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Cardiology > Wierd and wonderful cardiology > Flashcards

Wierd and wonderful cardiology Flashcards

1
Q

List three antibiotics that can be given in all trimesters of pregnancy

A
  • penicillin
  • ampicillin
  • amoxicillin
  • erythromycin
  • mezlocillin
  • cephalosporin
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2
Q

List two antibiotics that need to have a risk-benefit assessment prior to prescribing during pregnancy

A
  • Vancomycin
  • imipenem
  • rifampicin
  • teicoplanin
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3
Q

List one antibiotic that is contraindicated in pregnancy

A
  • aminoglycosides (e.g. gentamycin)
  • quinolones (e.g. ciprofloxaxin, moxifloxaxin)
  • tetracyclines
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4
Q

List a type of aminoglycoside and and types of bacteria bacteria it is prescribed for

Is it prescribed for aerobic or anaerobic bacteria?

A
  • gentamycin
  • good cover gram-negative antimicrobal for gram negative AEROBES (e.g. Pseudomonas, Nisseria meningitides, moraxella, Klebsiella)
  • not effective against gram negative anaerobes and gram +ve bacteria
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5
Q

List one type of quinolone and an example of a bacteria it is prescribed for

A
  • quinolones (e.g. ciprofloxaxin, moxifloxaxin)
  • effective against gram negative and gram positive bacteria
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6
Q

Explain why a pregnant individual is more at risk of a valve thrombosis compared to a non-pregnant individual

A

Pregnant women have a hypercoaguable state

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7
Q

A pregnant women with a mechanical valve is in her first trimester. Pre-pregnancy she was on warfarin. Her dose pre-pregnancy was 2mg daily. Can she continue this?

A
  • Yes
  • if the dose is less than 5mg, this should be continued pre-conception + pregnancy
  • at the 5mg dose, the risk of embryopathy is the lowest
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8
Q

A pregnant women with a mechanical valve is in her first trimester. If she were to continue warfarin, what is the risk to the fetus?

A

Warfarin crosses the placenta and can cause embryopathy (0.6 – 10% of cases) wheres heparin/clexane do not cross the placenta

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9
Q

A pregnant women with a metallic valve is concerned about the risk of embryopathy associated with warfarin. What gestation is of the highest concern and what could be an alternative?

A
  • could consider UFH or LMWH at 6-12 week gestation if
    > low dose warfarin requirement
    > high dose requirment that would require serial monitoring of INR
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10
Q

For pregnant women with a mechanical valve, is the preferred option warfarin or clexane and why?

A

Warfarin is the preferred option (if dose <5mg) as it carriers a lower risk of valve thrombosis

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11
Q

A pregnant women has an LVEF of 40%. She is on ramipril. Can this continue?

A

ACE inhibitors (-pril), ARBs (-sartan) and renin inhibitors (e.g. Aliskiren) are contraindicated due to fetotoxicity

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12
Q

A pregnant women has Familial Hypercholesterolaemia. Prior to the pre-conception period, she was managed with a statin. Can this continue in pregnancy?

A

Based on the FH Australian guideliens (2021) statins and other systemically absorbed cholesterol regulating drugs should be discontinued 3 mo before planned conception, as well as during pregnancy and breastfeeding (page 333)

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13
Q

What is the name of the condition that is a cardiovascular complication of spinal cord injury and what spinal level does it occur?

A
  • autonomic dysreflexia
  • SCI above T6
    *an injury below T6 would not produce this complication because intact splanchnic innervation allows for compensatory dilatation of the splanchnic vascular bed.
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14
Q

Outline the mechanism of autonomic dysreflexia

A
  • loss of coordinated autonomic responses to demand on vascular tone and heart rate
    > below T6 - Uninhibited or exaggerated sympathetic responses to noxious stimuli below the level of the injury lead to diffuse vasoconstriction and hypertension
    > A compensatory parasympathetic response produces bradycardia and vasodilation above the level of the lesion (i.e. above T6), but this is not sufficient to reduce elevated blood pressure
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15
Q

List 3 stimuli that may trigger autonomic dysreflexia

A
  • bladder distention
  • bowel impaction
  • pressure sores
  • bone fracturee
  • occult visceral distrubances
  • sexual activity
  • post procedure (e.g. labour)
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16
Q

