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Cardiology Flashcards

1
Q

Unstable angina vs NSTEMI

A

UA- no ST elevation and troponin normal

NSTEMI - no ST elevation , troponin raised

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2
Q

What is acute coronary syndrome?

A

STEMI NSTEMI UA

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3
Q

RFs for ischemic heart disease - unmodifiable (3)

A

Age
Male gender
Family history

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4
Q

RFs for ischemic heart disease - modifiable (5)

A

Smoking

Diabetes, HTN , high cholesterol, obesity

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5
Q

Likely occluded artery in an inferior MI

What leads would you see ST elevation

A

Right coronary

2,3, AVF

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6
Q

ST elevation leads I, avL,V5 ,V6
Likely occluded artery ?
Are of infarct ?

A

Left circumflex

Lateral MI

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7
Q

Anterior/anteroseptal MI
ST elevation in what leads
Likely occluded artery

A

V1-V4

LAD

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8
Q

Anterolateral MI
ST elevation in what leads
Likely occluded artery

A

1, avL, V4 V5 V6

LAD or left circumflex

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9
Q

Features of left main coronary artery (LMCA) occlusion on ECG
What should be done?

A

Widespread ST depression
ST elevation in aVR

Emergency coronary angio

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10
Q

STEMI - management acute

A 
MONA - IV morphine, O2, Nitrates, Aspirin 300 mg
Presentation :
Within 12 hr of sx onset:
- 1ry PCI = gold standard 
If unavailable or 12 hrs
- thrombolkysis ( Alteplase preferred)
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11
Q

Long term management of MI

A
  1. Aspirin , ACEi , statins - lifelong
  2. Ticragrelor or Prasugrel - 12 months OR clopidogrel
  3. B-blockers 12 months (atenolol, bisoprolol)

Statin 80 mg OD PO

AABC+S

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12
Q

NSTEMI / UA management

A

Give ASAP :
300mg Aspirin +
LMWH (enoxaparin, dalteparin) or Fondaparinux = SC
- no high risk of bleeding and no angio in next 24 hrs
- if angio likely in next 24 or creatinine >265 give
=unfractionated heparin - IV

Intermediate/high risk of=adverse cardio event ( predicted 6 month mortality > 3% :
angio w/in 96 hrs of admission
Intravenous glycoprotein receptor antagonist
= eptifibatide or tirofiban

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13
Q

Becks triad

A

Hypotension
Muffle heart sounds
Raised JVP

= cardiac tamponade

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14
Q

Cardiac tamponade

  • causes
  • features
A

Becks triad
Can develop as MI complication
Most important cause is trauma

CXR - enlarged globular heart
Dx - echo

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15
Q

Complications of MI

A 
Arrest - VFIB - mcc of death after MI 
CHF 
Acute pericarditis 
Dressler syndrome 
Left ventricular aneurysm 
Acute mitral regurgitation 
VSD, MR
Pericardial effusion
Cardiac tamponade
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16
Q

What is diagnostic of cardiac tamponade

Treatment

A

Dx - Echocardiogram

Treatments -
Oxygen + ventilation
1-2 L IV fluids
urgent pericardiocentesis

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17
Q

Atrial myxoma

Features

A

Left atrium 75%
Benign tumour , groves on inter-atrium septum wall
10% inherited

  • obstruct mitral valve = mid diastolic murmur , syncope, dyspnoea
  • PE stroke clubbing and blue fingers
  • AF
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18
Q

Echo : pedunculated heterogenous mass attached to fossa ovalis
Dx?

