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Pocket MSRA - Book 1 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is Stable Angina?

A

Exertional sounding chest pain, relieved by PRN GTN

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2
Q

What is the NICE approved 1st line investigation for stable angina?

A

CT coronary angiogram

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3
Q

What is the NICE algorithm for treating stable angina?

A

1 - B-blocker
2 - AND/OR dihydropyridine CCB
3 - ADD one of:
ISMN, Ivabradine, Ranolazine, Nicorandil
4 - Revascularisation

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4
Q

What is the 1st line treatment for Prinzmetal angina?

A

Dihydropyridine CCB (Amlodipine/Diltiazem)

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5
Q

What is the method of action of ISMN?

A

Vasodilator

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6
Q

What are the common side effects of ISMN?

A

Flushing, headaches, hypotension

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7
Q

What advice should be given when starting ISMN?

A

Take between 08:00 & 14:00 to avoid nitrate intolerance

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8
Q

What is the method of action of Ivabradine?

A

Slows HR down

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9
Q

What key requirement is there for starting Ivabradine?

A

Patient needs to be in NSR w/ HR >70bpm

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10
Q

When should Ivabradine be stopped?

A

In 3/12 if not working

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11
Q

When is Ranolazine a good choice for stable angina?

A

If bradycardic - improves HR

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12
Q

What are the side effects of Ranolazine?

A

Long QT

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13
Q

What are the contraindications to Ranolazine?

A

Moderate cardiac/renal/liver failure

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14
Q

What is the method of action of Nicorandil

A

Vasodilator

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15
Q

What are the contraindications to Nicorandil?

A

Low BP
LV dysfunction

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16
Q

What 2o prevention is given in stable angina?

A

Aspirin 75mg
Statins
ACE-i (if diabetic or LV dysfunction)

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17
Q

What is the Qrisk2 score used for?

A

Quantify 10 year cardiovascular risk

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18
Q

How often should Qrisk2 score be checked?

A

Every 5 years
(more frequently if known cardiovascular disease/high risk/>85)

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19
Q

What Qrisk2 score indicates starting Statins?

A

> 10%
(or if lifestyle interventions ineffective)

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20
Q

In what patient groups may Atorvastatin 20mg be used for 1o prevention without risk stratification?

A

> 85 y/o
CKD

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21
Q

How should Statins be used in proven CVD?

A

2o prevention
High-intensity statins (80mg Atorvastatin)

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22
Q

What are the treatment targets for high-intensity statins in proven CVD?

A

3/12 > 40% non-HDL reduction
(if not achieved inc dose)

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23
Q

What are the side effects of statins?

A

Myositis
Rhabdomyolysis - rare
Hepatitis
CONSTIPATION

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24
Q

What monitoring should be done for patients on statins?

A

LFTs at baseline, 3/12, 12/12
no need for CK if asymptomatic

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25
Q

In which patient group are statins contraindicated?

A

Pregnant women

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26
Q

What interaction does Amlodipine have with statins?

A

Interacts with simvastatin ONLY to increase level (acts as weak inhibitor)

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27
Q

How is Ezetibime used in lipid modification?

A

Monotherapy of 1o hypercholesterolaemia where statins are contraindicated

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28
Q

How are Fibrates used in lipid modification?

A

2o care
Better reduction of triglycerides

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29
Q

What are the risks of Fibrates?

A

Gallstones
Increased risk of Rhabdomyolysis when given w/ statins

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30
Q

How are Aliro/evoloCUmab used in lipid modification?

A

Specialist drug
1o heterozygous familial hypercholesterolaemia
Lowers LDL-C

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31
Q

What is Unstable Angina?

A

Cardiac sounding chest pain at rest
Troponin negative

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32
Q

How is risk determined in Unstable Angina?

A

GRACE score
If Low - DAPT + elective angiogram
If High (6/12 mortality >3%) - angiogram +/- proceed in SAME ADMISSION W/I 72HRS

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33
Q

What is Prinzmetal Angina?

A

Angina caused by a spasm in the coronary arteries (no lesion to stent)

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34
Q

How does Cocaine toxicity caused Prinzmetal Angina?

A

Sympathetic stimulation

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35
Q

What are the treatment options for Prinzmetal Angina?

A

Nitrates + CCB +/- angiogram (if not controlled)

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36
Q

What class of medications are used to control cocaine-induced hypertension?

A

Benzodiazepines

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37
Q

What is the protocol for conservative management of ACS?

A

MONA-BASH
Morphine, O2, nitrates (GTN S/L)
DAPT (Aspirin + Ticag/Clopi)
2o prevention
-Bisoprolol
-Aspirin
-Statins
Heparin (Fondaparinux)

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38
Q

What is the protocol for non-conservative management of ACS?

A

PPCI
-STEMI 90mins
-NSTEMI 72hrs

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39
Q

What medications are used for 2o prevention in ACS?

A

Bisoprolol
Aspirin
Statins

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40
Q

What are the ECG diagnostic criteria for STEMI?

A

> 1mm STE in contiguous limb lead
2mm STE in contiguous chest leads (1.5mm in women)
New LBBB

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41
Q

What patient groups may not present with chest pain in ACS?

A

Women
Diabetics

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42
Q

What ECG leads correspond to the inferior territory?

A

II, III, aVF
(RCA/LCx)

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43
Q

What ECG leads correspond to the anterior territory?

A

V1-V4
(LAD)

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44
Q

What ECG leads correspond to the lateral territory?

A

I, aVL, V5, V6
(LCx, LAD diagonal branch)

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45
Q

What is Wellen’s Syndrome?

A

Biphasic T-wave in V1 & V2
-only during chest pain
-critical LAD stenosis

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46
Q

What are the ECG findings of Pericarditis?

A

Widespread concave ST elevation w/ PR depression
-later on ST normalises w/ TWI

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47
Q

What are the treatment options for Pericarditis

A

NSAIDs
Colchicine

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48
Q

What are the s/e of Colchicine?

A

Diarrhoea
Nausea
Vomiting

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49
Q

What are the ECG findings of Brugada Syndrome?

A

Coved STE in >1 of V1-V3 followed by TWI

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50
Q

What is Brugada Syndrome?

A

Coved STE in >1 of V1-V3 followed by TWI + at least one of the clinical criteria

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51
Q

What are the clinical criteria for diagnosis of Brugada Syndrome?

A

Documented VF/polymorphic VT
Family hx sudden cardiac death <45
Coved-type ECGs in family members
Syncope
Nocturnal agonal resp
VT induced by electrical stimulation

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52
Q

What factors can unmask Brugada Syndrome?

A

Fever
Ischaemia
Drugs (cardiac)
Hypo/Hyperkalaemia
Post DC cardioversion
Hypothermia

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53
Q

What is the management for Brugada Syndrome?

A

ICD

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54
Q

What are the ECG diagnostic criteria for Left Ventricular Hypertrophy?

A

Voltage Criteria
-sum of deep S wave in V1 and tall R wave in V5-V6 >35mm
Non Voltage Criteria
-ST depression & TWI in LEFT sided leads

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55
Q

What are the ECG findings of Hypertrophic Obstructive Cardiomyopathy?

A

Left Ventricular Hypertrophy
Asymmetrical deep septal hypetrophy (deep Q waves in inferolateral leads)
LEFT atrial enlargement (P mitrale)

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56
Q

What are the ECG findings of High take-off?

A

Widespread STE at J-point
(young, healthy men)

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57
Q

What commonly prescribed drug interacts with Clopidogrel?

A

Omeprazole
-CYP450 inhibitor
-reduces its effectiveness
-Lansoprazole doesn’t interact, or Ticagrelor does not interact

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58
Q

When is Tirofiban used?

A

High-risk ACS patients

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59
Q

What are the side effects of Tirofiban?

A

Anaemia
Thrombocytopenia

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60
Q

What DVLA advice should be given to ACS patients?

A

Group 1
-no need to notify
-resume 1/52 if successful rx AND LVEF >40% AND no further revascularisation planned
-resume 4/52 otherwise
Group 2 (HGV)
-notify
-re-licensed >6/52 if LVEF >40% and ETT/ECG normal (Bruce protocol)

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61
Q

What are the complications of MI, and at what time do they occur?

A

<4hrs - cardiogenic shock/arrest, arrhythmias
4-24hrs - arrhythmias
1-3 days - fibrinous pericarditis
4-7 days - rupture of free wall, IV shunt, papillary muscle rupture (regurg)
Weeks-months - fibrosis of ventricular wall, weakn aneurysms w/ mural thrombosis, Dressler syndrome

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62
Q

What is Dressler Syndrome?

A

Autoimmune pericarditis post MI

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63
Q

When should ABPM be offered?

A

If clinic BP b/w 140/90-180/120

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64
Q

What are the diagnostic criteria for HTN?

A

Clinical BP >140/90 AND ABPM average >135/80
Stage 1 - clinical BP >140/90 AND ABPM average >135/80
Stage 2 - clinical BP >150/90 AND ABPM average >150/95
Stage 3 - SBP >180 or DBP >120 chronically

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65
Q

What is the NICE algorithm for HTN treatment?

A

1 - ACEi if <55 or T2DM, CCB if >55 or Afro/Carribean
2 - Add either CCB or Thiazide-like diuretic (Indapamide)
3 - ACEi + CCB + Indapamide
4 - Spironolactone if K+ <4.5, a/B-Blocker if K+ >4.5

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66
Q

What are the side effects of CCBs?

A

Ankle oedema
Headache
Flushing
GINGIVAL HYPERPLASIA
Constipation
Ulcers (Nifedipine)

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67
Q

What are the side effects of Thiazides?

A

IMPOTENCE
HYPERCa
HypoNa/K
Gout

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68
Q

What are the red flags requiring investigation for a 2o cause of HTN?

A

<40 y/o
Sudden worsening
Accelerated/malignant (>200 SBP)
Stroke <50
Refractory (>140/90 OR >130/80 w/ DM AND on 3x drugs)

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69
Q

What are the endocrine causes of HTN and what ix should be performed for each?

A

Acromegaly (OGTT, IGF-1)
Hyperthyroidism (TFTs)
Conn’s Adenoma (Aldosterone:Renin ratio, if >40 for CT adrenal)
Cushing’s (Dex suppresion test)
Phaechromocytoma (24hr urinary metanephrines)

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70
Q

What are the renal causes of HTN?

A

Adult polycystic kidney disease (USS renal tract)
Renal aa stenosis/fibromuscular dysplasia (MRA renal aa +/- angio)
Glomerulonephritis (dipstick, MCS, pro)

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71
Q

What is the drug of choice for HTN in systemic sclerosis renal crisis?

A

Ramipril

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72
Q

What are the drugs of choice for controlling HTN in Pre-eclampsia?

A

Labetalol
Nifedipine
Methyldopa

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73
Q

What are the drugs of choice for controlling HTN in Aortic dissection?

A

IV Labetalol/Esmolol
(target SBP 100-120)

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74
Q

What is the drug of choice for controlling HTN in Conn’s syndrome?

A

Spironolactone

75
Q

What are the drugs of choice for treating malignant HTN?

A

Nitrates
Nitroprusside
Labetalol

76
Q

What is the drug of choice for controlling HTN in SAH?

A

Nimodipine (reduces vasospasm)
(hyperhydration w/ 3L IVI)

77
Q

What are the NYHA classifications for Heart Failure?

A

Class 1 - no limitations
Class 2 - mild sx w/ normal activity, minimal limitation
Class 3 - mod sx w/ minimal activity, moderate limitation
Class 4 - sx at rest

78
Q

What are the principles of managing patients with CCF in hospital?

A

Fluid balance - IP/OP charts, U&Es, fluid restrict, daily weights
Echo
Diuretics - IV Furosemide, consider PO Bumetanide
Consider ISMN/Hydralazine if renal function poor

79
Q

What is the method of action of Furosemide in Heart Failure?

A

Loop diuretic to offload fluids
NO PROGNOSTIC BENEFIT

80
Q

What are the side effects of Furosemide?

A

HypoK/Na
Exacerbation of hyperglycaemia
Gout

81
Q

What diuretics can be added if oedema is refractory to Furosemide in heart failure?

A

Mineralocorticoid antagonist (Spironolactone) - PROGNOSTIC BENEFIT
Thiazides (Metolazone)

82
Q

What is the method of action of ACEi in heart failure?

A

Remodel the heart by reducing afterload (BP)
PROGNOSTIC BENEFIT

83
Q

What are the side effects of ACEi?

A

Hyperkalaemia
Dry cough
Angioedema

84
Q

Which B-Blockers have prognostic benefit in heart failure?

A

Bisoprolol
Carvedilol (cardiac slsective)
Metoprolol

85
Q

What contraindications are the to prescribing B-blockers in heart failure?

A

Caution in asthmatics
Not to be used w/ non-dihydropyridine CCB (Verapamil) - causes low cardiac output

86
Q

What can be given to treat B-Blocker overdose?

A

IV Glucagon

87
Q

What are the side effects of Spironolactone?

A

Painful gynaecomastia
Hyperkalaemia
Impotence

88
Q

What alternative MRA can be considered if Spironolactone is not tolerated?

A

Eplerenone

89
Q

What is Entresto and when is it indicated in heart failure?

A

Combination of Valsartan (PROGNOSTIC BENEFIT) and Sacubitril
Indicated if LVE <35%

90
Q

What are the indications for Ivabradine in heart failure?

A

LVEF <35% AND NSR AND HR >75bpm

91
Q

What are the indications for Digoxin in heart failure?

A

NSR to improve sx (+ve inotrope)
(requires loading)

92
Q

What is the management of HFpEF?

A

No prognostic medications
Diuretics for sx
Avoid B-blockers

93
Q

What is the acute management of pulmonary oedema?

A

A - sit patient up
B - high-flow O2, CPAP
C - if SBP >90-100 give nitrate, nitroprusside and opiates. Caution w/ IV Furosemide and IVI
D/E - treat underlying causes
Avoid B-blockers
If SBP <90 treat as cardiogenic shock (inotropes)

94
Q

What is high output heart failure?

A

Failure of heart to meet increasing needs
-anaemia
-hyperthyroidism
-Paget’s
-acromegaly
-AV malformations
-pregnancy
-malnutrition

95
Q

When are ICDs used in heart failure?

A

Cases of narrow complex QRS w/o LBBB

96
Q

When is CRT (biventricular pacing) used in heart failure?

A

LBBB or broad complex QRS

97
Q

How does aortic stenosis present?

A

Angina
Syncope
SOBOE
LVF (LV outflow tract obstruction)

98
Q

What commonly prescribed drugs can worsen aortic stenosis?

A

Vasodilators/ACEi (decrease afterload)
B-blockers/CCB (decrease contractility)

99
Q

What is the characteristic murmur of aortic stenosis?

A

Ejection systolic murmur
-loudest at LEFT sternal edge
-radiating to carotids
-low-volume, slow rising pulse

100
Q

What are the indications for surgical management of aortic stenosis?

A

Symptomatic AS
Asymptomatic w/ severe AS on ECHO

101
Q

How should aortic stenosis be monitored?

A

Annual ECHO

102
Q

What investigation should not be performed when investigating aortic stenosis?

A

Stress exercise test

103
Q

How does mitral regurgitation present?

A

Usually mild/asymptomatic
Severe MR presents as heart failure (flash pulmonary oedema)
AF

104
Q

What is the medical management of mitral regurgitation?

A

Control heart failure and AF
(severe cases require surgery)

105
Q

What is the characteristic murmur of mitral regurgitation?

A

Apical panystolic murmur radiating to axilla
Apex displacement DOWN w/ LEFT parasternal heave

106
Q

How should mitral regurgitation be monitored?

A

Annual ECHO

107
Q

What is the most common causative organism of infective endocarditis?

A

Staph aureus

108
Q

What is the gold standard investigation for infective endocarditis?

A

Transoesophageal EHO
(TTE often used)

109
Q

Which valve is commonly affected in infective endocarditis in IVDU?

A

Tricuspid
(RIGHT sided due to venous introduction)

110
Q

What are the complications of infective endocarditis?

A

Aortic valve vegetation
-can progress to abscess causing aortic root dilatation
Septic emboli to vascular beds

111
Q

How can septic emboli in infective endocarditis be identified?

A

Kidneys - urine dipstick
Brain - MRI
Retina (Roth spots) - fundoscopy
Spleen - Splenomegaly, CT AP
Limbs - ischaemic limb, pulses, CTA

112
Q

What isolated bacteria in infective endocarditis would indicate colonoscopy?

A

S. bovis/gut commensals
(screen for colorectal ca)

113
Q

What are the diagnostic criteria for infective endocarditis?

A

Duke Criteria - 2 major OR 1 major + 3 minor OR all minor
MAJOR (BE) - 2x +ve BC, endocardium involvement (new murmur, abscess etc.)
MINOR - >38C, +ve BC, immunological phenomenon (glomerulonephritis, Olser nodes), vascular phenomenon (Janeway lesions), risk factors (IVDU, immunocompromise, artificial valve)

114
Q

What is Libmann-Sacks endocarditis?

A

Sterile vegetations on both sides of valve in SLE

115
Q

What is an atrial myxoma?

A

Atrial tumour

116
Q

How do atrial myxomas present?

A

Positional dizziness
SOB
Palpitations
Pansystolic murmur
FEMALE

117
Q

What are the symptoms of carcinoid syndrome?

A

Adult-onset refractory wheeze (mistaken for asthma)
Diarrhoea
Facial flushing
New murmur (RIGHT sided - PS or TR

118
Q

What is carcinoid syndrome?

A

Syndrome of excess 5-HT production caused by neuroendrocrine tumour

119
Q

What are the common sites of carcinoid tumours?

A

GI TRACT
-require liver mets to give rise to sx
Lungs
Kidneys
Breast

120
Q

What are the treatment options for carcinoid syndrome?

A

Octreotide
Resection

121
Q

What are the ECG findings of 1o AV block?

A

Prolonged PR (>200ms)
QRS relationship maintained

122
Q

What are the ECG findings of Mobitz 1 (Wenckebach)?

A

Progressive prolongation of PR interval until dropped QRS

123
Q

What are the ECG findings of Mobitz 2?

A

Normal PR interval
Randomly dropped QRS complexes

124
Q

What are the ECG findings of 3o AV block?

A

AV dissociation

125
Q

What are the ECG findings of Bifascicular block?

A

RBBB AND
LEFT ant OR post fascicular block (LEFT or RIGHT axis deviation respectively)

126
Q

What are the ECG findings of Trifasicular block?

A

Classically - Bifascicular block and 1o AV block
Misnomer - true trifascicular block is a complete heart block

127
Q

What are the ECG findings of Monomorphic VT?

A

Identical, concordant, broad QRS complexes

128
Q

What are the ECG findings of Polymorphic VT?

A

Concordant, broad QRS complexes w/ multiple morphologies

129
Q

What are the ECG findings of Torsades de Pointes?

A

Polymorphic VT w/ long QT
Discordant

130
Q

What is the emergency treatment of Torsades de Pointes?

A

IV Magnesium

131
Q

What are the ECG findings of VF?

A

Chaotic irregular waveforms of varying amplitude
No P/QRS/T

132
Q

What are the EG findings of Tachy-brady syndrome?

A

Alternating brady and tachycardia

133
Q

What is the management of Tachy-brady syndrome?

A

Pacemaker for bradycardia and rate-control
B-blockers for tachycardia

134
Q

What are the ECG findings of PEA?

A

Any ECG rhythm but no pulse clinically

135
Q

What are the ECG findings of Wolf-Parkinson White?

A

Slurred upstroke of QRS complex (delta wave)
Shortened PR

136
Q

What are the ECG findings of arrhythomgenic RIGHT ventricular cardiomyopathy?

A

Small +ve deflection at end of QRS (epsilon wave)
Slightly wide QRS

137
Q

What are the ECG findings of hypothermia?

A

Bradycardia w/ prolonged ventricular ectopic
Prolongation of P-wave, QRS, QTc
Positive deflection at J-point (Osborne wave)

138
Q

What are the ECG findings of hypercalcaemia?

A

Short QTc

139
Q

What are the ECG findings of hypocalcaemia?

A

Long QTc
-can degenerate to TdP

140
Q

What are the ECG findings of hyperkalaemia?

A

Prolonged PR interval
Small/absent P-waves
Peaked T-waves
Widened QRS complexes
Degenerates to sinusoidal rhythm - VF - asystole

141
Q

What are the ECG findings of hypokalaemia?

A

Deflection after T-wave (U-wave)
Flat T-waves
ST depression

142
Q

What are the ECG findings of RBBB?

A

RSR findings V1-V3

143
Q

What are the ECG findings of LBBB?

A

Deep S-wave in V1-V3 (W)
LAD

144
Q

What are the ECG findings of pacemaker rhythms?

A

RV pacemaker leads to LBBB
LV pacemaker leads to RBBB

145
Q

What are the ECG findings of PE?

A

SINUS TACHYCARDIA
RIGHT heart strain
-RAD
-ST depression
-TWI in V1-V3, II, III, aVF (anteroinferior)
Q1S3T3 (Q-wave in I, S&T inversion in III)

146
Q

What are the causes of a prolonged QTc?

A

Drugs (Digoxin, TCA, macrolides, quinolones, anti-psychotics)
Hypos (Ca, Mg, K, thermia, thyroid, adrenalism)
Ischaemia/general illness

147
Q

What are the ECG findings of Atrial Fibrillation?

A

Irregularly irregular
Narrow QRS complexes
Lack of P-waves

148
Q

What are the ECG findings of Atrial Flutter?

A

P-waves w/ sawtooth baseline
300bpm limited by AV blocks (ie. 2:1)

149
Q

What scoring systems are used to assess the need for anticoagulation in AF?

A

HASBLED/ORBIT
CHA2DS2VASC

150
Q

What are the components of the HASBLED score?

A

HTN
Abnormal renal/liver function
Stroke hx
Bleeding history/predisposition
Labile INRs
Elderly
Drugs/Alcohol

151
Q

What are the components of the ORBIT score?

A

Sex
Hb concentration
Age
Bleeding history
Antiplatelet therapy

152
Q

What are the components of the CHA2S2VASC score?

A

C - Congestive HF
H - HTN
A2 - Age >75
D - Diabetes
S2 - Stroke/TIA/VTE
V - Vascular hx (MI/PVD)
A - Age 64-75
Sc - Female (ONLY IF ANY OTHER SCORE)

153
Q

When should rhythm control be considered in AF?

A

Young patients
Reversible/acute onset <48hr
Sx of CCF
COMPROMISE

154
Q

What are the options for rhythm control in AF?

A

Electrical
-DC cardioversion (ECHO, anticoag)
-ablation (oulmonary vv)
Chemical
-Amiodarone
-Flecanide

155
Q

Why is an ECHO required prior to DC cardioversion in AF?

A

To check for intramural thrombus

156
Q

How should anticoagulation be given around DC cardioversion in AF?

A

4 weeks prior AND 12 months after

157
Q

In which patients is Amiodarone preferred for chemical cardioversion?

A

Patients w/ LV failure

158
Q

What are the side effects of Amiodarone?

A

Photosenstivity
Slate grey pigmentation
Hepatotoxicitity
Hypo/Hyper thyroid
Pulmonary fibrosis

159
Q

Which commonly prescribed cardiological drugs does Amiodarone interact with?

A

Warfarin
Digoxin

160
Q

How is Flecanide used for chemical cardioversion?

A

For paroxysms
(pill in pocket)

161
Q

In which patients is Flecanide contraindicated?

A

Patients w/ structural heart condition

162
Q

What are the options for rate control in AF?

A

B-blocker
-preferred if angina/HTN
CCB (Diltiazem/Verapamil)
Digoxin
-sedentary patients
-CHF

163
Q

What are the symptoms of Digoxin overdose?

A

N/V/D
Blurred vision w/ xanthopsia/haloes
Palpitations/syncope
Confusion

164
Q

What is the treatment for Digoxin overdose?

A

Digibind
-fab fragment

165
Q

In which patient group is rate control for AF contraindicated?

A

Pt w/ accessory pathway (WPW)
-favours conduction down that pathway
-loses AV node safety netting

166
Q

What are the 4 adverse features of arrhythmias?

A

Shock
Syncope
MI
HF

167
Q

What are the management options for profound bradycardia?

A

Atropine 500mcg
-up to 3mcg if risk of asystole
IV Isoprenalie
IV adrenaline
Transcutaneous pacing
-proceed to PPM

168
Q

What features in a bradycardic patient suggest a higher risk of asystole?

A

Recent asystole
Mobitz II or 3o AV block
Pauses >3s

169
Q

What is the management for an unstable tachycardia?

A

Synchronised DC shock x3
Amiodarone 300mg IV/10-20mins
Repeat shock
Amiodarone 900mg/24hrs

170
Q

What is the management for a regular narrow complex tachycardia?

A

Vagal manoeuvres
Adenosine 6/12/12mg boluses
Rate control (atrial flutter)

171
Q

What is the management for an irregular narrow complex tachycardia?

A

AF management

172
Q

What is the management for a regular broad complex tachycardia?

A

Amiodarone 300mg IV/20-60mins THEN 900mg/24hrs
if SVT w/ abberancy give Adenosine

173
Q

What is the management of an irregular broad complex tachycardia?

A

AF w/ BBB - treat as AF
Pre-excited AF - Amiodarone
Polymorphic VT/TdP - Mg 2g

174
Q

What are the features of cardiac tamponade?

A

Beck’s triad
-muffled heart sounds
-raised VP
-hypotension
Kussmaul’s sign
Pulsus parodoxus

175
Q

What is Kussmaul’s sign?

A

Paradoxically raised JVP on inspiration

176
Q

What is pulsus parodoxus?

A

Exaggerated BP variation w/ resp cycle
-falls during inspiration

177
Q

What are the ECG findings of cardiac tamponade?

A

Low voltage QRS complexes alternating in amplitude
-electrical alternans

178
Q

What is the management of cardiac tamponade?

A

IVI
Pericardiocentesis

179
Q

What is the management of anaphylaxis?

A

IVI
IM adrenaline (500mcg/0.5ml 1:1000)
-if refractory to 2x doses for adrenaline infusion

180
Q

What additional drugs may be given in anaphylaxis?

A

Chlorphenamine 10mg IM
Hydrocortisone 200mg IM

181
Q

What are the key components of ALS in cardiac arrest?

A

30:2 compressions (2min cycle)
Adrenaline 1mg after 3-5mins
Amiodarone 300mg after 3x shocks

182
Q

What are the shockable rhythms in cardiac arrest?

A

VF
Pulseless VT

183
Q

What are the non-shockable rhythms in cardiac arrest?

A

PEA
Asystole

184
Q

What are the reversible causes of cardiac arrest?

A

Hypoxia
Hypothermia
Hypovolaemia
Hypo/hyperkalaemia
Toxins
Tension Pneumothorax
Tamponade
Thrombus

Pocket MSRA - Book 1 (7 decks)

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