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Cardiology Flashcards

1
Q

ACEi MOA?

A
  1. Inhibit Angiotensin I to II
  2. Activated by Phase 1 metabolism in liver
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2
Q

ACEi s/e?

A
  1. Cough (15%, up to 1yr after starting)
  2. Angioedema (up to 1yr)
  3. Hyperkalaemia
  4. 1st dose hypotension
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3
Q

ACEi cautions and c/i?

A
  1. Pregnancy and breastfeeding
  2. Renovascular disease = renal impairment
  3. Aortic stenosis = may cause hypotension
  4. Hereditary idiopathic angioedema
  5. Specialist advice when starting ACEi with K > 5
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4
Q

ACEi interaction?

A

> 80mg furosemide daily –> increases risk of hypotension

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5
Q

ACEi monitoring?

A
  1. U&E before Rx and after increasing dose
  2. Creatinine 30% baseline and K 5.5 acceptable
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6
Q

HTN ACEi/ARB criteria?

A
  1. <55
  2. T2DM
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7
Q

HTN CCB criteria?

A
  1. > 55 + no T2DM
  2. ACEi + no T2DM
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8
Q

Chronic HF Rx?

A
  1. ACEi + BB (start one at a time)
  2. Alodesterone antagonist
  3. Specialist = Ivabridine/Entresto/Dixogin/Hydralazine/CRT
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9
Q

Ivabridine HF criteria?

A
  1. SR > 75
  2. LVEF < 35%
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10
Q

Sacubitril Valsartan HF criteria?

A
  1. LVEF < 35%
  2. Symptomatic on ACEi or ARB
  3. Should be initiated following ACEi or ARB period
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11
Q

Digoxin HF criteria?

A
  1. Strongly indicated if coexistent AF
  2. May improve symptoms, doesnt reduce mortality
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12
Q

Hydralazine + Nitrate HF criteria?

A
  1. May be particularly indicated in Afro-Caribbean patients
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13
Q

CRT HF criteria?

A
  1. Widened QRS (LBBB)
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14
Q

HF ‘other’ Rx”

A
  1. Annual influenza vaccine
  2. One-off pneumococcal vaccine
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15
Q

Who needs booster pneumococcal vaccine every 5 years?

A
  1. Asplenia
  2. Splenic dysfunction
  3. CKD
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16
Q

HF furosemide mortality effect?

A

No effect

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17
Q

ACEi and BB mortality effect in HFpEF?

A

None

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18
Q

AF post-stroke management?

A
  1. Warfarin or DOAC
  2. Following a TIA, start anticoagulation immediately
  3. In acute stroke, in the absence of haemorrhage, start anticoagulation after 2 weeks (due to risk of haemorrhagic transformation)
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19
Q

Shockable rhythms?

A

VF/Pulseless VT

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20
Q

Non-shockable rhythm?

A

Asystole/PEA

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21
Q

Cardiac arrest in CCU?

A

Up to three quick successive stacked shocks, then CPR

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22
Q

Adrenaline in ALS?

A
  1. 1mg ASAP non-shockable
  2. 1mg after 3rd shock for shockable
  3. Repeat 1mg every 3-5 mins
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23
Q

Amiodarone in ALS?

A
  1. Amiodarone 300mg VF/pulseless VT after 3 shocks
  2. 150mg VF/pulseless VT after 5 shocks
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24
Q

Alternative to amiodarone in ALS?