A

Atrial myxoma

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19
Q

Axis deviation

A 
Check lead 1 and AVF 
 1 & AVF - both pointing up = normal 
1 up , AVF down - left axis deviation
1 down, AVF up - right axis deviation 
Both down - right superior axis deviation
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20
Q

Causes of left axis deviation (5)

A 
Inferior MI  
LVH 
Left anterior fascicular block or hemi-block
Obese 
WPW
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21
Q

Right axis deviation causes (6)

A 
Lateral MI 
RVH 
Left posterior fascicular block or hemiblock 
Thin tall children 
Chronic lung disease 
Pulmonary embolism
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22
Q

Causes of extreme right axis deviation

A

Congenital heart disease

Left ventricular aneurysm

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23
Q

1st degree heart block + management

A

PR > .2s only

No treatment as long as pt is asymptomatic

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24
Q

2nd degree heart block + management

A
  1. Mobitz 1 = wenkebach
    Progressive prolongation of PR until a beat drops
  2. Mobitz 2
    Constant PR interval, but P wave often not followed by QRS

Permanent pacemaker

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25
Q

3rd degree heart block + management

A

No association between P and QRS

Pacemaker

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26
Q

Rate control in AF

A

B blockers - 1st line , CI in asthma
CCB - (non dihydropyridine )= diltiazem, verapamil - used in asthma
Digoxin - preferred choice if coexistent with heart failure

Unstable - cardio version

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27
Q

Aflutter management

A

Cardioversion - shock

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28
Q

VTach management

A

Conscious/ semiconscious hemodynamically stabl e
- Amiodarone

Unstable - DC cardioversion

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29
Q

Vfib management

A
  • defibrillation - asynchronised shock
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30
Q

Symptomatic sinus bradycardia

Treatment

A

O2 , ABCD
Atropine .5mg IV push , can repeat until 3mg given
If no response - temporary transcutaneous pacemaker

Normal in young athletes

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31
Q

Sinus tachy causes

A

Excercise, stress, anger
Hx of infection

Treat the cause

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32
Q

CHF management

A

Symptomatic relief and reduce vol overload - diuretics
= furosemide, lascivious or bumetanide
Start w/ ACEi or BB one at a time, If sx persist and the next one
- start with ACEi if diabetic
If sx still persist - add Spironolactone

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33
Q

CHF on treatment , still has LL oedema

Next step

A

Up dose of fursemide
Or switch to bumetanide to torsemide
Consider admission for IV loop diuretics

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34
Q

HF + a fib management

A

Digoxin

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35
Q

Patent foramen ovale
Features
Most accurate investigation

A

R—>L atrium blood flow
Most individuals - not problematic , undetected
Paradoxical embolism - emb from venous to arterial side
= stroke or TIA

Transoesophageal echo with bubble contrast = gold

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36
Q

Pericarditis
Features
ECG

A

Within 48 hrs of MI
Pleuritic chest pain , worse lying flat and during inspiration +_ fever, pericardial rub
Confirm via echo
ECG - widespread saddle shaped ST elevation + upward con cavity + PR depression

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37
Q

Treatment pericarditis

A

Full dose NSAID -
=ibuprofen 100-1800mg/d; indomethacin 75-150mg/d

Aspirin
2-4g/d

=7-14 days

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38
Q

Dressler syndrome

Features , ECG

A

Pericarditis in 2-6 weeks following MI
Autoimmune reaction against antigenic proteins as myocardium recovers
Same features as pericarditis + raised ESR
Saddle shaped ST elevation +- PR depression

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39
Q

Treatment of Dressler’s syndrome

A

NSAIDs

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40
Q

Left ventricular aneurysm
Features
XR ECHO ECG

A

4-6 weeks post MI
Weakened myocardium - thin muscular layer - aneurysm formation
Left ventricle failure + persistent ST elevation
Can increase risk of stroke
ECG - persistent ST elevation + LVF
Bulge at left heart border XR
Echo - paradoxical movement of ventricular wall

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41
Q

VSD
Features
Treatment

A

1st week after MI in 1-2% patients
Pan systolic murmur + acute heart failure
Echo- diagnostic - excludes MR
Urgent surgical correction

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42
Q

Mitral regurgitation

A

Pan systolic murmur (early-mid diastolic)
2-15 days after MI
Ischemia or rupture of papillary muscles of mitral valve
Hypotension tachycardia pulmonary oedema
Echo- dx
Treatment - vasodilator therapy and surgical repair

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43
Q

New murmur + fever + malaise and rigours
Dx?
Initial step?

