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DIPLOMA 📚 > Cardiovascular 2 > Flashcards

Cardiovascular 2 Flashcards

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1
Q

Epidemiology of angina

A

Just under £2 mill people

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2
Q

Symptoms of angina

A

Chest, jaw, arm pain, sweating, indigestion, nausea

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3
Q

Pathogenesis of angina

A

Atherosclerosis
Smooth muscle cells migrate and release collagen
Fibrous plaque formation
Atheromatous plaque

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4
Q

Causes of vasospastic (prinzmetals) angina

A 
Smoking
Electrolyte disturbance (mg/k)
Cocaine 
Cold 
Insulin resistance
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5
Q

What is cardiac x syndrome

A

Angina like pain
Positive evidence of MI
Normal coronary angiogram

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6
Q

Management of angina

A

Aspirin 300mg stat then 75mg OD

SL or buccal GTN

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7
Q

Angina prophylaxis

A

1) BB (atenolol, bisop, metop, propranolol)
2) rlCCB (diltiazem, verapamil)
3) ISMN
4) nicorandil
5) ivabradine
6) ranolazine

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8
Q

Drugs used in pharmacological stress test

A

Adenosine
Dipyridamole
Dobutamine
Thallium-201 radio labelled

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9
Q

How do nitrates work

A

Stimulate cGMP production and inhibit thromboxane synthase

Nitrates are converted into nitric oxide NO which is identical to endothelin derived relaxing factor (EDRF) and endogenous vasodilator

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10
Q

How does nicorandil work

A

Potassium channel activator acts to increase permeability of K+ channels and also as a nitric oxide donor:

Arterial vasodilation reducing afterload
NO donor produces peripheral venous relaxation and a reduction in preload

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11
Q

Side effects of nicorandil

A

GI ulcers, skin and mucosal ulceration

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12
Q

Nicorandil study

A

The impact of nicorandil in angina (IONA)

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13
Q

How do BB work in angina

A

Reduce myocardial oxygen demand via reduction in sympathetic stimulation of the heart

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14
Q

When do you use CBBs for angina

A

Second line rlCCBs

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15
Q

Can you use rlCCB in sick sinus syndrome and heart block

A

NO!

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16
Q

Can you use CCBs in angina and patients with congestive heart failure or low ejection fraction

A

no but you can use amlodipine (PRAISE trial)

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17
Q

True or false - ranolazine effects HR, BP or inotrooic state of the myocardium

A

No it doesn’t

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18
Q

How does ranolazine work?

A

Inhibits late sodium current and calcium overload during ischaemia therefore reducing ischaemia

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19
Q

Interactions with ranolazine

A

Contraindicated with potent CYP3A4 inhibitors such as rifampicin, carbamazepine. It doubles plasma level of sim a statin and increases digoxin level by 1.5 times

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20
Q

Ranolazine should be used with caution in:

A

<60kg
CHF
Elderly

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21
Q

Can ranolazine prolong QT

A

Yes

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22
Q

Ranolazine is contraindicated in what renal function

A

<30ml/min

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23
Q

Ivabradine is used when

A

Angina with sinus rhythm who are intolerant of BB (can also be used in addition to BB)

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24
Q

Can you use ivabradine with rlCCB

A

NOOOO

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25
Q

Most common side effect of ivabradine

A

Luminous visual phenomena

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26
Q

Studies for ramipril in stable CAD

A

HOPE

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27
Q

Study for perindopril in stable CAD

A

EUROPA

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28
Q

Contraindications to prasugrel

A

Previous stroke
Age >75yrs
Low body weight <60kg

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29
Q

Why can ticagrelor cause on administration

A

Transient dyspnoea

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30
Q

MOA of thrombolytic drugs

A

Converts plasminogen into active plasmin, which degrades fibrin and so breaks up thrombi. Also they produce clot dissolving and pro-coagulant actions

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31
Q

Name 4 thrombolytic drugs

A

Streptokinase
Alteplase
Reteplase
Tenecteplase

32
Q

Pre-disposing factors for arrhythmia

A 
Post-MI necrosis 
Hypertension
Diabetes
Inflammatory heart condition
Sympathetic stimulation
Drugs
Electrolyte abnormalities
Hypovolaemia 
Systemic infection
Pericarditis
Pulmonary disease
Post-Op
Hyperthyroid
33
Q

Signs and symptoms of arrhythmias

A 
Palpitations
Fatigue 
Chest pain 
SoB
Syncope
Light headed ness
34
Q

Patient with sinus bradycardia who is unstable can have what treatment

A

IV atropine 0.5-1mg every 3-5 mins up to 3mg total

35
Q

Causes of sinus tachycardia

A 
Exercise
Excitement
Heammorhage 
Infection
Hypovolaemia
Anaemia
PE
Shock
Thyrotoxicosis
Drugs (nicotine, thyroxine, isoprenaline, aminophylline, atropine)
36
Q

Three management objectives for AF

A

Prevention of stroke
Preservation of ventricular function
Control of the arrhythmia

37
Q

Which classes should be avoided in the acute management of AF

A

Class 1 and 2

38
Q

Non cardiac causes of AF

A 
Nicotine 
Alcohol
Caffeine 
Physical and mental stress
Hyperthyroid
Premenstrual
Electrolyte disturbance
Drugs
Anaemia
Anxiety 
Fever
Infection
39
Q

