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3rd yr clinical > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is the primary prevention for CVD?

A

Meds based on QRISK3 - if over 10% give statin or if patient has CKD/T1D

20mg atorvastatin
Aim for 40% reduction in lipids after 3 months

statins interact with macrolide antibiotics eg. clarith

Can cause muscle weakness

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2
Q

What are the medications given for secondary prevention of CVD

A

6A’s

Antiplatelet- Aspirin + Clopidogrel
Atorvastatin (80mg)
Atenolol (or other beta blocker- max dose)
Ace inhibitors (ramipril - max dose)

If HF give an aldosterone antagonist - spironolactone

Ace inhibit + spironolactone together cause high risk of K+

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3
Q

What anti platelet therapy will a patient get after an MI?

A

For 12 months they will get dual anti-platelet therapy along with the other 4A’s

Aspirin 75mg and Clopidogrel for 12 months

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4
Q

What are the treatment options for stable angina

A

Immediate relief- GTN sublingual spray

Long term relief- Beta-blocker, calcium channel blocker (avoid in HF with reduced EF)

Surgical intervention
PCI- balloon and stent insertion
CABG- bypass

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5
Q

What ECG changes can be seen in an MI

A

STEMI- ST elevation and new LBBB

NSTEMI- ST segment depression/ no change and T wave inversion

If an NSTEMI- use troponin to diagnose

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6
Q

What ECG leads will show changes for a blockage in the

LCA
LAD
Circumflex
RCA

A

LCA- I, aVL, V3-6 - anterolateral (bigger numbers, bigger blood supply)

LAD- V1-4 (4 lads)

Circumflex- I, AVL, V5-6 (Not LAD but still left)

RCA- II,III,aVF (weird ones)

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7
Q

What is the initial management of an MI

A

MONA
Morphine (IV) with antiemetic
Oxygen
Nitrates (GTN)
Aspirin 300mg

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8
Q

What are the options for hospital management of a STEMI

A

PCI- if patient gets to hospital within 2 hrs of presentation

Thrombolysis- fibrinolytic agent like streptokinase * significant bleeding risk*

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9
Q

What is the initial management of an NSTEMI

A

BATMAN

-base decision about angiography/PCI
-Aspirin 300mg stat
-Ticagrelor 180mg stat (clopidogrel if high risk of bleeding)
-Morphine
-Anti-thrombin therapy
-nitrate

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10
Q

What is Dressler’s syndrome?

A

Post MI syndrome 2-3 weeks after- inflammation of pericardium
-Pleuritic chest pain, low grade fever and pericardial rub
-ECG- global ST elevation and T wave inversion

Management
NSAIDs, steroids, percardiocentesis

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11
Q

What are the causes, presentation and management of pericarditis ?

A

Causes
Infection, autoimmune injury, uraemia, methotrexate, cancer

Presentation
Sharp chest pain (pleuritic), worse lying down, better sitting forward

Management
NSAIDs
Colchichine (for 3 months)

Second line- steroids

Treat underlying cause

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12
Q

What is the cause of LVHF and what are the main investigations

A

Reduced CO causes a backlog of blood in the in left atrium and pulmonary vessels - fluid leaks into lungs- pulmonary oedema

Will hear 3rd HS and bibasal crackles on auscultation

BNP most important in bloods
ECHO to measure LV function - over 50% is normal
CXR- - cardiomegaly and upper lobe diversion– pressure in back veins

Management
Diuretics
Sit up
Stop IV fluids
Monitor fluid balance

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13
Q

What are the causes of chronic HF and how is it managed

A

-IHD, Valve disease (aortic stenosis), HTN, Arrhythmias, cardiomyopathy

Medical treatment-ABAL
Ace inhibitor - in valve disease give an ARB instead (candesartan)
Beta blocker
Aldosterone antagonist- spironolactone
Loop directive

Other specialist meds-
SGLT2 inhibitor
Digoxin

Surgical management
Implantable cardioverter defibrillator if patient has had ventricular tachycardia/ fib

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14
Q

What must be monitored when on medication for HF

A

U&E
Ace inhibitors and aldosterone antagonists both can cause hyperkalaemia

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15
Q

What investigations are done in a patient with newly diagnosed HTN?

A

Urine albumin creatine ratio Urine dipstick for proteinuria and haematuria
Bloods- HbA1c, u&E, lipids
Fundus exam
ECG

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16
Q

What is the management for hypertension in patients under 55

A

Ace inhibitors- rampapril
Beta blocker

Depending on serum potassium Thiazide diuretic (indapamide)

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17
Q

What is the management for HTN in patients over 55

A

CCB (amlodipine)
Beta blocker
Thiazide diuretic

18
Q

What is the management for HTN in afrocarribean patients

A

CCB (amlodipine)
beta blocker
Thiazide diuretic

19
Q

How do diuretics affect serum potassium

A

Thiazide diuretics can cause hypokalaemia due to increased excretion of potassium

If this occurs you can use a potassium sparing diuretic like spironolactone which causes sodium and water excretion but potassium reabsorption

20
Q

What are the causes and presentation of aortic stenosis

A

Age related calcification
Bicuspid aortic valve
Rheumatoid HD

Ejection systolic high pitched crescendo decrescendo murmur
Radiates to carotids
Thrill in aortic area
Slow rising pulse
Narrow pulse pressure
Exertional syncope

21
Q

What are the causes and features of aortic regurgitation

A

Age related weakness
Bicuspid aortic valve
Connective tissue disorders- Marfans sydrome

