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3b specialties > Cardiology > Flashcards

Cardiology Flashcards

1
Q

3 key features of typical angina?

A

Central chest pain
Precipitated by exertion
Relieved by rest or nitrates, usually within 5 minutes

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2
Q

What medication is used for an attack of angina and when should an ambulance be called?

A

Glyceryl trinitrate used as and when necessary, repeated if needed after 5 minutes, call ambulance if pain persists 5 minutes after second dose

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3
Q

Drugs for secondary prevention of CVD in angina?

A

Aspirin and statin

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4
Q

What dose of aspirin is used for prevention of CVD?

A

75mg daily

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5
Q

What are the first line anti-anginal drugs?

A

Beta blocker or rate-limiting CCB (verapamil)

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6
Q

Second line treatment for angina?

A

Beta blocker and CCB.
DO NOT prescribe a beta blocker + verapamil due to risk of heart block. Instead use non-rate limiting CCB e.g. nifedipine

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7
Q

Third line options for angina?

A

Ivabradine, nicorandil, ranolazine

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8
Q

Which type of cholesterol, HDL or LDL, guides the goals of lipid therapy?

A

LDL

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9
Q

What dose of atorvastatin is used for:

1) Primary prevention if QRISK >10%
2) Secondary prevention in pts with pre-existing CVD

A

1) 20mg (this is controversial in some centres)

2) 80mg

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10
Q

Name 3 criteria that would constitute metabolic syndrome

A

Any 3 out of the following 5:

  • Hyperinsulinaemia
  • Decreased HDL
  • Central obesity
  • Hypertriglycerdaemia
  • Hypertension
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11
Q

Name 4 modifiable and 4 non-modifiable risk factors for ACS

A

Modifiable: DM, obesity, sedentary lifestyle, smoking, HTN, dyslipidaemia
Non-mod: age, male, South Asian, FH in a first degree relative (<55 in men, <65 in women), previous MI

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12
Q

Which patients may present atypically with ACS?

How may they present?

A 
Those with autonomic dysfunction e.g. diabetes and the elderly. 
Silent MI (no pain), delirium, hypotension, epigastric pain
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13
Q

Name 3 investigations in a patient presenting with ACS.

A

ECG, bloods- troponin (also FBC, U&Es, LFTs), CXR

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14
Q

Name 3 other conditions that can cause a raised troponin

A

Acute heart failure, myocarditis, pericarditis, pulmonary embolism, renal failure, sepsis

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15
Q

What is the intial management for ACS?

A

Initiate dual anti-platelet therapy= aspirin 300mg + other antiplatelet (ticagrelor, clopidogrel)
IV morphine and IV metoclopramide
O2 therapy if <94%
GTN

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16
Q

What is the gold standard reperfusion strategy for STEMI?

A

PCI

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17
Q

What time frame from onset of symptoms is PCI indicated in?

A

Within 12 hours of symptom onset

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18
Q

What is the treatment method used if PCI isn’t available within 90-120 minutes of diagnosis of STEMI?

A

Thrombolysis

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19
Q

What is the diagnostic difference between NSTEMI and UA?

A 
NSTEMI= troponin positive +/- ischaemic changes on ECG
UA= negative troponin +/- ischaemic changes on ECG
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20
Q

What ischaemic changes may be seen on ECG in a NSTEMI?

A

ST depression, T wave inversion

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21
Q

Following ACS, how long should patients remain on aspirin and at what dose?
How long should they remain on the other antiplatelet agent e.g. ticagrelor?

A

75mg daily, LIFELONG

12 months

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22
Q

Aside from antiplatelet agents, what other drugs are used in the post-acute management of ACS?

A

Statins
Beta blockers
Nitrates- PRN and regular if required
ACE inhibitors

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23
Q

What is the mnemonic for complications of ACS?

A 
Sudden Death on PRAED Street
Sudden death
Pericarditis/pump failure
Rupture
Aneurysm/arrhythmia
Embolism
Dressler syndrome
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24
Q

What marker is useful for detecting re-infarction following MI and why is troponin not used?

A

CK-MB

Troponin not used as levels take 14 days to normalise

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25
Q

Which two types of troponin may be measured to diagnose MI?

A

Troponin T or I

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26
Q

Displaced apex beat, S3 and pulmonary congestion are signs of right or left heart failure?

A

Left heart failure

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27
Q

Name 3 signs of right heart failure?

A

Elevated JVP, hepatomegaly, ascites, significant peripheral oedema

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28
Q

Key blood test when investigating suspected heart failure?

A

B-type natriuretic peptide

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29
Q

What are the classical Xray findings in heart failure?

A 
Alveolar oedema
Kerley B lines
Cardiomegaly
Dilated upper lobe vessels 
Effusion
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30
Q

What is the key investigation in suspected heart failure?

A

TTE

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31
Q

Other than bloods, BNP and echo, what investigation should all patients with heart failure have?

A

ECG

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32
Q

What is first line medication for heart failure?

