Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AKT > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Acyanotic congenital heart disease

A 
VSD
ASD
Patent ductus arteriosus
Coarctation of the aorta
Aortic valve stenosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Cyanotic congenital heart disease

A

Tetralogy of fallot
Transposition of the great arteries
Tricuspid atresia

Less common:
Pulmonary atresia
Hypoplastic left heart
Truncus arteriosus
Total anomolous pulmonary venous drainage
Ebstein anomaly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Presentation of ASD

A 
Asymptomatic in children
SOB
Palpitations
Exercise intolerance
Syncope
Oedema
Arrhythmia - AF and atrial flutter
Pulmonary HTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

ASD murmur

A

Soft systolic ejection murmur

pulmonary area, upper left sternal edge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Management of ASD

A

Closure of defect by catheter or surgical closure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

VSD associations

A 
Edward's syndrome
Patau's syndrome
Down's syndrome
Diabetes in pregnancy
Fetal alcohol syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Presentation of VSD

A 
Asymptomatic if small
Moderate have symptoms at 5-6 weeks
Dyspnoea on feeding
FTT
Recurrent respiratory infections
Heart failure
Very large VSD - pulmonary hypertension, right to left shunt and Eisenmenger's syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Murmur in VSD

A

Loud, harsh, pansystolic murmur at the lower left sternal edge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

CXR in VSD

A

Cardiomegaly

Increased pulmonary vasculature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Management of VSD

A 
Diuretics
High energy feeds
ACE-I to reduce afterload
Surgical repair if heart failure
Catheter closure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is patent ductus arteriosus?

A

Patent duct at 3 months after term

Usually closes after 10-15 hours in term babies
Full anatomical closure in 2-3 weeks
Occurs in 50% of preterm babies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Presentation of PDA

A 
Small PDAs are asymptomatic
Recurrent respiratory infections
Feeding difficulties
FTT
Poor growth
Heart failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Findings in PDA

A

Loud, machinery, continuous murmur loudest in the left upper sternal border
Bounding femoral pulses
Signs of heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Management of PDA

A

Premature, small duct: indomethacin, observe
Premature, large duct: fluid restrict, diuretic, may need surgery
Term: unlikely to close itself. Diuretics, surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Associations of coarctation of the aorta (4)

A

Cerebral aneurysms - berry aneurysms in 10%
Turner’s syndrome
Patau’s syndrome (trisomy 13)
Edward’s syndrome (trisomy 18)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Presentation of coarctation of the aorta

A

In the first few weeks, becomes unwell after closure of ductus arteriosus

Poor feeding
Lethargy
Heart failure
Differential cyanosis
Features of Turner's syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Findings in coarctation of the aorta

A

Systolic murmur in the left infraclavicular area
Reduced pulses and BP in legs
Differential cyanosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CXR in coarctation of the aorta

A 
Heart failure
Rib notching (due to collaterals)
Indentation of the aortic shadow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Management of coarctation of the aorta

A 
Prostaglandin E1
Diuretics
Inotropes
Surgery or ballon angioplasty
In adults - beta blockers +/- ACE I
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Causes of aortic stenosis

A 
Degenerative calcification
Bicuspid aortic valve
William's syndrome (supravalvular aortic stenosis)
Post-rheumatic disease
HOCM (subvalvular)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Presentation of aortic stenosis

A 
Only in childhood if severe
Fatigue
Chest pain
Syncope
Dyspnoea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Findings of aortic stenosis

A

Ejection systolic murmur radiating to the carotids
Soft or absent S2
Slow rising pulse (pulsus parvus et tardus)
Thrill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Management of aortic stenosis

A

Surgery if symptomatic or valvular gradient over 40 mmHg

Aortic valve replacement - usually transcatheter aortic valve implantation (TAVI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Prognosis of aortic stenosis

A

Sudden cardiac death is rare if asymptomatic

Poor outcomes once symptomatic, 2 year survival without surgery around 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Four findings in tetralogy of fallot

A

Right ventricular outflow tract obstruction
Ventricular septal defect
Overriding aorta
Right ventricular hypertrophy

Some children also have ASD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Features of tetralogy of fallot

A 
FTT
Feeding difficulties
Agitation
SOB 
SOBOE in older children
Cyanotic episodes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Findings on examination in tetralogy of fallot

A 
Small child
Cyanosis
Scoliosis
Clubbing
Ejection systolic murmur (due to pulmonary stenosis)
Cause a right-to-left shunt
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

CXR in tetralogy of fallot

A

Boot shaped heart

Increased pulmonary vasculature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

When does tetralogy of fallot present?