A

Lidocaine

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25
O2 post-resus?
94-98%
26
4Hs?
Hypoxia Hypovolaemia Hypothermia Hypokalaemia,glycaemia,calcaemia
27
4 Ts?
Tension pneumothorax Tamponade Thrombus (Coronary/pulmonary) Toxin
28
Beck's triad of cardiac tamponade?
1. Hypotension 2. Raised JVP 3. Muffled heart sounds
29
ECG electrical alternans?
Cardiac tamponade
30
Absent of Y descent in JVP?
Tamponade = TampAX
31
Cardiac tamponade > Constrictive pericarditis?
1. Absent Y descent 2. Pulsus paradoxus present 3. Kussmaul's sign present
32
Constrictive pericarditis > Cardiac tamponade?
1. X + Y present 2. Pulsus paradoxus absent 3. Kussmaul's sign present 4. Pericardial calcification on CXR
33
Kussmaul's sign?
Paradoxical sign in JVP on inspiration present in constrictive pericarditis
34
Cardiac tamponade Rx?
Urgent pericardiocentesis
35
ARB examples?
1. Candesartan 2. Losartan 3. Irbesartan
36
ARB MOA?
Blocks effect of Angiotensin II at AT1 receptor
37
Immediate management of suspected ACS?
1. GTN 2. Aspirin 300mg 3. O2 if SpO2 < 92% 4. ECG ASAP
38
Acute chest pain referral?
1. Abnormal ECG in past 12 hours = Emergency admission 2. 12-72 hours ago = same day hospital assessment 3. >72 hours ago = ECG and troponin
39
Anginal Pain?
1. Constricting discomfort in front of chest, neck, shoulders, jaw, arms 2. Precipitated by physical exertion 3. Relieved by rest or GTN in 5 mins All 3 = Typical Angina 2 = Atypical angina 1 = Non-anginal chest pain
40
Possible stable angina Ix?
1. CT coronary angiography 2. Non-invasive functional imaging 3. Invasive coronary angiography
41
Non-invasive functional imaging examples?
1. MPS with SPECT 2. Stress echo 3. 1st pass contrast MRI 4. MR for stress-induced WMA
42
Stage 1 HTN?
Clinic BP >= 140/90 mmHg and subsequent ABPM daytime average or HBPM average BP >= 135/85 mmHg
43
Stage 2 HTN?
Clinic BP >= 160/100 mmHg and subsequent ABPM daytime average or HBPM average BP >= 150/95 mmHg
44
Severe HTN?
Clinic systolic BP >= 180 mmHg, or clinic diastolic BP >= 110 mmHg
45
Stage 1 HTN treatment criteria?
< 80 y/o AND 1 of the following 1. Target organ damage 2. Established CVD 3. Renal disease 4. Diabetes 5. 10yr risk >10%
46
Reducing salt intake by 6g/day BP effect?
Lowers by 10mmHg
47
Pt < 40 y/o HTN?
Refer to specialist to exclude secondary causes?
48
HTN flowchart steps?
1. A OR C 2. A+C/A+D OR C+A/C+D 3. A+C+D 4. If K < 4.5 add low dose spironolactone, if K > 4.5 add alpha/beta blocker
49
BP targets?
1. < 80 y/o = clinic 140/90, ABPM 135/85 2. > 80 y/o = clinic 150/90, ABPM 145/85
50
Aliskiren?
Direct renin inhibitor
51
Raynaud's phenomenon with extremity ischaemia?
Buerger's disease
52
Buerger's disease?
1. AKA Thrombangitis obliterans 2. Small and medium vessel vasculitis strongly associated with smoking 3. Features = extremity ischaemia (intermittent claudication, ischaemic ulcers), superficial thrombophlebitis, Raynaud's phenomenon
53
Angina pectoris Rx?
1. Conservative 2. Medical 3. PCI 4. Surgical
54
Angina pectoris medical Rx?
1. Aspirin + Statin 2. Sublingual GTN to abort attackd 3. BB or CCB 1st line 4. BB + CCB 2nd line 5. If on monotherapy and cannot tolerate the other = long-acting nitrate/ivabridine/nicorandil/ranolzine 6. If on BB + CCB, only add a third drug whilst a pt is awaiting assessment for PCI or CABG
55
Nitrate tolerance mushkies?
1. NICE advises that patients who take standard-release isosorbide mononitrate should use an asymmetric dosing interval to maintain a daily nitrate-free time of 10-14 hours to minimise the development of nitrate tolerance 2. This effect not seen in pts who take OD modified-release ISMN
56
Angina pectoris drug management mushkies?
