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Diploma Exam > Cardiology > Flashcards

Cardiology Flashcards

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1
Q

What are some non- cardiac causes of AF

A
  1. Thyrotoxicosis (check tfts)
  2. Acute infection
  3. Pulmonary disease (check cxr)
  4. Alcohol excess (acute or chronic)
  5. The peri operative period
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2
Q

Which cardiology medication should be stopped in patients with AF & why?

A

Ivabradine- ineffective

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3
Q

How is acute onset AF (<48 hours) managed?

A
  • HR controlled
  • Offered cardioversion
  • If haemodynamically unstable, DC cardioversion
  • If haemodynamically stable, pharmacological- dc if this fails
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4
Q

What medications are used for pharmacological cardioversion in ACUTE AF?

A

amiodarone
vernaket
Flecainide

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5
Q

Terms for cardioversion if AF has been present >48 hours?

A
  • Electrical cardioversion preferred
  • Attempt after at least 3 weeks of anticoagulation/
  • rule out left atrial thrombus & start parenteral anticoag
  • after cardioversion, oral anticoag minimum 4 weeks
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6
Q

What is first line for long term rhythm control in AF?

A

B blockers

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7
Q

What are 2nd line for long term rhythm control in AF? What are the contraindications of each?

A
  1. Flecainide or propafenone (if no IHD, structural heart disease or heart failure),
  2. dronedarone (if no LVSD or heart failure present)
  3. amiodarone
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8
Q

What drug is first line for AF if patient has acute heart failure and why?

A

Digoxin
Because b blockers contraindicated in acute HF
RLCCBs contraindicated in HF

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9
Q

What medication can be used for pill in the pocket for paroxysmal AF?

A
  • flecainide (300mg for patients >70kg, 200mg if <70kg)
  • propafenone (600mg for patients >70kg, 450mg if <70kg).

MAX 1 dose in 24 hours

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10
Q

Which AF drug should be avoided in paroxysmal AF?

A

digoxin as it can flip them from sinus rhythm into af & worsen the af

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11
Q

What is the main risk of cardio version >48 hours?

A

There is a risk that a thrombus has formed and successful cardioversion could lead to a stroke.

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12
Q

Which cardiology drug can double digoxin levels?

A

amiodarone

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13
Q

Which medicines are contraindicated in HF & why?

A

NSAIDs (na retention)
RLCCBs
pioglitazone
dronedarone, flecanide,

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14
Q

What is first line treatment for HF- REF?

A

Bblocker + ACE inhibitor
ARB if ACE not tolerated

SPECIALIST- Hydralazine + Isosorbide if ACE/ARB not tolerated

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15
Q

How is chronic hyperkalaemia due to CKD/ ACE inhibitor use in HF managed?

A

Patriomer - 8.4g OD

Sodium zirconium cyclosilicate - 10g TDS then 5mg OD maintenance

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16
Q

After first line treatment for HF what are second and third line options?

A

2nd line- add MRA to BB + ACEi
(spironolactone/eplerenone)

3rd line- specialist

  • ADD Ivabradine (if in sinus rhythm)
  • replace ACE with sacubitril valsartan
  • digoxin (if in sinus rhythm)
17
Q

Medicines to hold in AKI

A 
Contrast media (for scans)
ACEi/ ARBs
NSAIDs/ COX2i
Diuretics
metformin 
renally cleared opioids
DMARDs (e.g methotrexate)
18
Q

When must ACEi be stopped before entresto is started?

A

36 hour wash out period so in practice 2 days.

Reason: increased risk of angiodema with sucabitril & ACEi.

19
Q

What does QRISK assess

A

10 year cardiovascular risk and how this compares to a healthy person of the same age.

Used for PRIMARY prevention only

20
Q

What is the treatment for hypertension

A

Step 1 <55/ white: ACE (or ARB)
Step 1 >55/black : CCB (or thiazide like indapamide)
Step 2: Combo of ACE/ARB + CCB/thiazide
Step 3: ACE/ARB + CCB + thiazide
Step 4: spironolactone/ Ablocker/ Bblocker

21
Q

What is recommended for primary prevention of CVD and when?

A

Atorvastatin 20mg OD is recommended if:

  • QRISK2 score is >10%
  • patient has type 1 diabetes
  • > 85 years old if life expectancy is long
22
Q

How is stable angina managed?

A

Treatment: GTN spray
1st line : Bblocker/ RLCCB
2nd line: combo Bblocker + normal CCB
3rd line: isosorbide, Ivabradine, nicorandil, ranolazine

Secondary prevention CVD:

  • aspirin (+PPI if needed)
  • atorvastatin 80mg OD regardless of lipids
23
Q

What are the post MI secondary prevention medication

A

BADS

Bblocker
ACEi
Dual antiplatelets 12 months then stop one (+/- PPI)
Statin (atorva 80mg OD)

24
Q

What is alteplase & when can it be given?

A

Thrombolyic agent for ischaemic strokes

Give within 4.5 hours of symptom onset

25
Q

Why is anticoagulation held 2 weeks after a stroke?

A

Risk of haemorrhage transformation
Not for LMWH or TED stockings

But can use IPCs

26
Q

When should statins be initiated after acute stroke and why?

A

After 48 hours due to the risk of haemorrhage transformation.

Use high intensity statin

27
Q

Which antidepressant is recommended post stroke?

A

sertraline due to its better cardiovascular safety profile

28
Q

How many ays frogmen for hip/knee ops?

A

Hip- 28 days
Knee 14 days

more days for hip as more further from the floor

29
Q

What is defined as poor anticoagulant control on warfarin?

A

2x INR >5 or 1x INR >8 in six months
2x NR <1.5 in six months
time in therapeutic range (TTR) <65%

30
Q

How should vitamin K be given and why?

A

IV only

Not s/c due to inconsistent correction of warfarin
Not IM due to the risk of haematoma formation

Diploma Exam (2 decks)

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