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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)?

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
What treatments are available for rate control in AF?
Beta blockers(not solatol), rate limiting CCB - diltaziem (unlicensed) or verapamil or digoxin DIVE BETA
26
When should digoxin be used for rate control?
HF, non paroxysmal AF and rate limiting drugs are unsuitable
27
What should be done if mono-therapy is found to be unsuitable?
A combination of: bb, digoxin or diltiazem should be considered(2) Otherwise consider rhythm control If LVEF <40% BB + digoxin is preferred
28
What drugs can be used for long term rhythm control in AF?
BB (as first line), flecainide, Amiodarone, propafenone, dronedarone(second line ) solatol(not first line) FAB rhythm S:PD
29
When should cardio version be considered, and what types exist l?
In pt who’s symptoms continue after HR has been controlled Electrical or pharmacological
30
What anti-arrhythmic drugs shouldn’t be offered to patients with known ischaemic or structural heart disease?
Fleccainide, propafenone
31
What type of pt should Amiodarone be considered in?
Left ventricular impairment or heart failure
32
When can pill in pocket method be used for paroxysmal AF?
No hx of very ventricular dysfunction or valvular or ischaemic heart disease >100 systolic >70 Bpm
33
When should electrical cardio version be offered?
If AfF has existed for more than 48 hours
34
What is the aim of cardio version
To restore sinus rhythm
35
What is required for electrical cardio version?
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
What drugs can be used for pharmacological cardio version?
Flecanide or Amiodarone( structural/ IHD)
37
When is should left atrial ablation be considered?
If tx isn’t tolerated in pt with symptomatic paroxysmal or persistent AF Atrial flutter (tx similar to Af but ablation preferred
38
What tools are used to assess stroke and bleeding risk?
Stroke: CHAD2DS2-VASc Bleeding: ORBIT, higher accuracy than has bled
39
When do we decide it is okay to give anticoagulants?
When risk of stroke is higher than risk of bleeding cHAD2VAS2C > 2
40
What are the CHADSVASC risk factors and their scores
1 (congestive HF, HBP, age 65-74, T2DM, vascular disease, female) 2 (age >75, stroke/tia/VTE)
41
What are some of examples of vascular disease?
Previous MI, peripheral artery disease or aortic plaque
42
What are the risk factors for bleeding, and their score?
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
Which scores determine the risk for orbit tool?
0-2 low risk 3 medium risk 4-7 high risk
44
Is aspirin recommended for stroke prevention in AF?
No multiple randomised trials, only 1 showed that aspirin was more effective than placebo(slightly)
45
What drugs can cause QT interval prolongation?
A - Antiarrythmics (Amiodarone, sotalol, fleccainide) B - antiBiotics (quinolones, macrolides, aminoglycosides) C - antipsyChotics (haloperidol, Quetiapine, risperidone) D - antiDepressants D - Diuretics E - antiEmetics (ondansetron)
46
What is torsade de pointes?
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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