Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine - Finals > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

AF rate management (in asthmatics)

A

Diltiazem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

AF rate management

A

Beta-blockers and calcium channel blockers are first line for rate control in patients with atrial fibrillation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hypercalcaemia ECG changes

A

QT shortening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which medications increase risk of VTE?

A

COCP, hormone replacement (especially if with progesterone), raloxifene/tamoxifen, antipsychotics (especially olazapine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is HOCM associated with?

A

WPW syndrome
T wave inversion
ST depression
Tall broad QRS complexes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Acute management of cardiac chest pain

A 
Morphine 
Oxygen
Nitroglycerin
Aspirin
Ticargrelor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Acute management of ACS

A

Aspirin 300mg
ECG within 10 minutes of arrival
PCI
Further telemetry monitoring + 300mg clopidogrel/ticagrelor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Management of Angina

A

Antiplatelet in in all patients
B-blocker in some patients (+/- CCB ; +/- Nitrates)
If severe - vascular revascularisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the ECG findings associated with wrong limb placement?

A

aVR - upwards

Lead II - downwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is new onset LBBB a sign of?

A

ACS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Contraindications to an exercise tolerance test

A

replacement joints, poor mobility, chest pain at rest, bbb changes on ECG, aortic stenosis, HOCM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which protocol is used to assess patients using an exercise tolerance test?

A

Bruce

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When is PCI considered the gold-standard treatment following MI?

A

if deliverable within 120 minutes and within 12 hours of symptom onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the biggest risk factor for developing AF?

A

Hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Different types of AF

A

Paroxysmal - self-terminating episodes (>1) each lasting less than a week
Persistent AF - non-self-terminating and last more than 7 days
Permanent AF - persistent symptoms that cannot be reverted to sinus rhythm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the anticoagulant of choice in AF patients with a prosthetic metal valve?

A

Warfarin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the anticoagulant of choice in AF patients?

A

Edoxiban

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Rate control for AF

A

1 - B-blocker
2 - CCB
3 - Digoxin
4 - Pacemaker + SAN ablation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Rhythm control for AF

A

Cardioversion if less than 48 hours from symptom onset otherwise anticoagulate for 3 weeks and then cardiovert

Then commence rhythm drugs e.g.,
1 - Flecainide (unless Hx of IHD or obstructive coronary disease)
2 - Sotalol
3 - Amiodarone (most potent and toxic - for use in patients with IHD)

Note - anti-coagulation should continue post-treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is fast AF (HR >200bpm) suggestive of? Management?

A

Accessory pathway

Manage with B-blocker/Amiodarone/ Felcainide
Pathway ablation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What conditions/medications are associated with orthostatic syncope?

A

Parkinson’s, Multiple System Atrophy, Diabetes, Amloidosis, Uramia, Anti-hypertensives and vasodilators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Diagnosis of Orthostatic Hypotension

A

drop in SBP of >20mmHg and DBP of >10mmHg within 3 mins of standing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What should you do in the GP setting for patients that presents with a transient loss of consciousness (T-LOC)?

A

Refer to T-LOC clinic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Poor prognostic factors of palpitations

A

Short history, prolonged episode, clear trigger, feeling poorly, on activity, syncope, chest pain, poor FHx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How would you attempt to record episodes of palpitation that occur daily/1-2 weekly/more than fortnightly/on exercise?

A
  • Daily episodes - Holter
  • 1-2 weeks - event recorder
  • > 2 weeks - implantable loop recorder
  • On exercise - ETT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

When are implantable ICDs used?

A

chronic bradycardia or VT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the difference between implantable defibrillator and cardiac resynchronisation pacemaker?

A

ICD - lead to RV apex to deliver shock

CRP - additional leads to coronary sinus, atrial pacing lead and RV defibrillating lead

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the success of RF ablations?

A

Accessory pathway SVR - 95%
Atrial Flutter - 95%
AF - 65%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the windows for hyperacute treatment of stroke?

A

<4.5 hours for thrombolysis followed by thrombectomy

<6 hours for thrombectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Define neuroplasticity

A

reorganisation of neuronal tissue to relearn tasks that were lost due to stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Difference between arteriosclerosis and atherosclerosis

A

Arteriosclerosis - thickening of blood vessel walls due to hypertension
Artherosclerosis - lumin plaques due to hypercholesterolaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Are large vessel strokes embolic or thrombotic?

A

Embolic - thrombus would take long to occlude a large vessel by which time collaterals can compensate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Can small vessel strokes can affect the cortex?

A

Not really - due to multiple collaterals supplying blood to the cortex, usually a large vessel stroke is required to cause ischaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Left cortex deficit and cortical signs

A

R-sided motor weakness
+/- dysphasia
+/- agnosia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Which large vessel supplies both brocas and wernickes area?

