Cardiology Flashcards
Which features score 2 points in the CHADSVASC score?
Age >75
Previous Stroke OR TIA
What is the management of stable angina?
1st - Beta blocker
2nd - CCB (not rate limiting)
All patients should have aspirin and statin.
If beta blocker contraindicated, rate-limiting CCB
What medical management should everyone have after an ACS?
DAPT - aspirin and clopidogrel
Statin
ACEi and beta blocker (same reason as why they are used in HF - prevents cardiac remodelling and improves systolic function)
If someone has symptoms of ACS (chest pain, sweaty etc) and has ST depression V1-V3 on ECG, what’s the likely diagnosis?
Posterior MI
NB// also look out for posterolateral MI, where you would also have ST elevation in lateral leads
Complication of RIGHT CORONARY ARTERY STEMI?
AVN affected, therefore 1st degree heart block and bradycardia
Which medications are indicated in cardiac arrest VF/pulseless VT after 3 shocks?
BOTH 1g IV Adrenaline and 300mg IV Amiodarone
List adverse signs of arrhythmia?
Shock, syncope, chest pain/acute ischaemia, acute HF
What are the ECG findings of WPW?
Why is WPW dangerous?
What is the management?
broadened QRS, shortened PR interval, slurred upstroke ?
presence of congenital abnormal conduction pathway can conduct AF to VF (unlike AVN which has speed limit)
Ablation
Does spironolactone improve mortality in heart failure?
Yes
In HF with co-existent AF, which medication should be prescribed after the 1st/2nd line?
Digoxin
Which T2DM drug is contraindicated in HF and why?
Pioglitazone - causes fluid retention
How to differentiate familial vs non-familial hypercholesterolaemia?
What is the name of the criteria used?
Raised LDL >5
Xanthomata
Simon Broome Criteria
What medication can be started as prophylaxis in someone with repeat episodes of VT? What monitoring is required and why?
Amiodarone
Can cause thyroid dysfunction, lung fibrosis and liver damage
Therefore need CXR, TFTs, LFTs (and Use)
It causes qt prolongation (kinda how it works in first place), so is still proarrythmic in a sense
Which common medication does clopidogrel interact with which reduces its own effectiveness?
Omeprazole
Therefore switch to lansoprazole instead
Broad QRS, small p waves, Tall T waves?
Hyperkalaemia
Which drugs are used in pharmacological cardioversion in AF?
Flecainide if NO STRUCTURAL HEART DISEASE (scar tissue/abnormal tissue/anatomy alters electrical conduction, which can precipitate dangerous arrhythmias with flecainide)
Amiodarone
What is the initial ALS algorithm if you witness a patient arresting whilst on cardiac monitoring and it is VF/pulseless VT?
Immediate 3 shocks (these count as 1) then commence CPR
In who should you not use the QRISK score in? (and prescribe statins anyway)
T1DM
CKD
Familial hypercholesterolaemia
What are the side effects of adenosine?
Bronchospasm (avoid in asthmatics)
Chest pain
Flushing
(impending sense of doom as pause in sinus rhythm)
Which patients with AF should be anti coagulated?
If CHADVASC is 2 or more
In men, consider if 1
What are the ECG changes in Hypokalaemia?
U have not pot and no T, but a long PR and long QT
ie. U waves (upward deflection at end of T wave)
Prolonged PR interval
Long QT
Triad of raised JVP, hypotension and muffled heart sounds? What does ECG show? How to manage?
Pericardial effusion causing cardiac tamponade
ECG - alternating heights of R waves (electrical alternans)
Manage with urgent pericardiocentesis
Note: raised JVP either caused by HF/fluid overload or by cardiac tamponade.
Which Abx class do statins interact with?
Macrolides (stop statin while on them)
What is nicorandil and what is its side effect?
Nitrate-like drug used in angina
Side effect = mucosal ulceration (eyes, mouth, anus)
What is the medical management of STEMI?
DAPT (aspirin + prasugrel if PCI OR ticagrelor if fibrinolysis)
ticagrelor is reversible, given fibrinolysis has high bleeding risk
What are the complications of aortic dissection?
Forwards tear = stroke, upper limb ischaemia
Backwards tear = aortic regurgitation, cardiac tamponade
Mx of aortic dissection?
Type A = surgical
Type B = conservative
BP control with IV labetolol
What are the side effects of ACEi?
dry cough
angiooedema - swelling of mouth, face, tongue)
What should the choice of anticoagulation always be in valvular AF?
Warfarin
What is the antiplatelet/anticoagulation management post-stroke if it was caused by AF?
After 2 weeks, switch clopidogrel to anticoagulation
What is new LBBB most likely to represent?
New LBBB is always pathological
It is most likely to represent an anterior MI
What are the complications post-MI?
What is the most common?
Most common = VF
anatomical - pericardium, ventricle wall, septum (pericarditis, Dressler’s, LV anuerysm, LV free wall rupture, VSD)
Functional - Shock, Arrhythmia, chronic HF
Choice of anti-HTN medication?
> 55 or Afro-Caribbean = CCB
Otherwise ACEi
Diabetics always get ACEi!
What are the side effects of the GTN spray?
Hypotension, dizziness
Headache
(all of these due to vasodilation)
What are the side effects of beta blockers?
