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AKT > Cardiology > Flashcards

Cardiology Flashcards

1
Q

steps of Hypetension

A

A if under 55
C if over 55.

then A+C / A+D. C+A / C+D

THEN A+C+D (Thiazide like diuretic

Then if k+ >4.5 - a/b blocker
if k+ under 4.5 spiranolactone

see specialist.

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2
Q

what are the cut offs for blood pressure

A

140/90in clinic the give home reading.

135/85 at home means stage 1

150/95 means stage 2 - treat regardless

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3
Q

when to treat stage 1 of HTN

A

If <80 AND Any of
Target organ damage
Established CVD
Renal disease
Diabetes
10 year cardiorisk

TERD 10.

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4
Q

well score more than 4 or less than 4

A

more than 4 PE likely - do CTPA if you can’t do anticoagualte.
less than 4 PE unlikely - do dimer

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5
Q

Angina Management

A

Aspirin and Statin
GTN to abort attacks

Nice recommend B-blocker or C-blocker first line.

Ca blocker is mono therapy (Diltiazam / Verapamil)

if used with beta blocker (have to use long acting dihdropyridine (nifedipine to avoid heart block)

if no benefits increase both doses

next step is nicorandil/ranolozine/ivabradine

refer to PCI /CABG.

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6
Q

what is next step for Afrocarribean taking Amlodipine for BP

A

ARB losartan or. candesartan as NICE say is more effective that ACE.

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7
Q

When to refer HTN

A

if on third drug / uncontrolled

or

Under 40 with stage 1 HTN and no evidence of target organ damage.

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8
Q

angina and abdominal pain what med is causing

A

nicorandil can cause GI ulcers. Don’t use in diverticulitis.

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9
Q

Which HTN drug causes Low libido and ED.

A

BB

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10
Q

driving post MI and PCI according to DVLA

A

IF NO other PCI planned
EF <40% drive within 1 week
don’t need to inform the DVLA

if taxi.lorri.bus then inform DVLA and 6 week’s.

if not successful PCI then 4 weeks.

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11
Q

what do you see on ECG for WPW wolf Parkinson white

A

Short PR INTERVAL and Upsloping of ST. sometimes called delta wave.

axis deviation away from the side that is affect ed.

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12
Q

when do you stop statins

A

s/e
if on macrocodes (mycin)
pregnancy

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13
Q

what side effects can you have with ACE inhibitors and with which drug / medical condition

A

Hypotension you can have with High dose loop diuretics (furosemide 80mg)
or with Aortic stenosis

You don’t really get it with Bendroflumethiazide (thiazide ) as its a weak diuretic prescribed commonly with ACEi .

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14
Q

How soon after an MI can you have sex

A

4 weeks

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15
Q

Give me 3 lifestyle advices after MI

A

Advise Mediterranean diet - butter and cheese swap for oil based products - don’t recommend omega 3 or oily fish

exercise 20-30 mins a day or until slight breathless

No sex for 4 weeks after MI - avoid Sildenafil for 6 months or avoid if taking nicoradil/ nitrates.

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16
Q

What drugs following MI

A

Dual antiplatelet therapy
ACEi
B blocker
Statin.

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17
Q

Acute MI and have symptoms of Heart Failure which drug should be added

A

Aldosterone Antagonist - Eplerenone.

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18
Q

who should get primary statin prevention

A

10 year cardiovascular risk >10%
T1DM more than 10 years
EGFR <60

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18
Q

who should get primary statin prevention

A

10 year cardiovascular risk >10%
T1DM more than 10 years
EGFR <60

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19
Q

acute mi DRIVING ADVICE

A

If ACS - 4 weeks off driving

1 week if successfully treated with PCI

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20
Q

acute mi DRIVING ADVICE

A

If ACS - 4 weeks off driving

1 week if successfully treated with PCI

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21
Q

what resting BP does group 2 drivrrs need

A

under 180 s or 100 d

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22
Q

CABG driving

A

4 weeks

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23
Q

PPM driving post

A

1 week

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24
Q

ICD driving

A

if arythmia - 6 months
if prophylaxis - 1 month

any ICD bars group 2 license

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25
Q

catheter ablation for arrhythmia post driving

A

2 days

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26
Q

AAA more than 6cm - DVLA

A

inform DVLA - need annual review
more than 6.5 ban from driving

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27
Q

heart transplant driving

A

6 weeks don’t need to inform

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28
Q

which calcium channel blockers used in Angina as dual therapy with beta blocker
and which as mono therapy

