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first year med > cardio conditions > Flashcards

cardio conditions Flashcards

1
Q

whats the first line treatment for a 45 year old afroCaribbean with hypertension?

A

CCB (amlodipine)

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2
Q

how do you treat resistant hypertension?

A

low dose spironolactone - monitor U&Es

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3
Q

what are investigations for angina?

A

CT coronary angiography (CTCA) - young atypical symptoms

exercise tolerance test (ETT) - old classic symptoms but normal ECG

old + classic symptoms = clinical diagnoses

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4
Q

whats the first line treatment for angina?

A

symptomatic relief = GTN spray (vasodilator)

beta blocker - bisoprolol
CCB - amlodipine

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5
Q

how do you diagnose acute coronary syndrome?

A

unresponsive to GTN

ST elevation or new LBBB = STEMI

raised troponin or other ECG change = NSTEMI

none of above = unstable angina or MSK chest pain

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6
Q

what is meant by serial troponins and when are they commonly done?

A

used in ACS diagnosis

should be done on arrival to hospital then 6-12hrs later
- a rise is consistent with myocardial ischemia (released from ischaemic muscle)

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7
Q

what is the treatment of an acute STEMI?

A

within 2hrs of presentation = PCI

after 2 hrs = thrombolysis (injecting fibrinolytic medication which break down fibrin + rapidly dissolves clot)

( + MONAA)

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8
Q

what is the treatment for an acute NSTEMI?

A

MONAA

M - morphine
O - oxygen (<95%)
N - nitrates - sublingual GTN
A - aspirin (antiplatelet)
A - antiplatelet = ticagrelor
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9
Q

what is the GRACE score used for?

A

gives 6 month risk of death or repeat MI after NSTEMI

<5% = low risk
5-10% = medium risk
> 10% = high risk

medium or high risk - early PCI to treat underlying CAD

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10
Q

what are the 6 As of secondary prevention management of ACS?

A

Aspirin
Another antiplatelet - clopidogrel, ticagrelor
Atorvastatin
ACEi - ramipril
Atenolol - or other betablocker
Aldosterone antagonist for those with clinical HF (spironolactone)

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11
Q

what are symptoms of limb ischaemia?

A

limb ischaemia = arteries = ARTS

A - absent pulse + hair
R - red sores (ulcers)
T - toes + feet pale or black
S - sharp calf pain

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12
Q

what are the 6 Ps of acute limb ischaemia?

A 
pain - unrelieved
paraesthesia - tingling + numbness
pulseless
pallor - pale
polar - cold
paralysis
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13
Q

what are investigations for limb ischaemia?

A

artery brachial index (ABI)

  • normal = 0.9 - 1.3
  • claudication = 0.4 - 0.85
  • severe = 0 - 0.4

doppler ultrasound

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14
Q

how do you manage limb ischaemia?

A

LWMH
anti-platelet - aspirin
cholesterol lowering - statins

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15
Q

what are aneurysms? what are pseudoaneurysms?

A

permanent dilatation of the artery to twice the normal diameter

false aneurysm = pseudoaneurysm = surrounding tissue form wall of aneurysm

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16
Q

when should you repair an abdominal aortic aneurysm?

A

> = 5.5cm in diameter
expanding at a rate of >1cm/year
symptomatic

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17
Q

what are symptoms of abdominal aortic aneurysms?

A

mostly asymptomatic but if rapid expansion / rupture:

severe pain - epigastric, radiating to the back
hypotension, tachycardia, profound anaemia, sudden death
trashing - discolouration due to emboli from aortic thrombus

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18
Q

what is the management of a DVT?

A

6 weeks anti-coagulation = LWMH
thrombolytic therapy for large iliofemoral thrombosis
compression stockings

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19
Q

what is the acute management of supraventricular tachycardia?

A

step wise with continuous monitoring:

valsalva manoeuvre - NOT in patients with clot risk
carotid sinus massage - “
adenosine - rapid bolus, feel like dying - contraindicated in asthmatics
verapamil (CCB)
DC cardioversion - if haemodynamically unstable do first

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20
Q

long term management of SVTs?

A

CCBs - verapamil, diltiazem
beta blockers
flecainide / amiodarone
radiofrequency ablation

21
Q

when would you not give rate control in AF?

A

reversible
new onset - within 48hrs
causing HF
remain symptomatic despite rate control

22
Q

the moment AF switches to sinus rhythm is when there’s the highest risk for embolism leading to stroke

how can this risk be reduced?

A

CHAD2Ds2-VASc - assess risk of emboli stroke (>2 anticoagulate)
HASBLED - risk of bleeding

anticoagulation:

  1. warfarin= vitamin K antagonist (give K to counteract)
    - maintain INR between 2-3
    - needs monitored, interaction problems, long half life
  2. DOACs
    - shorter half life
    - apixaban, edoxaban, rivaroxaban = factor Xa inhibitors
    - dabigatran = thrombin inhibitor
23
Q

what is the most common method of rhythm control?

A

cardioversion

DC cardioversion = timed electric shock

  • must have had symptoms <48hrs or be anticoagulated prior
  • echo first to look for emboli

pharmacological cardioversion

  • flecainide = Na channel blocker
  • amiodarone = K channel blocker

if neither work - catheter ablation

24
Q

what does an ECG of atrial flutter look like?