A

Infective endocarditis

Blood culture —> echo

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44
Q

RF of infective endocarditis

A

Previous episode of endocarditis = strongest RF
Rheumatic valve disease
Prosthetic valve
Congenital heart defects
IV drug users - typically tricuspid lesion

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45
Q

Causative organism of IE

A

Staph aureus - general
Epidermis is - after prosthetic valve surgery
Viridans (mitris and sanguidis) - poor dental hygiene or after dental procedure

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46
Q

Modified duke criteria - major

A 
IE 
2 major or 1 major 3 minor or 5 minor
Major - 
1. + blood culture 
2, showing HÁČEK or known organism) or 
persistent bacteremia in 2 cultures >12 hrs apart or 
3 or + with staph aureus or epidermidis

2.evidence of endocarditis involvement = echo +ve for IE

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47
Q

Modified duke criteria - minor

A
  1. Predisposing heart condition or IVDU
  2. Microbiological evidence that doesn’t meet major criteria
  3. Fever >38
  4. Vascular phenomena
    = Jane way , petechia, purpura, splinter hgx, major emboli, splenomegaly
  5. Immunological phenomena
    - oiler node, Roth spots, glomerulonephritis
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48
Q

Oiler node vs janeway lesion

A

O - painful red nodules on hand and feet
J- non tender, small erythematous or hemorhhagic macular or nodular lesions on soles /palms
= septic microemboli

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49
Q

Endocarditis - initial empirical blind therapy

A

National valve endocarditis -
Amoxicillin + low dose gentamicin or
Vancomycin + low dose gentamicin - ig peicillin allergic or MRSA suspect or sever sepsis

Hx of prosthetic valve
Vancomycin + low dose gentamicin+ rifampin

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50
Q

CHA2DS2VASc score

A 
CHF 
HTN 
Age =/>75 = 2pts 
DM
S- prior stroke , TIA, thromboembolism = 2pts
Vascular disease
Age 65-74 
Sex category - female

Score =/> 2 - warfarin or DOAC , men >/=1 - the same

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51
Q

Score to estimate risk of major bleeding inpatients on anti coagulation for atrial fibrillation

A

HAS BLED score

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52
Q

What score predicts 3 month outcome in ischaemic stroke patients receiving tPA (alteplase)

A

DRAGON score

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53
Q

What is the QRISK2 score

A

Determines risk of cardiovascular event in next 10 years

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54
Q

Pulmonary oedema

Features

A 
Desaturation
Dyspnoea
Orthopnoea
Auscultation = crackles /rales
Tachycardia 
Kerley lines on CXR
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55
Q

Most appropriate investigation for pulmonary oedema

A

CXR

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56
Q

Investigation needed to identify cause of pulmonary oedema

A

Echo

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57
Q

Management of pulmonary oedema

A 
MONF
Morphine O2 Nitrates Furosemide
O2 sat >92% or 90 in COPD
2 puffs GTN 
40 mg IV furosemide - slow
Diamorphine 2/5-5mg IV slowly or morphine 5-10mg IV slow

If heart failure also present : + ACEi or BB one at a time on discharge

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58
Q

Dissecting aortic aneurysm

Clinchers

A 
Unequal pulses upper limb 
Hx of Marfan 
Tall long slender limbs and fingers
Ehler danlos/ Turner
Severe chest pain radiating to back 
HTN - most important RF
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59
Q

Dissecting aneurysm presentation

A

Presentation: hypotension, SOF , tachycardia, sweating

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60
Q

Most important risk factor dissecting aneurysm

A

HTN

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61
Q

Pathophysiology of dissecting aneurysm

A

Tear in tunica intima wall of aorta

- blood floes between layers of aorta - forces layers apart

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62
Q

Investigations for dissecting aortic aneurysm

A

Emergency - US or CT
TEE - 98% sensitive, 97% specific
- preferred imaging modality
CT scan w/ contrast or MRI

