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Yr 4 - ACC > Corrections - Cardiology pt2 > Flashcards

Corrections - Cardiology pt2 Flashcards

1
Q

What are the 2 management options for symptomatic aortic stenosis?

A

1) Surgical aortic valve replacement –> for low/medium operative risk patients

2) Transcatheter aortic valve replacement –> for high operative risk patients

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2
Q

management of patients on warfarin who have an INR >8 (who aren’t bleeding)?

A

Stop warfarin and give oral vitamin K

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3
Q

2nd line management of symptomatic bradycardia if atropine fails?

A

Immediate external pacing (transcutaneous)

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4
Q

When is new onset AF considered for electrical cardioversion?

A

If presents within 48 hours

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5
Q

What is coarctation of the aorta?

A

Congenital abnormality where there is narrowing of the aorta, leading to hypoperfusion of lower body.

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6
Q

How can coarctaction of aorta affect pulses in legs?

A

Can present with weakened femoral pulses.

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7
Q

Why are ACEi contraindicated in hypertrophic obstructive cardiomyopathy (HOCM)?

A

ACEi reduce afterload which may worsen the LVOT gradient.

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8
Q

Why is upper limb BP often greater than lower limb BP in coarctation of aorta?

A

As the narrowing often occurs after the left subclavian artery branches from the aorta

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9
Q

What murmur is heard in pulmonary stenosis?

A

Ejection systolic murmur that is louder on inspiration.

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10
Q

Why is the ejection systolic murmur in pulmonary stenosis louder on inspiration?

A

This is due to blood flowing through the narrow pulmonary valve throughout systole.

It is affected by inspiration as this increases venous blood return to the right side of the heart.

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11
Q

Is an ejection systolic murmur characteristic of aortic stenosis louder on inspiration or expiration?

A

Expiration.

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12
Q

Management of uncomplicated aortic dissection of the descending aorta?

A

Medical management with IV labetalol

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13
Q

At what age do patients with stage 1 HTN not require treatment?

A

> 80 y/o

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14
Q

What pulse deficits may be seen in aortic dissection?

A

1) weak or absent carotid, brachial, or femoral pulse

2) variation in arm BP

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15
Q

Why is moderate to severe aortic stenosis a contraindication to ACEi?

A

As the vasodilator effect of ACEi might lead to a reduction in coronary perfusion pressure, leading to cardiac ischaemia.

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16
Q

What is the site of action of furosemide?

A

Ascending loop of Henle - inhibits the Na-K-Cl cotransporter.

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17
Q

What are the ECG changes criteria for PCI or thrombolysis?

A

1) ST elevation of >2mm (2 small squares) in 2 or more consecutive anterior leads (V1-V6)

OR

2) ST elevation of >1mm (1 small square) in greater than 2 consecutive inferior leads (II, III, aVF, aVL)

OR

3) New LBBB

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18
Q

Which class of Abx can cause torsades de pointes?

A

Macrolides

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19
Q

How can potassium affect QT interval?

A

Hypokalaemia can cause long QT syndrome

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20
Q

Management of infective endocarditis causing HF?

A

Indication for emergency valve replacement surgery

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21
Q

What is the 2nd line drug treatment for angina pectoris if 1st line drugs (beta blockers or CCBs) are contraindicated or not tolerated?

A

Nicorandil

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22
Q

What is a key side effect of nicorandil?

A

GI tract ulceration

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23
Q

What is nicorandil?

A

A vasodilatory drug used to treat angina.

It is a potassium channel activator. Vasodilation is through activation of guanylyl cyclase which results in increase cGMP.

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24
Q

Adverse effects of nicorandil?

A

1) headache
2) flushing
3) skin, mucosal & eye ulceration (includes GI & anal ulcers)

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25
Q

Contraindication of nicorandil?

A

LV failure

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26
Q

What valvular abnormality is most commonly associated with coarctation of the aorta?

A

Bicuspid aortic valve

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27
Q

What is the JVP increasing with inspiration known as?

A

Kussmaul’s sign

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28
Q

What is the JVP increasing with inspiration a feature of?

A

Constrictive pericarditis

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29
Q

2nd line therapy in HF with reduced EF?

A

Add spironolactone and consider SGLT-2 inhibitor (empagliflozin)

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30
Q

What is the most specific ECG finding in pericarditis?

A

PR depression

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31
Q

In ALS, what should be given to patients who are in VF/pulseless VT after 5 shocks have been administered?

A

Amiodarone 150mg

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32
Q

What should patients in pulseless electrical activity and asystole immediately receive?

A

1mg IV adrenaline 1:10,000 (repeat every 3-5 minutes during alternate 2min loops of CPR)

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33
Q

Management of broad complex tachycardia?

A

Assume that broad-complex tachycardia is VT unless there is a documented history of SVT with BBB.

Treat with IV amiodarone.

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34
Q

Management of VF/pulseless VT as soon as identified?

A

1 shock

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35
Q

Management of widened QRS or arrhythmia in tricyclic overdose?

A

IV bicarb

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36
Q

Which Abx is a well-recognised cause of cholestasis?

A

Co-amoxiclav

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37
Q

What are the adverse effects of amiodarone?

A

1) thyroid dysfunction: both hypothyroidism and hyper-thyroidism

2) corneal deposits

3) pulmonary fibrosis/pneumonitis

4) liver fibrosis/hepatitis

5) peripheral neuropathy, myopathy

6) photosensitivity

7) ‘slate grey’ appearance

8) thrombophlebitis and injection site reactions

9) bradycardia

10) lengths QT interval

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38
Q

What are 2 important drug interactions of amiodarone?

A

1) decreased metabolism of warfarin, therefore increased INR

2) increased digoxin levels

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39
Q

How does amiodarone affect digoxin levels?

A

Increased digoxin levels

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40
Q

How does amiodarone affect warfarin levels?

A

decreased metabolism of warfarin, therefore increased INR

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41
Q

What can be added as a second line treatment for rate control in atrial fibrillation?

A

Digoxin

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42
Q

Give 3 drugs causing lung fibrosis

A

1) amiodarone
2) bleomycin
3) methotrexate

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43
Q

Does drug-induced fibrosis (amiodarone, bleomycin & methotrexate) cause upper or lower zone lung fibrosis?

A

Lower zones

44
Q

Does TB cause upper or lower zone fibrosis?

A

Upper

45
Q

What is the most likely cause of an irregular broad complex tachycardia in a stable patient?

A

AF with BBB

46
Q

What is the 1st line investigation for stable chest pain of suspected coronary artery disease aetiology?

A

Contrast CT coronary angiogram

47
Q

If angina is not controlled with a beta blocker, what is the next step?

A

Add a longer acting dihydropyridine calcium channel blocker e.g. amlodipine

48
Q

Which medication used in IHD can patients develop a tolerance to, necessitating a change in dosing regime?

A

Isosorbide mononitrate

49
Q

What is the 1st line anti-anginal for stable angina in a patient with known HF?

A

Bisoprolol (if no contraindications)

50
Q

Why can patients taking standard release isosorbide mononitrate experience a relief and then return of symptoms?

A

Due to development of nitrate tolerance (only seen in standard-release, not modified-release)

51
Q

Management of development of tolerance in isosorbide mononitrate?

A

Change dosing times (asymmetric dosing regimes)

52
Q

What is Beck’s triad?

A

Seen in cardiac tamponade:

1) raised JVP (does not change with breathing i.e. negative Kussmaul’s sign)

2) muffled heart sounds

3) hypotension

53
Q

Features of mitral stenosis?

A
  • haemoptysis
  • SOB
  • irregularly irregular pulse (can be 2ary to AF)
  • mid diastolic murmur
54
Q

What feature may suggest that the leaflets still have some mobility in mitral stenosis?

