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Station 5 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Screening for end organ damage in hypertension?

A

Urine dip/urine ACR and U&Es
ECG, CXR and Echo
Fundoscopy to look for hypertensive retinopathy -» CT head if papilloedema

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2
Q

What indications of secondary HTN should you look for on examination?

A

Hands: Radio-radial and radio-femoral delay (co-arctation)
Recheck BP manually and confirm on ambulatory monitoring.
Face: Acromegalic face, Cushingoid facies
Abdo: PKD or renal bruit in renal artery stenosis

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3
Q

What are the causes of hypertension? (4 subtypes)

A

Vast majority have primary hypertension.
Renal- ADPKD, renovascular disease
Endocrine- Primary hyperaldosteronism (Conn’s), Cushings, Acromegaly or Phaechromocytoma
Cardio- Aortic co-arctation
Pre-eclampsia in pregnancy

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4
Q

How would you exclude secondary causes of hypertension?

A

Renin angiotensin ratio (ensure off drugs that affect result I.e beta blockers, ACEi and CCB)- for hyperhyperaldosteronism
Plasma and/or urine metanephrines in phaechromocytoma.
MRA in renal artery stenosis.
IGF1 and OGTT/MRI head in Acromegaly.
Overnight dexamethasone suppression test in Cushings.

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5
Q

When should you treat stage 1 HTN?

A

If evidence of end organ damage, history of IHD, diabetes, CKD or Qrisk >20%

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6
Q

When should you arrange admission for hypertension

A

Severe hypertension and grade 3 or 4 retinopathy (or new end organ damage)
Suspected secondary hypertension

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7
Q

Give the HTN management guidelines.

A

> 55 or afrocarribean= CCB
<55 = ACEi
Then the other or thiazide- like diuretics
All 3
Add Spiro if K <4.5 or beta blocker or alpha blocker if K >4.5

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8
Q

When would you consider intravenous antihypertensives with invasive BP monitoring?

A

Encephalopathy/stroke/myocardial infarction/acute LVF secondary to malignant hypertension.

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9
Q

Causes of papilloedema?

A

Raised ICP- SOP, BIH, cavernous sinus thrombosis

Accelerated phase hypertenion

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10
Q

Secondary prevention drugs in IHD?

A

Beta blockers
Ticagrelor/Clopidogrel
ACEi
Statin

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11
Q

Acute management of ACS

A

Aspirin loading and Ticagrelor/Prasugrel (in STEMI)
Fondaparinux
In STEMI PPCI within 12 hours of sumptoms and within 120 minutes of when fibrinolysis could have been given.
In NSTEMI and unstable angina-> angiography +/- Stent
CABG

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12
Q

What are the latest guidelines on screening of malignancy in unprovoked DVT?

A

According to the latest NICE guidelines do not offer further investigations for cancer to people with unprovoked DVT or PE unless they have relevant clinical symptoms or sign.
Bloods tests and examination and full history as minimum.

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13
Q

When would you do thrombophilia testing in patients with unprovoked DVT?

A

Planned to stop anticoagulation and first degree relative with history of VTE
Can offer antiphospholipid in those who plan to stop anticoagulation but don’t have a FH.

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14
Q

When would you offer IVC filter?

A

In patients with VTE for which anticoagulation is contraindicated or the patient has had recurrence of VTE whilst on anticoagulation (only after confirming compliance, measuring appropriate levels and trialling on alternative anticoagulation).

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15
Q

What would you do In suspected DVT with positive d-dimer and negative USS scan?

A

Stop anticoagulation and reassess with USS in 6-8 days time.

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16
Q

Sources of blood loss important to ask in anaemia?

A 
Rectal bleeding 
Haemoptysis 
Haematemesis 
Haematuria 
Epistaxis 
PV bleeding
17
Q

In an anaemic patient of Meditarranian heritage what might you consider?

A

Thalassaemia

18
Q

In an anaemic patient of Afro-Carribean heritage what might you consider?

A

Sickle cell

19
Q

What are the examination findings in anaemia?

A

Koilnychia
Glossitis, angular stomatitis (iron and B12 def)
Abdo mass and hepatomegaly
Scars on the abdomen

20
Q

Investigations in anaemia

A

FBC, UES, LFTs, Coag
Iron studied- TIBC, transferrin saturation, ferritin
B12 and folate, coeliac screen
Haemoglobin electrophoresis- thalassaemia and HbS

Faecal occult blood

OGD and colonoscopy
CT TAP

21
Q

Where would you find the telangiectasia in hereditary haemorrhagic telangiectasia?

A

Lips, face and buccal mucosa

22
Q

What are the associated complications of hereditary haemorrhagic telangiectasia? (4)

A

Gastrointestinal haemorrhage
Epistaxis
Haemoptysis
Vascular malformations- pulmonary shunts and intracranial aneurysms

23
Q

Significant LS BP drop?

A

> 20mmHg in systolic BP at 2 minutes or >10mmHg in diastolic

24
Q

Common causes of reduced mobility?

A

Change in drugs- increased drowsiness, postural hypotension, EPSEs
Infection- commonly chest and urine
Pain
Exacerbations of previously known neurological disease

25
Q

Common precipitants of AF?

A

Caffeine, alcohol, exercise

26
Q

Associated conditions with AF?

A

Valvular heart disease particularly mitral valve
Infection
Hyperthyroidism
HTN

27
Q

What would you examine for in a patient presenting with atrial fibrillation?

A 
Pulse and tremor (Hyperthyroidism)
BP 
HS ?valvular disease 
Signs of CCF 
Thyroid eye signs 
Goitre
28
Q

What are the important investigations you would need to undertake in a diagnosis of AF?

A

ECG or Holter monitor to confirm
Echo to rule out structural heart disease
TSH and T4

29
Q

Define

1) Paroxysmal AF
2) Persistent AF
3) Permanent AF

A

1) <7 day, self terminating
2) >7 days, requires chemical or electrical cardio version
3) >1 year or when no further attempts to restore sinus rhythm

30
Q

Describe the management of AF?

A

Rhythm control: chemical or electrical cardioversion
Rate control: B blockers, digoxin, rate limiting CCB
Referral to electrophysiologist for ablation.

Anticoagulation to reduce risk of stroke- DOACs or warfarin. Use CHADsVASC vs HASBLED.

31
Q

CHADsVASC score?

A 
CCF=1 
HTN =1
Age >75 =2 
Diabetes= 1
Stroke/TIA= 2
Vascular disease = 
Age 65-74= 1 
Sex female =2, male 1
32
Q

When is anticoagulation advised according to CHADsVasc?

A 
1= medium stroke risk therefore patient preference 
2= high risk and should be given in the absence of CI
33
Q

HASBLED score?

A 
HTN (uncontrolled) 
Abnormal kidney or liver function (1 for each) 
Stroke
Bleeding 
Labile INR 
Elderly 
Drugs 
>3 is high risk
34
Q

What lifestyle factors would you suggest for patients with postural hypotension?

A

Don’t salt restrict
Increase hydration
Eat regularly

Station 5 (12 decks)

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