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AKT > Cardio > Flashcards

Cardio Flashcards

1
Q

What are the differentials of acute chest pain, classed by severity?

A

ACS, PE, aortic dissection, pneumothorax. Chronic but urgent: angina from stable disease, aortic stenosis, aortic aneurysm, lung ca. Acute: pericarditis, pneumonia, shingles, PUD, GORD, cholecystitis. Other: MSK, psychological.

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2
Q

How is an ACS treated?

A

Aspirin 300mg chewed before swallow, if stable GTN spray 400-800microg 5minly OR 300-600microg tablet. If persistent, IV fentanyl 25-50, risk w low BP. Oxygen if sats < 93%. IV access and bloods.

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3
Q

How is stable angina defined? Who gets it and what are the principles of management?

A

Chest discomfort < 10mins, resolves w rest, hasn’t changed in 1 month. Patients who can’t have definitive stent/bypass. Aim to treat episodes, optimise CVD health. Flu + pneumonia vaccines.

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4
Q

How is stable angina treated with relievers?

A

GTN spray 400-800microg 5minly up to 1200 OR 300-600 microg tablet up to 1800microg. If pain >10min, call AV. Pt sitting down. Have written action plan.

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5
Q

What are the 2 main preventers used in stable angina?

A

Atenolol OD, metoprolol tartrate BD +/- amlodipine, nifedipine daily. OR diltiazem, verapamil alone, (Non-DH work on heart).

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6
Q

What are 2nd line preventers in stable angina?

A

Long acting nitrates: GTN 5mg patch, isosorbide modified release 30mg - risk tolerance. Nicorandil by specialist.

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7
Q

What are the non-pharm features of heart failure management?

A

Daily weight (rv if 2kg in 2 days), fluid restrict if congested, salt < 5g per day, healthy BMI, physical activity support when well, restrict if overloaded, action plan, immunisations, refer to multidisciplinary HF management program if high risk.

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8
Q

How is heart failure classified and what are the usual causes?

A

HFrEF if LVEF < 50% - ischaemic, idiopathic, medication induced, familial. HFpEF - HTN, older females, amyloid, HOCM. NYHA functional classes - no limitation, slight limit, marked limitation, symptoms at rest.

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9
Q

What drugs are indicated in HFrEF?

A

ACEI/ARB or ARNI, spironolactone, SGLT2 inhibitor. Beta blocker (bisorpolo, carvedilol, nebivolol, metoprolol succinate MR) if euvolaemic. Aim max doses within months of diagnosis.

ARNI better if LVEF < 40%.

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10
Q

How is acute pulmonary oedema managed? What are some precipitants?

A

Sit upright, frusemide 20-80mg IV/IM (fluid overload affects enteral absorption), HF oxygen if sats < 92%, consider nitrates if normal BP and not responding. AKI, PE, sepsis, AMI, thyroid dysfunction, anaemia, arrhythmia.

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11
Q

How is HFpEF managed?

A

Treat cause, treat exarcebating factors, treat symptoms and comorbidities. Minimal medications, SLGT2 inhibitors not approved.

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12
Q

What is a hypertensive emergency and hypertensive urgency?

A

Emergency: usually >220/140, with acute end organ damage/dysfunction. Need reduction in minutes with IV. Urgency: >180, symptoms like headache but no acute end organ damage, reduce within hours.

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13
Q

When does acute asymptomatic hypertension need treatment?

A

Evidence of acute end organ damage, consider if known aneurysm or anticoagulated. Otherwise treat over days.

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14
Q

What are lifestyle factors affecting hypertension?

A

Stress, limited exercise, high salt + high fat diet, OSA/poor sleep, excess coffee and alcohol, recreational drugs.

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15
Q

What are the cut-offs for hypertension diagnosis and treatment?

A

Clinic 140/90, 24 ABPM 130/80 (sleep 120/70, awake 135/85), home BP 135/85. Treat if >160/100, otherwise use CVD risk. Aim < 140/90, 130/80 if diabetes w albumin or high risk.

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16
Q

When is ambulatory blood pressure monitoring indicated?

A

Suspecting white coat hypertension, hypertension not responding to treatment, suspecting episodic or nocturnal hypertension.

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17
Q

What physical exam features should be checked with new hypertension?

A

Pulse, JVP, apex beat, oedema, bruits, palpable kidneys, optic fundi, BMI, waist circumference, signs of cushings or thyroid disease.

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18
Q

What investigations should be done for all patients with hypertension?

A

UEC, fasting sugar, lipids, ECG, urine ACR + dipstick for blood.

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19
Q

What tests are used to screen for secondary causes of hypertension?

A

Aldosterone to renin ratio for primary hyperaldosteronism (>2h after waking, WH diuretics and ACE). 24H urine cortisol OR dex suppression test for cushings. Plasma metanephrines AND 24h urine catecholamines for phaeochromocytoma. Renal artery duplex US or CT angio for RAS.

