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MSRA > Cardiovascular Medicine > Flashcards

Cardiovascular Medicine Flashcards

1
Q

What is the first line management of SVT?

A

Vagal manoeuvres

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2
Q

What is the second line management of SVT?

A

Adenisune (6mg -> 12mg -> 18mg)

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3
Q

Who is adenosine contraindicated in?

A

Asthmatics

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4
Q

When is a shock delivered in DC cardioversion?

A

Synchronised to peak of R wave

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5
Q

What is the first line investigation in heart failure?

A

NT-pro BNP

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6
Q

Which conditions can increase BNP?

A

Ischaemia, tachycardia, hyperaemia, GFR <60, RV overload, sepsis, COPD, diabetes mellitus, age >70m liver cirrhosis, LVH

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7
Q

Which conditions can decrease BNP?

A

Obesity, ACEi, dirurectics, beta blockers, AT II blocker, aldosterone antagonists

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8
Q

Which parameters are measured in a CHA2DS2-VASC score?

A

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)

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9
Q

Which patients should receive a statin for primary prevention?

A

10 year CV risk >= 10% OR most type 1 diabetics OR CKD if eGFR <60

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10
Q

Which drug is given for CV primary prevention?

A

Atorvastatin 20mg OD

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11
Q

Which patients should receive secondary prevention for CV disease?

A

Known IHD, CVD or PAD

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12
Q

Which drug and dose is given for CV secondary prevention?

A

Atorvastatin 80mg OD

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13
Q

Which anti-platelet/anticoagulation therapy is given to patients post ACS/PCI?

A

First 4 weeks - triple therapy (2 anti platelets + 1 anticoagulant).

4 weeks - 6 months - dual therapy (1 antiplatelet and 1 anticoagulant.
Complete 12 months.

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14
Q

Which normal variants are seen in athletes on ECG (4)?

A

Sinus bradycardia, junctional rhythm, 1st degree heart block, Mobitz type I

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15
Q

Define stage 1 HTN

A

Clinic BP >= 140/90mmHg, HBPM /ABPM>=135/85mmHg

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16
Q

Define stage 2 HTN

A

Clinic BP >= 160/100mmHg, HBPM/ABPM >=150/95mmHg

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17
Q

Describe the features of Buerger’s disease (5)?

A

Small vessel vasculitis associated with smoking. Features:
Extremity ischaemia
Intermittent claudication
Ichaemic ulcers
Superficial thrombophlebitis
Raynauds

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18
Q

What is the first line investigation for aortic stenosis?

A

ECHO

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19
Q

How is a STEMI managed if PCI is unavailable?

A

Fondaparinux, fibrinolysis

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20
Q

Which coronary lesion can cause complete heart block in a MI?

A

Right coronary artery

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21
Q

When is rate control used to treat acute onset AF?

A

> = 48 hours

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22
Q

Which drugs are given as secondary prevention post MI?

A

ACEi, B-blocker, statin, DAPT (12 months)

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23
Q

To what level is an increase in serum creatine acceptable on starting an ACEi?

A

Up to 30% from baseline

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24
Q

In acute onset AF, when is electrical car diversion used?

A

Haemodynamic instability

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25
Q

When can either rate or rhythm control be used to treat acute onset AF?

A

Presentation < 48 hours

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26
Q

How long should a haemodynamically stable patient be anti coagulated for prior to cardio version?

A

3 weeks

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27
Q

Which ECG signs are seen in hypokalaemia?

A

U waves, small/absent T waves, prolonged PR interval, ST depression, long QT

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28
Q

What advice is given regarding driving post MI?

A

Stop for 1 week. No need to inform DVLA

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29
Q

Which ECG leads correlate to the anteroseptal region of the heart?

A

V1-V4

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30
Q

Which ECG leads correlate to the inferior region of the heart?

A

II, III, avF

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31
Q

Which ECG leads correlate to the lateral region of the heart?

A

I, avL =/- V5-V6

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32
Q

Which ECG leads correlate to the posterior region of the heart?

A

V1-V3 (reciprocal changed seen). V7-V9

33
Q

Which coronary artery supplies the anterolateral region of the heart?

A

Left anterior descending

34
Q

Which coronary artery supplies the inferior region of the heart?

A

Right coronary artery

35
Q

Which artery supplies the AV node?

A

Right coronary artery

36
Q

Which coronary artery supplies the anterolateral region of the heart?

A

Proximal left anterior descending

37
Q

Which coronary artery supplies the lateral region of the heart?

A

Left circumflex

38
Q

Which coronary arteries supplies the posterior region of the heart?

A

Left circumflex, right coronary

39
Q

Which ECG changes are seen in a posterior MI?

A

Reciprocal changes of STEMI - Horizontal ST depression, tall, broad R waves, upright T waves, dominant R wave in V2

40
Q

What is the first line management for angina?

A

B blocker or Ca2+ channel blocker

41
Q

Which drugs should be used if a calcium channel blocker is used in mono therapy?