A

Loop diuretics e.g. furosemide

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33
Q

Outline the stepwise drug management of heart failure.

A

1) Loop diuretics- furosemide
2) ACE inhibitor
3) Beta blockers (bisoprolol, carvedilol, nebivolol)
4) Aldosterone antagoists (spironolactone)
5) Ivabradine
6) Hydralazine plus nitrate

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34
Q

Give 4 causes of secondary hypertension

A

Renal- diabetic nephropathy, glomerulonephritis, PKD
Endocrine- Conn syndrome, phaeochromocytoma
Pre-eclampsia
Coarctation of the aorta

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35
Q

How is HTN diagnosed?

A

Clinic blood pressure >=140/90 mmHg and either ambulatory or home blood pressure monitoring average 135/85mmHg or higher

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36
Q

Other than BP, name 4 investigations to carry out in a patient newly diagnosed with HTN.

A

U&E, echo (if HF suspected), ECG, fasting blood glucose, lipid profile,

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37
Q

Name 4 conditions hypertension predisposes to

A

ACS, stroke, CKD, hypertensive retinopathy, aortic aneurysm, aortic dissection

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38
Q

What are the treatments targets for hypertension in:

  • Under 80 year olds
  • Over 80 year olds
  • Diabetics
A
  • <140/90mmHg
  • <150/90mmHg
  • <130/80mmHg
39
Q

If a patient needs triple therapy to control their hypertension, what would this consist of?

A

ACE inhibitor/ARB + calcium channel blocker + thiazide diuretic

40
Q

Give an example of a thiazide diuretic.

A

Indapamide

41
Q

What is first line therapy for hypertension in a diabetic? What if they are >55?

A

ACE inhibitor. Same regardless of age

42
Q

Give 4 causes of pericarditis

A 
Idiopathic
Viral- coxsackie, EBV
AI disease- SLE, sarcoidosis
Acute MI
Drugs- hydralaine, isoniazid, penicillin
Uraemia
43
Q

What is the most common presenting feature of pericarditis?

A

Sharp retrosternal chest pain, classicaly worse on leaning back and better sitting forward

44
Q

Muffled heart sounds, hypotension and raised JVP are called what triad? What is this suggestive off?

A

Beck’s triad, suggestive of cardiac tamponade

45
Q

What is the most specific ECG finding for pericarditis?

A

PR segment depression

46
Q

What may a CXR reveal in pericarditis?

A

Cardiomegaly from pericardial effusion

47
Q

What is the mainstay of treatment for pericarditis?

A

NSAIDs/aspirin and colchicine

48
Q

What is the purpose of giving colchicine for pericarditis, and what is a common side effect patients should be warned about?

A

To prevent recurrence.

Common side effect= GI disturbance e.g. diarrhoea

49
Q

What is given in pericarditis if NSAIDs + colchicine is ineffective?
When else may these be useful for pericarditis?

A

Corticosteroids

Given in connective tissue disease, uraemic or immune-mediated pericarditis.

50
Q

The SA nodal artery is a branch of which artery in 90% of the population?

A

Right coronary artery

51
Q

Give 4 causes of bradycardia.

A 
Physiological- athletes, young, sleeping
Medications- beta blockers, CCBs, anti-arrhythmics, digoxin
Infection (myocarditis)
Sick sinus sydrome
Metabolic- hypothyroidism, hypothermia
52
Q

What is the first line management for bradycardia if there are adverse clinical signs or risk of asystole?

A

IV atropine

53
Q

When assessing risk of asystole, what factors should be taken into account?

A

Recent asystole, Mobitz II heart block, complete heart block with wide QRS, ventricular pause >3s.

54
Q

What is the long term management for bradycardia and in which patients is it indicated?

A

Dual chamber pacemaker

Patients with symptomatic bradycardia due to sick sinus syndrome and/or AV conduction block

55
Q

In which type of heart block is a permanent pacemaker indicated even if asymptomatic?

A

Mobitz type II and third degree/complete heart block

56
Q

Why is the QRS complex widened in bundle branch blocks?

A

One ventricle depolarisation is delayed, then must be depolarised indirectly from the other bundle branch. Delayed ventricular depolarisation causes widening of QRS complex.

57
Q

Which type of bundle branch block invariably indicates underlying pathology e.g. IHD, cardiomyopathy or hypertrophy?

A

LBBB

58
Q

Name 2 associated conditions with RBBB/

A

RVH, right heart strain, pulmonary stenosis, pulmonary emboli

59
Q

A new LBBB on ECG + chest pain is suspicious of what?

A

Acute MI

60
Q

Which ECG leads do you look at for WiLiaM MaRroW?

A

V1 and V6

61
Q

A narrow complex tachycardia typically originates where?

A

Supraventricular- atria, SAN, AVN

62
Q

What are 4 causes of LBBB?

A

Aortic stenosis, IHD, HTN, dilated cardiomyopathy, anterior MI, hyperkalaemia, digoxin toxicity

63
Q

NICE recommends performing manual plse palpaton to assess for presence of an irregularly irregular pulse that may indicate AF in pts presenting with any of 5 symptoms. What are these symptoms?

A 
Breathless/dyspnoea
Palpitations
Syncope/dizziness
Chest discomfort
Stroke/TIA
64
Q

First line Ix for AF?

A

ECG

65
Q

How does AF predispose to stroke?

A

The disorganised atrial electrical activity means the atria fibrillate rather than contract, leading to pooling of blood and a predisposition to thrombus formation or emboli.

66
Q

Give 3 non-cardiac causes of AF

A

Fever/infections, thyrotoxicosis, electrolyte disturbance (hypoK, hypoMg), drug/alcohol/caffeine use,

67
Q

Name 4 blood tests to perform when investigating AF and why you would do them.

A

FBC- look for infection e.g. leucocytosis; anaemia
U&Es- hypokalaemia, hypoMg
TFTs- look for hyperthyroid
LFTs- evidence of alcohol use/liver damage

68
Q

Other than ECG and bloods, what investigation might you do for AF?

A

TTE- if considering rhythm control, if suspicion of structural heart disease

69
Q

What is the management of new onset AF with haemodynamic instability?

A

Immediate synchronised DC cardioversion

70
Q

What score is used to assess stroke risk in AF?

Name the components

A 
CHA2DS2-VASc
CCF
Hypertension
Age: >=75 (2), 65-74 (1)
Diabetes
Stroke/VTE history (2)
Vascular disease
Sex category: female (1)
71
Q

What are the two treatment modalities in approaching AF and which dose NICE recommend as a first line strategy?

A

Rate and rhythm control

Rate control is first line

72
Q

When would rate control not be first line management for AF? Give 2 situations.

A

If there is a reversible cause, if it’s new onset AF (<48h), heart failure is present, rhythm control more suitable (clinical judgement)

73
Q

What is first line therapy for rate control of AF?

A

Beta blocker or rate-limiting CCB monotherapy

74
Q

What is second line therapy for rate control of AF if first line doesn’t control symptoms?

A

Combo therapy with any two of: beta blocker, diltiazem, digoxin

75
Q

Give 2 examples of a rate limiting calcium channel blocker.

A

Diltiazem and verapamil

76
Q

Give 3 drugs that may be used to cardiovert patients with AF.
What are 2 factors that might mean you aim for rhythm control rather than rate control?

A

Sotalol, amiodarone, flecainide

Younger (<65), first episode of AF, AF secondary to treatable cause, congestive heart failure, symptomatic.

77
Q

What CHADS-VASc score should prompt anticoagulant therapy?

A

2+

1+ in men, consider anticoagulation

78
Q

Characteristic ECG feature in atrial flutter?

A

Saw tooth waves (F waves)

79
Q

What is the main difference between AF and atrial flutter?

A

Atrial flutter is regular atrial rate whereas atrial fib is irregular

80
Q

What management may be offered in AF which doesn’t respond to medical therapy?

A

Radiofrequency ablation

81
Q

True/false: patients with atrial flutter do not require anticoagulation because the atrial contractions are regular.

A

False- patients should be risk assessed to decide whether they should be anticoagulated as with AF

82
Q

What is the management for patients presenting acutely with atrial flutter?

A

Synchronised DC cardioversion

83
Q

Management of recurrent atrial flutter or when cardioversion is unsuccessful?

A

Radiofrequency ablation of the flutter circuit

84
Q

What are the two general pathophysiological mechanisms that cause SVT?

A

Re-entry mechanisms or impulse initiation disorders.

85
Q

What is the most common type of SVT?

A

Atrioventricular nodal re-entrant tachycardia

86
Q

Name the investigations that should be carried out for SVT and in what order?

A

1) ECG

2) Electrolytes, TFTs and toxicology (e.g. digoxin)

87
Q

Management of SVT in a haemodynamically unstable patient?

A

Sedation and urgent DC cardioversion

88
Q

Stepwise managment of SVT in haemodynamically stable patient?

A

1) Vagal maneouvres
2) IV adenosine
3) If unsuccessful, consider digoxin, beta blocker or amiodarone
4) Synchornised DC cardioversion

89
Q

Describe the administration of IV adenosine and what side effects do you need to warn the patient of beforehand.

A

Given rapidly via large-bore cannula in ACF, followed by saline flush
SEs= chest tightness, impending sense of doom, breathlessness and discomfort.

90
Q

What drug is used as an alternative to adenosine for SVT if it’s CI? In particular what patient group is adenosine CI in?

A

IV verapamil

CI in asthmatics

91
Q

Give 3 adverse features of bradycardia that suggest treatment is necessary.

A

Shock, heart failure, myocardial ischaemia, syncope

92
Q

Give 3 cardiac causes of clubbing.

A

Atrial myxoma, bacterial endocarditis, cyanotic congenital heart disease.
(Remember ABC)

93
Q

MI in which region is frequently associated with bradycardia?

A

Inferior MI

3b specialties (15 decks)

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