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MSRA > cardio > Flashcards

cardio Flashcards

1
Q

clopidogrel

  1. mechanism of action
  2. which drug makes it less effective?
A
  1. antagonist of the P2Y12 adenosine diphosphate (ADP) receptor, inhibiting the activation of platelets
  2. omeprazole (and other PPIs)
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2
Q

statin & dose for cardiac:

  1. primary prevention
  2. secondary prevention
A
  1. atorvastatin 20mg
  2. atorvastatin 80mg
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3
Q

in T1DM without CVD offer primary prevention statin (20mg atorvastatin) if:

(4)

A

> 40y
have had T1DM >10yrs
have nephropathy
have other CVD RF

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4
Q

adverse effects of statins (2):

A
  1. myopathy
  2. liver impairment (thus LFTs at baseline, 3 months and 12 months)
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5
Q

contra-indication to statins (2):

A
  1. macrolide therapy
  2. pregnancy
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6
Q

who should receive a statin?

A

all people with established cardiovascular disease (stroke, TIA, ischaemic heart disease, peripheral arterial disease)
following the 2014 update, NICE recommend anyone with a 10-year cardiovascular risk >= 10%
patients with type 2 diabetes mellitus should now be assessed using QRISK2 like other patients are, to determine whether they should be started on statins
patients with type 1 diabetes mellitus who were diagnosed more than 10 years ago OR are aged over 40 OR have established nephropathy

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7
Q

MI secondary prevention drugs (4):

A
  • dual antiplatelet (aspirin + another)
  • ACEI
  • B blocker
  • statin
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8
Q

beta blocker side effects (5):

A

bronchospasm
cold peripheries
fatigue
sleep disturbances, including nightmares
erectile dysfunction

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9
Q

normal ECG variants in the SPORTY: (4)

A
  1. sinus bradycardia
  2. junctional rhythm
  3. first degree heart block
  4. Mobitz type 1 (Wenkebach)
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10
Q

beta blocker contra-indications (4):

A
  1. uncontrolled heart failure
  2. asthma
  3. sick sinus syndrome
  4. concurrent verapamil use (may precipitate severe bradycardia)
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11
Q

adenosine

  1. what’s it used to treat?
  2. who should it be avoided in?
  3. adverse effects (4)
A
  1. SVT
  2. asthmatics
  3. chest pain
    bronchospasm
    transient flushing
    can enhance conduction down accessory pathways, resulting in increased ventricular rate (e.g. WPW syndrome)
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12
Q

loop diuretics (e.g. furosemide)

adverse effects:

A

HYPO:
hypotension
hyponatraemia
hypokalaemia, hypomagnesaemia
hypochloraemic alkalosis
hypocalcaemia

ototoxicity

renal impairment (from dehydration + direct toxic effect)

hyperglycaemia (less common than with thiazides)

gout

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13
Q

angina medical mgt:

A

all pts:
- aspirin
- statin
- GTN

  1. BB or CCB (rate limiting e.g. verapamil/ diltiazem*)
  • if CCB + BB use longer acting CCB e.g. amlodipine/ MR nifedipine
  1. add CCB/ BB

if on monotherapy and cannot tolerate addition of CCB/ BB consider one of:
- long acting nitrate
- nicorandil
- ranolazine

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14
Q

which drug offers no PROGNOSTIC benefit in chronic heart failure?

A

furosemide

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15
Q

which drug is beneficial to LT survival in heart failure

A

ramipril

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16
Q

chronic heart failure mgt: -

A

for all:
- annual influenza vaccine
- once-off pneumococcal vaccine

  1. ACE (have no effect on mortality in heart failure with preserved ejection fraction) &BB
  2. aldosterone antagonist (e.g. spironolactone, eplerenone)

?SGLT-2 inhibitors (if reduced ejection fraction) _GLIFOCIN

  1. ivabradine, sacubitril-valsartan, hydralazine in combination with nitrate, digoxin and cardiac resynchronisation therapy
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17
Q

thiazide diuretics SE: (7)

A

postural hypotension
HYPOkalaemia (increased sodium delivery to distal convuluted tubule–>: increased sodium absorption in exchange for potassium and hydrogen ions)
HYPOnatraemia
HYPERcalcaemia
gout
impaired glucose tolerance
impotence

