Heart Flashcards
1
Q
DDx chest pain
A
- Unstable angina / MI / NSTEMI
- Coronary artery spasm
- Dissecting aortic aneurysm
- Pulmonary embolism
- Pericarditis
- GORD
- Acute coronary syndrome
2
Q
Hx questions chest pain
A
- Breathlessness
- Pallor / sweatin
- Past hx GORD
- Nausea
- Nature of pain - radiating
- FMHx heart disease before age 55yrs in 1st degree relative
- Risk factors for DVT / PE - surgery, long haul flight
- Use of any OTC NSAID
- Recent URTI
3
Q
Immediate mx chest pain
A
- Call for an urgent ambulance
- Aspiring 300mg stat
- IV Fentanyl 50mcg
- 2 large bore IVC
- Oxygen to titrate sats > 94%
- GTN if SBP >100
- Repeat ECG and maintain cardiac monitoring
4
Q
Secondary causes high cholesterol
A
- Hypothyroidism
- Nephrotic syndrome
- Type 2 diabetes
- Cholestasis / obstruction of liver
5
Q
Drugs for secondary CHD prevention
A
- Aspirin / Clopidogrel
- ACE-i
- B blocker
- Statin
- Short acting nitrates PRN
6
Q
Hx questions for presentation with palpitations
A
- frequency and duration of episodes
- nature: fast? regular or irregular?
- precipitating factors (eg caffeine, stress, medication)
- features suggestive of ischaemia (eg chest pain, dyspnoea, nausea)
- symptoms suggestive of arrhythmia (presyncope, syncope)
- features of hyperthyroidism (eg weight loss, tremor, diarrhoea, diaphoresis, heat intolerance)
- anxiety
- features of phaeochromocytoma (eg paroxysmal headaches, flushing)
- features of VTE
- drugs including illicit
7
Q
DDx palpitations
A
- Cardiac arrhythmias - SVT
- Structural heart disease - cardiomyopathy
- Systemic disorders - hyperthyroidism
- Medication - beta blockers
- Lifestyle - caffeine, cannabis, cocaine
8
Q
Lack of response to anti-hypertensive medication
A
- Non-adherence to treatment
- Secondary hypertension: primary aldosteronism, phaechromocytoma
- Sleep apnoea
- Undisclosed alcohol or drug use
- Medication use, OTC
- White coat HTN
9
Q
Those considered already high risk on the CVRA
A
- Diabetes and aged >60 years
- Diabetes with microalbuminuria (>20 μg/min, or urine ACR >2.5 mg/mmol males and >3.5 mg/mmol females)
- Mod or severe CKD (persistent proteinuria or eGFR <45 mL/ min/1.73 m2)
- Diagnosis of familial hypercholesterolaemia
- SBP ≥180 mmHg or DBP ≥110 mmHg
- Serum total cholesterol >7.5 mmol/L
- ASTI peoples aged >74 years
10
Q
Long term mx for CCF
A
- heart failure rehabilitation program
- daily weight checks and flexible diuretic therapy
- early presentation to GP if weight increases / symptoms
- fluid and salt restriction
- medication adherence – home medicines review
- awareness of psychosocial issues and depression
- advanced care planning
11
Q
Important CCF drugs shown to improve survival
A
- ACE-i (ARB if not tolerated)
- Beta blocker, cardiac selective: bisoprolol
- Aldosterone antagonist: spironolactone
12
Q
Risk factors for developing AF
A
- obesity
- HTN
- T2DM
- smoking
- OSA
- CAD
- valvular heart disease
- heart failure
- chronic kidney disease
- hyperthyroidism
- excessive alcohol
- sepsis
- electrolyte abnormalities
13
Q
Anticoagulation therapy for proximal DVT / PE
A
Apixaban 10mg BD 7/7 then decease to 5mg BD
OR
Rivaroxaban 15mg BD 21 days then decrease 20mg OD
14
Q
APO tx in prehospital setting
A
- Frusemide 20-80mg IV or IM. repeat 20 mins
- High flow O2 if sats < 94%
- GTN 400mcg sublingual, repeat 5 mins
