Cardiology Flashcards
CHA2DS2VASc components
Congestive HF HTN A2 age 65-74 or 75+ Diabetes S2 stroke, TIA or VTE before Vascular disease (IHD, PAD) Sex - female
anticoagulation based on CHADVASC score
0 - no treatment
1 - males - consider anticoag, females - no treatment
2 - offer anticoag
management of supraventricular tachycardia
valsava manoeuvre (a vagal manoeuvre) IV adenosine if doesn't work electrical cardioversion if doesn't work
where is a mitral stenosis murmur heard and what position accentuates it?
apex
accentuated lying on left
what murmur can rheumatic heart disease cause?
it’s the commonest cause of mitral stenosis murmur
timing of mitral stenosis
mid diastolic
timing of aortic stenosis
ejection systolic
paediatric ejection systolic murmurs
ASD (HS I - AV valves closing)
fallot’s
holosystolic murmurs
mitral + tricuspid regurgitation - AV valves that make HS I
VSD
what timing is aortic regurgitation?
early diastolic - aortic valve is HS II
continuous machine-like murmur - what could it be?
patent ductus arteriosus
hypokalaemia on ECG
U waves
small/absent/inverted T waves
prolonged PR + QT
ST depression
name 1 drug that can cause hypokalaemia
furosemide
diagnosis of HF in someone who’s had a previous MI
echo in 2 weeks
diagnosis of HF in someone who’s not had a previous MI
measure BNP
if high - echo in 2 weeks
if raised - echo in 6 weeks
what should be used for anticoagulation in AF?
warfarin or NOAC
aspirin not recommended for reducing stroke risk
HASBLED - used to calculate risk/benefit of starting someone on warfarin
HTN uncontrolled Abnormal renal/liver function Stroke Bleeding history Labile INRs Elderly (>65) Drugs predisposing to bleeding or alcohol (>8 drinks/week)
3+ - high risk of bleeding
how does warfarin work?
inhibits reduction of vitamin K
this helps carboxylate clotting factors 1972 + protein C
warfarin - target INR post VTE? (first time and recurrent time)
2.5
if recurrent - 3.5
warfarin - target INR of AF?
2.5
5 things that potentiate warfarin
liver disease P450 inhibitors: amiodarone ciprofloxacin cranberry juice NSAIDs
SEs of warfarin
teratogenic (but fine breastfeeding)
skin necrosis
purple toes
someone on warfarin after PE. INR drops to 1.3. what to do?
increase warfarin dose
start LMWH - rapid anticoag - until INR fine
what is the cutoff for investigating BP?
140/90 +
stages of HTN
1 - clinic 140/90+ - abpm/hbpm 135/85+
2 - clinic 160/100+ - abpm/hbpm 150/95+
severe - clinic 180/or/110+
what are the criteria for treating HTN?
stage 2, or stage 1 (135/85)+, <80y and target organ/CV/renal disease/diabetes/10y CV risk 20%+
if an ACEi + CCB combo isn’t working, what’s the next thing to add for HTN? examples?
thiaziude-like diuretic eg chlorthalidone or indapamide
if ACEi, CCB + thiazide diuretic aren’t working, what’s next mgmt for HTN? what BP defines not working?
140/90+ - resistant HTN
if K 4.5 or less - spironolactone
if K > 4.5 - higher-dose thiazide-like treatment
if this doesn’t work consider alpha or beta blocker
what are the BP targets?
<80y - clinic 140/90; amb/home 135/85
> 80y - clinic 150/90; amb/home 145/85
management of VT
immediate cardioversion if adverse signs - BP < 90, CP, HF, LOC
if not, antiarrhythmics eg amiodarone
if fails, electrical cardioversion - DC shocks
what could a broad complex tachycardia with low BP indicate?
ventricular tachycardia
management of aortic stenosis
aortic valve replacement if symptomatic or gradient > 40
4 signs of aortic stenosis
narrow pulse pressure
slow rising pulse
LVH/failure
1 thing that decreases effects of warfarin? why does this happen? how does this affect INR?
st johns wort
induces P450 enzyme system (which metabolises warfarin?)
shortens INR
what is bumetanide?
loop diuretic
what are the indications of loop diuretics?
heart failure - acute (IV) or chronic (oral)
resistant HTN
adverse effects of loop diuretics
gout otoxicity + nephrotoxicity hypotension low Na / K / Ca hyperglycaemia alklalosis
what kind of acute cardiac problem does alcoholism + severe hypokalaemia point to? mgmt?
polymorphic VT (torsade de pointes) - give 2g Mg
risk of combining statins and erythro/clarithromycin?
features of this?
statin-induced myopathy
myalgia + increased creatine kinase
what are the 2 main adverse effects of statins?
myopathy
liver impairment - monitor LFTs
what do you give in primary prevention of stroke?
atorvastatin 20mg on
what do you give in secondary prevention of stroke?
atorvastatin 80mg on
features of heart failure on CXR?
Alveolar oedema (bat's wings) B - Kerley B lines (interstitial oedema) Cardiomegaly Dilated prominent upper lobe vessels Effusion - pleural
what does a boot-shaped heart indicate?
tetralogy of fallot
what does a widened mediastinum on CXR indicate?
aortic dissection or aneursym
when should oxygen therapy be avoided if there’s no hypoxia?
ACS/MI
stroke
obstetric emergencies
anxiety
Breathlessness, raised JVP, fine basal crackles, 3rd heart sound - what is it?
Pulmonary oedema
As fine bibasal crackles are a feature, + other signs of HF
Raised JVP
Muffled heart sounds
Hypotension
What is it?
Pericardial effusion
Ascites, pulsatile liver, peripheral oedema + pansystolic murmur?
Tricuspid regurgitation
Drug induced facial swelling, breathing difficulty + stridor - what could have caused this? (Not anaphylaxis)
ACEi-induced angioedema
what electrolyte abnormalities can cause long QT?
low K / Mg / Ca - ie the 3 involved in muscle contraction
what can long QT predispose to?
torsades de pointes
what is torsades de pointes? how dangerous is it? what can it cause?
polymorphic VT - multiple ventricular foci so QRS vary in amplitude, axis + duration
life threatening - can cause VF
what is HS I?
closing of atrioventricular valves - ie mitral (left atrium to ventricle) + tricuspid (right atrium to ventricle)
what is HS II?
closing of aortic (left ventricle to aorta) + pulmonary (right ventricle to pulmonary artery) valves
what are the 4 main types of SVT?
AF
Aflutter
WPW
paroxysmal SVT
what is a U wave?
wave that follows the T wave
what is doxazosin? what used for?
a1 blocker
HTN + BPH-associated urinary retention
management of torsade de pointes
IV magnesium sulphate
what metabolic abnormality can ACEis cause?
hyperkalaemia
what can cause torsade de pointes?
low Ca, K, Mg
hypothermia
causes of HS4
HF
MI
HTN
how does HTN affect heart? how is this identified OE?
pressure overload - ventricle thickens inwards
apex beat is powerful but not displaced
HS3 - causes
normal up to age 30
HF
MI
HTN
what is a big indication for warfarin and not a NOAC? what INR would you aim for?
metallic valve
3-4
how do ACEis help in MR?
reduce afterload so more blood goes out of heart rather than back into atria
3 signs of RHF
raised JVP
oedema
ascites
what does a Q wave indicate?
full thickness transmural infarct
complications of MI
sudden death on PRAED street Pump failure Ruptured papillary or septum Aneurysm + arrhythmias Embolism Dressler's + pericarditis
symptom of dressler’s/pericarditis post MI
management
“pain has changed” + doesn’t respond to opiates
give ibuprofen
acute bioprosthetic valve failure - presentation
sudden failure
acute severe pulmonary oedema + cardiogenic shock
WPW - presentation
palpitations
dizziness
tachycardia
on exertion?
what are the CIs to nitrates in ACS?
hypotension (sBP <90)
bradycardia (<50)
recent sildenafil use
pericarditis - presentation
pleuritic chest pain
may have a few days hx
what is sick sinus syndrome + how does it present? causes?
SAN dysfunction - causes tachy or brady
fatigue, dizziness, LOC, chest pain, palpitations (irregular beats)
causes:
usually age-related scarring + hardening of SAN
sometimes beta blockers, ccbs
which disorders is MR assoc with?
ehlers dahnlos
marfan’s
both collagen disorders
widespread joint hypermobility + striae on skin - dx?
ehlers dahnlos
what is a CI to adenosine?
asthma
