Cardiovascular Flashcards
1
Q
An ECG showing an irregularly irregular heart rate and absent p waves are characteristic signs of which ECG pattern?
A
Atrial Fibrillation
This is when the left atrium loses refractoriness before the end of atrial systole, causing recurrent, uncoordinated contraction
2
Q
What classification system is used to classify severity of cardiovascular disability in heart failure
A
The New York Heart Association (NYHA) Classification system
3
Q
ECG features of First Degree Heart Block
A
Prolonged PR interval (>200ms)
4
Q
How is first degree heart block managed
A
It is a benign condition and does not need treating. However, any pathological underlying cause should be reversed.
5
Q
What inheritance pattern is Hypertrophic obstructive cardiomyopathy
A
Autosomal dominant
6
Q
Hypertrophic obstructive cardiomyopathy are at an increased risk of which conditions
A
Heart failure
Myocardial infarction
Arrhythmias
Sudden cardiac death
7
Q
ECG features of Complete Heart Block
A
No relationship between the P waves and the QRS complexes.
This occurs when the electrical impulses do not pass successfully from the atria to the ventricles
8
Q
ECG features of Second degree type 2 heart block
A
Fixed prolonged PR interval with intermittently absent QRS complexes following a P wave
9
Q
ECG features of Second degree type 1 heart block
A
Gradual lengthening PR interval which eventually leads to an absent QRS complex
Also known as Wenkebach
10
Q
Characteristic CXR feature of granulomatosis with polyangiitis
A
Bilateral nodular and cavitating infiltrates
11
Q
What three body systems are typically affected in Granulomatosis with polyangiitis (Wegener’s granulomatosis)
A
Upper respiratory tract e.g. Epistaxis, chronic sinusitis
Lower respiratory tract e.g. Cough, haemoptysis
Renal e.g. Haematuria
12
Q
A high NT-proBNP is suggestive of what condition
A
A high NT-proBNP suggests ventricular stretch and a likely diagnosis of congestive cardiac failure and pulmonary oedema
13
Q
What is the gold standard investigation to confirm the definitive diagnosis of heart failure
A
Echocardiogram (ECHO)
14
Q
What is the ECG pattern:
Broad complex tachycardia without P-waves
A
Ventricular tachycardia (VT)
15
Q
What is the ECG features of P pulmonale?
A
Right atrial enlargement produces a peaked P wave (P pulmonale)
Sign of cor pulmonale i.e. right heart failure secondary to long-standing pulmonary arterial hypertension
16
Q
Tall, peaked T waves, QTc shortening and ST-segment depression on ECG is characteristic of which electrolyte disturbance
A
Hyperkalaemia
17
Q
T wave inversion, QTc prolongation and visible U waves on ECG is characteristic of which electrolyte disturbance
A
Hypokalaemia
18
Q
Isolated QTc shortening on ECG is characteristic of which electrolyte disturbance
A
Hypercalcaemia
19
Q
Isolated QTc elongation on ECG is characteristic of which electrolyte disturbance
A
Hypocalcaemia
20
Q
None
A
None
21
Q
Short PR intervals and delta waves (slurred upstroke in the QRS complex) is the classical ECG pattern of what condition?
A
Wolff-Parkinson-White syndrome (a type of supraventricular tachycardia)
22
Q
How is Wolff-Parkinson-White syndrome managed?
A
Ablation of the accessory pathway
23
Q
ECG finding in hypothermia
A
Jesus its bloody freezing = J waves, irregular rhythms, bradycardia, first degree heart block
J-wave/Osborne wave are positive deflection is seen occurring at the junction between the QRS complex and the ST-segment.
24
Q
P pulmonale is an ECG finding of what condition
A
Right atrial enlargement
P pulmonale refers to peaked P wave i.e. P waves have a large amplitude
25
ECG findings of pericarditis
Widespread saddle-shaped ST elevation
PR depression
26
Likely Dx:
Pleuritic chest pain that radiates to the back
Pain relieved by sitting up
Pain worse on lying flat
Recent Hx of viral infection
Pericarditis (inflammation of the pericardium)
27
What is the definitive treatment for cardiac tamponade
Pericardiocentesis i.e. insertion of a needle into the pericardium to drain the built up fluid
28
Atropine is not working for acute bradycardia with haemodynamically unstable features secondary to beta blocker overdose
What is the next best step
Glucagon
29
What is the first line management in acute pericarditis
Exercise restriction and NSAIDs
30
Gold standard investigation to diagnose aortic dissection
CT angiogram
A false lumen is a key finding in diagnostic of aortic dissection
31
What is the initial management of aortic dissection
Dissection occurs when a tear in the tunica intima of the aorta creates a false lumen whereby blood can flow between the inner and outer layers of the walls of the aorta.