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18
Q

cardiac tamponade presentation

A

Beck’s triad
1. hypotension
2. raised JVP
3. muffled heart sounds

dyspnoea
tachycardia
an absent Y descent on the JVP - this is due to the limited right ventricular filling
pulsus paradoxus - an abnormally large drop in BP during inspiration
Kussmaul’s sign - much debate about this
ECG: electrical alternans (variability in amplitude of QRS)

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19
Q

1st degree heart block definition:

A

PR prolongation (PR>0.2s)

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20
Q

2nd degree heart block definition:

A

type 1 (Mobitz I/ Wenckebach)
- PR prolongation until dropped beat occurs

type 2 (Mobitz II)
- constant PR but p wave often not followed by QRS

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21
Q

3rd degree heart block definition:

A

no association between p waves and QRS complex

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22
Q

complete heart block following MI
–> which coronary artery is most likely to be affected?

A

Right coronary artery
(as this supplies AV node)

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23
Q

HOCM sx:

A

(asx)
exertional SOB
angina
syncope (typically post exercise)
jerky pulse

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24
Q

HOCM murmurs: (2)

A

ESM - ventricular outflow tract obstruction
increased by valsalva
decreased by squatting

pansystolic murmur - mitral regurg

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25
Q

HOCM associations: (2)

A

Friedrich’s ataxia
WPW

26
Q

HOCM echo findings:

A

MR SAM ASH

mitral regurgitation (MR)
systolic anterior motion (SAM) of the anterior mitral valve leaflet
asymmetric hypertrophy (ASH)

27
Q

HOCM ECG features: (5)

A

LVH
non-specific ST segment and T-wave abnormalities, progressive T wave inversion may be seen
deep Q waves
AF (sometimes)

28
Q

HOCM mgt

A

ABCDE

Amiodarone
Beta-blockers or verapamil for symptoms
Cardioverter defibrillator
Dual chamber pacemaker
Endocarditis prophylaxis*

29
Q

drug classes to avoid in HOCM (3)

A

nitrates
ACEi
inotropes

30
Q

new AF mgt (<48hrs of onset of sx) : -

A

anticoagulate lifelong if RF for ischaemic stroke

cardioversion, either:
- electrical (DC)
- pharmacological - amiodarone (if structural heart disease)

(or flecainide if no evidence of structural heart disease)

31
Q

new AF (onset >48hrs)

A
  • anticoagulate for at least 3 weeks prior to cardioversion

OR TOE to exclude left atrial appendage (LAA) thrombus.
if -ve can heparinise and cardiovert immediately.

electrical cardioversion

If high risk of cardioversion failure (e.g. Previous failure or AF recurrence) then it is recommend to have at least 4 weeks amiodarone or sotalol prior to electrical cardioversion

then anticoagulate for at least 4 weeks

32
Q

amioderone monitoring:

A

TFT, LFT, U&E, CXR prior to rx
TFT, LFT every 6 months

33
Q

amioderone adverse effects:

A
  • thyroid dysfunction (hypo&hyperthyroid)
  • corneal deposits
  • pulmonary fibrosis/pneumonitis
  • liver fibrosis/hepatitis
  • peripheral neuropathy, myopathy
  • photosensitivity
    ‘- slate-grey’ appearance
  • thrombophlebitis and injection site reactions
  • bradycardia
  • lengths QT interval
34
Q

valve most commonly affected in infective endocarditis:

i. generally
ii. IVDU

A

i. mitral valve
ii. tricuspid valve

35
Q

NSTEMI antiplatelets:

A

aspirin:

+ ticagrelor if not high risk of bleeding
+ clopidogrel if high risk of bleeding

should be based on 6 month mortality risk:
if >1.5% clopidogrel for 12 months
if >3% angio within 96hrs

36
Q

CHA2DS2VS

A

C - CCF (1)
H - HTN (or treated HTN (1)
A- age >75 (2)
65-75 (1)
D - diabetes (1)
S - stroke/ TIA/ VTE (2)
V - vascular disease (IHD/ PAD) (1)
S - sex (1 if female)

37
Q

CHA2DS2VS

when to offer anticoagulation

A

in males consider if 1+
2+ offer anticoagulation

38
Q

hypercalcaemia ECG changes

A

short QT

39
Q

GTN SE: (4)

