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Finals > Cardio 2 > Flashcards

Cardio 2 Flashcards

1
Q

Management of aortic stenosis

A

Asymptomatic= observe unless valvular gradient >40mmHg or LVF dysfunction
Symptomatic= valve replacement

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2
Q

What are different types of valve replacement in AS

A

Transcatheter or surgical
Choice depends on patient risk

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3
Q

What is soft/absent S2 seen in

A

AS

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4
Q

If someone has HF, low BP and poor U&Es, what do

A

Increase furosemide dose to ensure their is sufficienct concentration of drug in kidneys

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5
Q

What treat cardiac tamponade with if neoplastic cause

A

Percutaneous balloon pericardiotomy

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6
Q

If not giving opiod for ACS, what use instead

A

Paracetamol
Avoid NSAIDs

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7
Q

What is a pedunculated heterogenous mass on echo attached to atrial septum

A

Atrial myxomaA

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8
Q

Atrial myxoma presentation

A

B symptoms
AF
Mid-diastolic murmur

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9
Q

Murmur in ASD

A

Fixed splitting of S2
ESM

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10
Q

If someone has had AF for over 48 hours but need to electrically anticoagulate, what can do beforehand

A

Echo to look for thrombus

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11
Q

First line anti-anginal if known HF

A

Bisoprolol

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12
Q

If using a standard release nitrate, how prevent tolerance

A

Asymmetric dosing where take 1 in evening and 1 in morning

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13
Q

How differentiate aortic sclerosis from aortic stenosis on examination

A

Aortic stenosis will radiate to carotids but sclerosis won’t

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14
Q

Cardiac causes of stroke

A

Aortic dissection
ASD
Infective endocarditis
Ventricular thrombus

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15
Q

How investigate if having recurrent episodes of syncope but a normal ECG

A

Holter monitoring

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16
Q

What causes radial pulse to disappear on inspiration

A

Pulsus paradoxus- cardiac tamponade

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17
Q

Side effects of amiodarone

A

thyroid dysfunction
corneal deposits
pulmonary fibrosis
liver fibrosis
peripheral neuropathy myopathy
photosensitivity
‘slate-grey’ appearance
thrombophlebitis
bradycardia
lengths QT interval

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18
Q

What investigations need to do before starting on amiodarone

A

TFT, LFT, U&E, CXR

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19
Q

What tests need to do while on amiodarone

A

LFT
TFT every 6 months

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20
Q

What does prolonged PR interval suggest in IE

A

Aortic abscess

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21
Q

When prioritise rhythm control over rate in acute AF

A

HF
First onset AF
Obvious reversible cause

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22
Q

What surgery is done for stanford A

A

Aortic root replacement

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23
Q

What do if someone post PCI starts reinfarcting or has haemodynamic instability

A

Urgent CABG

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24
Q

What cardiac drug can cause GI ulceration and sometimes perforation

A

Nicorandil

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25
Q

What drug is strictly CI in VT

A

Verapamil

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26
Q

Management of irregular broad complex tachycardia

A

Seek expert help

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27
Q

How differentiate between pericarditis from tamponade

A

Kussmauls sign positive in pericarditis where JVP does not fall on inspiration

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28
Q

What vessel use for venous cutdown

A

Long saphenous vein

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29
Q

What investigation do all pericarditis patients need

A

TTE

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30
Q

What drugs can be given for VT

A

Amiodarone
Lidocaine
Procainmide

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31
Q

What do if drug therapy fails for VT

A

Electrical cardioversion

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32
Q

What do if someone on dual antiplatelet therapy for CVD presents now requires DOAC for AF

A

If stable
- stop antiplatelets
Commence DOAC

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33
Q

What test is needed pre digoxin

A

Hypokalaemia needs to be excluded as predisposed to toxicity

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34
Q

How know when to treat HTN

A

Treat all stage 2 and 3
Only treat 1 if age <80 and 1 of
- renal disease
- DM
- CVD
- Q-RISK>10%