63
Q

Stanford classification of aortic dissection

A

Type A - ascending aorta -2/3 of cases

B - descending aorta, distal to left subclavian , 1/3 of cases

64
Q

Management of aortic dissection

A

Type A - surgical , control BP to 100-120 mmHg SBP in the meantime
Type B - conservative - bed rest , reduce BP , IV labetalol to prevent progression

65
Q

LBBB

ECG features

A

Broad QRS - notched M = I avL V6(not always)
Deep inverted negative QRS - V1 usually
LAD - not always
New onset LBBB - characteristic for MI

“William” = W in V1 , M in V6

66
Q

Rule turned abdominal aortic aneurysm

Most appropriate initial investigation

A

US

If not in options pick CT abdomen

67
Q

AAA screening in the UK

Criteria

A

Men @ 65 years old via ultrasound

Once only

68
Q

Coronary artery dominance

A

Artery that supplies the posterior descending artery - determines dominance
85% - Right coronary artery
15% left circumflex

Artery dominance = RCA =gives off PDA in 85% of people

69
Q

ECG changes hypokalemia

A

U wave - an additional wave after T

70
Q

Management hypokalemia

A

Oral or IV kcl based on severity
<2.5 - IV
Treat the cause

71
Q

Paroxysmal supraventricular tachycardia

Features

A

Narrow complex SVT
Usually in young patients
Palpitations light headed ness,
Recurrent young

72
Q

management of PSVT

A 
Initial : Valsalva , carotid massage
No improvement —> IV adenosine 
= 6mg rapid IV bolus if fails
—> Additional 12 mg - no improvement 
—>Further 12 mg — no improvement 
—> DC cardioversion

Verapamil CCB - in asthmatics

73
Q

Prevention of future PSVT episodes

A

B blockers

Radio-frequency ablation

74
Q

Torsades de pointes

Features

A

Polymorphic Broad complex ventricular tachy
- beat 2 beat variations
Broad QRS, long QT, fainting episodes
Young athlete, recurrent

75
Q

Treatment of torsades de pointes

A

IV MgSo4

76
Q

HTN classification - stage 1

A

Clinic BP >/= 140/90 +Ambulatory BP monitor >/= 135/85 mmHg
Or
Home BP monitor - BP >/= 135/85

77
Q

Stage 2 - HTN

A

Clinic BP >/= 160/100 mmHg +

ABPM or HBPM >/= 150/95 mmHg

78
Q

Stage 3 HTN

A

Clinic SBP >180 mmHg

Clinic DBP >/= 110 mmHg

79
Q

When you should you treat stage 1 HTN

A 
Patient <80 yrs + any :
target organ damage 
Established CVD
Renal disease
Diabetes
10 year cardiovascular risk >/= 20%
80
Q

Stage 1 HTN management

A

Lifestyle + diet modification and follow up

Unless criteria to be treated present

81
Q

What should be done for a stage 2 HTN at clinic before starting antihypertensives

A

Check ABPM or HBPM

82
Q

Stage 2 HTN or higher + <40 YO

What should you consider

A

2ry causes of HTN - refer to specialist to exclude

83
Q

Medical management HTN

A

Step 1
<55 yo + white - ACEi ARBs
>55 yo + white - CCB
Afrocarribean + any age - CCB

Step 2 - still hypertensive after step 1
ACEi + CCB

Step 3 
Add diuretic = thiazides 
- chlorthalidone 12-25 mg OD
Or indapamide 1.5mg OD modified release, or daily 2.5mg OD
Bendroflumethazide NOT recommended

Step 4 - resistant HTN
<4.5 mmol/l - spironolactone 25mg OD
>4.5mmol/l - add higher dose thiazides like diuretic
If further diuretic not tolerated or CI = consider alpha or beta blocker
Refer to specialist - if they fail to respond to step 4