A

Rate limiting drug - verapamil or diltiazem

42
Q

If B blocker and Ca2+ channel blocker are used in dual therapy, which drugs should be used?

A

Longer acting DHP Ca2+ channel blocker (e.g. amlodipine)

43
Q

What is the 2nd line management of angina?

A

B-blocker and longer acting DHP Ca2+ channel blocker (e.g. amlodipine)

44
Q

What treatment is given for an NSTEMI?

A

Aspirin
Ticagrelor (if not high bleeding risk)/clopidogrel (if high bleeding risk)
Fondaparinux (not high bleeding risk)

45
Q

What is the criteria for STEMI diagnosis?

A

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

46
Q

What is the commonest cause of death post MI?

A

VF

47
Q

When can periocarditis present post transmural MI?

A

First 48 hours

48
Q

When does Dressler’s syndrome present?

A

2-6 weeks post MI

49
Q

Which features are seen in LV aneurysm?

A

Persistent ST elevation and LV failure

50
Q

When can left ventricular free wall rupture present post MI?

A

1-2 weeks

51
Q

Which murmur is heard in a VSD?

A

Pansystolic

52
Q

Which murmur is heard in acute mitral regurgitation?

A

Early to mid systolic murmur

53
Q

What can cause acute mitral regurgitation post MI?

A

Ischaemia or rupture of papillae muscle

54
Q

How does left ventricular free wall rupture present post MI?

A

Heart failure secondary to tamponade (elevated JVP, pulsus paradoxes, diminished heart sounds)

55
Q

Which anti platelets are given post ACS?

A

Aspirin (lifelong), ticagrelor (12 months)

56
Q

Which anti platelets are given post PCI?

A

Aspirin (lifelong), ticagrelor/prasugrel (12 months)

57
Q

Which anti platelets are given post TIA?

A

Clopidogrel (lifelong)

58
Q

Which anti-platelets are given post-stroke and for how long?

A

Aspirin 300mg OD for 2/52, then clopidogrel 75mg OD

59
Q

Which adverse signs are seen in per-arrest bradycardia (4)?

A

Shock, syncope, MI, heart failure

60
Q

What is the first line treatment for peri-arrest bradycardia?

A

Atropine 500mcg

61
Q

How much atropine can be given in adverse bradycardia?

A

Up to 3mg

62
Q

What are the management options of peri-arrest bradycardia?

A

Transcutaneous pacing.
Isoprenaline/adrenaline infusion titrated to response

63
Q

Describe the features of aortic regurgitation

A

Early diastolic
Collapsing pulse
Wide pulse pressure
Quincke’s sign
De Musset’s sign (head bobbing)

64
Q

Describe the features of aortic stenosis

A

Delayed ESM
Narrow pulse pressure
Slow rising pulse
Soft/absent S2
Thrill
LVH/HF

65
Q

Which drugs can be used to manage ventricular tachycardia?

A

Amiodarone
Lidocaine
Procainamide

66
Q

Which drug is contraindicated in ventricular tachycardia?

A

Verapamil

67
Q

Which ECG changes are seen in Wolff-Parkinson White?

A

Short PR interval
Wide QRS complex - slurred upstroke ‘delta wave’

Left axis deviation - right accessory pathway
Right axis deviation - left accessory pathway

68
Q

Which ECG changes are seen in acute pericarditis?

A

Global ST elevation

69
Q

Describe ECG features seen in cardiac tamponade

A

Electrical alternans - alteration of QRS complex between beats

70
Q

Which adverse signs are seen in peri-arrest tachycardia?

A

Shock
(Hypotension <90mmHg SBP, pallor, sweaty, clammy, cold extremities, confusion, impaired consciousness)
Syncope
MI
Heart failure

71
Q

How is a tachycardia with adverse signs managed?

A

Synchronised DC shock - up to 3

72
Q

What is first line management of HTN in patients <55 years/with T2DM?

A

ACEi/ARB

73
Q

What is first line management of HTN in patient >=55 years/without T2DM?

A

Ca2+ channel blocker

74
Q

What is the second step of management in patients <55 years/with T2DM?

A

ACEi + Ca2+ blocker
OR
ACEi + thiazide like diuretic

75
Q

What is secondary line management of HTN in patients >=55 years/without T2DM?

A

Ca2+ blocker + ACEi
OR
Ca2+ blocker + thiazide like diuretic

76
Q

What is the third step of management in the HTN guideline?

A

ACEi + Ca2+ blocker + thiazide like diuretic

77
Q

What is the fourth step of management in the HTN guideline?

A

ACEi + Ca2+ blocker + thiazide like diuretic

AND

If K+ <= 4.5, spironolactone
OR
If K+ >4.5, alpha or beta blocker

78
Q

Which ECG changes are seen in hypothermia?

A

AF
Prolonged PR
Wide QRS
QT elongation
J waves

MSRA (13 decks)

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