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ZMSRA > CARDIO > Flashcards

CARDIO Flashcards

1
Q

ALS shockable vs non shockable rhythms

A

: shockable’ rhythms: ventricular fibrillation/pulseless ventricular tachycardia (VF/pulseless VT)

‘non-shockable’ rhythms: asystole/pulseless-electrical activity (asystole/PEA)

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2
Q

if the cardiac arrested is witnessed in a monitored patient (e.g. in a coronary care unit) then the 2015 guidelines recommend

A

up to three quick successive (stacked) shocks’,

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3
Q

ALS when to give adrenaline in non shockable rhythms

A

ASAp

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4
Q

ALS: when to give amiodarone in SHOCKABLE rhythms

A

after 3 shocks

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5
Q

ALS: when to give adrenaline in SHOCKABLE rhythm s?

A

once compressions restarted after 3rd shock
repeat every 3-5 minutes

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6
Q

what are the 4 Hs and 4 TS

A

Hypoxia

Hypovolaemia

Hyperkalaemia, hypokalaemia, hypoglycaemia, hypocalcaemia, acidaemia and other metabolic disorders

Hypothermia

Hypoxia

Hypovolaemia

Hyperkalaemia, hypokalaemia, hypoglycaemia, hypocalcaemia, acidaemia and other metabolic disorders

Hypothermia

Thrombosis (coronary or pulmonary)

Tension pneumothorax

Tamponade – cardiac

Toxins

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7
Q

Angina pectoris: drug management

A

1.beta-blocker or a calcium channel blocker
calcium channel blocker is used as monotherapy a rate-limiting one such as verapamil or diltiazem

if used in combination with a beta-blocker then use a longer-acting dihydropyridine calcium channel blocker

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8
Q

features of aortic regurgitation

A

early diastolic murmur: intensity of the murmur is increased by thehandgrip manoeuvre

collapsing pulse

wide pulse pressure

Quincke’s sign (nailbed pulsation)

De Musset’s sign (head bobbing)

mid-diastolic Austin-Flint murmur i

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9
Q

What is chadvasc

A

CCongestive heart failure1
HHypertension (or treated hypertension)1
A2Age >= 75 years2Age 65-74 years1
DDiabetes1
S2Prior Stroke, TIA or thromboembolism2
VVascular disease (including ischaemic heart disease and peripheral arterial disease)1
SSex (female) 1

0 no treatment
1 treatment for men
>2 anticoagulate

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10
Q

Management of AF <48hrs

A

Heparinised
Cardioversion - electrical (pharmacological if structural heart disease)
Further anticoagulation is unnecessary thereafter unless factors of ischaemic stroke

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11
Q

Tachycardia with adverse signs mx

A

synchronised DC shocks up to 3
Treatment following this is given according to whether the QRS complex is narrow or broad and whether the rhythm is regular or irregular.

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12
Q

Broad complex tachycardia no adverse signs

A

Regular

assume ventricular tachycardia (unless previously confirmed SVT with bundle branch block)

loading dose ofamiodaronefollowed by 24 hour infusion

Irregular

seek expert help. Possibilities include:

atrial fibrillation with bundle branch block- the most likely cause in a stable patient

atrial fibrillation with ventricular pre-excitation

torsade de pointes

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13
Q

Narrow complex tachycardia no adverse signs mx

A

Regular

vagal manoeuvres followed by IV adenosine

if the above is unsuccessful consider a diagnosis of atrial flutter and control rate (e.g. beta-blockers)

Irregular

probable atrial fibrillation

if onset < 48 hr consider electrical or chemical cardioversion

rate control: beta-blockers are usually first-line unless there is a contraindication

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14
Q

DVLA rules

A

1 week - angioplasty , pacemaker
4 weeks- ACS, CABG, ICD

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15
Q

Secondary prevention of stable cardiovascular disease with an indication for an anticoagulant

