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Phase 3a > GP - Cardio > Flashcards

GP - Cardio Flashcards

1
Q

Describe chronic coronary syndrome

A

Stable angina - relieved by rest/GTN spray

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2
Q

Describe acute coronary syndrome

A

Unstable angina

Non-ST-elevation myocardial infarction = elevated troponin, CK, myoglobin

ST-elevation myocardial infarction = elevated troponin, CK, myoglobin + ST elevations on ECG

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3
Q

What is the management for stable angina?

A
  • Lifestyle changes
  • Medication (aspirin + statin + BB/CCB)
  • Percutaneous coronary intervention
  • Surgery
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4
Q

What is the immediate management for acute coronary syndrome?

A
  • ECG
  • Aspirin 300mg
  • O2 if sats <94%
  • Morphine (pain)
  • Nitrate (pain/HTN)
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5
Q

What is the management for a STEMI?

A
  • Aspirin 300mg
  • P2Y12 receptor antagonist = ticagrelor/prasugrel
  • Unfractionated heparin
  • PCI within 2 hours of onset of sx
  • Fibrinolysis (if delay in PCI) - ECG 60-90 minutes after
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6
Q

What is the management for a NSTEMI?

A
  • Aspirin 300mg
  • Fondaparinux (if no immediate PCI planned)
  • Estimate 6 month mortality (GRACE)

Low risk = ticagrelor

Moderate/high risk = PCI, prasugrel/ticagrelor, unfractionated heparin, drug-eluting stents

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7
Q

What is the management for widespread coronary disease/recurrent MIs?

A

Coronary artery bypass graft (CABG)

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8
Q

What is Dressler’s syndrome, what are the clinical features and what is the management?

A
  • 2-6 weeks post MI
  • Fever
  • Pleuritic pain
  • Pericardial effusion
  • Raised ESR
  • NSAIDs
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9
Q

What are the stages of HTN?

A

Stage 1 = 140/90
Stage 2 = 160/90
Stage 3 = 180/120 (malignant)

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10
Q

What is heart failure?

A

Heart is unable to pump enough blood to meet the metabolic needs of the body

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11
Q

What is the main cause of acute heart failure?

A

Dressler’s syndrome - swelling/inflammation of sac around heart post MI

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12
Q

What is the management for acute heart failure?

A

OMFG:
- Oxygen
- Morphine
- Furosemide
- GTN spray

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13
Q

What are the main causes of chronic heart failure (diastolic)?

A
  • Hypertrophic obstruction cardiomyopathy
  • Restrictive cardiomyopathy
  • Cardiac tamponade
  • Constrictive pericarditis
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14
Q

What are the main causes of chronic heart failure (systolic)?

A
  • Ischaemic heart disease
  • Dilated cardiomyopathy
  • Myocarditis
  • Arrhythmias
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15
Q

What are the causes of left/right sided heart failure?

A

Left = hypertension/aortic stenosis/aortic regurgitation/etc.

Right = usually occurs after left-sided/pulmonary HTN/OSA

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16
Q

What are the features of left sided heart failure?

A
  • Pulmonary oedema
  • Dyspnoea/orthopnoea/paroxysmal nocturnal dyspnoea
  • Bibasal fine crackles
  • Cyanosis
  • Reduced capillary refill
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17
Q

What are the features of right sided heart failure?

A
  • Weight gain
  • Peripheral oedema
  • Raised JVP
  • Hepatomegaly
18
Q

What is the first investigation for heart failure?

A

NT-proBNP - released when cardiomyocytes are stretched

<400pg/ml = normal
400-2000pg/ml = moderate
>2000pg/ml = severe

19
Q

What are other investigations for heart failure?

A
  • Echo
  • CXR - ABCDEF
  • ECG
  • Bloods
20
Q

What features on a chest x-ray would indicate heart failure?

A

ABCDEF:
- Alveolar oedema (bat wings)
- Kerley B lines (interstitial oedema)
- Cardiomegaly
- Dilated upper lobe vessels of lung
- Effusion (pleural)
- Fluid in horizontal fissure

21
Q

What is the management for chronic heart failure?