First line is ABCDE with resuscitation if required
Control the blood pressure to prevent further extension of the dissection with IV beta blocker, most commonly IV metoprolol
32
Radio-radial delay and radio-femoral delay are clinical signs of what condition
Aortic dissection
33
What affect does Clarithromycin have on ECG
Prolongs the QTc interval
34
What is the normal QT interval
< 440ms (two large squares)
35
When is the QT interval considered prolonged
>450 ms (two large squares)
36
A collapsing pulse is pathognomonic feature of what condition
Aortic regurgitation
37
Name the murmur
Early diastolic murmur which is heard best over the left sternal edge
Aortic regurgitation
38
Malar flush is a feature of what type of murmur?
Mitral stenosis
Malar = Mitral
39
Wide pulse pressure is associated with what type of murmur?
Aortic regurgitation i.e. the systolic and the diastolic are wide apart such as 157/61 mmHg
The pulse is wide so you have to Reach for it (Reach = Regurgiation)
40
Narrow pulse pressure is associated with what type of murmur?
Aortic stenosis i.e. the systolic and the diastolic are close together
Narrow valve flaps in stenosis= narrow pulse pressure
41
What is the first line imaging investigation for infective endocarditis
Transthoracic echocardiogram
42
Although not the first line imaging investigation for infective endocarditis. Which test is the most sensitive diagnostic test
Transoesophageal echocardiogram
43
What is the name of the criteria used as a diagnostic guide for infective endocarditis (IE), but should be used together with clinical judgement.
Modified Duke criteria
Definite IE :-
Two major criteria
OR
One major + three minor criteria
OR
All five minor criteria
44
Why is prolonged PR interval on ECG, with evidence of aortic valve involvement on echocardiogram an indication for surgery in infective endocarditis
This finding is highly associated with an aortic root abscess, a potentially fatal complication of infective endocarditis
An aortic root abscess requires prompt and extensive surgical debridement of infected and necrotic tissue, with subsequent prosthetic valve reconstruction.
45
What type of heart block is this?
ECG finding: PR interval >200ms
First degree heart block
Caused the prolonged conduction of electrical activity through the AV node
46
Name a cause of first degree heart block
High vagal tone (e.g. athletes)
MI (mainly inferior)
Electrolyte abnormalities (e.g. hyperkalaemia)
Drugs: NHP-CCBs, beta-blockers, digoxin, cholinesterase inhibitors
47
How is first degree heart block managed
First degree heart block itself is benign and does not need treating. However, any pathological underlying cause should be reversed.
48
What type of heart block is this?
Progressive lengthening of the PR interval until the P wave drop beat occurs
2nd Degree heart block - Mobitz type I
Usually due to reversible conduction block at the AV node
Usually a pattern such as 2:1
49
Name a cause of 2nd Degree heart block - Mobitz type I
High vagal tone (e.g. athletes)
MI (mainly inferior)
Myocarditis
Cardiac surgery
Drugs such as beta/calcium channel blockers, digoxin
50
Management of 2nd degree heart block Mobitz Type I
Generally asymptomatic and does not require any specific management as the risk of high AV block/ complete heart block is low.
If symptoms do arise, ECG monitoring may be required, exclude precipitating drugs and if bradycardic may require atropine.
51
What type of heart block is this?
Random P wave block (no pattern)
Constant PR intervals and then randomly a block occurs
Second degree heart block Mobitz type II
Usually caused by conduction system failure, especially at the His-Purkinje system
Different to Mobitz type I as type I has a prolonging PR interval before a drop beat and usually a pattern e.g. 3:1 block.
52
Name a cause of second degree heart block Mobitz Type II
Infarction particularly anterior MI which damages the bundle branches
Surgery: mitral valve repair or septal ablation
Inflammatory/autoimmune: rheumatic heart disease, SLE, systemic sclerosis, myocarditis
Fibrosis: Lenegre's disease
Infiltration: sarcoidosis, haemochromatosis, amyloidosis
Medication: beta-blockers, calcium channel blockers, Digoxin, amiodarone
53
What is the definitive management of second degree heart block mobitz type II
Second-degree requires Secondary input
Permanent pacemaker as these patients are at risk of risk of complete heart block and becoming haemodynamically unstable
54
What heart block is this?