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35
Q

What is first line anti-hypertensive use guideline

A

Under 55 or T2DM
-ACEi or ARB
Over 55 or black
- CCB

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36
Q

What is second line anti hypertensive for a black person

A

ARB not ACEi

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37
Q

Second line management of HTN

A

If taking ACE i or ARB, add CCB or thiazide like diuretic
If taking CCB, add ACEi, ARB or thiazide like diuretic
(ARB if black)

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38
Q

Third line for HTN

A

Add whatever missing of ACEi/ARB, CCB or thiazide like diuretic

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39
Q

What do 4th line for HTN

A

Either seek expert help or add 4th line drug
- if potassium>4.5 then add beta blocker
- if potassium 4.5 and lower then add spironolactone

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40
Q

Metabolic side effects of thiazide diuretics

A

Hyperglycaemia
High lipids
High uric acid

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41
Q

Target BP for HTN

A

Clinic
- Under 80 BP<140/90
- Over 80 BP<145/85
ABPM
- Under 80 BP<135/85
- Over 80 BP<150/90

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42
Q

What cardiac drug would cause marked tongue and facial swelling after starting

A

ACEi from angioedema

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43
Q

Why are thiazide like diuretics preferred nowadays

A

Poor metabolic SEs
- high lipids, glucose and uric acid

44
Q

How do ventricular premature beats appear on ECG

A

Wide QRS complexes between normal P wave- QRS

45
Q

How differentiate between RBBB and LBBB

A

RBBB- MaRRoW= M in V1 and W in V6
LBBB- WiLLiaM- W in V1 and W in V6

46
Q

Causes of RBBB

A

Normal variant- particularly common as become older
RVH
Cor pulmonale
PE
MI
Cardiomyopathy

47
Q

What happens in Mobitz T1 HB

A

Progressive prolongation of PR before missing a beat

48
Q

What happens in Mobitz T2 HB

A

PR interval constant but not always followed by a QRS

49
Q

How describe a Mobitz T2 HB

A

Ratio of QRS to p waves

50
Q

Which cardiac drugs can prolong the QT

A

Sotalol
Amiodarone

51
Q

Which diuretic most likely to cause hypocalcaemia

A

Loop diuretics

52
Q

On which cardiac drug do you see bright spots in vision

A

Ivabradine

53
Q

Presentation of left ventricular aneurysm post MI

A

Persistent ST elevation in absence of chest pain
Left ventricular failure

54
Q

What is wenkenbach phenomena

A

T1 HB
Progressive PR elongation before skipping a QRS

55
Q

Which HB/’s can be normal

A

T1
Mobitz T1

56
Q

What can consider 3rd line for black people with HF

A

After ACEi, beta blocker and spironolactone
Can consider hydralazine and nitrate

57
Q

Patient presents with sudden onset chest pain worse on breathing in, with RBBB

A

PE

58
Q

When starting an ACEi, how manage a rise in creatinine

A

If less than 30% acceptable, repeat bloods

59
Q

Where calculate QT to and from

A

Start of Q to end of T

60
Q

If has HF and has HTN, which drugs should avoid

A

CCB ideally as exacerbates oedema but can give amlodipine if thiazides CI like in goût and diabetes

61
Q

What determines what length of time holter give

A

Depends on the frequency of palpitations
Eg- if get 2-3 x a week then want to have a 72 hour tape as opposed to 24 hour

