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MRCGP > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Angina questions

A

Pain characteristics
Relationship to exertion
Associated symptoms (SOB)
Exercise tolerance
Some patients (especially those with diabetes) may not describe pain but may have reproducible exercise-induced symptoms (nausea/SOB)

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2
Q

CVD risk factors

A

CVD hx (MI, CABG, CCF, TIA, PVD)
ejection systolic murmur suggesting aortic stenosis.
Hypertrophic cardiomyopathy, e.g. family history, examination, or ECG changes.
Age
Male
Smoker or ex-smoker
FHx IHD<60
Ethnic background, South Asian and Afro-Caribbean
Lifestyle, sedentary, unhealthy diet, alcohol
CKD
Diabetes
Hyperlipidaemia
Hypertension
Obesity or overweight
RA, PCOS
Serious mental health problems

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3
Q

Non cardiac causes of chest pain

A

Gastrointestinal cause, GORD, biliary colic- Check relation to food
MSK
Pericarditis
Anxiety or panic disorder
Respiratory cause
Breast pain
Shingles
Viral cause

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4
Q

Initial management angina

A

Atorvastatin 20mg
Aspirin 75mg
GTN
Bisoprolol 2.5mg
Urgent referral rapid access chest pain clinic

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5
Q

Symptoms of unstable angina

A

Pain at rest, which may occur at night
Pain on minimal exertion
Angina that seems to be rapidly progressing despite increasing medical treatment

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6
Q

Advice to reduce CVD risk factors

A

Smoking cessation
Diabetes control
Weight management
Appropriate exercise

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7
Q

ECG changes suggesting STEMI

A

S–T elevation 1 mm or greater in 2 or more I, II, III, AVR, AVL, AVF
S–T elevation 2 mm or greater in 2 or more V1 to V6
New LBBB
widespread ST depression.
T‑wave inversion esp V2, V3, and V4

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8
Q

STEMI management

A

999, 300mg aspirin, GTN, pain relief

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9
Q

Pericarditis signs

A

Chest pain, sharp, pleuritic, improved by sitting up + leaning forward
Pericardial friction rub
ECG widespread concave S–T segment elevation or PR depression
Pericardial effusion
Fever, flu-like symptoms, raised CRP
Pericarditis can cause raised troponin.

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10
Q

Underlying causes of AF

A

Infection
Dehydration
Surgery
Cardiac- MI, HTN or valvular heart disease, ischaemic or non-ischaemic cardiomyopathy
Respiratory- exacerbation COPD, sleep apnoea, PE, pneumonia
Excessive alcohol intake
Thyrotoxicosis
Obesity

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11
Q

CHA2DSVASc

A

Congestive heart failure
Hypertension hx
Age>75
Diabetes
Stroke
Vascular disease (CVD, PVD)
Age 65-74
Female

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12
Q

ORBIT

A

Hb under 120 F, 130 M
Age >74 years +1

Bleeding history +2
Any history of GI bleeding, intracranial bleeding, or hemorrhagic stroke

GFR <60 mL/min/1.73 m2 +1

Treatment with antiplatelet agents +1

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13
Q

Admit AF if

A

Pulse>150
SBP<90 mmHg
Myocardial ischaemia
Severe dizziness or SOB
Haemodynamic instability
Pulmonary oedema
Chest pain
Syncope or presyncope

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14
Q

Rate control medication

A

Bisoprolol
Diltiazem
Verapamil (NOT WITH B-BLOCKER)
Digoxin

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15
Q

pAF management

A

Routine cardiology referral for holter to diagnose
Anticoagulate as in AF
Routine cardiology ref re ablation/pill in pocket flecainide

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16
Q

Symptoms CCF

A

Dyspnoea
Peripheral oedema
Fatigue
Weakness
Decreased exercise tolerance

17
Q

Ix CCF

A

FBC, electrolytes and renal function, LFT, TFT, lipids, HBa1c, ferritin, urinalysis
BNP
ECG
CXR
Urgent cardio ref if BNP>400

18
Q

Lifestyle modification for CCF

A

Reduce salt intake (2g/day)
Stop alcohol + smoking
Cardiac rehab for breathlessness
Annual influenza + one off pneumococcal

19
Q

CCF exacerbation causes

A

MI
Arrhythmia
Poor adherence to treatment
New medication
Diet/exercise
Anaemia
Infection

20
Q

Murmur hx

A

Chest pain
Syncope
Palpitations
SOB
Fatigue
Congenital heart disease
Rheumatic fever
Heart failure

21
Q

Positions of murmurs

A

The apex in the left lateral position in expiration (mitral murmurs)
The left sternal border sitting forward in expiration (aortic regurgitation)
The neck for radiation (aortic stenosis).
MRS ASS

22
Q

When do you need fasting lipids?