Severe bradycardia and dissociation between the P waves and the QRS complexes.
Third degree heart block
55
Name a cause of Third Degree Heart Block
MI (mainly inferior)
Drugs acting at the AV node (beta blockers, calcium channel blockers)
Idiopathic fibrosis
56
What is the definitive management of Third Degree Heart Block
Permanent pacemaker due to the risk of sudden death
57
Delta waves is an ECG finding of what condition
Delta waves are intermittent QRS complexes with pre-excitation
Wolff-Parkinson-White syndrome
58
What is the definitive management of Wolff-Parkinson-White syndrome
Catheter ablation of the accessory conduction pathway
59
What is the management of Wolff-Parkinson-White syndrome in unstable patients
Urgent direct current (DC) cardioversion
Unstable patients (blood pressure <90/60mmHg or with signs of systemic hypoperfusion or fast atrial fibrillation)
60
What is the first line management option for Wolff-Parkinson-White syndrome in a stable patient
Vagal manoeuvres (carotid sinus massage or Valsalva manoeuvre)
61
Vagal manoeuvres (carotid sinus massage or Valsalva manoeuvre) is the first line management option for Wolff-Parkinson-White syndrome in a stable patient.
If that fails what is second line?
IV adenosine
62
De Musset's sign is when there is a rhythmic head nodding or bobbing in-sync with each heart beat.
Which type of murmur is this associated with?
Aortic regurgitation
63
What criteria is used to classic findings to aid the diagnosis of Rheumatic Fever
Jones criteria
Classifies the findings into major and minor manifestations
64
What drug may be used fourth-line in hypertensive patients who have a potassium greater than 4.5 mmol/L
Beta blocker e.g. Propranolol
65
What drug may be used fourth-line in hypertensive patients who have a potassium less than 4.5 mmol/L
Mineralocorticoid receptor antagonists e.g. Spironolactone as it is potassium-sparing, which means it can increase potassium levels
66
First-line treatment for hypertension in patients of any age with a history of type 2 diabetes
ACE-inhibitor e.g. Ramipril
If unable to tolerate ACE-inhibitor then switch to Angiotensin Receptor Blocker e.g. Candesartan
67
First-line treatment for hypertension in patients over 55 years of age with no history of type 2 diabetes
Calcium channel blocker e.g. Amlodipine
68
First-line treatment for hypertension in patients under 55 years of age with no history of type 2 diabetes
ACE-inhibitor e.g. Ramipril
If unable to tolerate ACE-inhibitor then switch to Angiotensin Receptor Blocker e.g. Candesartan
69
First-line treatment for hypertension in patients of any age of a Black African or Afro-Caribbean family heritage
Calcium channel blocker e.g. Amlodipine
70
What is the second line treatment for hypertension
Calcium channel blocker e.g. Amlodipine
AND
ACE-inhibitor e.g. Ramipril
71
What is the third line treatment for hypertension
Calcium channel blocker e.g. Amlodipine
AND
ACE-inhibitor e.g. Ramipril
AND
Thiazide like diuretic e.g. Indapamide
72
How should I manage a person with confirmed heart failure with reduced ejection fraction?
Ensure drugs which may cause or worsen heart failure are reviewed and stopped if appropriate.
Commence a beta blocker and ACE inhibitor
Loop diuretic e.g. Bendroflumethiazide, if they have symptoms of fluid overload are present
73
Right sided murmurs are exacerbated by what:
A) Inspiration
B) Expiration
Right sided murmurs are exacerbated by inspiration
Tricuspid and Pulmonary murmurs are right sided
"rIght = Inspiration"
74
Left sided murmurs are exacerbated by what:
A) Inspiration
B) Expiration
Left sided murmurs are exacerbated by expiration
Mitral and Aortic murmurs are left sided
"lEft = Expiration"
75
What is the commonly encountered single valve lesion secondary to rheumatic heart disease
Mitral stenosis
Diastolic murmur (typically mid-diastolic) exacerbated by expiration (hence left sided). Pliable valves sometimes have an audible opening “snap”.
The stenosis also leads to left atrial dilatation, increasing the risk of atrial fibrillation (AF), which is a common complication of MS
76
Metallic heart valves should be anti-coagulated with what type of anticoagulant
Warfarin i.e. vitamin K antagonist
77
Aortic stenosis (AS) is associated with a classic triad of symptoms
1) Heart failure
2) Syncope
3) Angina
78
Pulsatile liver can be examination finding of what type of murmur?
