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1c Conditions > Passmed - Cardio > Flashcards

Passmed - Cardio Flashcards

1
Q

Angina not controlled by beta-blocker?

A

a longer-acting dihydropyridine calcium channel blocker should be added (amlodipine)

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2
Q

Verapamil should never be used in conjugation with…

A

a beta-blocker as it is a rate-limiting calcium-channel blocker
Doing so could lead to severe bradycardia and precipitate a patient into heart failure.

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3
Q

Angina drug management

A

All should receive aspirin and a statin
sublingual glyceryl trinitrate to abort angina attacks
a beta-blocker or a calcium channel blocker first-line based

if a patient is taking both a beta-blocker and a calcium-channel blocker then only add a third drug whilst a patient is awaiting assessment for PCI or CABG

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4
Q

Acute pericarditis

A

inflammation of the pericardium
Sharp central chest pain, aggravated lying flat, eased leaning forward, ST elevation
Risk factors - auto-immune inflammatory conditions such as SLE, scleroderma and rheumatoid arthritis. Other causes include myocardial infarction, viral infection, TB and uraemia

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5
Q

Stage 1 hypertension (clinic reading)?

A

140/90

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6
Q

Acute heart failure not responding to treatment?

A

Consider CPAP

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7
Q

Heart failure acute management?

A

For all patients - IV loop diuretics (furosemide, bumetanide)

(Possibly oxygen and vasodilators)

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8
Q

Angina management: if a patient has an inadequate response to verapamil?

A

Adding long-acting nitrates is suitable (isosorbide mononitrate)

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9
Q

Angina medication?

A

All - aspirin and statin
Acute - sublingual glyceryl trinitrate
NICE - beta blocker or calcium channel blocker

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10
Q

Common cardio drugs contraindicated in pregnancy?

A

ACEi (e.g. ramipril)

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11
Q

Pulmonary embolism triad?

A

Pleuritic chest pain
Dyspnoea
Haemoptysis

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12
Q

2 level PE Wells score?

A

Clinical signs and symptoms of DVT - 3
Alternative diagnosis is less likely than PE - 3
Immobile for more than 3 days or surgery in last 4 weeks - 1.5
Previous DVT/PE - 1.5
Haemoptysis - 1
Malignancy - 1

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13
Q

PE likely on Wells?

A

More than 4 points

4 or less = PE unlikely

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14
Q

If PE is likely?

A

CTPA
(Give anticoagulant if CTPA is delayed)

CTPA +ve = PE diagnosed
CTPA -ve = proximal leg vein USS if DVT suspected

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15
Q

If PE is unlikely?

A

Arrange D-dimer

If +ve = immediate CTPA
If -ve = stop anticoagulant, PE unlikely

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16
Q

ECG in hypothermia

A

bradycardia
‘J’ wave (Osborne waves) - small hump at the end of the QRS complex
first degree heart block
long QT interval
atrial and ventricular arrhythmias

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17
Q

Myocardial infarction complications?

A

Cardiac arrest
Cardiogenic shock
Chronic heart failure
Tachyarrhythmias
Bradyarrhythmias
Pericarditis
Left ventricular free wall rupture
Left ventricular aneurysm
Ventricular septal defect
Acute mitral regurgitation

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18
Q

Investigating suspected PE: if the CTPA is negative then consider what investigation?

A

a proximal leg vein ultrasound scan if DVT is suspected

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19
Q

Clinical features of aortic stenosis

A

-chest pain
-dyspnoea
-syncope / presyncope (e.g. exertional dizziness)
-an ejection systolic murmur (ESM); radiates to the carotids (is decreased following the Valsalva manoeuvre)

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20
Q

Features of severe aortic stenosis

A

narrow pulse pressure
slow rising pulse
delayed ESM
soft/absent S2
S4
thrill
duration of murmur
left ventricular hypertrophy or failure

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21
Q

Causes of aortic stenosis

A

-degenerative calcification (most common cause in older patients > 65 years)
-bicuspid aortic valve (most common cause in younger patients < 65 years)
-William’s syndrome (supravalvular aortic stenosis)
-post-rheumatic disease
-subvalvular: HOCM

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22
Q

Aortic stenosis management?

A

Symptomatic - valve replacement
Asymptomatic - discharge
Asymptomatic but valvular gradient > 40 mmHg and with features such as left ventricular systolic dysfunction - consider surgery
(Balloon valvuloplasty (in children with no aortic valve calcification or adults with critical AS and not fit for surgery)

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23
Q

options for aortic valve replacement (AVR) include:

A

-surgical AVR - young, low/medium operative risk patients. Cardiovascular disease may coexist. For this reason, an angiogram is often done prior to surgery so that the procedures can be combined
-transcatheter AVR (TAVR) is used for patients with a high operative risk

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24
Q

ACS management

A

-aspirin 300mg
-oxygen (only be given if the patient has oxygen saturations < 94%)
-morphine (only be given for patients with severe pain)
-nitrates (should be used in caution if patient hypotensive)

Percutaneous coronary intervention
Fibrinolysis

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25
Q

Infective endocarditis in intravenous drug users most commonly affects which valve?