A

Age 1-2 months

Sometimes missed till 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Associations with tetralogy of fallot

A

DiGeorge syndrome

Foetal alcohol syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Treatment of tetralogy of fallot

A

Prostaglandin E1
Surgical repair in the first year
Shunt may be used as interim or palliative measure
Cyanotic episodes may be helped by beta blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is transposition of the great arteries associated with?

A

Maternal diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Presentation of transposition of the great arteries

A 
Neonates
Later presentation if mixing e.g. VSD
Respiratory distress
Cyanosis
Heart failure
Shock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Findings of transposition of the great arteries

A

Cyanosis
Severe hypoxaemia and acidosis

Murmur if no VSD: none, loud S2
Murmur if VSD: systolic
Murmur if pulmonary stenosis: ejection systolic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

CXR in transposition of the great arteries

A

‘egg on a string’ heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Management of transposition of the great arteries

A

Prostaglandin infusion

Arterial switch operation at day 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Presentation of tricuspid atresia

A

Cyanosis
Heart failure
Growth restriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Findings in tricuspid atresia

A 
Cyanosis
Raised JVP
Large and pulsatile liver
If VSD - pansystolic murmur
If surgically formed anastomoses - continuous murmur
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

CXR in tricuspid atresia

A

Cardiomegaly
Prominent right heart border
Reduced pulmonary vascular markings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Management of tricuspid atresia

A 
Prostaglandin E1 infusion
Surgical correction (Fontan's operation, 5% mortality)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Types of pulmonary atresia

A

Pulmonary atresia with intact ventricular septum

Pulmonary atresia with VSD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Presentation of pulmonary atresia

A

Immediately after birth

Cyanosis
Feeding difficulties
Dyspnoea
Fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Management of pulmonary atresia

A

Prostaglandin
Surgical repair
Temporary shunt
Ultimately may need heart transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What chromosomal abnormality is pulmonary atresia with VSD associated with?

A

22q11 deletion syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are the abnormalities in hypoplastic left heart syndrome?

A

Mitral valve and/or aortic valve narrowed or blocked
LV underdeveloped
Aorta underdeveloped
ASD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What are the abnormalities in truncus ateriosus?

A

Single large artery leaving the ventricles which then divides

VSD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are the abnormalities in total anomolous pulmonary venous drainage?

A

Pulmonary veins are not connected to the left atria but instead return to the right side of the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are the abnormalities in Ebstein’s anomaly?

A

Tricuspid valve is malformed

Right ventricle is malformed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Presentation of Ebstein’s anomaly

A

Usually age 10-30

Neonates: cyanosis, heart failure
Adults: fatigue, SOBOE, cyanosis, right heart failure

Supraventricular tachycardia
Risk of cardiac death from ventricular arrhythmia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Findings in Ebstein’s anomaly

A

Pansystolic murmur at the lower left parasternal edge due to tricuspid regurgitation
Cyanosis
Clubbing
Signs of right heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Signs of right heart failure

A

Peripheral oedema
Hepatomegaly
Ascites
Raised JVP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

CXR in Ebstein’s anomaly

A

Cardiomegaly

Large RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Management of Ebstein’s anomaly

A

Manage heart failure
Manage arrhythmia
Early surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How long after MI can sexual activity resume?

A

4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

How long after MI can you prescribe sildenafil?

What drugs are contraindicated with sildenafil?

A

6 months

AVOID if on nitrates or nicorandil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Causes of right bundle branch block

A 
Normal variant
Right ventricular hypertrophy
Chronically increased RV pressure e.g. cor pulmonale
PE
MI
Atrial septal defect
Cardiomyopathy or myocarditis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

How do statins work?

A

Inhibit HMG CoA reductase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

At what time of day should patients take statins and why?

