Cardiology 3 Flashcards
When treating a diabetic patient with hypertension, which combinations of anti-hypertensives should be avoided if possible?
thiazides and BB as can cause insulin resistance
Thiazides can cause which electrolyte abnormalities (3)
Adverse effects (3)
low K and Na
High calcium
gout, impaired glucose intolerance, impotence
Heart failure with reduced ejection fraction is defined as an ejection fraction below?
40%
Which PPI interacts with clopi?
Clopi MOA
Omeprazole - makes it less effective
Anti-platelet
Bioprosthetic versus mechanical valves
Anticoagulation for prosthetic
How is each option chosen?
Anticoagulation for mechanical aortic and mitral
Prosthetic - warfarin for first three months, otherwise aspirin long term
Given in >65yo aortic or >70 for mitral
Mechanical - warfarin aortic 3, mitral 3.5
Heart block
1st degree
Mobitz type 1
Mobitz type 2
Third degree
1st degree - prolonged PR >0.2
Mobitz type 1 increasingly prolonged PR then a dropped QRS
Mobitz type 2 PR interval is constant but the P wave is often not followed by a QRS complex
Third degree no association between P and QRS
Major bleeding
Minor bleeding + INR >8
No bleeding INR >8
Minor bleeding INR 5-8
No bleeding INR 5-8
Stop warfarin, IV vit K 5mg
Prothrombin complex concentrate - if not available then FFP*
Stop warfarin
Give IV vit K 1-3mg
Repeat dose of IV vit K if INR still too high after 24 hrs
Restart warfarin when INR < 5.0
Stop warfarin
Give PO vit K 1-5mg by mouth
Repeat dose of vitamin K if INR still too high after 24hrs Restart when INR < 5.0
Stop warfarin
Give IV vit K 1-3mg
Restart when INR < 5.0
Withhold 1 or 2 doses of warfarin
Reduce subsequent maintenance dose
What are the below scoring systems used for?
ABCD2
DAS28
Child Pugh
SCOFF
Epworth
IPSS
Waterlow
FRAX
Ranson
MUST
TIA
RA severity
Liver cirrhosis
Eating disorders
Sleep apnoea
Prostate symptoms score
Pressure sores
10 year risk of developing osteoporotic fracture
Acute pancreatitis
Malnutrition
Brugada syndrome
AD/AR
Common in which demographic?
Mutation in which gene?
ECG changes (3)
Ix of choice
Mx
Autosomal dominant
Asians
SCN5A gene
Convex ST segment elevation
Negative T waves V1-V3
RBB
Administration of flecainide or ajmaline - more apparent ECG changes following this
Mx ICD
What is Buerger’s diease?
Strongly associated with?
Features (5)
Small to medium vessel vasculitis
Smoking
Extremity ischaemia
Intermittent claudication
Ischaemic ulcers
Superficial thrombophlebitis
Raynaud’s phenomenon
Beck’s triad (3)
Found in which condition?
hypotension
raised JVP
muffled heart sounds
cardiac tamponade
Cardiac tamponade
ECG findings
Mx
ECG: electrical alternans
Mx urgent pericardiocentesis
When can one use dabigatran?
Non valvular AF with at least one of:
prev stroke/ TIA/ systemic embolism
LVEF <40% or NYHA class 2 or above
75yo >=
65yo >= with DM, CAD, HTN
VTE prophylaxis post knee or hip replacement surgery
Normal variants ECG in an athlete (4)
sinus bradycardia
junctional rhythm
first degree heart block
Mobitz type 1 (Wenckebach phenomenon)
multiple red/yellow vesicles on the extensor surfaces
Eruptive xanthoma
Ix for palpitations
1st line (4) (including three sets of bloods)
2nd line (1)
3rd line (2)
ECG
TFT
FBC
U+E
2nd line 24 hour Holter
3rd line external loop recorder
implantable loop recorder
MI secondary prevention meds (4)
dual antiplatelet therapy (aspirin plus ticagrelor OR prasugrel)
ACE inhibitor
beta-blocker
statin
Pts who have sx of acute heart failure following an MI should be treated with?
How many days post MI should this treatment be started?
aldosterone antagonist - eplerenone should be initiated within 3-14 days of the MI
Coarctation associations (4)
Turner’s syndrome
Bicuspid aortic valve
Berry aneurysms
Neurofibromatosis
Coarctation signs
Infancy:
Adults: (2)
Pulse
Murmur
Sound
infancy: heart failure
adult: hypertension, notching of the inferior border of the ribs
radio-femoral delay
mid systolic murmur, maximal over back
apical click from the aortic valve
HOCM
Features - can give hint
MR SAM ASH
mitral regurg, systolic anterior motion, asymmetric hypertrophy
HOCM
ECG findings (3)
left ventricular hypertrophy
deep q waves
+/- AF
HOCM
Murmur type
Increases with?
Decreases with?
Ejection systolic murmur
Increases with Valsalva manoeuvre
Decreases on squatting
jerky pulse, large ‘a’ waves, double apex beat = ?
HOCM
SVT management (3)
CI for 2nd line tx, alternative choice
Prevention (2)
- vagal manoeuvres e.g valsalva and carotid sinus massage
- adenosine 6mg, then 12mg, then 18mg
- electrical cardioversion
asthmatics - verapamil
BB or ablation
WPW
ECG (3)
right sided accessory pathway gives
left sided accessory pathways gives
short PR interval
wide QRS complexes
slurred upstroke - ‘delta wave’
left axis deviation if right-sided accessory pathway*
right axis deviation if left-sided accessory pathway*
Type A WPW
Type B WPW
Most common type?
Left sided pathway i.e RAD - dominant R wave
Right sided pathway i.e LAD - no dominant R wave
LAD (type B)
WPW associations (3)
HOCM
mitral valve prolapse
thyrotoxicosis
WPW mx (2)
ablation of accessory pathway
or medical mx with sotalol, amiodarone or flecainide
Sharp pain relieved by sitting forwards, can be pleuritic?
Pericarditis
What is Boerhaaves syndrome?
Diagnostic Ix
Mx
Spontaneous rupture of the oesophagus that occurs as a result of repeated episodes of vomiting.
CT contrast swallow
Thoracotomy and lavage if <12 hours
Advice given to those who develop tolerance to ISMN?
Take the second dose after 8 hours instead of 12
Warfarin INR target
VTE
recurrent VTE
AF
SE (4)
2.5
3.5
2.5
SE purple toes, skin necrosis, teratogenic, bleeding
Examples of thrombolytic drugs (2)
CI (8)
alteplase, streptokinase
Active bleeding
Recent haemorrhage or surgery
Bleeding disorders
Intracranial neoplasm
Stroke <3 months prior
Aortic dissection
Recent head injury
Severe HTN
What is Takayasu’s arteritis?
Large vessel vasculitis
Name some features of Takayasu’s arteritis (6)
Hints:
Age, gender, ethnicity
x2 non specific
Impact on BP
Pulse
Murmur
Associated with which condition?
Mx
Young female Asians
- malaise, headache
- unequal BP in upper limbs
- carotid bruit and tenderness
- weak peripheral pulses
- upper and lower limb claudication on exertion
- AR
RAS
Steroids
When would you consider treating a patient with stage 1 hypertension?
aged under 60
ORBIT score (5)
Use
Risk group
Use instead of HASBLED
Hb <130 M <120 F 2
Age >74 1
eGFR <60 1
Prev hx of bleeding 2
On antiplatelets 1
2 or less low risk
3 medium risk
4 or more high risk
