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FINALS > CARDIOLOGY > Flashcards

CARDIOLOGY Flashcards

1
Q

What is most common cause of death following an MI?

A

Cardiac arrest due to VF

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2
Q

What medications can improve the long-term prognosis of patients with chronic heart failure?

A

ACE-i’s

Bete-blockers

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3
Q

What type of arrhythmia is common following an inferior MI?

A

AV block

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4
Q

When do patients develop pericarditis post-MI?

A

48 hours

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5
Q

When does Dressler’s syndrome occur?

A

2-6 weeks following an MI

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6
Q

What are the features of Dressler’s syndrome?

A

fever, pleuritic pain, pericardial effusion and a raised ESR

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7
Q

What is seen on an ECG in a left ventricular aneurysm (post-MI)?

A

Persistent ST elevation
Left ventricular failure

Patients should be anti coagulated

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8
Q

What is the primary prevention of cardiovascular disease?

A

QRISK score >10% = offer a statin

All patients with CKD/T1DM >10 years should be offered a statin

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9
Q

When should lipids be checked after starting a statin?

A

Baseline

3 months - aim for 40% reduction in non-HDL cholesterol (always check adherence before increasing the dose)

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10
Q

What is secondary prevention for cardiovascular disease?

A

4A’s

A – Aspirin (plus a second antiplatelet such as clopidogrel for 12 months)

A – Atorvastatin 80mg

A – Atenolol (or other beta-blocker – commonly bisoprolol) titrated to maximum tolerated dose

A – ACE inhibitor (commonly ramipril) titrated to maximum tolerated dose

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11
Q

How is angina defined?

A

Discomfort in the chest, arm or neck.

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12
Q

What can bring on angina?

A

Exertions, cold weather or emotion.

Exacerbated by anaemia.

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13
Q

Name four different types of angina.

A

Stable
Unstable
Decubitus - lying down
Variant/Prinzmetal’s - coronary artery spasm
Syndrome X - during exercise test, no coronary artery disease

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14
Q

What is Prinzmetal’s or variant angina?

A

Angina associated with ST elevation may be associated with coronary artery vasospasm. Can be hard to distinguish from an MI until changes resolve rapidly with GTN.

Should be treated with a CCB and long-acting nitrate.

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15
Q

What is the gold standard investigation for angina?

A

CT Coronary Angiography

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16
Q

What are the four principles to managing angina?

A

RAMP

R – Refer to cardiology (urgently if unstable)
A – Advise them about the diagnosis, management and when to call an ambulance
M – Medical treatment
P – Procedural or surgical interventions

17
Q

What are the aims of medical management in angina?

A

Immediate Symptomatic Relief
Long Term Symptomatic Relief
Secondary prevention of cardiovascular disease

18
Q

How should patients be instructed to use a GTN spray?

A

Take GTN, then repeat after 5 minutes. If there is still pain 5 minutes after the repeat dose – call an ambulance.

19
Q

What is the long-term symptomatic relief for angina?

A

Beta blocker (e.g. bisoprolol 5mg once daily) or;

Calcium channel blocker (e.g. amlodipine 5mg once daily)

either (or used in combination if symptoms are not controlled on one)

20
Q

What is the secondary prevention for angina?

A

Aspirin (i.e. 75mg once daily)
Atorvastatin 80mg once daily
ACE inhibitor
Already on a beta-blocker for symptomatic relief.

21
Q

What are the complications of an MI?

A

Death Passing PRAED st

DEATH - VF, LVF, CVA

Passing - pump failure (HF)

P - pericarditis - saddle-shaped ST elevation

R - rupture = cardiac tamponade (Beck’s triad - hypotension, ^JVP, muffled heart sounds)

A - arrythmias

E - embolism

D - Dressler’s syndrome (recurrent pericarditis - needs NSAIDs)

22
Q

What is seen on an ECG in a posterior MI?

A

ST depression (reciprocal) as opposed to wide-spread (NSTEMI)

23
Q

What is the risk of using verapamil and beta-blockers together?

A

Complete heart block

24
Q

Which CCB should be used alongside a beta-blocker in angina?

A

Modified release nifedipine

25
Q

What can be added to a beta-blocker / CCB in angina if symptoms are not controlled?

A

Long-acting nitrate e.g. isosorbide mononitrate
Ivabradine
Nicorandil
Ranolazine

26
Q

Give a side effect of ivabradine

A

Luminous phenomena (brightness)

27
Q

Give a side effect of nicorandil

A

Flushing

GI ulcers

28
Q

Give a contraindication to nicorandil

A

Left ventricular heart failure

29
Q

How can nitrate tolerance be avoided?

A

Asymetric dosing interval
Maintain daily nitrate-free period of 10-14 hours

OR use modified release

30
Q

How do nitrates work?

A

Release nitric oxide from smooth muscle
Causes vasodilation
Increases coronary perfusion
Decreases venous return

31
Q

Which calcium channel blocker is licensed for use in heart failure?

A

Amlodipine

FINALS (26 decks)

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