Cardiovascular Flashcards
What is the difference between Mobitz type 1 and 2?
- Mobitz Type 1: progressive PR prolongation
- Mobitz Type 2: the PR interval is constant but some P waves are dropped
Name some indications for temporary pacing
- Symptomatic bradycardia
- Prophylactically for severe bradycardia (2nd/3rd degree AV block, posterior MI etc.)
Name some indications for permanent pacing
- Alternating RBBB/LBBB
- Unexplained syncope with bifascicular/trifascicular block
- Symptomatic sinus node disease
- Carotid sinus hypersensitivity/ malignant vasovagal syncope
What is the mechanism of digoxin
- Cardiac glycoside: inhibits the sodium-potassium ATPase pump
- Improves cardiac contraction
Describe the presentation of digoxin toxicity
- Nausea and vomiting
- Bradycardia or tachycardia
- VT/VF
- Reverse tick appearance in lateral leads
Describe the management of digoxin toxicity
- Stop digoxin
- Digibind
Name the indications for amiodarone
- VT
- Supraventricular tachycardia
What is adenosine used for?
Conversion of paroxysmal supraventricular tachycardia
Which factors does warfarin inhibit?
II, VII, IX and X
What is the mechanism of action of dabigatran and apixaban?
Direct thrombin inhibitors
What is the mechanism of action of rivaroxaban and edoxaban?
Factor Xa inhibitors
What investigations might be done to diagnose heart failure?
- ECHO
- 12 lead ECG
- BNP
- Radionucleotide scan
- Left ventriculogram
- Cardiac MRI
Name some of the causes of heart failure
- Ischaemic heart disease
- Valvular heart disease
- Pericardial constriction or effusion
- Inherited
- Cardiomyopathies
- Hypertension
- Infections
Name the management options for heart failure
- Diuretics (furosemide/bumetanide)
- ACE Inhibitors/ARBs
- Beta blockers
- ARBs
- ARNIs (Entresto)
Which heart failure treatments improve symptoms?
- Diuretics
- Digoxin
- ACE inhibitors/ARBs
- Spironolactone
- Valsartan
Which heart failure treatments improve survival?
- ACE inhibitors/ARBs
- Spironolactone
- Valsartan
- Beta blockers
- Ivabradine
Name some of the common side effects of furosemide
- Dehydration
- Hypotension
- Hypokalaemia
- Hyponatraemia
- Gout
- Impaired glucose tolerance
- Diabetes
Describe the stages of hypertension
- Stage 1: ABPM 135/85 mmHg
- Stage 2: ABPM 150/95mmHg
- Severe: Systolic >180mmHg or diastolic > 110mmHg
What is the first line anti-hypertensive medication for someone aged over 55 years or of Afro-Caribbean descent
Calcium channel blockers (if contraindicated then thiazide like diuretic)
What is the second line treatments for hypertension?
Thiazide type diuretic (indapamide etc.)
What are the third line options for hypertension?
- CCB
- ACEI
- Diuretic
What is the first line management of hypertension in someone <55 years?
ACEI or ARB
What is the fourth line management for hypertension
- Spironolactone if potassium <4.5
- Alpha blocker or beta blocker if potassium >4.5
How can stable angina be managed?
- Address risk factors
- Statins
- ACE Inhibitors
- Aspirin 75mg or Clopidogrel
- Beta blockers
- Calciun channel blockers
- Ivabridine
- GTN
- Nicorandil (K+ channel blocker)
- PCI or CABG
Name the drugs used for thrombolysis in an MI
- Tenecteplase
- Alteplase
- Streptokinase
How can an MI be managed acutely?
-Oxygen if sats <94%
-GTN
-Opiates
-Aspirin 300mg
-Clopidogrel 300mg or Ticagrelor 180m
-Fondaparinux/LMWH
-GIIb/IIIa receptor blockers
-Prasugrel
-
How can MIs be prevented by secondary prevention
- Aspirin 75mg
- Clopidogrel 75mg or Ticagrelor 90mg
- Beta blockers
- Statins
- ACE inhibitors
How does dilated cardiomyopathy present?
- Dyspnoea
- Fatigue
- Orthopnoea
- Ankle swelling
- Cough
- Narrow pulse pressure
- Elevated JVP
- MR murmur
Which drugs can be used to treat dilated cardiomyopathy?
- ACEIs
- Diuretics
- Beta blockers
- Spironolactone
- Cardiac transplant
How does hypertrophic cardiomyopathy present?
- Fatigue
- Dyspnoea
- Angina
- Pre-syncope and syncope
- Notched pulse pattern
- Thrills and murmurs
How can hypertrophic cardiomyopathy be managed?
- Avoid heavy exercise or dehydration
- Genetics
- Beta blockers or verapamil
- Surgery or alcohol septal ablation
How can pericarditis be managed?
- NSAIDs and colchicine
- Drainage
How does cardiac tamponade present?
- SOB and dizziness and chest pain
- Low BP
- Pulsus paradoxus
How can constrictive pericarditis be managed?
- Limited diuretics
- Pericardectomy
Which organism is the most common cause of infective endocarditis?
Strep viridans (staph aureus is 2nd)
How does infective endocarditis present?
- Fever
- New heart murmur
- Splenomegaly
- Petechiae
- Osler nodes
- Janeway lesions
- Splinter haemorrhages
Which antibiotics should be used for infective endocarditis?
- Amoxicillin +/- gentamicin
- Severe: vancomycin + gentamicin
- Prosthetic valve: vancomycin + gentamicin
How does mitral stenosis present?
- Dyspnoea
- Haemoptisis
- Systemic embolisation
- IE
- Chest pain
- Mitral facies
- Diastolic thrill and RV heave
- Rumbling diastolic murmur at apex
How does mitral regurgitation present?
- Acute: SOB, pulmonary oedema and cardiogenic shock
- Chronic: dyspnoea, exhaustion and RHF
- High pitched blowing holosystolic murmur
How does aortic stenosis present?
- Chest pain
- Syncope
- Breathlessness on exertion
- Heart failure
- Harsh cresendo-decrescendo systolic murmur
How does aortic regurgitation present?
- Exertional breathlessness
- Collapsing pulse
- Wide pulse pressure
- Soft high pitched early diastolic murmur
How does acute limb ischaemia present?
- Pale
- Pulseless
- Painful
- Paralysed
- Paraesthetic
- Perishingly cold
How can acute limb ischaemia be managed?
- Urgent reconstruction for trauma
- Fasciotomy for compartment syndrome
- Embolectomy
- Anticoagulation
- Thrombolysis
- Amputation
How can chronic limb ischaemia be managed?
- Antiplatelets
- Statin
- BP control
- Smoking cessation
- Exercise
- Diabetic control
- Angioplasty, stent, surgical bypass and endovascular reconstruction
- Amputation`
How can varicose veins be managed?
- Prevention
- Referral for bleeding varicose veins or venous ulcers
- Endothermal ablation, ultrasound guided foam sclerotherapy and striping of the vein
How can venous ulcers be managed?
- Graduated compression
- Debridement and cleaning
- Dressing
- Antibiotics only if infected
- Pentoxifylline if chronic
- Topical steroid for surrounding venous dermatitis