A
  • FIRST LINE = ACE-inhibitor and beta blocker
  • Aldosterone antagonist (spironolactone)
    ^ ACEis and spironolactone can both cause hyperkalaemia
  • Hydralazine
  • Digoxin
  • Furosemide
22
Q

How can AF be classified?

A
  • First detected episode
  • Paroxysmal = terminate spontaneously
  • Persistent = not self-terminating
  • Permanent = continuous AF which cannot be cardioverted
23
Q

What are the aims of AF management?

A
  • Rate control = accept that the pulse will be irregular but slow the rate down to avoid negative effects on cardiac function
  • Rhythm control = get the patient back into, and maintain, normal sinus rhythm (cardioversion)
24
Q

What is the management for AF?

A

Rate control = BB or rate-limiting CCB e.g. diltiazem or digoxin

Rhythm control = electrical (DC) cardioversion or amiodarone (if structural heart disease) or flecainide

25
Q

What scoring system is used in patients with AF?

A

CHA2DS2VASc

  • CHF
  • HTN
  • Age >75 or 65-74
  • Diabetes
  • Stroke/TIA previously
  • Vascular disease
  • Sex female
26
Q

What anticoagulants are given to patients with AF?

A

DOACs - apixaban, dabigatran, edoxaban, rivaroxavan

Second line = warfarin (where DOACs contraindicated or not tolerated)

27
Q

What are the clinical features of pericarditis?

A
  • Pleuritic chest pain relieved by sitting forwards
  • Non-productive cough
  • Dyspnoea
  • Flu-like symptoms
  • JVP increases on inspiration (Kussmaul’s sign)
28
Q

What are the ECG changes in pericarditis?

A
  • Saddle-shaped ST elevation
  • PR depression
29
Q

What is the management for pericarditis?

A

NSAID + colchicine +/- PPI

30
Q

What is the first line management for HTN?

A

<55 or diabetic = ACEi e.g. ramipril

> 55 or Afro-Caribbean = CCB e.g. amlodipine

31
Q

How does the presentation of MI differ from aortic dissection?

A

MI = intensity builds

Aortic dissection = maximal pain at onset. Migration of pain caudally and weak left-sided pulse due to subclavian artery involvement

32
Q

What is required for a diagnosis of orthostatic/postural hypotension?

A

Systolic drop >20mmHg at 1 or 3 minutes after lying/sitting for 5 minutes

33
Q

When are pacemakers indicated?

A
  • Symptomatic bradycardia
  • Type 2 heart block
  • Third degree heart block
  • Atrioventricular node ablation for AF
  • Severe HF
34
Q

Describe single-chamber pacemakers

A
  • Lead in either RA or RV
  • RA = issue with SAN and conduction through AVN is normal = stimulate depolarisation in RA which passes to LA and ventricles
  • RV = conduction through AVN is abnormal = stimulate ventricles directly
35
Q

Describe dual-chamber pacemakers

A
  • Leads in RA and RV
  • Pacemakers coordinates contractions of atria and ventricles
36
Q

Describe biventricular (triple-chamber) pacemakers

A
  • Leads in RA, RV and LV
  • Usually in patients with severe HF
  • Coordinate contraction of chambers to optimise heart function = cardiac resynchronisation therapy (CRT)
37
Q

Describe implantable cardioverter defibrillators

A
  • Continually monitor heart and apply defibrillator shock if ventricular tachycardia or ventricular fibrillation is identified

Used in:
- Previous cardiac arrest
- Hypertrophic obstructive cardiomyopathy
- Long QT syndrome

38
Q

How are pacemakers identified on ECGs?

A

Sharp vertical line
- Before P wave = atria
- Before QRS complex = ventricles

39
Q

What is the management for bradycardia?

A

500mcg IV atropine

40
Q

What is the management for supraventricular tachycardia?

A
  • Vagal manoeuvres
  • IV adenosine 6mg/12mg/18mg (verapamil if asthmatic)
  • Electrical cardioversion

Prophylaxis = beta blockers/radiofrequency ablation

41
Q

Give 4 examples of calcium channel blockers

A
  • Amlodipine
  • Lercanidipine
  • Diltiazem
  • Verapamil

Phase 3a (21 decks)

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