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Exams :) > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Acute chest pain DDx (7)

A 
ACS
Aortic dissection
PE
Pneumothorax
Coronary artery spasm
Oesophageal rupture/spasm
Pericarditis
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2
Q

Acute Cardiac Chest pain - immediate management (meds + doses)

A 
O2 if Sats <94%
Aspirin 300mg PO Stat
GTN spray (400-800mcg s/l, or tab 300-600 mcg s/l) every 5 mins, up to 3 doses (IF HAEMODYNAMICALLY STABLE)
2x large bore IV access
IV Morphine 2.5-5mg, every 5-10 minutes
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3
Q

Already high CVS risk groups (7)

A
  • Diabetes + age .60
  • Diabetes w/ microalbuminuria (ACR >2.5)
  • Mod CKD (eGFR <45)
  • Familial hypercholesterolaemia
  • TChol >7.5
  • BP >180/>110
  • ATSI age >74 y.o
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4
Q

Other 2ndary causes of HTN (5)

A
  • Primary aldosteronism (Conn’s syndrome)
  • Cushing’s disease
  • Phaeochromocytoma
  • Renovascular disease
  • OSA
Treatment failure considerations
		○ Non-adherence
		○ Undiagnosed secondary conditions
		○ Other meds causing hypertensive effects
		○ OSA
		○ Use of eTOH/illicit drugs
		○ High salt intake
		○ White coat
		○ Volume overload (esp. w/ CKD)
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5
Q

AAA risk factors (6)

A
  • Peripheral vascular disease
  • Smoking
  • HTN
  • COPD
  • Marfans
  • First-degree relative
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6
Q

Metabolic syndrome diagnostic criteria (5)

A
  • Elevated waist circumference
  • Elevated triglyceride levels >1.7
  • Reduced HDL <1.0 (<1.3 in women)
  • Elevated BP >130/85
  • Elevated fasting glucose >5.5
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7
Q

Other causes of elevated troponin apart from ACS (9)

A
  • Cardiac surgery
  • Post-ablation or PPM insertion
  • HOCM
  • Tachyarrhythmias
  • Infiltrative disease (sarcoid, amyloid)
  • Myocarditis
  • PE
  • Renal failure
  • Rhabdo
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8
Q

Who is coronary calcium scoring suitable for?

A

Low -intermediate CVS risk people who are asymptomatic

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9
Q

Heart failure definitions

A

HFrEF = symptoms/signs and LVEF <50%
HFpEF = symptoms/signs and LVEF >50% and
–objective structural heart disease (LV hypertrophy, atrial enlargement)
–diastolic dysfunction

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10
Q

Heart failure specific symptoms (4) and signs (4)

A 
Symptoms:
-Dyspnoea
-Orthopnoea
-PND
-Fatigue
Signs
-Elevated JVP
-Hepatojugular reflex
-3rd heart sound
-Laterally displaced apex beat
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11
Q

HFpEF Rx (2)

A

-Diuretics + HTN management (MRA, ACEi/ARB preferred)

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11
Q

heart failure Acute decompensation causes (9)

A
  • AMI
  • Hypoxia
  • Arrhythmia (AF/VE’s)
  • Pericardial tamponade
  • Infections
  • Anaemia
  • Thyroid disease
  • Acute renal failure
  • New meds
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12
Q

HFrEF medical management algorithm

  • Congested vs. euvolaemic
  • How often to uptitrate meds
  • When to repeat TTE
  • Other options
A
  • Uptitrate meds every 2-4 weeks
  • Repeat TTE in 3-6 months
  • Change ACEi/ARB to ARNI if persistent HFrEF <40%
  • Consider ivabradine or device therapy if LVEF <35% and sinus rhythm >70bpm
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13
Q

Approach to managing Heart Failure comorbidities:

  • HTN
  • Coronary artery disease
  • AF
  • Hyponatraemia
  • COPD
  • Arthritis
A

