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GPEP > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Management of STABLE angina

A
  • GTN spray (stat then 5 mins)
  • Aspirin
  • statin
  • ACEi If any comorbidities (HF, T2dM)
  • BB or CCB for symptom management

Refer to cardiology for stress testing. May need PCI or CABg if multivessel involvement or not improving on medical therapy

Can also use nitrates instead of BB for sx managmenet

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2
Q

Management of unSTABLE angina

A

immediate referral to hospital and let cardiologist or gen med know

  • Load with aspirin
  • Load with clopidogrel if ischaemia on ECG
  • Give GTN (if BP allows)
  • Give O2 only if <93 sats
  • monitor obs

remember unstable angina falls under the umbrella term of ACS

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3
Q

ECG changes with angina vs NSTEMI vs STEMI

A

Angina: Temporary ST-segment depression or T-wave inversion during episodes, with normalization afterward.

NSTEMI: Persistent ST-segment depression and/or T-wave inversion without ST-segment elevation.

STEMI: significant ST-segment elevation, possible new Q-waves, and dynamic T-wave changes, reflecting a full-thickness infarction.

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4
Q

Immediate management of NSTEMI

A

ABCDE
Refer to hospital ASAP - let cardio/gen med know
Load with aspirin
GTN for pain relief +/- morhpine
Consider O2 only if <93%

They will be considered for angio and anticoagulation, then a decision made re medical vs revascularisation tx (PCI or CABG)

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5
Q

Immediate management of a STEMI

A

ABCD
Call PCI able hospital ASAP - stemi protocol
Load with aspirin
Load with clopidogrel (if ECG changes or trop raise)
GTN spray
Analgesia

  • if PCI hospital is >2hrs away discuss option of fibrinolysis
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6
Q

Secondary prevention treatment of ACS
Split into lifestyle and pharmacologic

A

Lifestyle
- stop smoking
- cardiac rehab
- exercise and weight loss
- Reduce alcohol

Pharmacologic
- DAPT for 12 months, then aspirin ongoing
- Statin indefinately
- ACEi (ARB if intolerant)
- BB (or CCB if intolerant) for 12 months, if HFrEF then indefinate

+/- aldosterone antagonist if any HFrEF

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7
Q

Timings to know with STEMI treatment

A

offer Angiography: If presenting <12 hours and PCI hosp is <2hrs away

Consider fibrinolysis if presenting >12 hours of symptoms or PCI hosp is >2hrs away

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8
Q

How to investigate a patient with new stable AF

A

ECG
Bloods: TFTs, UEs, INR/coags, FBC
CHADsVASC and HASBLED scores
Request OP ECHO

then bring back ASAP to start management

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9
Q

Management of UNstable AF or if <12 hours since sx onset

Unstable meaning HF, chest pain, hypotension, syncope

A

ABCD
Refer to hospital under Gen med
If <48 since sx onset discuss cardioversion with Cardio

if it has been over 12 hrs since onset risk of thromboembolic events is high and rate control is preferred

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10
Q

Management of new stable AF

A

if definitely <12 hours consider ref for cardioversion, otherwise:

  1. Bloods (FBC, UEs, Coag, TFTs, LFTs)
  2. treat any reversible causes
  3. Refer for OP ECHO
  4. consider Anticoagulation (dabigatran, rivaroxaban, warfarin)
    - pending on chadsvasc/hasbled

5a. Rate control (BBs, dihydro CCB or digoxin) OR
5b. Rhythm control (cardioversion or antiarrhythmics)

  • rate control is preferred as cardioversion has a high recurrence rate/risk of thromboembolic events and AAMs have lots of SE’s
  • target HR <80bpm rest, 110bpm walking

stop DAPT if starting anticoagulation due to bleeding risk unless unstable IHD

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11
Q

Which anticoagulant is preferred for AF and why

A

Dabigatran preferred due to lower risk of ICH and reversal agent idacruzimab (CrCl >50mL)

rivaroxaban CrCl >15

Warfarin – The only approved agent for patients with a moderate to severe mitral stenosis, mechanical heart valve, or with creatinine clearance ≤ 15.