A

regularly irregular
no p waves - “saw tooth T waves”
normal QRS duration

25
Q

what does an ECG of Wolff-Parkinson White look like? how is this treated?

A

short PR interval <0.12s
wide QRS complex >0.12s
delta wave - slurred upstroke of QRS

definitive treatment = radiofrequency ablation of the accessory pathway.

26
Q

how can supraventricular tachycardia and ventricular tachycardia be differentiated?

A

adenosine

no effect in VT but will help SVT

27
Q

what is torsades de pointes?

A

ventricular contraction prior to proper repolarisation
polymorphic VT - QRS progressively smaller then larger over and over

occurs in patients with prolonged QT interval

terminate spontaneously or progress into VT

28
Q

what does an ECG of Brugada syndrome look like?

A

ST elevation with RBBB in leads V1-3

changes may be seen after administering flecainide - Na channel blocker

29
Q

what is the treatment for 2nd (mobitz II) and 3rd degree heart block?

A

first line = atropine IV

no improvement - 
other inotropes (noradrenalin)
defibrillate

long term = pacemaker

30
Q

how is heart failure classified?

A

New York Heart Association (NYHA) classification -

  • class I = no exercise limitation, no fatigue, dyspnoea or palpitations
  • class II = mild limitation, comfortable at rest but normal physical activity produces fatigue, SOB or palpitations
  • class III = marked limitation, comfortable at rest but gentle activity produces symptoms
  • class IV = symptoms of heart failure occur at rest and are exacerbated by any physical activity
31
Q

what are the symptoms of heart failure?

A

exertional dyspnoea
orthopnoea - SOB when lying down, relieved by standing (how many pillows?
paroxysmal nocturnal dyspnoea - sudden awake with SOB + cough
cough - white/pink frothy sputum
peripheral oedema - pitting

32
Q

signs of HF?

A

bi-basal crackles
elevated JVP
3rd and 4 th heart sounds
cardiomegaly

33
Q

what is an elevated BNP a sign of?

A

heart failure

34
Q

what is the drug therapy for heart failure?

A

ACEi - ramipril (avoid with valvular heart disease)
beta-blockers - bisoprolol (not for asthmatics)

spironolactone in HFrEF + symptoms not controlled with ACE + Beta
- (thin, weak, unable to eject fully, EF <=40%)

35
Q

treatment for LVF + pulmonary oedema?

A

Pour SOD

pour - pour away (stop) IV fluids
S - sit up - takes fluid to bases
O - oxygen if <95%
D - diuretic(loop) = furosemide (reduces circulating volume)

36
Q

causes of infective endocarditis?

A

bacteraemia - poor dental hygiene, IV drugs, prosthetic heart valves
rheumatic disease
congenital abnormalities + degeneration

  • valve disease promotes platelet/fibrin deposition
37
Q

signs of infective endocarditis?

A

new/changing heart murmur
sepsis/embolic event of unknown origin
splinting haemorrhages - bloody lines in nail beds
roth spots - red spots in back of the eye with pale centres
janeway lesions - nonpainful, red spots on hand palms or feet soles
osler nodes - painful, bloody nodules on finger tips/toes

38
Q

what are the causative organisms of infective endocarditis?

A

staph aureus

  • IV drug users
  • usually tricuspid valves

staph epidermis - prosthetic valves

strep viridans - after dental surgery

HACEK group (gram -ves)
Haemophilus
Actinobacillus
Cardiabacteria
Eikenella
Kingella
39
Q

investigations for infective endocarditis?

A

take 3 sets of blood cultures from different sites - before treatment
–> if negative think atypical

echo for endocardial involvement - vegetation, abscess, dodgy prosthetic

CRP, inflammatory markers, FBC

40
Q

patient gets pericarditis 4-6weeks post MI

A

Dressler’s syndrome

41
Q

what is the wells score used for?

A

DVT risk calculation

42
Q

A 60-year-old man with a history of late-stage cirrhosis and alcohol abuse is being managed on the gastroenterology ward. An abnormality is found on his most recent echocardiogram.
What is the MOST LIKELY diagnosis?

A

dilated cardiomyopathy

43
Q

treatment for native valve infective endocarditis

A

amoxicillin, gentamicin IV for 4-6weeks

–> step viridans (after dental)

(Already Got native valve)

44
Q

treatment for prosthetic valve infective endocarditis

A

Vancomycin, Gentamicin IV + Rifampicin PO for 4-6 weeks

–> staph epidermidis

(prosthetic valve has Very Good Rhythm)

45
Q

treatment for staph aureus infective endocarditis

A

flucloxacillin IV 4-6weeks

46
Q

treatment for suspected MRSA infective endocarditis

A

vancomycin, rifampicin, gentamicin IV 4-6weeks

47
Q

treatment of first degree heart block

A

no intervention (if stable)

PR >0.2s

48
Q

tachycardia treatment of an unstable patient

A

up to 3 synchronised shocks

amiodarone IV

49
Q

treatment of stable ventricular tachycardia

A

amiodarone infusion

first year med (15 decks)

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