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1MSRA - Learning Points > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Which features score 2 points in the CHADSVASC score?

A

Age >75
Previous Stroke OR TIA

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2
Q

What is the management of stable angina?

A

1st - Beta blocker
2nd - CCB (not rate limiting)

All patients should have aspirin and statin.

If beta blocker contraindicated, rate-limiting CCB

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3
Q

What medical management should everyone have after an ACS?

A

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)

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4
Q

If someone has symptoms of ACS (chest pain, sweaty etc) and has ST depression V1-V3 on ECG, what’s the likely diagnosis?

A

Posterior MI

NB// also look out for posterolateral MI, where you would also have ST elevation in lateral leads

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5
Q

Complication of RIGHT CORONARY ARTERY STEMI?

A

AVN affected, therefore 1st degree heart block and bradycardia

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6
Q

Which medications are indicated in cardiac arrest VF/pulseless VT after 3 shocks?

A

BOTH 1g IV Adrenaline and 300mg IV Amiodarone

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7
Q

List adverse signs of arrhythmia?

A

Shock, syncope, chest pain/acute ischaemia, acute HF

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8
Q

What are the ECG findings of WPW?
Why is WPW dangerous?
What is the management?

A

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

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9
Q

Does spironolactone improve mortality in heart failure?

A

Yes

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10
Q

In HF with co-existent AF, which medication should be prescribed after the 1st/2nd line?

A

Digoxin

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11
Q

Which T2DM drug is contraindicated in HF and why?

A

Pioglitazone - causes fluid retention

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12
Q

How to differentiate familial vs non-familial hypercholesterolaemia?

What is the name of the criteria used?

A

Raised LDL >5
Xanthomata

Simon Broome Criteria

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13
Q

What medication can be started as prophylaxis in someone with repeat episodes of VT? What monitoring is required and why?

A

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

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14
Q

Which common medication does clopidogrel interact with which reduces its own effectiveness?

A

Omeprazole

Therefore switch to lansoprazole instead

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15
Q

Broad QRS, small p waves, Tall T waves?

A

Hyperkalaemia

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16
Q

Which drugs are used in pharmacological cardioversion in AF?

A

Flecainide if NO STRUCTURAL HEART DISEASE (scar tissue/abnormal tissue/anatomy alters electrical conduction, which can precipitate dangerous arrhythmias with flecainide)

Amiodarone

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17
Q

What is the initial ALS algorithm if you witness a patient arresting whilst on cardiac monitoring and it is VF/pulseless VT?

A

Immediate 3 shocks (these count as 1) then commence CPR

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18
Q

In who should you not use the QRISK score in? (and prescribe statins anyway)

A

T1DM
CKD
Familial hypercholesterolaemia

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19
Q

What are the side effects of adenosine?

A

Bronchospasm (avoid in asthmatics)
Chest pain
Flushing
(impending sense of doom as pause in sinus rhythm)

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20
Q

Which patients with AF should be anti coagulated?

A

If CHADVASC is 2 or more

In men, consider if 1

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21
Q

What are the ECG changes in Hypokalaemia?

A

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

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22
Q

Triad of raised JVP, hypotension and muffled heart sounds? What does ECG show? How to manage?

A

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.

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23
Q

Which Abx class do statins interact with?

A

Macrolides (stop statin while on them)

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24
Q

What is nicorandil and what is its side effect?

A

Nitrate-like drug used in angina

Side effect = mucosal ulceration (eyes, mouth, anus)

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25
Q

What is the medical management of STEMI?

A

DAPT (aspirin + prasugrel if PCI OR ticagrelor if fibrinolysis)

ticagrelor is reversible, given fibrinolysis has high bleeding risk

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26
Q

What are the complications of aortic dissection?

A

Forwards tear = stroke, upper limb ischaemia

Backwards tear = aortic regurgitation, cardiac tamponade

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27
Q

Mx of aortic dissection?

A

Type A = surgical
Type B = conservative

BP control with IV labetolol

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28
Q

What are the side effects of ACEi?

A

dry cough
angiooedema - swelling of mouth, face, tongue)

29
Q

What should the choice of anticoagulation always be in valvular AF?

A

Warfarin

30
Q

What is the antiplatelet/anticoagulation management post-stroke if it was caused by AF?

A

After 2 weeks, switch clopidogrel to anticoagulation

31
Q

What is new LBBB most likely to represent?

A

New LBBB is always pathological

It is most likely to represent an anterior MI

32
Q

What are the complications post-MI?
What is the most common?

A

Most common = VF

anatomical - pericardium, ventricle wall, septum (pericarditis, Dressler’s, LV anuerysm, LV free wall rupture, VSD)

Functional - Shock, Arrhythmia, chronic HF

33
Q

Choice of anti-HTN medication?

