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Year 5 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is the mechanism of action of Dabigatran?

A

Direct thrombin inhibitor

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2
Q

What drug is used to reverse the effects of Dabigatran?

A

Idarucizumab

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3
Q

Name the 4 different types of heart (AV) block and what is shown on ECG

A

1st degree - increased PR interval >0.2 seconds
2nd degree mobitz 1 (wenckebach) - increasing PR until QRS drop
2nd degree mobitz 2 - constant PR interval but random QRS drops
3rd degree - no association between p waves and QRS

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4
Q

Symptoms of severe hypertension

A

Headaches
Visual disturbances
Seizures

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5
Q

Classifications of hypertension

A

Stage 1 - >140/90
Stage 2 >160/100
Stage 3 > 180/110

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6
Q

Causes of secondary hypertension

A 
Renal artery stenosis 
Glomerulonephritis 
PCKD
Primary hyperaldosteronism (conns)
Congenital adrenal hyperplasia 
Phaeochromocytoma
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7
Q

What investigations should you do when diagnosing hypertension?

A 
U&Es - check for renal disease
HbA1c - check for diabetes, important CVD risk factor
Lipids
TFT - can contribute to cause
ECG
Urine dip
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8
Q

Medical management of hypertension

A

1) A or C
2) A+C or A+D
3) A+C+D
4) If K+ <4.5 - add spironolactone, if K+ >4.5 add alpha or beta blocker

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9
Q

What are the 3 features of angina?

A

Central constricting chest pain
Precipitated by physical exertion
Relieved by rest or GTN spray

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10
Q

How is Angina Managed?

A

Aspirin and Statin (If non contraindications)
Sublingual GTN
Beta blocker
Calcium channel blocker - if used in combination with beta blocker then long acting one e.g, modified release nifedipine
Long acting nitrate - if symptoms still aren’t controlled

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11
Q

Which calcium channel blocker should never be co prescribed with a beta blocker and why?

A

Verapamil

Risk of complete heart block

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12
Q

How can you tell what type of MI has occurred from ECG?

Which artery has been affected?

A

Anterior MI: V1-V4 (Left anterior descending)
Inferior MI: II, III, aVF (right coronary artery)
Lateral MI: V5-V6 (left circumflex)

Posterior MI: Tall R waves in V1-V3 (left circumflex/right coronary)

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13
Q

What is the management of STEMI?

A

MONA - emphasis on aspirin 300mg, others can be considered
Refer for PCI if symptoms started within 12 hours and can be performed within 120 minutes
Thrombolysis if PCI not available and can be performed within 12 hours of onset of symptoms

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14
Q

What medication should be given prior to PCI?

A

Duel anti placement therapy (aspirin + prasugrel/clopidogrel) and unfractionated heparin

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15
Q

How is NSTEMI Managed?

A 
GRACE risk - determines 6 month mortality 
Coronary angiography (with follow on PCI if necessary) within 72 hours if GRACE >3%
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16
Q

Complications following MI

A

Cardiac arrest - due to VF development
Cardiogenic shock
Pericarditis (within 48 hours), Dressler’s syndrome (2-6 weeks)
Left ventricular aneurysm - persistent ST elevation
Left ventricular wall rupture (occurs 1-2 weeks after)
Ventricular septal defect - pan systolic murmur, occurs in 1st week

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17
Q

What are the options for rate control within AF

A

Atenolol
Diltiazem
Digoxin - if patient has coexisting heart failure

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18
Q

What are the options for rhythm control within AF?

A

Flecanide - no structural heart disease
Amiodarone- evidence of structural heart disease
Digoxin - patients with heart failure

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19
Q

When would you consider anticoagulation in AF?

A

CHADS2VAS score:
1 for males
2 for females

If 0, then do TTE to look for evidence of structural heart disease - this is also an indication

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20
Q

What is the genetic inheritance of HOCM?

A

Autosomal dominant

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21
Q

What is the pathophysiology of HOCM?

A

Mutation in myosin chain protein
Leads to ventricular hypertophy - this leads to decreased cardiac output and increased thickness of intraventricular septum

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22
Q

What is the pulse in HOCM?

A

Bisferiens - double pulse felt due to missed aortic valve disease
Jerky pulse

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23
Q

Management of HOCM?

A 
ABCDE
A - amiodarone 
B - beta blockers
C - cardioverter defibrillator 
D - duel chamber pacemaker 
E - endocarditis prophylaxis
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24
Q

What is the heart conduction issue associated with HOCM?