1. If CCB monotherapy use rate-limiting e.g. verapamil or diltiazem 2. If used in combination with BB --> long-acting dihydropyridine e.g. amlodipine, modified release nifedipine (do NOT prescribe BB with verapamil due to risk of complete heart block) 3. If poor response to initial treatment then increase medication to maximum tolerated dose
57
Rate-limiting CCBs?
Verapamil or diltiazem
58
When in DM is BP target 130/80?
Adult with T1DM has albuminuria or 2 or more features of metabolic syndrome
59
ACEi vs. ARB for African?
ARB
60
Torsades de pointes?
Polymorphic VT with prolonged QT
61
Congenital Long QT?
1. Jervell-Lange-Nielsen syndrome 2. Romano-Ward syndrome
62
Abx causing torsades?
Macrolides
63
Torsades Rx?
IV Magnesium sulphate
64
Statin adverse effects?
1. Myopathy 2. Liver impairment 3. Intracerebral haemorrhage in pts who have had a stroke
65
Statin liver impairment monitoring?
1. LFTs at baseline, 3m, and 12m 2. Discontinue if serum transaminase rise and persist at 3x upper limit of normal
66
Statin Contraindications?
1. Macrolides 2. Pregnency
67
Statin indications?
1. All with established CVD 2. 10 yr risk > 10% 3. T1DM diagnosed more than 10 years ago OR are aged over 40 OR have established nephropathy
68
When to increase atorvastatin 20mg primary prevention dose?
If non-HDL has not reduced for >=40%
69
Acute AF Rx?
1. Haemodynamically unstable = electrical cardioversion 2. Haemodynamically stable < 48h = rate or rhythm control 3. Haemodynamically stable > 48h/uncertain = rate control
70
If pt considered for long term rhythm control?
Delay cardioversion until they have been maintained on therapeutic anticoagulation for a minimum of 3 weeks
71
When is rate control not offered as 1st line Rx strategy in AF?
1. AF has reversible cause 2. HF primarily caused by AF 3. New-onset AF (<48h) 4. Atrial flutter whose condition is considered suitable for an ablation strategy to restore sinus rhythm
72
Rate control agents in AF?
1. BB 2. CCB 3. Digoxin (only if person does no or very little physical exercise or other rate‑limiting drug options are ruled out because of comorbidities)
73
Rhythm control agents in AF?
1. BB 2. Dronedarone: 2nd line in pts following cardioversion 3. Amiodarone: particularly if coexisting HF
74
Catheter ablation indication for AF?
Not responded to or wish to avoid, antiarrhythmic medication.
75
Anticoagulation before catheter ablation?
4 weeks before and during the procedure
76
Does catheter ablation reduce stroke risk?
No
77
Catheter ablation complications?
1. Cardiac tamponade 2. Stroke 3. Pulmonary vein stenosis
78
Fleicanide patient?
Those without evidence of structural heart disease
79
Loop diuretic indications?
1. HF (acute and chronic) 2. Resistant HTN, particularly in pts with renal impairment
80
Loop diuretic s/e?
1. Ototoxicity 2. Hypocalcaemia 3. Hyperglycaemia 4. Gout
81
Grapefruit juice CYP3A4 effect?
Potent inhibitor
82
CHA2DS2-VASc score?
Congestive HF HTN Age >=75 (or 64-74) DM Stroke/TIA/Embolism Vascular disease (IHD/PAD) Sex (Female)
83
CHA2DS2-VASc score interpretation?
0 = no treatment 1 = consider in male, no treatment in females 2 = offer anticoagulation
84
AF + valvular heart disease?
Absolute indication for anticoagulation
85
Bleeding risk consideration with anticoagulants in AF?
ORBIT score (prev. HAS-BLED)
86
LQT1?
Swimming
87
LQT2?
Syncope following emotional stress, exercise or auditory stimuli
88
LQT3?
At night or at rest
89
LQTS Rx?
1. BB 2. ICD
90
How do drugs usually prolong QT?
Blockage of potassium channels
91
Non-sedating antihistamine that is a classical cause of prolonged QT?
Terfenadine
92
Bradycardia with adverse signs Rx?
1. Atropine 500mcg IV 2. Atropine up to maximum 3mg 3. Transcutaneous pacing 4. Isoprenaline/adrenaline infusion titrated to response 5. Specialist help for transvenous pacing
93
Potential risk of asystole conditions?
1. Complete heart block with broad complex QRS 2. Recent asystole 3. Mobitz Type II AV Block 4. Ventricular pause > 3 seconds
94
ABCD2?
