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CCC > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is the treatment for heart failure?

A

HF due to LVSD:
1st: ACEi/ARB (Ramipril)+ beta-blocker (Bisoprolol) + diuretic: 80mg Furosemide (if periph/pulm oedema)
2nd: Aldosterone antagonist (spironolactone) or Hydralazine w/nitrate
3rd: Digoxin or resynchronisation therapy
Consider implantable defib at any stage if appropriate

HF w/preserved EF:
Manage comorbidities: HTN, secondary prevention of MI, T2DM

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2
Q

How is hypertension managed in those <55yo?

A

Lifestyle advice

1) ACEi: 1.25-10mg PO Ramipril
2) ACEi + CCB: Amlodipine PO 5-10mg/Diltiazem 60-300mg PO
3) ACEi + CCB + Thiazide: Indapamide PO 1.25-5mg
4) ACEi + CCB + Thiazide + Spironolactone (K+ <4.5) PO 25mg /alpha: Doxazosin 1-16mg PO/beta blocker: PO Bisoprolol 5-20mg

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3
Q

How is hypertension managed in those >55yo?

A

OR Afro-carribbean
Lifestyle advice
1) CCB: Amlodipine PO 5-10mg/Diltiazem 60-300mg PO
2) ACEi + CCB + Thiazide: Indapamide PO 1.25-5mg
3) ACEi + CCB + Thiazide + Spironolactone (K+ <4.5) PO 25mg /alpha: Doxazosin 1-16mg PO/beta blocker: PO Bisoprolol 5-20mg

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4
Q

Who is risk assessed for IHD?

A 
>40 with RFs for developing IHD (Diabetics)
T1DM
CKD
Smokers
FHx
HTN
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5
Q

What do the Q-risk scores correlate to?

A

Risk of developing CVD in the next 10years

>10% high risk

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6
Q

How is hyperlipidaemia risk reduced?

A

Full lipid profile then start:
Atorvastatin 20mg if Qrisk >10%
Atorvastatin 80mg if known CVD

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7
Q

What are the different stages of hypertension?

A

Stage 1: 140/90 ABPM: >135

Stage 2: 160/110 ABPM: >150

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8
Q

How is acute pulmonary oedema treated?

A 
Sit up
15L/min
Catheterise
Morphine- ARDS
Furosemide 40mg IV
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9
Q 
What blood test needs to be done before starting:
ACEi
Beta blocker
Furosemide
Aldosterone
A

ACEi: U&E- Hyperkalaemia (contraindication for Rampiril), Creatinine, electrolytes, eGFR at initiation, after dose increase, then every 3m
Beta: HR, BP, clinical status after every dose increase (start low & go slow- all patients w/LVF <40%)
Furosemide: Weight, U&Es
Aldosterone: Potassium, eGFR, Creatinine

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10
Q

What pathology can cause AF?

A

Cardiac: CAD, LVHF, MI, HTN, mitral valve disease, congenital (cardiomyopathies)
Pulm: PE, pneumonia, bronchocarcinoma
Metabolic: Hyperthyroid, OH-, sepsis, caffeine, antiarrhythmics, HyperMg, HypoK, acidosis, infection, bronchodilators

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11
Q

What are the signs & symptoms of AF?

A 
Asymptomatic
Palpitations
Chest pain
Dyspnoea
Dizziness/syncope
Embolic event: Stroke/TIA
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12
Q

What is the pathophysiology of AF?

A

Irregular atrial rhythm 300-600bpm
AV node unable to transmit beats as quickly as this
Results in irregular ventricular rhythm
Reduced CO by 20%

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13
Q

How is AF investigated?

A

Pulse: Irregularly irregular
ECG: No p-waves, irregular (narrow) QRS but normal shape, variable ventricular rate, no isoelectric baseline
Bloods: U&Es, TFTs, Cardiac enzymes
ECHO

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14
Q

How is AF managed?

A

Tx cause & associated Heart failure
1) Rate: Beta blocker/CCB (Diltiazem), Digoxin if sedimentary & non-paroxysmal
Poor monotherapy compliance then dual therapy
2) Rhythm: If rate control unsuccessful- Flecainide (pill in the pocket) & Amiodarone
Anticoagulant: Heparin
3) DC Cardioversion: >48hrs, Amiodarone 4w before & 12m after
Long-term Rhythm: Beta blocker
Pill in the pocket: Infrequent paroxysmal

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15
Q

What are the different types of AF?

A

Acute: Onset within 48hours
Paroxysmal: Self-terminating in 7 days
Recurrent: >2 episodes (paroxysmal or persistent)
Lone/idiopathic: Absence of disease
Persistent: Cardioverted or >7days
Permanent: Cardioversion/SR not possible >1yr

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16
Q

What are ectopic beats?

A

Extra beats
25% of the blood is expelled from the heart
The next ‘normal’ beat is the beat a patient complains about
This beat ‘recalibrate’ the heart to expel all the blood left

17
Q

How is atrial flutter managed?

A

Beta blockers
Best = ablation
Longstanding untreated can lead to dilated cardiomyopathy (reversible)

18
Q

What drug used by cancer patients and IVDUs can cause bradycardia?

A

Methadone

19
Q

What is the CHADS-VASc Score?

A 
Assessing risk of stroke in AF
C- Congestive HF
H-HTN 140-90 or on meds
A- Age >75 (/2)
D- DM
S- Prior stroke/TIA/VTE (/2)
V- Vascular disease
A- Age 65-74
Sc- Sex (Female)
20
Q

What is the HAS BLED Score?

A 
Risk of bleeding on anticoagulation therapy
H-HTN Uncontrolled 160
A- Abnormal LFTs &amp; U&amp;Es
S-Prior Stroke 
B- History of bleeding
L- Labile INR 
E- Elderly >65
D- Drugs NSAIDS, anti platelets, OH- consumption harmful
21
Q

What does the scoring system for CHADS-VASc relate to?

A

0 for Men 1 for women= LOW risk, No anticoagulant therapy but consider daily aspirin
1 for men= Consider anticoagulation (Aspirin or Warfarin)
>2= Anticoagulation treatment commenced (Warfarin/NOAC), INR: 2-3

22
Q

What co-morbidities are common with AF?

A 
HTN
HF
CAD
Valvular
DM
Obesity
CKD
23
Q

What order is AF medication given in?

A

Rate control
THEN
Rhythm Control
Unless AF has a reversible cause

24
Q

Which anticoagulants should be offered & when in AF?

A

Apix/Rivaroxaban: Prev stroke/TIA, >75, DM, HTN, HF

Dabigatran: Prev stroke/TIA/embolism, NY Class 2+ HF, >75 or >65 + DM/CAD/HTN

25
Q

What medications should not be given to people with structural heart disease or IHD?

A

Class 1c antiarrhythmics: Flecainide or Propafenone

26
Q

How is acute AF treated?

A

Life-threatening Haem instability: Emergency cardioversion
Non-life threatening Haem instability: Rate/rhythm control if <48hrs or rate control if >48hrs & anticoagulation min 3w before cardioversion

27
Q

How is hypertension diagnosed?

A

Clinical BP from both arms (take highest reading)
If >140/90: ABPM or HBPM
Severe: Do not wait, treat immediately

If not diagnosed: Measure BP every 5years

28
Q

How does ABPM & HBPM work?

A

ABPM: BP over 24hours
At least 2readings/hr between 8am-10pm
Diagnosis confirmed by average of 14 readings
HBPM: 2 measurements 1 min apart whilst seated
Record BP twice daily in am & pm for 4-7days
Discard measurement on 1st day & average the rest

29
Q

What are the indications for giving antihypertensive medications?

A

All people <80 w/stage 1 HTN plus: target organ damage, DM, renal disease, QRISK >10%, CVD
Any age w/stage 2 HTN
<55 ACEi
<40 refer to specialist

30
Q

What are the blood pressure targets for clinic BP?

A

<80: <140/90

>80: <150/90

31
Q

What is the NY Heart Association Classification for HF?

A

1: No limitations
2: Slight limitations of physical activity- mild HF
3: Marked limitations of physical activity- moderate HF
4: Symptoms of HF present at rest- severe HF

CCC (21 decks)

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