A

dual - nifidepine, felodipine

mono - verapamil and diltiazam

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29
Q

when NOT to use rate control in AF

A

If reversible cause
heart failure caused by AF
Atrial Flutter - that could be ablated

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30
Q

Chads vasc what are the results

A

0 - 2 months anticoagulation
more than 1 - lifelong.

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30
Q

Chads vasc what are the results

A

0 - 2 months anticoagulation
more than 1 - lifelong.

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31
Q

Chads vasc what are the results

A

0 - 2 months anticoagulation
2 or more- lifelong. if woman
1 or more life long if. man

32
Q

ChadsVasc 2 scoring

A

CCF
Hypertension or treated
A2ge - 75 = 2, 65=1
Diabetes
S2troke or TIA. =2
Vascular disease
S ex - female.

1 for everything but you can score 2 on age or stroke.

33
Q

has-bled stand for and scoring

A

hB 130 M. / 120 F (2)
Age 74
bleeding history (2)
Renal impairment - EGFR <60
anti platelet - 1

0-2 low
3 med
4-7 high

34
Q

warfarin management of high INR.
Major Bleeding

A

Stop Warfarin
IV Vit K 5mg
Prothrombin complex concentrate if not then FFP

35
Q

Warfarin Management of high ins
INR >8 minor bleed

A

Stop warfarin
Give intravenous vitamin K 1-3mg
Repeat dose of vitamin K if INR still too high after 24 hours
Restart warfarin when INR < 5.0

36
Q

INR > 8.0
No bleeding

A

Stop warfarin
Give vitamin K 1-5mg by mouth, using the intravenous preparation orally
Repeat dose of vitamin K if INR still too high after 24 hours
Restart when INR < 5.0

37
Q

INR 5 - 8
Minor Bleeding

A

Stop warfarin
Give intravenous vitamin K 1-3mg
Restart when INR < 5.0

38
Q

INR 5-8 no bleeding.

A

Withhold 1 or 2 doses of warfarin
Reduce subsequent maintenance dose

39
Q

biggest factor for resistant hypertension

A

Raised BMI

40
Q

when to use bio prosthetic valve and what to give post op

A

> 65 aortic or >70 mitral
long term anticoagulation not needed. give aspirin long term and warfarin for 3 months.

41
Q

blood monitoring of LFT

A

baseline
3 month
12 month

42
Q

4 side effects of GTN

A

Hypotension , Tachycardia , Headache. , flushing

43
Q

DVLA for ICD insertion or shock of ICD

A

Group 1 - 6 months can’t drive
group 2 - can’t drive for life.

44
Q

first Line investigation for angina - stable

A

CT coronary angiography.

then its non invasive stuff

then invasive angio

45
Q

side effect of thiazide like diuretic and gout

A

raises serum rate levels.

46
Q

new BP 180/120 and no worrying signs what is next step management

A

Carry out investigations for target organ damage - ECG, Urine and bloods.

47
Q

if Patient taking high dose furosemide 80mg and you want to start ACEi WHAT DO YOU DO

A

Refer to secondary care.

48
Q

bendroflumethiazide has what side effect on blood sugar control

A

causes hyperglycaemia

49
Q

when not to use indapamide for HTN

A

if hyponatremia

50
Q

if k+ > 4.5 what to do for step 4 HTN

A

use alpha blocker or beta blocker (alpha = doxazocin)

51
Q

what bloods to check before starting anti-arrythmic drug

A

Hypokalemia.
Amiodarone causes hypokaelima .

