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Royal College 2023 > Cardiology > Flashcards

Cardiology Flashcards

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1
Q

Warfarin use in older adults as per Beers criteria

A

Potentially inappropriate medication
Higher risk of major bleeding
Lower effectiveness
DOAC preferred for NVAF/VTE
Recent study showed that switching warfarin to DOAC sig inc risk for bleeding in frail older adults

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2
Q

Rivaroxaban and dabigatran vs. apixaban

A

Both have higher risk of major bleeding and GIB vs. apix
Riva - if OD dosing needed

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3
Q

Screening for AF

A

Opportunistic in those 65+ yo
Pulse check or ECG

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4
Q

Ticagrelor and prasugrel vs. clopidogrel

A

Both inc risk of major bleeding in older adult vs. clopidogrel
Especially if 75+
May be offset by CV benefits in select patients

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5
Q

Benefits and risks of anticoagulation in AF

A

Benefits
1. Reduced risk of stroke
2. Reduced risk of PE/DVT

Risks
1. Major bleeding like ICH, GIB
2. Other minor bleeding

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6
Q

What medication would you prescribe for patient with AF (GFR 30)?

A

Apixaban
5 mg PO BID
Normal dose 5 mg PO BID, dose reduce if 2 of:
1. Cr 133+
2. Age 80+
3. Weight <60 kg

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7
Q

Target HR for AF

A

<100 BPM

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8
Q

In hospital cardiac arrest: survival, % home, % neuro deficits

A

Survival = 25%
Home = 50%
Deficits = 40%

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9
Q

Cardiac arrest and frailty outcomes

A

Frailty associated with:
Decreased likelihood of ROSC
Inc hospital mortality
Inc discharge to LTC

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10
Q

Ddx for AF with RVR, not responding to BB and diarrhea

A
  1. Hyperthyroidism
  2. Hypovolemia from diarrhea causing RVR
  3. Amyloid
  4. Caffeine
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11
Q

3 steps for immediate medical treatment for patient in rapid AF in CHF

A
  1. Supplemental O2
  2. IV Diuresis
  3. Electrical cardio version if unstable
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12
Q

Rate vs rhythm control in AF

A

Rate control for medium term
Longer term
Rhythm control preferred if:
- Recently diagnosed AF (1 yr)
- Highly symptomatic
- Multiple recurrences
- Difficult to achieve rate control
- Arrhythmia induced cardiomyopathy

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13
Q

4 contraindications to anticoagulation in AF

A
  1. Recurrent irreversible pulmonary bleed
  2. Recurrent irreversible GI bleed
  3. Recurrent irreversible urogenital bleed
  4. Esophageal varices
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14
Q

What is arterial compliance and what is a surrogate physiologic measurement?

A

Ability of blood vessel to expand and contract passively with changes in pressure (change in volume divided by change in pressure)
Surrogate measure = pulse pressure (SBP-DBP)

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15
Q

What is POTS? What is tx?

A

POTS = postural orthostatic tachycardia syndrome
Increase in HR>30 from supine to standing without significant BP drop
Sx: light head, palpitations, tremulous, chest pain
Tx: stop offending meds, inc salt/water intake, compression stockings, abdominal binder, exercise
Propanolol, ivabradine, midodrine (if also HOTN)

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16
Q

Would you treat DLD in 80+ yo with MI?

A

Good evidence for secondary prevention
Significant reduction in major vascular events
Also good evidence for primary prevention

17
Q

How are HDL and LDL affected by aging?

A

HDL-c inc
TG and LDL declined

18
Q

6 clinical findings for acute limb ischemic

A
  1. Pain
  2. Pallor
  3. Pulselessness
  4. Poikilothermia
  5. Paralysis
  6. Paresthesia
19
Q

When do you refer patient for surgery with PVD?

A

Critical limb ischemia
Inadequate response to optimal medical therapy

20
Q

Symptoms of chronic PAD?

A

Claudication
Skin discolouration
Cold to touch
Ulcer
Pulse abnormalities

21
Q

Four atypical ways in which elderly may present with MI?

A
  1. GI symptoms
  2. SOB
  3. Dizzy
  4. Delirium
  5. Fatigue
22
Q

Management of CHF with diastolic dysfunction?

A
  1. Candesartan
  2. Tx HTN
  3. Loop diuretics (Lasix)
  4. Spironolactone
  5. SGLT-2 inh
23
Q

SAGE-AF trial found that 25% participants received inappropriate DOAC dose. What are 3 factors associated with inappropriate dosing?

A
  1. Advanced age
  2. Hx of renal failure
  3. Higher CHADS VASC score
24
Q

Apixaban is metabolized by what?

A

CYP 3A4

25
Q

List 5 patient risk factors that might indicate futility of TAVI or SAVR

A
  1. Advanced dementia
  2. Bedbound/immobile
  3. Cachexia/sev sarcopenia
  4. Disability for all/most aDLs
  5. End stage renal/liver/lung malignant dx
26
Q

4 physiologic changes to CV systems that predispose to CHF

A
  1. Isolated systolic HTN due to atherosclerosis
  2. LV wall thickening (inc myocyte, inc collagen)
  3. Reduced LV early diastolic filling
  4. Inc atrial contribution to filling
27
Q

Four ways heart rate and rhythm change in normal aging

A
  1. Resting HR decrease
  2. Max HR decrease
  3. Respiratory variation decreases
  4. Inc PVCs
28
Q

4 advantages to transitioning from warfarin to DOAC

A
  1. No need for monitoring blood work
  2. Lower risk of ICH/major bleed
  3. More effective at stroke prevention
  4. Fewer drug drug interactions

Two disadvantages
1. Twice a day dosing
2. Harder to reverse

29
Q

4 risk factors that might indicate futility of TAVI or SAVR

A

ABCDE mnemonic
Advanced dementia
Bedbound/non mobile
Cachexia/severe sarcopenia
Disability for most/all BADLs
End stage lung/liver/renal/malignant disease

30
Q

List three patient factors that favour TAVI over SAVR?

A
  1. Frailty
  2. Age 75+
  3. Limited mobility
  4. Limited life expectancy
  5. Risk of surgical morbidity or mortality intermediate risk or greater
31
Q

What factors are associated with delirium post TAVI?

A
  1. BADL impairment
  2. IADL impairment
  3. Malnutrition
  4. Impaired mobility
  5. MMSE <27
32
Q

What are 2 reasons why rivaroxaban is avoid use as per Beers?

A
  1. Higher risk of ICH
  2. Higher risk of GI bleed
33
Q

What DOAC is use with caution in Beers?

A

Dabigatran

Royal College 2023 (79 decks)

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