Cardiovascular Medicine Flashcards
What is the first line management of SVT?
Vagal manoeuvres
What is the second line management of SVT?
Adenisune (6mg -> 12mg -> 18mg)
Who is adenosine contraindicated in?
Asthmatics
When is a shock delivered in DC cardioversion?
Synchronised to peak of R wave
What is the first line investigation in heart failure?
NT-pro BNP
Which conditions can increase BNP?
Ischaemia, tachycardia, hyperaemia, GFR <60, RV overload, sepsis, COPD, diabetes mellitus, age >70m liver cirrhosis, LVH
Which conditions can decrease BNP?
Obesity, ACEi, dirurectics, beta blockers, AT II blocker, aldosterone antagonists
Which parameters are measured in a CHA2DS2-VASC score?
CCF (1), HTN (1), Age >= 75 (2), Age 65-74 (1), Diabetes (1), Stroke-TIA-VTE (2), Vascular disease (IHD/PAD) (1), Sex- female (1)
Which patients should receive a statin for primary prevention?
10 year CV risk >= 10% OR most type 1 diabetics OR CKD if eGFR <60
Which drug is given for CV primary prevention?
Atorvastatin 20mg OD
Which patients should receive secondary prevention for CV disease?
Known IHD, CVD or PAD
Which drug and dose is given for CV secondary prevention?
Atorvastatin 80mg OD
Which anti-platelet/anticoagulation therapy is given to patients post ACS/PCI?
First 4 weeks - triple therapy (2 anti platelets + 1 anticoagulant).
4 weeks - 6 months - dual therapy (1 antiplatelet and 1 anticoagulant.
Complete 12 months.
Which normal variants are seen in athletes on ECG (4)?
Sinus bradycardia, junctional rhythm, 1st degree heart block, Mobitz type I
Define stage 1 HTN
Clinic BP >= 140/90mmHg, HBPM /ABPM>=135/85mmHg
Define stage 2 HTN
Clinic BP >= 160/100mmHg, HBPM/ABPM >=150/95mmHg
Describe the features of Buerger’s disease (5)?
Small vessel vasculitis associated with smoking. Features:
Extremity ischaemia
Intermittent claudication
Ichaemic ulcers
Superficial thrombophlebitis
Raynauds
What is the first line investigation for aortic stenosis?
ECHO
How is a STEMI managed if PCI is unavailable?
Fondaparinux, fibrinolysis
Which coronary lesion can cause complete heart block in a MI?
Right coronary artery
When is rate control used to treat acute onset AF?
> = 48 hours
Which drugs are given as secondary prevention post MI?
ACEi, B-blocker, statin, DAPT (12 months)
To what level is an increase in serum creatine acceptable on starting an ACEi?
Up to 30% from baseline
In acute onset AF, when is electrical car diversion used?
Haemodynamic instability
When can either rate or rhythm control be used to treat acute onset AF?
Presentation < 48 hours
How long should a haemodynamically stable patient be anti coagulated for prior to cardio version?
3 weeks
Which ECG signs are seen in hypokalaemia?
U waves, small/absent T waves, prolonged PR interval, ST depression, long QT
What advice is given regarding driving post MI?
Stop for 1 week. No need to inform DVLA
Which ECG leads correlate to the anteroseptal region of the heart?
V1-V4
Which ECG leads correlate to the inferior region of the heart?
II, III, avF
Which ECG leads correlate to the lateral region of the heart?
I, avL =/- V5-V6
Which ECG leads correlate to the posterior region of the heart?
V1-V3 (reciprocal changed seen). V7-V9
Which coronary artery supplies the anterolateral region of the heart?
Left anterior descending
Which coronary artery supplies the inferior region of the heart?
Right coronary artery
Which artery supplies the AV node?
Right coronary artery
Which coronary artery supplies the anterolateral region of the heart?
Proximal left anterior descending
Which coronary artery supplies the lateral region of the heart?
Left circumflex
Which coronary arteries supplies the posterior region of the heart?
Left circumflex, right coronary
Which ECG changes are seen in a posterior MI?
Reciprocal changes of STEMI - Horizontal ST depression, tall, broad R waves, upright T waves, dominant R wave in V2
What is the first line management for angina?
B blocker or Ca2+ channel blocker
Which drugs should be used if a calcium channel blocker is used in mono therapy?
Rate limiting drug - verapamil or diltiazem
If B blocker and Ca2+ channel blocker are used in dual therapy, which drugs should be used?
