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MSRA > Cardiology > Flashcards

Cardiology Flashcards

1
Q

How do we treat SVT if vasovagal maneuvers haven’t worked?

A

IV adenosine, and if this doesn’t work electric cardioversion

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2
Q

When is amiodarone given in ALS?

A

amiodarone 300 mg should be given to patients who are in VF/pulseless VT after 3 shocks have been administered.
a further dose of amiodarone 150 mg should be given to patients who are in VF/pulseless VT after 5 shocks have been administered

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3
Q

Where do you see U waves on ECG?

A

Hypokalaemia

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4
Q

What electrolyte abnormalities does bendroflumethiazide cause?

A

Bendroflumethiazide causes both hyponatraemia and hypokalaemia.

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5
Q

For which arrhythmia do we give amiodarone?

A

Ventricular tachycardia

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6
Q

What is bumetanide?

A

Loop diuretic

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7
Q

What is the most common organism that causes IE?

A

Gram +ve cocci

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8
Q

How do we treat stable fast AF?

A

Starting bisoprolol would be correct if the patient were haemodynamically stable. If the patient’s blood pressure was higher, they could receive a beta blocker to slow down the heart and allow the ventricles to fill. However in this case if the heart is slowed momentarily it will drop blood pressure and the patient may arrest, due to inadequate coronary artery perfusion.

Starting digoxin is incorrect. Digoxin is the second line of management for atrial fibrillation if the patient is haemodynamically stable. In this case, the patient is not haemodynamically stable, so pharmacologic therapies are not considered until cardioversion has been attempted and blood pressure returns to normal.

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9
Q

How do we treat unstable AF?

A

Electric cardioversion

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9
Q

Which abx can lead to torsades de pointes?

A

Macrolides like Clari

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10
Q

What is furosemide?

A

Loop diuretic - can cause hypokalaemia

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11
Q

Which post MI medication can cause angioedema?

A

Ramipril - characterised by marked tongue and facial swelling

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12
Q

Which type of BBB is never normal?

A

LBBB

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13
Q

Which medication is teratogenic: LMWH or warfarin?

A

Warfarin

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14
Q

What do we use DAS-28 scale for?

A

Measure of disease activity in rheumatoid arthritis

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15
Q

A 45-year-old man presents to his general practitioner concerned about his sex life. He is unable to get and maintain an erection and feel it is affecting him mentally. Which HF med may cause this?

A

Beta blockers

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16
Q

When do we use pericardiocentesis?

A

Cardiac tamponadeW

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17
Q

When do we use the Bishop score?

A

Used to help assess the whether induction of labour will be required

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18
Q

What is the APGAR score used for?

A

Assesses the health of a newborn immediately after birth

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19
Q

What is the Child-Pugh classification used for?

A

A scoring system used to assess the severity of liver cirrhosis

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20
Q

How do we treat torsades de pointes?

A

Magnesium sulphate

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21
Q

How do we treat htn in diabetics?

A

ACE inhibitors/A2RBs are first-line regardless of age

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22
Q

What is Beck’s triad?

A

Beck’s triad of falling BP, rising JVP and muffled heart sound is characteristic of cardiac tamponade

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23
Q

What is indapamide?

A

Loop diuretic

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24
Q

How does mitral stenosis present?

A

shortness of breath, fatigue, and a malar flush on his cheeks. Cardiovascular examination reveals a regular, low-volume pulse and a mid-diastolic murmur loudest with the patient leaning to his left-hand side.

25
Q

What is the murmur seen in mitral stenosis?

A

Mid-diastolic murmur loudest with the patient leaning to the LHS

26
Q

What ECG change might you see in mitral stenosis?

A

P mitrale

27
Q

What is first line tx for a pt with heart failure with reduced LVEF

A

A beta blocker and an ACE inhibitor as first-line treatment

28
Q

What is the GRACE score?

A

The doctor is calculating the 6-month mortality of NSTEMI using a GRACE score - this includes age, ECG, troponin, renal function. Other factors that are considered include blood pressure, heart rate, and if the patient had a cardiac arrest on presentation. Renal function is important for consideration as the kidney is a common target organ that is injured in an acute myocardial infarction (AMI).

29
Q

Being treated for HF. For the past few months she has noticed bilateral tinnitus and hearing loss. Which med might be responsible?

A

Furosemide - loop diuretics can cause ototoxicity

30
Q

When is an S3 sound normal?

A

If <30 y.o.
An S3 heart sound is typically associated with conditions that lead to rapid ventricular filling

31
Q

Give a common SE of adenosine

A

Patients should be warned that adenosine administration can cause a transient feeling of warmth/flushing

32
Q

When may we stop ACEi in renal deterioration?

