Cardio 2

Question 1

What is the difference between fast and slow AF

Answer 1

Fast AF = >100bpm

Slow AF = <60bpm

Question 2

first line mx angina

Answer 2

aspirin + atorvastatin

beta blocker /non DHP CCB + GTN

Question 3

what are non-DHP CCB

Answer 3

THE WEIRD NAMED ONES

e.g. diltaziem, verapamil

Question 4

what is second line mx angina

Answer 4

beta blocker + DHP CCB + GTN

Question 5

what are DHP CCB

Answer 5

the usual named ones

e.g. nifedipine

Question 6

what typeof CCB must you never give with BB and why

Answer 6

never give NON DHP CCB with BETA BLOCK

because they can cause complete heart block

Question 7

causes of secondary HTN

Answer 7

Renal - RAS, PKD, CKD, chronic glomerulonephritis
Endocrine - hyperthyroid, cushings, conn’s, phaeo, CAH
CV - aortic coarctation

Question 8

when do you treat HTN

Answer 8

if >140/90 and UNDER 80yo and with end organ damage, CVD, renal disease, diabetes, Qrisk >10%

Question 9

what is the target BP for <80yo with HTN

Answer 9

Target for <80yo: <140/90n

Question 10

what is the target BP for >80yo with HTN

Answer 10

Target for over 80yo: <150/90

Question 11

how do you manage resistant HTN (after ACEi/ARB + CCB+ TLD)

Answer 11

if K+<4.5: spironolactone

if K+>4.5: alpha/betablocker

Question 12

what patients must you give ATORVASTATIN 80mg in

Answer 12

FOR SECONDARY PREVENTION

so if known IHD, CVD, PAD (not if just high Qrisk)

Question 13

how is a pericardial rub audible

Answer 13

on left lower sternal edge, with patient leaning forward on inspiration

Question 14

what do you need to monitor with unfractionated hepain

Answer 14

APTT

Question 15

what does QRISK measure

Answer 15

your 10 year risk of developing cardiovasc disease

Question 16

what should you be given if Qrisk <10%

Answer 16

lifestyle modification

Question 17

what should you be given if Qrisk >10%

Answer 17

high dose statin (20mg atorvastatin)

Question 18

causes of cardiac tampoinade

Answer 18

vascular: MI, rupture, aortic dissection
infection: pericarditis
trauma: includes iatrogenic
cancer…
cause a pericardial effusion

Question 19

when is it appropriate to do a PCI after the reccomended time priod of 12h from sx onset?

Answer 19

when patients have persistent ischaemia following fibrinolysis (e.g. at a nonPCI centre)

Question 20

which angina med do patients commonly develop resistance to

Answer 20

standard-release isosorbide mononitrate (not modified release)

Question 21

investigations for suspected rheumatic fever

Answer 21

Throat swab)
Bloods (FBC, ESR, ASOT anti streptolysin O titre )
Blood cultures 
ECG
CXR 
Echo

Question 22

what will Echo show in rheymatic fever

Answer 22

valve leaflet and chordal thickerning

mitral valve dilatation and collapse

Question 23

what is the time pattern of rheumatic feber

Answer 23

rheumatic fever is RECURRENT > causes progressive cardiac damage

Question 24

how long should patients with rheum fever keep taking antibioitics for as secondary prevention?

Answer 24

10 years or until age 40

lifetime prophylaxis may be needed if severe heart damage

Question 25

what occurs in ECG in acute rhem fever

Answer 25

prolonged PR | Heart block

Question 26

what is the timescale of the two disease patterns in Rheumatic fever

Answer 26

ACUTE >> immune response to strep pyogenes, 2-6 weeks from initial pharyngeal infection CHRONIC >> recurrent through life

Question 27

ix for pericarditis

Answer 27

ECG: widespreast PR depression and saddle shgaped ST elevation Echo (TTE): to exclude pericardial effusion Troponin: to check for PRIOR MISSED MI viral serology (later, non-urgent) if suspecting viral cause

Question 28

why is it important to do a troponin for pericarditis

Answer 28

because a prior silent MI may have caused it

Question 29

what is the most common complication of pericardityis you must be weary of ?

Answer 29

PERICARDIAL EFFUSION > TAMPONADE so get a CXR > it will show cardiomeg with normla pulm vassc

Question 30

what causes WPW

Answer 30

presence of an accessory pathway conducting between atria and ventricles abnormally > premature ventricular contractions

Question 31

ecg features of WPW

Answer 31

short PR interval wide QRS complexes with a slurred upstroke - 'delta wave' left axis deviation if right-sided accessory pathway* right axis deviation if left-sided accessory pathway*

Question 32

what sets off WPW arrythmia?

Answer 32

``` HOCM mitral valve prolapse Ebstein's anomaly thyrotoxicosis secundum ASD ```

Question 33

mx of WPW

Answer 33

ablation of accessory pathway OR amiodarone / fleicanide

Question 34

findings on ECG for pericarditis

Answer 34

Saddle shaped ST elevation | PR dePRession

Question 35

absolute contraindications to thrombolysis

Answer 35

``` active internal bleeding recent haemorrhage, trauma or surgery (including dental extraction) coagulation and bleeding disorders intracranial neoplasm stroke < 3 months aortic dissection recent head injury severe hypertension ```

Question 36

what is first line is CHADS VASC high?

Answer 36

DOAC e.g. apixaban, rivaroxaban, dabigatran

Question 37

what must you give if witnessed cardiac arrest while on monitor

Answer 37

3 SHOCKS (instead of just 1)

Question 38

what kind of erythema do you get with rheumatic fever

Answer 38

erythema MARGINATUM

Question 39

what must you synchronise DC cardioversion to?

Answer 39

synchronise to R wave

Question 40

when do you NOT need to synchronise DC cardioversion

Answer 40

in defibrillation (VF, VT)

Question 41

what drug reverses dabigatran effect

Answer 41

Idarucizumab

Question 42

posterior MI on ECG

Answer 42

tall R waves in V1, V2

Question 43

ECG change with HYPERCALCAEMIA

Answer 43

short QT

Question 44

what must you not forget to give in AF if you can cardiovert <48 hours

Answer 44

GIVE RAPID ANTICOAG e.g.

Question 45

causes of orthostatic hypotension (drop of BP >20/10 on standing)

Answer 45

- hypovolaemia - autonomic dysfunction: diabetes, Parkinson's - drugs: diuretics, antihypertensives, L-dopa, phenothiazines, antidepressants, sedatives - alcohol

Question 46

which cardiac drug must be avoided in VT

Answer 46

VERAPAMIL -- because it will inhibit heart contraction furter

Question 47

electrolyte changes causing long QT

Answer 47

hypocalcaemia, hypokalaemia, hypomagnesaemia\

Question 48

what is the second investigation type you must do in someone found to have a RAISED BP in clinic?

Answer 48

AMBULATORY BP MONITORING (this will confirm whether they actually have HTN - no need to call them back into clinic!)