A

> 55 or Afro-Caribbean = CCB

Otherwise ACEi

Diabetics always get ACEi!

34
Q

What are the side effects of the GTN spray?

A

Hypotension, dizziness

Headache

(all of these due to vasodilation)

35
Q

What are the side effects of beta blockers?

A

Hypotension, bradycardia
SLEEP DISTURBANCE
ERECTILE DYSFUNCTION

36
Q

What are the symptoms of HOCM?
What are the heart signs?

A

MR SAM ASH

Mitral Regurg
Systolic anterior motion of mitral valve
Asymmetric hypertrophy

37
Q

Should dental procedures receive routine infective endocarditis prophylaxis?

A

No

38
Q

Which anti-HTN meds are contraindicated in HOCM?

A

ACEi

39
Q

What factors decrease BNP levels?

A

Obesity and medication (anti-HTN)

40
Q

What are the adverse effects of adenosine?

A

Chest pain
Bronchospasm
Flushing
(note feeling of doom when given as pause in rhythm)

41
Q

Early diastolic vs mid diastolic murmur cause?

A

Early diastolic = aortic regurgitation

Mid diastolic = mitral stenosis

42
Q

Who should receive preventative anticoagulation in AF?

A

Always If chadsvasc score 2
If male and score is 1, consider

Females are 1 at baseline anyway so need to score 2

43
Q

Management of orthostatic hypotension?

A

Medication is fludrocortisone and midodrine (alpha agonist)

Lifestyle includes hydration and increased salt intake

44
Q

Which heart issue is associated with ADPCKD?

A

Mitral valve prolapse!
This can cause mitral regurgitation

45
Q

When should you test LFTs for statins? How do they work?

A

baseline, 3 months, 12 months

46
Q

Who should receive statins?

A

QRISK >10%

Established CVD/stroke

T1DM and had for 10years/aged over40/have nephropathy

47
Q

NB// if furosemide not working, no benefit switching to bumetanide

A
48
Q

Causes of secondary/refractory HTN?

A

Coarctation of Aorta
Renal Artery Stenosis

Endocrine causes - phaechromocytoma, Cushing’s, Acromegaly

49
Q

What are the rate limiting CCBs?

A

Diltiazem and Verapamil

50
Q

How to manage raised INR?

A

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

51
Q

Which medication can worsen gout?

A

Thiazide diuretics

52
Q

What to do in terms of antiplatelets vs anticoagulants if stroke/TIA caused by AF?

A

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.

53
Q

Aetiology of Aortic Stenosis?

Management?

A

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

54
Q

What CXR sign can coarctation of aorta cause?

A

Rib notching
(as intercostal vessels dilate)

55
Q

Management of HOCM?

A

amiodarone
bisoprolol
ICD

(cause of deaths is functional aortic stenosis due to muscle hypertrophy OR ventricular arrhythmia)

56
Q

Management of ACS?

A

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

57
Q

Mx of aortic dissection?

A

Type A = surgical
Type B = conservative (BP control)

58
Q

Two types of ventricular tachycardia?

A

Monomorphic

Polymorphic (Long QT -> TdP)

Monomorphic VT is treated with amiodarone
TdP with mag sulf

VERAPAMIL CAN PRECIPITATE CARDIAC ARREST SO IS CONTRAINDICATED

59
Q

What to do if second anti-anginal not sufficient?

A

Add 3rd - long acting nitrate (isosorbide)
AND REFER FOR PCI/CABG ie. needs secondary care assessment

60
Q

What are the endocrine causes of HTN?

A

Cushing’s
Phaechromocytoma
ACROMEGALY

61
Q

How does acromegaly cause hypertension?

A

GH and IGF1 cause fluid retention

They stiffen artery walls

OSA due to acromegaly causes increased cortisol -> raised BP

62
Q

NB// If symptoms of PVD in young patient, more likely to be Berger’s than PVD

A
63
Q

How soon can you drive after an ACS?

A

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

64
Q

What does saddle shaped ST elevation actually mean?

A

ST segment that’s raised has concave bit at start giving saddle shape

65
Q

ECG - short PR and slurred upstroke on QRS

A

WPF (accessory pathway)

66
Q

Threshold for Stage 1 HTN following HBPM?

A

HBMP >135/85

67
Q

Management option for HF patient optimised on medication. but has EF <50 % and broad QRS?

A

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

68
Q

What is the most common type of aortic coarctation in adults? Where does the mean location wise?

A

Post-ductal

i.e. narrowing is after the L subclavian artery, hence producing BP difference between upper and lower limb.

69
Q

In new AF patients presenting onset >48hrs, in which situation do you TOE vs just anticoagulate for 3?

A

Only TOE if they’re unstable and therefore you don’t want to wait for 3 weeks of anticoagulation before cardioverting.

1MSRA - Learning Points (20 decks)

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