A

The BNF recommends the angiotensin-converting enzyme inhibitors should only be stopped if the creatinine increases by 30% or eGFR falls by 25% or greater.

33
Q

What is the murmur seen in aortic regurg?

A

early diastolic murmur, high-pitched and ‘blowing’ in character

34
Q

Which medications should a pt be taking four weeks post-MI?

A

TABAS (Ticagrelor, Aspirin, Betablocker, ACEI, Statin)

35
Q

What is the first line treatment for regular broad complex tachycardias without adverse features?

A

IV amiodarone is the first-line treatment for regular broad complex tachycardias without adverse features

36
Q

What is Buerger’s disease?

A

Buerger’s disease, or thromboangiitis obliterans, is a condition characterised by progressive inflammation and thrombosis of the small and medium arteries in the hands and feet. It can present as acute ischaemia or chronic progressive ischaemic changes to the skin/tissues. Ultimately it may result in gangrene of the affected area, often needing amputation. It is strongly associated with an extensive smoking history. The exact pathophysiology is not fully understood. Often follows from Raynaud’s

37
Q

Is the most appropriate first-line anti-anginal for stable angina in a patient with known heart failure, if there are no contraindications

A

Beta blockers

38
Q

When do we use transcutaneous pacing?

A

If atropine alone fails to control a patient’s bradyarrhythmia, alternative options include isoprenaline infusions or transcutaneous pacing.

39
Q

What foodstuff is contraindicated with simvastatin?

A

Grapefruit juice

40
Q

What is diltiazem?

A

Rate-limiting calcium channel blocker

41
Q

What is verapamil?

A

Rate-limiting calcium channel blocker

42
Q

How does pericarditis present?

A

anterior chest pain that is worse on deep inspiration and lying down

43
Q

How do we manage acute onset of AF?

A

Acute onset of atrial fibrillation: if ≥ 48 hours - rate control initially, then if considered for long-term rhythm control, delay cardioversion until they have been maintained on therapeutic anticoagulation for a minimum of 3 weeks

44
Q

How may we manage orthostatic hypotension?

A

Fludrocortisone or midodrine

45
Q

Following ACS, what medical mx is started?

A

DABS:
Dual anti-platelet
ACEi
Beta-blocker
Statin

46
Q

What do we start if there is co-existent AF with chronic HF?

A

Digoxin

47
Q

How do we treat WPW?

A

accessory pathway ablation

48
Q

How does WPW present on ECG?

A

a shortened PR interval and wide QRS complexes associated with a slurred upstroke seen in lead II

49
Q

What do statins do?

A

Statins inhibit HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis

50
Q

Which kind of MI infarct can cause arrhythmias?

A

So the RCA is the artery typically implicated in an Inferior STEMI - which presents with STE in II, III, AVF.

The RCA also supplies the AV node, so if infarcted, this can lead to arrhythmia.

As such, Inferior STEMIs can be associated with arrhythmia

51
Q

Where may you see notching of the inferior border of the ribs

A

Notching of the inferior border of the ribs is present in around 70% of adults with coarctation of the aorta

52
Q

What is the pattern of inheritance in HOCM?

A

Autosomal dominant

53
Q

What are janeway lesions?

A

Janeway lesions are painless, erythematous haemorhagic lesions seen on the palms and soles.

54
Q

What are Roth spots?

A

Roth spots are retinal haemorrhages.

55
Q

What is erythema multiforme?

A

Erythema multiforme is again caused by immune complex deposition classically appearing as a target or ‘bulls eye’.

56
Q

How would you manage first degree heart block in an athlete?

A

First-degree heart block is a normal variant in an athlete. It does not require intervention

57
Q

How is the BP altered in coarctation of the aorta?

A

The most common type of coarctation of the aorta seen in adults is the postductal variety, i.e. the aortic narrowing is distal to the ductus arteriosus. This means that the upper limb blood pressure is greater than that in the lower limbs as the narrowing occurs after the left subclavian artery branches from the aorta.

58
Q

How long do we treat PE for?

A

Length of anticoagulation
* all patients should have anticoagulation for at least 3 months
* if the VTE was provoked = 3 months
* if the VTE was unprovoked = 6 months
* If patient has cancer = 6 months

59
Q

When are nitrates contraindicated

A

When systolic <90 - vasodilator

59
Q

What is the most common cause of death in patients following a myocardial infarction?

A

Ventricular fibrillation

MSRA (21 decks)

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