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Pass Med > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Warfarin INR ranges

A

Venous thromboembolism- INR 2.5, if recurrent 3.5
A fib INR 2.5
Mechanical heart valves differ by site

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2
Q

Warfarin s/e

A 
Haemorrhage
Teratogenic
Skin necrosis 
Purple toes 
Bleeding- stop 5 days prior to surgery
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3
Q

Statins s/e

A

Myopathy- myalgia, myositis, rhabdomyolysis

Liver impairment - baseline 3, and 12 months

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4
Q

Who should get statins?

A

All people with established cardiovascular disease
NICE- anyone with a 10 year cardiovascular risk
Patients with dm2 - QRISK2 and decide
Dm1 over 10 years or over 40 or nephropathy

New evidence suggests don’t need to be taken at night.

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5
Q

Bradycardia treatment;

A

Management depends on
If signs of hemodynamic compromise
Identifying potential risk of asystole

Haemodynamic compromise; shock - bp<90, pallor, sweating, cold extremities, confusion, syncope.

Atropine is first line, doesn’t work or if risk of asystole-pacing is ind.

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6
Q

ABPM results

A

If >135/85
Treat if under 80 and target organ damage, CV disease, renal disease, diabetes or QRISK over 20.

If 150>95
Treat

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7
Q

PPV vaccine

A

Most only need one dose, if asplenia, splenic dysfunction or CKD need booster every 5 years

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8
Q

Pericarditis - features

A

Differential in any patient presenting with chest pain

Features;
Chest pain- can be pleuritic- relieved by sitting forwards
Non productive cough, dyspnoea flu like symptoms
Pericardial rub
Tachypnoea
Tachycardia

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9
Q

Pericarditis- causes

A 
Viral infection- coxsackie
TB
Uremia
Trauma
Post MI- Dresslets syndrome 
CTD
Hypothyroidism
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10
Q

ECG changes in pericarditis

A

Widespread saddle shaped ST elevation

PR depression

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11
Q

WPW

A

Caused by a congenital accessory conducting pathway between atria and ventricle leaving to AV reentry tachycardia.
AF can become VF

ECG features;
Short PR
Wide QRS with slurred upstroke
LAD* usuallyor RAD

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12
Q

WPW associations

A 
HOCM
Mitral valve prolapse
Epstein’s anomaly 
Thyrotoxicosis 
Secundeum ASD
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13
Q

WPW treatment

A

Definitive treatment; radio frequency ablation of the accessory pathway
Medical; amidarone, flecainide, sotalol

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14
Q

Infective endocarditis

Risk factors

A

Most important is prev hx of endocarditis
Previously normal valves (50% at presentation)
Rheumatic valve disease 30%
Prosthetic valves
Congenital heart defects
IV drug users

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15
Q

Causes of infective endo

A

Staph aureus now- strep viridans in developing world

Non infective- Libman sacks- seen in SLE
Malignancy- marantic endocarditis

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16
Q

MI complications

A

Cardiac arrest- usually from v fib, most common cause of death following MI
Cardiogenic shock-damage to myocardium, reduced ejection fraction
Chronic heart failure
Tachyarrhythmias- V fib most common, VT also
Bradyarrthymias- AV block more common after anterior infaraction
Pericarditis- first 24hrs following trans mural 10%. Dressler tends to happen 2-6 weeks following mI
Left ventricular aneurysm- weaken myocardium, persistent st ELEVATION AND lv failure. Need to be anticog, thrombus might form in a.
LV free wall rupture 3% 1-2 weeks after
VSD 1-2% patient in first week
Acute MR- papillary muscle damage

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17
Q

Anaphylaxis in <6months

A

Adeneline 0.15ml 1in 1000
Hydrocortisone; 25mg
Chorphenamine- 250mcg per kg

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18
Q

Anaphylaxis in 6month- 6year

A

Adrenaline 0.15ml 1in 1000
Hydro or 50mg
Chlorphenamine 2.5mg

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19
Q

6-12 years

A

Adrenaline 0.3ml 1 in 1000
Hydrocortisone 100mg
Chlorpheamine 5mg

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20
Q

Over 12

A

Adrenaline 0.5mls 1 in 1000
Hydrocortisone 200mg
Chlorphenamine 10mg

Adrenaline repeat every 5 mins

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21
Q

Long QT

A

Inherited condition- delayed repolarization of the ventricles.
Can lead to VT and death
Corrected QT in adults M is 430 and F 450

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22
Q

Causes of prolonged QT

A

Congenital- jervell- Lange- Nielsen syndrome- includes deafness
Romano-ward- no deafness

Drugs- cispadone, domperidone, anti arrhythmic, citalopram, escitalopram, venlafaxine, erythromycin, clarithromycin, TCA, amiodarone, sotalol, methadone, chloroquine, haloperidol, chlorpromazine

