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CARDIOLOGY - RIA > Cardio/drugs/ALS guidelines > Flashcards

Cardio/drugs/ALS guidelines Flashcards

1
Q

Atherosclerosis definition

A

Atheromas - fatty deposits in the artery walls

Sclerois - process of hardening or stifferning of the blood vessels walls

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2
Q

what causes atherosclerosis

A

caused by chronic inflammation and activation of the immune system in the artery wall… causing deposition of lipids in the artery wall followed by the development of fibrous atheromatous plaques

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3
Q

what does the fibrous atheromatous plaques lead to… in terms of :

  • stiffening
  • stenosis
  • plaque rupture
A

Stiffening: of blood vessel walls leads to HTN & strain on heart trying to pump against resistance

Stenosis: reducing blood flow e.g. in angina

Plaque rupture: giving off a thrombus that blocks a distal vessel leading to ischaemia e.g. ACS

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4
Q

3 non modifiable risk factors for atherosclerosis

A
  • older age
  • family history
  • male
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5
Q

modifiable risk factors for atherosclerosis

A
  • smoking
  • alcohol consumption
  • poor diet: high sugar & trans fat & reduced fruit and veg and omega 3 consumption
  • low exercise
  • obesity
  • poor sleep
  • stress
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6
Q

medical co-morbidities that increase the risk of atherosclerosis and should be carefully managed to minimise risk (5)

A
  • DM
  • HTN
  • CKD
  • Inflammatory conditions such as RA
  • Atypical antipsychotic medications
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7
Q

what does the QRISK % indicate

A

percentage risk that a patient will have a stroke or MI in the next 10 years

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8
Q

QRISK indication for starting a statin

A

QRISK > 10%

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9
Q

what should all patients with CKD or T1DM for more than 10 years be offered

A

Atorvostatin 20 mg

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10
Q

when should lipids be checked after starting statins

A

@ 3 months

& 12 months

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11
Q

what is the ALT & AST rise when started on statins and what is indication to stop statins

A

transient ALT & AST rise in first few weeks of use….

need stopping if rise is more than 3 x upper limit for normal

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12
Q

4 A’s for secondary prevention of CVD

A
  1. Aspirin + 2nd antiplatelet e.g. clopidogrel for 12 months
  2. Atorvostatin 80 mg
  3. Atenolol or Bisoprolol
  4. ACE inhib - Ramipril
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13
Q

3 side effects of statins

A
  • myopathy (check CK in pt with muscle pain/weakness)
  • T2DM
  • Haemorrhagic stroke
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14
Q

1st line management of SUPRAVENTRICULAR TACHYCARDIA

A

VAGAL MANEUVRES

A) Carotic sinus massage
B) Valsalva (blow against empty syringe

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15
Q

Drug of choice for narrow complex

A

adenosine

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16
Q

drug of choice for broad complex

A

amiodarone 6mg IV

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17
Q

3 side effects of Amiodarone

A
  • pulmonary fibrosis
  • hypo/hyper thyroidism
  • Liver pathology - check LFTs
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18
Q

3 drugs that can cause pulmonary fibrosis

A
  • Amiodarone
  • Methotrexate
  • Nitrofurantoin
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19
Q

causes of raised anion gap

A

MUDPILES

M - methanol
U - uraemia 
D - DKA 
P - 
I - iron overdose
L - lactic acid
E - 
S - salicylate
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20
Q

first line antihypertensive for age < 55 & not african caribbean

A

ACEi or ARB

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21
Q

first line antihypertensive for > 55 years OR black african

A

calcium channel blocker

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22
Q

3 e.g. of calcium channel blockers

A
  • verapamil
  • amlodopine
  • diltiazem
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23
Q

3rd line treatment for Hypertension

A

ACEi/ARB & CCB & thiazide like diuretic

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24
Q

what are the 4 rhythms you could see in a PULSELESS UNRESPONSIVE PATIENT

A

1) ventricular tachycardia
2) Ventricular fibrillation
3) Pulseless electrical activity
4) Asystole

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25
Q

adverse features (4) to determine if a patient is stable or unstable with an arrhythmia

A
  • Heart failure
  • Myocardial ischaemia
  • Shock
  • Syncope
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26
Q

Normal QRS duration

A

100 ms

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27
Q

QRS duration for ‘narrow QRS’

A

< 70 ms

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28
Q

ABCDE assessment of adult tachycardia?

A

A - assess airway
B - Monitor SpO2 & give oxygen if hypoxic
C - Obtain IV access
D -
E -
- identify & treat reversible causes such as electrolyte abnormalities

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29
Q

Atrial Fibrillation ECG findings?

A

Irregular narrow complex tachycardia

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30
Q

Management of regular, narrow complex tachycardia? 1st and 2nd line

A

1) Vagal manoeuvres

2) Adenosine 6 mg rapid IV bolus

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31
Q

what medications can be considered if in heart failure with probable AF?

A
  • digoxin

- amiodarone

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32
Q

regular broad complex tachycardia?

A

Ventricular tachycardia

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33
Q

management of VT

A

Amiodarone 300 mg IV over 20-60 mins

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34
Q

side effects of amiodarone

A
  • corneal deposits
  • photosensitivity
  • hepatitis
  • pneumonitis
  • lung fibrosis
  • raised INR
  • raised T4
35
Q

3 causes of VT

A
  • electrolyte disturbances
  • ischaemia
  • post MI: origin around old scar tissue in heart
36
Q

ECG findings for VT and VF

A

both broad complex tachycardias

VT is regular
VF is irregular

37
Q

management of VF or pulseless/unstable ventricular tachycardia

A
  • asynchronized DC shock

- adrenaline 1 mg immediately

38
Q

where do supraventricular tachycardias arise from?

