OTHERS Flashcards
What is brugada syndrome?
a form of inherited cardiovascular disease with may present with sudden cardiac death
It’s rare
It affects the heart’s electrical systemic leading to abnormal heart rhythms and an icnreased risk of sudden cardiac arrest
What is Brugada sign on ECG?
incomplete/partial right bundle-branch block and convex ST elevations in the anterior precordial leads
How is brugada syndrome inherited?
In an autosomal dominant fashion
Who is Brugada syndrome more common in?
Asians
Whats the pathophysiology of Brugada syndrome?
20-40% of cases are caused by a mutation in the SCN5A gene which encodes the myocardial Na+ channel protein
What are symptoms of Brugada syndrome?
Palpitations
Syncope
Sudden cardiac arrest
Whats the investigation of choice for suspected Brugada syndrome?
Administration of flecainide or ajmaline as these make the ECG changes more apparent
How is Brugada syndrome managed?
With an implantable Cardioverter-defibrillator
What is Buerger’s disease?
Aka thomboangiitis obliterans
a small and medium vessel vasculitis
Characterised by inflammation and clotting which can ultimately lead to obstruction of blood flow and tissue damage
What is Buerger’s disease strongly associated with?
Smoking
What are the features of Buerger’s disease?
extremity ischaemia - intermittent claudication and ischaemic ulcers
superficial thrombophlebitis
Raynaud’s phenomenon
What are the specific rules for driving with hypertension?
can drive unless treatment causes unacceptable side effects, no need to notify DVLA
You must stop driving if you have malignant hypertension and you can drive again when Dr says its well controlled and BP is consistently <180/110mmHg
Bus, coach or lorry - you must tell DVLA if you have hypertension
What are the rules of driving after an elective angioplasty?
1 week off
What are the rules of driving following a CABG?
4 weeks off
What are the rules of driving after acute coronary syndrome?
4 weeks off (1 week if successfully managed with angioplasty)
If you have angina what are the rules with driving?
You can drive unless you get symptoms at rest
What are the rules of driving after having an ICD in?
if implanted for sustained ventricular arrhythmia: cease driving for 6 months
if implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers
What are the DVLA rules for an aortic aneurysm of >/=6cm
Notify DVLA
Licensing will be permitted subject to annual review
An aortic diameter of =/>6.5cm disqualifies you from driving
What are the rules of driving following a heart transplant?
Do not drive for 6 weeks
No need to notify DVLA
What is Wellen’s syndrome?
An ECG pattern that is typically caused by high-grade stenosis in the LAD coronary artery
ECG features includ biphasic or deep T wave inversion in V2-3, minimal ST elevation and no Q waves
What is mild hypothermia?
32-35°C
What is moderate or severe hypothermia?
<32 degrees
What are signs of hypothermia?
shivering
cold and pale skin
slurred speech
tachypnoea, tachycardia and hypertension (mild)
respiratory depression, bradycardia and hypothermia (if moderate)
confusion/ impaired mental state
What ECG changes may you see in hypothermia?
Acute ST elevation
J waves
What can cause palpitations?
arrhythmias
stress
increased awareness of normal heart beat / extrasystoles
What investigations should you do for palpitations?
12 lead ECG
TFT
U&Es
FBC
What electrolyte disturbances can cause arrhythmias?
Hypomagnesaemia
Hypokalaemia
What is holter monitoring?
A portable, battery-operated device that continuously records ECG from 2-3 leads
Done for 24 hours usually
What is long QT syndrome?
an inherited condition associated with delayed repolarization of the ventricles
What can long QT syndrome lead to?
Ventricular tachycardia
Torsades de pointes
(And therefore collapse and Duden death)
What drugs can cause long QT sundrome?
Class 1a antiarrhythmics, amiodarone, sotalol
TCA, SSRI
Methadone
Chloroquine
Terfenadine
Erythromycin
Haloperidol
Ondansetron
What can cause long QT sundrome?
Some congenital conditions
Drugs
Hypocalcaemia, hypokalaemia and hypomagnesaemia
Acute MI
Myocarditis
Hypothermia
Subarachnoid haemorrhage
Which electrolyte abnormalities can cause long QT sundrome?
hypocalcaemia, hypokalaemia, hypomagnesaemia
How do you manage long QT syndrome?
Avoid drugs and other precipitates
Beta blockers (not sotalol!)
ICD for high risk cases
What is Takayasu’s arthritis?
A large vessel vasculitis that typically causes occlusion of the aorta and therefore absent limb pulse
More common in younger females and Asian people
What drug is warfarin?
Anticoagulant
Whats the moa of warfarin?
inhibits epoxide reductase preventing the reduction of vitamin K to its active hydroquinone form
this in turn acts as a cofactor in the carboxylation of clotting factor II, VII, IX and X and protein C.
What are indications for warfarin?
Mechanical heart valves
Second-line after DOACs:
venous thromboembolism and AF
What factors potentiates warfarin?
liver disease
P450 enzyme inhibitors, e.g.: amiodarone, ciprofloxacin
cranberry juice
drugs which displace warfarin from plasma albumin, e.g. NSAIDs
inhibit platelet function: NSAIDs
What are side effects of warfarin?
Haemorrhage
Teratogenic
Skin necrosis
Purple toes
What are inducers of P450 system?
Antiepilepics - phenytoin and carbamazepine
Phenobarbitone
Rifampicin
ST Johns wort
Chronic alcohol intake
Griseofulvin
Smoking
What are inhibitor of P450 system?
antibiotics: ciprofloxacin, clarithromycine/erythromycin
isoniazid
cimetidine,omeprazole
amiodarone
allopurinol
imidazoles: ketoconazole, fluconazole
SSRIs: fluoxetine, sertraline
ritonavir
sodium valproate
acute alcohol intake
quinupristin
What is dabigatran?
Oral anticoagulant
Whats the moa of dabigatran?
Direct thrombin inhibitor
What are the 2 indications of dabigatran?
Prophylaxis of VTE following hip/knee surgery
Prevention of stroke in pt with non-valvular AF
What are SE of dabigatran?
Haemorrhage
What can be used for rapid reversal of dabigatran?
Idarucizumab
What was the RE-ALIGN study?
study showed significantly higher bleeding and thrombotic events in patients with recent mechanical heart valve replacement using dabigatran compared with warfarin.
Previously there had been no guidance to support the use of dabigatran in patients with prosthetic heart valves but the advice has now changed to dabigatran being contraindicated in such patients.
What is bivalirudin?
A reversible direct thrombin inhibitor used as an anticoagulant in the management of ACS
What is clopidogrel?
An antiplatelet agent used in the management of CVD
What are indications for clopidogrel?
Following an ischaemic stroke
in patients with peripheral arterial disease.
What are examples of thienopyridines?
Clopidogrel
prasugrel
ticagrelor
ticlopidine
Whats the moa of thienopyridines?
Antagonist of the P2Y12 adenosine diphosphate receptor - inhibits activation of platelets
What is the ORBIT score for?
Predicts bleeding risk in patients on anticoagulation for afib, similar to HAS-BLED.
What are examples of DOACs?
Dabigatran
Edoxaban
Rivaroxabamn
Apixaban
