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Cardiology Flashcards

1
Q

CHA2DS2-VASc

A

CCF - 1

HTN - 1

Age:
=>75 - 2
65-74 - 1

DM - 1

Stroke/TIA - 2

IHD/PAD - 1

Female - 1

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2
Q

CHADS-VaSc 1 (male)

A

Consider anticoagulation with DOAC (Rivaroxaban)

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3
Q

CHADS-VaSc 1 (female)

A

No anticoagulation

Need ECHO to exclude valvular heart disease

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4
Q

CHADS-VaSc 2

A

Offer anticoagulation with DOAC

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5
Q

Normal PR interval

A

120 - 200 ms

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6
Q

Anteroseptal - ECG changes

A

V1 - V4

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7
Q

Inferior - ECG changes

A

II, III, aVF

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8
Q

Anterolateral - ECG

A

V4-V6, I, aVL

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9
Q

Lateral - ECG changes

A

I, aVL +/- V5-V6

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10
Q

Posterior - ECG changes

A

Tall R waves V1-V2

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11
Q

Coronary artery affected: Anteroseptal changes

A

Left anterior descending

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12
Q

Coronary artery affected: Inferior changes

A

Right coronary

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13
Q

Coronary artery affected: Anterolateral changes

A

Left anterior descending,
or,
Left circumflex

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14
Q

Coronary artery affected: Lateral changes

A

Left circumflex

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15
Q

Coronary artery affected: Posterior changes

A

Usually left circumflex, also right coronary

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16
Q

Definition of pulmonary arterial hypertension

A

Resting mean pulmonary artery pressure is >= 25 mmHg

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17
Q

Normal QRS duration

A

< 120 ms

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18
Q

INR > 8.0 with No bleeding

A

Oral Vitamin K 1-5 mg

Repeat dose vitamin K if INR still too high after 24hr

Restart warfarin when INR < 5

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19
Q

Heart failure - 1st-line management for all patients

A

ACEi + beta-blocker

start one, then add other

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20
Q

Heart failure - 2nd-line

A 
Aldosterone antagonist 
(spironolactone/eplerenone)
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21
Q

Heart failure - 3rd-line options

A

Ivabradine

Sacubitril-valsartan

Digoxin

Hydralazine with nitrate

Cardiac resynchroniziiton therpy

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22
Q

Heart failure management – criteria for ivabridine

A

Sinus rhythm >75 bpm +

LVEF <35%

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23
Q

Criteria for using sacubitril-valsartan (Entresto) for heart failure

A

LVEF <35%

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24
Q

Heart failure management - indication for digoxin

A

Coexistant AF

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25
Q

Heart failure management - indication for hydralazine with nitrate

A

Afro-Caribbean patient

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26
Q

Heart failure management - indication for cardiac resynchronization therapy

A

Widened QRS complex >130ms

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27
Q

Widened QRS complex >130ms

A
  • IHD
  • HTN
  • Aortic stenosis
  • Cardiomyopathy
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28
Q

Prolonged QTc in men

A

> 440ms

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29
Q

Causes of LBBB

A
  • IHD
  • HTN
  • Aortic stenosis
  • Cardiomyopathy
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30
Q

Hypertension - 4th line medical management
(already taking A + C + D)
- K < 4.5 mmol/l

A

Add low-dose spironolactone

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31
Q

Hypertension - 4th line medical management
(already taking A + C + D)
- K > 4.5 mmol/l

A

Add alpha-blocker (doxazosin) or beta-blocker (nebivolol, carvedilol)

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32
Q

Angina - all patients should be on

in absence of contraindications

A

Aspirin
Statin
Sublingual GTN prn

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33
Q

Angina - 1st line treatment

A

Beta-blocker + Calcium channel blocker

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34
Q

Medications which may exacerbate heart failure

A

Thiazolidinediones (pioglitazone)

Verapamil

NSAIDs

Glucocorticoids

Class I antiarrhythmics (fleicanide)

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35
Q

Severe hypertension requiring same-day specialist assessment/admission.