A

Night

This is when the majority of cholesterol synthesis takes place

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Which statin to prescribe and which dose?

A

Primary prevention = atorvastatin 20mg

Secondary prevention = atorvastatin 80mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

When to increase statin dose in primary prevention?

What should you increase it to?

A

If non-HDL has not reduced by >40%

Consider increasing to 80mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Contraindications to statins

A

Macrolides (erythromycin, clarithromycin)
Pregnancy
Previous intracranial haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Who should be prescribed a statin?

A 
Established cardiovascular disease
10 year cardiovascular risk greater than or equal to 10% (as per QRISK2)
T1DM diagnosed >10 years ago
T1DM age >40
T1DM with established nephropathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Side effects of statins

A

Myopathy
Liver impairment
Possible increased risk of cerebral haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Who is more at risk of myopathy from statins?

A

Increased age
Female
Low BMI

More common with simvastatin/atorvastatin than rosuvastatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

When to check liver function when taking a statin?

When should you then decide to stop the statin?

A

Baseline, 3 months and 12 months

Stop if serum transaminase rise to and persist at 3 times upper limit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Normal QTc in men

A

<430ms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Normal QTc in females

A

<450ms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What is long QT syndrome?

A

Inherited condition with delayed repolarisation of the ventricles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Features of long QT syndrome

A

Sudden cardiac death
Found on ECG or family screening
Syncope after exercise or emotion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Management of long QT syndrome

A 
Avoid precipitant drugs and exercise
Beta blockers (NOT sotalol)
Implantable cardioverter defibrillator
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Causes of a long QT

A 
Congenital
Drugs
Acute MI
Myocarditis
Hypothermia
Low Ca, Low K, Low Mg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Congenital causes of long QT

A

Jervell-Lange-Nielson Syndrome (has deafness)

Romano-Ward Syndrome (no deafness)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Drugs causing long QT

A 
Amiodarone
Sotalol
Tricyclic antidepressants
SSRI especially citalopram
Methadone
Chloroquine 
Erythromycin
Haloperidol
Ondansetron
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

ECG changes for an anteroseptal infarct

A

V1-V4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Vessels affected in an anteroseptal infarct

A

left anterior descending

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What area and which artery is affected if the ischemic changes are in V1-V4?

A

Anteroseptal

left anterior descending artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

ECG changes for inferior infarct

A

II, III, aVF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Vessels affected in an inferior infarct

A

right coronary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Which area and which vessel is affected if the ischaemic changes are in II, III, and aVF?

A

Inferior

Right coronary artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

ECG changes for anterolateral infarct

A

V4-6, I, aVL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Vessels affected in an anterolateral infarct

A

left anterior descending or left circumflex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Which area and which vessel is affected if the ischaemic changes are in V4-6, I, aVL?

A

Anterolateral

Left anterior descending artery or left circumflex artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

ECG changes in a lateral infarct

A

I, aVL +/- V5, V6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Vessels affected in a lateral infarct

A

Left circumflex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Which area and which vessel is affected if the ischaemic changes are in I, aVL +/- V5, V6?

A

Lateral

left circumflex vessel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

ECG changes in a posterior infarct

A

Tall R waves in V1-2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Vessels affected in a posterior infarct

A

Usually left circumflex

Also right coronary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Which area is affected if the ischaemic changes are in V1-2?

A

Posterior infarct

Usually left circumflex, also right coronary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What does BNP stand for in cardiology?

A

B-type natriuretic peptide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What is BNP?

A

A hormone produced mostly by the left ventricle in response to strain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What causes raised BNP levels?

A

Heart failure
MI
Valvular disease
CKD due to reduced excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Drugs that reduce BNP

A

ACE-I
Angiotensin 2 receptor blockers
Diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Using BNP in heart failure

A

Unlikely if levels low <100
Good marker of prognosis
Effective treatment lowers BNP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

How do beta blockers work?

