Cardiology Flashcards
Angina first line management
Beta blocker/ccb
Angina management
- Aspirin, statin, s/l GTN to abort angina attacks.
- Beta-blocker or CCB.
If CCB used as monotherapy, a rate-limiting one such as verapamil or diltiazem should be used.
If used in combination with a beta-blocker then use a longer-acting dihydropyridine calcium channel blocker (e.g. amlodipine, modified-release nifedipine) - Titrate medications to max tolerated doses.
- If still symptomatic after monotherapy with a beta-blocker add a calcium channel blocker and vice versa.
- If can’t do step 4 then add one of:
a long-acting nitrate
ivabradine
nicorandil
ranolazine
What can’t you prescribe with a beta blocker
Verapamil (risk of complete heart block)
What is used to treat torsades
IV magnesium
Becks triad
For tamponade
Muffled HS
Raised JVP
Low bp
How to screen for ADPCKD
USS
Hypokalaemia ECG changes?
PR prolongation and flattened T waves
When could you cardiovert for AF
If within 48h.
If not need to anticoagulate and wait 3 weeks.
How is familial hypercholesterolaemia treated in pregnancy?
colesevalm. (Bile salt thing)
Only thing thats safe in pregnancy/ breastfeeding.
What criteria is used to diagnose familial hypercholesterolaemia?
Simon Broome.
What would make you suspect familial hypercholesterolaemia
TC > 7.5 mmol/L
+/-
A personal or family history of premature coronary heart disease (event u 60).
How to clinically diagnose familial hypercholesterolaemia
Use Simon Broome criteria:
In adults total cholesterol > 7.5 and LDL > 4.5
plus:
for definite FH: tendon xanthoma in patients or 1st or 2nd degree relatives or DNA-based evidence of FH
for possible FH: family history of myocardial infarction below age 50 years in 2nd degree relative, below age 60 in 1st degree relative, or a family history of raised cholesterol levels
What are you looking for when assessing response to statin in familial Hypercholesterolaemia?
aim to achieve at least a 50% reduction in LDL
How would you treat familial hypercholesterolaemia?
Atorva 20 or rosuva 10.
Atorva 20 if renal impairment.
Hypercalcaemia ecg changes
Shortened QT
Osborn (J) waves if severe.
Hypocalcaemia ECG changes
prolonged QT
Hypokalaemia ECG changes
Flattened T
ST depression
U waves
Hypomagnaesaemia ECG changes
Tall T
ST depression
Hypermagnaesaemia ECG changes
Prolonged PR
Widened QRS
When can you cardiovert AF?
If within 48h
What condition is a rate limiting CCB C/I
Heart failure
What chadsvasc score would you anticoagulate
Greater than or equal to 2
Consider in men with score of 1.
Rumbling mid diastolic murmur
Mitral stenosis
What is Dresslers syndrome?
When does it happen?
2-6 weeks after MI
Fever, pleuritic pain, pericardial effusion and a raised ESR.
It is treated with NSAIDs.
Autoimmune.
How is LV aneurysm treated
Anticoag
After which MI is AV block more common?
Inferior.
Which vessel is affected in inferior MI
Right coronary
Which territory is LAD
V1->v4 (anterior
Which territory is Lcx?
V5v6, 1 and AVL
Which meds do you need to be careful with in first degree heart block
Beta blockers, rate limiting CCBs, dig.
When would warfarin be favoured over DOAC
Severe liver impairment, eGFR below 30, weight over 120 kg
Which valvular complication do you get post MI and why?
Mitral regurgitation due to rupture of papillary muscles.
Which valve is most commonly affected in endocarditis
Mitral
MR murmur
pan systolic
ST depression with TWI v5 and v6
Digitalis effects (reverse tick).
