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FRACP Long Case > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Risk factors for ACS?

A 
Previous IHD
DM
Hyperlipidaemia
HTN
Family history
Smoking
OCP 
Obesity 
Long term use of NSAIDs
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2
Q

Management of infarction?

A

Primary PCI if door to balloon time is <90minutes

Thrombolysis if not - alteplase and then delayed PCI

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3
Q

Complications of infarct?

A 
Ventricular arrhythmias
Papillary muscle rupture --> MR
Bradyarrhythmias
Cardiac failure
Further ischaemia or reinfarction
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4
Q

Long term management of infarction

A 
Early revascularisation
Aspirin and ticagrelor/clopidogrel for >1yr
Statin - LDL <1.8
Beta-blockers HR <70
ACE-Is  max dose
Spirolactone/epleronone
Coronary bypass grafts
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5
Q

Secondary prevention of infarction?

A 
Weight reduction
Exercise 3x/week
Lipid reduction
Smoking cessation
HTN management <130/80
Cardiac rehabilitation
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6
Q

Causes of Left heart failure?

A

Volume overload - AR, MR, PDA
Pressure overload - HTN, AS
Myocardial disease - IHD and dilated CM

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7
Q

Causes of Dilated CM?

A 
Idiopathic
EToL
Viral
Familial
Myocarditis
Tachycardia induced
Peripartum
Neuromuscular disease
Connective tissue disease
Haemochromatosis
Sarcoidosis
Drugs - Doxirubicin
Radiation
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8
Q

Causes of right heart failure?

A

Volume overload - ASD, TR
Pressure overload - PS, pulm. HTN
Myocardial disease - CM secondary to LVF, right ventricular infarction

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9
Q

Acute control of Systolic Heart Failure?

A

Decrease physical activity
Control fluid retention - diuretics, low-salt diet, fluid restriction
Daily weights
RAAS blockade - ACE-Is or ARB and neprilysin
Spironolactone
Catecholamine blockade - Beta-blockade
IV inotropes

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10
Q

Long term control of Systolic Heart Failure?

A 
Treat Iron deficiency
Prevent Arrhythmias - Defibrillator
Bi-ventricular pacing - QRS>150
LVAD as a bridge to transplant
Heart transplant
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11
Q

Treatment of Diastolic heart failure?

A

Beta-Blockers
Small doses of diuretics
Control HTN

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12
Q

Familial Hypercholesterolaemia?

A

Defect or low LDL
Autosomal dominant
10x elevation in serum cholesterol
MIs at 30-40yrs
Find out about LDLs and HDLs
? history of pancreatitis - hypertriglyceridaemia
EtOH consumption, hypothyroidism, OCP use
Xanthomas on exam
Treat with Statin, ezetimibe, gemfibrozil
PSCK9 inhibitors
Diet

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13
Q

Aim for Hypertension treatment?

A

Nil issues - <140/90

CVD or DM - <130/80

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14
Q

Investigations for HTN:

A

ECG - ? LVH
Urine for protein
Hypokalaemia –> renin-aldosterone levels
Ct angiogram - renal arteries
Sleep study - OSA
Urinary catecholamines - Phaeochromocytoma
Ix for cushings syndrome

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15
Q

Conservative BP management?

A 
Weight reduction
Exercise
EtOH reduction
Salt reduction 
OSA management
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16
Q

Medication BP management?

A 
Thiazide diuretics
ACE-Is
Calcium channel blockers
Beta blockers
Spironolactone
17
Q

Evaluation for heart transplant?

A
  1. History and examination
  2. Body weight
  3. Cardiac assessment:
    - GHPS for EF
    - TTE - valves and ? thrombus
    - Coronary angiogram - ?IHD
    - 24hr holter for ? arrhythmias
    - Right heart catheter ? pulm HTN - CONTRAINDICATION FOR TRANSPLANT
  4. HLA tissue typing
  5. CXR and lung function tests
  6. FBC, EUCs, LFTs, cholesterol, BSLs ESR and Coagulation sties
  7. Serology - HAV, HBV, HCV, HIV, CMV, EBV, HSV, TPG
  8. Psych, renal and dental assessments if required
  9. Social work referral
18
Q

Heart transplant history?

A

Cause of heart failure
Previous IHD symptoms ? previous angiograms
Symptoms pre-surgery
Exercise tolerance pre-surgery
Treatments pre-surgery - drugs, defibs, LVAD
Problems with the surgery
Endomycardial biopsies
Immunosuppressive medications
Episodes of rejection? Treatment with methylpred? ? MTX or muromonab
Complications of immunosuppression
Angiograms post op
Effect on current life
Cancers - skin, lymphoproliferative, cervical

19
Q

Heart transplant examination?

A 
Median sternotomy scar
Signs of pericarditis - ? rejection
Neck scars - endomyocardial biospy
? Steroid effects - cushingoid appearance
? signs of infection
20
Q

Heart transplant investigations?

A 
Endomyocardial biospies
FBC, EUCs, LFTs, BSLs
Drug levels
Urine protein and creatinine
CXR
ECG and TTE
GHPS
21
Q

Discussion points for heart transplant?

A 
Rejection - biopsy and pred
Infection risk from immunosuppression - fungal, viral and bacterial
Cancer risk - skin, PTLD, cervical
Hyperlipidaemia
Hypertension
Myocardial infarction
Prognosis
22
Q

Causes of AF:

A 
AGE
HTN
Mitral valve disease
IHD
Recent surgery
ASD
WPW syndrome
Recent EtOH binge
PE
Thyrotoxicosis
Exercise
23
Q

Investigations for arrhythmias?

A 
Resting ECG
EPS
TTE
TFTs
Angiogram
24
Q

Indications for PPM insertion?

A

Intermittent or permanent complete heart block
Intermittent or permanent 2nd degree heart block with symptomatic bradycardia
Sinus node dysfunction with symptomatic bradycardia

25
Q

Indications for implanted cardioverter-defibrillators?

A

Confirmed VT or VF
Symptomatic long QT
EF <30% with QRS >150

26
Q

Assessment of patients with frequent activations of a defibrillator?

A

Check device programming
Exclude new ischaemia
Introduce or increase anti-arrhythmic treatment
Consider VT ablation

27
Q

Management principles of AF?

A

Maintain SR
Control the HR
Protect from embolic events

28
Q

CHA2DS2-VASc?

A 
Congestive HF = 1 
HTN = 1
Age 65-74yrs = 1
Age >75yrs = 2
DM = 1
Stroke or TIA = 2
Vascular disease = 1
Sc = female = 1

Male patient score of 1 = anticoagulant
Female patient score of 2 = anticoagulant

FRACP Long Case (3 decks)

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