Electrolyte imbalances- hypocalcemia, hypokalaemia, hypomg, hypothermia

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23
Q

ECG In hypothermia

A 
Prolonged QT
Bradycardia
J Wave
First degree heart block 
A and V arrhythmias
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24
Q

Complete heart block following an MI

A

Right coronary artery lesion

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25
Q

Complete heart block

A 
Features; 
Syncope
Heart failure
Bradycardia
Wide pulse pressure 
Cannon waves
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26
Q

Types of heart block

A

First degree- prolonged PR > 0.2 s
Second degree- type 1 mobitz
Type 11- p wave often not followed by a QRS complex

Third degree, no association between p WAVES AND QRS

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27
Q

Takayasu arteritis

A

Large vessel vasculitis
Typically causes occlusion of the aorta- often an absent limb pulse
More common in females and Asian

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28
Q

Features of Takayasu arteritis

A 
Systemic features of vasculitis- malaise, headache 
Unequal pressure in upper limbs 
Carotid bruit
Intermittent claudication 
Aortic regurg in 20%

Associated w renal artery stenosis
Mgmt
Steroids

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29
Q

Ejection systolic

A 
AS
PS
HOCM
ASD
Fallon’s
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30
Q

Pansystolic

A

MR
TR- both are blowing in character
VSD

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31
Q

Late systolic

A

Mitral valve prolapse

Coarc of Aorta

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32
Q

Early diastolic

A

AR

Graham steel murmur- PR

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33
Q

Mid-late diastolic

A

MS

Austin- flint

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34
Q

Continuous

A

PDA

35
Q

Clopidogrel

A

Stop a week before elective surgery

If used with PPI- makes it less effective - still new data

36
Q

A flutter ECG findings

A

Sawtooth appearance

Mgmt - similar to a fib but meds are less effective
More sensitive to cardioversion
Radiofreq abalation of the tricuspid valve isthmus is curative for most patients

37
Q

ECG myocardial disease

A

MI;
Hyperactive T waves often the first sign- only last for a few mins
ST elevation
T wave inversion- in fist 24hours- can last for days to months
Pathological Q waves

38
Q

Statin interaction

A

Statin +erythromycin/clarithromycin

39
Q

Loop diuretics

A

Furosemide and bumetanide - inhibit the Na K Cl cotransporter in the thick ascending limb of the loop of Henley

Indication; heart failure
Resistant hypertension- particularly if renal impairment

Adverse effects-
Ototoxicity
Hypokalemia
Dehydration
Angioedema
Nephrotoxicty
Gout
40
Q

LEAD IN MI

A

I V5 V6- Circumflex- LATERAL
II III AVF- inferior- RCA
V1-V4- LAD Anterior

41
Q

Don’t prescribe beta blockers with

A

Verapamil- Bradycardia and asystole

42
Q

Management of Torsades de POINTS

A

IV mag sul

43
Q

Causes of long QT

A 
Congenital - jervell Lange Nielsen, Romano ward syndorme
Antiarrhythmics- amiodarone, sotalol
TCA
Anti psychotics
Chloroquine
Tergenadine 
Erythromycin
Hypoca, hypokalemia, hypomag,
Myocarditis
Hypothermia
SAH
44
Q

SVT management

A

Fatal manoeuvres- valsalva
IVO adenosine- use verapamil in asthma some
Elective cardio venison

Prevention- beta blockers, radiofreq abalation

45
Q

Amidarone

A

MOA- Blocks potassium channels which inhibits repolarisition and hence prolongs action potential.

NEED TFT left every 6 months

S/e
Thyroid dysfunction
Corneal deposits
Liver fibrosis 
Pulmonary fibrosis 
Peripheral neuropathy
Photo sensitivity
Slate grey appearance
Brady cardia
46
Q

Thrombolysis

A

Activate plasminogen to form plasmin- degrades fibrin

Contraindications
Active internal bleeding
Recent haemorrhage, trauma or surgery- including dental extraction
Intracranial neoplasm 
Stroke <3 months
Recent head injury
Pregnancy severe hypertension
47
Q

Hep E

A

Associated with face all oral spread, commonly affecting shellfish and pork products
Bloods show elevated bilirubin and transaminits

48
Q

Mody

A 
Mature onset diabetes of the young
DM2 in under 25
Inherited in AD fashion 
Family history is often present 
Usually very sensitive to SUR

Mody 3 60% of cases

49
Q

C Diff

A

Gram positive - encountered in hospital practice
Causes pseudomembranous colitis - intentional damage due to exotoxins.
Commonly caused by broad spectrum antibiotics- suppress normal flora
2nd and 3rd generation cephalosporins

