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RACP > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Systolic Heart Failure

Heart Failure Reduced Ejection Fraction

A
  • LVEF
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2
Q

Diastolic Heart Failure

(Heart Failure Preserved Ejection Fraction

A

LVEF >40%

Exclude IHD and Valvular Disease

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3
Q

NYHA Classification

A

I - No symptoms, even during exercise
II - Reduced physical capacity during medium exercise
III - Severely reduced physical capacity
during slight exercise, but asymptomatic at rest
IV - Symptomatic at rest

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4
Q

Ix of HF

A

Bloods

- FBE, UEC, LFTs, BNP, TFT, Fe Studies

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5
Q

Cardiac adaptations to HF

A
  • Cardiomegaly (same %, of a bigger volume)
  • 2ndary LVH
  • Valvular disfunction due to dilation
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6
Q

Management of Sys HF

A 
Mx
# Non-Pharmacologica Therapy - Na, Diet, Smoking, Exerc
# Initial Pharmacological Therapy
1. Low pressure/No oedema
- Inotropes +/- fluids
2. Low pressure/ Oedema
- Inotropes
3. High Pressure/No Oedema
- ACE/ARB
4. High Pressure/Oedema
- ACE/ARB + diuretics
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7
Q

CHADS2VASc

A 
C - Congestive heart failure - 1
 H - Hypertension - 1
 A2 - Age ≥75 years - 2
 D - Diabetes Mellitus - 1
 S2 - Prior Stroke or TIA - 2
 V - Vascular disease PVD, AMI, aortic plaque - 1
 A - Age 65–74 years - 1
 Sc - Sex category (Female) - 1
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8
Q

Pharmacological management of HF

A
  1. Diuretics
  2. ACEi/ARB
  3. Beta Blocker - Best NNT
  4. Ivabradine
  5. Hydralazine/nitrates
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9
Q

Diuretics - Heart Failure

A

Frusemide
- increased survival in APO
# Thiazide
- Good symptom relief (no good long/short term data)
# Aldactone
- Increased survival - good long term data
- RALES Trial 30% better survival

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10
Q

ACEi/ARB - Heart Failure

A 
# ACE
- Survival benefit (~7%)
- Dose that can be tolerated (K/BP) 
# ARB
- Similar improvement to ACE
- Used if intolerance to ACE

No benefit in Diastolic function

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11
Q

Beta Blockers - Heart Failure

A

Survival Benefit - highest dose tolerated
# Cardio selective - no head to head studies (~34%)
- Carvidolol
- Bisoprolol
- Metoprolol XL

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12
Q

Ivabradine - Heart Failure

A 
# SHIFT Study 
- 18% Decrease in major outcome - admission/CV death
# Mechanism
- Decrease HR - (funny channels)
- Neutral inotrope capacity
- Doesn't decrease BP
# Criteria
- NYHA II, III
- EF77
- Sinus
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13
Q

Hydralazine/Nitrates - Heart Failure

A
  • Consider if high BP/poor renal function
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14
Q

HF Drugs to Avoid

A
  • NSAIDs
  • Anti-arrhythmic
  • Ca Channel blockers
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15
Q

ICD in HF

A
  • LVEF
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16
Q

Neprilysin & Valsartan - Heart Failure

A

Paradigm HF Trial

  • 20% Decrease in death
  • additional therapy
  • Superior to ACE
17
Q

AF

A 
2 Components
# Substrate abnormalities
- LA stretch
- Increased LA pressure
- LA fibrosis
- Autonomic Abnormalities
# Electrical triggers
18
Q

Indications for ICD

A

Class I

- Symptomatic Sinus bradycardia (

19
Q

Vibrates

A
  • Increase lipoprotein lipase activity - decrease LDL, increase HDL and importantly decrease Trig
20
Q

HCM

A

Key Finding in HCM

  • Hypertrophy and diastolic dysfunction
  • Dynamic pressure gradient
  • 1st Degree relative screening – 5yrs screening
21
Q

ICD in HCM

A
  • Unexplained Syncope
  • Abnormal BP response to exercise
  • > 30mm ventricular wall thickness
  • Non-Sustained VT
  • Cardiac MRI >15% gallium uptake - Fibrosis
  • CAD
22
Q

Prolonged QT (congenital)

A
  • Betablocker (not sotalol)

