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UKMLA > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Numbers of stage 1 hypertension?

A

140/90 clinical, 135/85 Home

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2
Q

Numbers of stage 2 Hypertension

A

150/100 clinical, 145/95 home

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3
Q

Numbers of stage 3 hypertension (severe)?

A

180 systolic clinical or 120 diastolic home

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4
Q

Treatment for T2DM w/ HTN

A
  1. ACE/ARB first line
  2. Calcium channel blockers/diuretics
  3. Either of the ones miss next
  4. If K <4.5, spironolactone, if not asthmatic Bisoprolol
    Otherwise refer to specialist
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5
Q

Treatment for afrocarribeans with HTN

A

ARBs or CCBs

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6
Q

HTN tx depending on age?

A

> 50 = CCB, <50 = ACE/ARB

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7
Q

What is the pathway for HTN treatment

A

A + C/D + D/C + B/spironolactone if K<4.5 + referral

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8
Q

MOA of ACE inhibitors and common examples?

A

Stops conversion of angiotensin 1 into angiotensin 2
THEREFORE
Less A2 = vasodilation = reduced BP
Less A2 = less activation of aldosterone = less NA and water retention
Less A2 = less constriction of efferent arterioles in kidney = vasodilation and less strain on kidneys

Ramipril, lisinopril, elanopril

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9
Q

Positive use of ACE inhibitors in diabetics?

A

Renoprotective

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10
Q

What is ACS

A

acute coronary syndrome made up of STEMI, NSTEMI and UA

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11
Q

What is STEMI

A

St elevation in any of the ECG rhythm leads, indicating myocardial infarction (occlusion of blood flow

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12
Q

What is NSTEMI

A

St depression and p wav inversion usually, not as severe as STEMI (partial occlusion)

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13
Q

What is UA

A

Unstable angina, usually present at rest not as severe as NSTEMI/STEMI.

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14
Q

Difference between UA and NSTEMI?

A

No changes in troponin

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15
Q

Mainstay clinical symptoms of ACS

A

Central crushing chets pain, left arm/jaw pain, pale, clammy - diabetics may present atypical (nausea and vomiting)

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16
Q

Leads I, II, aVF indicate what territory?

A

Right coronary artery (INFERIOR)

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17
Q

Leads I, V5 and V6 indicate what territory?

A

Left circumflex artery (LATERAL)

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18
Q

Leads V1,2,3,4 indicate what territory?

A

Left Anterior Descending (LAD)
ANTERIOR

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19
Q

Mona?

A

Mnemonic for treatment in ACS
Morphine
Oxygen (if <94% or 88% in COPD)
Nitrates
Aspiring (300mg)

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20
Q

What is the first lien treatment pathway for STEMI?

A
  1. 300mg aspirin
  2. If PCI available in 120 hours then PCI
    - praugrel
    - unfractioned heparin + bailout glycoprotein IIa/IIIb inhibitor
    - drug eluding stent in preference
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21
Q

If STEMI is identified but PCI isn’t available in 120 hours then what?

A
  1. 300mg aspirin
  2. Fibrinolysis
    - antithrombin
    - ticagrelor post procedure
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22
Q

When would you give Clopidogrel not ticagrelor or praugrel?

A

If bleeding risk
Or already taking DOAC (apixaban/rivoroxaban)

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23
Q

Treatment of NSTEMI?

A
  1. 300mg aspirin
  2. Fondaparinux if no immediate PCI
  3. GRACE score
  4. High risk:
    - PCI in 72 hours
    - praugrel or ticagrelor
    - +unfractioned heparin
    - drug eluding stent
  5. Low risk
    - ticagrelor

Clopidogrel if already DOAC or bleed risk

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24
Q

What is an intermediate/high risk GRACE score?

A

3% +

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25
Q

Lifelong treatment for patients who have had ACS

A
  1. Aspirin
  2. Second antiplatelet (Clopidogrel/ticagrelor)
  3. Beta blocker
  4. Ace
  5. Statin
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26
Q

What is pericarditis

A

Inflammation of the pericardium

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27
Q

What are key symptoms of acute pericarditis

A

Chest pain relieved with sitting forward
Non-reductive cough, dyspnoea and flu symptoms
Pericardial rub (high pitched grating to and fro sound)

28
Q

ECG changes with pericarditis?

A

Widespread issues
- saddle shaped ST elevation
- PR depression

29
Q

What is the key investigation to do with pericarditis?