A

Antagonists of adrenergic beta receptors

Located in heart, peripheral vasculature, bronchi, pancreas, liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Side effects of beta blockers

A 
Bronchospasm
Cold peripheries
Fatigue
Sleep disturbance including nightmares
Erectile dysfunction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Indications for beta blockers

A 
Angina
Post MI
Heart failure
Arrythmia
HTN
Thyrotoxicosis
Migraine prophylaxis
Anxiety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Contraindications to beta blockers

A

Uncontrolled heart failure
Asthma
Sick sinus syndrome
Concurrent verapamil use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Why can’t you use beta blockers and verapamil together?

A

May precipitate severe bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Stage 1 hypertension

A

Clinic BP ≥ 140/90

ABPM ≥ 135/85

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Stage 2 hypertension

A

Clinic BP ≥ 160/100

ABPM ≥ 150/95

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Severe hypertension

A

Clinic systolic ≥ 180

Clinic diastolic ≥ 120

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

When to offer treatment of stage 1 hypertension?

A

<80 years AND any of:

Target organ damage
Established cardiovasular disease
Established renal disease 
Diabetes
10 year risk >10%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

When should you admit in severe hypertension?

A

Signs of retinal haemorrhage or papilloedema (accelerated hypertension)

New onset confusion, chest pain, acute kidney injury, heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Management of severe hypertension

A

Admit if life threatening symptoms or accelerated hypertension
Refer if pheochromocytoma suspected
Urgent investigations for end organ damage - bloods, urine ACR, ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Lifestyle advice for management of hypertension

A

Low salt diet - less than 6g/day, ideally less than 3g/day
Reduce caffeine
General lifestyle advice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Patient <40 years diagnosed with hypertension?

A

Refer to secondary care to consider underlying causes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

BP targets in T1DM

A

<135/85

Unless have albuminuria or 2 features of metabolic syndrome, then it is <130/80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Step 1 HTN management: <55 years or T2DM

A

ACE-I/ARB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Step 1 HTN management: >55 years or black/caribbean

A

CCB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Step 2 HTN management: <55 years or T2DM

A

ACE-I/ARB plus CCB OR thiazide like diuretic

111
Q

Step 2 HTN management: >55 years or black/caribbean

A

CCB plus ACE-I/ARB OR thiazide like diuretic

112
Q

Step 3 HTN management

A

ACE-I/ARB + CCB + thiazide like diuretic

113
Q

Step 4 HTN management

A

K <4.5: low dose spironolactone

K >4.5: alpha or beta blocker

114
Q

Clinic BP target age <80

A

140/90

115
Q

ABPM BP target age <80

A

135/85

116
Q

Clinic BP target age >80

A

150/90

117
Q

ABPM BP target age >80

A

145/85

118
Q

Hypokalaemia and hypertension - causes

A 
Cushing's syndrome
Conn's syndrome
Liddle's syndrome
11-beta hydroxylase deficiency
Carbenoxolone (anti-ulcer drug)
Liquorice excess
119
Q

Hypokalaemia without hypertension - causes

A 
Diuretics
GI loss
Renal tubular acidosis type 1 and 2
Bartter's syndrome
Gitelmann syndrome
120
Q

What drugs should a patient be on following an MI?

A

Dual antiplatelet (aspirin + a second)
ACE inhibitor
Beta-blocker
Statin

121
Q

Exercise following an MI

A

20-30 minutes a day until slightly breathless

122
Q

Sex following an MI

A

4 weeks post MI

123
Q

What age would a patient get a biological heart valve rather than mechanical? Aortic and mitral

A

Aortic >65 years

Mitral >70

124
Q

Anticoagulation in biological heart valves

A

Life long aspirin

125
Q

What is the disadvantage of biological heart valves?

A

Structural deterioration and calcification over time

126
Q

Target INR in mechanical heart valves - aortic and mitral

A

Aortic 3.0

Mitral 3.5

127
Q

Do patients with mechanical heart valves get aspirin along with warfarin?

A

Only if there is an additional factor e.g. IHD

128
Q

How does digoxin work?