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20
Q

What are the non-pharm features of hypertension management?

A

Smoking cessation, salt < 6g per day (4 if secondary prevention), DASH diet: whole grains, reduce fat, 5 serves veg; alcohol < 10 per week; BMI < 25, exercise 150-300min moderate activity or 75-150 vigorous + 2 days of muscle strengthening per week.

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21
Q

How are RAS inhibitors used in hypertension?

A

Better in HFrEF + CKD, may cause rise in Cr 25% and potassium 0.5mmol. Avoid in renal artery stenosis Risks: angioedema, hyperkalaemia, dry cough.

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22
Q

How are calcium channel blockers + thiazides used in hypertension?

A

DH CCBS (amlodipine, nifedipine, felodipine, lercanidipine), good w angina. Risk oedma from fluid redistribution, diuretics won’t help (change dose or ACE). HCT, indapamide - vasodilate, less diurese. Avoid in gout, young ppl (increase diabetes), monitor Na and K 3-6 weeks.

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23
Q

What are 2nd line options for managing hypertension?

A

K sparing diuretics, beta blockers (eg. post AMI), alpha blockers -prazosin, central alpha agonist (methyldopa, moxonidine).

24
Q

What are the features of aortic and mitral stenosis?

A

AS: syncope, angina, dyspnoea. Ejection, cres-decres sytolic murmur. MS: usually from rheumatic heart disease, exertional dyspnoea, AF - LA pressure/enlargement. Diastolic rumble w opening snap.

25
Q

What are the features on history/exam in hypertrophic cardiomyopathy?

A

1/500 people, inherited condition. Family history, unexplained syncope, previous VT. Dyspnoea on exertion. Systolic murmur at left lower sternal edge (outflow obstruction).

26
Q

What are the investigation features and treatment for hypertrophic cardiomyopathy?

A

ECG: LVH, dagger q-wave inferolaterally. Echo: wall thickness >30mm. Recommend ICD implant, avoid competitive sport, beta blockers for symptoms only. Septal reduction therapy if severe.

27
Q

What are 2 forms of peripheral vascular obstruction?

A

Cholesterol embolisation from a plaque - eg post procedure, acute digital ischaemia (blue toe syndrome - pain then blue). Gangrene = prolonged ischaemia.

28
Q

What are some secondary causes of dyslipidaemia?

A

Hypothyroidism, nephrotic syndrome, poorly controlled T2DM, cholestasis, CKD, alcoholism.

29
Q

What are the features of familial hypercholesterolaemia? How is it managed?

A

FHx (FDR w early IHD, exam findings, diagnosis), xanthomas, arcus cornealis < 45 (xathelasma), LDL > 5. Specialist review, treat chol + BP as high risk CVD, relatives tested - cascade testing.

30
Q

What medications are used to manage dyslipidaemia?

A

Chol: Statins, 2: ezetimibe (less strong, LFTs affect), PCSK9 injections by specialists. TG: diet, 4g Omega 3 fish oil if < 4. If >4, fenofibrate. TG risk pancreatitis more than CVD.

31
Q

What are the features of statin induced muscle symptoms? How is it managed?

A

More common after 1 month, in older or with AKI. Bilateral aching/stiffness in big muscles. Check CK - if up to 5x ULN, WH for 2-4 weeks to see if related. If weakness or CK >5 x ULN, WH statin 6-8 weeks. Rhabdo - refer. Re-try statin unless rhabdo or CK >10x.

32
Q

How is established coronary heart disease treated? (pharm + non pharm)

A

DAPT for 12mo, then aspirin; ACEI indefinitely; statin indefininitely; betablocker for 12mo then review (cont if HF, ischaemia). Meditarranean diet, exercise - cardiac rehab, flu vax.

No driving 2 week post stent, 4 week post CABG. PDE5 contraindicated on nitrates.

33
Q

When is the CVD risk calculator used?

A

First nations 30yo, Diabetes 35, other 45. No familial hypercholesterolaemia or moderate CKD (eGFR >45).

34
Q

What additional factors can influence a patient’s CVD risk category? When do you repeat a calculation?

A

Ethnicity, ATSI, Fhx (FD Male < 55, F < 65), CKD, CTCA score, current severe mental illness. Use clinic BP. Low risk - 5 years, intermediate - 2 years.

35
Q

When is a CT coronary artery calcium score useful?

A

For ruling out disease in low/intermediate risk OR considering changing therapy. No IV access required. Not if symptomatic. If score >100, recommend aspirin and statin, if 0 reassuring, between - consider meds.

36
Q

How is stress testing and angiography used in CVD workup?

A

Stress test if symptomatic. C/I if high risk unstable angina, severe AS, uncontrolled arrhythmia or haemodynamic instability. Stress echo can miss single vessel and circumflex disease. Angio for suspected/known disease - CTCA has 100% NPV.

