Cardiology Flashcards
How much elevation in leads for STEMI?
1mm limb, 2mm chest
When do Tnl levels begin to rise and for how long?
3-4 hours for up to two weeks
What hs/Tnl level for likely myocardial necrosis?
34 for men, 16 for women
When is hs-Tnl taken?
Admission and 1 hour
What may be seen in a posterior MI?
ST depression in leads v1-4
What four conditions can mimic STEMI on ECG?
- Early repolarisation (V1-2 in younger, athletic patients)
- Pericarditis (widespread, concave ST changes)
- Bruguda syndrome (Genetic electrical arhythmia)
- Takotsubo cardiomyopathy (stress reaction ‘broken heart’)
Which antiplatelet therapy is indicated in STEMI?
Aspirin (300 mg loading dose, 75mg od)
Prasugrel (60 mg loading, 10 mg od 12/12)
[PPCI, u75, >60kg, no prior TIA]
Clopidogrel (600mg loading, 75 mg daily)
Ticagrelor (180mg loading, 90mg bd)
[First choice NSTEMI]
NSTEMI medical management?
- Morphine
- Aspirin
- LMWH (Enoxaparin, 48 hours)
- Ticagralor if GRACE Score risk >3: (180mg loading, 90mg bd)
What investigations should be offered for patients with CAD likelihoods of:
61-90%
30-60%
10-29%?
61-90% - Invasive coronary angiography
30-60% - Stress MRI, echo, myoview
10-29% - CT Calcium scoring
What is the drug treatment for Stable Angina?
- Asprin 75mg OD ( or clopidogrel 75mg)
- GTN
- Beta-blockers AND non-dihydropyridines (diltiazem/verapamil)
What sinus node-blocking agent and dose may be used where beta-blockade is contra-indicated? (and HR above 70)
Ivabradine (5-7.5 mg)
What are four signs of secondary causes of HTN?
- Cushing’s
- Enlarged kidneys
- Renal bruits
- Radio-femoral delay (coarction)
What 5 investigations should be undergone in HTN?
Kidney
- Urine: Protein, albumin:creatinine ratio, haematuria
- Blood: Glucose, electrolytes, creatinine, eGFR, cholesterol total and ratio
Eyes
3. Retina screen
Heart
- ECG
- Echo if suggestion of LVH or valve disease
Which patients should be prescribed CCB over an ACEi?
55+ or African or Carribean origin
What four drugs should be started in a Hypertensive Emergency?
- Sodium nitroprusside
- Labetalol
- GTN
- Esmolol (0.5-1mg over 1 minute)
What combination of classes is advised in Hypertensive urgency? (And which specific drugs)
- ACEi
2. Calcium antagonist (nifedipine 20mg BD for three days and amlodipine 10 mg OD)
What is the investigation and managment plan for the triad of Headache, sweating, and tachycardia?
Phaeochromocytoma:
- 24 hr urine collection (metanephrines and catecholamines)
- Abdo CT/MRI
- Phenoxybenzamine 10 mg OD/BD, increasing (Alpha and beta blockade)
- Resection
What are four Ix for Cushing’s?
- Plasma glucose
- 24hr urine cortisol (3x normal)
- Low-dose dexamethasone suppresion test.
- Adrenal CT
Primary Aldosteronism?
- Suspicion
- Confirmation
- Low/normal potassium and high/normal sodium
- Resistant hypertension
- Aldosterone:Renin ratio
Which patients are likely to have HFNEF?
- Elderly
- Overweight
- HTN
- AF
What are the CXR features of Heart failure?
A. Alveolar Oedema
B. Kerley B Lines
C. Cardiomegaly
D. ‘Deer antlers’ perihilar-shadowing
What five drugs are used in the medical management of HF?
- Diuretics (Furosemide 40mg-500mg, Bumetanide, Dendroflumethiazide 2-5mg OD, Metolazone 2.5-5mg, Spironolactone 25mg OD)
- ACEi
- ARB (Valsartan/candesartan)
- ARNI [neprilysin inhibitor] (Sabcutril w/ valsartan)
- Beta blockers [low and go slow]
Carvedilol (Two weeks 3.125 mg BD - 6.25 mg BD - 12.5 mg BD - 25 mg BD)
Bisoprolol (1 week 1.25 mg OD, 2.5 mg OD, 3.75 mg OD, 5mg OD 4 weeks, 7.5 mg OD, 10mg OD)
What does ‘Start low and go slow’ mean for Beta blockade?
Carvedilol (Two weeks 3.125 mg BD - 6.25 mg BD - 12.5 mg BD - 25 mg BD)
Bisoprolol (1 week 1.25 mg OD, 2.5 mg OD, 3.75 mg OD, 5mg OD 4 weeks, 7.5 mg OD, 10mg OD)
When is a CRT pacemaker indicated and how does it work?
Cardiac resynchronisation pacemakers
- Left Bundle Branch Block
- The broad QRS results in septum-lateral wall delay
