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Core Conditions Year 3 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

STEMI:

1) Initial assessment
2) Initial management
3) Intervention
4) Long term management

A

1) 12-lead ECG, brief history and exam
Blood tests: FBC, U+Es, glucose, Troponin, cholesterol
(Chest x-ray)
2) 300mg aspirin if not given already
300mg clopidogrel/ ticagrelor
5-10mg morphine + 10mg metoclopramide
Oxygen if sats < 95%
3) Primary PCI if available, if not thrombolysis
4) 5mg Beta blocker, 2.5mg ACEi, 75mg/day clopidogrel

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2
Q

NSTEMI:

Prescriptions (including high risk and low risk)

A

5mg Beta blocker, Nitrates
Fondaparinux if low bleeding risk/ no angiography planned. If not, LMWH for 8 days

High risk: GPIIb/IIIa antagonist Tirofiban, Clopidogrel and Aspirin
Low risk: Clopidogrel and discharge if repeat troponin -ve

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3
Q

MI:

Discharge drugs

A

ACEi (ARB if not tolerated) - Indefinitely
Beta blocker for 12 months
Statin - Indefinitely
Antiplatelet (aspirin + ..grel.. for 12 months

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4
Q

Angina:

1) Symptom relief
2) First line therapy
3) 2nd line/ 1st line not tolerated

A

1) GTN spray
2) Beta blocker or Calcium channel blocker
3) Long acting nitrate (Isosorbide mononitrate) or Ivabradine

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5
Q

Secondary prevention for stable angina

A

Antiplatelet therapy - aspirin or clopidogrel

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6
Q

Secondary prevention for stable angina with Diabetes

and Why?

A

ACEi

Slows renal disease in DM as well as benefits in angina

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7
Q

Atrial fibrilation

Diagnosis

A

Pulse palpation for irregularly irregular pulse

12 lead ECG to look for absence of P waves

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8
Q

Atrial Fibrilation

Scores to assess risks

A

CHADSVASc for risk of stroke

HAS-BLED for risk of major bleed

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9
Q

Atrial Fibrillation

Rate control

A 
Beta blocker (propanolol/ atenolol) or 
Calcium channel blocker (verapamil/ diltiazem)

Digoxin can be considered in people with sedentary lifestyle

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10
Q

Atrial Fibrillation

Rhythm control

A

Amiodarone
By specialists: Cardioversion, sotalol
Atrial ablation

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11
Q

Atrial Fibrillation

Anticoagulation

A

Depends on CHADSVASc score (1 or more) and HAS-BLED risk

Offer a choice of warfarin or a NOAC

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12
Q

Hypertension

Modifiable risk factors

A 
Obesity
Stress
Dietary salt
Oral contraceptive
Sedentary lifestyle
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13
Q

Hypertension

Non-modifiable risk factors

A 
Increasing age
Ethnicity (African American)
Men <65
Women 65+
Family history
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14
Q 
Hypertension
Stages:
1)
2)
3)
A

1) 140/90
2) 160/100
3) Severe 180/110

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15
Q

Endocrine causes of Hypertension

A

Cushing’s (Raised cortisol = vasoconstriction)

Conn’s (Increased sodium/ water retention, Potassium excretion = hypervolaemia)

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16
Q

What is Conn’s syndrome?

A

Primary hyperaldosteronism
Increases activity of Na+/ K+ pumps in the distal tubule and collecting duct
Na+ absorption and K+ excretion

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17
Q

Investigations in Hypertension and differential diagnosis it is investigating

A

Urine test for cortisol - Cushing’s
Bloods - decreased K+? - Conn’s, Cushing’s, renal disease
Bloods - Thyroid function - Hyperthyroidism
Examination - Radio-femoral delay? - Coarctation

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18
Q 
Management of Hypertension
1st
2nd
3rd
4th
A

1st: ACEi <55, Ca blocker or thiazide Diuretic >55
2nd: A+C or A+D
3rd: A+C+D
4th: A+C+D+ Beta blocker/ alpha blocker/ ARB

19
Q

First line management of hypertension in diabetics

A

ACE inhibitor

20
Q

Common causes of Heart Failure

A

Ischaemic heart disease
Hypertension
Valvular disease: Aortic stenosis = increased afterload
Aortic regurgitation = Increased preload

21
Q

Presentation of Left heart failure

A

Fluid backs up on lungs: Breathlessness, bibasal crackles, orthopnoea, nocturnal dyspnoea
Pulsus alternans (strong and weak alternating beats)
Breathlessness and fatigue
Tachycardia

22
Q

Presentation of Right heart failure

A

Fluid backs up in tissues: Peripheral oedema, ascites, hepatomegaly and raised JVP
Tachycardia

23
Q

Investigations in Heart failure
General tests
Specific pathway for MI/ non-MI sufferers

A

ECG, CXR
Bloods: FBC (anaemia), TFTs (hyperthyroid), U+Es (renal causes), LFTs (liver failure caused by oedema)

Past MI - Doppler Echo
No previous MI - B type natriuretic peptide. High = Doppler echo. Low = unlikely heart failure

24
Q

Management of Heart failure

1) Management of fluid overload
2) Cardiac support

A

1) Loop diuretic (Furosemide)
K+ sparing diuretic if needed (Spironolactone)
2) ACEi + Beta-blocker
Calcium channel blockers should be avoided in those with reduced ejection fraction

25
Q

Assessment of a DVT

A

Well’s score (2+ = likely DVT)
D-dimer: -ve result = exclude DVT
+ve result = Compression ultrasound

26
Q

Prescribing for DVT

A

NOAC
(Warfarin)
LMWH (Dalteparin): Contraindicated in recent stroke and GI ulcer
Fondaparinux: contraindicated in renal impairment, bacterial endocarditis

27
Q

Main acute and chronic cause of Peripheral vascular disease?

A 
Acute = thrombosis
Chronic = atherosclerosis
28
Q

Risk factors for peripheral vascular disease?

A 
Smoking
HTN
Obesity
Sedentary
Diabetes
Dyslipidaemia
29
Q

Acute Presentation of peripheral vascular disease

A 
Pain (constant)
Pulseless
Pallor
Perishingly cold
Paraesthesia
Paralysis
30
Q

Presentation of chronic peripheral vascular disease - Claudication

A

Pulses disappear on exertion

Calf pain/ cramp on walking predictable distance

31
Q

Presentation of Critical limb ischaemia

A

Pain at rest
Absent pulses
Patient hangs foot out of bed to relieve pain
Rubor

32
Q

Investigations for Peripheral vascular disease

A

Bloods (lipids, glucose, FBC, CRP)
ECG
ABPI - Normal = 1, Claudication <0.9, Rest pain <0.6

33
Q

Treating Claudication

A

1) Exercise programme - exercise to the point of pain
2) Angioplasty/ bypass
3) Naftidrofluryl oxalate if patient doesn’t want surgery

34
Q

Causes and Risk factors of varicose veins

A

Caused by valve insufficiency and retrograde blood flow
Genetic component
Pregnancy, getting older and obesity are all risk factors

35
Q

Presentation of varicose veins

A

Tortuous superficial veins
Itching and swelling
Discomfort after prolonged standing
Discomfort relieved by elevation or compression

36
Q

Complications of varicose veins

A

Venous ulcer
Skin pigmentation/ venous eczema
Thrombophlebitis

37
Q

Treating varicose veins

What mistake should you be careful not to make?

A

Stripping or ablation (surgical)
Compression stockings can relieve symptoms
You MUST rule out arterial disease by ABPI before issuing compression stockings

38
Q

Causes of Abdominal Aortic Aneurysm

A 
Inflammatory (vasculitis)
Infective (TB, endocarditis, syphillis)
Congenital (Ehler's Danlos, Marffan's)
Trauma
Atheroma
39
Q

Risk factors for abdominal aortic aneurysm

A 
Smoking
HTN
Male
Increasing age
FHx
Atherosclerosis
COPD
40
Q

Symptoms of unruptured AAA

A

Often asymptomatic
Can get pain from the pressure (back, loin, abdo)
Expansile, pulsatile abdominal mass

41
Q

First investigation you should do for an AAA

A

Ultrasound

42
Q

How do you manage an AAA that is:

1) 3 - 4.4cm
2) 4.5 - 5.4cm
3) 5.5cm+

A

1) Annual ultrasound
2) 3month ultrasound
3) ?Surgery or ultrasound every 3 months

43
Q

Key biochemical finding in Conn’s syndrome?

A

Low Potassium (K+)

Core Conditions Year 3 (3 decks)

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