Cardiology Flashcards
What blood tests should you organise if you suspect stable angina? (7)
What other test could you organise in primary care?
FBC (anaemia), U&Es, fasting glucose, HbA1c (diabetes), LFTs (before starting statins), lipid profile, TFTs (exclude other cause of angina)
ECG
What is the gold standard for diagnosing stable angina?
CT coronary angiography
What are the 3 features of typical angina?
Constricting discomfort in front of chest, arms, shoulders or jaw
Precipitated by exertion
Relieved by rest or GTN within 5 minutes
What is the general management of stable angina?
Refer to cardiology
Advice
Medication
Procedure or surgery e.g. PCI
What is the medical management of stable angina?
- Primary prevention (2)
- Secondary prevention (3)
- GTN spray, Beta-blocker or CCB
2. Aspirin 75mg OD, atorvastatin 80mg, ACEI if diabetic
What are second line options for managing stable angina? (4)
Long-acting nitrate
Nicorandil
Ivabridine
Ranolazine
What ECG changes suggest previous ischaemia? (3)
Pathological Q waves
LBBB
ST segment and T wave changes (e.g. inversion, flattening)
What ECG changes would indicate a STEMI? (3)
ST elevation or >2mm in 2 or more anterior leads
ST elevation of >1mm in 2 or more inferior leads
New LBBB
What are the criteria for PCI to treat a STEMI?
Symptoms presented within 12h
Can be done in 120 minutes
What should happen after giving fibrinolysis for a STEMI?
Repeat ECG after 60-90 minutes; if still ECG changes, go onto PCI
Give LMWH, unfractionated or fondaparinux
What is the initial management for an NSTEMI or unstable angina?
Beta blocker Aspirin 300mg STAT Ticagrelor 190mg STAT or clopidogrel 300g STAT Morphine Anticoagulant e.g. fondaparinux Nitrates
What score is used after an NSTEMI?
What do the scores mean in terms of management?
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
What are the complications of an MI? (5)
Death Rupture of papillary muscles or muscle wall Edema Aneurysms and arrhythmias Dressler's syndrome; manage with NSAIDs
What blood pressure readings diagnose hypertension (clinic and ambulatory?
Clinic reading 140/90 or ambulatory reading 135/85
What other investigations would you carry out after diagnosing hypertension?
Urine dipstick and ACR
Fundoscopy
ECG
Bloods: HbA1c, U&Es, eGFR, lipid profile
Under what criteria would you medically treat stage 1 hypertension? (6)
Aged <80 with one of: target organ damage, CVD, renal disease, diabetes, QRISK >10%
What are the blood pressure targets?
<140/90 if <80 years
<150/90 if >80 years
What should you monitor when starting an ACEI or diuretic?
U&Es
What are the causes of secondary hypertension?
Renal disease
Obesity
Pregnancy or pre-eclampsia
Endocrine e.g. Conn’s
What are the complications of hypertension? (5)
Stroke Hypertensive retinopathy Ischaemic heart disease Heart failure Hypertensive nephropathy
What is the difference between malignant hypertension and a hypertensive urgency?
- Systolic >200 or diastolic >130 with end organ damage
2. Systolic >180 or diatolic >120 with no end organ damage
What signs would indiate malignant hypertension? (6)
Heart:
- Pulmonary oedema (acute LVF)
- Aortic dissection
Eyes and brain:
- Encephalopathy
- Papilloedema
Kidneys:
- Nephropathy
Angiopathic haemolytic anaemia
What diagnostic criteria is used for infective endocarditis?
Duke’s criteria
Which 2 investigations are important for diagnosing infective endocarditis?
Echo Blood cultures (x2 in two different places)
What are the gradings for heart murmurs? (6)
I - audible by an expert II - quiet III - moderately loud IV - markedly loud with thrill V - very loud with thrill VI - audible without stethoscope
What causes the following murmurs?
- Ejection systolic
- Pan systolic
- Early diastolic
- Late diastolic
- Aortic or pulmonary stenosis, ASD
- Mitral or tricuspid regurgitation, VSD
- Aortic or pulmonary regurgitation
- Mitral or tricuspid stenosis
What are some causes of aortic regurgitation?
Aortic dissection Infective endocarditis Connective tissue disorder Ankylosing spondylitis Takayasu's disease
What is the difference between valvular AF and non-valvular AF?
What are the causes of non-valvular AF? (5)
Valvular AF = mitral stenosis or a mechanical valve
Non-valvular: Sepsis Mitral regurgitation Ischaemic heart disease Thyrotoxicosis Hypertension
Which patients should have rhythm control as first-line for their AF? (4)
New onset AF (within 48h)
Reversible cause
AF is causing heart failure
Remain symptomatic despite being rate controlled
What are the options for controlling AF?
- Rate
- Rhythm
- Beta blocker, CCB (e.g. dilitazem), digoxin or combination if not controlled
- Cardioversion - pharmacological (flecainide, amiodarone) or electrical
NB - must anticoagulate anyone that has been in AF for >48h if stable and planning rhythm control
What are the NHYA stages for heart failure?
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
What blood test should you order for heart failure?
What should you do about the results?
NT pro BNP
>2000 - echo in 2 weeks
>400 - echo in 6 weeks
<400 - heart failure unlikely
What is the management for heart failure?
ACE I
Beta blocker
Aldosterone antagonists (if above not working)
Loop diuretics (if overloaded)
Which common cardiac medication should be avoided in heart failure?
Calcium channel blockers
What is the management for acute heart failure?
- Immediate
- Long-term
- Pour SOD
Stop any IV fluids, sit upright, oxygen if <95%, diuretics - Fluid balance, daily U&Es and weight, if cardiogenic shock, refer to ICU
What would you expect to see on ECG in someone with LVH?
T wave inversion
High voltage R waves
What can long QTc turn into if untreated?
Torsades de Pointes
How would you describe VT?
Regular, broad complex tachycardia usually at a rate of >120 bpm
How do you investigate and manage pericarditis?
Echo and troponins
NSAIDs and colchicine