-HTN
• Avoid diltiazem/verapamil/moxonidine in HFrEF
• HFpEF –> MRA +/- ACEi/ARB
-Coronary artery disease
• Ivabradine if sinus HR >70bpm and LVEF <35%
-AF
• B-blockers and digoxin preferred for rate control
-Hyponatraemia
• Restrict fluid
• Reconsider need for diuretics
-COPD
• B-blockers are safe for most w/ COPD
-Arthritis
• Avoid NSAIDs if ↓severe LVEF or hyponatraemia

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14
Q

AF anticoagulation doses & dose reduction criteria

A

Apixaban 5mg BD
–Dose reduce if 2 of, age >80, weight <60kg, Creat >133
Rivaraoxaban 20mg daily
–Dose reduce 15mg daily if CrCl 30-49 AND/OR combo w/ DAPT
Dabigatran 150mg BD
–Dose reduce to 110mg BD if age >75 OR CrCl 30-50 OR combo w/ DAPT

  • Bleeding risk scores should not be used to avoid anticoagulation in pts w/ AF - net benefit always favours stroke prevention > major bleeding
    • NOACs preferred to warfarin (even reasonable to change to NOAC from warfarin)
    • If antiplatelet agents indicated (e.g post-ACS or stent), only use clopi+aspirin for up to 12 mths
    • If Crl <30, use warfarin
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15
Q

AF Risk Factors (8)

A

-Heart failure
-HTN
-Valvular heart disease
-T2DM
-Obesity
-OSA
-Alcoholism
-Hyperthyroidism

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16
Q

AF risk factors for bleeding (6)

A

-HTN
-Labile INR
-Excess eTOH
-Anaemia
-Renal/liver impairment
-Frailty and falls

17
Q

AF Rhythm control - preferred in who?

A

-Younger, physically active people, highly symptomatic
-Paroxysmal/early persistent
-Presence of Left Ventricular dysfunction
-No severe L) atrial enlargement
-Adequate rate control difficult

18
Q

AF acute rhythm control options (3)

A

-Synchronised DC cardioversion (defer for 3/52 of OAC or TTE if AF >48 hours)
-Fleicainide
-Amiodarone

19
Q

AF long-term rhythm control options
-If no LV dysfunction
-If LV dysfunction
-Alternative

A

If no LV dysfunction or CAD - flecainide 50mg BD sotalol 40mg BD
If LV dysfunction - amiodarone 200mg TDS –> wean
-Catheter ablation (continue anticoag EVEN AFTER procedure if high stroke risk)

20
Q

AF long-term rate control options (4)

A

-Beta-blockers (atenolol 25mg daily, metoprolol 25mg BD)
-Non-DHP CCBs (Diltiazem/verapamil 180mg MR daily) - avoid if LV dysfunction
-Add digoxin to above (2nd line)
-Add amiodarone to above - 200mg daily

21
Q

DVT risk factors (6)

A

○ PHx of DVT
○ Sudden immobility/extended travel (within four weeks)
○ Surgery/medical illness (within three months)
○ Hormonal contraception
○ Pregnancy
○ FHx of venous disease

22
Q

DVT - blood tests before starting anticoagulation (4)

A

-FBE
-UEC/LFT
-Coags
-Beta-hcg (confirm not pregnant)

23
Q

DVT anticoagulant dosing

A

-Rivaroxaban 15mg BD for 3/52 –> 20mg daily
-Apixaban 10mg BD for 1/52 –> 5mg BD

CrCl needs to be >30
Dabigatran & warfarin need concurrent clexane as well

Clexane if pregnant

24
Q

Post-thrombotic syndrome prevention (1)

A

Graduated compression stockings from ankle to just below knee, 30-40mmHg

25
Q

Rheumatic heart disease management aspects (7)

A

○ Benzathine benpen 1.2 million units IM every 4 weeks
-Notifiable conditon (WA/NT/QLD/SA/NSW)
-Education re: early treatment of strep infections to prevent recurring ARF
-Continue anticoagulation during pregnancy
-Regular specialist r/v / TTE/dental review
-Annual flu vaccine
-Consider endocarditis prophylaxis for surgeries

26
Q

Endocarditis prophylaxis criteria (2)

A

1) Pre-existing cardiac condition (e.g prosthetic heart valve, rhuematic heart disease)
2) Type of procedure - dental, derm/MSK procedures w/ infected skin, resp/ENT, genitourinary/GI procedures