A

For LDL, needs 12 hrs fast overnight

23
Q

Secondary causes of hyperlipidaemia

A

T2DM (TGs)
Hypothyroidism (cholesterol + TGs)
Nephrotic syndrome (cholesterol)
Cholestatic liver disease (cholesterol)
Alcohol excess (TGs)
Obesity (TGs)
Anorexia nervosa (cholesterol)
Drug causes:
Olanzapine, clozapine
Sertraline, venlafaxine, quetiapine, mirtazapine
Cyclosporin

24
Q

New high lipid Ix

A

HbA1c, TFTs, U+E, urine dip, LFT

25
Q

How do you diagnose familial hypercholesterolaemia?

A

Definite if:
Cholesterol>7.5 + tendon xanthomas
(or in 1st or second degree relative)
OR LDL-receptor mutation, familial defective apo B100, or a PCSK9 mutation
Possible if MI<50 2nd degree or 60 1st degree
Cholesterol>7.5 adult or 6.7 child
LDL-C>4.9 adult 4.0 child

26
Q

When do you offer statin regardless of QRISK?

A

T1DM if
-older than 40 years.
-diabetes diagnosed>10 yrs
-established nephropathy.
-other CVD risk factors.

Any CKD

27
Q

Which medications cause long QT?

A

Antiarrhythmics, e.g. flecainide, amiodarone, sotalol
Lithium
TCAs
SSRIs- citalopram, escitalopram
Antipsychotics, e.g. haloperidol, phenothiazines such as chlorpromazine
Domperidone
Methadone
Erythromycin, clarithromycin, quinolones such as ciprofloxacin
Fluconazole
Quinine

28
Q

High risk Vs med risk Vs low risk CCF
And referral

A

High risk – any of:
BNP greater than 2000 nanogram/L
Previous MI
Major ECG changes, ischaemia or LBBB or QRS>120
Medium risk – BNP> 400
Low risk – BNP less than 400 no cardiac history, no cvd risk factors
High + medium both urgent referral cardiology

29
Q

CCF treatment

A

ACEi/ARB Ramipril 2.5mg
Bisoprolol 2.5mg OD
Spironolactone 12.5-25mg OD
Consider dapagliflozin
Consider aspirin 75mg if CVD, consider atorvastatin 20mg

30
Q

Dapagliflozin details

A

10mg once daily
Risk fourniers gangrene, normoglycaemic ketoacidosis
Sick day rules
UTIs and genital infections

31
Q

Red flags palpitations

A

breathlessness, chest pain, syncope, or pre-syncope
Sudden onset and offset, very rapid, and can be described as too fast to count + haemodynamic instability (?SVT/VT)
Triggered by exercise
Hx sudden death

32
Q

Common triggers palpitations

A

Caffeine
Alcohol
Ilicit drugs
Salbutamol
Theophylline
Decongestants
Citalopram
TCAs

33
Q

Underlying cause palpitations

A

Cardiac structural disease- cardiomyopathy, valvular disease
Psychiatric- anxiety, PTSD
High output state-infection, anaemia, pregnancy
Endocrine- hyperthyroid, phaeochromocytoma
Electrolyte imbalances

34
Q

Stages of hypertension

A

Stage 1
Clinic BP 140/90-159/99 mmHg HBPM average BP 135/85-149/94

Stage 2
Clinic BP 160/100-180/120
HBPM average BP 150/95+

Stage 3
Clinic BP 180 /120+

35
Q

Treatment HTN

A

1st line
If age<55 or T2DM =A
If age>55 or black African = C
If CCF = D

2nd line
A + C or A + D or C+D

3rd line
A + C + D

4th line- refer + B or alpha blocker

A = ACEi or ARB (ARB if black African)
B= bisoprolol
C= CCB
D= indapamide/thiazide

36
Q

Ix HTN

A

Assess for end organ damage
-ECG for LVH
-Retinopathy
-U+E and urine ACR, HbA1c, lipids

MRCGP (20 decks)

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