Severe tricuspid regurgitation due to backflow of blood into the liver during systole. It may be associated with hepatomegaly.
The patient may also have other features of right-sided heart failure including peripheral oedema and ascites.
79
Chest pain is a feature of what murmur?
Aortic stenosis
This is because the reduced blood flow across the aortic valve means that there is reduced blood flow to the coronary arteries, which branch directly off the aorta superior to the aortic valve
80
What murmur radiates to the carotid arteries
Aortic stenosis
81
What vascular obstruction causes an ST elevation in leads II, III and aVF
These leads correspond with an inferior-MI
Right coronary artery - supplies blood to the right ventricle, the right atrium, and the sinoatrial (SA) and atrioventricular (AV) nodes
82
What vascular obstruction causes an ST elevation in leads V4, V5, V6, I and aVL
These leads correspond with an antero-lateral MI
Left anterior descending artery (LAD) - supplies blood to the front of the left side of the heart
83
What vascular obstruction causes an ST elevation in leads I, aVL, V5 and V6
These leads correspond with a posterior MI
Left circumflex artery (LCx) - supplies blood to the back of the heart
Tall R waves in V1-V2
84
What type of aortic dissection typically causes radial-femoral delay rather than radial-radial delay
Aortic dissection (Type B)
85
Aortic dissection (Type B) refers to aortic dissection in which part of the aorta
Dissection in the descending portion of the aorta
BD - Type B Descending
Causes radial-femoral delay rather than radial-radial delay
86
What type of aortic dissection typically causes radial-radial delay rather than radial-femoral delay
Aortic dissection (Type A)
87
Aortic dissection (Type A) refers to aortic dissection in which part of the aorta
Dissection in the ascending portion of the aorta
All the doubles:
AA- Type A Ascending
RR - Radial Radial Delay
Causes radial-radial delay rather than radial-femoral delay
88
Bilateral hilar lymphadenopathy on chest x-ray is a chest x-ray finding in what condition
Sarcoidosis
89
What is the most common viral cause of myocarditis
Coxsackievirus B
90
What medication is first-line option for rate control of atrial fibrillation.
Beta blockers e.g. bisoprolol
91
What are the four components to assess for haemodynamic stability
Shock (suggests end organ hypoperfusion)
Syncope (evidence of brain hypoperfusion)
Chest pain (evidence of myocardial ischaemia)
Pulmonary oedema (evidence of heart failure)
92
What is the first line treatment for patients in fast AF who are haemodynamically unstable
Synchronised DC cardioversion
93
What is the first line treatment in AF patients who are stable and who present within 48 hours of onset of symptoms
Rhythm control with either synchronised DC cardioversion or pharmacological cardioversion
After 48 hours they need to be anticoagulated as a thrombus may have formed
94
AF is >48 hours (or onset is uncertain) but you want to rhythm control them with synchronised DC cardioversion.
Whats the plan
Patient must be anticoagulated for at least 3 weeks before DC cardioversion can be done.
Alternatively the patient can have a transoesophageal ECHO to rule out a thrombus in the left atrial appendage before cardioversion.
You want to do this for those that have AF with a reversible cause, who have heart failure thought to be primarily caused by AF or for whom a rhythm control strategy would be more suitable based on clinical judgement.
95
Rate or rhythm control the AF?
AF has a reversible cause
Rhythm control with either synchronised DC cardioversion or pharmacological cardioversion
After presenting after 48 hours of symptom onset they need to be anticoagulated for at least 3 weeks before DC cardioversion can be done as a thrombus may have formed
96
Rate or rhythm control the AF?
Heart failure thought to be primarily caused by AF.
Rhythm control with either synchronised DC cardioversion or pharmacological cardioversion
After presenting after 48 hours of symptom onset they need to be anticoagulated for at least 3 weeks before DC cardioversion can be done as a thrombus may have formed
97
Rate or rhythm control the AF?
New onset AF (presenting within 48 hours)
Rhythm control with either synchronised DC cardioversion or pharmacological cardioversion
98
What are the 4 situations in which you would choose rhythm control over rate control in AF
1) Reversible cause for AF
2) Heart failure thought to be primarily caused by AF
3) New-onset AF
4) Rhythm control strategy would be more suitable based on clinical judgement.
