Cardio Flashcards
Which antihypertensive is C/I in renovascular disease eg renal artery stenosis
ACEi
All ACS should get
aspirin 300mg
When is STEMI eligible for PCI
If <12h presentation (or ongoing ischaemia at presentation)
AND
<120 min availability of PCI
If an ACS patient has PCI they should get what medication extra
Prasugrel for DAPT
Or if already on an anticoag- clopi
Alternative to PCI for STEMI
fibrinolysis
What if STEMI had fibrinolysis and then the repeat ECG has persisting ischaemia
PCI
When should NSTEMI have immediate angio +/- PCI
unstable
When should NSTEMI get fonda?
If not having immediate angio and not bleed risk
When should NSTEMI have PCI within 72h
If GRACE >3%
If NSTEMI is medically managed what do you give
Ticagrelor
Or clopi if bleed risk
What is a normal ejection fraction
50-60%
In a witnessed arrest on a monitor what do you do differently in ALS
If the initial rhythm is VF/VT, give up to three quick successive (stacked) shocks. Start chest compressions immediately after the third shock and continue CPR for 2 min.
Heart failure 1, 2 3rd line drugs
- ACE and beta blocker
- Aldosterone agonist (spiro) or eplerenone
- Empagliflozin
angina worse on lying down
de cubitus
Further treatment if angina not controlled on a max dose beta blocker?
Add CCB such as amlodipine, modified-release nifedipine, or modified-release felodipine
(note not diltiazem or verapamil as they are rate limiting CCBs- not to use in combo with BB)
First line meds to start in angina
Aspirin, statin, GTN spray and beta blocker or CCB (if CCB used as monotherapy then rate limiting one eg verapamil/diltiazem. If in combo with BB then amlod/nifed)
valve most affected in endocarditis of IVDUs
tricuspid
MI causing a new left bundle branch block is most likely to be in what region?
anterior or anteroseptal
Alternating QRS amplitude on ecg shows
pericardial effusion
ECG change in hypocalcaemia
long qt
Post MI meds
ACE (or ARB)
Beta blocker
DAPT (one must be aspirin)
Statin
syphilis, marfans and elhers danlos can cause what valve disease
Aortic regurg
aortic valve disease- when is wide v narrow pulse pressure seen
wide in regurg
narrow in stenosis
which is the only bicuspid valve normally
mitral
systolic murmur with mid systolic click
or pansystolic
mitral regurg
most common cause of mitral stenosis
rheumatic fever
systolic snap and diastolic rumble murmur
mitral stenosis
malar flush in what valve disease
mitral stenosis
haemodynamically unstable AF rx
DC cardioversion
or can do medical cardioversion with amiodarone IV or IV flecainide
leg ulcer that is shallow with irregular borders at the medial malleolus
venous
Venous ulcer rx
elevate
compression
ABPI must be what for compression stockings
> 0.6
when is AAA screening
men in 65th year
scan recalls for AAA
> 3cm every year
4.5cm every 3 months
5.5 2ww vasc referral
most common site of aneurysm
popliteal
is lymphoedema pitting or non pitting
non pitting eventually
arm exercise resulting in neurology such as vertigo, diploplia
Subclavian steal syndrome
J waves seen in
hypothermia
U waves seen in
hypokalaemia
delta waves on ecg
WPW
Hypokalaemia ECG findings
U have no Pot and no T, but a long PR and a long QT
U waves
ST depression
Complete heart block following a MI- where is the lesion
Right coronary artery lesion
First line for angina
beta-blocker or a rate limiting calcium channel blocker
second line for angina
combine beta blocker and CCB but change CCB to NON RATE LIMITING
If still no improvement add one of:
a long-acting nitrate
ivabradine
nicorandil
ranolazine
what increase in Cr is acceptable in initiating ACEi?
30%
Mx if ABPM is >= 135/85 mmHg (i.e. stage 1 hypertension)
treat if < 80 years of age
AND any of the following apply; target organ damage,
established cardiovascular disease, renal disease,
diabetes
QRISK 10% or greater
Mx if ABPM/HBPM >= 150/95 mmHg (i.e. stage 2 hypertension)
offer all drug rx
What to offer if HTN not controlled on triple therapy (ACE, CCB and TLD)
If K <4.5- spironolactone
If K>4.5 - alpha or beta blocker
drug contraindicated in ventricular tachycardia
verapamil
recommended treatment for regular broad complex tachycardia without adverse signs
amiodarone
drug that can make clopi less effective
omeprazole (can use lansoprazole instead)
pericarditis ecg changes
Global ST and PR segment changes
Persistent ST elevation following recent MI, no chest pain, tired and breathless
left ventricular aneurysm
Post MI
Pain on lying flat, widespread ST elevation and PR depression
Fever
Dressler’s syndrome (pericarditis)
Acute heart failure post MI with signs of tamponade
LV free wall rupture
Acute heart failure post MI with pan systolic murmur
VSD
Post MI acute hypotension and pulm oedema with an early-mid systolic murmur
Acute mitral regurg (papillary muscle rupture)
what disease can falsely elevate BNP
COPD
collapsing pulse
aortic regurg
how do you decide whether to anticoagulate an AF patient
CHADVASC, however if they also have valvular hear disease you must anticoagulate
cardio med to avoid in HOCUM
ACEi
Appearance of RHS on ECH
S1Q3T3 or TWI in V1-4
What to do with anticoag post cardioversion for AF?
Continue for at least 4 weeks. Redo CHADVASC, if still risk for stroke then continue anticoag life long
unequal arm pulses and BP with chest pain
aortic dissection
c/i to IV adenosine
asthma- give verapamil
preferred first line med in HF if the person has diabetes mellitus or has signs of fluid overload.
acei
preferred first line med in HF if the person has angina.
BB
What are the risks of asystole in the bradycardia algorithm
recent asystole
Mobitz II block
CHB + broad QRS
Ventricular pause >3s
when to screen for secondary causes of HTN
under 40 who lack traditional risk factors for essential hypertension
other signs and/or symptoms of secondary causes
resistant hypertension.