A

anticoagulant monotherapy is given without the addition of antiplatelets

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16
Q

Poorly controlled hypertension, already taking an ACE inhibitor, calcium channel blocker and a thiazide diuretic next step

A

potassium < 4.5 mmol/l add low-dose spironolactone

if potassium > 4.5 mmol/l add an alpha- or beta-blocker

17
Q

GRACE score

A

age

heart rate, blood pressure

cardiac (Killip class) and renal function (serum creatinine)

cardiac arrest on presentation

ECG findings

troponin levels

Which patients with NSTEMI/unstable angina should have coronary angiography (with follow-on PCI if necessary)?

immediate: patient who are clinically unstable (e.g. hypotensive)

within 72 hours: patients with a GRACE score > 3%i.e. those at intermediate, high or highest risk

18
Q

Ecg changes in pericarditis

A

changes in pericarditis are oftenglobal/widespread, as opposed to the ‘territories’ seen in ischaemic events

‘saddle-shaped’ ST elevation

PR depression: most specific ECG marker for pericarditis

19
Q

Peri-arrest rhythms: bradycardia and haemodynamic compromose mx

A

Atropine (500mcg IV) is the first line treatment in this situation.

If there is an unsatisfactory response the following interventions may be used:
atropine, up to a maximum of 3mg
transcutaneous pacing
isoprenaline/adrenaline infusion titrated to response

Specialist help should be sought for consideration of transvenous pacing if there is no response to the above measures.

20
Q

Atrialnfibrrikation managing stroke risk

A

CHA₂DS₂-VASc tool should be used
>1 and male or >2 and female
DOAC
Wayfaring if rneak function poor

21
Q

Antiplatelet Secondary prevention for ACS

A

Aspirin (lifelong) & ticagrelor (12 months) fir ACS and post PCI

22
Q

When is clopidogrel used as secondary prevention

A

TIA
Ischemic stroke
Peripheral arterial disease

23
Q

Stain contra - indications

A

macrol ides .e. erythromycin
pregnancy

24
Q

Indications for statins

A

Established CVS disease and 10 year risk> 10%
T1DM >40 yr or have nephropathy

25
Q

Statins doses

A

atorvastatin 20mg for primary prevention

atorvastatin 80mg for secondary prevention

26
Q

How do statins work

A

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

27
Q

following the administration of 2 doses of intramuscular adrenaline, if symptoms of anaphylaxis are not improving

A

Adrenaline infusion should be started.

28
Q

Patients with MI secondary to cocaine use should be given

A

IV benzodiazepines as part of acute (ACS) treatment

29
Q

NICE guidelines advise starting anticoagulation ? ? weeks after the event (in the absence of haemorrhage) unless it is a very large cerebral infarct. It advises that ‘anticoagulation treatment should not be used routinely for the treatment of acute stroke’. This is due to the risk of haemorrhagic transformation.

A

2 weeks

30
Q

Which cakciumnchannel blockers are used in angina

A

if a calcium channel blocker is used as monotherapy a rate-limiting one such as verapamil or diltiazem should be used
if used in combination with a beta-blocker then use a longer-acting dihydropyridine calcium channel blocker (e.g. amlodipine, modified-release nifedipine)

31
Q

Organophosphate insecticide poisoning

A

mnemonic = SLUD)
Salivation
Lacrimation
Urination
Defecation/diarrhoea
cardiovascular: hypotension, bradycardia
also: small pupils, muscle fasciculation

Management
atropine

32
Q

acute limb ischaemia mx

A

ABC approach
analgesia: IV opioids are often used
intravenous unfractionated heparin is usually given to prevent thrombus propagation, particularly if the patient is not suitable for immediate surgery
vascular review

Definitive management:
intra-arterial thrombolysis
surgical embolectomy
angioplasty
bypass surgery
amputation: for patients with irreversible ischaemia

ZMSRA (12 decks)

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