Cardiology Flashcards
1
Q
What is stage 1 hypertension?
A
BP > 140/90 < 159/99 on two separate occasions
2
Q
What is stage 2 hypertension?
A
BP > 160/100 < 180/120 mmHg on two separate occasions
3
Q
What is severe/malignant/accelerated hypertension?
A
BP > 180/120 mmHg with possibility of end-organ damage (retinal haemorrhage, papilloedema, kidney failure)
4
Q
General lifestyle advice for a patient with hypertension
A
- Diet - Lower salt, low-fat diet, increase fibre
- Reduce caffeine
- Stop smoking
- Cut back on alcohol
- Weight loss and exercise
5
Q
What 2 classes of drugs may be offered alongside normal antihypertensive drugs?
A
Statins and anticoagulants to reduce overall CVD risk
6
Q
What is the 1st line antihypertensive for a white 54 year old lady with T2DM?
A
ACEi or ARB
7
Q
What is the 2nd line antihypertensives for a white 54 year old lady with T2DM?
A
- ACEi or ARB
2. ACEi/ARB + CCB or thiazide-like diuretic
8
Q
What is the 1st line antihypertensive for a black 30 year old man without T2DM?
A
CCB
9
Q
What is the 2nd line antihypertensive for a black 30 year old man without T2DM?
A
- CCB
2. ACEi or ARB or thiazide-like diuretic
10
Q
A patient with uncontrolled hypertension presents with hypokalaemia. What drug can be offered?
A
Low dose spironolactone
11
Q
A patient with uncontrolled hypertension presents with hyperkalaemia. What drug can be offered?
A
Alpha or beta blocker
12
Q
MOA for ACEi
A
Block conversion of angiotensin I to II
13
Q
Side effects of ACEi
A
Hypotension, impaired kidney function, dry cough, hyperkalaemia
14
Q
What should be regularly checked for someone on ACEi?
A
Renal function
15
Q
MOA for ARBs
A
Blocks action of angiotensin II
16
Q
Side effects of ARBs
A
Hyperkalaemia, hypotension
17
Q
MOA of thiazide-like diuretics
A
Reduce Na/K resorption and promote diuresis to reduce circulating volume on the distal convoluted tubule
18
Q
Side effects of thiazide-like diuretics
A
Hypotension, hyponatraemia, hypercalcaemia, gout, sunlight sensitivity
19
Q
What class of CCB are used for hypertension?
A
Group 1 - dihydropyridines
20
Q
2 examples of CCBs used for hypertension
A
Nifedipine
Amlodipine
21
Q
Common side effects of CCBs
A
Vasodilatory flushing/headaches/oedema, bradycardia
22
Q
What two dietary items can affect the efficacy of antihypertensives?
A
Alcohol and glycerine - liquorice
23
Q
Name 5 causes of secondary hypertension
A
- Renal disease - PKD
- Sleep apnoea
- Conn’s Syndrome - adrenal cortex tumour secreting aldosterone
- Obesity
- Hyperthyroidism
24
Q
Management of hypertensive emergency
A
A&E/ITU referral
IV labetalol
25
Common causes of hypertensive emergencies
Poor medication compliance/sudden withdrawal of antihypertensive, pre-eclampsia, older age
26
Define postural hypotension
Drop in BP upon standing sitting of < 20 mmHg systolic (< 30 mmHg in hypertensive patients) and/or fall in diastolic of < 10 mmHg within 3 minutes of standing.
27
Pathophysiology behind postural hypotension
Delayed/absent constriction of blood vessels in lower body leads to blood pooling in extremities instead of returning to the heart - reduced cardiac output, cerebral hypo perfusion. Can be caused by reduced cardiac output alone.
28
5 drugs that can cause hypotension
1. Beta blockers
2. Alpha-blockers (BPH - tamsulosin)
3. Thiazide diuretics/excess antihypertensives
4. 5-Phosphodiesterase inhibitors (Sildenafil - Viagra)
5. Tricyclic antidepressants
29
Risk factors for hypotension
PD, DM, Lewy Body dementia, frailty, dehydration (esp. if on diuretics), alcohol
30
Investigations for hypotension
- Postural/lying and sitting blood pressure
- Tilt-table test
- FBC to rule out anaemia
31
Management for hypotension
1. Careful elimination of drugs that trigger orthostatic hypotension
2. Safe moving to improve orthostatic tolerance
3. Increase dietary salt and drink 2 l of water a day
32
What does S1 represent?
Lub: Closing of AV valves (tricuspid and mitral valves) at the start of systolic ventricular contraction
33
What does S2 represent?
Closing of the semilunar valves (pulmonary and aortic valves) once systolic contraction is complete.
34
What does S3 represent?
Rapid ventricular filling as the chord tendinae pull to their full length. Normal in younger people but can indicate heart failure in older people as the ventricles and chord are weakened/stiffened.
35
What does S4 represent?
Heard before S1. Abnormal - indicates a stiff/hypertrophic ventricle and is caused by turbulent flow from an atria contracting against a non-compliant, stiff ventricle.
36
Where are each of the valves located?
Aortic - 2nd ICS R sternal edge
Pulmonary - 2nd ICS L sternal edge
Tricuspid - 5th ICS L sternal edge
Mitral - 5th ICS MCL
37
Murmur assessment - SCRIPT
```
Site - Where is it loudest?
Character - Harsh/soft/crescendo or decrescendo, crescendo-decrenscendo
Radiation
Intensity - How easy it is to hear?
Pitch - High or low (velocity)
Timing - Systolic or diastolic
```
38
What are the semilunar valves?
Aortic and pulmonary valves - 3 crescent shape cusps that close to create the DUB sound
39
What are the atrioventricular valves?
Mitral and tricuspid valves - Bicuspid valves with chordae tendinae that close to create the LUB sound
40
Role of aortic valve
Oxygenated blood from the lung passes through the left ventricle to the aorta
41
Role of pulmonary valve
Deoxygenated blood from the body passes through the right ventricle to the pulmonary artery
42
Role of the tricuspid valve
Deoxygenated blood from the vena cava passes through the right atrium to the right ventricle
43
Role of the mitral valve
Oxygenated blood from the pulmonary vein passes through the left atrium into the left ventricle
44
Order of blood flow via the valves
T P M A
45
What valves are open in systole?
Aortic and pulmonary valves
46
What valves are closed in systole?
Tricuspid and mitral valves
47
What valves are closed in diastole?
Aortic and pulmonary valves
48
Causes of valvular heart disease
1. Infective endocarditis - Tricuspid valves
2. Old age - Leaky valves or calcified valves (atherosclerotic risk factors)
3. Congenital disorders - Marfan's, EDS, cardiac congenital abnormalities
4. Rheumatic fever - Post untreated Streptococcal throat infection
49
Characteristics of aortic valve disease
1. Angina, dyspnoea, syncope as oxygenated blood flow is reduced
2. Loud on expiration (blood forced to left side of heart as intrathoracic pressure increases)
50
Differences between AS and AR
AS: Ejection systolic, carotid artery radiation, radio-radial delay
AR: Early diastolic, whoosh, collapsing pulse, De Musset's nodding
51
Characteristics of mitral valve disease
1. Dyspnoea, fatigue, AF as cardiac output is reduced
| 2. Loud on expiration
52
Differences between MS and MR
MS: Malar flush, palpable apex beat, diastolic murmur
MR: Pansystolic, axillar radiation
MVP: Mid-systolic or late-systolic, low BMI, pacts excavatum
53
Characteristics of tricuspid valve disease
1. Oedema, JVP, ascites as blood backs up to the body
| 2. Loud on inspiration as blood enters right heart
54
Characteristics of pulmonary valve disease
1. Dyspnoea, cyanosis, JVP as reduced blood flow to lungs
2. Almost always secondary to underlying cause (RHF)
3. Loud on inspiration
55
What is a common complication of valve disease?
I.E
56
Main con of mechanical heart valve
Lifelong anticoagulation - Warfarin
57
What is a risk factor for pulmonic regurgitation?
Previous pulmonary valve surgery (often for stenosis)
58
What is a congenital cause of tricuspid regurgitation?
Ebstein's anomaly - Leaflets are abnormally formed and placed downwards
59
What is a risk factor for tricuspid stenosis?
I.E
60
What is a risk factor for mitral regurgitation?
MVP
61
Pathophysiology of mitral regurgitation
Blood leaks back from the left ventricle into the left atrium, due to rupture of chord tendineae/papillary muscles
62
What is a pulmonary complication of mitral stenosis?
Increased left atrial pressure results in pulmonary hypertension
63
Where does blood leak in aortic regurgitation?
Aorta blood leaks back into left ventricle
64
10 RF for DVT
1. Age
2. Obesity
3. Pregnancy (particularly 6 weeks post-birth)
4. Thrombophilia - Antiphospholipid syndrome, sickle cell disease
5. Family history
6. Oestrogen containing medication
7. Major surgery
8. Frequent flying
9. Malignancy
10. Chronic or inflammatory conditions such as HF
65
What does the Wells score predict?
Probability of a patient with DVT/PE symptoms having a DVT/PE
66
What bloods should you request in unprovoked DVT?
FBC, serum calcium, liver function, anti phospholipid antibodies
67
What investigations should a patient with unprovoked DVT undergo?
Chest/abdo/pelvis CT scan
Prostate check
Mammogram
68
What arteries are affected in PAD?
Large peripheral arteries
69
Pain on exercise that is relieved by rest could suggest
PAD
70
Name 5 signs/symptoms of PAD
1. Pain in legs whilst exercising that is relieved by rest
2. Hair loss on legs/feet
3. Brittle, slow-growing toenails
4. Erectile dysfunction
5. Shiny skin
71
Signs/symptoms and management of critical limb ischaemia?
6 Ps: Pain, pulselessness, pallor, paralysis, paraesthesia, poilkothermic.
Referral to vascular immediately, angioplasty, stenting or bypass surgery.
72
What ABPI measurement suggests PAD?
< 0.9
73
Describe the difference between embolic and thrombotic critical limb ischaemia?
Embolic CLI is acute onset and the leg appears white; thrombotic CLI is a progressive onset with increased pain whilst exercising.
74
3 main pharmacotherapies for PAD
1. Reduce CVD risk with statins and anti platelets
2. Nafitdrofuryl Oxalate: Peripheral vasodilator, avoid in those with gout/renal stones
3. Cilostazol: Phosphodiestase III inhibitor that has a vasoldilatory anti-platelet role
75
What valves become incompetent in varicose veins?
Perforator valves found between deep veins and superficial veins
76
What leads to the brown discolouration of legs in those with varicose veins?
The engorged superficial veins leak and Hb is broken down into haemosiderin. This over time turns the skin brown and gives varicose eczema.
77
What 2 tests can be done to determine if someone has incompetent valves in varicose veins?
1. Trendelburg's
| 2. Perthes Manoeuvre
78
What is the inner-most layer of the aorta called?
Tunica intima
79
What are 5 RF for aortic dissection?
1. Male gender
2. HTN
3. Smoking
4. Aortic valve disease
5. Cocaine use
80
What ECG changes might you see in aortic dissection?
ST segment elevation in inferior lead
81
Management for aortic dissection
Stenting/grafting
82
What layers of the aorta are affected in aortic aneurysm?
All 3 layers
83
What is the management of a 3-5.4 cm AAA?
1. Stop smoking
2. Screening appointments for men > 65 years
3. Surveillance
84
Who is a AAA surgical candidate?
Aneurysm > 5.5 cm or > 4.5 cm and increased by > 0.5 cm in 6 months
85
Rheumatic fever is a hypersensitivity reaction to what bacteria?
Group A beta haemolytic streptococcus
86
What are the 3 main areas affected in rheumatic fever?
1. Heart - Murmurs, tachycardia, cardiomegaly
2. Joints - Migrating polyarticular arthritis
3. Skin - Erythema marginatum and subcutaneous nodules
87
What valve is most commonly damaged in rheumatic fever?
Mitral valve - mitral stenosis
88
What type of ulcer affects the tips of toes/between toes/lateral side of leg/bony prominences?
