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Phase 3b Medicine - Riona > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Give 2 things atherosclerotic plaques cause

A

Hypertension
Angina
ACS (MI/stroke)

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2
Q

Give 2 modifiable risk factors for CVD

A 
Smoking
Exercise
Diet
Alcohol
Sleep
Stress
Obesity
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3
Q

Give 2 non-modifiable risk factors for CVD

A

Age
FH
Male

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4
Q

What is primary prevention?

A

Interventions before any CVD

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5
Q

What is secondary prevention?

A

Interventions when patients have CVD

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6
Q

What score do you use in the primary prevention of CVD?

A

QRISK3

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7
Q

What does the QRISK3 calculate?

A

Percentage risk of patient having a stroke/MI in the next 10 years

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8
Q

What do you do if the QRISK3 is >10%?

A

Statin (atorvastatin 20mg)

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9
Q

What is the secondary prevention of CVD?

A 
4As
Aspirin (+clopidogrel) 
Atorvastatin 80mg
Atenolol (/other BB)
ACEi
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10
Q

What is the gold standard investigation for angina?

A

CT coronary angiography

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11
Q

Immediate symptomatic relief in angina

A

GTN spray

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12
Q

Long term symptomatic relief in angina

A

BB or CCB

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13
Q

Secondary prevention of angina

A

Aspirin
Atorvastatin
ACEi
BB

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14
Q

Surgical management of angina

A

PCI or CABG

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15
Q

Give 2 parts of the heart the RCA supplies

A

RA
RV
Inferior LV
Posterior septum

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16
Q

Give 2 parts of the heart the circumflex artery supplies

A

LA

Posterior LV

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17
Q

Give 2 parts of the heart the LAD supplies

A

Anterior LV

Anterior septum

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18
Q

ECG in STEMI

A

ST elevation

New LBBB

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19
Q

ECG in NSTEMI

A

ST depression
T wave inversion
Pathological Q waves

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20
Q

ECG in unstable angina

A

No pathological changes

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21
Q

Symptoms of ACS (MI/unstable angina)

A 
Central constricting chest pain
N&V
Sweating
Feeling of impending doom
SOB
Palpitations
Pain radiating to jaw/arms
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22
Q

LCA ECG leads

A

I, aVL, V3-6

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23
Q

LAD ECG leads

A

V1-4

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24
Q

Circumflex ECG leads

A

I, aVL, V5-6

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25
Q

RCA ECG leads

A

II, III, aVF

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26
Q

What does a rise in troponin mean?

A

Myocardial ischaemia

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27
Q

What are troponins?

A

Proteins found in cardiac muscle

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28
Q

What is the downside of using troponins?

A

They are non-specific

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29
Q

Give 2 non-ACS causes for raised troponins

A 
CRF
Sepsis
Myocarditis
Aortic dissection
PE
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30
Q

What is the treatment for an acute STEMI?

A

PCI <2 hours

Thrombolysis (alteplase) <6 hours

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31
Q

What is the treatment for an acute NSTEMI?

A 
BATMAN
BB
Aspirin 300mg
Ticagrelor 180mg (/clopidogrel 300mg)
Morphine
Anticoagulant (LMWH)
Nitrates
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32
Q

What score gives a 6 month risk of death or repeat MI after having an NSTEMI?

A

GRACE score

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33
Q

What is Dressler’s syndrome?

A

2-3 weeks after MI there is a localised immune response and pericarditis happens
Pleuritic chest pain, low grade fever, pericardial rub
ECG, echo, inflammatory markers
NSAIDs +/- steroids

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34
Q

Secondary prevention of ACS

A 
6As
Aspirin 75mg
Antiplatelet (clopidogrel)
Atorvastatin 80mg
ACEi
Atenolol
Aldosterone antagonist (clinical heart failure)
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35
Q

What does LVF cause?

A

Pulmonary oedema

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36
Q

Give 2 triggers for acute LVF

A

Iatrogenic (IV fluids)
Sepsis
MI
Arrhythmias

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37
Q

Symptoms of acute LVF

A

SOB, worse on lying flat
Unwell
Cough (frothy white/pink sputum)

38
Q

What type of respiratory failure does acute LVF cause?

A

Type 1

Low O2, normal CO2

39
Q

Signs of acute LVF

A 
Increased RR
Reduced O2
Tachycardia
3rd heart sound
Bilateral basal crackles on auscultation
Hypotension
Raised JVP or peripheral oedema if also RVF
40
Q

What blood test do you do for suspected Lacute VF?

A

BNP

41
Q

What is BNP?

A

B-type natriuretic peptide
Hormone that is released from the ventricles when the myocardium is overstretched
Its action is to relax the smooth muscle in blood vessels

42
Q

What is the downside of using BNP?

A

Non-specific

43
Q

Give 2 non-HF causes of raised BNP

A 
Tachycardia
Sepsis
PE
Renal impairment
COPD
44
Q

What does an echo look for in acute LVF?

A

Ejection fraction

45
Q

What is a normal ejection fraction?