A

BP >=180/120 and any of:

  • Retinal haemorrhage /papilloedema
  • New confusion
  • Chest pain
  • Signs of heart failure
  • AKI
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36
Q

Most appropriate first-line anti-anginal for stable angina in a patient with heart failure.

A

Bisoprolol (beta-blocker)

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37
Q

If calcium channel blocker is used as monotherapy in stable angina - which one should be used?

A

Rate-limiting CCB (verapamil, diltiazem)

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38
Q

If calcium channel blocker is used in combo with beta-blocker in stable angina - which one should be used?

A

Long-acting dihydropyridine CCB (modified-release nifedipine).

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39
Q

Verapamil should never be prescribed with

A

Beta-blockers (risk of complete heart block)

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40
Q

Stage 1 HTN - clinic reading

A

> =140/90 mmHg

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41
Q

Stage 1 hypertension - criteria (ABPM/HBPM)

A

Average >= 135/85 mmHg

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42
Q

Stage 2 hypertension - criteria (clinic reading)

A

> =160/100 mmHg

43
Q

Stage 2 hypertension - criteria (ABPM/HBPM)

A

Average >= 150/95 mmHg

44
Q

Severe hypertension - criteria

A

Systolic BP >= 180 mmHg
or
Diastolic BP >= 120 mmHg

45
Q

Clopidogrel effectiveness may be reduced by concurrent use of:

A

Omeprazole/esomeprazole

lansoprazole ok

46
Q

At what eGFR should thiazide diuretics be avoided in CKD?

A

eGFR <30 ml/min (CKD stage 4)

47
Q

Hypertension - 1st line management <55 years old and not AFC

48
Q

Hypertension - 1st line management any age, with T2DM, not AFC

49
Q

Hypertension - 1st line management >55 years old not T2DM

A

Calcium channel blocker (amlodipine)

50
Q

Hypertension - 1st line management any age, AFC, not T2DM

A

Calcium channel blocker (amlodipine)

51
Q

Hypertension - 2nd line management - already taking ACEi/ARB

A

Add:
CCB (amlodipine)
or
TLD (indapamide)

52
Q

Hypertension - 2nd line management - already taking CCB

A

Add:
ACEi or ARB (ARB if AFC)
or
TLD (indapamide)

53
Q

Hypertension - 3rd line management, already taking ACEi + TLD

54
Q

Hypertension - 3rd line management, already taking ACEi + CCB

A

Thiazide-like diuretic (Indapamide)

55
Q

Myocardial infarction secondary prevention - all patients should be offered

A
  • Dual antiplatelet therapy
  • ACEi
  • Beta-blocker
  • Statin
56
Q

Myocardial infarction secondary prevention - with signs of heart failure + reduced LVEF

A

Aldosterone antagonist (eplerenone)

57
Q

Timing of initiation aldosterone antagonist post-MI

A

Within 3-14 days of MI

After ACEi initiated

58
Q

Dual antiplatelet therapy following medically-managed ACS

A

Aspirin life-long
+
Ticagrelor for 12 months

59
Q

Dual antiplatelet therapy following PCI

A

Aspirin life-long
+
Ticagrelor or prasugrel for 12 months

60
Q

Anti-thrombotic therapy for bio-prosthetic heart valve

61
Q

Anti-thrombotic therapy for mechanical prosthetic heart valve

A

Warfarin + aspirin

62
Q

DVLA advice post ACS (successful angioplasty)

A

1 week off driving

63
Q

DVLA advice post ACS

not successfully treated by angioplasty

A

4 weeks of driving

64
Q

DVLA advice post elective angioplasty

A

1 week off driving

65
Q

DVLA advice post CABG

A

4 weeks off driving

66
Q

DVLA advice post pacemaker insertion

A

1 week off driving

67
Q

1st-line agents for long-term rate-control in AF

A

standard beta-blocker
or
rate-limiting calcium channel blocker (diltiazem)

