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Finals flashcards > Cardio > Flashcards

Cardio Flashcards

1
Q

What’s the physiology of Eisenmenger’s?

A

Associated with septal defects and patent DA. In a VSD, a left to right shunt exposes right ventricle to left v higher pressures, till the R ventricle hypertrophies enough that the shunt is reversed. This causes cyanosis and pulmonary hypertension.

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2
Q

Features of Eisenmenger’s and mx

A

Cyanosis, clubbing, murmur that disappears. Tx with heart-lung transplant

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3
Q

What is a globular heart a sign of?

A

ASD

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4
Q

What murmur does a VSD cause?

A

Blowing pan-systolic murmur

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5
Q

What psych drugs cause prolonged QT?

A

Anti-psychotics: haloperidol
TCAs: imipramine, noratriptylline, amitryptilline
SSRIs: citalopram
Seratonin receptor antagonists: ondansetron (also anti-emitic)

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6
Q

What AB can cause prolonged QT?

A

Erythromycin

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7
Q

What anti-arrhythmics can cause prolonged QT?

A

Amiodarone, sotalol

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8
Q

What electrolyte imbalances can prolong QT?

A

HYPOMg, Ca, K

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9
Q

Other causes of long QT

A

Hypothermia, subarachnoid haem

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10
Q

Mx of long QT

A

Beta blocker, avoid strenuous activity (can precipitate). Defib if high risk (implantable).

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11
Q

What investigation would you order for a patient with frequent collapse but normal resting ECG?

A

24 hour tape

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12
Q

What does long QT risk causing?

A

VT, then torsades (mono to polymorphic). Monomorphic VT is typically caused by MI.

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13
Q

Mx of VT

A 
Adverse signs (CP, heart failure, hypotensive): immediate cardioversion.
Stable: amiodarone. If drugs fail- DC shocks.
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14
Q

Is VT broad or narrow complex QRS?

A

Broad. SVT = narrow (s for small)

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15
Q

HOCM- demographic and inheritance pattern

A

Young, athletic individuals.
Autosomal dominant.
Causes thickened myocardium. LVH = reduced cardiac output.

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16
Q

Warfarin rules and targets for surgery

A

Stop warfarin 5 days prior to surgery. INR should be below 1.5.
Target for VTE and AF = 2.5
Target for recurrent VTE = 3.5

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17
Q

What can potentiate warfarin?

A

P450 inhibitors (amiodarone, ciprofloxacin).
Liver disease.
Anti-platelets.

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18
Q

Signs of heart failure

A 
Third heart sound
Displaced apex beat
Bibasal crackles
Pink, frothy sputum
Raised JVP
Oedema
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19
Q

Sx of heart failure

A

Sob, reduced exercise tolerance, swollen ankles/calves, fatigue.

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20
Q

Inv. for heart failure

A

ECG, bloods, BNP, echo, CX

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21
Q

Left V aneurysm appearance on ECG

A

Persistent ST elevation. Anticoagulate- stroke risk.

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22
Q

List complications after MI

A

VF (most common cause of death following CA)
Pericarditis, Dressler’s
LV Aneurysm or free wall rupture
Papillary muscle rupture (can cause mitral regurg and thus a murmur).
Cardiogenic shock

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23
Q

How does orlistat work?

A

Inhibits pancreatic and gastric lipase to reduce digestion of fat.

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24
Q

Unstable AF

A

Emergency: Immediate synchronised DC cardioversion

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25
Q

Bradycardia mx

A

Atropine 500mcg
If unsuccessful, repeat atropine or do transcutaneous pacing.
Beware of asystole.

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26
Q

What valve disease is PKD associated with?

A

Mitral valve prolapse. Beware of mitral regurg and arrhythmias

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27
Q

Side effects of amiodarone and baseline investigations

A

Pulmonary fibrosis, pneumonitis - CX
Hepatitis and fibrosis - LFTs
Thyroid issues either way- TFTs
Us and Es- can prolong QT so make sure they don’t have hypokalaemia

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28
Q

ECG changes for pericarditis

A

Saddle shaped ST elevation

PR depression

29
Q

Investigations for pericarditis

A

ECG and echo if suspect

30
Q

Mx of pericarditis

A

NSAIDs and colchine

31
Q

Symptoms of pericarditis

A

CP relieved by sitting forwards, can be pleuritic.

May have flu-like symptoms, sob, np cough.

32
Q

Pericarditis signs

A

Pericardial rub

Tachypnoe and cardia

33
Q

ALS mx for asystole/pulseless-electrical activity

A

Adrenaline 1mg + 2 mins compressions. Rhythm check.

34
Q

Reversible causes of cardiac arrest- The Ts

A

Thrombus (cardio or pulmonary)
Toxins
Tamponade (cardiac)
Tension pneumothorax

35
Q

Tx pathway for hypertension

A

A (under 55 or T2DM) or C (55 or Afro)
A + C / A + D (A = ACE or aldosterone antagnoist). If Afro, aldosterone antag is preferable to ACE.
A + C + Thiazide Diuretic
Add beta/alpha blocker if k above 4.5, otherwise spiranolactone.

36
Q

What is the most common cause of mitral stenosis?

What is the murmur associated with it?

A

Rheumatoid disease

Opening snap, followed by low pitched rumble.

