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4th year revision > Cardiology + stroke > Flashcards

Cardiology + stroke Flashcards

1
Q

how do you manage a STEMI?

A
  1. MONA
  2. If PCI can be delivered within 120 mins = PCI + unfractionated heparin + clopidogrel/praseguel
  3. If PCI cannot be delivered within 120 mins = fibrinolysis (streptokinase) + antithrombin + ticegralor
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2
Q

how do you manage a NSTEMI/unstable angina?

A
  1. MONA
  2. If immediate PCI is planned = PCI + unfractionated heparin
  3. If PCI not planned = fondaparinux
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3
Q

How do you manage a stroke?

A

300mg aspirin as soon as haemorrhagic stroke has been ruled out + thrombolysis (within 4.5hrs of onset of symptoms) +/- thrombectomy (within 6hrs - if large vessel stroke)

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4
Q

what is included for secondary prevention of stroke?

A
  • if atherosclerosis is primary cause then continue aspirin for 2 weeks then lifelong clopidogrel + statin + hypertensive mx
  • if cardioembolic is primary cause then NOAC (rivaroxaban etc) +/- hypertensive mx
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5
Q

How do you decide if someone with AF requires anticoagulation?

A

CHA2DS2VAS score.

  • men = 1 or more point then anticoagulate
  • women = 2 or more then anticoagulate
C = congestive heart failure (1)
H = hypertension (1)
A2 = Age 75 or more (2)
D = diabetes (1)
S2 = stroke/TIA (2)
V = vascular disease (1)
A = age 65-75 (1)
S = sex - female (1)
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6
Q

what is Beck’s triad?

A

signs of tamponade

  1. raised JVP
  2. Hypotension
  3. muffled heart sounds
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7
Q

What are the types of aortic dissection and what is the managment of each?

A

Type A = ascending aorta and arch of aorta. Mx is aortic graft

Type B = descending aorta. Mx is conservative - BP control is key

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8
Q

pulsus paradoxicus

A

tamponade

drop in systolic BP with inspiration

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9
Q

what murmur is associated with dilated cardiomyopathy

A

mitral regurgitation

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10
Q

what murmur is strongly associated with rheumatic fever

A

mitral stenosis

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11
Q

describe the inheritance of hypertrophic cardiomyopathy

A

AD but 50% are sporadic

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12
Q

what is the investigation of choice for cardiomyopathy

A

echo

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13
Q

what is rheumatic fever and how does it present

A

illness that presents 2-4 weeks post group A beta haemolytic strep infection (usually pharyngitis)

Symptoms include arthritis, pericarditis, chorea, erythmea marginatum, subcutanous nodules

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14
Q

how do you manage rheumatic fever

A
  1. IV benzylpenicillin then 10 days of phenoxymethylpenicillin
  2. Manage presentation ie NSAIDs for arthritis, steroids for heart failure
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15
Q

what organisms cause endocarditis?

A
  1. staph aureus most common. If acute presentation or IVDU think staph aureus
  2. staph epidermidis. Prosthetic valve less than 2 months ago
  3. strep viridans. Post dental procedure
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16
Q

what antibiotics should be used in endocarditis?

A

Native valve = amoxicillin and gentamicin
Prosthetic valve = vancomycin and gentamicin
IVDU/staph = flucloxicillin

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17
Q

what investigations should be done for endocarditis

A

3x blood cultures, echo

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18
Q

what investigations should be done for heart failure?

A
  1. ECG
  2. BNP (if not raised then unlikely to be heart failure)
  3. echo
  4. CXR
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19
Q

what is the management for heart failure (non acute)

A
  1. ACEi + B-blocker
  2. spironolactone
  3. loop diuretic ie furosemide, ivabridine
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20
Q

what is an important differential in a young patient with chest pain

A

myocarditis

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21
Q

what is the most common cause of myocarditis

A

viral infection - often coxsackie

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22
Q

what is the gold standard investigation for myocarditis

A

endomyocardial biopsy via cardiac catheterisation is gold standard but comes with risks

also can do cardiac MI, ECG and troponins (will be high)

23
Q

chest pain relieved on sitting forward

A

pericarditis

24
Q

saddle shaped global ST elevation

A

pericarditis

25
Q

what effect does hypocalcaemia have on the ECG

A

prolongs QT

26
Q

what effect does hypercalcaemia have on the ECG

A

shortens QT

27
Q

what effect does hypokalaemia have on the ECG

A

flattens T wave, U wave

28
Q

what effect does hyperkalaemia have on the ECG

A

tall tented T wave

29
Q

risk of treating hypernatraemia

A

to fast from high to low - the brain will blow (cerebral oedema)

30
Q

risk of treating hyponatraemia

A

to fast from low to high the pontine will die (cerebral pontine demyelination)

31
Q

what is the cause of congenital long QT sydrome

A

genetics -
AD - romano ward syndrome
AR - jervel and lang neilsen syndrome (associated with deafness

32
Q

how does congenital long QT present

A

feinting, seizures, hearing loss (AR), sudden death, QT >480ms

33
Q

how is congenital long QT managed

A
  • avoidance of triggers, avoid QT prolonging drugs, b-blocker, ICD
34
Q

what is a risk of congenital long QT

A

torsades de pointes

35
Q

what are the types of congenital long QT

A

type 1 - triggers include strenuous exercise

type 2 - triggers include loud noises

36
Q

how does Brugada syndrome present?

A

ST elevation and RBBB

VF

37
Q

what are triggers for Brugada syndrome

A

fever, alcohol, large meals but can also be at rest

38
Q

How do you diagnose Brugada syndrome

A

provocation test with flecainide

39
Q

how do you manage Brugada syndrome

A

trigger avoidance

40
Q

how does catecholaminergic polymorphic VT present?

A

bidirectional VT in children triggered by emotional stress or physical activity

41
Q

how do you manage CPVT

A

ICD, flecainide, b blockers

42
Q

what causes congenital short QT syndrome

A

mutation in cardiac K channels

43
Q

how does congenital short QT present

A

AF in newborns, QT <300

44
Q

how do you manage congenital short QT

A

ICD, quinine

45
Q

what is the investigation of choice for aortic stenosis

A

echo

46
Q

how do you manage aortic stenosis?

A
  1. symptomatic = valve replacement
  2. asymptomatic with valvular gradient >40 = valve replacement
  3. asymptomatic = monitor
47
Q

what are the options for aortic valve replacement

A
  1. surgical = young fit adults
  2. transcatheter = high risk patients
  3. balloon valvoplasty = children or adults not fit for valve replacement
48
Q

what is the investigation of choice for aortic dissection

A

trans oesophageal echo

49
Q

which conditions are associated with heart failure with a preserved ejection fraction

A

hypertrophic cardiomyopathy and restrictive cardiomyopathy

50
Q

which condition is associated with heart failure with a reduced ejection fraction

A

dilated cardiomyopathy

51
Q

where are inhaled foreign bodies most likely to be found?

A

right main bronchus

52
Q

at what size would a AAA warrant surgical repair?

A

5.5cm or growing more than 1cm per year

53
Q

what is the management order for heart failure?

A 
B - b/blockers 
A - Acei 
S - spironolactone 
H - hydralazine + nitrates 
e 
D - digoxin
54
Q

symptoms of heart attack + markedly raised DDimers + normal troponin? what is the diagnosis and what is the key investigation for this condition>

A

Aortic dissection - CT aortic angio

4th year revision (32 decks)

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