50
Q

Features of c diff

A

Diarrhoea
Abdo pain
Raised white blood cell count
Toxic mega colon may develop

Detect in stool

51
Q

Tx for c DIFF

A

Oral methronidazole for 10-14 days
Add in vancomycin if not responding
All oral

IV if life threatening

52
Q

Raised ALP

A 
Liver- cholestasis, hepatitis, fatty liver, neoplasia 
Pagets 
Osteomalacia
Bone mets
Hyperparathyroidism 
Renal failure 
Pregnancy
Growing children 
Healing fractures
53
Q

Raised alp and raised calcium

A

Bone mets

Hyperparathyroidism

54
Q

Roared ALP and low calcium

A

Osteomalacia

Renal failure

55
Q

Goodpastures

A

Associated with rapidly progressive glomerulnephritis +- pulmonary haemorrhage
Caused by anti glomerular basement membrane ab against IV collagen
More common in men and has biomodal age dis 20-30 60-70
Hal dr2

Plamaphoeriss
Steroids
Cyclophosphamide

56
Q

Dipyridamole MOA

A

Used as an anti-coag

Inhibits phosphodiesterase

57
Q

NICE BP targets for DM2

A

If end organ damage <130/80

Otherwise <140/80

58
Q

Evidence of anterior MI and AR

A

Proximal aortic dissection ?

59
Q

Macklemore triad for Boerhaave syndrome

A

Vomiting
Thoracic pain
Subcutaneous emphysema

Middle aged men with background of alcohol abuse

60
Q

Treating aortic dissection

A

Type a- Surg

Type b - non surg

61
Q

Boerhaaves syndrome

A

Rupture of the oesophagus as a result of repeated episodes of vomiting
Usually c/o sudden onset severe chest pain that may complicate severe vomiting

62
Q

Nicorandil

A

Potassium channel activator - vasodilator effect on coronary arteries
S/E- headache, flushing, anal ulceration

Used to treat angina

63
Q

ACEi S/E

A

Cough- 15% of patients and may occur up to 1 year after starting treatment
Angioedema- up to 1 year after starting treatment
Hyperkalemia
First dose hypotension

64
Q

ACEI cautions and CI

A

Avoid if preg/ breastfeeding
Renal disease
Aortic stenosis
High dose diuretics

U& E before - rise in creatinine and K may be expected. Cr rise of no more than 30% . EGFR should be less than 20%

65
Q

HTN in diabetes treatment

A

First line - ACEi - renal protective effect

66
Q

Isosorbide mononitrare

A

Patients may develop tolerance to this med and you might need to change dosing regime

67
Q

Angina drug mgmt

A

All patients should get aspirin and statin - if not CI
Sublingual GTN for attacks
Beta blocker or CCB first line based on co morbidities
If CCB by itself- verapamil or diltiazem

68
Q

Ejection systolic

A 
AS
PS
HOCM
ASD
Fallots
69
Q

Pansystolic

A

MR TR- blowing

VSD

70
Q

Late systolic

A

M prolapse

Coarch

71
Q

Early diastolic

A

AR- blowing

Graham steel

72
Q

Mid late diastolic

A

MS

Austin flint- severe AR

73
Q

Continuous machine like

A

PDA

74
Q

HOCM

A

AD disorder of muscle tissue caused by defects in the genes encoding contractile proteins.
1/500

75
Q

HCOM features

A 
Often asymptomatic 
Dypnoea
Angina 
Syncope 
Sudden death 
Ejection systolic murmur- increases valsalva- decreases squatting
76
Q

Associations HOCM

A

WPW

Friedrechihs ataxia

77
Q

Echo findings

A

MR
Systolic anterior motion of MV leaflet
Asymmetric hypertrophy

MR SAM ASH

78
Q

ECG HOCM

A

LVhypertropghy
Progressive t wave inversion
Deep q waves
A fib

79
Q

A fib rate control

A

Beta blockers
CCB

Digoxin- not first line

80
Q

Rate control if

A

Older than 65

Hx of ischemic heart disease

81
Q

Rhythm control if

A

Younger than 65
Symptomatic
First presentation
Congestive heart failure

82
Q

Epstein anomaly

A

Low insertion of the tricuspid valve - large atrium and small ventricle

Associations - tricupsid incompetence
WPW

Li exposure in uterus

Tricuspid valve leaflets are attached to the walls of the septum and tight ventricle

83
Q

BNP

A

Made in response to strain- left ventricular myocardium

Effects- vasodilator
Diuretic and natriuretic

84
Q

Clinical uses of BNP

A

Diagnosisi of patients with a true dyspnoea
Prognosis of chronic heart failure
Guiding treatment in chronic HF
Screen for cardiac dysfunction

Pass Med (8 decks)

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