52
Q

Amiodarone Monitoring

A

TFT, LFT , UE , CXR prior to treatement

TFT, LFT every 6 months.

53
Q

if ABPM at home is stable - what is next course of action

A

recheck every 5 years.

54
Q

what medication do you stop in left atrial appendage closure.

A

anticoagulation.

55
Q

what blood tests do you check for with statins and when do you stop statin

A

LFT - if Serum ALT/AST go 3x the upper limmit.

56
Q

Patient with CVD and now new AF - chadsvasc score high what med do you start and what med do you stop - why

A

stop antiplatet if CVD stable
start DOAC.

57
Q

S/E of thiazide diuretics 5

A

Hypokalemia
hypercalcemia
Impotence
Impaired Glucose tolerance
GOUT (not pseudogout)

58
Q

which drugs reduce mortality in LVF heart failure

A

ACE
BB
ARB
Aldosterone Antagonists
Hydralazine / Nitrates.

59
Q

at what step do you refer to Cardio in ANGINA

A

step 3 - adding in nitrates.

60
Q

what should target home readings be for BP

A

135/85

61
Q

nicorandil has what side effect

A

ULCERATION of anal, mouth , eye or GI.

62
Q

if patient has stage 1 HTN ( >135/85 BUT LESS THAN 150/95) What is management plan
O

A

Over 80 start meds
Under 80 AND any of following - start meds
- Target organ damage
- renal disease
- DM
- CVD
Qrisk >10 %

63
Q

Common cause of Secondary HTN

A

Conns

64
Q

HOCM is what type of inheritance

A

Autosomal dominant - you have one variant you’re fooooked.

65
Q

HOCM is what type of inheritance

A

Autosomal dominant - you have one variant you’re fooooked.

66
Q

Features of Echo findings in hocm

A

MR (Mitral regurgitation)
SAM( systolic anterior motion of anterior mitral valve leaflet)
ASH(ASymmetric hypertrophy)

67
Q

Myopathy is more common in which types of statins

A

Lipopholic - Simvastatin atorvastatin
not as common in hydrophobic like rosuva and prava.

68
Q

iF UNDER 60 AND STAGE ONE HTN WITH NO END ORGAN DAMAGE HOW TO MANAGE

A

LIFESTYLE
MONITOR ANNUALY
CONSIDER STARTING meds.

69
Q

how to record HMBP

A

2 readings - BD
4-7 days
discard first day.

70
Q

clinic reading above what to trigger HTN pathway

A

140/90

71
Q

normotensive amount
stage 1 criteria
stage 2 criteria
SEVERE HTN

when do we treat stage 1

A

<135/85
>135/85
>150/95
>180 >120

IF UNDER 80 AND
TARGET END ORGAN DAMAGE
CVD
RENAL DISEASE
DIABETES
10 YEAR RISK 10%

72
Q

WHAT IS AIM FOR HTN UNDER TREATMENT

A

140/90 Clinic
135/85 at home.

73
Q

how to maintain nitrate free period

A

take second dose before 12 hour mark.

74
Q

when to inform DVLA about HTN

A

if Group B and Above 180/110.

75
Q

When checking UE after starting ACEi - what to do with results

A

If Creatinine doubles/more than 300 or K+ goes >5.5

76
Q

which juices affect which drugs/meds

A

Cranberry - red like blood - warfarin
Grapefruit - yellow like fat - statin

77
Q

Takayyasu Arteritis demographic

A

10-40 asian women (sounds asian)
absent pulse

manage with steroids

78
Q

BP target for >80

A

150/90

79
Q

T1DM blood pr3ssure target

A

135.85

iF ANY Albuminuria 130/80.

80
Q

why do we need to be cautious using BB in Diabetics

A

Beta-blockers can theoretically suppress all of the adrenergically mediated symptoms of hypoglycemia and thus can lead to unawareness of hypoglycemic events.

AKT (3 decks)

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