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PRIYA CARDIO > Zeros to Finals > Flashcards

Zeros to Finals Flashcards

1
Q

what is a QRISK score?

A
  • calculates the percentage risk that a patient will have a stroke or an MI in the next 10 years
  • if they have >10% risk then start atorvastatin 20mg
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2
Q

what should all patients with CDK or T1DM for more than 10 years be started on?

A

atorvastatin 20mg

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3
Q

4As to remember secondary prevention of cardiovascular disease?

A

aspirin - plus a second antiplatelet such as clopidogrel for 12 months
atorvastatin 80mg
atenolol titrated to max tolerated dose
ACEi eg ramipril titrated to max tolerated dose

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4
Q

what are some side effects of statins?

A
  • myopathy (check CK in patients with muscle pain or weakness)
  • T2DM
  • haemorrhagic strokes (very rare)
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5
Q

GS in angina?

A

CT coronary angiography

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6
Q

what is CT coronary angiography?

A

injecting contrast dye and taking CT images times with the heart beat to give a detailed view of the coronary arteries, highlighting any narrowing

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7
Q

what are the instructions for taking GTN?

A

spray under tongue when symptoms start, then repeat 5 mins after if required
if there is still pain after 5 mins - call 999

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8
Q

what is the long term symptomatic relief for angina?

A

5mg bisoprolol and 5mg amlodipine

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9
Q

what is PCI?

A

percutaneous coronary intervention with coronary angioplasty

  • put catheter into patient’s brachial and femoral artery, feeding that up to the coronary arteries under xray guidance and injection contrast so the narrowed arteries are highlighted
  • then treated with balloon dilation followed by insertion of a stent
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10
Q

what is CABG?

A

coronary artery bypass graft

  • opening patient’s chest along the sternum, taking a graft vein from the patient’s leg (usually the great saphenous vein) and sewing it on to the affected coronary artery to bypass the stenosis
  • complication rate higher than PCI
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11
Q

what does the left coronary artery become?

A

the circumflex and LAD

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12
Q

where does he RCA curve and what does it supply?

A
  • it curves around the right side and under the heart and supplied the right atrium, right ventricle, inferior aspect of the left ventricle and posterior septal area
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13
Q

where does the cicrumflex artery curve and what does it supply?

A
  • left atrium

- posterior aspect of left ventricle

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14
Q

where does the LAD travel and what does it supply?

A
  • anterior aspect of the left ventricle

- anterior aspect of the septum

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15
Q

what do you do if someone is suspected of ACS symptoms but not ST elevation?

A
  • perform troponin blood tests
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16
Q

which ECG leads are affected in left coronary artery and which heart area

A

I, aVL, V3-6

anterolateral

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17
Q

LAD leads and heart area

A

V1-4

anterior

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18
Q

circumflex leads and heart area

A

I, aVL, V5-6

lateral

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19
Q

right coronary artery and heart area

A

II, III, aVF

inferior

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20
Q

how is a diagnosis of dressler’s syndrome made?

A

ECG (global ST elevation + T wave inversion)
echocardiogram (pericardial effusion)
raised inflammatory markers (CRP and ESR)

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21
Q

what are the 4 types of MI?

A

type 1 - traditional MI due to acute coronary event
type 2 - ischaemia due to increased demand or reduced supply of O2 (eg secondary to severe anaemia, tachycardia or hypotension)
type 3 - sudden cardiac death or cardiac arrest suggestive or an ischaemic event
type 4 - MI associated with procedures such as PCI, coronary stenting and CABG

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22
Q

explain process of acute left ventricular failure

A
  • left ventricle unable to move blood through left side of heart and out into the body
  • causes backlog and increases blood in the left atrium, pulmonary veins and lungs
  • fluid leaks > pulmonary oedema (lung and alveoli become full of interstitial fluid)
  • interferes with normal gas exchange in the lungs > SOB, reduced O2 etc
23
Q

what is the presentation of acute LVF

A

rapid onset breathlessness which is exacerbated by lying flat and improves on sitting up
- type 1 resp failure

24
Q

what is BNP

A
  • a hormone released from the heart ventricle when cardiac muscle is stretch beyond normal range
  • if high, the heart is overloaded with blood
  • BNP acts to relax the smooth muscle in blood vessels
25
Q

an ejection fraction above X% is normal..?

