Vascular/Cardiothoracic/Cardiology Flashcards
1
Q
Screening aortic aneurysm
A
3-4.4cm 12 months
- 5-5.4cm 3 months
- 5cm+ 2 week ref
2
Q
Aortic aneurysm diagnosis
A
US first, then CT angiogram guide surgery
3
Q
ABPR critical ischaemia
A
<0.3
4
Q
Critical limb ischaemia features
A
Rest pain >2w
Hanging legs of bed relieves
Gangrene
5
Q
Diagnose acute limb threatening ischaemia
A
Doppler US then ABPI if positive
6
Q
Acute limb threatening ischaemia treatment
A
IV heparin and vascular review
Thromolysis or surgery is definitive
7
Q
Drugs for all patients PAD
A
Atorvastatin 80mg and clopidogrel
8
Q
DVT diagnosis
A
Well score then proximal leg US, if negative then D dimer
DOAC if delay
9
Q
Treatment DVT
A
1) DOAC
2) LMWH (dalteparin) followed by warfarin - renal impairment
10
Q
Venous ulcer treatment
A
Compression bandaging
11
Q
Aortic dissection diagnosis
A
CT angiography - false lumen
Transoesophageal ECHO if unstable
12
Q
Aortic dissection treatment
A
A - surgery and control BP
B - control BP
13
Q
Initial MI treatment
A
MONA:
- morphine
- oxygen
- nitrates
- aspirin
14
Q
STEMI - when do PCI and fibrinolysis
A
PCI - within 2 hours or consider after 12h if ongoing ischaemia
Fibrinolysis - within 12h
15
Q
Antiplatelet therapy before PCI
A
Aspirin and prasugrel, if already taking anticoagulant clopidogrel
16
Q
Antiplatelet therapy fibrinolysis
A
Fondaparinux during then ticagrelor after procedure
Repeat ECG 60-90m and consider PCI
17
Q
NSTEMI treatment
A
Fondaparinux if no PCI, unfractionated heparin if PCI
Depends on GRACE risk assessment
- <3% fondaparinux and dual antiplatelet therapy
- > 3% PCI, unfractionated heparin and dual antiplatelet therapy
18
Q
NSTEMI dual antiplatelet therapy
A
GRACE:
- <3 - ticagrelor and aspirin
- > 3 - prasugrelor/ticagrelor and aspirin
19
Q
Antiplatelet therapy in MI if bleeding risk
A
Clopidogrel instead of ticagrelor/prasugrelor
20
Q
Bradyarrythmia most common after what MI
A
Inferior (II, III, avF)
21
Q
Identify pericarditis after MI
A
Within 48h
22
Q
Identify dressler syndrome after MI
A
2-6w after
Basically pericarditis
23
Q
Dressler syndrome treatment
A
NSAID
24
Q
Identify ventricuar aneurysm after MI
A
Persistent ST elevation and left ventricle failure
25
Identify free wall rupture after MI
1-2w after
| Acute HF secondar to cardiac tamponade - raised JVP, pulses paradoxus (drop in BP when breath in)
26
Identiify ventrical septal defect after MI
1st week
| Acute HF and pansystolic murmur
27
Identify acute mitral regurgitation after MI
Due to rupture papillary muscle
| Acute hypotension, pulmonary oedema, early to mid systolic murmur
28
MI secondary prevention
All patients:
- dual antiplatelet therapy, stop second after 12m
- ACEI
- beta blocker
- statin
29
Stable angina diagnose
CT coronary angiography
30
Stable angina treatment
Aspirin
Atorvastatin
GTN
Long term relief
31
Stable angina long term relief
1) Beta blocker or CCB
2) Increase dose
3) Both
4) Consider long acting nitrate
32
CCB choice in stable angina
Monotherapy - rate limiting like verapamil or diltiazam
| Dualtherapy - long acting like modified release nefedipine
33
Pericarditis diagnosis
ECG and ECHO
34
Pericarditis treatment
NSAID and colchine
35
Classification hypertension
1) Clinic 140/90 home 135/85
2) Clinic 160/100 home 150/95
3) Clinic 180/120
36
Hypertension treatment if <55 or T2 diabetes
1) ACEI or ARB
2) + CCB or thiazide like diuretic
3) + CCB and thiazide like diuretic
4) + spironolactone if K<4.5, otherwise a blocker or b blocker
37
Hypertension treatment if >55 or black
1) CCB
2) + ACEI or ARB or thiazide like diuretic
3) Follow same as <55
38
Most common valve infective endocarditis
Mitral valve
39
Cause infective endocarditis
Staph aureus
40
Cause infective endocarditis poor dental hygeine
Strep viridans
41
Cause infective endocarditis valve surgery last 2m
Staph epiderdimis
42
Cause infective endocarditis colorectal cancer
Strep bovis
43
Dukes major
Blood culture positive
| Evidence on ECHO
44
Infective endocarditis treatment
1) Amoxicillin
| 2) Vancomycin and gentamin if allergic
45
Diagnose acute HF
ECHO and BNP
46
Treatment acute HF
All patients - loop diuretic
Vasodilators if ischaemia
CPAP if resp failure
Inotropes if hypotension - dobutamine or norephinephrine
47
Diagnose chronic HF
B type peptide
48
Treatment chronic HF
Loop diuretics everyone
1) ACEI and beta blocker
2) Spironolactone and monitor K
3) Varies depending
49