A

An opening snap

55
Q

Management of major bleeding in patients taking warfarin (regardless of INR)?

e.g. variceal haemorrhage, intracranial haemorrhage

A

1) stop warfarin

2) give IV vitamin K 5mg

3) prothrombin complex concentrate (if not available then FFP)

56
Q

Management of minor bleeding in patients on warfarin whose INR is >8.0?

A

1) stop warfarin

2) give IV vitamin K 1-3mg

3) repeat dose of vitamin K if INR still too high after 24 hours

4) restart warfarin when INR < 5.0

57
Q

Management of patients on warfarin whose INR is >8.0 but no bleeding?

A

1) stop warfarin

2) give vitamin K 1-5mg orally

3) repeat dose of vitamin K if INR still too high after 24 hours

4) restart when INR < 5.0

58
Q

Management of minor bleeding in patients on warfarin whose INR is 5.0-8.0?

A

1) Stop warfarin

2) Give intravenous vitamin K 1-3mg

3) Restart when INR < 5.0

59
Q

Management of patients on warfarin whose INR is 5.0-8.0 but with no bleeding?

A

1) Withhold 1 or 2 doses of warfarin

2) Reduce subsequent maintenance dose

60
Q

Stepwise management of HTN for patients aged <55 or type 2 diabetes?

A

1) ACEi or ARB

2) ACEi/ARB + CCB or ACEi/ARB + thiazide-like diuretic

3) ACEi/ARB + CCB + thiazide-like diuretic

4) Depending on K+, add spironolactone or alpha/beta blocker

61
Q

Stepwise management of HTN for patients aged ≥55 or Black African or African-Caribbean ethnicity?

A

1) CCB

2) CCB + ACEi/ARB or CCB + thiazide-like diuretic

3) ACEi/ARB + CCB + thiazide-like diuretic

4) Depending on K+ (>/< 4.5), add spironolactone or alpha/beta blocker

62
Q

What is Sydenham’s chorea a complication of?

A

Rheumatic fever (following strep infection)

63
Q

What cardiac defect are alcoholics at risk of?

A

Dilated cardiomyopathy

This would cause a reduction in LV EF, with a dilated LV.

64
Q

Management of major bleeding for patients on warfarin?

A

Stop warfarin, give 5mg vit K IV, give prothrombin complex concentrate IV

65
Q

Management of AF following an acute stroke (not haemorrhagic)?

A

Long term anticoagulation (DOAC) started 2 weeks after the event.

300mg aspirin during these 2 weeks.

66
Q

How can acute mitral valve regurgitation post-MI present?

A

Flash pulmonary oedema.

In mitral regurg, regurgitant jets of blood are directed back towards the pulmonary veins, causing fluid congestion in the lungs.

67
Q

If a patients BP is >180/120 mmHg but there are no worrying signs, what is the first step in management?

A

Investigations for end-organ damage.

68
Q

What vaccinations are offered to patients with HF?

A

Annual influenza & once off pneumococcal

69
Q

Which patients groups require a pneumococcal revaccination every 5 years?

A

Asplenia, splenic dysfunction or CKD

70
Q

What ECG changes are associated with hypothermia?

A
  • bradycardia
  • prolonged QT interval
  • ‘J waves’: a small hump at the end of the QRS complex
  • 1st degree heart block
71
Q

What are ‘J waves’ on an ECG?

A

A small hump at the end of the QRS complex

72
Q

How long does troponin remain elevated for post-MI?

A

10 days

73
Q

How long does creatine kinase (CK-MB) remain elevated for post-MI?

A

3-4 days (useful for detecting re-infarction in the window of 4-10 days after initial insult).

74
Q

What class of medication is bumetanide?

A

Loop diuretic

75
Q

How can loop diuretics affect K+?

A

Can cause hypokalaemia

76
Q

Which type of diuretic can cause ototoxicity?

A

Loop diuretics

77
Q

Haemoptysis can be a symptom of what valve defect?

A

Mitral stenosis

78
Q

1st line investigation for stable chest pain of suspected coronary artery disease aetiology?

A

Contrast-enhanced CT coronary angiogram

79
Q

What is the most common organism causing infective endocarditis (not <2 months post-valve surgery)?

A

Staph. aureus

80
Q

What is the most common organism causing infective endocarditis if <2 months post-valve surgery?

A

Staph. epidermidis

81
Q

What are some contraindications to thrombolysis?

A
  • active internal bleeding
  • recent haemorrhage, trauma or surgery (including dental extraction)
  • coagulation and bleeding disorders
  • intracranial neoplasm
  • stroke <3 months
  • aortic dissection
  • recent head injury
  • severe HTN
82
Q

Why are intracranial tumours an absolute contraindication to thrombolysis?

A

Because of their association with spontaneous intracranial haemorrhage.

83
Q

What should patients on warfarin undergoing emergency surgery receive?

A

Four-factor prothrombin complex concentrate

84
Q

What can be offered to patients with HF with reduced EF who are already on ACEi (or ARB) and a beta blocker?

A

Mineralcorticoid receptor antagonist e.g. spironolactone

85
Q

What is used 1st line to prevent angina attacks?

A

Beta blocker or CCB

86
Q

How can ACEi affect BNP levels?

A

Can give falsely low BNP results

87
Q

How do thiazide diuretics affect calcium?

A

Can cause hypercalcaemia (and hypocalciuria)

88
Q

How can thiazide diuretics affect sodium?

A

Can cause hyponatraemia

89
Q

How is hypertrophic obstructive cardiomyopathy inherited?

A

Autosomal dominant disorder

90
Q

What class of drug is digoxin?

A

Cardiac glycoside

91
Q

What is the main indication for dignoxin?

A

1) Rate control in management of AF

2) Sometimes used for improving symptoms (but not mortality) in patients with heart failure - due to positive inotropic properties

92
Q

Mechanism of digoxin?

A

1) Decreases conduction through the AV node which slows the ventricular rate in atrial fibrillation and flutter.

2) increases the force of cardiac muscle contraction due to inhibition of the Na+/K+ ATPase pump. Also stimulates vagus nerve

93
Q

Digoxin has a narrow therapeutic index.

Features of digoxin toxicity?

A
  • generally unwell, lethargy
  • nausea & vomiting
  • anorexia
  • confusion
  • yellow-green vision
  • gynaecomastia
  • arrhythmias (e.g. AV block, bradycardia)
94
Q

How can digoxin toxicity affect vision?

A

Yellow-green vision

95
Q

What is the classic precipitating factor for digoxin toxicity?

A

Hypokalaemia.

96
Q

How can hypokalaemia precipitate digoxin toxicity?

A

Digoxin normally binds to the ATPase pump on the same site as potassium.

Hypokalaemia → digoxin more easily bind to the ATPase pump → increased inhibitory effects.

97
Q

What is the most common feature of carbon monoxide poisoning?

A

Headache (often described as dull, throbbing and frontal).

98
Q

What investigation should all patients with suspected acute pericarditis have?

A

Transthoracic echocardiography

99
Q

Should patients with AF who have had catheter ablation still be anticoagulated?

A

Yes - as per their CHA2DS2-VASc score

100
Q

Typical patient group with myocarditis?

A

Young (<50) with history of recent viral illness, acute history.

101
Q

Presentation of myocarditis?

A
  • chest pain
  • dyspnoea
  • arrhythmias
102
Q

Troponin in myocarditis?

A

Raised

103
Q

ECG changes in myocarditis?

A
  • tachycardia
    arrhythmias
  • ST/T wave changes including ST-segment elevation and T wave inversion
104
Q

What is acute chest syndrome?

A

A complication of sickle-cell disease and presents with dyspnoea, chest pain, cough, hypoxia and new pulmonary infiltrates seen on CXR.

105
Q

What is electrical alterans?

A

Alternating QRS amplitudes in any or all leads on an ECG

106
Q

What does electrical alterans indicate?

A

Cardiac tamponade

107
Q
A

Yr 4 - ACC (73 decks)

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