A

hypotension
tachycardia
headache
flushing

40
Q

cx post MI:

A

cardiac arrest (VF)
cardiogenic shock
chronic heart failure
arrhythmias
pericarditis (Dresslers’ syndrome)
left ventricular aneurysm
LV free wall rupture
VSD
acute mitral regurg

41
Q

Dresslers’ syndrome

i. what is it?

ii. presentation

iii. rx

A

= pericarditis 2-6 weeks post MI
(thought to be autoimmune reaction to recovering myocardium)

ii. fever
pleuritic pain
pericardial effusion
raised ESR

iii. NSAIDs

42
Q

LV aneurysm post MI
i. ECG changes

A

i. persistent ST elevation

43
Q

LV free wall rupture post MI

i. how long after MI

ii. presentation

iii. mgt

A

i. 1-2 weeks

ii. raised JVP, pulsus paradoxus, diminished heart sounds
i.e. acute heart failure secondary to cardiac tamponade

iii. pericardiocentesis

44
Q

VSD post MI:

i. how long after MI

ii. presentation

iii. ddx (1)

A

i. 1-2 weeks

ii. acute heart failure + PANSYSTOLIC MURMUR

iii. acute mitral regurgitation

45
Q

acute mitral regurgitation post MI

i. following which type of MI is it most common

ii. type of murmur

A

i. infero-posterior

ii. early/mid SYSTOLIC murmur

46
Q

ACEi SE (4)

A

cough
angioedema
hyperkalaemia
1st dose hypotension

47
Q

ACEi inhibitor rx
–> what change of renal function acceptable?

A

creatinine increase by 30% from baseline

48
Q

WPW ECG changes: (4)

A

short PR
wide QRS with slurred upstroke - delta wave
left axis deviation in R sided accessory pathway
right axis deviation in L sided accessory pathway

49
Q

WPW mgt:

A

definitive = radiofrequency ablation of accessory pathway

sotalol (avoid in co-existant AF)
amioderone
flecainide

50
Q

aortic stenosis presentation

A

SAD
Syncope
Angina
Dyspnoea

ESM
radiation to carotids
decreased following Valsalva

51
Q

features of severe aortic stenosis (8)

A

narrow pulse pressure
slow rising pulse
delayed ESM
soft/absent S2
S4
thrill
duration of murmur
left ventricular hypertrophy or failure

52
Q

aortic stenosis causes (5)

A

calcification (most common in >65)
bicuspid valve (most common in <65)
William’s syndrome
rheumatic
HOCM

53
Q

aortic regurgitation presentation: (7)

A

early diastolic murmur: intensity of the murmur is increased by the handgrip manoeuvre
collapsing pulse
wide pulse pressure

Quincke’s sign (nailbed pulsation)

De Musset’s sign (head bobbing)

mid-diastolic Austin-Flint murmur in severe AR - due to partial closure of the anterior mitral valve cusps caused by the regurgitation streams

54
Q

mitral stenosis features:

A

dyspnoea
↑ left atrial pressure → pulmonary venous hypertension
haemoptysis

mid-late diastolic murmur (best heard in expiration)
loud S1

opening snap

low volume pulse
malar flush
atrial fibrillation (secondary to ↑ left atrial pressure → left atrial enlargement)

55
Q

mitral stenosis causes

A

rheumatic fever

56
Q

bradycardia + signs of shock mgt

A

atropine 500mcg (up to x3)
then transcutaneous pacing +/- isoprenaline/ adrenaline infusion

then transvenous pacing + specialist help

57
Q

nicorandil

i. adverse effects (3)

ii. CI

A

i. headache
flushing
skin/ mucosal/ eye ulceration (including anal ulceration)

ii. severe hypotension

58
Q

HTN mgt

A
59
Q

SVT

i. mgt

ii. prevention

A

i.
1. Vagal manoeuvres
2. iv adenosine 6mg–> 12mg–> 18mg (CI in asthma, give verapamil instead)
3. cardioversion

ii. BBs
radio-frequency ablation

60
Q

ECG territories

A
61
Q

PE –> findings on blood gas

A

respiratory alkalosis

MSRA (14 decks)

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