A

50%

26
Q

what is cardiomegaly defined as

A

cardiothoracic ratio of more than 0.5 (when the diameter of the widest part of the heart is more than half the diameter of the widest part of the lung fields)

27
Q

which specific test can be done for chronic heart failure?

A

NT-proBNP

>2000 = urgent referral

28
Q

first line medical treatment for chronic heart failure

A 
ABAL
ACEi 
Beta blocker
Aldosterone antagonist
Loop diuretic
29
Q

what is cor pulmonale?

A

right sided heart failure caused by respiratory disease
- the increased pressure and resistance in the pulmonary arteries results in the right ventricle being unable to pump blood out of the ventricle > back log of blood in right atrium, VC and the systemic venous system

30
Q

what is the most common cause of cor pulmonale?

A

COPD

31
Q

what kind of drug is indapamide and which condition is it used in?

A

thiazide like diuretic

hypertension (2.5mg)

32
Q

when is a potassium sparing drug (spironolactone) used and how does it work?

A

when thiazide diuretics cause hypokalaemia

it works by blocking the action of aldosterone in the kidneys, resulting in Na+ excretion and K+ reabsorption

33
Q

why is S3 normal in young patients but represents heard failure in older patients?

A
  • in young, the heart functions so well that the ventricles easily allow rapid filling
  • in older, the ventricles and chordae are stiff and weak so they reach their limit much faster than normal
34
Q

where is Erb’s point and what can be heard here?

A

in the 3rd ICS on the left sternal border

S1 and S1

35
Q

which special move is done for mitral stenosis?

A

patient lies on left hand side

36
Q

which special move is done for aortic regurg?

A

patient sat up, leaning forward and holding exhalation

37
Q

how long do bioprosthetic valves last?

A

limited - 10 years

38
Q

how long do mechanical valves lasts and what is the con?

A

20+ years

lifelong anticoagulation with warfarin

39
Q

what is TAVI?

A

treatment for severe aortic stenosis
- catheter inserted into the femoral artery, feeding a wire under xray guidance to the location of the aortic valve, then inflating a balloon to stretch the stenonsed aortic valve and implementing a bioprosthetic valve

40
Q

why is AF and embolism related?

A

tendency for blood to collect in the atria

41
Q

what does AF look like on ECG?

A

absent P waves
narrow QRS
irregularly irregular rhythm

42
Q

most common causes of AF - MRS SMITH

A 
sepsis
mitral valve pathology (stenosis or regurg) 
ischaemic heart disease
thyrotoxicosis 
hypertension
43
Q

when SHOULDNT rate control be first line in AF?

A
  • reversible AF
  • new onset AF (<48 hours)
  • AF is causing heart failure
44
Q

which system affects warfarin?

A

cytochrome P450 in the liver

45
Q

what is the CHA2DS2VASC score

A 
C - congestive heart failure
H - hypertension
A2 - Age >75 (scores 2)
D - diabetes
S2 - stroke or TIA previously (scores 2)
V - vascular disease
A - age 65-74
S - sex (female)
46
Q

what do chadvasc results tell us?

A 
0 = no anticoagulation
1 = consider 
>1 = offer
47
Q

what are the 2 cardiac arrest (pulseless) shockable rhythms?

A

ventricular tachycardia

ventricular fibrillation

48
Q

what are the 2 cardiac arrest (pulseless) unshockable rhythms?

A

pulseless electrical activity

asystole

49
Q

how to treat an unstable tachycardia patient?

A

consider up to 3 synchronised shocks

consider an amiodarone infusion

50
Q

how to treat stable narrow complex (<0.12s) tachycardia

A

AF - rate control with bblocker or dilitiazem
Aflutter - control rate with bblocker
SVT - treat with vagal manoeuvres and adenosine

51
Q

how to treat stable broad complex (>0.12s) tachycardia?

A

VT / unclear = amiodarone infusion
SVT with BBB = treat as normal SVT
irregular - seek help

52
Q

what causes atrial flutter?

A

a re-enterant rhythm in either atrium

  • the electrical signal re-circulates in a self-perpetuating loop due to an extra electrical pathway in the atria (the signal goes round and round the atria at 300bpm
  • the signal gets into ventricles every second lap (due to long RP of AV node) at 150bpm
53
Q

what does atrialflutter look like on ECG

A

sawtooth

54
Q

what causes SVT

A

the electrical signalling re-entering the atria

PRIYA CARDIO (3 decks)

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