Cardiology 3 Flashcards by H JP

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

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Thiazides can cause which electrolyte abnormalities (3)
Adverse effects (3)

low K and Na
High calcium

gout, impaired glucose intolerance, impotence

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Heart failure with reduced ejection fraction is defined as an ejection fraction below?

40%

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Which PPI interacts with clopi?
Clopi MOA

Omeprazole - makes it less effective
Anti-platelet

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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

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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

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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

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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

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Brugada syndrome
AD/AR
Common in which demographic?
Mutation in which gene?
ECG changes (3)

Ix of choice

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

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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

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Beck’s triad (3)
Found in which condition?

hypotension
raised JVP
muffled heart sounds

cardiac tamponade

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Cardiac tamponade
ECG findings

ECG: electrical alternans

Mx urgent pericardiocentesis

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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

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Normal variants ECG in an athlete (4)

sinus bradycardia
junctional rhythm
first degree heart block
Mobitz type 1 (Wenckebach phenomenon)

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multiple red/yellow vesicles on the extensor surfaces

Eruptive xanthoma

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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)

1. vagal manoeuvres e.g valsalva and carotid sinus massage 2. adenosine 6mg, then 12mg, then 18mg 3. 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