A

Increases myocardial contractility

Decreases conduction within the AV node

129
Q

Indications for digoxin

A

AF and atrial flutter

Heart failure

130
Q

Side effects of digoxin

A 
GI upset
Arrhythmia
Confusion
Dizziness
Blurred vision
131
Q

ECG features in digoxin

A

Down sloping ST/ reverse tick
Flat/inverted T waves
Short QT
Arrhythmia

132
Q

Features of digoxin toxicity

A 
Generally unwell
Nausea, vomiting, diarrhoea
Confusion
Yellow-green vision
Arrhythmia - AV block, bradycardia
Gynaecomastia
133
Q

Precipitants of digoxin toxicity

A 
Hypokalaemia
Increasing age
Renal impairment
MI
Low magnesium, low albumin
High calcium, high sodium
Hypothermia
Hypothyroid
134
Q

Drugs causing digoxin toxicity

A 
Amiodarone
Quinidine
Verapamil
Diltiazem
Spironolactone
Ciclosporin
Drugs that reduce K+: thiazides, loop diuretics
135
Q

Drugs for angina

A

1) Aspirin + statin + sublingual GTN
2) Beta blocker OR CCB
3) Both

136
Q

DVLA - hypertension

A

If group 2 then disqualified if BP is persistently over 180/100

137
Q

DVLA - angioplasty (elective)

A

1 week off

138
Q

DVLA - CABG

A

4 weeks off

139
Q

DVLA - MI

A

4 weeks off

reduced to 1 week if sucessfully treated by angioplasty

140
Q

DVLA - angina

A

Must stop driving if symptoms occur at the wheel

141
Q

DVLA - pacemaker insertion

A

1 week off

142
Q

DVLA - ICD for sustained ventricular arrhythmia

A

6 months off

143
Q

DVLA - ICD prophylactically

A

1 month off

144
Q

DVLA - group 2 drivers and ICD for sustained ventricular arrhythmia

A

Banned

145
Q

DVLA - successful catheter ablation for arrhythmia

A

2 days off

146
Q

DVLA - aortic aneurysm of 6 to 6.5cm

A

Notify DVLA

License subject to yearly review

147
Q

DVLA - aortic aneurysm of 6.5cm or more

A

Banned

148
Q

DVLA - heart transplant

A

6 weeks off

149
Q

What is Wolff-Parkinson-White?

A

Congenital accessory conducting pathway between the atria and ventricles leading to AVRT

As accessory pathway doesn’t slow conduction, AF can degenerate to VF

150
Q

ECG Features of Wolff Parkinson White

A

Short PR interval
Wide QRS complexes with slurred upstroke - delta wave
Left axis deviation if right sided accessory pathway
Right axis deviation if left sided accessory pathway

151
Q

Wolff Parkinson White - associations

A 
HOCM
Mitral valve prolapse
Ebstein's anomaly
Thyrotoxicosis
Secundum ASD
152
Q

Wolff Parkinson White - management

A

Radiofrequency ablation of the accessory pathway
Sotalol (though NOT if have AF)
Amiodarone
Flecanide

153
Q

Wolff Parkinson White - presentation

A

Asymptomatic

Episodes of SVT

154
Q

HOCM inheritance

A

Autosomal dominant

155
Q

HOCM symptoms

A 
Asymptomatic
Exertional dyspnoea
Angina 
Syncope
Sudden death
156
Q

HOCM examination findings

A

Arrhythmia
Jerky pulse
Ejection systolic murmur - increases with valsalva, decreases with squatting

157
Q

ECHO findings in HOCM

A

“MR SAM ASH”
Mitral regurg
Systolic anterior motion of the anterior mitral valve leaflet
Asymptomatic hypertrophy

158
Q

ECG findings in HOCM

A 
LVH
Non specific ST segment and T wave abnormalities
Progressive T wave inversion
Deep Q waves
May sometimes see AF
159
Q

HOCM associations

A

Friedreich’s ataxia

Wolff Parkinson White

160
Q

Investigations for angina

A

1st: CT coronary angiography
2nd: non-invasive imaging
3rd: angiography

161
Q

Statins and pregnancy

A

Stop when trying to conceive

Remain off whilst breastfeeding

162
Q

Moderate to severe aortic stenosis and ACE-I

A

Contraindicated

163
Q

When should you choose rate control when managing AF?

A

> 65 years

Ischaemic heart disease

164
Q

When should you choose rhythm control when managing AF?