List three clinical symptoms of autonomic dysreflexia

A
  • headache
  • diaphoresis
  • increased blood pressure (from baseline)
  • symptoms of hypertension > flushing, blurred vision, nausea
17
Q

Outline the acute management of autonomic dysreflexia

A
  • Removal of noxious stimulus
  • Orthostatic manoeuvres: Sit upright, legs dangling, remove tight clothing or constrictive devices
  • Investigate bowels and bladder (most common)
    > investigate bladder first > then check for constipation
18
Q

List two abnormalities associated with HOCM

A
  • LV outflow obstruction
  • diastolic dysfunction
  • myocardial ischaemia
  • mitral regurgitation
19
Q

List 4 symptoms associated with HOCM

A
  • fatigue
  • dyspnoea
  • chest pain
  • palpitations
  • presyncope/syncope
20
Q

What is a significant complication of untreated HOCM?

A
  • sudden cardiac death
  • progressive HF symptoms (occasionally associated with systolic dysfunction)
  • AF associated with risk of stroke
21
Q

How does HF manifest in HOCM patients?

A

exertional dyspnoea

22
Q

outline one mechanism of how HOCM can lead to HF

A
  • Diastolic dysfunction due to myocardial hypertrophy
  • Impaired LV emptying due to LVOT obstruction, resulting in increased LV end-diastolic pressure
  • Mitral regurgitation
  • Systolic dysfunction in a patient with more extensive myocardial involvement
    *note PND and orthopnea are UNCOMMON symptoms
23
Q

What is the marker associated with increased sudden death among patients with HOCM?

A
  • Unexplained syncope (ie, not related to neurocardiogenic/vasovagal causes) is considered a marker for increased risk of sudden death, particularly when recent and when occurring in young patients
24
Q

What is the cause of HCM and what is the inheritance pattern?

A
  • mutations in one of the sarcomere genes with encode the contractile apparatus of the heart
  • autosomal dominant inheritance
25
Q

What is the main symptom associated with HCM?

A

exertional dyspnoea

26
Q

What is the nature of chest pain associated with HCM

A
  • exertional chest pain
  • prolonged, atypical
  • precipitated by heavy meals
27
Q

What type of peripheral pulse is associated with HOCM or severe AR?

A
  • double impulse cardiac pulse > single central pulse separated by a distinct mid-systolic dip
  • An early component percussion wave results from rapid left ventricular ejection. A late component tidal wave represents a reflected wave from the periphery due to an artery’s recoil effect. It is best felt in the peripheral arteries, such as the brachial and radial arteries
28
Q

What findings would you expect on a TTE in regards to HOCM

A
  • hyperdynamic LV function
  • small underfilled LV cavity
  • systolic anteriot motion
29
Q

Outline the type of murmur associated with HCM and why it is different to a murmur associated with aortic stenosis

A

HOCM - systolic ejection murmur due to the mitral valve hitting the thickened septal wall
> best heard between apex and L) sternal border
> louder with decreasing preload or decreasing afterload (e.g. Valsalva, abrupt standing) as there is lower blood volume in the left ventricule

AS - ejection systolic murmur, right upper border and radiates to the carotids

30
Q

Outline the treatment for HOCM in an asymptomatic patient

A
  • counsel regarding hydration (especially during activity + losses such as diarrhoea) - this is because lower afterload and lower LVEDV can worsen Sx
  • serial monitoring
31
Q

list 3 therapies that should be avoided in HOCM and why

A

Common treatments that cause peripheral vasodilation, intravascular volume depletion, or increasing myocardial contractility that may increase LVOT obstruction include:
- Nifedipine and amlodipine
- Nitroglycerin
- Arterial vasodilators, such as angiotensin converting enzyme inhibitors and angiotensin II receptor blockers
- Digoxin
- Furosemide and other diuretics, except in rare circumstances and in small doses

32
Q

What is the 1st line medical therapy in HCM?

A

1st line is medical therapy
- When symtpoms develop for a beta blocker that is non-vasodilation (e.g. metoprolol)
- If refractory or intolerance to beta-blocker try a non-dhp (cardio selective) calcium channel blocker – verapamil or diltiazem

33
Q

Where might cyanide be found and what is the first line therapy/antidote?

A
  • hydroxycobalamin (vitamin B12) is given
  • hydrogen cyanide may be in gas
  • often given with Rx of carbon monoxide poisoning
34
Q

What is the mainstay treatment in SCAD?

A

beta blockers

Cardiology (7 decks)

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