Cardiology Flashcards
How does clopidogrel prevent haemostasis? Name 3 other drugs that similarly behave
Prevents ADP binding to P2Y12 to stop activation of GPIIb/IIIa.
This prevents fibrinogen-mediated cross linking of platelets
Other members: Ticagrelor, prasurgel, ticodipine
How and when do you treat patent ductus arteriosus?
NSAIDs inhibit prostagladin synthesis to close duct
Give 1 week post-natally
How is PDA identified in terms of…
Cyanosis
Pulse
Palpation
Auscultation
non-cyanotic (cyanosis late stage)
Collapsing pulse, wide pulse pressure
L subclavicular thrill, heaving apex beat
Continuous machinery murmur
With ADP inhibitors, which…
Is most associated with dyspnoea
Is less effective with PPIs
is best for those with high bleed risk?
Ticagrelor causes breathlessness
Clopidogrel
Clopidogrel
What does this trace show?
Who is it more likely in?
How is it treated?
Multi-focal Atrial Tachycardia
Severe COPD/CCF
Correct electrolytes + hypoxia
Rate-limiting beta blockers
Name which congenital heart condition matches the oxygen saturation findings
Rise in pulmonary artery
Rise in pulmonary artery + right ventricle
Rise in PA + RV + RA
Fall in aorta
Fall in aorta and LV
Fall in aorta + LV + RA
Patent ductus arteriosus: Aorta and pulm artery connected
VSD: L>R shunt
ASD: LR shunt then blood moves into ventricle
Eisemenger: Pulm hypertension –> sclerosis –> RL shunt instead
PDA + Eisenmenger
VSD + Eisenmenger
ASD + Eisenmenger
How do loop diuretics work?
Act on the *Na-K-Cl Cotransporter (NAKCC) in thick ascending limb of Henle to reduce NaCl reabsorption.
*More selectively NaKCC
What are the main side effects of loop diuretics
Electrolyte loss loss: Low sodium, potassium, magnesium, calcium, chloride (H+ causing met alkalosis)
Hydration loss (renal impairment and hypotension)
Hearing loss
Glucose and Gout Gain
In a patient with ‘tearing’ back pain, what other clinical features indicate aortic dissection?
Hypertension
Pulse deficit: Absent central pulses, >20mmHg variation in blood pressure
Aortic regurgitation
+ vessel specific deficits eg angina, paraplegia, limb ischaemia
What anti-clotting therapy would you advise in the following scenarios?
1. Secondary prevention of stable cardiovascular disease?
2. Post-ACS/PCI
3. VTE on antiplatelet
- Typically antiplatelets but give anticoagulant instead if need for anticoagulation exists (eg AF, PE etc)
- Triple therapy (2 anti-platelets, 1 anticoagulant) for up to 6 months post-event, then dual therapy (1 of each) to reach 12 months
- Give anticoags 3-6 months; continue indefinitely if low ORBIT score
What is an early diastolic murmur indicative of?
What other clinical signs can be observed?
Aortic regurgitation
Pulse: Wide pressures, collapsing pulse, nailbed pulsation (Quincke’s sign)
De Musset’s sign
Mid-diastolic murmur (lie pt on side): Known as Austin-Flint. Severe AR causes MS due to backflow preventing full mitral valve closure
How can the causes of aortic regurgitation be organised by
Acuity
Pathology
Valve disease
Acute: Infective endocarditis
Chronic:
- Rheumatic fever
- Calcific disease
- CTDs
- Bicuspid aortic valves
Aortic root dilatation
Acute: Dissection
Chronic
- Bicuspid aortic valve
- Ank spond
- HTN
- Marfan’s syndrome
Why are ACEIs renoprotective?
Inhibition of AT 1 to 2
Reduced AT2 results in vasodilation and reduced blood pressure.
Reduced BP in efferent (distal) arterioles leads to reduced glomerular pressure
.’. reduced strain on filtration barriers in kidney
What are the main side effects of ACEIs
Cough
Angioedema within a year
Hyperkalaemia
Hypotension after first dose
Who should be shown caution with ACEIs
Prengancy + breastfeeding should be avoided
Renovascular disease
Aortic stenosis
Potassium >=5.0mmol
What is the general principle for U+E monitoring with ACEIs?
Ok to have
<=30% rise in creat from baseline
Increased potassium to 5.5
Significant renal impairment can be seen in what condition following commencement of ACEIs
Bilateral Renal Artery Stenosis
Mid-late diastolic murmur, dyspnoea and pink sputum indicates what?
Mitral stenosis
Aside from mid-late diastolic murmur, what other sounds can be heard in mitral stenosis?
Loud S1 (progresses to S2 if severe)
Opening snap
What imaging aids diagnosis of MS?
Echo is most useful: <1sqcm diameter (usually 4-6sqcm)
CXR can show splayed carina, elevated L main bronchus, double right heart border, cardiomegaly
How is mitral stenosis managed?
If AF: Anticoagulate with warfarin, consider DOAC if mild MS
If symptomatic: Perc balloon valvulotomy, mitral valve surgery (commisurotomy, valve replacement)
Outline post-PCI care
Increased clot risk given synthetic material so need…
Aspirin indefinitely
Clopidogrel for months at discretion of cardiology
What are the procedural complications of PCI?
Haematoma: At access site, if hypotension/flank pain think retroperitoneal
Femoral pseudoaneurysm: Pulsatile mass, femoral bruits, compromised distal pulses
Embolisation: Of atherosclerosis cholesterol. Purpura, renal impairment, blue toes
What are the longer term PCI complications?
Restenosis in 5-20% patients, typically 2-6 months. More likely in DM, renal impairment, stents in venous bypass grafts
Stent thrombosis 1-2%