Cardiac causes of AF

A 
IHD
MI
CHF
Cardiomyopathy 
Valvular disease
Congenital heart disease
Myocardial scarring eg TB
Long QT syndrome 
Brugada syndrome
40
Q

What scale is used for AF and what are they

A

EHRA scale

1) no symptoms
2) mild: normal daily activity unaffected
3) severe: normal daily activity affected
4) disabling: normal daily activity discontinued

41
Q

What shoes AF on an ECG

A

Irregular R waves

42
Q

What’s CHA2DS2VASC

A 
CHF
Hypertension
Age >75
Diabetes 
Stroke 
Vascular disease 
Age 65-74
Sex (female)
43
Q

HASBLED

A 
Hypertension
Abnormal liver/renal
Stroke
Bleeding 
Labile INR
Elderly >65
Drugs (alcohol)
44
Q

Anticoagulant in crcl < 15ml/min

A

Warfarin

45
Q

What’s paroxysmal AF

A

Self limiting <48hrs

46
Q

What’s persistent AF

A

AF episode continues > 7 days or necessitates termination via cardioversion

47
Q

What’s long-standing persistent AF

A

Lasts longer than 1yr

48
Q

Management of acute AF in a stable patient

A

Oral BB or rlCCB

49
Q

Acute management of AF in severely compromised patient

A

IV verapamil or metoprolol
Acute setting target HR 80-100

Amiodarone can be used in selected patients

50
Q

Acute AF with a slow ventricular response can be treated with what

A

Atropine 0.5-2mg IV

51
Q

Drug options for pharmacological cardioversion in AF

A

Flecainide 2mg/kg over 10mins

Propfenone AF<48hrs 2mg/kg over 10-20mins

Amiodarone 5mg/kg for 1st hr then 50mg/hr via central line

52
Q

Anticoagulation should be in place for direct current cardioversion for how long prior and post?

A

3 weeks prior unless AF <48hrs and up to 4 weeks post

53
Q

For pharmacological cardioversion in AF can you use flecainide or propafenone in IHD CHF and asthma/COPd for propafenone

A

NO use amiodarone

54
Q

Why should rlCCB be avoided in HF

A

Negative inotropic effect

55
Q

Does digoxin work during exercise

A

Nope

56
Q

Half life of amiodarone

A

30-120 days

57
Q

What is dronedarone

A

Rate control similar to amiodarone structure

58
Q

Two types of ventricular arrhythmia

A

Ventricular tachycardia

Ventricular fibrillation

59
Q

Management of ventricular tachycardia in a haemodynamically stable patient

A

Correct electrolyte abnormalities
Use amiodarone or lidocaine infusion
If persists use DCC or further amiodarone

60
Q

Management of ventricular tachycardia in haemodynamically unstable patient

A

Use DC cardioversion

Then amiodarone

61
Q

Treatment of ventricular fibrillation

A

Defibrillation always required
Once rhythm re-established use amiodarone or procainamide
Can sometimes use lidocaine

62
Q

How many classes are there in the Vaughan Williams classification

A

4

63
Q

How do class 1a drugs work in the Vaughan Williams classification and give examples

A

Slow phase 0 and depress phase 4 depolarisation

Used in VT associated with Wolff-Parkinson-white syndrome

Procainamide
Disolyramide

64
Q

How do class 1b drugs work in the Vaughan Williams classification and give examples

A

Shorten refractoriness and the action potential as well as WT internal

Lidocaine
Phenytoin

65
Q

True or false: phenytoin is a class 1b anti-arrhythmia drug that the IV prep is strongly alkaline and may crystallise in tissues

A

True dat

66
Q

Contraindications of lidocaine

A

Sinoatrial disorder
AV block
Myocardial depression
Porphyria

67
Q

How do class 1c drugs work in the Vaughan Williams classification and give examples

A

Sodium channel blockers which prolong PR, QRS and QT interval but no effect on refractory period

Flecainide
Propafenone

68
Q

Contraindications to flecainide

A

Severe cardiac failure
Cardiomyopathy
Recent MI

69
Q

Cautions to propafenone use

A

Contraindicated in asthma and bronchispastic disease

Increases plasma digoxin levels

70
Q

How does the class 2 of the Vaughan Williams classification drugs work and give examples

A

Beta blockers - modulate sympathetic stimulation

Bisoprolol

71
Q

How does the class 3 of the Vaughan Williams classification drugs work and give examples

A

Blockade of the potassium channels increasing refractoriness action potential and QT interval

Amiodarone
Sotolol
Bretylium

72
Q

Benefit of dronedarone over amiodarone

A

Amiodarone without the iodine atom therefore no thyroid toxicity

73
Q

Cautions with sotalol

A

Diuretics and hypokalaemia

74
Q

How does the class 4 of the Vaughan Williams classification drugs work and give examples

A

Calcium channel blockers

Verapamil
Diltiazem

75
Q

Other drugs for arrhythmias not in the Vaughan Williams classification

A

Digoxin

Adenosine (caution asthma)

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