Chronic HF 3rd line in reduced LVEV
Ivabradine or sacabitril-valsartan
50
Chronic HF 3rd line in AF
Digoxin
51
Chronic HF 3rd line if black
Hydrolazine and nitrate
52
Supraventricular tachy ECG
Narrow complex QRS
53
Supraventricular tachy acute treatment
1) Vagal maneuvres
2) IV adenosine - 6, 12, 18 or verapamil if asthma
3) Electrical cardioversion
54
Supraventricular tachy prevention
Beta blocker
| Radio-frequency ablation
55
Types of AF
First episode
Paroxysmal - 2 episodes
Persistent - 2 episodes and lasts >7d
Permanent
56
AF rate control
1) B blocker
2) CCB
3) Digoxin
57
AF rhythm control
1) Betablocker
2) Amiodarone
3) Catheter ablation -4w anticoagulation before and still needs after
58
When is cardioversion done in AF
Unstable or failure of treatment
59
When can cardioversion be done in AF
If <48h from presentation, if not needs 3w anticoagulation prior
60
Pharmacological cardioversion
Amiodarone or flecanaide
61
CHA2DS2VS score
```
Congestion HF
Hypertension
Age >75 2, age >65 1
Diabetes
Prior stroke or TIA or VTE 2
Vascular disease
Sex female
```
62
Assess bleeding risk in AF
ORBIT score
63
Anticoagulant choice AF
1) Doac
| 2) Warfarin
64
Ventricular tachy ECG
Broad complex QRS
65
Ventricular tachy treatment
Unstable - cardioversion
| Stable - amiodarone
66
Treatment peri arrest brady
1) Atropine 500 micrograms
2) Repeat up to 3mg
3) Transcutaneous pacing
4) Transvenous pacing
67
Treatment peri arrest tachy
Unstable - up to 3 DC shocks then treat depending on wide or narrow QRS
68
Torsades de pointes ECG
Form of ventricular tachy - broad QRS
69
Torsades de pointes treatment
IV magneisum sulphate
70
What is WPW
Congenital accessory pathway
71
WPW ECG
Short PR
| Wide QRS with delta wave
72
WPW treatment
Radiofrequency ablation accesory pathway
73
Cardiac tamponade triad
Becks triad:
- hypotension
- raised JVP
- muffled heart sounds
74
What is cardiac tamponade
Accumulation pericardial fluid under pressure
75
Differentiate cardiac tamponade from constrictive pericarditis
Tamponade - pulsus paraxous present, kausmaull sign rare (increase in JVP during inspiration)
76
Cardiac tamponade treatment
Urgent pericardiocentesis
77
Identify myocarditis
Young and acute
Chest pain
SOB
Increased inflammatory, increased cardiac enzymes, increased BNP
78
Myocarditis cause
Viral most common - coxsackie, HIV
79
Most common cardiomyopathy
Dilated (90%)
80
Identify dilated cardiomyopathy
Systolic murmur
S3
Balloon appearance on xray
81
Identify HOCM
Exertion SOB
Systolic murmur
Jerky pulse, double apex beat
82
Aortic regurgitation murmur
Early diastolic
83
Aortic regurgitation pulse
Collapsing pulse
| Wide pulse pressure
84
Aortic stenosis murmur
Ejection systolic
85
Aortic stenosis pulse
Slow rising pulse
| Narrow pulse pressure
86
When consider surgery in valve disease
Symptomatic or valvular gradient >40
87
Mitral regurgitation murmur
Pansystolic
88
Rheumatic fever most common valve problem
Mitral stenosis
89
Mitral stenosis murmur
Mid/late diastolic murmur
90
Mitral stenosis pulse
Low volume pulse
91
Tricuspid regurgitation murmur
Pansystolic
92
Tricuspid regurgitation cause
Pulmonary hypertension (eg COPD)
93
Drugs in life support
Adrenaline 1mg every 3-5m
| Amiodarone 300mg after 3 shocks, then 150mg after 5
94
Atrial septal defect murmur and heart sounds
Ejection systolic
| Splitting S2
95
Driving after ACS
4 weeks later
96
Driving aortic aneurysm
Cant >6.5cm
97
What is rheumatic fever
Immunological reaction 2-6w after strep pyogene infection
98
Statins primary and secondary prevention
Primary - atorvastatin 20mg
| Secondary - atorvastatin 80mg
99
Warfarin and major bleeding
Stop warfarin
| IV vit K 5mg and prothrombin complex
100
INR >8 and minor bleeding
Stop warfarin
IV vit K 1-3mg
Restart when INR < 5
101
INR >8 and no bleeding
Stop warfarin
IV vit K BY MOUTH
Restart when INR < 5
102
INR 5-8 and no bleeding
Withhold 1 or 2 doses warfarin
| Restart after
103
Digoxin ECG
Downslopping ST depression
Flattened/inverted T waves
Decrased QT interval
Brady
104
Hypokalaemia ECG
U waves
Small T waves
Increased PR
105
Hyperkalaemia ECG
Peaked T waves
Broad QRS
Sinusoidal if severe
106
Hypothermia ECG
J waves
107
Always pathological on ECG
LBBB
108
Infective endocarditis normally affects
Mitral valve
| Tricuspid valve in IVDU
109
ECG in cor pulmonale
Electrical alterans (alterating height QRS)
110
Pulse with headbobbing
Aortic regurgitation
111
Valve disease in marfans
Aortic regurgitation