99
Raised JVP on examination is most likely to be seen in:
A) Left-sided heart failure
B) Right-sided heart failure
Right sided heart failure
100
Ankle oedema on examination is most likely to be seen in:
A) Left-sided heart failure
B) Right-sided heart failure
Right sided heart failure
101
Ascites on examination is most likely to be seen in:
A) Left-sided heart failure
B) Right-sided heart failure
Right sided heart failure
102
Orthopnoea on examination is most likely to be seen in:
A) Left-sided heart failure
B) Right-sided heart failure
Left sided heart failure
103
What is the first line diagnostic investigation for stable angina
CT coronary angiography
104
What surgical intervention is preferred for severe aortic stenosis in patients under 75 years old
Surgical aortic valve replacement
105
What surgical intervention is preferred for severe aortic stenosis in patients over 75 years old
Transcatheter aortic valve implantation (TAVI)
Preferred over more invasive surgical aortic valve replacement
106
Spironolactone is a potassium-sparing diuretic which acts as an anti-mineralocorticoid. A common side effect of spironolactone is:
A) Hypokalaemia
B) Hyperkalaemia
B) Hyperkalaemia
107
Percutaneous coronary intervention (PCI) is available to patients who present within how many occurs since the onset of chest pain
12 hours
108
Percutaneous coronary intervention (PCI) is available to patients who have been diagnosed with STEMI within what time frame
PCI should occur within 2 hours of diagnosis for STEMI
109
What is a notorious side effects of dihydropyridine calcium channel blocker e.g. Amlodipine
Lower leg oedema
110
Brugada's syndrome is caused by a mutation in what gene?
Sodium ion channel gene mutation (SCN5A)
This gene codes for a voltage-gated sodium channel
111
What is the definitive treatment of Brugada's syndrome
Implantable cardioverter defibrillator (ICD)
Reduces the risk of sudden death from arrhythmias such as VT/VF.
112
What are the ECG findings suggestive of Hypertrophic cardiomyopathy
Left ventricular hypertrophy (S wave depth in V1 + tallest R wave height in V5-V6)
Abnormal Q waves
Deep inverted T waves
113
What is the inheritance pattern for hypertrophic cardiomyopathy
Autosomal dominant
114
Hypertrophic cardiomyopathy is a congential condition as a result of mutations in genes coding for what protein?
Sarcomeric protein in cardiac myocytes
115
Driving advice post pacemaker implantation or cardiac resynchronization therapy
Notify DVLA and resume driving after 1 week
116
Why should beta-blockers and verapamil never be prescribed together
Risk of exacerbating atrioventricular conduction disorders, precipitating bradycardia and acquired complete heart block
117
What murmur is commonly seen 2-10 days post myocardial infarction
Acute mitral regurgitation
Medical emergency and needs mitral valve repair or replacement
118
Where in the heart is brain natriuretic peptide secreted from
Cardiac ventricles in response to increased stress which can develop due to heart failure
119
Hypocalcaemia does what to the QT interval
Prolongs the QT interval
120
Hypercalcaemia does what to the QT interval
Shortens the QT interval
121
What are the three steps you need to take if you have a major bleed in a patient who is on warfarin
Stop warfarin
Give intravenous vitamin K 5mg
Prothrombin complex concentrate
122
NSTEMI patients with a GRACE score > 3% should have coronary angiography within what time period since admission
72 hours
123
What risk stratifying system is used to determine the patients risk of future adverse cardiovascular events and ultimately decided the management option (in patients with ACS)
Grace score
124
What is the next step of management in a patient with new BP greater or equal to 180/120 mmHg with associated retinal haemorrhage or papilloedema
Admit for specialist assessment
125
What vaccines should be offered to patients with heart failure
Annual Influenza vaccine
AND
Single pneumococcal vaccination
126
What drugs should be a patient be discharged with following an MI
6 As:
Aspirin
Another antiplatelet e.g. Clopidogrel or Ticagrelor
Atorvastatin (Statin)
ACEi
Atenolol (beta blocker)
Aldosterone antagonist (if they have heart failure)
127
What medication is used for pharmacologically cardioversion in AF
Amiodarone
AND
Flecainide
128
Widened mediastinum is pathognomonic of what condition
Aortic dissection
129
Side effects of GTN spray
'3 H's'
1. Headache
2. Hypotensive
3. HR increase
130
Likely Dx:
Chest pain, SoB, dizziness
Post-menopausal woman
Recent Hx of emotionally stressful experience or situation
Takotsubo cardiomyopathy
131
Echo finding of Takotsubo cardiomyopathy
Hypokinetic apex.