A

MCA

36
Q

Right cortex deficit and cortical signs

A 
L-sided motor weakness 
\+/- hemispatial neglect
\+/- personality changes
\+/- sensory inattention
\+/- apraxia
37
Q

Criteria for TACS/PACS/LACS and POCS

A

LACS

  • Unilateral weakness
  • Homonymous hemianopia
  • High cerebral function (dysphasia)

PACS
- Two of the LACS criteria

LACUNAR Stroke

  • Pure sensory
  • Pure motor

POCS (One of the following)

  • Cranial nerve palsy
  • Bilateral motor or sensory deficit
  • Conjugate eye movement disorder
  • Cerebellar dysfunction
  • Isolated hemianopia
38
Q

What is considered a long PR interval?

A

> 0.2

39
Q

What are the different types of second-degree heart block?

A

Mobitz 1 - PR interval increases until conduction is missed

Mobitz 2 - PR interval constant but every nth beat missed

40
Q

Define TIA

A

Lack of brain damage - not defined in terms of time anymore

41
Q

What on an echo is a sign of AF?

A

RA dilatation

42
Q

Describe antiplatelet therapy post stroke

A

Aspirin 300mg for 14 days
followed by clopidogrel 75mg lifelong (or aspirin 75mg + Dipyridamole MR 200mg)

Note: Lansoprazole for gastroprotection (not other PPIs as may interfere with antiplatelet function)

43
Q

Describe anti-hypertensive therapy post stroke

A

For use immediately after haemorrhagic stroke if >140 (do not use acutely in ischaemic stroke)

ACEI
Thiazide
CCB

44
Q

Describe statin therapy post stroke

A

low/mod risk –> Simvastatin 40mg

high risk –> Atorvastatin 80mg

45
Q

Co-therapy of Simvastatin and which antibiotic is contraindicated

A

Clarithromycin - risk of myopathy or rhabdomyolysis

46
Q

Describe anti-coagulant therapy post stroke

A

Anti-coagulate immediately after TIA and 2 weeks following a stroke to avoid bleed.

  • Warfarin or DOAC

Epixaban is best

47
Q

Initial management of acute heart failure

A 
Sit up
give O2
give furosemide
vasodilator to offload heart 
iv morphine

Note: avoid B-blocker

48
Q

Referral of heart failure from primary care

A

Cardiac rehab nurses and HF nurses

49
Q

Management of Chronic HF

A

Loop Diuretic, B-blocker, ACEI

e.g.,

Furosemide, Bisoprolol, Ramipril

50
Q

Management of Native valve IE (incl, for penicillin allergic)

A

Amoxicillin (Vancomycin) and Gentamicin

51
Q

Management of PWID native valve IE

A

Flucloxacillin

52
Q

Management of Prosthetic valve IE

A

Vancomycin + Gentamicin + Rifampicin

53
Q

Ix for IE

A

TTEcho

TOEcho - diagnostic used if TTE negative but high clinical suspicion

54
Q

Acute management of SVT

A

Acute management
vagal manoeuvres: e.g. Valsalva manoeuvre, carotid sinus massage
intravenous adenosine 6mg → 12mg → 12mg: contraindicated in asthmatics - verapamil is a preferable option
electrical cardioversion

55
Q

Persistent ST elevation following recent MI, no chest pain

A

left ventricular aneurysm

56
Q

ECG changes in cocaine use

A

QRS widening and QT prolongation

57
Q

Associations of Coarctation of the aorta

A

Remember BANT

Bicuspid aortic valve
berry Aneurysms
Neurofibromatosis 1
Turner’s syndrome

58
Q

Features of coarctation of the aorta

A

infancy: heart failure
adult: hypertension
radio-femoral delay
mid systolic murmur, maximal over back
apical click from the aortic valve
notching of the inferior border of the ribs (due to collateral vessels) is not seen in young children

59
Q

Acute SOB and desaturation following MI

A

Mitral Regurgitation due to tendinous cord rupture

This causes pulmonary congestion and oedema

60
Q

Treatment of symptomatic bradycardia

A

IV atropine 3mg

If fails external pacing

61
Q

What is the CHA2DS2-VASc score for?

A

Anticoagulation for AF

62
Q

CHA2DS2-VASc score

A

Congestive HF (1), Hypertension (1), Age >= 75 (2), Age 65-74 (1), Diabetes (1), Prior Stroke or TIA (2), Vascular disease (1), Sex Female (1)

2 or more offer anticoagulation

63
Q

What do you do if CHA2DS2-VASc score indicate no need for anticoagulation?

A

Transthoracic echocardiogram to exclude valvular disease

64
Q

CHA2DS2-VASc score 0 + valvular disease + AF = what treatment?