Arterial
89
What type of ulcer affects the gaiter area of the leg?
Venous
90
5 characteristics of arterial ulcers
1. Pain that worsens at night and occurs at rest
2. Symmetrical
3. Well defined borders
4. Minimal bleeding
5. < 0.8 ABPI
91
5 characteristics of venous ulcers
1. Discrete borders
2. Irregular and sloping
3. Surrounding oedema
4. Fibrous and granulomatous tissue
5. > 0.9 ABPI
92
Management for arterial ulcers
1. Lifestyle changes
2. Vascular bypass/angioplasty
3. Skin grafting
93
Management of venous ulcers
1. Clean, compressive bandages
2. Corticosteroid cream for varicose eczema
3. Lifestyle changes
4. Referral to vascular surgeons
94
Criteria (4 points) for vascular surgeon referral for venous leg ulcer
1. Has not healed in 2 weeks despite active treatment
2. Recurrent venous ulcers
3. ABPI < 0.8 or > 1.2
4. Patients who cannot have compression
95
ECG appearance for RBBB
Prolonged QRS shifted to the right
96
ECG appearance for LBBB
Prolonged QRS shifted to the left
97
Irregular atrial beating and a HR > 140 bpm suggests
AF
98
AF that lasts > 30 seconds < 7 days is described as
Paroxysmal AF
99
Persistent AF is described as
Episodes > 7 days or < 7 days with medical intervention
100
Permanent AF is defined as
AF that fails to stop after cardioversion or relapses within 24 hours
101
Common complications of AF
Stroke and acute HF
102
What bloods should be ordered in AF?
FBC, U&Es, cardiac enzymes, TFTs
103
Management of AF in a haemodynamically unstable patient
DC cardioversion
104
2 risk tests to calculate for newly-diagnosed AF
CHA2DS2VASc - Stroke risk = CHF, HTN, Age, DM, Stroke, Vascular Disease, Age, Sex
HAS-BLED - Bleed risk = HTN, LFT, Renal function, Stroke, Bleeding, Labile INRs, Elderly, Drugs (antiplatelets/NSAIDs), alcohol
105
Pharmacological intervention for AF
1. Rate control: Beta blockers and/or CCB (verapamil, diltiazem)
2. Anticoagulation
3. Rhythm control: Sotalol, flecainide (avoid in IHD/valvular HD), amiodarone.
106
Pathophysiology for atrial flutter
Atria beat regularly at a much faster rate
107
RF for atrial flutter
Valvular disease, atrial surgery, atrial defects, HF, hyperthyroidism, COPD, pneumonia, asthma.
108
ECG findings in atrial flutter
- Sawtooth P waves
- -ve P waves in leads II, III, aVF
- Narrow QRS
- P:QRS 2:1
109
Definite treatment of atrial flutter
Catheter ablation
110
Supraventricular tachycardia is caused by
Short circuits between the atria and ventricles, increasing the heart rate
111
Supraventricular tachycardia is commonly seen in
Children/young adults
112
Persistent SVT is treated with
Cardioversion and IV-antiarrythmics such as adenosine or verapamil
113
What 2 techniques are taught to those with SVT?
Valsalva manoeuvre - Blow into syringe for 15 seconds
Carotid sinus massage
(also reduce caffeine/smoking/alcohol)
114
1st degree heart block is characterised by
Prolonged PR > 0.2 seconds - athletes, post-MI, beta-blockers, increased risk of AF
115
Type I 2nd degree heart block/Wenkebach is characterised by
Dropped QRS and increasing PR in AV node
116
Type II 2nd degree heart block/ Mobitz is characterised by
Dropped QRS and constant PR in bundle of His or Purkinje fibres
117
3rd degree heart block/complete is characterised by
No association between P waves and QRS, bradycardia, irregular pulse, cardiac arrest.
118
Management for AV block
Pacemaker
119
3 fascicles of the heart
1. Right bundle branch
2. Left anterior fascicle
3. Left posterior fascicle
120
3 RF for trifascucular block
1. IHD
2. Cardiomyopathy
3. Hypertension
121
What type of BBB is common in healthy patients?
