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PM Important > Cardiology > Flashcards

Cardiology Flashcards

1
Q

At what BP value does hypertension become symptomatic?

A

> 200/120mmHg

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2
Q

What is stage 1 hypertension?

A
  • clinial BP >=140/90

- ABPM/HPBM >=135/85

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3
Q

What is stage 2 hypertension?

A
  • clinial BP >=160/100

- ABPM/HPBM >=150/95

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4
Q

What is severe hypertension?

A

systolic >=180

diastolic >=120

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5
Q

Drug causes of HTN

A
  • leflunomide
  • MAOI
  • corticosteroids
  • NSAIDs
  • pregnancy
  • coarctation of aorta
  • COCP
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6
Q

What do you do if someone has a BP >=180/120mmHg?

A
  • specialist assessment if retinal haemorrhage or papilloedema, life threatening symptoms or suspected phaeochromocytoma
  • urgent investigation for end organ damage
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7
Q

How would you treat someone with a BP of >=140/90?

A
  • repeat reading
  • offer ABPM/HBPM
  • if >=135/85, treat if >80yo and one of factors
  • factors: target organ damage, CVD, renal disease, diabetes, CV risk >=10%
  • if>=150/95, treat regardless of age
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8
Q

What are the blood pressure targets?

A
  • <80yo: 140/90mmHg clinical, 135/85mmHg

- >80yo: 150/90mmHg clinical, 145/85mmHg

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9
Q

ACEi ADR

A
  • hyperkalaemia
  • cough
  • angioedema
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10
Q

Calcium channel blockers ADR

A
  • flushing
  • ankle swelling
  • headache
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11
Q

Thiazide type diuretics ADR

A
  • hyponatraemia
  • hypokalaemia
  • dehydration
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12
Q

A2RB ADR

A

hyperkalaemia

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13
Q

Causes of ejection systolic murmur:

A
  • aortic stenosis
  • aortic sclerosis
  • pulmonary stenosis
  • tetralogy of fallot
  • HOCM
  • atrial septal defect
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14
Q

Causes of pan systolic murmur:

A
  • mitral/tricuspid regurgitation

- ventricular septal defect

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15
Q

Causes of late systolic murmur:

A
  • mitral valve prolapse

- coarctation aorta

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16
Q

Causes of early diastolic murmur:

A
  • aortic regurgitation

- graham steel murmur (pulmonary regurgitation)

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17
Q

Causes of mid-late diastolic murmur:

A
  • mitral stenosis

- Austin-Flint (severe aortic regurgitation)

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18
Q

Clinical signs of aortic stenosis:

A
  • murmur radiates to carotids, decreases with valsalva
  • narrow rising pulse
  • narrow pulse pressure
  • delayed ESM
  • soft/absent S2
  • S4
  • thrill
  • left ventricular hypertrophy (makes murmur quieter)
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19
Q

Clinical signs of aortic regurgitation:

A
  • murmur intensity increased with handgrip manoeuvre
  • collapsing pulse
  • wide pulse pressure
  • Quincke’s sign
  • DeMusset’s sign
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20
Q

Clinical signs of mitral stenosis:

A
  • mid-late diastolic murmur (best hear in expiration)
  • loud S1 opening snap
  • low volume pulse
  • malar flush
  • atrial fibrillation
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21
Q

Most common cause of mitral stenosis?

A

rheumatic fever

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22
Q

Most common cause of aortic stenosis?

A

> 65yo - calcification

<65yo - bicuspid aortic valve

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23
Q

Clinical signs of mitral regurgitation:

A
  • murmur at apex and radiating to axilla
  • S1 may be quiet incomplete closure
  • severe may cause widely split S2/3
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24
Q

Clinical signs of patent ductus arteriosus:

A
  • left subclavicular thrill
  • continuous machinery murmur
  • large volume
  • bounding
  • collapsing pulse
  • wide pulse pressures
  • heaving apex beat
  • reverse split S2
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25
Q

How do you treat patent ductus arteriosus?

A

indomethacin or ibuprofen

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26
Q

What is tetralogy of fallot?