27
Q

HOCM inheritance pattern?
-Clinical presentation?
-Ix? (3)

A

-Autosomal dominant
-Often asymptomatic, usually exertional dyspnoea. Can have abnormal ECG/systolic murmur

-ECG - large QRS voltages +/- ST segment or T wave repolarisation changes
-TTE
-Holeter monitor - assess for presence of VT

28
Q

HOCM management aspects (5)

A

-Cease playing competitive sport (can do low-mod intensity exercise)
-Meds - bblockers/verapamil for symptomatic pts
-Septal reduction tehrapy - if severe LVOT
-ICD - if 1> RFs for sudden cardiac death
-Family screening - all 1st-deg relatives - exam, ECG, TTE
–Cascade screening for pathogenic HCM mutation

No need for prophylactic endocarditis Abx

29
Q

Pericarditis management
+1 examination finding

A

-Aspirin 750mg-1000mg TDS for 1-2/52
OR Ibuprofen 600mg TDS for 1-2/52, then wean

PLUS colchicine 500mcg BD (if >70kg) or daily (if <70kg)
PLUS activity restriction

Pericardial friction rub on ausc @ L) lower sternal border

30
Q

Routine investigations for newly diagnosed AF (6)

A

-FBE
-UEC
-TSH
-CMP
-TTE
-24 hour Holter

31
Q

Heart failure/APO initial investigations (8)

A

-ECG
-CXR
-Trop
-UEC
-FBE
-TSH
-Iron studies
-Echo

32
Q

Scleroderma patients - increased risk of what 3 conditions?

A

-Pulmonary hypertension (most commonly due to L) heart disease)
-Interstitial lung disease
-Anaemia

33
Q

Scleroderma Ix (3) & Rx aspects (3)

A

○ TTE - PAH
§ Annual screening of scleroderma pts with TTE
○ ECG - R) heart strain
○ CXR - enlarged pulmonary arteries

	Meds (various)
	Annual flu + pneumovax
	Avoid pregnancy due to poor maternal/foetal outcomes
34
Q

Wolff Parkinson White ECG features (3)

A

-Delta wave (slurred upstroke of QRS complex)
-Tall R waves
-Inverted T waves V1-V3 (mimicks RVH, but not actually present)

35
Q

LBBB ECG features (4)
Other conditions impacted re: concurrent diagnosis on ECG (2)

A

Broad QRS (duration > 120ms)
**Dominant S wave in V1
**Broad monophasic R wave in lateral leads (I, aVL, V5-6)
Absence of Q waves in lateral leads

Ventricular hypertrophy
Myocardial ischaemia/AMI

36
Q

RBBB ECG features (4)

A

Briad QRS (duration > 120ms)
RSR’ pattern in V1-3 (“M-shaped” QRS complex)
Wide, slurred S wave in lateral leads (I, aVL, V5-6
ST depression/T wave inversion in right precordial leads (V1-V3)

37
Q

Prolonging PR interval w/ dropout of QRS ?
vs. intermittent non-conducted P waves without progressive PR prolongation

A

Mobitz I - Wenckebach
Mobitz II

38
Q

LVH non-voltage criteria (2)

A

-Increased R wave peak time V5-V6
-ST segment depression/T wave inversion I, aVL, V5-V6

Also left axis deviation

39
Q

STEMI territory names for:
-V1-V2
-V3-V4
-V5-V6
-I, aVL
-II, III, aVF

A
  • V12 Anteroseptal
    -V34 Anteroapical
    -V56 Anterolateral
    -I, aVL Lateral
    -II, III, aVF Inferior
40
Q

Anticoagulation withholding timeframes prior to surgery
-Dabigatran/Riva/Apixa
-Aspirin
-Antiplatelets

A

-Apix/Riva/Dabig - 1-3 days prior to surgery
-Aspirin - ?continue (or WH 7 days prior)
-Antiplatelets - 5-7 days prior

Warfarin - INR <1.5 before surgery, check INR 7 days prior
W/H 3-5 days prior
(Clexane if INR <2 (subtherapeutic))

Exams :) (20 decks)

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