Cardiology Flashcards
What is the management of heart failure?
ACE inhibitor and beta-blocker - 1st line
Aldosterone antagonist (eg. spironolactone) - 2nd line
Dapagliflozin - 3rd line
Symptoms of fluid overload - prescribe loop diuretic (furosemide)
Digoxin - only if heart failure is in combination with atrial fibrilation
What is the definitions of hypertension stages 1, 2 and 3, and when should they be treated?
STAGE 1
BP equal or higher than 140/90.
Treat if < 80 years of age + one of the following:
- target organ damage
- established CV disease
- renal disease
- diabetes
- 1-year CV risk equivalent to 10% or greater
STAGE 2
BP equal or higher than 160/100
Always treat
What are the steps of hypertension treatment in non-diabetic patients?
STEP 1
- If age < 55y: ACE inhibitor
- If age equal or higher than 55 or black african or Caribbean origin: calcium channel blocker (if CCB cannot be tolerated, offer thiazide like diuretics)
- If still uncontrolled BP, go to STEP 2
STEP 2
- Combination of 2 classes
- ACE inhibitor (or ARB)
- Calcium channel blocker
- Thiazide-like diuretic
If Afro-Caribbean origin, the second medication should be an ARB or thiazide
STEP 3
- Combination of three classes
What are the steps of hypertension treatment in diabetic patients?
STEP 1
- Any age: ACE inhibitor
- Black african or Caribbean: consider ARB in preference to ACE inhibitor
STEP 2
- Combination of 2 classes
- ACE inhibitor (or ARB)
- Calcium channel blocker
- Thiazide-like diuretic
STEP 3
- Combination of three classes
What are the characteristics of a left ventricular aneurysm?
Complication resulting from an MI.
Presents 4-6 weeks after MI.
Persistenly raised ST segments.
What are the characteristics of Dressler’s syndrome?
Secondary form of pericarditis that occurs post MI.
Presents 1 week or several months after an MI.
Fever, pleuritic pain, pericardial and pleural effusion.
The pleuritic pain is usually the main complaint.
What are the symptoms of Tetralogy of Fallot?
Cyanotic heart condition of the first few weeks of life.
Symptoms depend on the severity. The low oxygen saturation and cyanosis are due to blood shunting across the ventricular septal defect into the aorta.
Ejection systolic murmur due to pulmonary stenosis.
Four characteristic features are
- Pulmonary stenosis (ejection systolic murmur)
- Right ventricular hypertrophy
- Overriding aorta
- Ventricular septal defect
Chest X-Ray shows a “boot-shaped” heart.
ECG shows right ventricular hypertrophy.
What do U waves represent?
Hypokalaemia
What do J waves represent?
Hypothermia
What do delta waves represent?
Wolff Parkinson White syndrome
What is coronary dominance, and which artery is dominant in 85% of the general population?
The artery that supplies the posterior descending artery determines the coronary dominance.
If the PDA is supplied by the right coronary artery, then the coronary circulation can be classified as “right-dominant”. This is found in 85% of population.
If the PDA is supplied by the circumflex artery (a branch of the left artery), then the coronary circulation can be classified as “left-dominant”
How to differentiate murmurs?
SYSTOLIC
- Ejection: aortic stenosis (2ICS right of the sternum)
- Pansystolic: mitral regurgitation (apex), tricuspid stenosis (lower left sternal edge), VSD
DIASTOLIC
- Early diastolic: aortic regurgitation (left upper sternal border)
- Mid-late diastolic: mitral stenosis (apex)
What are the definitions and treatments of the different degrees of heat block?
FIRST DEGREE
PR interval > 0.2 sec
TT: none required
SECOND DEGREE
- Mobitz type I (Wenckebach phenomenon): progressive prolongation of PR interval until a dropped beat occurs
TT: none required if asymptomatic, atropine if symptomatic
- Mobitz type II: PR interval is constant but the P wave is often not followed by a QRS complex
TT: atropine initially if symptomatic, definitive tt with pacemaker
THIRD DEGREE
P waves will occur regularly, but completely unconnected to QRS complexes
TT: atropine followed by transcutaneous pacing, permanent pacemaker
Which medication used to treat gout should not be used for CHF patients?
NSAIDs should be avoided in patients with CKD, HF or ischaemic heart disease. Selective COX-2 inhibitors (celecoxib) should also be avoided.
NSAIDs inhibit the synthesis of prostaglandins, which lead to reduction in sodium excretion, renal perfusion and GFR. They can also reduce the effectiveness and increase the toxicity of ACEI and diuretics, which can result in exacerbation of HF.
Also, thiazide diuretics increase the risk of gout due to reduced clearance of uric acid.
Which valvulopaty can be expected after an inferior MI?
Mitral regurgitation