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12
Q

CHA2DS2 VASc

A

C: Congestive heart failure (1 point)
H: Hypertension (1 point)
A: Age ≥75 years (2 points)
D: Diabetes mellitus (1 point)
S: Stroke/TIA/Thromboembolism (history of) (2 points)
V: Vascular disease (1 point)
A: Age 65–74 years (1 point)
Sc: Sex category (female sex) (1 point)

Total Score Interpretation:
0 points: Low risk (consider no anticoagulation
1 point: consider anticoagulation
≥2 points: strongly consider anticoagulation

risk of stroke without AC

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13
Q

HASBLED score

bleeding risk for those considering anticoagulation

A

HTN
Abnormal renal and liver dysfunction
Stroke
Bleeding
Labile INR
Eldery >65
Drugs or alcohol

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14
Q

Side effects of nitrates

A

hypotension
tachycardia
headaches
flushing

many patients who take nitrates develop tolerance and experience reduced efficacy

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15
Q

What type of MI (location and vessel involved) can cause arrhythmia after and why

A

Inferior (II, III, aVF)
Right coronary artery

RCA supplies the AV node so can cause arrhythmias

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16
Q

Leads and arteries involved in:
Anteroseptal
Anterolateral
Lateral
Inferior
Posterior

A

Anteroseptal: V1-2 (LAD)
Anterior: V3-4 (proximal LAD)
Lateral: I, V5-6, aVL (Left circumflex)
Inferior: II, III, aVF (RCA)
Posterior: Reciprocal changes in V1-3, and STE in V7-9 (L circumflex or RCA)

Reciprocal changes: STD and UPRIGHT T waves, easy to confuse w NSTEMI

17
Q

Features of pericarditis

A

Chest pain: pleuritic, improved with leaning forward
SOB/dyspnoea, dry cough, flu like symptoms
pericardial rub

ECG: widespread STE (saddle shape), PR depression
Bloods: elevated inflammatory markers, 30% have high troponin

PR depression is the most specific marker for percarditis

18
Q

Four pillars of HF treatment

A

ARNI (or ACEi /ARBs if not meeting special criteria)
BB
mineralocorticoid receptor antagonists (Spirolactone)
SGLT2

19
Q

HF used to be defined as right (pedal oedema, raised JVP etc) vs left (pulm oedema, SOB). What defination do we now commonly use

A

HFpEF (EF >50%) with structural heart disease* and/or diastolic dysfunction

HFrEF (EF < 50%)

* Such as left ventricular hypertrophy or left atrial enlargement.

20
Q

Tx of pericarditis

A

Aspirin: start high then downtitrate after 2 weeks
colchicine for 3 months
Avoid strenuous exercise until symptom resolution

21
Q

ECG findings of pericarditis

A

PR depression and diffuse ST elevation which can be followed by T wave flattening and inversion

Stage 1 – widespread ST elevation and PR depression with reciprocal changes in aVR (occurs during the first two weeks)
Stage 2 – normalisation of ST changes; generalised T wave flattening (1 to 3 weeks)
Stage 3 – flattened T waves become inverted (3 to several weeks)
Stage 4 – ECG returns to normal (several weeks onwards)

22
Q

Abdominal aortic aneurysm
What size should you refer for surgical intervention

A

> 5.5cm in males
5.0cm in female

22
Q

Abdominal aortic aneurysm
Frequency of monitoring

A

2.5-3cm (10 yrly imaging)
>3cm annual imaging

23
Q

What ages should we start CVD risk assessment

A

men at 45 years, or 30 years if Maori/PI/south Asian
women at 55 years, or 40 years if Maori/PI/South Asian

From 25 years if any severe mental illness (schizophrenia, major depressive disorder, bipolar disorder, schizoaffective disorder), every two years

Diabetics (type 1 and 2) from diagnosis

24
Q

What groups of people do not need CVDRA done as they are already classified ‘high risk’ >15%

A
  • CHF
  • Diabetes with EGFR <45
  • CKD with eGFR <30
  • previous CV event (MI, stroke/TIA, CABG, PCI, PVD, angina)
  • carotid/coronary disease (CAC >400 or carotid plaque on USS)
  • familial hypercholesterolaemia

GPEP (24 decks)

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