- ICD - Indications

23
Q

Acute Management of Chest Pain

A
  • Aspirin

- O2 if

24
Q

Avoid Study

A
  • O2 if Stats
25
Q

STEMI

A
  1. Dx
    - Solely by ECG
  2. Mx
    # PCI
    # Thrombolytic
    3.
26
Q

Long QT Syndrome

A

Delayed/abnormal polarisation/repolarisation

Dx

  • on routine ECG or following family screening
  • Need to look at corrected (rate dependant)

Management
- avoid drugs which prolong the QT interval and other precipitants if appropriate (e.g. Strenuous exercise)
beta-blockers***
- implantable cardioverter defibrillators in high risk cases

*the usual mechanism by which drugs prolong the QT interval is blockage of potassium channels.

**a non-sedating antihistamine and classic cause of prolonged QT in a patient, especially if also taking P450 enzyme inhibitor, e.g. Patient with a cold takes terfenadine and erythromycin at the same time

27
Q

Types of long QT Sydromes - Genetic

A
  • Long QT1 - usually associated with exertional syncope, often swimming
  • Long QT2 - often associated with syncope occurring following emotional stress, exercise or auditory stimuli
  • Long QT3 - events often occur at night or at rest
    sudden cardiac death
28
Q

Enzymes and AMI

A 
1st - Myoglobin - 1-2 hours
2nd - CK-MB - 2-6 hours
3rd - CK - 4-8 hours
4th - Trop T
5th - AST
6th - LDH

CK-MB is useful to look for reinfarction as it returns to normal after 2-3 days (troponin T remains elevated for up to 10 days)

29
Q

Hypertrophic obstructive cardiomyopathy (HOCM)

A
  • HOCM is the most common cause of death in young people
  • is an autosomal dominant disorder of muscle tissue caused by defects in the genes encoding contractile proteins.
  • The most common defects involve a mutation in the gene encoding β-myosin heavy chain protein or myosin binding protein C.
  • The estimated prevalence is 1 in 500
30
Q

Infective Endocarditis

A
  • Streptococcus viridans (most common cause - 40-50%).
  • Staphylococcus epidermidis (especially prosthetic valves)
  • Staphylococcus aureus (especially acute presentation, IVDUs)
  • Streptococcus bovis is associated with colorectal cancer
  • non-infective: systemic lupus erythematosus (Libman-Sacks), malignancy: marantic endocarditis
31
Q

Agents with proven efficacy in the pharmacological cardioversion of atrial fibrillation

A
  • amiodarone
  • flecainide (if no structural heart disease)
  • others (less commonly used in UK): quinidine, dofetilide, ibutilide, propafenone
32
Q

Congenital heart disease

A
  • cyanotic: TGA most common at birth, Fallot’s most common overall
  • acyanotic: VSD most common cause
33
Q

Aortic dissection

A
  • type A - ascending aorta - control BP(IV labetalol/betablocker) + surgery
  • type B - descending aorta - control BP(IV labetalol/beta blocker)
34
Q

Management of AF

A
  1. Rate Control
    - 1st beta blockers preferable to digoxin
    - 2nd Ca Channel Blockers
    - 3rd Digoxin not used 1st line unless cardiac failure
  2. Rhythm Control
    - if >48hrs - Toe DCR/ameoderone
    - if <48hrs - DCR/ameroderone
35
Q

Acute Pericarditis causes

A

viral infections (Coxsackie)
tuberculosis
uraemia (causes ‘fibrinous’ pericarditis)
trauma
post-myocardial infarction, Dressler’s syndrome
connective tissue disease
hypothyroidism

36
Q

Acute Pericarditis Dx

A
  • Chest pain relieved by sitting forward
  • Chest pain relieved by exhaling
    ECG changes
  • widespread ‘saddle-shaped’ ST elevation
  • PR depression: most specific ECG marker for pericarditis
37
Q

Myocardial infarction: secondary prevention

A

All patients should be offered the following drugs:

  • dual antiplatelet therapy (aspirin plus a second antiplatelet agent) - event without stent
  • ACE inhibitor
  • beta-blocker
  • statin
38
Q

AMI regions

A

http://d32xxyeh8kfs8k.cloudfront.net/images_Passmedicine/pdd519b.png

RACP (15 decks)

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