A

<65 years
Symptomatic
1st presentation
Heart failure

165
Q

Rate control for AF

A

1st line: beta blocker or rate limiting CCB (diltiazem)

2nd line: Digoxin

166
Q

Rhythm control options for AF

A

Electrical cardioversion
Pharmacological cardioversion
Catheter ablation

167
Q

Drugs used for pharmacological cardioversion in AF

A

Flecanide

Amiodarone if structural heart disease

168
Q

Anticoagulation after catheter ablation in AF

A

Still need life long

169
Q

CHADSVASC scoring system

A 
Congestive heart failure = 1
HTN = 1
Age >75 = 2
Age 65-75 = 1
Diabetes = 1
Stroke/TIA/thrombus = 2
Vascular disease = 1
Sex female = 1
170
Q

What CHADSVASC score would you give treatment for?

A 
0 = none
1 = male consider, female none
2 = treat
171
Q

What scoring system assesses bleeding risk when considering anticoagulation?

A

ORBIT

172
Q

ORBIT scoring system

A 
Hb <130 in men or <120 in women = 2
Age >74 = 1
Bleeding history = 2
Renal impairment = 1
Treatment with antiplatelets = 1
173
Q

Interpreting ORBIT scoring system

A 
0-2 = low risk
3 = medium risk
4-7 = high risk
174
Q

Clotting factors blocked by warfarin

A

II, VII, IX and X

2, 7, 9, 10

175
Q

Side effects of warfarin

A

Haemorrhage
Teratogenic but can be used in breastfeeding
Skin necrosis
Purple toes

176
Q

Major bleeding on warfarin

A

Stop warfarin
IV vit K 5mg
Prothrombin concentrate or if not available FFP

177
Q

INR >8 and minor bleeding

A

Stop warfarin
IV vit K 5mg, repeat 24 hours if needed
Restart warfarin when INR <5

178
Q

INR >8 and no bleeding

A

Stop warfarin
Oral vit K, repeat 24 hours if needed
Restart warfarin when INR <5

179
Q

INR 5-8 and minor bleeding

A

Stop warfarin
IV vit K
Restart warfarin when INR <5

180
Q

INR 5-8 and no bleeding

A

Withhold 1/2 doses of warfarin

Restart at lower dose

181
Q

Things that potentiate warfarin

A 
Liver disease
P450 enzyme inhibitors
Cranberry juice
Drugs that displace warfarin from albumin e.g. NSAIDs
Drugs that inhibit platelets e.g. NSAIDs
182
Q

Effect of P450 enzyme inhibitors on warfarin?

A

Increase INR

183
Q

Effect of P450 enzyme inducers on warfarin?

A

Decrease INR

184
Q

ECG findings in atrial flutter

A

Saw tooth pattern
AV block e.g. 2 to 1
Flutter waves after adenosine

185
Q

Management of atrial flutter

A

Similar to AF

Radiofrequency ablation of tricuspid valve isthmus

186
Q

First degree heart block - ECG findings

A

PR >0.2 seconds

187
Q

What are the names for second degree heart block type 1?

A

Mobitz type 1

Wenckebach

188
Q

Second degree heart block type 1 - ECG findings

A

Progressive prolongation of the PR interval until a dropped beat occurs

189
Q

Second degree heart block type 2 - ECG findings

A

PR interval constant but P wave often not followed by QRS (i.e. random)

190
Q

Complete heart block

A

No association between P waves and QRS

191
Q

Features of complete heart block

A 
Syncope
Heart failure
Bradycardia
Wide pulse pressure
Cannon waves in JVP
Variable intensity of S1
192
Q

What is Takayasu’s arteritis?

A

Large vessel arteritis causing occlusion of the aorta

193
Q

What should an absent limb pulse make you think about?

A

Takayasu’s arteritis

194
Q

Features of Takayasu’s arteritis

A 
Systemic features
Unequal BP in upper limbs
Carotid bruit
Intermittent claudication
Aortic regurg
195
Q

Management of Takayasu’s arteritis

A

Steroids

196
Q

Gives some examples of calcium channel blockers

A 
Verapamil
Diltiazem
Amlodipine
Nifedipine
Felodipine
197
Q

What type of drug is verapamil?

A

CCB

198
Q

What type of drug is diltiazem?

A

CCB

199
Q

What type of drug is amlodipine?

A

CCB

200
Q

What type of drug is nifedipine?

A

CCB

201
Q

What type of drug is felodipine?

A

CCB

202
Q

Verapamil side effects and cautions

A 
Can't use with beta blockers due to risk of heart block
Heart failure
Constipation
Hypotension
Bradycardia
Flushing
203
Q

Diltiazem side effects

A

Hypotension
Bradycardia
Heart failure
Ankle swelling

204
Q

Amlodipine side effects

A

Flushing
Headache
Ankle swelling

205
Q

How do ACE inhibitors work?

A

Block angiotensin 1 to angiotensin 2

  • reduce vasoconstriction
  • promote renal sodium and water excretion
206
Q

Side effects of ACE inhibitors

A

Cough in 15%
Angiooedema
Hyperkalaemia
1st dose hypotension

207
Q

Contraindications to ACE inhibitors

A 
Pregnancy and breast feeding
Renovascular disease
Aortic stenosis
Hereditary of idiopathic angioedema
Need specialist advice if K over 5.0
208
Q

When to monitor U+Es when on an ACE inhibitor?

A

Before starting

After every dose increase

209
Q

What changes are acceptable when monitoring U+Es on an ACE inhibitor?

A

Creatinine up to 30% from baseline

K up to 5.5

210
Q

Examples of ARBs

A

Candesartan
Losartan
Irbesartan

211
Q

What type of drug is candesartan?

A

Angiotensin 2 receptor blocker

212
Q

What type of drug is losartan?

A

Angiotensin 2 receptor blocker

213
Q

What type of drug is irbesartan?

A

Angiotensin 2 receptor blocker

214
Q

Indication for ARBs

A

When ACE inhibitor not tolerated due to cough

Used preferentially in black/Caribbean

215
Q

Side effects of ARBs

A

Hypotension

Hypokalaemia

216
Q

Examples of thiazide like diuretics

A

Indapamide
Chlortalidone
Bendroflumethiazide

217
Q

What type of drug is indapamide?

A

Thiazide like diuretic

218
Q

What type of drug is chlortalidone?

A

Thiazide like diuretic

219
Q

What type of drug is bendroflumethiazide?

A

Thiazide like diuretic

220
Q

How do thiazide like diuretics work?

A

Block Na reabsorption in the DCT by blocking the Na/Cl symporter

Increase K+ excretion due to more Na reaching the collecting duct

221
Q

Side effects of thiazide like diuretics

A 
Dehydration, low Na, low K, low Cl
Postural hypotension
Gout
Impaired glucose tolerance
Impotence

RARE: thrombocytopenia, agranulocytosis, pancreatitis, photosensitive rash

222
Q

How do loop diuretics work?

A

Inhibit the Na/K/Cl cotransporter in the thick ascending limb of the loop of henle, reducing absorption of NaCl

223
Q

Examples of loop diuretics

A

Furosemide

Bumetanide

224
Q

What type of drug is furosemide?

A

Loop diuretic

225
Q

What type of drug is bumetanide?

A

Loop diuretic

226
Q

Indications for loop diuretics

A

Heart failure

Resistent hypertension

227
Q

Side effects of loop diuretics

A 
Hypotension
Low Na, low K, low Mg, low Ca
Ototoxicity
Renal impairment
Hyperglycaemia
Gout
228
Q

What type of drug is spironolactone?

A

Potassium sparing diuretic

229
Q

What type of drug is eplerenone?

A

Potassium sparing diuretic

230
Q

What type of drug is amiloride?

A

Potassium sparing diuretic

231
Q

How does spironolactone work?

A

Aldosterone antagonist

232
Q

Indications for spironolactone

A

Ascites
Heart failure
Nephrotic syndrome
Conn’s syndrome

233
Q

What is the Jones criteria for?

A

Diagnosing rheumatic fever

234
Q

What are the major criteria for the Jones criteria?

A 
Erythema marginatum
Sydenham's chorea
Polyarthritis
Carditis and valvulitis
Subcutaneous nodules
235
Q

What are the minor criteria for the Jones criteria?

A

Raised CRP/ESR
Pyrexia
Arthralgia
Prolonged PR

236
Q

What criteria must be met to diagnose rheumatic fever?

