 at home
34
stage 2 HTN
>160/100 hospital
>150/95 at home
35
mx HTN
1. <55=ACEi, >55 or afrocaribbean=CCB
2. add CCB, if afrocaribbean + ARB
3. + thiazide like diuretic (indapamide)
36
target BP in HTN
>80y <150/90
<80y <140/90
37
S1
closing AV valves
38
S2
closing semilunar valves
39
S3
due to rapid V filling
can be normal <40y
40
S4
before S1 - stiff ventricle
41
cause mitral stenosis
rheumatic heart disease
IE
42
features mitral stenosis
mid diastolic low pitched murmur
loud S1
malor flush
AF
43
features tricuspid regurg
pan systolic
split S2
thrill
increased JVP with giant CV waves (lancisis sign)
pulsatile liver
peripheral oedema
ascites
44
features pulmonary stenosis
ejection systolic murmur with deep inspiration
widely split S2
thrill
increased JVP with giant A waves
peripheral oedema
ascites
45
murmur grades
I = difficult to hear
VI = audible with stethoscope of chest
46
cause mitral regurg
age
IHD
IE
connective tissue disorders
47
features mitral regurg
pan systolic high pitched
radiates to L axilla
leads to HF and S3
48
causes aortic stenosis
age
rheumatic heart disease
49
features aortic stenosis
most common murmur
ejection systolic high pitched crescendo decrescendo
radiates to carotids
slow rising pulse
narrow PP
exertional syncop
50
causes aortic regurg
age
connective tissue disorders
51
features aortic regurg
early diastolic soft murmur
collapsing pulse
austin flint murmur : at apex-early diastolic rumbling
52
AF ECG
absent P
narrow QRS
irregularly irregular
53
valvular AF
also have mod/sev mitral stenosis or mechanical valve
54
causes AF
sepsis
mitral valve
IHD
thyrotoxicosis
HTN
55
mx AF
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
HASBLED
bleeding risk
HTN
abnornal renal
stroke
bleeding
labile INR
elderly
alcohol
57
shockable rhythms
VT
VF
58
mx of a tachy rhythm in unstable patient
up to 3 syncronised shocks
amiodarone
59
narrow complex tachycardias
AF
atrial flutter
SVT
60
atrial flutter ECG
sawtooth
61
mx atrial flutter
BB
62
mx SVT
valsalva manoevre
carotid sinus massage
adenosine
DC cardioversion
63
what does adenosine do
slow conduction through AV node
64
when not to use adenosine
asthma
COPD
HF
heart block
severe hypotension
65
doses adenosine
6mg
then 12mg
then 12mg
as fast IV bolus
66
broad complex tachycardia
VT
SVT with BBB
67
mx VT
amiodarone infusion
68
wolf parkinson white
extra pathway - bundle of kent
69
ECG WPW
short PR
wide QRS
delta wave (slurred upstroke QRS)
70
definitive tx WPW
radiofreq ablation
71
malignant/accelerated HTN
BP >180/120 with retinal heamorrhage or papilloedema
72
mx malignant/accelerated HTN
IV: sodium nitroprusside, labetalol, GTN, nicardipine
73
torsades de points
polymorphic VT that occurs in prolonged QT
74
mx torsades de points
acute: magnesium infusion, defib if VT
long term: BB, pacemaker
75
causes prolonged QT
QT syndrome
medds: antipsychotics, citalopram flecainide, sotalol, amiodarone, macrolide abx
electrolytes: low K, low Mg, low Ca
76
first degree heart block
PR >0.2s
77
second degree heart block
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
3rd degree heart block
complete
no relation between P and QRS
risk asystole
79
mx bradycardia and AV block
stable = observe
unstable= atropine 500mcg IV up to 6 doses, noradrenaline, transcutaneous cardiac pacing
80
pacemaker indications
bradycardia with sx
mobitz type 2 AV block
3rd degree heart block
severe HF
hypertrophic obstrictive cardiomyopathy
81
ECG changes with pacemaker
single chamber: 1 line before P or QRS
dual chamber: line before P and QRS
82
stable angina
sx come on with exertion and relieved by rest or GTN
83
unstable angina
sx at random at rest
84
cardiac chest pai
constricting/tight
may radiate to jaw or l arm
N+V
clammy
sweating
feeling of impending doom
SOB
palpitation
85
ACS
unstable angina
STEMI
NSTEMI
86
silent MI
typical chest pain not experienced
people woth DM at high risk
87
mx NSTEMI
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
types MI
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
CXR features HF
alveolar oedema
kerley B lines
cardiomegaly
dilated upper lobe vessels
pleural effusion
90
mx peripheral oedema HF
furosemide: IV if sev and pitting, otherwise oral
91
class of drug furosemide
loop diuretics
92
why is furosemide preferred in HF to spironolactone
spironolactone risk increased K
93
monitoring fluid overload HF
regular wt - should reduce
monitor fluid input and output
94
cause of murmur in HF
mitral regurg =pansystolic
95
criteria PPCI in STEMI
ST elevation over 2mm in 2 contiguous chest leads or >1mm in 2 contiguous limb leads
chest pain or other evidence ischaemia
96
what is the HEART score for
to see if admit or discharge with chest pain
hx, ecg, age, RF, trop
low risk=discharge
mod=observe
high=admit
97
non STE ACS mx in ED
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
inpatient mx non STE ACS
cardiac monitoring >/= 24h
medical vs invasive mx: usually angiogram and PCI
secondary prevention
stay approx 72h
physio
reduce RF
99
TTO post MI
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
follow up post MI
clinic in 1m
TOE
cardiac rehab programme
smoking cessation
GP uptitrate secondary prevention
101
advice post MI
no driving 1wk if PCI, 4 wks if none
gradual return activity
6w off work
102
stable angina meds
aspirin
statin
anti-anginal: BB, CCB, nitrates, nicorandil, ivabradine, rondazine
refer for intervention if failed 2 anti-anginals
103
interventions for stable angina
PCI: sx relief, need DAPT 6m
CABG favoured if 3 vessel disease, L main stem disease, valvular disease, sometimes diabetics
104
gold standard ix aortic dissection
CT aortogram
105
PESI score
decision to admit PE
106
rate control drugs AF
BB
CCB
digoxin
107
rhythm control drugs AF
flecanide
amiodarone
procedures
108
mx acute pulmonary oedema
sit forward
high flow oxygen
if shocked speak to critical care asap
vasodilate: diamorphine, GTN
diuretics: furosemide
+/- CPAP
rx cause
109
who is at risk VT/VF
severe LVSD
prev VT/VF
inherited cardiac conditions: HCM, brugada
110
prolonged QT ECG
>/= 2 large squares (440ms)
111
prolonged PR ECG
>/= 3-5 small squares (120-200ms)
usually first degree heart block
112
features postural tachycardia syndrome
young
F
dizziness, palpitations and chest pain after exercise/heat
fainting and feet go purple
113
conditions associated with postural tachcyardia syndrome
SLE
ehlers danlos
lyme disease
chronic fatigue syndrome
MS
sarcoidosis
114
diagnosis postural tachycardia syndrome
tilt table test
115
ms postural tachcyardia syndrome
lifestyle-avoid triggers
bisoprolol
116
CV causes collapse
prolonged QT
postural tachycardia syndrome
AAA dissection
bruasa syndrome
aortic stenosis
MI
heart blocks
postural hypotension
117
causes long QT
amiodarone
arithromycin
metoclopramide
citalopram
low K/Mg/Ca
genetic
118
associations with genetic long QT
deafness
increased HR
Fhx sudden deaths