Longer acting DHP Ca2+ channel blocker (e.g. amlodipine)
What is the 2nd line management of angina?
B-blocker and longer acting DHP Ca2+ channel blocker (e.g. amlodipine)
What treatment is given for an NSTEMI?
Aspirin
Ticagrelor (if not high bleeding risk)/clopidogrel (if high bleeding risk)
Fondaparinux (not high bleeding risk)
What is the criteria for STEMI diagnosis?
Symptoms consistent with ACS (>= 20 mins) with persistent (>20mins) ECG features in 2 contiguous leads of:
- 2.5mm ST elevation in leads V2-3 in men <40
OR
- 2.0 mm ST elevation in V2-3 in men >40
- 1.5 mm ST elevation in V2-3 in women
- 1mm ST elevation in other leads
New LBBB
What is the commonest cause of death post MI?
VF
When can periocarditis present post transmural MI?
First 48 hours
When does Dressler’s syndrome present?
2-6 weeks post MI
Which features are seen in LV aneurysm?
Persistent ST elevation and LV failure
When can left ventricular free wall rupture present post MI?
1-2 weeks
Which murmur is heard in a VSD?
Pansystolic
Which murmur is heard in acute mitral regurgitation?
Early to mid systolic murmur
What can cause acute mitral regurgitation post MI?
Ischaemia or rupture of papillae muscle
How does left ventricular free wall rupture present post MI?
Heart failure secondary to tamponade (elevated JVP, pulsus paradoxes, diminished heart sounds)
Which anti platelets are given post ACS?
Aspirin (lifelong), ticagrelor (12 months)
Which anti platelets are given post PCI?
Aspirin (lifelong), ticagrelor/prasugrel (12 months)
Which anti platelets are given post TIA?
Clopidogrel (lifelong)
Which anti-platelets are given post-stroke and for how long?
Aspirin 300mg OD for 2/52, then clopidogrel 75mg OD
Which adverse signs are seen in per-arrest bradycardia (4)?
Shock, syncope, MI, heart failure
What is the first line treatment for peri-arrest bradycardia?
Atropine 500mcg
How much atropine can be given in adverse bradycardia?
Up to 3mg
What are the management options of peri-arrest bradycardia?
Transcutaneous pacing.
Isoprenaline/adrenaline infusion titrated to response
Describe the features of aortic regurgitation
Early diastolic
Collapsing pulse
Wide pulse pressure
Quincke’s sign
De Musset’s sign (head bobbing)
Describe the features of aortic stenosis
Delayed ESM
Narrow pulse pressure
Slow rising pulse
Soft/absent S2
Thrill
LVH/HF
Which drugs can be used to manage ventricular tachycardia?
Amiodarone
Lidocaine
Procainamide
Which drug is contraindicated in ventricular tachycardia?
Verapamil
Which ECG changes are seen in Wolff-Parkinson White?
Short PR interval
Wide QRS complex - slurred upstroke ‘delta wave’
Left axis deviation - right accessory pathway
Right axis deviation - left accessory pathway
Which ECG changes are seen in acute pericarditis?
Global ST elevation
Describe ECG features seen in cardiac tamponade
Electrical alternans - alteration of QRS complex between beats
Which adverse signs are seen in peri-arrest tachycardia?
Shock
(Hypotension <90mmHg SBP, pallor, sweaty, clammy, cold extremities, confusion, impaired consciousness)
Syncope
MI
Heart failure
How is a tachycardia with adverse signs managed?
Synchronised DC shock - up to 3
What is first line management of HTN in patients <55 years/with T2DM?
ACEi/ARB
What is first line management of HTN in patient >=55 years/without T2DM?
Ca2+ channel blocker
What is the second step of management in patients <55 years/with T2DM?
ACEi + Ca2+ blocker
OR
ACEi + thiazide like diuretic
What is secondary line management of HTN in patients >=55 years/without T2DM?
Ca2+ blocker + ACEi
OR
Ca2+ blocker + thiazide like diuretic
What is the third step of management in the HTN guideline?
ACEi + Ca2+ blocker + thiazide like diuretic
What is the fourth step of management in the HTN guideline?
ACEi + Ca2+ blocker + thiazide like diuretic
AND
If K+ <= 4.5, spironolactone
OR
If K+ >4.5, alpha or beta blocker
Which ECG changes are seen in hypothermia?
AF
Prolonged PR
Wide QRS
QT elongation
J waves