A

Anticoagulation

65
Q

What is the HASBLED Scoring for

A

Estimates risk of major bleeding for patients on anticoagulation to assess risk-benefit in atrial fibrillation care

66
Q

HASBLED Score

A

Hypertension, uncontrolled, systolic BP > 160 mmHg (1),

Abnormal renal function (dialysis or creatinine > 200) (1)
Or
Abnormal liver function (cirrhosis, bilirubin > 2 times normal, ALT/AST/ALP > 3 times normal (1)

Stroke (1)

Bleeding (history of/tendency) (1)

Labile INRs (1)

Elderly >65 (1)

Drugs Predisposing to Bleeding (Antiplatelet agents, NSAIDs) (1)
Or
Alcohol Use (>8 drinks/week) (1)

> =3 total points means high risk of bleeding

67
Q

New onset weak thready pulse, systolic murmur and elevated JVP post-MI

A

Rupture of the papillary muscle due to a myocardial infarction can lead to acute mitral regurgitation

68
Q

Kussmaul’s sign

A

In constrictive pericarditis, the JVP will rise on inspiration

69
Q

Difference between typical and atypical chest pain

A

Typical meets all criteria
Atypical as it only meets 2 out of the 3 criteria of stable angina.

Sharp chest pain (rather than constricting)
Precipitated by physical exertion
Relieved by GTN spray within 5 minutes

70
Q

AAA screening and monitoring

A

Screening: single abdominal ultrasound for males aged 65.

Monitoring:

  • <3cm no further action
  • 3 - 4.4cm scan every 12 months
  • 4.5 - 5.5cm scan every 3 months
  • > 5.5cm Refer within 2 weeks to vascular surgery for probable intervention - elective endovascular repair (EVAR)

If monitoring shows an increase of >1cm/year then refer within 2 weeks

71
Q

In which patients should cyclizine be used with caution?

A

Heart failure - it may reduce CO

72
Q

Causes of raised BNP

A

Anything that precipitates LV dysfunction

Heart failure, MI, valvular disease, CKD

73
Q

Effects of BNP

A

Reduce load on LV therefore;

vasodilator, diuretic, natriuretic, suppresses sympathetic tone and the RAA system

74
Q

When if hypertonic saline indicated?

A

Severe hyponatraemia <120

75
Q

Primary and secondary prevention of hyperlipidaemia

A

Primary - Atorvastatin 20mg od (if non-HDL not ≤40% the up the dose to 80mg)

Secondary - Atorvastatin 80mg od

76
Q

Which heart failure medications have no effect on mortality?

A

Furosemide (Loops) - symptom relief

77
Q

Which heart failure medications reduce mortality?

A

ACEI, B-blocker, Spironolactone

78
Q

Adrenaline in Cardiac arrest

A

10ml 1 in 10,000 adrenaline via IV
or
1ml 1 in 1,000 adrenaline via IV

79
Q

Management of Angina

A

All should be given aspirin and a statin

Sublingual GTN for symptoms

Beta-blocker or CCB (Verapamil or Diltiazem) to reduce attack frequency

If suboptimal response add the other (switch CCB to modified release nifedipine to avoid heart block) - if does not tolerate look at other therapies below

Last line - add third agent e.g. long-acting nitrate, ivabradine, nicorandil or ranolazine - whilst awaiting PCI or CABG

80
Q

Adverse effects of Ivabradine therapy for Angina

A

visual effects, particular luminous phenomena, are common
headache
bradycardia, heart block

81
Q

First-line in acute pericarditis

A

Ibuprofen and Colchicine

82
Q

Absolute contraindications to thrombolysis

A
  • Previous intracranial haemorrhage
  • Seizure at onset of stroke
  • Intracranial neoplasm
  • Suspected subarachnoid haemorrhage
  • Stroke or traumatic brain injury in preceding 3 months
  • Lumbar puncture in preceding 7 days
  • Gastrointestinal haemorrhage in preceding 3 weeks
  • Active bleeding
  • Pregnancy
  • Oesophageal varices
  • Uncontrolled hypertension >200/120mmHg
83
Q

Initial conservative antiplatelet management of NSTEMI

A

aspirin, plus either:
ticagrelor, if not high bleeding risk
clopidogrel, if high bleeding risk

84
Q

STEMI management: for patients undergoing PCI

A
  • dual antiplatelet therapy
  • unfractionated heparin
  • bailout glycoprotein IIb/IIIa inhibitor (GPI) if radial access used
85
Q

Factors that lower BNP levels

A 
Obesity
Diuretics
ACE inhibitors
Beta-blockers
Angiotensin 2 receptor blockers
Aldosterone antagonists
86
Q

Long-term management of Chronic Failure

A

First-line: Beta-blocker and ACEI (either started one at a time) + Loop (Furosemide - for fluid overload)

Second-line: Aldosterone Antagonist (spironolactone and eplerenone)

Third-line: ivabradine (HR >75bpm), sacubitril-valsartan, hydralazine (particularly in afro-caribeans) in combination with nitrate, digoxin (coexisting AF) and cardiac resynchronisation therapy (if widened QRS -> LBBB)

87
Q

Acute management of heart failure

A 
oxygen
IV loop diuretics
opiates
vasodilators
inotropic agents
CPAP
ultrafiltration
mechanical circulatory assistance: e.g. intra-aortic balloon counterpulsation or ventricular assist devices
stop beta-blockers

Medicine - Finals (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions