Cardio/drugs/ALS guidelines Flashcards by Ria Marwaha

Atherosclerosis definition

Atheromas - fatty deposits in the artery walls

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

How well did you know this?

Not at all

Perfectly

what causes atherosclerosis

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

How well did you know this?

Not at all

Perfectly

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

stiffening
stenosis
plaque rupture

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

How well did you know this?

Not at all

Perfectly

3 non modifiable risk factors for atherosclerosis

older age
family history
male

How well did you know this?

Not at all

Perfectly

modifiable risk factors for atherosclerosis

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

How well did you know this?

Not at all

Perfectly

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

DM
HTN
CKD
Inflammatory conditions such as RA
Atypical antipsychotic medications

How well did you know this?

Not at all

Perfectly

what does the QRISK % indicate

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

How well did you know this?

Not at all

Perfectly

QRISK indication for starting a statin

QRISK > 10%

How well did you know this?

Not at all

Perfectly

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

Atorvostatin 20 mg

How well did you know this?

Not at all

Perfectly

when should lipids be checked after starting statins

@ 3 months

& 12 months

How well did you know this?

Not at all

Perfectly

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

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

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

How well did you know this?

Not at all

Perfectly

4 A’s for secondary prevention of CVD

Aspirin + 2nd antiplatelet e.g. clopidogrel for 12 months
Atorvostatin 80 mg
Atenolol or Bisoprolol
ACE inhib - Ramipril

How well did you know this?

Not at all

Perfectly

3 side effects of statins

myopathy (check CK in pt with muscle pain/weakness)
T2DM
Haemorrhagic stroke

How well did you know this?

Not at all

Perfectly

1st line management of SUPRAVENTRICULAR TACHYCARDIA

VAGAL MANEUVRES

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

How well did you know this?

Not at all

Perfectly

Drug of choice for narrow complex

adenosine

How well did you know this?

Not at all

Perfectly

drug of choice for broad complex

amiodarone 6mg IV

How well did you know this?

Not at all

Perfectly

3 side effects of Amiodarone

pulmonary fibrosis
hypo/hyper thyroidism
Liver pathology - check LFTs

How well did you know this?

Not at all

Perfectly

3 drugs that can cause pulmonary fibrosis

Amiodarone
Methotrexate
Nitrofurantoin

How well did you know this?

Not at all

Perfectly

causes of raised anion gap

MUDPILES

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

How well did you know this?

Not at all

Perfectly

first line antihypertensive for age < 55 & not african caribbean

ACEi or ARB

How well did you know this?

Not at all

Perfectly

first line antihypertensive for > 55 years OR black african

calcium channel blocker

How well did you know this?

Not at all

Perfectly

3 e.g. of calcium channel blockers

verapamil
amlodopine
diltiazem

How well did you know this?

Not at all

Perfectly

3rd line treatment for Hypertension

ACEi/ARB & CCB & thiazide like diuretic

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

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

- Heart failure - Myocardial ischaemia - Shock - Syncope

Normal QRS duration

100 ms

QRS duration for 'narrow QRS'

< 70 ms

ABCDE assessment of adult tachycardia?

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

Atrial Fibrillation ECG findings?

Irregular narrow complex tachycardia

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

1) Vagal manoeuvres | 2) Adenosine 6 mg rapid IV bolus

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

- digoxin | - amiodarone

regular broad complex tachycardia?

Ventricular tachycardia

management of VT

Amiodarone 300 mg IV over 20-60 mins

side effects of amiodarone

- corneal deposits - photosensitivity - hepatitis - pneumonitis - lung fibrosis - raised INR - raised T4

3 causes of VT

- electrolyte disturbances - ischaemia - post MI: origin around old scar tissue in heart

ECG findings for VT and VF

both broad complex tachycardias VT is regular VF is irregular

management of VF or pulseless/unstable ventricular tachycardia

- asynchronized DC shock | - adrenaline 1 mg immediately

where do supraventricular tachycardias arise from?

arise from above the bifurcation of the bundle of His

name 1 irregular and regular supraventricular tachycardias

regular: Atrial flutter irregular: atrial fibrillation

Atrial fibrillation: - ECG findings - what actually happens

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

5 causes of AF

- ischaemia - hypertension - MI - PE - mitral valve disease

symptoms of AF (4)

- faintness - chest pain - asymptomatic - dyspnoea - palpitations

4 types of AF?

- paroxysmal - recurrent - persistent - permanent

what is paroxysmal AF, & management?

Recurrent spontaneous episodes, self-terminating within 7 days pill in pocket: flecanide or propafenone

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

persistent AF

describe permanent AF? & management

AF unchanged after efforts to cardiovert rate control & anticoagulation

when is DC cardioversion considered for AF?

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

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

CHADS-VASc

score used to assess bleeding risk in patients on anticoagulation

HASBLED

mechanism of action of Apixaban?

Factor Xa inhibitor

direct thrombin inhibitor

Dabigatran

mechanism of action of warfarin

Vitamin K antagonist

4 contraindications for warfarin

- pregnancy - severe HTN - bleeding disorder - peptic ulcer

Vit K deficiency leads to reduction in:

``` Factor 2 Factor 7 Factor 9 Factor 10 Protein C ```

describe ECG findings for 2nd degree heart block

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

other names for 2nd degree heart block

Mobitz 1 Wenchebach

ECG findings for 1st degree heart block

prolongs PR interval | >0.22 seconds

ECG findings for 2nd degree heart block/Mobitz 2

- normal PR interval | - intermittent non conducted P waves

cause of bundle branch blocks

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

LBBB ECG finding

deep S wave in V1 tall R waved in V6

how does adenosine work

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

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

adenosine

what causes WWW

extra electrical pathway connecting atria and ventricles

definitive treatment for WWW

radiofrequency ablation

how does atropine work

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

side effects of atropine

- pupil dilatation - urinary retention - dry eyes - constipation

aspirin mechanism

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

mechanism of Tirofiban

Gylcoprotein 2b/3a antagonist

mechanism of dabigatran

direct thrombin inhibitor

mechanism of loop diuretics & example

inhibit Na/2Cl/K co transporter | furosemide

mechanism of thiazide like diuretics & exampls

inhibit Nal/Cl co transporter bendroflumethiazide

side effects of loop diuretics

- dehydration - ototoxic - low potassium - low calcium

side effects of thiazide like diuretics

- gout - impotence - low potassium - high calcium - low Mg

mechanism of calcium channel antagonists and how this works

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

side effects of caclium channel blockers

- flushes - headache - oedema - gingival hypertrophy

what CCB to not give with BB and why

verapamil risk of severe brady

beta blockers contraindicated in

asthma and heart blcok

mechanmism of digoxin

blocks na-k pump

side effects of digoxin

- yellow vision - confusion - gynaecomastia - nausea - reduced apetite - any arrhythmia e.g. SVT

mechanism of statin

inhibit enzyme HMG-CoA reductase

role of enzyme HMG-CoA reductase

de novo synthesis of cholesterol

side effects of ACEi

- dry cough - hypotension - taste distrubance - high potassium

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

renal artery stenosis

what rise of creatinine should be expected with ACEi

< 20% and GFR decrease by < 15%