62
Q

What is seen in gallop rhythm

A

S3 from HF

63
Q

In what lead it T wave inversion normal

A

aVR and III

64
Q

What is in trifasicular block

A

RBBB with left axis deviation PLUS 1st degree HB

65
Q

Presentation of stokes adams attacks

A

Get complete heart block and episodes of syncope

66
Q

What wave is electrical cardioversion synchronised to

A

R wave

67
Q

What is combined alpha and beta blocker

A

Labetalol

68
Q

What rise in troponin is concerning from baseline

A

20

69
Q

When can be confident not having an MI based off troponin

A

4 hours between first and final measurement

70
Q

Loading clopidogrel dose

A

300mg

71
Q

Loading ticagrelor dose

A

180mg

72
Q

Daily ticagrelor and clopidogrel dose

A

Tic- 90
Clopi- 75

73
Q

On top of meds, what is given part of managementfor MI

A

Cardio rehab

74
Q

Who are silent MIs seen in

A

DM
Elderly females
CKD stage 5

75
Q

Why is echo important in MI

A

To see if regional wall abnormalities- akinesia, dyskinesia

76
Q

What need to check daily on furosemide

A

U&Es for hypokalaemia

77
Q

How manage furosemide hypokalaemia

A

Options include adding spironolactone or SandoK

78
Q

What valves shut in S1

A

Mitral and tricuspid

79
Q

What valves shut in S2

A

Aortic and pulmonary

80
Q

Causes of mitral regurg

A

Mitral vavle prolapse
IHD- regional wall abnormalities
Dilated cardiomyopathy
Marfans
IE and rheum fever

81
Q

What worsens progression of valve disease

A

CKD as calcification
Hyperlipidaemia and DM

82
Q

What is the most common cause of secondary htn

A

Primary hyperaldosteronism

83
Q

What do if someone presents with new onset AF within last 48 hours

A

Cardiovert, options include
- DC cardioversion
- medical with flecainide or amiodarone if structural heart disease

84
Q

What medication affects effectiveness of clopidogrel

A

Omeprazole

85
Q

When see bisferiens pulse

A

Mixed aortic disease

86
Q

Which CCB use for angina

A

If monotherapy use verapamil or diltiazem
If in combination with beta blocker use longer release

87
Q

Lung crackles with normal CXR

A

PE

88
Q

How manage DM after a MI

A

Dose adjusted insulin infusion with regular monitoring of glucose to ensure under 11

89
Q

MOA of clopidogrel, prasugrel and ticagrelor

A

P2Y12 receptor antagonist

90
Q

What do with results of BNP in GP

A

If over 2,000 then cardio referral in 2 weeks
400-2000 cardio referral in 6 weeks
Under 400- consider other diagnoses

91
Q

Management of preserved EF HF

A

Loop diuretic
Manage rfx and supportive

92
Q

Typically if echo not preferred what use

A

Cardiac MRI

93
Q

Which valve replacement operation is preferred

A

Open as TAVI new and only do in people with lots of rfx

94
Q

Severe aortic stenosis signs

A

Absent S2
Narrow pulse pressure
S4

95
Q

Most common presenting aortic stenosis symptom

A

Exertional dyspnoea

96
Q

What can be done for palliative patients with severe aortic stenosis

A

Percutaneous balloon valvulotomy

97
Q

Long term complications of valve replacements

A

Endocarditis
Thrombus formation
Haemolysis

98
Q

When operate on asymptomatic aortic valve disease (regurg and stenosis)

A

Reduced LVF

99
Q

Investigations for IE

A

3 blood cultures
TTE often first line but if available to TOE as more sensitive

100
Q

What is most common presenting symptom of right sided endocarditis

A

Pulmonary septic emboli

101
Q

Where get septic emboli from IE

A

Lungs
Brain
Eyes
Spleen
Kidney

102
Q

Complications of IE

A

HF
Aortic abscess
Septic emboli- stroke, PE, kidneys
Osteomyelitis
Discitis
Psoas abscess
Valvular dysunction

103
Q

Post prosthetic valve replacement what is most common cause of IE

A

Within 2 months= s epidermis
After= s aureus

104
Q

How tell if axis deviation

A

Look at leads 1 and AVF
- if both positive then normal
- if both away from eachother then LAD
- if towards then RAD
- if both negative then extreme deviation

105
Q

Where does PR interval run from

A

Start of p wave to start of q wave

106
Q

Where is ST segment between

A

End of S to start of T

107
Q

What equation use for corrected QT

A

Bazzett- which estimates using HR of 60BPM
QT/RR^-2

Finals (29 decks)

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