A

TOE
- inflammatory markers
- Troponin

30
Q

Management of acute pericarditis

A

Most are managed as outpatients - acute pts. Managed inpatient

Treat underlying cause

Strenuous activity avoided

NSAIDS and Colchicine now generally used for first line for patients.

31
Q

What is adenosines side effects

A

Flushing, bronchospasm and chest pain

32
Q

What are non shockable rhythms

A

PEA and Asystole

33
Q

How many chets compressions should be for an adult ?

A

30:2

34
Q

Unsupervised adult arrests with a shockable rhythm what is your plan?

A

CPR whilst defib starts then 1 shock with 2 minutes of CPR

35
Q

Supervised adult arrests with shockable rhythm on cardiac award, what is the plan?

A

up to three defib shocks

36
Q

Supervised adult arrests with shockable rhythm on cardiac award, what is the plan?

A

up to three defib shocks and then 2 min CPR

37
Q

How to use adrenaline?

A

1mg adrenaline immediately in non-shockable rhythms

CPR, 1 shock, CPR 2 mins, 1 shock, CPR 2 mins, 1 shock, CPR 2 mins +1 mg adrenaline (repeated every 3-5 mins during CPR)

38
Q

When should amiodarone be used?

A

After 3 shocks of defib and 300mg should be used ONLY IF SHOCKABLE

39
Q

After 5 shocks what should be given?

A

150mg of amiodarone, lidocaine can be used instead

40
Q

Angina first line treatment?

A
  1. Aspirin
  2. Statin
  3. Calcium channel blockers but prescribed with verapamil or diltiazam
    (GTN for acute attacks)
  4. Beta blockers can be used in combination with calcium channel but needs to be long acting (nifedipine)
41
Q

What is a major side effect of ace inhibitors

A

Cough

42
Q

What is a major side effect of ace inhibitors

A

Cough

43
Q

Side effect of ARBs?

A
  1. Hypotension
  2. Hyperkalaemia
44
Q

Side effect of ARBs?

A
  1. Hypotension
  2. Hyperkalaemia
45
Q

What is aortic dissection?

A

Splitting of the walls of the aorta (outpuching)

46
Q

Main symptoms/features of aortic dissection

A

Chest-back pain (tearing pain)
- pulse deficit
0 regurg
- HTN

47
Q

What classifications are for aortic dissection categorising

A

Stanford and debakeys

48
Q

What is Stanford classification?

A

Type a = ascending
B = descending

49
Q

What is debakey classification

A

1 - ascending to aortic arch and may be beyond
2 - in and confined to ascending aorta
3 - originates and usually in descending

50
Q

Gold standard investigation for aortic dissection?

A

Chest xray - widened mediastinum

CT angio can be for pts planning surgery

TOE for those at risk of CT

51
Q

How is type A dissection treated?

A

Surgical management, BP controlled

52
Q

Type B aortic dissection management?

A

Conservative management, bed rest and reduced BP IV labetalol

53
Q

Cause of AFIB?

A

Re-entry loop or multiple foci

54
Q

What is first detected episode of AF

A

Symptomatic or asymptomatic and self terminating

55
Q

What is paroxysmal AF

A

More acute, lasts 7 days and is self terminating

56
Q

What is persistent AF

A

> 7 days, NOT self terminating

57
Q

What is permanent AF

A

Continuous AF cannot be cardioverted or may be inappropriate
- rate control and anticoag used

58
Q

What pulses are seen in those with AF

A

Irregularly irregular

59
Q

What investigations are done to diagnose AF

A

Palpitations
Dyspnoea
Chest pain
ECG

60
Q

Management of AF

A

Rate, rhythm

61
Q

What is rate control treatment

A

Beta blocker
Rate-limiting channel blocker

Then digoxin if all else fails

62
Q

Examples of beta blockers for AF

A

Atenolol, Bisoprolol

63
Q

Examples of rate limiting calcium channel blocker

A

Verapmail diltiazam

64
Q

What rhythm control treatment is used?

A

If in an acute unstable situation = cardioversion

<48 hours ACUTE (heparin + electrical cardioversion, amiodarone with structural heart disease, Flecainide without)

> 48 hours DELAYED (anticoagulation 3 week prior to cardioversion, TOE to check for thrombus)

65
Q

What score is used to figure out coagulation and provide anticoagulation strategy?

A

CHA2DS2-VASc score

66
Q

What score is needed for anticoagulation treatment

A

2

67
Q

Stroke prevention in AF first line treatment?

A

DOAC
- apixaban
- dabigatran
- edoxaban
- rivaroxaban

Warfarin second line
ASPIRIN IS NOT RECOMMENDED

UKMLA (3 decks)

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