84
Q

BP targets

  • diabetics
  • hypertensive w/o DM
A

DM - <130/80 mmHg if end organ damage otherwise <140/80 mmHg

HTN -
<80
- clinic 140/90 mmhg , A/HBPM 135/85
- 150/90 clinic , 145/85 mmhg

85
Q

Treatment of HTN in a diabetic patient

A

Always ACEi regardless of age
If DM + afrocarribean - ACEi + CCB as 1st step

Check eGFR before you start ACEi
<30 = advanced kidney disease - avoid ACEi & ARBs

86
Q

Why use ACEi in hypertensive DM

A

Reno-protective
Protection against diabetic retinopathy
+ve effect on glucose metabolism

87
Q

Postural hypotension
Def
Dx

A

Drop in SBP at least 20 mmHg within 3 mins of standing

Drop in DBP at least 10 mmhg within 3 minutes of standing

Dx - monitor BP

88
Q

Postural hypotension common in

A 
Elderly people (baroreceptors decline with age)
Esp in poly pharmacy and those with HTN

Antihypertensives can cause postural hypotension

89
Q

1st line in AFIB

A

Beta blockers
If asthmatic - CCB
If associate HF - give digoxin

Also calculate chadvasc score and anticoagulants accordingly - warfarin or DOAC

90
Q

Ventricular ectopic

Features

A

Ventricular trigeminal - 3 beat patterns
Missed skipped beat, unsustained palpitations +- SOB
Early/ broad QRS complex

91
Q

Causes ventricular ectopic

A

IHD - MI
Cardiomyopathy
Stress Alcohol Caffeine cocaine or natural

Can be benign if there’s no underlying hearts disease
If there is may ppt vfib

92
Q

What medications should NEVER be given to CKD CHD IHD patients

A

NSAIDS
Selective COX-2 inhibitors - celecoxib

They can worse heart failure and renal function
NSAIDs inhibit prostaglandin synthesis = decreased gfr = salt + water retention

93
Q

Silent MI in diabetics is due to

A

Autonomic neuropathy

94
Q

Pt w/. Hx of syncope + SOB + pulmonary embolism and early-mid diastolic murmur
Suspect

A

Think atrial myxoma

95
Q

Alcohol recommendations UK

A

Not more than 14 units - week
Not > 3 units a day
+ 2 alcohol free days a week

96
Q

Most important cause of ventricular tachycardia clinically

A

Hypokalemia

97
Q

Aortic stenosis murmur

Features

A

Ejection systolic
Rt 2nd ICS - radiates to carotid
SOB on activity, angina chest pain, syncope

98
Q

Pulmonary stenosis murmur

Features

A

Ejection systolic
Lt 2nd ICS lateral to sternum , radiates to left shoulder and infraclavicular area

Systemic cyanosis

99
Q

Aortic regurgitation

Features

A

Early diastolic
Rt 2nd ICS lateral to sternum
Heart failure sx

100
Q

Pulmonary regurgitation

Features

A

Early diastolic
Left 2nd ICS , lat to sternum
Rt sided HF sx

101
Q

Mitral stenosis

A 
Mid-late diastolic + opening click (loud S1)
- best heard on expiration 
Apex 5th ICS midclavicular line 
Sx of HF 
Low volume pulse , malar flush 
AFIB
102
Q

Tricuspid stenosis

Features

A

Diastolic rumble
4-5th ICS over LSB
Fluttering discomfort in neck

103
Q

Mitral regurgitation

Features

A

Pan- systolic murmur
Apex, left 5th ICS MCL radiates to axilla

CHF sx, oedema ascites

104
Q

Tricuspid regurgitation

Features

A

Pan systolic
4-5th ICS LSB
Sx of Rt sided CHF

105
Q

What murmurs have sx of rt sided heart failure

A

Pulmonary regurgitation - early diastolic

Tricuspid regurgitation - pan systolic

106
Q

Murmurs with HF sx

A

Aortic regurgitation - early diastolic
Pulmonary regurgitation - early diastolic (rt sided HF)
Mitral stenosis - mid-late diastolic w/ opening click
Mitral regurgitation - pan systolic (CHF)
Tricuspid regurgitation- pan systolic (RHF)