Risk stratifying patients with suspected TIA
95
Ranson criteria?
Acute pancreatitis
96
Acute pericarditis causes?
1. Infection = Viral (Coxsackie), TB 2. Inflammation = Uraemia, CTD 3. Malignancy 4. Metabolic = Hypothyroidism 5. Post-MI, Dressler's syndrome 6. Trauma
97
Acute pericarditis ECG?
1. Saddle shaped ST elevatiob 2. PR depression (most specific ECG marker for pericarditis)
98
Acute pericarditis Rx?
1. Underlying cause 2. NSAIDs + Colchicine
99
BB licensed for HF?
1. Bisoprolol 2. Carvedilol 3. Nebivolol
100
Warfarin indications?
1. Mechanical heart valves (mitral valves usually require higher INRs) 2. Second line after DOACs (recurrent VTE target = 3.5)
101
Warfarin potentiators?
1. Liver disease 2. P450 inhibitors 3. Cranberry juice 4. NSAIDs (displace warfarin from plasma albumin, inhibit platelet function)
102
Warfarin s/e?
1. Haemorrhage 2. Teratogenic (can be used in breastfeeding) 3. Skin necrosis 4. Purple toes
103
PE most common features?
1. Tachypnoea 2. Crackles 3. Tachycardia 4. Fever
104
PE rule-out criteria?
PERC score = all the criteria must be absent to have a negative PERC result (should be done when low pre-test probability of PE <15%, but want more reassurance) --> if -ve, probability of PE <2%
105
If PE is suspected, what score?
2 level Wells score 1. PE likely = > 4 2. PE likely = 4 points or less
106
High risk of stroke post-cardioversion anticoagulation?
Lifelong
107
Low risk of stroke post-cardioversion antivoagulation?
4 weeks
108
Cardioversion in AF indications?
1. Electrical cardioversion if haemodynamically unstable 2. Electrical or pharmacological cardioversion as an elective procedure where a rhythm control strategy is preferred
109
What is electrical cardioversion synchronised to?
R wave to prevent delivery of a shock during the vulnerable period of cardiac repolarisation when ventricular fibrillation can be induced
110
Pharmacological cardioversion?
1. Amiodarone if structural heart disease 2. Fleicanide or amiodarone in those w/o structural heart disease
111
Anticoagulation following electrical cardioversion if AF is confirmed as being less than 48 hours duration?
Unnecessary
112
If high risk of cardioversion failure e.g. previous failure or AF recurrence what should be done?
At least 4 weeks amiodarone or sotalol prior to electrical cardioversion
113
Chronic HF Dx?
NT-proBNP first line --> if high arrange TOE within 2 weeks, if raised arrange specialist assessment incl. TOE within 6 weeks
114
NT-proBNP levels?
1. < 400 = normal 2. 400 - 2000 = raised 3. > 2000 = high
115
Stable CVD combination anticoagulation and antiplatelent therapy?
Stop antiplatelet, only anticoagulation necessary
116
Post-ACS/PCI combination anticoagulation and antiplatelet therapy?
1. Triple therapy (2 antiplatelets + 1 anticoagulant) for 4 weeks-6 months after the event and dual therapy (1 antiplatelet + 1 anticoagulant) to complete 12 months
117
VTE combination anticoagulation and antiplatelet therapy?
Calculate ORBIT score, if low risk of bleeding then antiplatelets can be continued
118
ACS classification?
1. STEMI 2. NSTEMI/UAP
119
Common management of ACS?
1. Morphine for severe pain 2. Oxygen if <94% 3. Nitrates 4. Aspirin 300mg
120
STEMI criteria?
Clinical symptoms consistent with ACS (generally of ≥ 20 minutes duration) with persistent (> 20 minutes) ECG features in ≥ 2 contiguous leads of: 1. 2.5 mm (i.e ≥ 2.5 small squares) ST elevation in leads V2-3 in men under 40 years, or ≥ 2.0 mm (i.e ≥ 2 small squares) ST elevation in leads V2-3 in men over 40 years 2. 1.5 mm ST elevation in V2-3 in women 3. 1 mm ST elevation in other leads 4. New LBBB (LBBB should be considered new unless there is evidence otherwise)
121
STEMI and PCI not possible within 120 mins?
1. Fibrinolysis = give antithrombin 2. Ticagrelor 3. Consider PCI
122
STEMI and PCI possible within 120 mins and onset within 12h?