A

Tricuspid

26
Q

STEMI management

A

PCI if presents within 12 hours of onset AND PCI can be delivered within 120 minutes of the time when fibrinolysis could have been given
If PCI delayed, consider fibrinolysis first

27
Q

First degree heartblock?

A

PR interval > 0.2 seconds

28
Q

Second degree heart block

A

type 1 (Mobitz I, Wenckebach): progressive prolongation of the PR interval until a dropped beat occurs
type 2 (Mobitz II): PR interval is constant but the P wave is often not followed by a QRS complex

29
Q

Third degree heart block?

A

there is no association between the P waves and QRS complexes

30
Q

In hypothermia, rapid re-warming can lead to

A

peripheral vasodilation and shock
Distributive shock - decrease in blood pressure due to peripheral vasodilation -> can lead to hypoperfusion and damage to vital organs such as brain, lungs, and kidneys. More gradual re-warming would reduce the risk of this.

31
Q

Hypothermia temperature?

A

Mild hypothermia: 32-35°C
Moderate or severe hypothermia: < 32°C

32
Q

Provoked vs unprovoked PE treatment?

A

Unprovoked - 6 month DOAC
Provoked - 3 month DOAC

33
Q

Choice of anticoagulant?

A

First-line apixaban or rivaroxaban

34
Q

If cannot use first-line DOAC?

A

use LMWH followed by dabigatran or edoxaban OR
LMWH followed by a vitamin K antagonist (VKA, i.e. warfarin)

35
Q

first-line treatment for massive PE where there is circulatory failure (e.g. hypotension)

A

thrombolysis

36
Q

Which antibiotic can cause a prolonged QT interval?

A

Erythromycin

37
Q

CHA2DS2-VASc score?

A

Congestive heart failure = 1

Hypertension (or treated hypertension) = 1

A2 Age >= 75 years = 2
Age 65-74 years = 1

Diabetes = 1

Prior Stroke, TIA or thromboembolism = 2

Vascular disease (including ischaemic heart disease and peripheral arterial disease) = 1

Sex (female) = 1

38
Q

CHA2DS2-VASc score meaning?

A

0 = No treatment
1 = Males: Consider anticoagulation
Females: No treatment (this is because their score of 1 is only reached due to their gender)
2 or more = Offer anticoagulation

39
Q

If angina is not controlled with a beta-blocker, a

A

longer-acting dihydropyridine calcium channel blocker should be added (amlodipine)

40
Q

Angina management?

A

aspirin and a statin, sublingual glyceryl trinitrate to abort angina attacks

41
Q

Hypothermia ECG?

A

J waves

42
Q

Cardiac tamponade triad?

A

Classical features - Beck’s triad:
hypotension
raised JVP
muffled heart sounds

43
Q

Cardiac tamponade management?

A

Urgent pericardiocentesis

44
Q

Symptomatic bradycardia management?

A

Atropine (500mcg IV) - first line treatment

If there is an unsatisfactory response:
atropine, up to a maximum of 3mg
transcutaneous pacing
isoprenaline/adrenaline infusion titrated to response

45
Q

Haemodymamic compromise features in bradycardia?

A

shock: hypotension (systolic blood pressure < 90 mmHg), pallor, sweating, cold, clammy extremities, confusion or impaired consciousness
syncope
myocardial ischaemia
heart failure

46
Q

Posterior MI typically present on ECG with

A

tall R waves V1-2

47
Q

Verapamil and x should never be taken concurrently

A

Beta blockers - possibility of heart block and fatal arrest

48
Q

Poorly controlled hypertension, already taking an ACE inhibitor

A

add a calcium channel blocker or a thiazide-like diuretic

49
Q

ECG features of hypokalaemia

A

U waves
small or absent T waves (occasionally inversion)
prolong PR interval
ST depression
long QT

In Hypokalaemia, U have no Pot and no T, but a long PR and a long QT

50
Q

Recent sore throat, rash, arthritis, murmur →

A

?rheumatic fever

51
Q

First line management of acute pericarditis involves

A

combination of NSAID and colchicine

52
Q

If angina is not controlled with a beta-blocker

A

a longer-acting dihydropyridine calcium channel blocker should be added (amlodipine)

53
Q

in elevated JVP, persistent hypotension and tachycardia despite fluid resuscitation in a patient with chest wall trauma, consider

A

Cardiac tamponade

54
Q

Infective endocarditis in intravenous drug users most commonly affects

A

The tricuspid valve

55
Q

Ischaemic changes in leads V1-V4

A

left anterior descending

56
Q

Signs of right-sided heart failure are

A

raised JVP, ankle oedema and hepatomegaly

57
Q

The main ECG abnormality seen with hypercalcaemia is

A

shortening of the QT interval

58
Q

For patients of black African or African-Caribbean origin taking a calcium channel blocker for hypertension, if they require a second agent consider

A

an angiotensin receptor blocker in preference to an ACE inhibitor

59
Q

Cardiovascular disease: medication and doses for primary vs secondary?

A

atorvastatin 20mg for primary prevention, 80mg for secondary prevention

60
Q

Investigating suspected PE: if the CTPA is negative then consider

A

a proximal leg vein ultrasound scan if DVT is suspected

61
Q

the first line investigation for stable chest pain of suspected coronary artery disease aetiology

A

Contrast-enhanced CT coronary angiogram

1c Conditions (10 decks)

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