107
Q

Pan systolic murmur

A

Mitral regurgitation
Tricuspid regurgitation
VSD

108
Q

Diastolic murmurs

A

Aortic regurgitation - early
Pulmonary regurgitation - early
Mitral stenosis - mid to late + opening click
Tricuspid stenosis - rumble

109
Q

Common causes of mitral stenosis

A

Rheumatic fever!!!!!!!!

110
Q

CXR mitral stenosis

A

Straight left side heart border

MS - impeded LV filling - increased LA pressure - LA hypertrophy = straight left heart border

Blood goes back to lungs - pulmonary congestion , RVF

111
Q

Mitral aortic murmurs best heard

A

Expiration

Left heart = expirations

112
Q

Tricuspid + pulmonary murmurs best heard

A

Inspiration

Rt - insp

113
Q

ECG in mitral stenosis

A

Signs of RVH
P mitrale
AFIB

114
Q

Decreased Ejection fraction + decreased septal wall thickness

A

Dilated cardiomyopathy

115
Q

Increased ejection fraction + increased septal wall thickness

A

Hypertrophic cardiomyopathy

116
Q

Causes of dilated cardiomyopathy

A

Alcohol Pospartum HTN
Inherited - autosomal dominant
Infection - coxsackie B , HIV , parasitic, diphtheria
Hyperthyroidism
DMD
Kwashiorkor, pellagra, thiamine/selenium def
Doxorubicin

117
Q

Causes of falls

A

Cardiac - arrhythmia
Postural hypotension
Hypoglycemia
Seizure

118
Q

Cyanotic baby with ejection systolic murmur

A

TOF - pulmonary stenosis

119
Q

Preterm baby with continuous or machinery murmur

A

PDA

120
Q

Progressive severe cyanosis + poor feeding + pan systolic murmur

A

Tricuspid atresia

121
Q

Acyanotic + pan systolic murmur

A

VSD

122
Q

Diagnosis of patent ductus arteriosus

Management

A

Echo
Mgmt - indomethacin/ibuprofen - closes the duct
If assoc with anther congenital heart defect - prostaglandin E1 - keep open until surgically repaired

123
Q

TOF features

A

VSD
RVH
RV outflow tract obstricipn - pulmonary stenosis - ejection systolic murmur
Overriding aorta

124
Q

Management of TOF

A

Surgical repair

B blockers to reduce infundibular spasm = help cyanotic episodes

125
Q

Familial hypercholesterolemia
Inheritance pattern
When should suspect it?

A

AD

  1. Cholesterol >7.5 (N= < 5 mmol/l)
  2. Family hx of MI - 1st degree relative before 60 or 2nd degree below 50
126
Q

Most common valvular disease that causes syncopal attacks

A

Aortic stenosis

127
Q

Causes of AFIB

A

Endocardium - endocarditis , mitral valve disease
Myocardium - cardiomyopathy
Pericardium - constructive pericarditis
HF HTN MI
Hyperthyroidism, excessive alcohol and chronic lung disease

128
Q

Before prescribing amiodarone - what should be done

A

Amidarone = class 3 antiarrythmic - block K+ channels - inhibits depolarisation - prolongs action potential

TFT LFT UE CXR ECG

129
Q

Monitoring patients taking amiodarone

A

TFT LFT UE CXR ECG - prior to tx
TFT LFT every 6 mo.
ECG every 12 mo

130
Q

Adverse effects. Amiodarone

A 
Hypothyroidism , hyperthyroidism 
Corneal deposits 
Pulmonary fibrosis (**most serious) / pneumonitis 
Liver fibrosis/ hepatitis 
Peripheral neuropathy, myopathy 
Photosensitivity 
Grey skin 
Thrombophlebitis ( so usually given via central veins)
Bradycardia 
Prolonged qt
131
Q