132
How is Takotsubo cardiomyopathy managed
Conservative management
Self-resolves
133
What organism classically causes infective endocarditis in patients with poor dental hygiene or following a dental procedure
Streptococcus viridans
134
New onset murmur and low grade fever is pathognomonic of what condition
Infective endocarditis
135
What type of antibiotic leads to a prolonged QT interval which is associated with torsades de pointes
Macrolides such as erythromycin
136
Women with absent arm pulses is pathognomonic of what condition
Takayasu's arteritis (larger artery vasculitis)
137
What investigation is the primary test for the diagnosis and evaluation of severity in aortic stenosis
Echocardiography
138
What is the first line management option for Dressler's syndrome
High doses of non-steroidal anti-inflammatory drugs (NSAIDs), tapered down after two weeks
139
What is the next step in managing a patient with two measured BP >140/90
Offered either ambulatory BP monitoring or home blood pressure monitoring.
140
Patients with 'provoked' pulmonary embolism should be anticoagulated for how long?
3 months
141
Patients with 'unprovoked' pulmonary embolism should be anticoagulated for how long?
6 months
142
Patients with 'unprovoked' pulmonary embolism with active cancer should be anticoagulated for how long?
3-6 months
143
Infective endocarditis in intravenous drug users most commonly affects what valve
Tricuspid valve
144
Infective endocarditis in patients with previously normal valve most commonly affects what valve
Mitral valve
145
What three medications should be prescribed in stable angina
Beta blocker or calcium channel blocker e.g. verapamil
Aspirin
Statin
146
What anticoagulants is used as first line therapy for anticoagulation in patients with atrial fibrillation
Direct oral anticoagulants (DOACs) e.g. Apixaban
147
If angina is not controlled with a beta-blocker what medication should be added?
Longer-acting dihydropyridine calcium channel blocker e.g. amlodipine
148
What murmur causes P Mitrale appearance on ECG
Mitral stenosis
149
The first-line treatment for heart failure is ACE-inhibitor and a beta-blocker.
What is the second line treatment?
Addition of aldosterone antagonist e.g. spironolactone
Serum potassium levels should be monitored as both ICE inhibitors and aldosterone antagonists both cause hyperkalaemia
150
Trifasicular block is an important differential for falls in the elderly.
What is the triad of features
Right bundle branch block
Left anterior or posterior hemiblock
1st-degree heart block
151
In what three situations would a beta-blockers be stopped in acute heart failure
Heart rate < 50/min
Second or third degree AV block
Shock
152
S1Q3T3 is a ECG pattern for what condition
Pulmonary embolism
Describes a deep S wave in lead I, a Q wave in lead III and an inverted T wave in lead III.
Not a common finding and more commonly, sinus tachycardia is seen in pulmonary embolism.
153
Mobitz type I AV block with haemodynamic compromise.
Patient already received 3mg of atropine.
What is the next step in management
Transcutaneous pacing
154
CHA2DS2-VASc score is important consideration following a diagnosis of AF to reduce stroke risk.
A score of 1 (males) or 2 (females) indicates the patient should be started on medication to reduce the stroke risk.
What is the first line management for long-term risk reduction in strokes
DOAC such as rivaroxaban
155
Definitive management for Brugada syndrome
Implantable cardioverter-defibrillator
156
If angina is not controlled with a beta-blocker, what medication should be added
Longer-acting dihydropyridine calcium channel blocker
157
First line management of stable angina
Either a beta-blocker or a calcium channel blocker
All patient should be prescribed a statin, aspirin and GTN spray
158
If patients have persistent myocardial ischaemia following fibrinolysis then what is the next step of management
Transfer the patient for PCI
159
Q-Risk score of what indicates adding statin in hypertension management
>10%
160
First line investigation for chronic heart failure
N-terminal pro-B-type natriuretic peptide (NT‑proBNP)
161
What is the antidote for dabigatran
Idarucizumab
162
What is the antidote for warfarin
Phytomenadion
WARfarin = FIGHT (phyto)menadion
163
What is the antidote for heparin
Protamine
"Hep is a Pro"
164
Management of type A aortic dissection
Control BP (IV labetalol) + surgery
Problem is in the ascending aorta
165
Management of type B aortic dissection
Control BP(IV labetalol)
Problem is in the descending aorta
166
If the first 6mg bolus of adenosine does not work for Supraventricular tachycardia what is next step in management
if unsuccessful give 12 mg → if unsuccessful give further 18 mg
167
In constrictive pericarditis, the JVP will rise on inspiration
What sign is this
Kussmaul's sign
168
What is Kussmaul's sign
Raised JVP on inspiration
Typical of constrictive pericarditis
169
Treatment of torsades de pointes
IV magnesium sulfate