A

arise from above the bifurcation of the bundle of His

39
Q

name 1 irregular and regular supraventricular tachycardias

A

regular: Atrial flutter
irregular: atrial fibrillation

40
Q

Atrial fibrillation:

  • ECG findings
  • what actually happens
A

Irregular, narrow QRS complex tachycardia, absent P waves

loss of organised signalling leading to atrial spasms. Stagnation of blood in the atria predisposes to thrombus –> embolic stroke risk

41
Q

5 causes of AF

A
  • ischaemia
  • hypertension
  • MI
  • PE
  • mitral valve disease
42
Q

symptoms of AF (4)

A
  • faintness
  • chest pain
  • asymptomatic
  • dyspnoea
  • palpitations
43
Q

4 types of AF?

A
  • paroxysmal
  • recurrent
  • persistent
  • permanent
44
Q

what is paroxysmal AF, & management?

A

Recurrent spontaneous episodes, self-terminating within 7 days

pill in pocket: flecanide or propafenone

45
Q

type of AF where episodes are not self terminanting within 7 days

A

persistent AF

46
Q

describe permanent AF? & management

A

AF unchanged after efforts to cardiovert

rate control & anticoagulation

47
Q

when is DC cardioversion considered for AF?

A

new onset AF (within 48 hours) & haemodynamically unstable (e.g. SoB, syncope, dizziness, hypotension)

48
Q

name of score used to assess risk of stroke in AF patients & assess need for anticoagulation

A

CHADS-VASc

49
Q

score used to assess bleeding risk in patients on anticoagulation

A

HASBLED

50
Q

mechanism of action of Apixaban?

A

Factor Xa inhibitor

51
Q

direct thrombin inhibitor

A

Dabigatran

52
Q

mechanism of action of warfarin

A

Vitamin K antagonist

53
Q

4 contraindications for warfarin

A
  • pregnancy
  • severe HTN
  • bleeding disorder
  • peptic ulcer
54
Q

Vit K deficiency leads to reduction in:

A 
Factor 2 
Factor 7 
Factor 9 
Factor 10
Protein C
55
Q

describe ECG findings for 2nd degree heart block

A

Prolongation of PR interval until there is a dropped beat, then cycle repeats itself

56
Q

other names for 2nd degree heart block

A

Mobitz 1

Wenchebach

57
Q

ECG findings for 1st degree heart block

A

prolongs PR interval

>0.22 seconds

58
Q

ECG findings for 2nd degree heart block/Mobitz 2

A
  • normal PR interval

- intermittent non conducted P waves

59
Q

cause of bundle branch blocks

A

prolonged QRS complex. caused by delay in conduction tissues of one of the bundle branches

60
Q

LBBB ECG finding

A

deep S wave in V1

tall R waved in V6

61
Q

how does adenosine work

A

by slowing cardiac conduction primarily through the AV node. It interrupts the AV node pathway during SVT, resetting it back to sinus rhythm

62
Q

medication that gives patient a scary feeling of impending doom when injected

A

adenosine

63
Q

what causes WWW

A

extra electrical pathway connecting atria and ventricles

64
Q

definitive treatment for WWW

A

radiofrequency ablation

65
Q

how does atropine work

A

it is an antimuscarinic and works by inhibitng the parasympathetic nervous system

66
Q

side effects of atropine

A
  • pupil dilatation
  • urinary retention
  • dry eyes
  • constipation
67
Q

aspirin mechanism

A

irreversibly acetylates cyclo-oxygenase, preventing production of thromboxane A2 –> inhibiting platelet aggregation

68
Q

mechanism of Tirofiban

A

Gylcoprotein 2b/3a antagonist

69
Q

mechanism of dabigatran

A

direct thrombin inhibitor

70
Q

mechanism of loop diuretics & example

A

inhibit Na/2Cl/K co transporter

furosemide

71
Q

mechanism of thiazide like diuretics & exampls

A

inhibit Nal/Cl co transporter

bendroflumethiazide

72
Q

side effects of loop diuretics

A
  • dehydration
  • ototoxic
  • low potassium
  • low calcium
73
Q

side effects of thiazide like diuretics

A
  • gout
  • impotence
  • low potassium
  • high calcium
  • low Mg
74
Q

mechanism of calcium channel antagonists and how this works

A
  • reduce cell entry of Calcium via L type channels in smooth muscle
  • promote coronary and peripheral vasodilation and reduce myocardial oxygen consumption
75
Q

side effects of caclium channel blockers

A
  • flushes
  • headache
  • oedema
  • gingival hypertrophy
76
Q

what CCB to not give with BB and why

A

verapamil

risk of severe brady

77
Q

beta blockers contraindicated in

A

asthma

and heart blcok

78
Q

mechanmism of digoxin

A

blocks na-k pump

79
Q

side effects of digoxin

A
  • yellow vision
  • confusion
  • gynaecomastia
  • nausea
  • reduced apetite
  • any arrhythmia e.g. SVT
80
Q

mechanism of statin

A

inhibit enzyme HMG-CoA reductase

81
Q

role of enzyme HMG-CoA reductase

A

de novo synthesis of cholesterol

82
Q

side effects of ACEi

A
  • dry cough
  • hypotension
  • taste distrubance
  • high potassium
83
Q

what may a larger rise in creatinine after starting ACEi suggest?

A

renal artery stenosis

84
Q

what rise of creatinine should be expected with ACEi

A

< 20%

and GFR decrease by < 15%

CARDIOLOGY - RIA (8 decks)

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