Corrected pulmonary stenosis in TOF can later become

A

Pulmonary regurgitation

132
Q

Commonest valvular disease in elderly >65

A

Aortic stenosis

Usually asymptomatic apart from excercise intolerance
Can cause syncopal fainting

133
Q

Digoxin toxicity

A

GT - commonest - nausea, vomiting , anorexia
Neuro - hallucination, confusion
Visual - yellow haloes , yellow - green vision, blurred vision
Arrhythmia - Bradycardia , vtach , premature contractions

134
Q

Management of digoxin toxicity

A

Digoxin level
Digibind / digifab = digoxin immune FAB
Correct arrhythmia
Monitor K+

135
Q

Sx of aspirin toxicity

A

Tinnitus , impaired hearing

Hyperventilation , vomiting , dehydration, fever , double vision and feeling faint

136
Q

How do thiazides like diuretics work

Adverse effects

A

Inhibit Na absorption from beginning of proximal DCT
- block Na-Cl symporter

Postural hypotension, gout, hypokalemia and HypOnatremia
Hypercalcemia and hypocalciuria

137
Q

Loop diuretic moA

A

Inhibit Na-K-cl cotransporter in thick ascending limb of loop of henle

138
Q

Hypotension tachycardia and pulmonary post MI

A

Mitral regurgitation

139
Q

Osborne wave in

A

Hypothermia

140
Q 
Antiplatelet guideline 
Acute MI 
PCI 
TIA
Ischemic stroke 
Ischaemic stroke + AF 
PAD
A

MI - aspirin life-long , ticragrelor or clopidogrel 12 mo
PCI- aspirin life-long, prasugrel or ticragrelor 12 mo
TIA/ischemic stroke
- aspirin 300mg 2 weeks then clopidogrel 75mg lifelong
Ischemic stroke + AF
- aspirin 300mg 2 weeks then start anticoagulation warfarin/DOAC
PAD - Clopidogrel lifelong

141
Q

Who should receive statin - 1ry prevention

A

Anyone with 10 year CVD risk >/=10%
T1DM diagnosed >10 years ago or over 40 or established neuropathy
CKD if eGFR <60

Atorvastatin 20 mg OD
If LDL does not fall by >/= 40% - up dose to 80

142
Q

2ry prevention - start statins in cases of

A

Known IHD , cerebrovascular disease, PAD

Atorvastatin 80 mg OD

143
Q

Important side effects of CCBs

A

Ankle swelling

Gingival hyperplasia

144
Q

Most common arrhythmia in alcoholic cardiomyopathy

A

AFIB

145
Q

Holiday heart syndrome

A

Acute alcohol intake causing AF or clutter

146
Q

Widespread ST depression + ST elevation in aVR

A

Left main coronary artery occlusion

- emergency coronary angio

147
Q

AFib +unstable patient

Presents >48 hrs after sx onset

A

No cardioversion

Give BB + LMWH
Assess chad score for long term DOAC

148
Q

QRISK3 score

A

Risk of cardiovascular event in next 10 years

>10% + age = 84 —> start stain

149
Q

Complications of mitral stenosis

A

Atrial fibrillation
Venous thromboembolism
Cerebral infarction

150
Q

Common complication of aortic stenosis

A

LVH

151
Q

Most common arrythmia associated with congenital long QT syndrome

A

Ventricular tachyarrythmia

There is also risk of vfib - some patients use long term beta blocker treatment

152
Q

Investigations of Heart failure

A

NT-proBNP

If raised - do Echo

153
Q

Management of chest pain according onset

A

<3 hrs of chest pain onset
Troponin - <12 - repeat after 3 hrs of chest pain onset
>30 - correlate with ecg and hx - treat as ACS

> 3hrs
<12 - ACS unlikely
30 -ECG and history - treat as ACS

Revision (31 decks)

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