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Pre-Registration Exam > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What is arrhythmia?

A

ARRhythmia = Abnormal, Rate &/or Rhythm
Caused by issues with the electrical conducting system of the heart

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2
Q

What is normal, bradycardic and tachycardic heart rhythm?

A

60-100bpm
<60bpm
>100bpm

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3
Q

What is paroxysmal atrial fibrillation?

A

Episodes of AF that stop within 7 days, usually 2 days without tx

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4
Q

How is paroxysmal AF managed?

A

Pill in pocket - pt treats with AA drug when episode occurs

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5
Q

What is an ectopic beat? And how can it be treated?

A

Spontaneous extra/missed beat
Tx not usually required by BB are considered safest

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6
Q

What are symptoms of arrhythmia?

A

PADS
Palpitations
Abnormally fast, irregular or slow pulse
Dizziness/faint
Shortness of breath

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7
Q

What does management of arrhythmia require?

A

Diagnosis of the type, electrocardiography and identification of underlying causes

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8
Q

What are the main causes of arrhythmia

A

CHD, HBP, aging, cardiomyopathy ( muscle disorder), congenital and electrolyte imbalance

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9
Q

What are the different types of arrhythmia (9)?

A

Ectopic beats, AF, paroxysmal atrial fibrillation, atrial flutter, paroxysmal Supraventricular tachycardia, ventricular tachycardia, Supraventricular arrhythmia

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10
Q

What is the aim of AF treatment?

A

Reduce symptoms and prevent complications

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11
Q

What should be assessed in all pt with AF?

A

Risk of stroke, VTE risk, bleeding risk

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12
Q

How should all pt with life threatening haemodynamic instability caused by new-onset AF be treated?

A

Emergency electrical cardio version

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13
Q

How should pt with non-life threatening haemodynamic instability caused by new-onset AF be treated?

A

Rhythm or rate control should be considered if onset is <48 hours
Rate control is preferred if onset is >48 hours or uncertain

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14
Q

What type of non-AA medication should be offered to pt with new onset AF?

A

If not already taking anticoagulant Parental: heparin
Oral: DOAC, warfarin (in renal impairment)

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15
Q

What medications can only be used to treat Supraventricular arrhythmia?

A

Verapamil, adenosine & cardiac glycosides

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16
Q

What drugs can only be used to treat ventricular arrhythmia?

A

Lidocaine

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17
Q

What drugs can be used to treat Supraventricular and ventricular arrhythmia?

A

Amiodarone and BB

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18
Q

How does Vaughan Williams classify drugs?

A

According to effects on electrical activity of heart

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19
Q

What is class I (Vaughan Williams)?

A

Membrane stabilising drugs -sodium channel blockers
Lidocaine and flecainide

20
Q

What is class II (Vaughan Williams)?

A

BB

21
Q

What is class III (Vaughan Williams)?

A

Potassium channel blocker
Amiodarone, solatol(also 2)

22
Q

What is class IV (Vaughan Williams)?

A

CCB doesn’t include dihydropyridines

23
Q

What is the preferred first line treatment strategy for AF?

A

Rate control

24
Q

When is rate control not the preferred first line treatment?

A

New onset AF, atrial flutter suitable for ablation, AF with reversible cause l(mi, hyperthyroidism, caffeine, alcohol), HF mainly caused by Af, if rythmn is more suitable

25
Q

What treatments are available for rate control in AF?

A

Beta blockers(not solatol), rate limiting CCB - diltaziem (unlicensed) or verapamil or digoxin
DIVE BETA

26
Q

When should digoxin be used for rate control?

A

HF, non paroxysmal AF and rate limiting drugs are unsuitable

27
Q

What should be done if mono-therapy is found to be unsuitable?

A

A combination of: bb, digoxin or diltiazem should be considered(2)
Otherwise consider rhythm control
If LVEF <40% BB + digoxin is preferred

28
Q

What drugs can be used for long term rhythm control in AF?

A

BB (as first line), flecainide, Amiodarone, propafenone, dronedarone(second line ) solatol(not first line)
FAB rhythm S:PD

29
Q

When should cardio version be considered, and what types exist l?

A

In pt who’s symptoms continue after HR has been controlled
Electrical or pharmacological

30
Q

What anti-arrhythmic drugs shouldn’t be offered to patients with known ischaemic or structural heart disease?

A

Fleccainide, propafenone

31
Q

What type of pt should Amiodarone be considered in?

A

Left ventricular impairment or heart failure

32
Q

When can pill in pocket method be used for paroxysmal AF?

A

No hx of very ventricular dysfunction or valvular or ischaemic heart disease
>100 systolic >70 Bpm

33
Q

When should electrical cardio version be offered?

A

If AfF has existed for more than 48 hours

34
Q

What is the aim of cardio version

A

To restore sinus rhythm

35
Q

What is required for electrical cardio version?

A

Anticoaglation for at least 3 weeks due to stroke risk
If not possible give heparin immediately before cardio version
Oral anticoagulation should be given after

36
Q

What drugs can be used for pharmacological cardio version?

A

Flecanide or Amiodarone( structural/ IHD)

37
Q

When is should left atrial ablation be considered?

A

If tx isn’t tolerated in pt with symptomatic paroxysmal or persistent AF
Atrial flutter (tx similar to Af but ablation preferred

38
Q

What tools are used to assess stroke and bleeding risk?

A

Stroke: CHAD2DS2-VASc
Bleeding: ORBIT, higher accuracy than has bled

39
Q

When do we decide it is okay to give anticoagulants?

A

When risk of stroke is higher than risk of bleeding
cHAD2VAS2C > 2

40
Q

What are the CHADSVASC risk factors and their scores

A

1 (congestive HF, HBP, age 65-74, T2DM, vascular disease, female)
2 (age >75, stroke/tia/VTE)

41
Q

What are some of examples of vascular disease?

A

Previous MI, peripheral artery disease or aortic plaque

42
Q

What are the risk factors for bleeding, and their score?

A

O - older than 75 1
R - reduced haemoglobin hx anaemia 2
B - bleeding hx 2
I - inadequate renal function 1
T - treatment with anti-platelet 1

43
Q

Which scores determine the risk for orbit tool?

A

0-2 low risk
3 medium risk
4-7 high risk

44
Q

Is aspirin recommended for stroke prevention in AF?

A

No multiple randomised trials, only 1 showed that aspirin was more effective than placebo(slightly)

45
Q

What drugs can cause QT interval prolongation?

A

A - Antiarrythmics (Amiodarone, sotalol, fleccainide)
B - antiBiotics (quinolones, macrolides, aminoglycosides)
C - antipsyChotics (haloperidol, Quetiapine, risperidone)
D - antiDepressants
D - Diuretics
E - antiEmetics (ondansetron)

46
Q

What is torsade de pointes?

A

Heartbeats in a irregular way, usually very fast, body starved of oxygen leading to blackouts, fainting or death

Pre-Registration Exam (2 decks)

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