Cardiology Flashcards
Risk factors to assess for cardiac disease?
Smoking, alcohol, obesity, diabetes, low exercise, kidney disease, atypical antipsychotics
What scoring system do you use to assess stroke and myocardial infarction risk?
QRISK 3 score
What medication should you consider for primary prevention of cardiovascular disease and in what instances?
If QRISK 3 >10% of stroke/MI in 10 years then start atorvastatin 20mg OD at night.
OR
in CKD or Type I diabetes
What should you check if you are starting a statin and why?
You should check lipids, after 3 months you should see a 40% reduction in non HDL cholestrol.
Check LFTs at 0, 3 and 12 months. Transient increase in ALT and AST is nomral but not more than 3x normal
What is the treatment regime for secondary prevention of cardiac events?
AABS
Asprin and clopidogrel
ACE inhibitor
Beta blocker
Statin
What is the difference between stable and unstable angina
Stable angina only happens with exercise
Ustable angina happens even at rest
What investigations should you do for Angina
Physical examination
ECG
Bloods - U&Es, LFTs, FBC, lipids, thyroid, Hba1c
CT coronary angiogram
What is the correct GTN usage ?
Spray under tounge , again at 5 minutes, at 10 minutes if there is still pain call 999
Secondary prevention of cardiac disease
Aspirin and clopidogrel
ACE inhibitor
Beta blocker
Statin
What is an NSTEMI
Raise Troponin levels alongside ST depression, T wave inversion or pathological Q waves
When should you take troponin levels?
At onsent, 6 hours and 12 hours
What is the acute NSTEMI treatment (medical)
BATMAN
Betablockers
Aspirin - 300mg
Ticagrelor 180mg or clopidogrel
Moprhine
Anticoagulant - enoxaparin
Nitrates
What is dresslers syndrome?
Pericarditis 3 weeks after an MI
How does dresslers syndrome present
Pleuritic chest pain
What are the signs of dresslets syndrome
Pericardial rub,
ECG global ST elevation and T wave inversion
Raised CRP and ESR
What is the treatment for dresslers syndrome?
NSAIDs and Steroids
What is the secondary prevention medication for MIs
6As,
Aspirin
Another antiplatelet
Atorvastatin
ACE inhibitors
Atenolol
Aldosterone anatagonist
What are the best investigations for congestive heart failure?
B-type natriuretic peptide
Echocardiogram looking for ejection fraction
What is the managment of acute left ventricular failure
POUR SOD
Pour away the fluids
Sit up
Oxygen
Diuretics
What might you see on Xray in pulmonary oedema ?
Fluid in the fissures
Bi lateral pleaural effusions
Kerley lines
What blood test can you check in chronic heart failure and what action should it prompt
N-terminal pro-B-type natriuretic peptide
If over 2000 ng/L then urgent referral to cardiology
First line treatment for chronic heart failure?
ABAL
ACE inhibitor
Beta blocker
Aldosterone antagonist spironolactone or eplerenone
Loop diuretics
What is Cor Pulmonale?
Right sided heart failure caused by lung disease
What is the treatment algorithm for hypertension
step 1
Young = ACE inhibitor
Old Black = Calcium channel blocker
Step 2
Not black = ACE inhibitor and Calcium channel blocker
Black = Candesartan + Calcium channel blocker
Step 3
ACE inhibitor + Calcium channel blocker + Thiazide like diuretic (indapamide)
What is candesartan and what is the usual dosage?
Angiotensin II recpetor blocker
8mg - 32mg OD
What should you use if thiazide like diuretics are causing too much hypokalaemia ?
Use spironolactone
What is indapamide and what is the usual dosage?
thiazide like diuretic 2.5mg OD
What makes the S1 and what makes S2 heart sounds?
S1 Tricuspid and Mitral valves
S2 Pulmonary and Aortic valves
What murmur is an ejection systolic high pitched murmer
Aortic Stenosis
What causes a pan systolic whisteling murmor?
Mitral regugitation
What causes a rumbling diastolic murmur?
Mitral Stenosis
What is the target INR for a bioprosthetic valve?
2-3 INR
When is rythm control the preffered 1st option rather than rate control in AF?
Reversible cause of AF
New onset less than 48 hours
It is causing Heart failure
Symptomatic after rate control
What are the rate control options for AF
Beta Blocker Atenolol 50 mg
Calcium Channel Blocker diltiazem
Digoxin
What is the calcium channel blocker of choice for Rate control in AF
Diltiazem
You have indetified your AF patient should have cardioversion. What are the two types?
if new AF then immediate cardioversion
if longstanding AF then delayed cardioversion ( Anticoagulation for 3 weeks prior to cardioversion
What is the first line drug for pharmacological cardioversion of AF
Flecanide
or
Amiodarone
What are your options for long term rythmn control in AF
Beta blockers
Dronedarone
Amidodarone
What is the halflife of warfarin
1-3 days
What is the halflife of DOACs
12 hours
What is in HASBLED
hypertension
abnormal renal fucntion
stroke
bleeding
liabile INR
Elderly
Drugs
