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Finals > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What blood tests should you organise if you suspect stable angina? (7)
What other test could you organise in primary care?

A

FBC (anaemia), U&Es, fasting glucose, HbA1c (diabetes), LFTs (before starting statins), lipid profile, TFTs (exclude other cause of angina)
ECG

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2
Q

What is the gold standard for diagnosing stable angina?

A

CT coronary angiography

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3
Q

What are the 3 features of typical angina?

A

Constricting discomfort in front of chest, arms, shoulders or jaw
Precipitated by exertion
Relieved by rest or GTN within 5 minutes

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4
Q

What is the general management of stable angina?

A

Refer to cardiology
Advice
Medication
Procedure or surgery e.g. PCI

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5
Q

What is the medical management of stable angina?

  1. Primary prevention (2)
  2. Secondary prevention (3)
A
  1. GTN spray, Beta-blocker or CCB

2. Aspirin 75mg OD, atorvastatin 80mg, ACEI if diabetic

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6
Q

What are second line options for managing stable angina? (4)

A

Long-acting nitrate
Nicorandil
Ivabridine
Ranolazine

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7
Q

What ECG changes suggest previous ischaemia? (3)

A

Pathological Q waves
LBBB
ST segment and T wave changes (e.g. inversion, flattening)

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8
Q

What ECG changes would indicate a STEMI? (3)

A

ST elevation or >2mm in 2 or more anterior leads
ST elevation of >1mm in 2 or more inferior leads
New LBBB

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9
Q

What are the criteria for PCI to treat a STEMI?

A

Symptoms presented within 12h

Can be done in 120 minutes

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10
Q

What should happen after giving fibrinolysis for a STEMI?

A

Repeat ECG after 60-90 minutes; if still ECG changes, go onto PCI
Give LMWH, unfractionated or fondaparinux

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11
Q

What is the initial management for an NSTEMI or unstable angina?

A 
Beta blocker
Aspirin 300mg STAT
Ticagrelor 190mg STAT or clopidogrel 300g STAT
Morphine 
Anticoagulant e.g. fondaparinux
Nitrates
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12
Q

What score is used after an NSTEMI?

What do the scores mean in terms of management?

A

GRACE score
Low risk - 300mg clopidogrel STAT and continue for 12 months
Intermediate or high risk - 300mg clopidogrel STAT and subsequent coronary angiogrpahy with follow on PCI

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13
Q

What are the complications of an MI? (5)

A 
Death
Rupture of papillary muscles or muscle wall
Edema
Aneurysms and arrhythmias
Dressler's syndrome; manage with NSAIDs
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14
Q

What blood pressure readings diagnose hypertension (clinic and ambulatory?

A

Clinic reading 140/90 or ambulatory reading 135/85

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15
Q

What other investigations would you carry out after diagnosing hypertension?

A

Urine dipstick and ACR
Fundoscopy
ECG
Bloods: HbA1c, U&Es, eGFR, lipid profile

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16
Q

Under what criteria would you medically treat stage 1 hypertension? (6)

A

Aged <80 with one of: target organ damage, CVD, renal disease, diabetes, QRISK >10%

17
Q

What are the blood pressure targets?

A

<140/90 if <80 years

<150/90 if >80 years

18
Q

What should you monitor when starting an ACEI or diuretic?

A

U&Es

19
Q

What are the causes of secondary hypertension?

A

Renal disease
Obesity
Pregnancy or pre-eclampsia
Endocrine e.g. Conn’s

20
Q

What are the complications of hypertension? (5)

A 
Stroke
Hypertensive retinopathy 
Ischaemic heart disease
Heart failure
Hypertensive nephropathy
21
Q

What is the difference between malignant hypertension and a hypertensive urgency?

A
  1. Systolic >200 or diastolic >130 with end organ damage

2. Systolic >180 or diatolic >120 with no end organ damage

22
Q

What signs would indiate malignant hypertension? (6)

A

Heart:

  • Pulmonary oedema (acute LVF)
  • Aortic dissection

Eyes and brain:

  • Encephalopathy
  • Papilloedema

Kidneys:
- Nephropathy

Angiopathic haemolytic anaemia

23
Q

What diagnostic criteria is used for infective endocarditis?

A

Duke’s criteria

24
Q

Which 2 investigations are important for diagnosing infective endocarditis?

A 
Echo
Blood cultures (x2 in two different places)
25
Q

What are the gradings for heart murmurs? (6)

A 
I - audible by an expert 
II - quiet
III - moderately loud
IV - markedly loud with thrill
V - very loud with thrill
VI - audible without stethoscope
26
Q

What causes the following murmurs?

  1. Ejection systolic
  2. Pan systolic
  3. Early diastolic
  4. Late diastolic
A
  1. Aortic or pulmonary stenosis, ASD
  2. Mitral or tricuspid regurgitation, VSD
  3. Aortic or pulmonary regurgitation
  4. Mitral or tricuspid stenosis
27
Q

What are some causes of aortic regurgitation?

A 
Aortic dissection
Infective endocarditis
Connective tissue disorder 
Ankylosing spondylitis
Takayasu's disease
28
Q

What is the difference between valvular AF and non-valvular AF?
What are the causes of non-valvular AF? (5)

A

Valvular AF = mitral stenosis or a mechanical valve

Non-valvular:
Sepsis
Mitral regurgitation
Ischaemic heart disease
Thyrotoxicosis
Hypertension
29
Q

Which patients should have rhythm control as first-line for their AF? (4)

A

New onset AF (within 48h)
Reversible cause
AF is causing heart failure
Remain symptomatic despite being rate controlled

30
Q

What are the options for controlling AF?

  1. Rate
  2. Rhythm
A
  1. Beta blocker, CCB (e.g. dilitazem), digoxin or combination if not controlled
  2. Cardioversion - pharmacological (flecainide, amiodarone) or electrical

NB - must anticoagulate anyone that has been in AF for >48h if stable and planning rhythm control

31
Q

What are the NHYA stages for heart failure?

A

I - no symptoms on ordinary activity
II - slight limitation of activity by symptoms
III - less than ordinary activity leads to symptoms
IV - not able to carry out any activity without symptoms

32
Q

What blood test should you order for heart failure?

What should you do about the results?

A

NT pro BNP
>2000 - echo in 2 weeks
>400 - echo in 6 weeks
<400 - heart failure unlikely

33
Q

What is the management for heart failure?

A

ACE I
Beta blocker
Aldosterone antagonists (if above not working)
Loop diuretics (if overloaded)

34
Q

Which common cardiac medication should be avoided in heart failure?

A

Calcium channel blockers

35
Q

What is the management for acute heart failure?

  1. Immediate
  2. Long-term
A
  1. Pour SOD
    Stop any IV fluids, sit upright, oxygen if <95%, diuretics
  2. Fluid balance, daily U&Es and weight, if cardiogenic shock, refer to ICU
36
Q

What would you expect to see on ECG in someone with LVH?

A

T wave inversion

High voltage R waves

37
Q

What can long QTc turn into if untreated?

A

Torsades de Pointes

38
Q

How would you describe VT?

A

Regular, broad complex tachycardia usually at a rate of >120 bpm

39
Q

How do you investigate and manage pericarditis?

A

Echo and troponins

NSAIDs and colchicine

Finals (23 decks)

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