1. Prasugrel (ticagrelor if high bleeding risk, if already on anticoagulants give clopidogrel) 2. Unfractionated heparin + bailout glycoprotein IIb/IIIa inhibitor 3. Drug eluting stents should be used in preference
123
ECG 90 mins after fibrinolysis shows failure of resolution of ST elevation?
Transfer for PCI
124
NSTEMI/UAP management?
1. Aspirin 300mg 2. Fondaparinux if no immediate PCI planned 3. GRACE score --> low risk (<3%) vs. high risk >3%)
125
NSTEMI/UAP GRACE low risk Rx?
Ticagrelor
126
NSTEMI/UAP GRACE high risk Rx?
1. PCI immediately if unstable, otherwise within 72 hours 2. Give prasugrel or ticagrelor 3. Give unfractionated heparin
127
HOCM mushkies?
An autosomal dominant disorder of muscle tissue caused by defects in the genes encoding contractile proteins. The estimated prevalence is 1 in 500. HOCM is important as it is the most common cause of sudden cardiac death in the young.
128
HOCM pathophysiology?
1. Most common defects involve a mutation in the gene encoding β-myosin heavy chain protein or myosin-binding protein C 2. Results in predominantly diastolic dysfunction 3. Characterized by myofibrillar hypertrophy with chaotic and disorganized fashion myocytes ('disarray') and fibrosis on biopsy
129
HOCM associations?
1. Friedrich's ataxia 2. WPW
130
Broad complex, regular tachycardia Rx?
Loading dose of amiodarone followed by 24 hour infusion
131
Irregular broad complex tachycardia Rx?
Seek expert help (AF with BBB, AF with ventricular pre-excitation, torsades)
132
Narrow complex tachycardia Rx?
1. Vagal manoeuvres 2. IV Adenosine 3. If above unsuccessful consider dx of atrial flutter and control rate e.g. beta blockers
133
Can low risk PE pts be treated at home?
Yes
134
First line Rx for PE?
Apixaban or Rivaroxaban
135
Other PE treatment options?
1. If neither apixaban or rivaroxaban are suitable then either LMWH followed by dabigatran or edoxaban OR LMWH followed by a vitamin K antagonist (VKA, i.e. warfarin) 2. If renal impairment is severe (e.g. < 15/min) then LMWH, unfractionated heparin or LMWH followed by a VKA 3. If the patient has antiphospholipid syndrome (specifically 'triple positive' in the guidance) then LMWH followed by a VKA should be used
136
Provoked VTE treatment duration?
3 months (3-6 months for active cancer)
137
Unprovoked VTE treatment duration?
6 months
138
PE with haemodynamic instability Rx?
Thrombolysis
139
Recurrent PE despite anticoagulation Rx?
IVC filter
140
Angioplasty driving?
1 week off
141
CABG driving?
4 weeks off
142
ACS driving?
4 weeks off (1 week if successfully treated by angioplasty)
143
Pacemaker driving?
1 week off
144
ICD driving?
1. If implanted for sustained ventricular arrhythmia: cease driving for 6 months 2. If implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers
145
Heart transplant driving?
6 weeks
146
Successful catheter ablation for an arrhythmia driving?
2 days off
147
Aortic aneurysm >6cm driving?
Notify DVLA, >6.5cm disqualifies from driving
148
Antithrombin medication?
Fondaparinux
149
Hypokalaemia ECG?
1. U waves 2. Small or absent T waves 3. Prolonged PR interval 4. ST depression 5. Long QT
150
J wave?
Hypercalcaemia
151
Rate control for AF?
1. BB 2. CCB 3. Digoxin
152
ST elevation and Q waves in posterior leads V7-9?
Posterior infarction
153
Athlete ECG variants?
1. Sinus bradycardia 2. Junctional rhythm 3. 1st degree HB 4. Mobitz Type 1
154
WPW associations?
1. HOCM 2. Mitral valve prolapse 3. Ebstein's anomaly 4. Thyrotoxicosis 5. Secundum ASD
155
WPW Rx?
1. Definitive = RFA of accessory pathway 2. Medical = Sotalol, amiodarone, flecainide
156
Nicorandil MOA?
A vasodilatory drug used to treat angina. It is a potassium-channel activator with vasodilation is through activation of guanylyl cyclase which results in increase cGMP
157
Anal ulcer?
Nicorandil
158
Nicorandil s/e?
