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Year 4 PassMed Incorrect Qs > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Interpreting INR

Increased INR means…

INR management and blled situation:

Major bleeding (e.g. variceal haemorrhage, intracranial haemorrhage) (3)

INR > 8.0 and Minor bleeding (3 and restart when?)

A

Increased INR means… less likely to clot therefore bleed more

Major bleed
-Stop warfarin
- Give intravenous vitamin K 5mg
- Prothrombin complex concentrate - if not available then FFP*

Minor
- 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

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2
Q

What is Beurgers disease? (or thromboangiitis obliterans)

Present (4)

A

small and medium vessel vasculitis that is strongly associated with smoking.

Young person
- smoking Hx
- extremity ischaemia ie. claudication, ischaemic ulcers
- superficial phlebitis
- Reynauds

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3
Q

When would you choose rate control as first-line for AF ? (3)

A
  1. whose AF has an obvious reversible cause’ (can be pneumonia)
  2. if there is coexistent heart failure
  3. First onset of AF
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4
Q

Management of VT- polymorphic (Tosardes de Pointes)

-If patient shows any of the 3 signs of adverse effects…
then….

If patient doesn’t show these signs
1. First-line
Other examples (3)
2.

A
  • If patient is showing adverse signs (eg. HF, Hypotensive, Chest pain) then immediate cardioversion DC SYNCHRONISED!
  • If patient is does not show these signs:
    first line- Mg Sulfate
    Other anti-arrythmias:
  • amiodarone: ideally administered through a central line
  • lidocaine: use with caution in severe left ventricular impairment
  • procainamide

If these fail… SYNCHRONISED DC CARDIOVERSION

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5
Q

First-line for acute pericarditis

A

a combination of NSAIDs and colchicine for patients with acute idiopathic or viral pericarditis

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6
Q

What would you see on an ECG if you had HYPERcalcaemia?

A

Shortened QT interval

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7
Q

Mitral Stenosis Features

  1. Murmur…
  2. Loud…
  3. Pulse?
  4. rogue (dont need explanation)
  5. classic
  6. rogue
A
  1. Mid to late-diastolic murmur heard at apex and radiates to the axilla, heard best on expiration RILE
  2. Loud S1 and opening snap
  3. Low vol pulse
  4. Malar flush- plum-red discolouration of the high cheeks. It is classically associated with mitral valve stenosis due to the resulting CO2 retention and its vasodilatory effects
    5 Dyspnoea (increase LA pressure and inc. pul venous hypertension)
  5. HAEMOPTYSIS (potentially pink frothy sputum)- due to pulmonary pressures and vascular congestion
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8
Q

How does a Hypertrophic obstructive cardiomyopathy kill young athletes?

What is assoc with the condition and can cause death but is not a complication of the condition?

A

ventricular tachycardia secondary to ischaemia and this typically occurs in the setting of extreme exertion.

Wolff-Parkinson White syndrome

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9
Q

Step-wise management of stable angina (4)

A
  1. Everyone given statin, aspirin and GTN to relieve exacerbations
  2. B-blocker or Rate limiting CCB
  3. Add the other (used in combo a long acting dihydropurine should be given ie. Amlodipine or Nifedipine (short acting Verapamil cause heart block)
  4. 1/4 from: Isosorbide mononitrate (long acting nitrate), ivabradind (HCN Chanel), Nicorandil (K+ channel activator), Ranolazine (anti-anginal) only whilst waiting for CABG though
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10
Q

Genetic pattern of familial hypercholesterolaemia

Treatment-

A

Autosomal dominant

high-dose statins

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11
Q

Which heart failure drug long term can cause pathological fracture risk and the mechanism of this

A

Furosamide - Hypocalcemia is a side effect of loop diuretics - most likely result in excess PTH secretion and will cause more calcium to be released from bones weakening their structure.

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12
Q

Coarctation of the aorta murmur?

It causes…

A

. Mid-systolic murmur maximal over the back is often heard

Hypertension in young person

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13
Q

What cardiomyopathy are alcoholics at risk of getting?

A

dilated cardiomyopathy

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14
Q

Poly cystic Kidney disease assoc with what murmur?

A

Mitral valve prolapse

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15
Q

Common Side effects of thiazide diuretics (7)

PIG and the 4 Hs

Rare Side effect (4)
PART

A
  1. Thiazides can worsen glucose tolerance- cause Hyperglycaemia
  2. Hypercalaemia
  3. Hyponatraemia
  4. Hypokalaemia
  5. p- Postural hypertension
  6. i - impotence
  7. g- gout

Rare
P- pancreatitis
a- agranulocytosis
r- rash photosensitivity
t- thrombocytopaenia

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16
Q

Inconstrictive pericarditis (pericardial calcification therefore reuduced RV compliance) WHat happens to the JVP?