A

Wolff-Parkinson white

25
What is Wolff Parkinson White
Congenital accessory conducting pathway between atria and ventricles which leads to AV re renters tachycardia
26
ECG Features of Wolff Parkinson white
Short PR interval QRS slurred upstroke (delta waves) Left axis deviation
27
Management of Wolff parkinson white
Radiofrequency ablation of accessory pathway
28
Arrthymia risk assocaited with WPW?
Ventricular Fibrillation
29
What is Eisenmenger’s Syndrome?
Reversal of a left to right shunt in congenital heart defect due to pulmonary hypertension
30
What is bifascicular block
RBBB with left anterior or posterior hemiblock
31
What is trifasicular block?
Bifasicular block (RBBB with left anterior or posterior hemiblock) + 1st degree heart block
32
How is BNP interpreted?
<100 - normal >400 - high (arrange ECHO within 2 weeks) 100-400 - raised (arrange ECHO within 6 weeks)
33
Drug management in heart failure
1st line - ACEi + beta blocker 2nd line - add spironolactone, or hydralazine with nitrate Consider furosemide for symptomatic relief Consider digoxin if coexistent AF
34
Clinical features of pericarditis
``` Chest pain - often relieved by sitting forwards Non productive cough Dyspneoa Pericardial rub Tachycardia and tachypnoea ```
35
ECG Features of pericarditis
Saddle shaped widespread ST elevation | PR depression
36
Most common viral cause of pericarditis
Coxsackie
37
Management of pericarditis
Treat underlying cause | NSAID and colchicine - for idiopathic or viral pericarditis
38
Which valve is most commonly affected in endocarditis
Mitral valve
39
What criteria is used for infective endocarditis
Dukes
40
Risk factors for endocarditis
Rheumatic valve disease Prosthetic valves IVDUs Congenital heart defects
41
Management of endocarditis
IV abx Staphylococcus cause - flucloxacillin Streptococcus cause - benzylpenicillin
42
Indications for valve replacement surgery in endocarditis
Severe heart failure Overwhelming sepsis despite abx therapy Recurrent embolic episodes despite abx therapy Pregnancy
43
Triad for PE
Pleuritic chest pain Dyspneoa Haemoptysis
44
CXR findings in PE
Usually normal | Possible wedge shaped opacification
45
ECG findings in PE
Sinus tachycardia | S1Q3T3 - large S lead I, large Q lead III, inverted T lead III (only seen in 20% of patients)
46
How do you interpret the wells score?
>4 points - arrange CTPA <4 points - D dimer (if positive arrange CTPA) If CPTA is negative then consider proximal leg vein USS
47
Acute Medical management of PE?
1st line - apixiban or rivaroxaban | Thrombolysis - for patients with suspected massive PE (signs of circulatory failure e.g, hypotension)
48
Long term management of PE
Provoked - continue anticoagulant for 3 months (3-6 months for active cancer) Unprovoked - continue for 6 months
49
Features of aortic dissection
``` Central chest pain radiating to the back Hypertension Aortic regurgitation murmur Weak or absent carotid, brachial or femoral pulse Variation of >20mmHg BP between arms ```
50
Standford Types of aortic dissection
Standford A - ascending aorta | Standford B - descending aorta (distal to subclavian origin)
51
Management of aortic dissection
Type A - surgical management (control BP with labetalol while awaiting surgery) Type B - conservative management, best rest (control BP with labetalol to prevent progression)
52
Triad for cardiac tamponade
Becks triad: Raised JVP Hypotension Muffled heart sounds
53
How would a left ventricular free wall rupture present?
``` Usually occurs 1 week post MI as complication Cardiac tamponade Reduced BP Raised JVP Pulsus paradoxus ```
54
How would a ventricular septal defect present post MI
Occurs within first week post MI Acute heart failure symptoms - SoB, worse when lying flat, wheezy cough Pan systolic murmur
55
Side effects of ACEis
Dry cough Angiodema - may occur up to a year after starting treatment Hyperkalaemia
56
How would a ruptured papillary muscle present as a complication following MI?
Occurs in 1st week after Acute mitral regurgitation - pan systolic murmur Low BP Acutely SoB
57
What are the ECG changes associated with hypothermia?
``` Bradycardia J waves - small hump at the end of QRS complex First degree heart block Long QT interval Atrial and ventricular arrhythmias ```
58
When should anticoagulation therapy be started in a patient with AF + acute stroke and why
2 weeks after the event | Any earlier and there is a risk of haemorrhagic transformation of stroke

Year 5 (17 decks)

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