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GP FELLOWSHIP RNZGP > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Blood pressure causes for elevations (8)

A
  • Non compliance
  • Whitecoat
  • Recent weight gain
  • drugs (methamphetamines)
  • Renal failure
  • Anxiety
  • Wrong cuff size
  • Smoking
  • OSA
  • Sedentary lifestyle
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2
Q

HOCM major symptom

A

Exertional Dyspnoea

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3
Q

ECG findings in HOCM

A

High voltage QRS
ST changes and T wave repolarisation abnormalities

May be hard to distinguish from athletic young person

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4
Q

HOCM ECHO findings (and what they are assessing for)

A
  • LV thickness >11mm raises concern

Looking for
- LV function
- LVOT
- Pattern and degree of LVH
- Presence and degree of mitral regurg

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5
Q

Investigations for HOCM

A
  • ECHO
  • Stress ECHO (looking for exercise induced LVOT)
  • ECG
  • 24 hour holter monitor
  • Cardiac MRI
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6
Q

Diagnosis of CCF

A

Transthoracic ECHO
BNP

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7
Q

CCF management (general)

A
  • ACEi low dose (perindo 2.5-5mg)
  • Spironolactone (25mg)
  • Frusemide (up to 40mg)
  • Cardio-selective beta blocker (bisoprolol 1.25mg) (NOT in decompensated HF)
  • Low salt diet (<5g)
  • Fluid restrict 1-1.5L
  • Daily weights
  • Review 48 hours
  • Cardiac rehab
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8
Q

How much exercise per week

A

150-300 mintues moderate intensity/week

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9
Q

Angina episodic treatment

A

GTN spray 400mcg

Repeat every 5 min up to 3 doses
(note: if pain persists >10mins despite 2 doses –> ED)

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10
Q

Pharmacological management to prevent angina (broad categories)

A

USE TWO FROM DIFFERENT CLASSES

-Beta blocker (Metoprolol tartrate)

-Long acting nitrate (GTN 14 hour patch)

-Nondihydropyridine CCB (Diltiazem, verapamil)

-Dihydropyridine CCB (Amlodipine, nifedipine)

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11
Q

Pharmacological management to prevent angina: Betablocker dose.

A

Beta blocker:
Metoprolol tartrate 25mg BD (max 100mg BD)

(HFREF: use bisoprolol or metoprolol succinate)

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12
Q

Pharmacological management to prevent angina: Non-dihydropyridine calcium channel blocker

A

Diltiazem MR 180mg daily (up to 360mg)

OR

Verapamil MR 120mg daily ( up to 480mg)

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13
Q

Cautions with nondihydropyridine calcium channel blocker

A

Do not use with beta blocker (severe bradycardia and HF)

Avoid with ejection fraction <40 %

Do not use with dihydropyridine CCB (amlodipine or nifedipine)

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14
Q

Pharmacological management to prevent angina: Dihydropyridine calcium channel blocker

A

Amlodipine 2.5mg (up to 10mg)

Nifedipine MR 30mg (up to 60mg)

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15
Q

Pharmacological management to prevent angina: Long acting nitrate

A

Glyceryl trinitrate 5mg patch (14 hours/day)

max dose 15mg

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16
Q

Pharmacological management to prevent angina - refractory angina

A

Nicorandil 5mg BD
Max dose 20mg BD

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17
Q

History for HOCM

A
  • Exertional dyspnoea
  • non- exertional dyspnoea
  • Chest pain
  • palpitations
  • Presyncope

Rule out differentials
- Wheeze
- Cough or coryzal symptoms
- Fever
- VTE: immobilisation, calf pain

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18
Q

HOCM management following diagnosis

A
  • URGENT referral to cardiologist
  • Stop competitive sport (high intensity) until cardiology review
  • Any chest pain, presyncope to attend ED
  • Family will need testing
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19
Q

Metabolic syndrome diagnostic criteria

A
  • Waist circumference >88
    (>80 for asian, african, mediterranean)
  • Triglycerides >1.7
  • HDL-C <1
    (1.3 in women)
  • HTN: >130 or >85
  • Fasting glucose >5.5
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20
Q

Most common cause of Mitral Stenosis

A

Rheumatic heart disease

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21
Q

Clinical features of MITRAL STENOSIS (general and murmur findings)

A
  • Mitral Facies: flushed cheeks
  • Crackles due to pulmonary oedema
  • Advanced: RHF

Murmur:
- Opening snap
- Low pitched diastolic rumble
- At APEX
- Best heard with bell with patient lying on left side (held expiration)

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22
Q

What makes you Automatic CVD high risk ?
HINT 6

A
  • Diabetes & >60
  • Diabetes & microalbuminuria (ACR >2.5men/3.5women)
  • Mod-severe CKD
  • Familial hypercholesterolaemia
  • SPB >180 or diastolic >110
  • Total cholesterol >7.5
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23
Q