A

Evidence of recent strep infection AND 2 major criteria, OR 1 major + 2 minor

237
Q

What is evidence of recent strep infection?

A

Raised/rising strep antibodies
Positive throat swab
Positive rapid group A strep antibody test

238
Q

Management of rheumatic fever

A

Pen V if any signs of ongoing strep infection
NSAIDs
Management of any complications that arise

239
Q

Thiazide diuretic impact on calcium

A

Hypercalcaemia

Hypocalciuria

240
Q

Which angina medication is associated with GI ulcers?

A

Nicorandil

Particularly with perforation of diverticulum

241
Q

At which egfr should you stop a thiazide diuretic?

A

30

242
Q

Normal ECG changes in atheletes

A

Sinus bradycardia
Junctional rhythm
First degree heart block
Wenckebach phenomenon

243
Q

First line thiazide like diuretic

A

Indapamide

244
Q

Anticoagulation post MI if already on warfarin

A

anticoagulant + 2 antiplatelets for 4 weeks till 6 months

Then 1 antiplatelet + 1 anticoagulant till 12 months

245
Q

Monitoring for amiodarone

before starting and ongoing

A

Before starting: LFTs, TFTs, U+E, CXR

Every 6 months: TFTs, LFTs

246
Q

Half life of amiodarone

A

20-100 days

247
Q

Effect of amiodarone on p450

A

Inhibitor (increases INR)

248
Q

Effect of amiodarone on ECG

A

Lengthens QT

Bradycardia

249
Q

Side effects of amiodarone

A 
Hyper/hypo thyroidism
Corneal deposits
Pulmonary fibrosis
Liver fibrosis/hepatitis
Peripheral neuropathy
Slate grey skin
250
Q

Why are beta blockers used less in managing hypertension?

A

Less likely to prevent stroke and potential for impaired glucose tolerance

251
Q

What type of drug is isosorbide mononitrate?

A

A nitrate

252
Q

Side effects of nitrates

A

Hypotension
Tachycardia
Headaches
Flushing

253
Q

How do nitrates work?

A

Dilate coronary arteries

Reduce venous return to reduce oxygen demand in the left ventricle

254
Q

First line drug management for angina

A

Beta blocker OR

CCB

255
Q

Which CCB should be used if being used as monotherapy for angina?

A

Rate limiting CCB

Diltiazem or verapamil

256
Q

Which CCB should be used if being used in combination with a beta blocker for angina?

A

Modified release nifedipine

257
Q

Angina management if on beta blocker and CCB and still having symptoms?

A

Third drug only whilst waiting PCI or CABG

258
Q

NYHA class I

A

No symptoms

No limitation on activity

259
Q

NYHA class II

A

Mild symptoms

Slight limitation on activity - ordinary activity causes dyspnoea

260
Q

NYHA class III

A

Moderate symptoms

Marked limitation on activity - less than ordinary activity causes symptoms

261
Q

NYHA class IV

A

Severe symptoms even at rest

Unable to carry out any activity without discomfort

262
Q

Which patients group need a five yearly pneumococcal booster?

A

Asplenia
Splenic dysfunction
CKD

263
Q

1st line for heart failure

A

ACEI and beta blocker

264
Q

2nd line for heart failure

A

Aldosterone antagonists

e.g. spironolactone

265
Q

3rd line for heart failure

A 
Specialist input
Ivabradine
Digoxin
Hydralazine and nitrates
Cardiac resynchronisation
266
Q

Heart failure management if they also have AF

A

ACEI
Beta blocker
Digoxin

267
Q

Referral pathway if BNP is ‘high’

A

Specialist assessment including echo within 2 weeks

268
Q

Referral pathway if BNP is ‘raised’

A

Specialist assessment including echo within 6 weeks

269
Q

What is a high BNP?

A

> 400

270
Q

What is a raised BNP?

A

100-400

271
Q

What is a normal BNP?

A

<100

272
Q

What is a normal ejection fraction?

A

50-70%

273
Q

What is a borderline ejection fraction?

A

41-49%

274
Q

What is a low ejection fraction?

A

<40%

AKT (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions