CARDIOLOGY Flashcards
What is most common cause of death following an MI?
Cardiac arrest due to VF
What medications can improve the long-term prognosis of patients with chronic heart failure?
ACE-i’s
Bete-blockers
What type of arrhythmia is common following an inferior MI?
AV block
When do patients develop pericarditis post-MI?
48 hours
When does Dressler’s syndrome occur?
2-6 weeks following an MI
What are the features of Dressler’s syndrome?
fever, pleuritic pain, pericardial effusion and a raised ESR
What is seen on an ECG in a left ventricular aneurysm (post-MI)?
Persistent ST elevation
Left ventricular failure
Patients should be anti coagulated
What is the primary prevention of cardiovascular disease?
QRISK score >10% = offer a statin
All patients with CKD/T1DM >10 years should be offered a statin
When should lipids be checked after starting a statin?
Baseline
3 months - aim for 40% reduction in non-HDL cholesterol (always check adherence before increasing the dose)
What is secondary prevention for cardiovascular disease?
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
How is angina defined?
Discomfort in the chest, arm or neck.
What can bring on angina?
Exertions, cold weather or emotion.
Exacerbated by anaemia.
Name four different types of angina.
Stable
Unstable
Decubitus - lying down
Variant/Prinzmetal’s - coronary artery spasm
Syndrome X - during exercise test, no coronary artery disease
What is Prinzmetal’s or variant angina?
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.
What is the gold standard investigation for angina?
CT Coronary Angiography
What are the four principles to managing angina?
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
What are the aims of medical management in angina?
Immediate Symptomatic Relief
Long Term Symptomatic Relief
Secondary prevention of cardiovascular disease
How should patients be instructed to use a GTN spray?
Take GTN, then repeat after 5 minutes. If there is still pain 5 minutes after the repeat dose – call an ambulance.
What is the long-term symptomatic relief for angina?
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)
What is the secondary prevention for angina?
Aspirin (i.e. 75mg once daily)
Atorvastatin 80mg once daily
ACE inhibitor
Already on a beta-blocker for symptomatic relief.
What are the complications of an MI?
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)
What is seen on an ECG in a posterior MI?
ST depression (reciprocal) as opposed to wide-spread (NSTEMI)
What is the risk of using verapamil and beta-blockers together?
Complete heart block
Which CCB should be used alongside a beta-blocker in angina?
Modified release nifedipine
What can be added to a beta-blocker / CCB in angina if symptoms are not controlled?
Long-acting nitrate e.g. isosorbide mononitrate
Ivabradine
Nicorandil
Ranolazine
Give a side effect of ivabradine
Luminous phenomena (brightness)
Give a side effect of nicorandil
Flushing
GI ulcers
Give a contraindication to nicorandil
Left ventricular heart failure
How can nitrate tolerance be avoided?
Asymetric dosing interval
Maintain daily nitrate-free period of 10-14 hours
OR use modified release
How do nitrates work?
Release nitric oxide from smooth muscle
Causes vasodilation
Increases coronary perfusion
Decreases venous return
Which calcium channel blocker is licensed for use in heart failure?
Amlodipine
