Cardiovascular Flashcards
In which cases can a precordial thump be delivered?
Witnessed, monitored, unstable VT including pulseless VT if a defibrillator is not available for use
Which drugs are recommended post MI to improve mortality?
Dual antiplatelet therapy
Statins
ACE inhibitors
Beta blockers
Which antiplatelet can be given for ACS with ST elevation?
Aspirin plus clopidogrel for 1m or ticagrelor for 12m
Which antiplatelet can be given following PCI?
Aspirin plus one of the following for 12m:
Clopidogrel
Prasugrel
Ticagrelor
Which drugs are considered safe to use in pregnancy or during lactation to lower cholesterol?
Bile acid sequesterants or resins - e.g. colesevelam
What type of anticoagulation may be suitable for those at risk of HIT?
Fondaparinux
What is the definition of malignant hypertension?
A severe increase in BP to 180/120 with signs of retinal haemorrhage and papilloedema
What is Cheyne-Stokes breathing?
Breathing becomes progressively deeper and shallower in cycles, usually a result of brainstem lesions or raised ICP
What is an Ewart sign?
An area of dullness and bronchial breath sounds below the level of the left scapula, associated with a large pericardial effusion
What is the “Brugada sign”?
Coved ST segment elevation >2mm in >1 of V1 to V3 followed by a negative T wave
What is stage 1 hypertension?
ABPM of 135/85 to 149/94
What is the prevalence of 1st degree heart block?
7%
How many hours after MI is troponin maximally accurate?
12 hours
What is the treatment for medically managed ACS?
Aspirin and ticagrelor for 3 months
When is a pericardial friction rub best heard?
During expiration, when the patient is supine and leaning forward
Heard best at left lower sternal border
Name some clinical features associated with an aortic arch dissection?
Anterior chest pain
Can radiate into neck and jaw
In which conditions is rate control not advised for AF?
New onset
AF causing heart failure
Atrial flutter suitable for ablation
Reversible causes
Which drugs are first line for controlling stable angina?
Beta blocker
Calcium channel blocker
Name some contraindications for DOACs
Weight >120kg
Cr clearance <30ml/min
Significant liver dysfunction
What is the management plan for TIAs?
Give aspirin 300 mg immediately, unless
1. the patient has a bleeding disorder or is taking an anticoagulant (needs immediate admission for imaging to exclude a haemorrhage)
2. the patient is already taking low-dose aspirin regularly: continue the current dose of aspirin until reviewed by a specialist
3. Aspirin is contraindicated: discuss management urgently with the specialist team
If the patient has had more than 1 TIA (‘crescendo TIA’) or has a suspected cardioembolic source or severe carotid stenosis:
Discuss the need for admission or observation urgently with a stroke specialist
If the patient has had a suspected TIA in the last 7 days:
arrange urgent assessment (within 24 hours) by a specialist stroke physician
If the patient has had a suspected TIA which occurred more than a week previously:
refer for specialist assessment as soon as possible within 7 days
What are the features of essential tremor?
Postural tremor: worse if arms outstretched
Improved by alcohol and rest
Most common cause of titubation (head tremor)
What is the management for essential tremor?
Propranolol is first-line
Primidone is sometimes used
What may cause an elevated BNP?
Left ventricular hypertrophy
Ischaemia
Tachycardia
Right ventricular overload
Hypoxaemia (including pulmonary embolism)
GFR < 60 ml/min
Sepsis
COPD
Diabetes
Age > 70
Liver cirrhosis
What may cause a low BNP?
Obesity
Diuretics
ACE inhibitors
Beta-blockers
Angiotensin 2 receptor blockers
Aldosterone antagonists
What is the antiplatelet regimen following stroke?
Aspirin 300 mg daily for 2 weeks should be given immediately after an ischaemic stroke is confirmed by brain imaging. Following this, clopidogrel 75 mg daily should be given long-term -if it can be tolerated and is not contraindicated.
If clopidogrel is contraindicated or not tolerated, then the patient should be given modified-release dipyridamole alongside low dose aspirin.
What is the potassium cutoff for introducing spiro?
4.5 mmol/l
In whom is cardiac resynchronisation therapy effective?
Cardiac resynchronisation therapy is indicated in patients with left ventricular dysfunction, ejection fracture <35% and QRS duration >120ms.
What is the MOA of nicorandil?
Activates guanylyl cylcase which results in increased cGMP
Potassium channel activator
Name some SEs of nicorandil
headache
flushing
skin, mucosal and eye ulceration
gastrointestinal ulcers including anal ulceration
What is the MOA of bupropion?
A norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist
What are some contraindications to bupropion px?
Small risk of seizures (1 in 1,000)
contraindicated in epilepsy, pregnancy and breast feeding. Having an eating disorder is a relative contraindication
Name some ECG features of a posterior MI
Changes in V1-3
Reciprocal changes of STEMI are typically seen:
horizontal ST depression
tall, broad R waves
upright T waves
dominant R wave in V2
What is the 1st line investigation for stable angina?
CT coronary angiogram
Which score is now used to assess bleeding risk?
ORBIT
Which drugs should be avoided in HOCM?
Inotropes
ACE-i
Nitrates
What is the antiplatelet choice in medical NSTEMI management?
aspirin, plus either:
ticagrelor, if not high bleeding risk
clopidogrel, if high bleeding risk
