Cardiology Flashcards
What other investigation must you do before you order a CTPA for suspected PE?
CXR
Once ventricular fibrillation is identified, what is the first thing you do?
One shock, followed by 2 minutes of CPR
How does fluconazole affect INR in a patient taking warfarin?
It increases the INR (blood too thin)
Fluconazole is a CYP450 inhibitor, ∴ warfarin is not metabolised and builds up in the system
Hypokalaemia causes QT ___?
Prolongation
First line medication for preventing anginal attacks?
Β-blocker or RL calcium channel blocker (e.g. verapamil, diltiazem)
Never prescribe RL-CCB and β-blockers together
If prescribing both, use a non-RL-CCB (e.g. nifedipine)
How does clarithromycin affect INR in a pt on warfarin?
It increases INR. Clarithromycin is an enzyme inhibitor.
Symptomatic bradycardia, atropine (3g) failed, next step?
External pacing
Non-shockable rhythm identified. What is the first step?
1mg adrenaline, then commence CPR for 2 minutes
When do you give adrenaline in VT/VF?
1mg adrenaline after CPR has commenced after the THIRD DC shock
How does phenobarbital affect INR?
Decreases it (blood is thicker)
PR interval in WPW syndrome?
Shortened
AF <48h, electrical cardioversion planned. What do you need to do?
Start anticoagulants immediately alongside DC cardioversion
Anticoagulant should be rapid onset (e.g. heparin) and can be stopped when sinus rhythm is restored
Electrical cardioversion is also preferred to pharmacological cardioversion, especially if SHD present
PE Well’s ≤ 4 + D-dimer negative?
Stop anticoagulation and consider alternative diagnosis
Ejection systolic murmur, fixed split S2, and louder on inspiration?
ASD
Major bleeding on warfarin?
Stop warfarin, IV 5mg vitamin K + prothrombin complex concentrate
Cardiac arrest, PE suspected cause. What additional drug do you give?
Alteplase
What do you do about anticoagulation in a patient who had a catheter ablation for their AF?
Continue long term anticoagulation
Acute SOB + hypotension in someone with suspected MI?
Acute mitral regurgitation due to rupture of papillary muscle ⇒ backflow of blood from LV into LA during systole ⇒ prevents pulmonary veins draining into LA ⇒ pulmonary congestion ⇒ oedema
Most appropriate next step in someone with paroxysmal AF (first presentation, booked appt when felt palpitations but now resolved)?
Calculate CHA2DS2-VASc and consider DOAC
Single episode of paroxysmal AF should still prompt consideration of anticoagulation
Tall R waves in V1 and V2?
Posterior myocardial infarction, typically a LCA occlusion
Replace leads on the posterior chest wall and repeat ECG
STEMI pt, having PCI. What anticoagulation do you give them?
Pci = Prasugrel (+aspirin)
If already antiCoagulated = Clopidogrel
Prasugrel is a more effective anticoagulation with regards to stent insertion, but therefore causes more bleeding. Clopidogrel is less effective so if already on anti-coag, you don’t want to push them over the edge into a bleeding problem, so you give them the lesser of two anticoagulants.
Criteria for aortic valve replacement in AS?
- If symptomatic, replace
- If asymptomatic but valvular pressure gradient >40, consider for replacement
What electrolyte disturbances (urine + serum) can thiazide diuretics cause?
Hypercalcaemia and hypocalciuria
Pt with non-small cell lung cancer, comes in with nausea, third, constipation, joint pain, and fatigue. What might his ECG show?
Short QT interval. Pt likely has hypercalcaemia.
Squamous cell carcinomas of lung produce PTHrP ⇒ hypercalcaemia
Intermittent limb claudication, absent/weak peripheral pulses, young woman ⇒ ?
Takayasu’s arteritis
3 possible causative agents of pericarditis
Enteroviruses (e.g. coxsackie, echovirus) - MOST COMMON Mumps Rubella Hepatitis B Influenza
Acute pericarditis + erythema nodosum (or other skin lesions) + eye problems + genital/oral ulcers = ?
Behcet’s
Atherosclerosis risk factors: MR SHAHED
Male Race Smoking Hypertension Age/alcohol/AF Hyperlipidaemia Exercise/eating (poor) Diabetes
Collapsing pulse + early diastolic murmur = ?
Aortic regurgitation
May also find Corrigan’s sign and wide pulse pressure
