Cardio Flashcards
How to treat 1st episode of AF which presented <48h?
Begin anticoagulation, undergo immediate direct current (DC) cardioversion
What medications should be given after MI?
dual antiplatelet therapy (aspirin plus a second antiplatelet agent)
ACE inhibitor
beta-blocker
statin
Where do pulse changes happen in aortic dissection?
- weak or absent carotid, brachial, or femoral pulse
- variation in arm BP
What is given first in to prevent angina attacks, Verapamil or nicorandil?
Verapamil (make sure not on beta-blocker) then nicorandil
What is 1st line treatment of aortic stenosis with symptoms?
valve replacement
What is needed to make a diagnosis of Takayasu’s arteritis?
Magnetic resonance angiography (MRA) or CT angiography (CTA)
What is a side effect of amiodarone?
grey skin appearance
What ECG changes are seen in hypothermia?
Bradycardia (<60bpm) and not tachycardia
J waves
Prolonged PR, QT and QRS intervals
Shivering artefacts
VT, VF or asystole
How much statin is given for primary and secondary prevention?
Primary - 20 mg
Secondary - 80 mg
What is a side effect of beta-blockers?
cold peripheries
What only beta-blocker causes long QT syndrome?
Sotalol
When do you give ACEi as first line for hypertension?
<55Y or T2DM
When do you give CCB as first line for hypertension?
> /= 55Y AND not T2DM OR Black African/ Afro-Caribbran ethnicity
When would add a low-dose spironolactone for hypertension?
- Last Line
- K </= 4.5
When would add an alpha/beta blocker for hypertension?
- Last Line
- K > 4.5
What is an example of a thiazide LIKE diuretic?
indapamide
What is the target INR for patients on warfarin?
2.5
What is the target INR for patients on warfarin when thy have emboli/ recurrent venous embolism?
3.5
What is an example of a a longer-acting dihydropyridine calcium channel blocker?
Amlodipine / modified-release nifedipine
a long-acting nitrate, ivabradine, nicorandil and ranolazine are used for angina when?
- if a patient is on monotherapy and cannot tolerate the addition of a calcium channel blocker or a beta-blocker
- Specialist medication
What is Buerger’s disease (or thromboangiitis obliterans) disease and what is it assoaicted with?
- a small and medium vessel vasculitis
- causes Raynaud’s phenomenon (discolouration of extremities with cold exposure)
- extremity ischemia leading to intermittent claudication (pain in legs which occurs during exercise and is relieved by rest)
- Stringly associated with smoking
What are signs of left ventricular aneurysm?
Persistent ST elevation following recent MI, no chest pain
What are signs of left ventricular free wall rupture?
raised JVP, pulsus paradoxus and diminished heart sounds
- Bibasal crackles
- decrease in blood pressure on inspiration
What ECG changes does hypercalcaemia cause?
shortening of the QT interval
How to treat AF?
First question: is patient haemodinamically stable?
if no then DC
If yes, Two questions to ask:
i. is patient >65 y/o?
ii. Does patient has history of ischaemic heart disease?
If yes to ANY of the two questions then:
first line Beta Blockers, second line digoxin
If no to BOTH then
First line is fleccanide, second line ameodarone
What are signs of hypokalaemia in an ECG?
This shows up as T wave flattening or inversion and ST depression. As the severity progresses U waves (small waveform following T wave) and QT prolongation (>450ms) can be seen.
Can ACS (unstable angina + ischaemic symptoms) have ecg changes?
YES
no elevation in troponins, with or without electrocardiogram changes indicative of ischaemia
What murmur is associated with a bicuspid valve?
ejection systolic murmur
What is the target INR for patients with a mechanical heart valve?
3-3.5
What is the screening numbers for AAA?
<3 = normal
3-4.4 cm = rescan every 12m
4.5-5.4 = Rescan every 3 m
>/= 5.5 = refer within 2 w for vascular surgery for probable intervention
When do you give oxygen?
O2 < 92%
What is trifasicular block?
RBBB +left anterior or posterior hemiblock + 1st-degree heart block
What is Brugada syndrome?
ST segment elevation in leads V1 to V3
How many hypertension drugs can be given before you refer to a specialist?
4
What is the dosage of adrenaline for PEA?
1:10000 (1mg)
What is the dosage of adrenaline for anaphylaxis?
1:1000 (0.5mg)
What type of drug is verapamil?
CCB
If you have a high QRISK3 score with hypertension, what does that mean?
That you are at a greater risk of a cardiovascular disease to primary cardiovascular disease prevention should be given e.g. 20mg of statin
How does wrafarin affect PT and APTT?
Prolonged PT only
2 and 10 are in the common pathway; 7 in extrinsic; 9 in intrinsic
It affects factor 7 the most
When do you add ivabradine for angina patients?
- a long acting nitrate
- if a beta-blocker and dihydropyridine CCB can’t be tolerated
How to react first episode of AF which started >48h or uncertain if when started?
Rate control drugs e.g. beta-blockers
What are examples of rate control drugs for AF?
- Beta blocker
- CCB
- Digoxin
What are examples of rhythm control drugs for AF?
- beta-blockers
- dronedarone
- amiodarone
If a patient with AF has a stroke or TIA , what should be given as secondary prevention?
- Warfarin
- Apixaban
- direct thrombin
- factor Xa inhibitor
Is the Risk of falls or old age alone is sufficient reasoning to withhold anticoagulation?
No
What antithrombin therapy is given for a bio prosthetic valve?
Aspirin
What anti thrombin therapy is given for a mechanical valve?
Warfarin and aspirin
When do you thrombolyse for PE?
Massive PE + hypotension
What is first and second line management of SVT (narrow complex)?
- valsalva manoeuvre or carotid sinus massage
- IV adenosine
