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Final Year > cardiology passmed > Flashcards

cardiology passmed Flashcards

1
Q

VTE management

A

anticoagulate
> warfarin
>DOACs

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2
Q

when is it better to use LMWH?

A

antiphospholipid syndrome - triple positive

severe renal impairment <15/min

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3
Q

what score is useful for bleeding?

A

Orbit

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4
Q

Angina not controlled by beta block

A

dihydropyridine CCB - longer acting

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5
Q

ivabradine

A

reduces heart rate by inhibiting IF current

reducing oxygen demand

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6
Q

example of longer-acting dihydropyridine calcium channel blocker

A

Amlodipine
Nifedipine

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7
Q

Cardiac tamponade

Beck’s triad
hypotension
distended neck veins
muffled heart sounds

A

elevated JVP
persistent hypotension
tachycardia

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8
Q

pulsus paradoxus?

A

an abnormally large drop in BP during inspiration

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9
Q

Mx of cardiac tamponade?

A

urgent pericardiocentesis

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10
Q

Electrical cardioversion - Afib

A

synchronised to R wave to prevent delivery of shock in cardiac repolarisation > V fib can be induced

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11
Q

Cardioversion can happen in 2 eways in A fib

A

electrical DC cardiovert

Amiodarone
flecainade

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12
Q

Broad Complex Tachycardia

A

ventricular fibrillation
ventricular tachycardia

originate from the ventricles
> AMIODARONE acts on refractory period on the below

cardiac myocytes, AV node and SA node

good for ventricular arrhythmia

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13
Q

Narrow complex tachy’s

A

supraventricular - above ventricle

respond to adenosine

blocks transmission through AV node so abberrant SVT signals don’t reach ventricles

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14
Q

Unsynchronised cardioversion used in?

A

high energy shock
as soon as shock button pushed on a defibrillator

used in pulseless VT/VF

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15
Q

Synchronised DC cardioversion?

A

unstable atrial fib
atrial flutter
atrial tachy
vtach w a pulse
svt

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16
Q

Peri-arrest tachycardia

A

ABC assessment
Stable or unstable
QRS assessment > narrow or broad

Rhythm
> Regular
> Irregular

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17
Q

Peri-arrest
Stable assessment shows signs that it is unstable ?

A

shock - hypotensive <90
pallor, sweating, cold, clammy, confused

syncope
MI
HF

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18
Q

peri arrest, unstable
what next?

A

synchronised DC shock given upto 3

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19
Q

Tachycardia
Stable

QRS <0.12s
Regular QRS

A

vagal manouvres

> adenosine
6mg rapid IV blous
12mg
18mg

try CCB - verapamil
beta-block

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20
Q

Tachycardia
Stable

QRS Broad
Regular QRS

A

Amiodarone 300mg IV over 10-60 min

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21
Q

Stable tachycardia
narrow QRS
irregular

A

probable a fib
rate control : Beta blocker

consider : Digoxin / amiodarone

anticoagulate >48hours

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22
Q

broad QRS
stable tachycardia

A

Afib
bundle branch block

polymorphic VT torsades de pointes
magnesium 2g / 10 min

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23
Q

In suspected pulmonary embolism when would you use a ventilation-perfusion scan > CTPA?

A

eGFR significantly impaired V/Q scan preferred as contrast in CTPA is nephrotoxic

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24
Q

wolf-parkinson white?

A

accessory pathwya in electrical conduction of heart

25
Q

most common causative agent for endocarditis

A

Staphylococcus aureus Staphylococcus epidermidis
if < 2 months post valve surgery

26
Q

HTN
stage 2

A

BP >160/100

HBPM >150/95

27
Q

stage 3 HTN?

A

clinic >180
clinic diastolic >120

28
Q

<55 or T2DM
step 1 HTN management

A

ACEi
ARB

29
Q

> 55 / no T2DM / black african / african- caribbean ethnicity

A

Caclium channel blocker
nifedipine / amlodipine

30
Q

bradycardia and signs of shock mx?

A

500 micrograms of atropine
repeat upto max 3mg

31
Q

Adenosine used in?

A

stable, narrow complex tachycardias

32
Q

Amiodarone

A

Mx of ventricular fibrillation / vtachy

broad complex QRS

33
Q

Bradycardia mx
2 step approach?

A

1) identify the presence of signs indicating haemodynamic compromise

2) identify potential risk of asystole

34
Q

‘haemodynamic compromise’

A

shock:
Hypotension (systolic blood pressure < 90 mmHg),
pallor,
sweating,
cold,
clammy extremities, confusion or
impaired consciousness
syncope
Myocardial Ischaemia
heart failure

35
Q

after atropine?

A

atropine 500mcg IV

transcutaneous pacing
isoprenaline / adrenaline

36
Q

risk of asystole from bradycardia?

A

mobitz II AV block
complete heart block with broad QRS
ventricular pause >3s

37
Q

using ABPM to confirm a diagnosis of hypertension

A

2 measurements every hour for every waking hour

average of at least 14 measurements used

38
Q

Diagnosing HTN

A

measure both arms
record one from higher reading arm

39
Q

if BP >180/120

A

admit for specialist

retinal haemorrhage or new onset confusion, chest pain, signs of heart failure, AKI

40
Q

HBPM

A

2 consecutive measurements need to be taken at least 1 minute apart

twice daily in morning and evening

BP 4 days ideally for 7 days

41
Q

when to treat stage 1 HTN?

A

<135/85

<80yrs and target organ damage, cardiovascular disease, renal disease DMT2

42
Q

collapsing pulse, SOB, Cardiac murmurs

A

aortic regurgitation

43
Q

Ivabradine role in angina?

A

lowers HR kinda when beta block cannot be used

targets sinus node to reduce HR w/o affecting BP

44
Q

how does isosorbide mononitrate work?

A

decreases preload by vasodilation

decreases preload lowering the heart’s oxygen requirement for muscle contraction

effective in angina

45
Q

contraindications to statin

A

macrolide
> erythromycin, clarithromycin
pregnancy

46
Q

how much adrenaline in ALS?

A

1mg adrenaline 10mls of 1:10,000

20mls of NACL- 0.9% flush to aid entry into circulation

47
Q

Left ventricular free wall rupture

A

within 48 hours
chest pain

48
Q

Mitral valve prolapse

A

sudden shortness of breath

pulmoanry oedema

49
Q

left ventricular aneurysm

A

ST elevation in V1-6
fibrosis and dead tissue not able to move properly

pulmonary oedema signs > bibasal crackles,

S3 sound > left ventricle is larger

S4 left ventricle is stiffer than normal

50
Q

Hypocalcemia is a side effect of which antihypertensives?

A

loop diuretics

51
Q

torsades de pointes mx?

A

IV magnesium sulfate

stabilises cardiac myocytes
reduces influx of calcium

52
Q

hypercalcaemia ECG abnormality?

A

short QT interval

53
Q

aortic dissection stanford B?

A

site of dissection is descending aorta

mx of uncomplicated?

medical : IV beta blockade and analgesia

54
Q

aortic dissection stanford A

A

endovascular / open interventions

55
Q

aortic dissection
DeBakey classification

A

type I - ascending aorta

type II - originates in and is confined to the ascending aorta

type III - originates in descending aorta, rarely extends proximally but will extend distally

56
Q

candesartan

A

ARB

better for HTN addition step 2 in black patients

57
Q

sacubitril-valsartan

A

a neprilysin inhibitor)

needs a 36 hour washout period to prevent accumulation of bradykinin

58
Q

Digoxin

A

cardiac glycoside

slows down heart rate

59
Q
A

Final Year (23 decks)

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