68
Q

Indication to use digoxin as rate-limiting agent in AF

A

Sedentary
Beta-blocker/CCB not appropriate
Co-existent heart failure

69
Q

Caution/CI for ACEi

A 
Pregnancy/breastfeeding
Renovascular disease
Aortic stenosis
Hereditory angioedema
Potassium >= 5.0
70
Q

Amiodarone - baseline tests prior to starting

A

TFT, LFT, U&E, CXR

71
Q

Amiodarone - monitoring

A

TFT, LFT 6-monthly

72
Q

Drugs which cause QT prolongation

A 
Amiodarone
Sotalol
TCAs
SSRIs (especially citalopram)
Chloroquine
Erythromycin
Haloperidol
Ondansetron
73
Q

Target clinic BP if patient <80y

A

140/90 mmHg

74
Q

Target clinic BP if patient >=80y

A

150/90 mmHg

75
Q

Target ABPM/HBPM if patient <80y

A

135/85 mmHg

76
Q

Target ABPM/HBPM if patient >=80y

A

145/85 mmHg

77
Q

Target clinic BP: Type 1 diabetes without albuminuria/metabolic syndrome

A

135/85 mmHg

78
Q

Target clinic BP: Type 1 diabetes with albuminuria or metabolic syndrome

A

130/80 mmHg

79
Q

Target BP in CKD with Diabetes

A

<130/80 mmHg

80
Q

Target BP in CKD (not diabetic, ACR <70)

A

<140/90 mmHg

81
Q

Target BP in CKD (not diabetic, but ACR >70)

A

<130/80 mmHg

82
Q

Target clinic BP in T2DM (no CKD)

A

Same as gen pop:
Under 80y <140/90
Over 80y <150/90

83
Q

Target INR for aortic mechanical valve

84
Q

Target INR for mitral mechanical valve

85
Q

Statin for primary prevention

A

atorvastatin 20mg

86
Q

Statin for secondary prevention

A

atorvastatin 80mg

87
Q

Blood test monitoring for statins

A

LFTs at baseline, 3 months + 12 months

88
Q

Who should receive a statin for primary prevention

A
  • 10-year CV risk >=10%
  • T1DM diagnosed >10y / aged >40 / nephropathy
  • CKD
  • Familial hypercholesterolaemia
89
Q

Investigation for suspected IHD (non-acute) - 1st line

A

CT coronary angiography

90
Q

Investigation for suspected IHD (non-acute) - 2nd line

A

Non-invasive functional imaging

MR perfusion scan, stress echo

91
Q

Investigation for suspected IHD (non-acute) - 3rd line

A

Invasive coronary angiography

92
Q

DVLA post ICD insertion for HOCM (no history of arrhythmia)

A

4 weeks off driving

93
Q

Amlodipine maximum dose

A

10mg per day

94
Q

A side effect of which cardiac medication is ulceration?

A

Nicorandil (vasodilator used in angina)

95
Q

Statins in pregnancy

A

Contraindicated in pregnancy and pre-conception (congenital anomaly)

96
Q

Offer statin (without risk assessment) to T1DM if:

A

> 40y
Diagnosed >10y ago
Nephropathy
CVD risk factors

97
Q

Offer statin (without risk assessment) to

A

Certain T1DM pt
CKD
FH

98
Q

Consider offering statin (without risk assessment) to

A

> =85y

All T1DM

99
Q

<85y QRISK >10% + no T2DM

A

Lifestyle modification first (if appropriate)

Offer statin

100
Q

<85y QRISK >10% + T2DM

A

Offer statin

101
Q

Statin for primary prevention - followup

A

Repeat TC, HDL, non-HDL in 3m

Looking for 40% reduction in non-HDL

102
Q

If suspect chronic heart failure

A

NT-pro-BNP
ECG
Tests for other causes/aggravators

103
Q

Suspected CHF and NT-pro-BNP >2000

A

2 week referral for ECHO + cardiologist

104
Q

Suspected CHF and NT-pro-BNP 400-2000

A

6-week referral for ECHO + cardiologist

AKT (28 decks)

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