A

JVP increasing with inspiration is known as Kussmaul’s sign

When we breathe in, that increases venous return, so loads of blood is rushing to the RA. he lack of compliance means that the RA gets filled very quickly as it has no ability to expand. The RA is only able to accommodate a small proportion of the large volume of blood that returns inspiration and so the surplus needs to go somewhere (the IVC and SVC and hence the IJV), leading to a rise in JVP.

17
Q

Hypokalaemia

what would you see on ECG? (5)

Drug cause?

A

U waves
small or absent T waves (occasionally inversion)
prolong PR interval
ST depression
long QT

in Hypokalaemia, U have no Pot and no T, but a long PR and a long QT

Thiazide-diuretics eg indapamide

18
Q

ACEi Side effect

ACE - i

A

ACE - i side effects

A - Angieodema
C - Cough
E - Elevated potassium

i - 1st dose hypotension

19
Q

post surgery complcations by day 5Ws

day 1-2
day 3-5
day 5-7
day 5+
anytime

A

Day 1-2: ‘Wind’ - Pneumonia, aspiration, Pulmonary Embolism
Day 3-5: ‘Water’ - Urinary tract infection (esp. if catheterised)
Day 5-7: ‘Wound’ - Infection at the surgical site or abscess formation
Day 5+: ‘Walking’ - Deep vein thrombosis or Pulmonary embolism
Any time: ‘Wonder Drugs, transfusion reactions, sepsis, line contamination.

20
Q

If youve had catheter ablation for atrial fibrillation do you still need anticoag?

A

yes- still require long-term anticoagulation as per their CHA2DS2-VASc score. Hence warfarin should be continued if she was stable on it.

21
Q

Idications for urgent valvular in IE (5)

A
  1. severe valvular incompetence
  2. aortic abscess (often indicated by a lengthening PR interval)
  3. infections resistant to antibiotics/fungal infections
  4. Cardiac failure refractory to standard medical treatment
  5. recurrent emboli after antibiotic therapy
22
Q

Post-ischaemic stroke management

due to AF (2)
Not due to AF (2)

If the AF is due to valvular cause?

A

With AF (due to embolus)
Aspirin 300mg for 2 weeks + warfarin/DOAC life long for post stroke

Without AF (Stroke due to cerebral vessel atherosclerosis)
Aspirin 300mg for 2 weeks + life long clopidogrel 75mg post stroke

Valvular- ALWAYS WARFARIN!

23
Q

Management of aortic stenosis

No surgery- (1)

Surgery if: (2)

Type of surgery and for who? (3) one is kids

A

No surgery-
Asymptomatic

Surgery if:
- symp
- asymp but pressure >40mHg

Aortic valve replace- if younger, can take the surg and may have co-existing CVD therefore can combine surgery at the same time

TAVI- High operation risk

Kids- Balloon valvuloplasty no calcification or adults with no calcification

24
Q

What type of heart failure oes hypertrophic ob cardiomyopathy cause? and why?

A

LV HF with PRESERVED EF
Because the vent walls have stiffened, therefore not a contraction issue but a filling issue, blood still able to get ejected so EF normal, HF just due to poor filling

25
Q

trifasicular block = (3)

A

RBBB +left anterior or posterior hemiblock + 1st-degree heart block

26
Q

What do you see in W0lf-Parkinson-White syndrome? 3 but one you should spot!

A

short PR interval, a *delta wave and QRS prolongation.

27
Q

What is 2 key things to remember in SVT management?

1.

2.

Other signs.. (3)

A
  1. Asthma is a CI for adenosine so gve verampil instead
  2. If they are haem unstable systolic < 90mmHg or decreased consciousness etc. then first thing should not be vagal BUT SYNC CARDIOVERSION (as per peri-arrest guidelines)
  • Syncope
  • MI
  • HF
28
Q

If somone has had a previous MI and is on anti-platelet (Clopidogrel) but then has AF later in life and needs anti-coag, what should happen to their meds?

A

STOP the anti-platelet and start an oral anti-coag (DOAC)

29
Q

What anti-anginal drug can cause ulceration anywhere in GI tract?

A

Nicorandil (K+ channel activator)

30
Q

What wave do they synchronise the DC cardio very to?

A

R wave- to prevent VF in cardiac depolarisation

31
Q

Indications for rhythm over rate in AF if > 48 hours (3)

A
  • first episode
  • Symptomatic
  • symptomatic

Year 4 PassMed Incorrect Qs (37 decks)

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