1. Headache 2. Flushing 3. Skin, mucosal and eye ulceration (GI ulcer including anal ulceration)
159
Nicorandil C/I?
LV failure
160
Aortic dissection classifications?
1. Stanford 2. De Bakey
161
Stanford Aortic Dissection classification?
1. A = Ascending aorta, 2/3 2. B = Descending aorta, distal to left subclavian origin, 1/3
162
DeBakey Aortic Dissection classification?
1. Type I = originates in ascending aorta, propagates to at least the aortic arch and possibly beyond it distally 2. Type II = originates in and is confined to the ascending aorta 3. Type III = originates in descending aorta, rarely extends proximally but will extend distally
163
Aortic Dissection Ix?
1. Definitive = CT angiography CAP 2. TOE = unstable pts too risky to take to CT scanner
164
Type A AD Rx?
Surgical management, but blood pressure should be controlled to a target systolic of 100-120 mmHg whilst awaiting intervention
165
Type B AD Rx?
1. Conservative 2. Bed rest 3. Reduce blood pressure, IV labetalol to prevent progression
166
Causes of LBBB?
1. MI 2. HTN 3. AS 4. Cardiomyopathy 5. Rare = idiopathic fibrosis, digoxin toxicity, hyperkalaemia
167
HOCM Rx?
ABCDE Amiodarone BB or Verapamil for Sx Cardioverter defibrillator Dual chamber pacemaker Endocarditis prophylaxis
168
Medications to be avoided in HOCM?
1. Nitrates 2. Inotropes 3. ACEi
169
SVT Rx?
1. Vagal manoeuvres 2. IV Adenosine (6-->12-->18), C/I in asthmatics (verapamil is a preferable option) 3. Electrical cardioversion
170
SVT prevention?
1. BB 2. RFA
171
Hypothermia ECG?
J wave
172
HTN and asymmetrical kidneys?
Renal artery stenosis
173
Most common cause of secondary hypertension?
Primary hyperaldosteronism (incl. Conn's)
174
Complete heart block following MI lesion location?
Right coronary artery
175
Ototoxic diuretic?
Loop diuretics e.g. Furosemide
176
IE in IVDU which valve?
Tricuspid
177
Most affected valve by IE?
Mitral valve
178
Most common cause of IE?
Staphylococcus aureus
179
IE Following dental procedure?
Streptococcus viridans
180
IE in pt following prosthetic valve surgery?
CoNS e.g. Staphylococcus epidermidis
181
IE in pt with indwelling line?
CoNS e.g. Staphylococcus epidermidis
182
IE in pt with colorectal cancer?
Streptococcus bovis (gallolyticus subtype)
183
Culture negative causes of IE?
1. HACEK 2. Coxiella 3. Bartonella 4. Brucella
184
Dressler's syndrome features?
1. Fever 2. Pleuritic pain 3. Pericardial effusion 4. Raised effusion 5. 2-6 weeks after MI
185
Dressler's syndrome Rx?
NSAIDs
186
Post-MI LV Aneurysm ECG?
Persistent ST elevation
187
What medication should NOT be used in VT?
Verapamil
188
VT possible drug therapies?
1. Amiodarone 2. Lidocaine (use with caution in severe LV impairment) 3. Procainamide
189
AR features?
1. Early diastolic murmur 2. Collapsing pulse 3. Wide pulse pressure 4. Quincke's (nailbed pulsation) 5. De Musset's (headnodding) 6. Mid-diastolic Austin-Flint murmur in severe AR - due to partial closure of the anterior mitral valve cusps caused by the regurgitation streams
190
Aortic regurgitation Rx?
1. Medical management of any associated heart failure 2. Surgery indications = symptomatic with severe AR, asymptomatic with severe AR who have LV systolic dysfunction
191
ACS antiplatelets?
Aspirin lifelong and Ticagrelor 12m
192
PCI antiplatelets?
Aspirin lifelong and prasugrel/ticagrelor 12m
193
TIA antiplatelets?
Lifelong clopidogrel
194
Ischaemic stroke antiplatelets?
Aspirin 300mg 2 weeks, Clopidogrel 75mg lifelong
195
Clopidogrel interactions?
PPIs make them less effective
196
Statin LFT monitoring?
Baseline, 3m and 12m
197
AF and Chronic HF helpful medication?
Digoxin
198
Late diastolic murmur?
Mitral stenosis
199
Early diastolic murmur?
Aortic regurgitation
200
HF and wide QRS helpful management?
CRT
201
Drugs shown to reduce mortality in HF?
1. ACEi, ARB 2. BB 3. Spironolactone 4. Hydralazine and nitrates