4 first line betablockers in HFrEF

A

Bisoprolol 1.25 daily (inc to 10mg)

Carvedilol

Metoprolol succinate 23.75mg daily

Nebivolol 1.25 daily (up to 10mg)

24
Q

Contrindications to stress testing

A
  • Unstable angina
  • Severe AS
  • AMI/ new LBBB
  • Unstable HF
  • Haemodynamic instability
  • Uncontrolled arrhythmia
25
Q

Atrial Fibrillation management (non-pharmalogical)

A
  • Smoking cessation
  • etOH <3 std/week
  • Aerobic exercise 210/week
  • Weight loss to BMI <27
26
Q

Cut off for diagnosis of HTN for ambulatory BP

A

ABPM over 24 hrs >130

27
Q

LDL-C not sufficiently reduced on statin… What to add?

A
  • Ezetimibe
  • Bile acid binding
28
Q

Triglycerides not sufficiently reduced on statin… What to add?

A
  • Fenofibrate 145mg (90 if EGFR <60) *
  • fish oil 2-4g **
  • Triglygcerides >4
    ** Triglygcerides >10
29
Q

HFrEF when to change ACEi to ARNI ?

A

If at 3 -6 monthly ECHO the LVEF <40 then change

30
Q

Additional treatment options for HFrEF?

A
  • Cardiac device therapy (<35%)
  • Ivabradine if sinus rhythm >70 BPM and LVEF <35%
  • If ACEi,ARB and ARNI not tolerated then use nitrates or hydralazine
  • Consider nitrates and digoxin if refractory symptoms
31
Q

Causes of Hypertension (Secondary)

A

OSA
Renal parenchymal disease
Primary aldosteronism
Renal artery stenosis
NSAIDS
Corticosteroids
stimulants
Phaeochromocytoma
Cushing’s syndrome

32
Q

Resistant hypertension options

A

Indapamide 2.5mg Max

Atenolol 25mg
or Metoprolol 25mg BD

Spironolactone 12.5mg

33
Q

Valvular AF: what conditions constitute this?

A
  • Mitral valve stenosis (mod-severe)
  • mechanical heart valve
34
Q

Valvular AF anticoagulation

A

WARFARIN

35
Q

Metabolic syndrome qualifiers

A

Waist circ
high triglycerides >1.7
reduced HDL <1
BP >130
Impaired fasting glucose >5.5

36
Q

Moderate CVD Risk: which features makes medications necessary

A

ATSI
BP persistently >160
Family hist of premature CVD

37
Q

Premature CVD age cut offs

A

F <55
M < 60

38
Q

Mobitz type 1 action

A

If asymptomatic, nothing

39
Q

Mobitz type 2 action

A

Referral for pacing and pacemaker insertion

40
Q

When is it suitable to do a precordial thump?

A

Monitored pulseless VT (not VF) when defib not readily available

41
Q

Examples of broad complex tachycardia (three)

A
  • VT
  • AF with BBB
  • Torsades de pointes
42
Q

Examples of narrow complex tachycardia (three)
Hint: Irregular & regular

A

Irregular:
- AF

Regular
- WPW
- SVT
- AT
- AF
- SInus tachy

43
Q

Conscious VT & haemodynamically stable - what to do ?

A
  • Amiodarone 300mg IV over 10-20mins mins, then 900mg over 24hrs
44
Q

Narrow complex & regular QRS what to do?

A

Vagal manoeuvres
then ADENOSINE CHALLENGE 6mg rapid bolus

45
Q

A) ?
B) ?

A

Atrial flutter
Atrial fibrillation

46
Q

What to suspect with narrow complex tachycardia at 150BMP

A

FLUTTER with 2:1 block

47
Q

Best analgesic for acute coronary syndrome

A

Fentanyl

(morphine reduces absorption of antiplatelet agents)

48
Q

Complication of inferior STEMI

A

3rd degree heart block

49
Q

Wide QRS (more than three squares) what does this usually indicate

A

BBB

50
Q

Investigations for HTN for all people

A
  • UA
  • Urine ACR
  • Fasting BGL
  • Fasting Cholesterol
  • EUC
  • Hb
  • ECG
51
Q

Post AMI medication regime

A
  • Perindopril 2.5-5mg
  • Atorvatstatin 80mg
  • Bisoprolol 1.25- 2.5mg
  • aspirin 100mg
  • clopidogrel (12months) 75mg
52
Q

Driving restriction post AMI ?

A

2 weeks

53
Q

3 types of options for SVT cardioversion before you get to adenosine

A
  • Modified valsalva maneouver
  • Unilateral carotid sinus massage
  • Immersion of the face in cold water
54
Q

SVT 2nd line

A

Adenosine 6mg IV stat push

55
Q

Investigations for HOCM

A
  • ECHO
  • Stress ECHO (looking for exercise induced LVOT)
  • ECG
  • 24 hour holter monitor
  • Cardiac MRI

GP FELLOWSHIP RNZGP (20 decks)

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