37
Q

Most common causative agent of infective endocarditis

A 
Staph Aureus (especially among IVDU)
Staph epidermis = prosthetic valve surgery, think indwelling lines
38
Q

Anticoagulation post stroke with AF

A

300mg aspirin daily for two weeks, then lifelong anticoagulation.

39
Q

Statin side effects and CI

A

Myopathies and liver impairment.

CI: pregnancy, macrolides like erythromycin and clarithromycin.

40
Q

Statin doses for primary and secondary intervention

A

Atorvastarin 20mg
80mg for secondary
Indicated for established CVD or if QRISK is 10.

41
Q

What factors favour rate vs. rhythm control?

A

RAte: A for AGE. Over 65, ischaemic heart disease.
Rhythm: under 65, first presentation, CCF, symptomatic, correctable precipitant like alcohol.

42
Q

Drugs for rate control

A

Beta-blocker unless asthma
Ca blocker
Digoxin (first choice if heart failure)

43
Q

Drugs for rhythm control

A

Sotalol, amiodarone, flecanide, catheter ablation last resort- doesn’t reduce stroke risk though so still need to anti-coag.

44
Q

When would you cardiovert AF?

A

1) emergency

2) elective procedure

45
Q

Af > 48 hours

A

3 weeks anticoagulation
Cardiovert (electrical preferred in this case)
4 week anticoagulation

46
Q

AF < 48 hours

A

Heparin and early Cardioversion

47
Q

Life threatening signs of hypertension

A

CP, new confusion, heart failure, AKI.

Others: pappiloedema or retinal harm

48
Q

Stage 3 hypertension: mx options

A

1) Life-threatening signs: ED and admit
2) No sx: urgent end-organ damage investigations like fundoscopy, urine ACR,ECG
3) Phaechromacytoma?

49
Q

Mx of angina

A

Give all patients GTN, statin and aspirin (unless CI)
1st line: beta or rate limiting Ca block (verapamil/diltiazem). Titrate to max dose.

2nd line: beta + Ca blocker (switch to long acting like nifedipine).

3rd) can’t tolerate above, use ivabradine or LA nitrate. Only add 3rd drug if on combo if awaiting PCI/CABG.

50
Q

Advice for timing doses of standard-release isosorbide mononitrate

A 
Asymmetric dosing (e.g. 6am, 10pm)
Minimises development of nitrate tolerance
51
Q

Characteristic sign of tamponade

A

Pulsus paradoxus

52
Q

What is Beck’s triad? What investigation should you performed first if present?

A

C.tamponade: falling bp, muffled heart sounds, rising JVP. Perform echo.

53
Q

Secondary prevention of MI

A 
5 drugs
Ace
Beta
Statin
Dual anti-platelet
54
Q

What should you use as an alternative if ACE aren’t tolerated in hypertension mx?

A

Angiotension blocker e.g. losartan

55
Q

First line inv for heart failure

A

NT-proBNP

56
Q

What does cor pulmonale describe?

A

Right sided heart failure (RVH) caused by pulmonary artery hypertension. Related to COPD causing pulmonary vasoconstriction.

57
Q

Signs of RHF

A

Raised JVP, hepatomegaly, ankle oedema.

58
Q

Signs of LHF

A

Dyspnoea on exertion, orthopnea, paroxysmal nocturnal dyspnoea, wheeze, cough.

59
Q

Mx of heart failure

A

1) Ace + Beta (start one at a time)
2) Add aldosterone antagonist (spiranolactone)
3) Ivabradine, valsartan (both EF <35) , digoxin (AF, ionotropic), hydralazine with nitrate (for Afros), cardiac resync
Can use loop diuretics like furosemide but they don’t improve mortality.
One off pneumococcal, annual influenza.

60
Q

What ventilation should be considered in acute heart failure/pulmonary oedema not responding to tx?

A

CPAP

61
Q

Which beta blockers reduce mortality in heart failure?

A

Bisoprolol, carvedilol

62
Q

What drug should be used to mx anxiety and dyspnoea in acute heart failure? + mechanism

A

Morphine- opioid with vasodilator properties, reduces sympathetic drive.

63
Q

Mx options for acute heart failure

A 
O's and I's
O2
Opioids
IV loop diuretics
Ionotropes
CPAP
64
Q

What investigations should be performed prior to/with every dose increase of spiranolactone?

A

With any mineralocorticoid receptor antagonist, Na, K, renal function and bp should be performed.

65
Q

Mx of major haemorrhage on warfarin

A

Stop warfarin.
PT complex concentrates (don’t give if INR under 8)
IV Vit K.

66
Q

NSTEMI mx

A

Aspirin + GTN + morphine
Determine 6 month mortality risk (GRACE)
Ticagrelor (not high risk of bleeding) + fondaparinux
Clopi (intermediate/high risk > 3%) + unfractionated heparin

Coronary angiography + PCI if required:

  • immediate if unstable
  • within 72 hours if immediate risk/+
67
Q

Differentiating ACS from pericarditis on ECG

A 
Pericarditis = global changes, saddle shaped possibly.
Ischaemia = territory changes
68
Q

What ECG waves are seen in hypokalaemia and hypothermia?

A

Hypok - U waves

Hypothermia - J waves

69
Q

Atypical presentation of a.dissection

A

Neurological sx

Finals flashcards (15 decks)

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