RBBB
122
What type of BBB is common in patients with underlying cardiac pathology?
LBBB
123
ECG findings of BBB
Broad QRS and shifted in direction of block
124
Ventricular tachycardia is characterised by
Broad QRS and tachycardia
125
Pathophysiology of ventricular tachycardia and 4 causes/aetiology
Re-entry electrical circuit in the ventricles initiates its own contractions alongside the normal contractions.
Commonly post-MI (bypass scar tissue) but other RF include FH of Long-QT syndrome, hypokalaemia (low K), hypomagnesaemia (low Mg).
126
Management of ventricular tachycardia in a haemodynamically unstable patient
IV anti-arrhythmics, cardioversion, treat electrolyte imbalances
127
Management of ventricular tachycardia in a haemodynamically stable patient
Catheter ablation, implantable cardioverter defibrillator (ICD), anti-arrhythmics
128
What 2 drugs are pro-arrhythmic and promote QT prolongation?
Sotalol and amiodarone
129
Ventricular fibrillation can lead to
Cardiac arrest
130
Pathophysiology of ventricular fibrillation
Ventricles quiver preventing efficient heart contraction
131
Prolonged QT is a sign of
Torsades de Pointes
132
Dilated cardiomyopathy predominantly affects
Left ventricle
133
Systolic dysfunction is secondary to what cardiomyopathy?
Dilated cardiomyopathy
134
RF for dilated cardiomyopathy
Idiopathic, myocarditis/viral infection, familial, cocaine, alcohol, hypothyroidism, chemotherapy
135
Signs/symptoms of dilated cardiomyopathy
1. Congestive HF symptoms
| 2. Mitral regurgitation murmur due to LV dilation
136
Hypertrophic cardiomyopathy is what type of genetic condition?
Autosomal dominant
137
Diastolic dysfunction is secondary to what cardiomyopathy?
Hypertrophic cardiopathy
138
What should be avoided in a patient with hypertrophic cardiomyopathy?
Contact sport
139
Restrictive cardiomyopathy is caused by
Myocardial fibrosis
140
Myocarditis is caused by (3 points)
- Infection: Viral coxsackie
- Autoimmune: Giant cell myocarditis, sarcoidosis
- Toxins: Alcohol, radiation, chemotherapy (anthracyclines)
141
Flu-like symptoms and raised troponin could indicate
Myocarditis
142
What ECG leads show an inferior MI?
II, III, aVF (right coronary artery)
143
What ECG leads show an anterior MI?
V1-V4 (left anterior descending)
144
What ECG leads show a lateral MI?
V5-V6, left circumflex
145
NSTEMI management
MONA - Morphine, oxygen, nitrates, aspirin
146
STEMI (occluded artery) management
OH BATMAN: Oxygen, heparin, beta-blockers, aspirin, clopidogrel, ACEi, nitrates
and then PCI
147
Secondary ACS prevention (AABCs)
Aspirin, clopidogrel, beta-blocker, ACEi, statin
148
8 complications of a MI
1. Cardiac arrest
2. Cardiogenic shock (decreased ejection fraction due to v. damage)
3. Chronic heart failure
4. Arrhythmia
5. Pericarditis
6. Dressler's Syndrome
7. Left ventricular aneurysm
8. Ventricular septal defect
149
Pericarditis secondary to an MI presents with
1. Pain that worsens when lying flat
| 2. 48 hours post-MI
150
Dressler's Syndrome presents with
1. Fever
2. Pleuritic pain
3. Pericardial effusion
4. Raised ESR
5. 4 weeks post MI
151
Management for Dressler's Syndrome
NSAIDs
152
Persistent ST elevation post-MI is suggestive of
Left ventricular aneurysm
153
Acute HF and a pan-systolic murmur post-MI suggests
Ventricular septal defect
154
Unstable angina is exacerbated by
Nothing - will occur randomly, even at rest
155
Decubitus angina is triggered by
Lying flat
156
Prinzmetals angina is caused by
Coronary artery spasm
157
What drug is prescribed to reduce frequency of angina attacks?
Isosorbide mononitrate
158
3 angina red flags
1. Continuous pain
2. Pain at rest
3. Other symptoms - dizziness, nausea, palpitations
159
Gold-standard for angina diagnosis
CT-Coronary Angiography
160
ECG findings in someone with angina
1. Pathological Q waves (ischaemia/previous MI)
2. LBBB
3. T wave elevation
161
GTN spray recommendations
Take spray when symptoms begin, wait 5 minutes, if pain persists take 1 more spray, then call 999
162
LHF causes the backup of blood to the
Lungs
163
RHF causes the backup of blood to the
Body
164
5 causes of HF
1. Sepsis
2. CVD
3. Hypertension
4. Valvular heart disease
5. AF
165
A 70 year old man with a AKI develops sudden dyspnoea that worsens when lying down. He has coughed up white/pink frothy sputum. What's the diagnosis and what's the management?
Acute heart failure
- Stop IV fluids
- Oxygen
- Diuretics: Furosemide
- Monitor fluid balance
166
A patient with acute heart failure does not respond to usual treatment. What is the next recommendation?
Non-invasive ventilation using CPAP and ITU admission
167
What investigations must be ordered in acute heart failure (5 points)?
```
ECG: Rule out MI/arrythmmias
ABG: Type I resp failure
CXR: Cardiomegaly, pleural effusions, Kerley lines
Bloods: BNP, troponin
Echo
```
168
ABAL management plan in chronic heart failure
ACei
Beta blocker
Aldosterone antagonist - If reduced ejection fraction and symptomatic with A+B
Loop diuretics
169
What must all patients with heart failure get yearly?
Flu and pneumococcal vaccine
170
Subacute IE is caused by bacteria invading a
Thrombus
171
Acute IE is caused by
A thrombus
172
Most common IE cause in someone with poor dental health
Strep. Viridans
173
Most common IE cause in someone post-valve surgery
Staph. Epidermidis
174
5 causes of pericarditis
1. Infection: Coxsackie, TB
2. Post-MI/Dressler's
3. Autoimmune: SLE/RA/sarcoidosis
4. Mediastinal malignancy
5. Renal failure
175
Constant chest pain that improves leaning forward alongside a fever is a sign of
Pericarditis
176
2 ECG findings in pericarditis
1. Saddle-shaped ST elevation
| 2. PR depression
177
Treatment for pericarditis in someone unable to tolerate NSAIDs
Colchicine
178
Constrictive pericarditis is caused by
Pericardial fibrosis
179
3 signs/symptoms of constrictive pericarditis
1. RHF symptoms
2. Pericardial knock on S3
3. Muffled heart sounds
180
T inversion, AF and P-mitrale are signs of
Constrctive pericarditis
181
Pericardial effusions are commonly caused by what 2 conditions
Pericarditis and cancer
182
An untreated pericardial effusion can cause
Cardiac tamponade
183
4 causes of cardiac tamponade (TAMP)
Trauma
Aortic dissection
Medical cardiac catheter or biopsy
Pericardial effusion - cancer/infection/pericarditis
184
5 signs/symptoms of cardiac tamponade
```
Hypotension
Raised JVP
Tachycardia
Pulsus paoradoxus
Reduced heart sounds
```
185
2 ECG findings in pericardial effusion/cardiac tamponade
Low voltage QRS and tachycardia
186
Management for cardiac tamponade
Pericardiocentesis 90 degrees into 5th-6th intercostal space at left sternal border at cardiac notch of left lung
187
Most common atrial septal defect
Ostrium secondum
188
Eisenmenger's Syndrome is caused by
Pulmonary hypertension
189
Atrial septal defect causes what type of shunt?
Right to left
190
People with atrial septal defects are at an increased risk of what
Stroke if they have a DVT
191
2 causes of ventricular septal defect
Down's and Turner's
192
Most common cause of aortic coarctation
Turner's
193
When should the ductus arteriosus close?
2-3 weeks after birth, after this is patent ductus arterioles
194
A boot-shaped heart is a sign of
Tetralogy of Fallot
195
4 pathologies in tetralogy of fallot
1. Ventricular septal defect
2. Overriding aorta
3. Pulmonary stenosis
4. RVH
196
Example of a B1 receptor beta-blockers and what conditions is it used in?
Bisoprolol
| HTN, arrhythmia, secondary ACS prevention
197
Where do B2 receptor beta-blockers target?
Lungs/kidneys - can trigger asthma and promotes renin release
198
Side effect of atenolol
Increased risk of diabetes
199
Contraindications for beta blockers (3 points)
1. Bradycardia
2. Heart failure
3. Asthma
200
What are Group 1 CCBs termed and give an example?
Dihydropyridine - Amlodipine
201
What are Group 2 CCBs termed and give an example?
Non-dihydropyridine - Verapamil
202
Group 3 CCBs such as Diltiazem are most useful for
Angina and arrhythmia
203
Dihydropyridines work best for
Hypertension
204
Group 2 CCBS work best for
Tachyarryhythmias
205
What CCB should be avoided when a patient is already on a beta blocker?
Verapamil - Asystole
206
Diltiazem can worsen
Heart failure
207
Nicorandil is a
Potassium channel activator (vasodilator)
208
Nicorandil can promote
Coronary artery blood flow - HTN/angina
209
Side effects of nitrates (3)
1. Sudden hypotension
2. Headaches
3. Flushing
210
Amiodarone is used for
Supraventricular tachycardias
211
A patient is on amiodarone. What must they be careful of and what must be checked regularly?
Sunlight and check TFT
212
Statins prevent the conversion of HmG-CoA into what?
Mevalonic acid
213
Side effects of statins (5)
1. Headache
2. Myalgia (check CK)
3. Resp. symptoms (ILD)
4. T2DM
5. GI complaints
214
What 3 must be checked before starting a statin?
1. LFT
2. CK
3. HbA1c
215
What are 2 cautions/red-flags in statin use?
1. Development of respiratory symptoms i.e. ILD
| 2. Unexplained myalgia
216
4 key pieces of advice for a patient starting on an anticoagulant
1. Seek medical advice for bleeding that does not stop/recurs
2. Seek medical advice for sudden back pain (retroperitoneal bleed)
3. Avoid NSAIDs
4. Carry an alert card
217
Advice for a patient starting warfarin (5 points)
1. Take warfarin at the same time each day
2. Do not miss doses/take extra doses
3. Do not become pregnant
4. Limit alcohol
5. Avoid vitamin K foods (spinach, broccoli)
218
3 contraindications for warfarin
1. Haemorrhagic stroke
2. Renal failure
3. Liver failure
219
Cautions for warfarin use (5)
1. Age increases risk of bleeds
2. Previous bleeds/ischaemic stroke
3. HTN
4. Excessive alcohol/falls
220
Warfarin can induce what protein deficiency and how does this affect the skin?
C or S - causes localised painful skin lesions that thrombolyse
221
5 drugs that interact with warfarin
1. Amiodarone
2. Metronidazole/rifampicin
3. SSRIs/SNRIs (antiplatelet effect)
4. Tricyclic antidepressants increase anticoagulation effect
5. NSAIDs/aspirin
222
A vaccine that interacts with warfarin
Influenza
223
3 food/drinks that interact with warfarin
1. Grapefruit juice
2. Vitamin K containing food (spinach)
3. Alcohol
224
What DOAC can not be used to prevent VTE in surgery?
Edoxaban
225
What DOAC has an antidote?
Dabigatran
226
5 contraindications for DOACs
1. Bleeding/RF for bleeds
2. Poor renal function: creat clearance < 30
3. Prosthetic heart valves
4. Liver disease
5. Pregnancy
227
What has a quicker onset of action - DOAC or warfarin?
DOACs
228
What autoimmune condition pre-disposes someone to recurrent VTEs when on a DOAC?
Anti-phospholipid syndrome
229
5 things to check at a DOAC 3 monthly check
1. Compliance
2. Any new medications/OTC
3. Bleeding/bruising/haematuria/melana
4. Symptoms of VTE
5. Renal and liver function