A

> 50%

46
Q

Give 2 CXR findings in acute LVF

A

Cardiomegaly
Upper lobe venous diversion
Possible pleural effusions, Kerley lines

47
Q

What is the management for acute LVF?

A

Sit upright
Oxygen
Diuretics (IV furosemide 40mg)
Monitor fluid balance

48
Q

What are the 2 types of chronic heart failure?

A

Impaired LV contraction (systolic)

Impaired LV relaxation (diastolic)

49
Q

Give 3 symptoms of chronic heart failure

A 
SOBOE
Cough (frothy pink/white sputum)
Orthopnoea
PND
Peripheral oedema
50
Q

Give 2 investigations for chronic heart failure

A

Presentation
NT-proBNP
Echo
ECG

51
Q

Give 2 causes of chronic heart failure

A

IHD
Valvular disease
HTN
Arrhythmias

52
Q

What is the medical management of chronic heart failure?

A

ACEi
BB
+/- aldosterone antagonist
Loop diuretics

53
Q

What is cor pulmonale?

A

RHF caused by respiratory disease (pulmonary hypertension)

54
Q

Give 2 causes of cor pulmonale

A 
COPD
PE
ILD
CF
Primary pulmonary HTN
55
Q

Give 2 signs of cor pulmonale

A 
Hypoxia
Cyanosis
Raised JVP
Peripheral oedema
3rd HS
Murmurs
Hepatomegaly
SOBOE
56
Q

What is the management of cor pulmonale?

A

Treat symptoms and cause

57
Q

Give 2 causes of HTN

A

Renal disease
Obesity
Pregnancy induced/pre-eclampsia
Endocrine

58
Q

Give 2 complications of HTN

A 
IHD
CVA
Retinopathy
Nephropathy
HF
59
Q

What BP diagnoses HTN?

A

> 140/90 in clinic or >135/85 at home

60
Q

What are the BP readings for stage 2 and stage 3 HTN?

A

2: >160/100 clinic >150/95 home
3: >180/120 clinic

61
Q

What are the 5 main medications for HTN?

A 
ACEi 
BB
CCB
Thiazide like diuretic
ARB
62
Q

Talk through the steps of HTN management

A

1: If <55 and non-black use A, if >55 or black use C
2: A + C or A + D or C + D (ARB > A if black)
3: A + C + D
4: A + C + D + additional

63
Q

Give 2 additional medications for uncontrolled HTN

A

Potassium sparing diuretic
Alpha blocker
Beta blocker

64
Q

Give an example of an ACE inhibitor

A

Ramipril

65
Q

Give an example of a beta blocker

A

Bisoprolol

66
Q

Give an example of a CCB

A

Amlodipine

67
Q

Give an example of a thiazide like diuretic

A

Indapamide

68
Q

Give an example of an ARB

A

Candesartan

69
Q

Give an example of a potassium sparing diuretic

A

Spironolactone

70
Q

Give an example of an alpha blocker

A

Doxazosin

71
Q

What can spironolactone increase the risk of?

A

Hyperkalaemia

72
Q

Give 2 symptoms of AF

A

Palpitations
SOB
Syncope

73
Q

Give 2 features of AF on ECG

A

Absent P waves
Narrow QRS
Tachycardia
Irregularly irregular

74
Q

Give 2 causes of AF

A 
Sepsis
Mitral valve pathology
Ischaemic heart disease
Thyrotoxicosis
HTN
75
Q

What is the first line treatment for AF?

A

Rate control with a beta blocker

76
Q

Describe pharmacological cardioversion

A

Anticoagulate for >3 weeks prior

Flecanide/amiodarone

77
Q

Describe electrical cardioverson

A

Anticoagulate for >3 weeks prior

Cardiac defibrillator

78
Q

Give 2 medications used in long term rhythm control in AF

A

BB
Dronedarone
Amiodarone

79
Q

What is paroxysmal AF and what is the management?

A

Infrequent episodes of AF

Flecanide

80
Q

Why anticoagulant in AF?

A

Risk of stroke due to stagnating blood in atrium

81
Q

How does warfarin work?

A

Vitamin K antagonist

Prolongs PT

82
Q

How do we measure warfarin?

A

INR (PT of patient compared to normal adult, 1=normal)

83
Q

What INR do we aim for in AF?

A

2-3

84
Q

What can impact warfarin?

A

Cytochrome P450

Vitamin K foods

85
Q

Give an example of a DOAC

A

Apixaban

Rivaroxaban

86
Q

What is a disadvantage of a DOAC?

A

Cannot be reversed

87
Q

What is an advantage of a DOAC?

A

Shorter half life

No monitoring

88
Q

What tool is used for assessing whether a patient with AF needs anticoagulation?

A

CHA2DS2-VASc (score of >1=give anticoagulation)

89
Q

Describe CHA2DS2-VASc

A 
Congestive HF
HTN
Age >75
Diabetes
Stroke/TIA
Vascular disease
Age >65
Sex (F)
90
Q

What tool is used for assessing a patient’s risk of major bleeding whilst on anticoagulation?

A

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Phase 3b Medicine - Riona (17 decks)

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