Hypotension, bradycardia
SLEEP DISTURBANCE
ERECTILE DYSFUNCTION
What are the symptoms of HOCM?
What are the heart signs?
MR SAM ASH
Mitral Regurg
Systolic anterior motion of mitral valve
Asymmetric hypertrophy
Should dental procedures receive routine infective endocarditis prophylaxis?
No
Which anti-HTN meds are contraindicated in HOCM?
ACEi
What factors decrease BNP levels?
Obesity and medication (anti-HTN)
What are the adverse effects of adenosine?
Chest pain
Bronchospasm
Flushing
(note feeling of doom when given as pause in rhythm)
Early diastolic vs mid diastolic murmur cause?
Early diastolic = aortic regurgitation
Mid diastolic = mitral stenosis
Who should receive preventative anticoagulation in AF?
Always If chadsvasc score 2
If male and score is 1, consider
Females are 1 at baseline anyway so need to score 2
Management of orthostatic hypotension?
Medication is fludrocortisone and midodrine (alpha agonist)
Lifestyle includes hydration and increased salt intake
Which heart issue is associated with ADPCKD?
Mitral valve prolapse!
This can cause mitral regurgitation
When should you test LFTs for statins? How do they work?
baseline, 3 months, 12 months
Who should receive statins?
QRISK >10%
Established CVD/stroke
T1DM and had for 10years/aged over40/have nephropathy
NB// if furosemide not working, no benefit switching to bumetanide
Causes of secondary/refractory HTN?
Coarctation of Aorta
Renal Artery Stenosis
Endocrine causes - phaechromocytoma, Cushing’s, Acromegaly
What are the rate limiting CCBs?
Diltiazem and Verapamil
How to manage raised INR?
any situation where minor bleeding -> IV Vitamin K
any situation where major bleeding -> IV Vitamin K and PCC
if no bleeding, and INR 5-8 = withhold 1 or 2 doses of warfarin
if no bleeding but INR > 8, Oral Vitamin K
Which medication can worsen gout?
Thiazide diuretics
What to do in terms of antiplatelets vs anticoagulants if stroke/TIA caused by AF?
Anticoagulant trumps
If TIA, can start anticoagulation straight away
If ischaemic stroke confirmed, still need to wait 2 weeks prior to starting anticoagulation to prevent hemorrhagic transformation.
In meantime, use antiplatelet.
Aetiology of Aortic Stenosis?
Management?
In general
old - calcification (>65yrs)
young - biscupid aortic valve (<65yrs)
Management is ideally surgical valve replacement if able
Young - mechanical as lasts longer (need lifelong anticoagulants though)
Old - bioprosthetic (degrades quicker but avoids anticoagulation)
If SVR not suitable, balloon dilation
What CXR sign can coarctation of aorta cause?
Rib notching
(as intercostal vessels dilate)
Management of HOCM?
amiodarone
bisoprolol
ICD
(cause of deaths is functional aortic stenosis due to muscle hypertrophy OR ventricular arrhythmia)
Management of ACS?
STEMI - PCI if available in 2hrs
(+prasugrel)
if not, fibrinolysis (+ticagrelor)
NSTEMI - if not having PCI immediately, give fondaparinux.
Then if GRACE score >3% - PCI/fibrinolysis route
If <3%, medical Mx
Mx of aortic dissection?
Type A = surgical
Type B = conservative (BP control)
Two types of ventricular tachycardia?
Monomorphic
Polymorphic (Long QT -> TdP)
Monomorphic VT is treated with amiodarone
TdP with mag sulf
VERAPAMIL CAN PRECIPITATE CARDIAC ARREST SO IS CONTRAINDICATED
What to do if second anti-anginal not sufficient?
Add 3rd - long acting nitrate (isosorbide)
AND REFER FOR PCI/CABG ie. needs secondary care assessment
What are the endocrine causes of HTN?
Cushing’s
Phaechromocytoma
ACROMEGALY
How does acromegaly cause hypertension?
GH and IGF1 cause fluid retention
They stiffen artery walls
OSA due to acromegaly causes increased cortisol -> raised BP
NB// If symptoms of PVD in young patient, more likely to be Berger’s than PVD
How soon can you drive after an ACS?
It’s sooner if you’ve had definitive mx like PCI
If PCI and EF at least 50%, then in 1 week
if did not have PCI, need to wait 4 weeks
What does saddle shaped ST elevation actually mean?
ST segment that’s raised has concave bit at start giving saddle shape
ECG - short PR and slurred upstroke on QRS
WPF (accessory pathway)
Threshold for Stage 1 HTN following HBPM?
HBMP >135/85
Management option for HF patient optimised on medication. but has EF <50 % and broad QRS?
Cardiac Resynchronisation therapy - this essentially is a biventriuclar pacing
(helps ventricles to contract together at same time)
Note: if patient has history of VTs, then an ICD would also be useful
What is the most common type of aortic coarctation in adults? Where does the mean location wise?
Post-ductal
i.e. narrowing is after the L subclavian artery, hence producing BP difference between upper and lower limb.
In new AF patients presenting onset >48hrs, in which situation do you TOE vs just anticoagulate for 3?
Only TOE if they’re unstable and therefore you don’t want to wait for 3 weeks of anticoagulation before cardioverting.
