Cardiology Flashcards
What is the QRISK3 score?
The QRISK score estimates the percentage risk that a patient will have a stroke or myocardial infarction in the next 10 years. The NICE guidelines (updated February 2023) recommend when the result is above 10%, they should be offered a statin, initially atorvastatin 20mg at night.
Who is offered atorvastatin?
Primary prevention
CKD
Type 1 diabetics
What is the Simon Broome score?
Family history of premature cardiovascular disease (e.g., myocardial infarction under 60 in a first-degree relative)
Very high cholesterol (e.g., above 7.5 mmol/L in an adult)
Tendon xanthomata (hard nodules in the tendons containing cholesterol, often on the back of the hand and Achilles)
Used to assess familial hypercholesteremia
What are alternatives to statins?
Ezetimibe.
PCSK9 inhibitors
What monitoring is done for statins?
NICE recommend checking lipids 3 months after starting statins and increasing the dose to aim for a greater than 40% reduction in non-HDL cholesterol.
What are the three components of angina medical management?
Immediate symptomatic relief during episodes of angina
Long-term symptomatic relief
Secondary prevention of cardiovascular disease
What is the immediate symptom control for angina?
Take the GTN when the symptoms start
Take a second dose after 5 minutes if the symptoms remain
Take a third dose after a further 5 minutes if the symptoms remain
Call an ambulance after a further 5 minutes if the symptoms remain
What is the long term management for angina?
Beta blocker (e.g., bisoprolol)
Calcium-channel blocker (e.g., diltiazem or verapamil – both avoided in heart failure with reduced ejection fraction)
Beta blocker
Activity modifications
Nitrates
CCBs
Which long term angina drugs should be avoided in heart failure?
CCBs - not part of the algorithm
What are some alternative long term drugs for angina?
Ranolazine
Isosorbide
Nicorandil
Ivabrandine
What are the four secondary prevention medications for angina?
A – Aspirin 75mg once daily
A – Atorvastatin 80mg once daily
A – ACE inhibitor (if diabetes, hypertension, CKD or heart failure are also present)
A – Already on a beta blocker for symptomatic relief
or
Mono antiplatelet therapy
Aspirin
Beta blocker
Statins
What are some of the surgical interventions for angina?
PCI
CABG
What are some of the scars that treated patients with CHD might have?
List some bloods for patients with angina.
Physical examination (e.g., heart sounds, signs of heart failure, blood pressure and BMI)
ECG (a normal ECG does not exclude stable angina)
FBC (anaemia)
U&Es (required before starting an ACE inhibitor and other medications)
LFTs (required before starting statins)
Lipid profile
Thyroid function tests (hypothyroidism or hyperthyroidism)
HbA1C and fasting glucose (diabetes)
What tests should be done in patients with suspected angina?
Cardiac stress testing
CT coronary angiogram
What are some non-specific causes of raised troponin?
Chronic kidney disease
Sepsis
Myocarditis
Aortic dissection
Pulmonary embolism
What is the initial management for suspected ACS?
C – Call an ambulance
P – Perform an ECG
A – Aspirin 300mg
I – Intravenous morphine for pain if required (with an antiemetic, e.g., metoclopramide)
N – Nitrate (GTN)
What are the signs and symptoms of ACS?
Jaw and neck pain
Sweating and nausea
Left sided pain
Crushing sensation
Levine sign
What is the management of NSTEMI?
IGTAP
Inhibition of platelets and thrombin - Aspirin and fondaparinux
GRACE score 3% of MI in 6 months - 3 years times
Thrombolysis
Access or antiplatelets - ticagrelor vs clopidogrel and aspirin
PCI and angiography within 72 hours
What is time window for PCI in NSTEMI?
72 hours
What is the treatment for STEMI?
PCI delivered in less than 12 hours of onset and 90 minutes of hospital
Aspirin loading dose 300mg
Reperfusion therapy - fibrinolysis or PCI
Medical management - ticagrelor or clopidogrel
PCI and prasugrel
Unfractionated heparin
Bivalirudin and bailout GPI LMWH for radial access
Drug eluting stent
Fibrinolysis
Secondary care and rehabilitation
What is given in NSTEMI?
B – Base the decision about angiography and PCI on the GRACE score
A – Aspirin 300mg stat dose
T – Ticagrelor 180mg stat dose (clopidogrel if high bleeding risk, or prasugrel if having angiography)
M – Morphine titrated to control pain
A – Antithrombin therapy with fondaparinux (unless high bleeding risk or immediate angiography)
N – Nitrate (GTN)
What are the findings on CXR for heart failure?
Alveolar oedema
B lines
Cardiomegaly
Dilated upper vessels
Effusions and oedema
How does pro-NT-BNP influence timeframe for echocardiogram?
From 400 – 2000 ng/litre should be seen and have an echocardiogram within 6 weeks
Above 2000 ng/litre should be seen and have an echocardiogram within 2 weeks
What is the criteria for referring for echo for HF?
What are treatments for HF?
ABAD
What are left sided heart failure symptoms?
What are right sided heart failure symptoms?
What are the types of hypertension?
Essential hypertension accounts for 90% of hypertension. This is also known as primary hypertension. It means a high blood pressure has developed on its own and does not have a secondary cause.
Secondary causes of hypertension can be remembered with the “ROPED” mnemonic:
R – Renal disease
O – Obesity
P – Pregnancy-induced hypertension or pre-eclampsia
E – Endocrine
D – Drugs (e.g., alcohol, steroids, NSAIDs, oestrogen and liquorice)
How should murmurs be reported?
S – Site: where is the murmur loudest?
C – Character: soft / blowing / crescendo (getting louder) / decrescendo (getting quieter) / crescendo-decrescendo (louder then quieter)
R – Radiation: can you hear the murmur over the carotids (aortic stenosis) or left axilla (mitral regurgitation)?
I – Intensity: what grade is the murmur?
P – Pitch: is it high-pitched or low and rumbling? Pitch indicates velocity.
T – Timing: is it systolic or diastolic?
How is AF treated?