37
Q

What are the causes of pericarditis? What are the ECG features?

A

Uraemia, connective tissue disorder (SLE, RA), infection, drugs, HIV. PR depression, generalised ST elevation with ST/T wave ratio >0.25.

38
Q

How is pericarditis treated? When is admission indicated?

A

Colchicine (500microg OD or BD) for 3mo + aspirin or ibuprofen for 4 weeks. Admit: fever >38, large effusion/tamponade, not responding to meds in 1 week, subacute course without clear onset.

39
Q

What are the features of 3 different types of syncope?

A

Orthostatic hypotension (low volume, autonimic failure); vasovagal = neural, prodrome (nausea/sweat/pale), precipitants (heat, urine, stress), symptoms improve w positional change. Cardiac (rhythm, structure), sudden onset and offset, during exertion or sudden palpitations. Need admission.

40
Q

What are some syncope differentials in the elderly and young people?

A

Arrhythmia, infarct, dissection, PE, subarachnoid. Kids: seizure, arrhythmia. Teen: pseudoseizure, conversion disorder, narcolepsy, migraine, hyperventilation.

41
Q

What are some causes of myocarditis?

A

Virus (flu, coxsackie, HSV), bacteria, immune (SLE, sarcoid), drugs (clozapine, amphetamine)

42
Q

What are the risk factors for aortic dissections and aortic aneurysm?

When are AAAs repaired

A

D: male, age, hypertension, atherosclerosis. In young: connective tissue disorder, vasculitis, biscupid valve, cocaine. AAA: atherosclerosis, smoking, FHx, connective tissue disorder, caucasian.

> 5.5(M) 5.0 (F), grow >1cm in a year, symptomatic.

43
Q

How is metabolic syndrome defined?

A

3 of: increased waist circumference, elevated triglycerides, reduced HDL < 1, impaired fasting glucose > 5.5, HTN >135/85.

44
Q

How is VT managed?

A

If NSVT (up to 30 seconds) only treat if symptomatic. Stable VT - amiodarone 300mg IV over 30-60min. Unstable - shock. If pulseless VT with monitoring prior, praecordial thump.

45
Q

How are acute bradycardias managed?

A

Atropine if significant - blocks parasympathetics. Isoprenaline/adrenaline with caution.

46
Q

How is SVT managed?

A

Vagal manouevres (cold water, unilateral sinus massage, blow syringe). Adenosine 6mg rapid infusion (C/I in asthma). Chronic/paroxysmal: ablation 1st line, sometimes beta blockers.

60% from AVNRT, 35% from WPW.

47
Q

What are 3 types of heart block and how are they managed?

A

1st degree - PR > 0.2. 2nd degree type 1 - Wenkebach, benign, rarely use atropine. 2nd degree type II - needs pacemaker. 3rd degree - pacing, IV adrenaline if required, may occur after inferior AMI.

48
Q

What investigations are indicated in new stable AF?

A

FBE, UEC, CMP, TSH, Echo, 24h holter. Consider sleep study.

For risk factors, associated diseases and precipitants.

49
Q

What are the benefits of rhythm and rate control in AF?

A

Both equally good for mortality and stroke risk, rhythm better for symptoms. Rhythm control often in younger patients, physically active, no structural issues or paroxysmal AF.

50
Q

What are the features of anticoagulation in AF?

A

CCF, HTN, Age >75 (2), Diabetes, Prev stroke/TIA or VTE (2), Vascular disease (IHD, PVD), age >65 (1) 2pts = benefit. DOACs preferred to warfarin except for mitral stenosis or mechanical heart valve.

51
Q

What are the features of unstable AF? How is it treated?

A

Hypotension, RVR >110, heart failure, presyncope, angina/ischaemia. Cardiovert if unstable. Stable without failure - betablocker, otherwise amiodarone and digoxin 2nd line.

52
Q

What are the features of LVH on ECG

A

Voltage: V1/2 S wave + V 5/6 R wave >35mm or 7 squares. Non-voltage to confirm: r wave peak time or LV strain - ST depression and TWI laterally.

53
Q

What are the ECG features of ischaemia?

A

J point (between QRS and ST) compared to TP - 1/2 square depression, 1mm elevation or 2mm V2/3 for elevation. Q waves pathological if >1mm wide or 2mm deep. TWI in 2 contiguous leads (normal in lead III, children and BBBs).

54
Q

What can atrial flutter mimic? When should you consider it?

A

Supraventricular tachycardia. Flutter with 2:1 block often has rate 150. Won’t respond to adenosine, but will respond to DC shock + AF management.

55
Q

What are the features of PVCs- significance, triggers.

A

Usually benign, may cause skipped beat feeling. Triggered by stress, caffeine, sympathomimetics, ischaemia, digoxin. If occuring every 2nd beat = bigeminy.

AKT (30 decks)

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