A
  • ventricular septal defect
  • right ventricular hypertrophy
  • right ventricular outflow obstruction, pulmonary stenosis
  • overriding aorta
27
Q

Clinical signs of tetralogy of fallot:

A
  • cyanosis
  • right to left shunt
  • ejection systolic murmur due to pulmonary stenosis
  • right sided aortic arch
  • boot shaped heart
28
Q

What bacteria most commonly causes rheumatic fever?

A

strep pyogenes

29
Q

What type of reaction is rheumatic fever?

A

type II hypersensitivity

30
Q

What are the major criteria of rheumatic fever?

A
  • erythema marginatum
  • sydenham’s chorea
  • polyarthritis
  • carditis and valvulitis
  • subcutaneous nodules
31
Q

What are the minor criteria of rheumatic fever?

A
  • increased ESR or CRP
  • pyrexia
  • arthralgia
  • prolonged PR interval
32
Q

Factors favouring rate control in AF

A
  • over 65yo

- Hx of ischaemic heart disease

33
Q

Factors favouring rhythm control in AF

A
  • younger than 65yo
  • symptomatic
  • first presentation
  • lone AF or secondary to corrected precipitant (e.g. alcohol)
  • congestive heart failure
34
Q

Explain the ALS procedure for someone in VT/VF arrest:

A
  • 3 shocks with each shock followed by 2 min CPR

- adrenaline 1mg after 3 shocks, then every 3-5 minutes

35
Q

What is the ALS procedure when a cardiac arrest is witnessed in a monitored patient?

A

up to 3 quick successive shocks without CPR in between

36
Q

Explain the ALS procedure in systole or pulseless EA:

A
  • adrenaline 1mg ASAP

- 2 min CPR before reassessment

37
Q

What are the ECG signs of digoxin toxicity?

A
  • ST depression - reverse tick
  • flattened/inverted T waves
  • short QT
  • arrhythmias e.g. AV block, bradycardia
38
Q

What are the ECG signs of hypokalaemia?

A
  • U waves
  • small/absent T waves
  • long PR
  • ST depression
  • long QT
39
Q

What are the ECG signs of hyperkalaemia?

A
  • peaked/tall tented T waves
  • loss of P waves
  • broad QRS
  • sinusodial wave pattern
  • VF
40
Q

What are the ECG signs of hypothermia?

A
  • bradycardia
  • J waves
  • 1st degree HB
  • long QT
  • ventricular and atrial arrhythmias
41
Q

What are the coronary territories?

A

anteroseptal: V1-V4 (LAD)
inferior: II, III, aVF (right coronary)
anterolateral: V4-V6, I, aVL (LAD or left circumflex)
lateral: I, aVL, V5-V6 (left circumflex)
posterior: tall R waves V1-V2 (usually left circumflex or right coronary)

42
Q

ECG signs of myocardial ischaemia:

A 
acute:
-hyperacute T waves for few minutes
-STE
-T waves inverted within 24hrs
-pathological W waves
posterior MI: ST depression
43
Q

Management of acute heart failure:

A
  • O2
  • IV loop diuretics
  • opiates
  • vasodilators
  • inotropic agents
  • CPAP
  • ultrafiltration
  • mechanical circulatory assistance e.g. intra-aortic balloon counter pulsation or ventricular assist devices
  • discontinue beta blockers short term
44
Q

CXR signs of heart failure

A 
Alveolar oedema
kerley B line
Cardiomegaly
Dilated prominent upper lobe vessels
Effusion
45
Q

Potassium sparing diuretics (types, MOA, indications)

A
  • epithelial sodium channel blockers (amiloride and triamterene)
  • amiloride works in distal convoluted tubule
  • aldosterone antagonists (spironolactone and eplerenone)
  • work in cortical collection duct
  • used for HF, ascites (cirrhosis causing secondary hyperaldosteronism), nephrotic syndrome, Conn’s syndrome
46
Q

Loop diuretics (examples, ADR)

A
  • furosemide, bumetanide
  • hypokalaemia, hypotension, hyponatraemia, hypomagnesaemia, hypocalcaemia
  • hypochloraemic alkalosis
  • gout
  • ototoxicity
  • real impairment
  • hyperglycaemia
47
Q

Thiazide diuretics (ADR)

A
  • postural hypotension
  • dehydration
  • hyponatraemia, hypokalaemia, hypercalcaemia
  • gout
  • impaired glucose tolerance
  • impotence
  • rare: agranulocytosis, thrombocytopenia, pancreatitis, photosensitivity rash
48
Q

Nitrates (ADR)

A
  • hypotension
  • tachycardia
  • headache
  • flushing
49
Q

How can you avoid nitrate tolerance?