Early diastolic murmur - rumbling
Thrill in aortic area
Collapsing pulse
Wide pulse pressure
HF and pul oedema (back pressure into LV)

22
Q

What are the causes and features of mitral stenosis

A

Rheumatic HD
Infective endocarditis - splinter haemorrhages, janeway lesions, osler’s nodes

Mid- diastolic low pitched rumbling
Tapping apex beat
Malar flush- back pressure on pulmonary system
Atrial fibrillation

23
Q

What are the main features and causes of mitral regurgitation

A

Weakening of valve with age
IHD
Infective endocarditis
Rheumatic HD
CT disorders

Pansystolic high pitches whistling
Radiates to left axilla
Thrill on mitral area
Signs of HF and pul oedema
Atrial fibrillation

24
Q

What are the risk factors and bacterial causes of infective endocarditis

A

IV drug use, Structural heart pathology, CKD, immunocompromised, history

Causes
Staphylococcus - staph aureus
Streptococcus (viridian’s group)
Enterococcus (faecalis)

25
What is the presentation and investigations for infective endocarditis
-fever, fatigue, night sweats muscle aches, anorexia, new murmur, splinter haemorrhages, petechiae (non blanching red spots), laneway lesions , oilers nodes (both on pads of fingers) Do blood cultures before abx Cultures separated by at least 6 hrs and taken from different sites Transoesophageal echo - better than transthoracic Vegetation seen on valves
26
How is infective endocarditis diagnosed
The modified duke criteria Requires one major and 3 minor criteria or 5 minor criteria Major Positive blood cultures Imaging findings (vegetations) Minor Risk factors Fever over 38 Vascular phenomena (laneway lesions, ICH, splenic infarct) Immunological phenomena (oslers nodes, glomerulonephritis) Microbiological phenomena (positive cultures)
27
What is the management of infective endocarditis
IV antibiotics - amoxicillin and gentamicin for at least 4 weeks if valves are natural 6 weeks if prosthetic
28
What is the presentation and management of hypertrophic obstructive cardiomyopathy
SOB, fatigue, dizzy, syncope, chest pain, palms Ejection systolic murmur at lower left sternal border (louder on valsalva manoeuvre), fourth HS and thrill over left sternal border Management Genetic testing, ECG,CXR, Echo Beta blockers Surgical myectomy Septal ablation Implantable cardioverter defibrillator Avoid intense exercise, dehydration, ACE inhibit and nitrates
29
What are the main causes and investigations in AF
SMITH Sepsis, mitral valve pathology, ischaemic HD, thyrotoxicosis, HTN ECG- absent p waves, narrow QRS complex tacky, irregularly irreg rhythm Echo to investigated causes CHA2DVASc score to work out need to anti-coat
30
What are the management steps in AF
1. Rate control - beta blocker 1st line then CCB or digoxin 2. Rhythm control using cardio version- flecanide or amiodarone/ electrical or long term medication (beta blockers 1st line then amiodarone) 3. Anticoagulation - DOACs first line (apixaban) then warfarin 4.Assess CHA2DS2VASc score and ORBIT bleeding score
31
How do you choose between immediate and delayed cardio version
Immediate cardioversion- choose if AF is present for less than 48 hrs or they are life threateningly haemodynamically unstable Done with flecanide/ amiodarone or electrical Delayed cardio version- if AF present for more than 48 hrs and patient is stable Done using transoesophageal echocardiography guided cardioversion *In delayed* - patients should be anticoagulated for 3 weeks with rate control before
32
What is Wolff- Parkinson White syndrome
A type of supra ventricular tachycardia An extra-electrical accessory pathway cannot give anti-arrhythmic medications in people with this condition- like beta blockers etc - this can reduce AV conduction and will end up promoting accessory pathway conduction Radiofrequency ablation of the accessory pathway is the treatment
33
What is the stepwise management of SVT
1. Vagal manoeuvres Valsalva- blow into syringe Carotid massage Diving reflex- submerge face in cold water 2. Adenosine (A DOWN o sine) - rapid IV bolus into a large cannula 6mg, 12mg, 18mg Feeling of impending doom 3.Verapamil/beta blocker 4. DC cardioversion
34
Which cardiac arrest arrhythmia are shockable and non shockable
Shockable: Ventricular tachycardia, ventricular fibrillation Non shockable: systole, pulseless electrical activity
35
What is atrial flutter
Atrial rate around 300bpm signal doesn't reach ventricles every time Sawtooth on ECG Same treatment to AF- anticoagulant and radio frequency ablation
36
What are the causes and management of QT prolongation
Causes Long QT syndrome Antipsychotics, citalopram. flecnidine, amiodarone, macrolide antibiotics Hyperkalaemia, hypocalcaemia Torsades de pointes - associated with subarachnoid haemorrhage, will either stop or go to ventricular tachycardia Give a magnesium infusion to manage, or defibrillator Management Stop meds causing it Correct electrolytes Beta blockers Implantable cardioverters
37
What is first degree heart block
Every atrial impulse leads to a ventricular contraction just a longer PR interval >0.5
38
What is mobitz type 1 (Wenckebach) heart block
Conduction through AV node gets longer every time and then doesn't appear and then repeats Increasing PR interval until a p wave isn't followed by a QRS
39
What is mobitz type 2 heart block
Set ratio of P waves to QRS complexes
40
What is third degree heart block
No relationship between P and Q waves
41

3rd yr clinical (22 decks)

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