202
Aortic stenosis symptoms?
1. Syncope 2. Angina 3. Dyspnoea on exertion
203
Symptomatic aortic stenosis Rx?
Valve replacement
204
Asymptomatic aortic stenosis Rx?
1. If asymptomatic but valvular gradient > 40 mmHg and with features such as left ventricular systolic dysfunction then consider surgery 2. Aortic valve replacement 3. Balloon valvuloplasty
205
Aortic valve replacement for AS options?
1. TAVI for high operative risk 2. Surgical AVR is the treatment of choice for young, low/medium operative risk patients. Cardiovascular disease may coexist. For this reason, an angiogram is often done prior to surgery so that the procedures can be combined
206
Balloon valvuloplasty for AS options?
1. May be used in children with no aortic valve calcification 2. In adults limited to patients with critical aortic stenosis who are not fit for valve replacement
207
HTN alpha blocker example?
Doxazosin
208
T1DM offered statin if?
1. >40 y/o 2. DM for > 10y 3. Established nephropathy 4. Other CVD risk factors (obesity and hypertension)
209
Antibiotic prophylaxis for IE before dental procedure?
Not needed
210
Boerhaaves syndrome mushkies?
1. Spontaneous rupture of the oesophagus that occurs as a result of repeated episodes of vomiting 2. Severe sepsis occurs secondary to mediastinitis 3. Diagnosis is CT contrast swallow 4. Treatment is with thoracotomy and lavage, if less than 12 hours after onset then primary repair is usually feasible, surgery delayed beyond 12 hours is best managed by insertion of a T tube to create a controlled fistula between oesophagus and skin
211
U waves?
Hypokalaemia
212
MI secondary prevention?
1. DAPT 2. ACEi 3. BB 4. Statin
213
GRACE score criteria?
1. Age 2. ECG 3. Troponin 4. Renal function 5. BP, HR 6. Cardiac arrest on presentation
214
Causes of palpitations?
1. Stress 2. Increased awareness of normal heart beat/extrasystoles 3. Arrhythmias
215
Palpitations 1st line Ix?
1. 12 lead ECG 2. FBC, U&E, TFTs
216
Capturing episodic arrhythmias?
Holter monitor
217
Effects of BNP?
1. Vasodilator 2. Diuretic and natriuretic 3. Suppresses both sympathetic tone and the RAAS
218
BNP use in chronic HF?
1. Useful marker of prognosis 2. Guiding treatment (effective treatment lowers BNP levels)
219
When INR high and warfarin held, when is INR typically restarted?
When INR <5
220
Warfarin and Major bleeding?
1. Stop warfarin 2. IV 5mg Vitamin K 3. PCC (if not available then FFP)
221
INR > 8 and minor bleeding?
1. Stop warfarin 2. IV Vitamin K 1-3mg 3. Repeat dose of Vitamin K if INR still too high after 24 hours 4. Restart warfarin when INR < 5.0
222
INR > 8 and no bleeding?
1. Stop warfarin 2. Oral Vitamin K 1-5mg 3. Repeat Vitamin K if INR still too high after 24 hours 4. Restart warfarin when INR < 5.0
223
INR 5-8 and no bleeding?
1. Withhold 1 or 2 doses warfarin 2. Reduce subsequent maintenance dose
224
Antihypertensive causing both hyponatraemia and hypokalaemia?
Bendroflumethiazide
225
Thiazide effect on calcium?
Hypercalcaemia (causes hypercalciuria)
226
Persistent ST elevation following recent MI, no chest pain?
LV aneurysm
227
Syncope definition?
TLOC due to global cerebral hypoperfusion with rapid onset, short duration and spontaneous complete recovery
228
Pharmacological options for treatment of orthostatic hypotension?
Fludrocortisone and midodrine
229
Xanthelasma Rx?
1. Surgical excision 2. Topical trichloroacetic acid 3. Laser therapy 4. Electrodesiccation
230
Additional Rx for Acute MI and HF/LV systolic dysfunction?
Aldosterone antagonist
231
Native valve endocarditis Rx?
Amoxicillin + Gentamicin
232
Native valve endocarditis (NVE) with severe sepsis/pen allergy/MRSA?
Vancomycin + Gentamicin
233
NVE with severe sepsis and risk factors for gram negative infection?
Vancomycin + Meropenem

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