Exam Flashcards
Main causes of heart failure? (4)
Ischaemic heart disease
Dilated cardiomyopathy
Hypertension
Valvular heart disease
Heart sounds in heart failure?
May be S3 gallop rhythm
Management of heart failure:
a) first line
b) second line
c) third line
a) ACEi + BB
b) + one of spironolactone, ARB, hydralazine+nitrate
c) digoxin, cardiac resynchronization, ivabradine
Management of stable angina? (4)
GTN
B blockers +/- calcium blocker
Angioplasty + stent
CABG
Calcium blockers in angina used for a) monotherapy b) combination with beta blocker
a) rate-limiting- verapamil, diltiazem
b) dihydropiridine- modified release nifedipine
Indication for CABG?
Extensive three-vessel disease
ACS secondary prevention? (4)
Aspirin + clopidogrel
ACE inhibitor
Beta blocker
Statin
Commonest cause of death following MI?
Arrest -V. fib
DDx of new early-to-mid systolic murmur, post-MI? (2)
Acute mitral regurgutation secondary to papillary muscle rupture
Ventricular septal rupture
Persistent ST elevation weeks after MI, signs of heart failure?
LV aneurysm
Tall R waves in V1-V2 +/- ST depression in V1-V3
Posterior MI
Treatment of NSTEMI/unstable angina (4)
Aspirin 300mg, clopidogrel 300mg
Nitrates/morphine PRN for chest pain
Antithrombin treatment (fondaparinux) if not contraindicated
Intravenous tirofibban if undergoing angiography in next 96 hrs
When would fondaparinux be contraindicated in NSTEMI and what is given instead?
Patient having angiography within 24 hrs; creatinine greater than 265umol/l
Unfractionated heparin
Management of STEMI? (4)
Aspirin + P2Y12 receptor antagonist
Unfractionated heparin (if undergoing PCI)
Oxygen if hypoxic
PCI/thrombolysis
Chest pain in first 48 hours following MI, worse when lying down, associated with pericardial rub?
Pericarditis
1-2 week post MI: acute heart failure, raised JVP, dimished heart sounds, pulsus paradoxus?
Left ventricular wall rupture causing tamponade
Ischaemia/infarction/fibrosis of the sinus node, presenting with bradycardia and intermittent tachycardia
Sick sinus syndrome
Rate control options in AF? (3)
Beta blockers
Verapamil/diltiazem
Digoxin (if co-existent heart failure)
Low potassium enhances the toxicity of…
Digoxin
Management of acute atrial fibrillation (less than 48 hrs since onset)
a) if adverse features present
b) no adverse features
a) synchronized DC shock as for any other tachyarrythmia
b) Electrical or chemical cardioversion; or rate control
Drugs used for chemical cardioversion in AF? (2)
Amiodarone (use if evidence of structural/ischaemic heart disease)
Flecainide
Regular narrow-complex tachycardia that DOES NOT respond to vagal manouevres/adenosine
Atrial flutter
Management of atrial flutter? (2)
Rate control as for AF
Sinus node catheter ablation
Heart block:
a) prolonged PR interval, constant
b) progressive lengthening of PR interval
c) intermittent dropped QRS complexes
d) complete dissociation between atrial and ventricular activity
a) 1st degree
b) 2nd degree Mobitz 1
c) 2nd degree Mobitz 2
d) CHB
Syncope as a result of asystole?
Stokes Adams attacks
When should heart block be treated with permanent pacing?
Symptomatic Mobitz 1
Mobitz 2 and CHB
Secondary causes of hypertension? (5)
Renal parenchymal disease Renal artery stenosis Primary aldosteronism Phaeochromocytoma Cushing's syndrome
The treatment target for BP in under 80 year olds and over 80 year olds?
Under- 140/90
Over- 150/90
Step 1 in hypertension treatment algorithm?
Patients under 55- ACE inhibitor or ARB (A)
Patients over 55/Caribbean- Calcium blocker (C)
Hypertension algorithm:
Step 2
Step 3
A + C
A + C + D
Thiazide diuretics of choice?
Indapamide
Complete heart block following an MI- vessel affected?
Right coronary artery
What are the two main differentials of a tachycardia with wide QRS?
Ventricular tachycardia
A supraventricular tachycardia with aberrant conduction e.g. AF with BBB
If any patient with tachycardia has adverse signs, what treatment is indicated?
Synchronized DC shock (cardioversion)
Wide QRS with slurred upstroke
Wolff-parkinson White
Management of SVT? (3)
Vagal manouevres
Adenosine
Cardioversion
Management of regular broad complex tachycardia with no adverse signs?
Amiodarone- loading dose followed by infusion over 24hrs
Treatment of polymorphic VT?
IV magnsium/cardioversion
Why does ventricular tachycardia need to be treated immediately?
Potential to precipitate ventricular fibrillation causing cardiac arrest
What is the most important metabolic cause of ventricular tachycardia?
Hypokalaemia
Continuous machinery murmur + left subclavicular thrill
Patent ductus arteriosus
Notching of the inferior margins of the ribs + diminished lower limb pulses
Coarctation of the aorta
Management of bradycardia with adverse signs/risk of asystole?
Atropine
Central chest pain relieved by sitting forward + saddle shaped widespread ST elevation
Pericarditis
Management of anaphylaxis (5)
Secure airway and support oxygenation
IV fluids
500mcg of 1:1000 adrenaline IM
Chlorphenamine + Hydrocortisone
Causative organisms in endocarditis? (4)
Strep viridans
Staph aureus
Staph epidermidis
HACEK bacteria
Criteria used for diagnosis in infective endocarditis?
Duke criteria
Retinal haemorrhages with a pale centre?
Roth spots
Painful infarcts on finger pulps?
Oslers nodes
Painless macules on palms/soles?
Janeway lesions
STEMI ECG changes: area and vessel?
II, III and aVF
Inferior; RCA
STEMI ECG changes: area and vessel?
I, V5, V6
Lateral; circumflex artery
STEMI ECG changes: area and vessel?
V1/V2
Septal; LAD
STEMI ECG changes: area and vessel?
V3/V4
Anterior; LAD