A
  • second dose isosorbide mononitrate after 8 hours

- or use modified release isosorbide mononitrate

50
Q

Use of nicotinic acid and ADR

A
  • treatment for hyperlipidaemia - reduced cholesterol and triglycerides and increases HDL
  • ADR: flushing (prostaglandins), impaired glucose tolerance, myositis
51
Q

Use of nicorandil and ADR

A
  • vasodilatory drug for angina
  • ADR: flushing, headache, anal ulceration
  • CONTRA: left ventricular failure
52
Q

Use of ivabradine and ADR

A
  • anti-anginal
  • works on If funny current to decrease pacemaker activity in SAN
  • ADR: headache, bradycardia, heart block, visual effects (luminous phenomena)
53
Q

Dabigatran (MOA, indications, ADR)

A
  • direct thrombin inhibitor
  • for venous thromboembolism prophylaxis after hip or knee replacement
  • non-valvular AF with one of (see notes)
  • ADR: haemorrhage (reverse with idracizumab), reduce dose if CKD and not if creatinine clearance <30ml/min
54
Q

What is bivalirudin?

A
  • direct thrombin inhibitor

- anticoag in ACS

55
Q

Beta blockers (ADR, CONTRA)

A
  • ADR: bronchospasm, cold disease, fatigue, sleep disturbances, erectile dysfunction
  • CONTRA: asthma, uncontrolled HF, sick sinus syndrome, concurrent verapamil use
56
Q

Amiodarone (MOA, monitoring, ADR)

A
  • class III anti-arrhythmic administered in central vein (risk of thrombophlebitis)
  • check LFTs, TFTs, U&Es and CXR before Tx
  • check TFT and LFTs every 6 months
  • ADR: thyroid dysfunction, pulmonary fibrosis/pneumonitis, liver fibrosis/hepatitis, slate grey appearance, corneal deposits, peripheral neuropathy, photosensitivity, thrombophlebitis and injection site reactions, bradycardia, lengthens QT interval
57
Q

Adenosine (MOA, ADR)

A
  • to terminate SVT
  • enhanced by dipyridamole and blocked by theophylline
  • avoid in asthmatics (bronchospasm)
  • agonist of A1 receptor in AV node
  • half life: 8-10 seconds (use large calibre cannula)
  • ADR: chest pain, bronchospasm, transient flushing, enhances conduction down accessory pathways
58
Q

Caution and CONTRA of ACEi

A
  • avoid in pregnancy and breastfeeding
  • renovascular disease
  • aortic stenosis - hypotension
  • hereditary idiopathic angioedema
  • specialist advice if K+ >=5mmol/L
59
Q

Statins ADR and CONTRA

A
  • myopathy: myalgia, myositis, rhabdomyolysis and asymptomatic rise in creatinine kinase (more common lipophilic statins)
  • liver impairment: check LFTs at baseline, 3mo and 12mo, discontinue if AST conc 3x reference range
  • CONTRA: macrolides, pregnancy
60
Q

Examples of glycoproteins IIb/IIIa receptor antagonists

A
  • abciximab
  • eptifibatide
  • tirofiban
61
Q

Warfarin in emergency surgery:

A

If surgery can wait for 6-8 hours - give 5 mg vitamin K IV

If surgery can’t wait - 25-50 units/kg four-factor prothrombin complex

62
Q

Investigation for cardiac tamponade:

A

echocardiogram

63
Q

What is PERC criteria used for?

A

ruling out PE for patients with low (<15%) pre-test possibility

PM Important (16 decks)

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