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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
Lifelong treatment for patients who have had ACS
1. Aspirin 2. Second antiplatelet (Clopidogrel/ticagrelor) 3. Beta blocker 4. Ace 5. Statin
26
What is pericarditis
Inflammation of the pericardium
27
What are key symptoms of acute pericarditis
Chest pain relieved with sitting forward Non-reductive cough, dyspnoea and flu symptoms Pericardial rub (high pitched grating to and fro sound)
28
ECG changes with pericarditis?
Widespread issues - saddle shaped ST elevation - PR depression
29
What is the key investigation to do with pericarditis?
TOE - inflammatory markers - Troponin
30
Management of acute pericarditis
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
What is adenosines side effects
Flushing, bronchospasm and chest pain
32
What are non shockable rhythms
PEA and Asystole
33
How many chets compressions should be for an adult ?
30:2
34
Unsupervised adult arrests with a shockable rhythm what is your plan?
CPR whilst defib starts then 1 shock with 2 minutes of CPR
35
Supervised adult arrests with shockable rhythm on cardiac award, what is the plan?
up to three defib shocks
36
Supervised adult arrests with shockable rhythm on cardiac award, what is the plan?
up to three defib shocks and then 2 min CPR
37
How to use adrenaline?
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
When should amiodarone be used?
After 3 shocks of defib and 300mg should be used ONLY IF SHOCKABLE
39
After 5 shocks what should be given?
150mg of amiodarone, lidocaine can be used instead
40
Angina first line treatment?
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
What is a major side effect of ace inhibitors
Cough
42
What is a major side effect of ace inhibitors
Cough
43
Side effect of ARBs?
1. Hypotension 2. Hyperkalaemia
44
Side effect of ARBs?
1. Hypotension 2. Hyperkalaemia
45
What is aortic dissection?
Splitting of the walls of the aorta (outpuching)
46
Main symptoms/features of aortic dissection
Chest-back pain (tearing pain) - pulse deficit 0 regurg - HTN
47
What classifications are for aortic dissection categorising
Stanford and debakeys
48
What is Stanford classification?
Type a = ascending B = descending
49
What is debakey classification
1 - ascending to aortic arch and may be beyond 2 - in and confined to ascending aorta 3 - originates and usually in descending
50
Gold standard investigation for aortic dissection?
Chest xray - widened mediastinum CT angio can be for pts planning surgery TOE for those at risk of CT
51
How is type A dissection treated?
Surgical management, BP controlled
52
Type B aortic dissection management?
Conservative management, bed rest and reduced BP IV labetalol
53
Cause of AFIB?
Re-entry loop or multiple foci
54
What is first detected episode of AF
Symptomatic or asymptomatic and self terminating
55
What is paroxysmal AF
More acute, lasts 7 days and is self terminating
56
What is persistent AF
>7 days, NOT self terminating
57
What is permanent AF
Continuous AF cannot be cardioverted or may be inappropriate - rate control and anticoag used
58
What pulses are seen in those with AF
Irregularly irregular
59
What investigations are done to diagnose AF
Palpitations Dyspnoea Chest pain ECG
60
Management of AF
Rate, rhythm
61
What is rate control treatment
Beta blocker Rate-limiting channel blocker Then digoxin if all else fails
62
Examples of beta blockers for AF
Atenolol, Bisoprolol
63
Examples of rate limiting calcium channel blocker
Verapmail diltiazam
64
What rhythm control treatment is used?
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
What score is used to figure out coagulation and provide anticoagulation strategy?
CHA2DS2-VASc score
66
What score is needed for anticoagulation treatment
2
67
Stroke prevention in AF first line treatment?
DOAC - apixaban - dabigatran - edoxaban - rivaroxaban Warfarin second line ASPIRIN IS NOT RECOMMENDED
68
What is dabigatran?
direct thrombin inhibitor 1. VTE prophylaxis in hip/knee replacements 2. Stroke prophylaxis in patietns with non-valvular a fib with: - previous stroke/TIA -poor left ventricular heart ejection <40% - symptomatic heart failure NYHA Class 2 or more - Age 75+ - 65+ with either diabetes, artery disease or hTN
69
What drug can be used to reverse dabigataran?
Idarucizumab
70
What drugs are direct factor Xa inhibitors?
Rivaroxaban, apixaban, edoxaban
71
What reversal agent is used for rivaroxaban and apixaban?
Andexanet alfa
72
What types of heparin are they and what do they target?
1. Unfractionated (standard) heparin = thrombin complex, factor Xa.IXa,XIa,XIIa 2. LMW Heparin = antithrombin 3 & factor Xa
73
How is standard heparin given?
IV
74
How is LMWH given?
Subcutaneously
75
Do both heparins activate antithrombin 3?
Yes
76
Which heparin is more inclined to cause (HIT - Heparin induced thrombocytopenia)
Unfractioned/standard
77
How is unfractionated heparin monitored?
APTT (activated partial thromboplastin time)
78
How is LMWH onitored?
Anti-factor Xa
79
Heparin overdose can be reversed by what?
Protamine sulphate
80
What does fondaparinux activate?
Antithrombin 3 and therefore leads to inhibition of factors Xa
81
When is warfarin used?
Mechanical heart valves - target INR depends on valve mitral typically is higher than aortic (3.5>) Second line after DOACs target INR 2.5
82
Can warfarin be used in pregnancy?
No only in breastfeeding
83
What drugs potentiates (increases) warfarin conc.
Amiodarone/ciprofloxacin (p450 enzyme inhibitors) Cranberry juice NSAIDS Liver disease
84
What is the management of high INR?
INR of 5.0-8.0 no bleeding = with hold warfarin dose for 1/2 rounds, reduced subsequent INR 5.0-8.0 minor bleeding = stop warfarin, give IV vitamin K 1-3mg. Restart when iNR <5 INR >8.0 no bleeding = stop warfarin, vitamin k by mouth 1-5mg repeat dose if still high post 24 hours, restart when INR <5 INR >8.0 minor bleeding = stop warfarin, give IV Vit K 1-3mg repeat if high post 24 hours, restart when iNR <5 INR>8 Major bleeding = stop warfarin, IV Vit K 5mg, Prothrombin complex concentrate - if not available FFP
85
86
what are the 3 types of intestinal ischaemia and different features?
1. acute mesenteric ischaemia - sudden/short onset severe pain of the abdomen - usually caused by an emboli on the background of atrial fibrillation - emboli in the superior and inferior mesenteric arteries 2. chronic mesenteric ischaemia - intermittent colicky pain - abdominal bruit - embolus but can be from infective ednocarditis/malignancy - 3. ischameic colitis - ischaemia of inferior mesenteric arteries that cause bloody diarrhoea potential perforation of colon
87
what does the superior mesenteric artery supply?
duodenum first part of transverse colon
88
what does the inferior mesenteric artery supply?
second half of transverse colon to the rectum
89
what does the coeliac trunk supply?
breaks to 3 branches 1. left gastric (lesser curvature of stomach and oesophagus) 2. splenic (5 segments of spleen, body and tail of pancreas, left greater curvature of stomach and small gastric arteries) 3. common hepatic (gastroepiploic = right greater curvature) (pancreatoduodenal = head of pancreas & duodenum)
90
investigations for any intestinal ischaemia?
CT Abdo
91
management for intestinal ischaemia?
lap surgery and maybe steting if salvageable
92

UKMLA (14 decks)

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