Zeros to Finals Flashcards
what is a QRISK score?
- 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
what should all patients with CDK or T1DM for more than 10 years be started on?
atorvastatin 20mg
4As to remember secondary prevention of cardiovascular disease?
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
what are some side effects of statins?
- myopathy (check CK in patients with muscle pain or weakness)
- T2DM
- haemorrhagic strokes (very rare)
GS in angina?
CT coronary angiography
what is CT coronary angiography?
injecting contrast dye and taking CT images times with the heart beat to give a detailed view of the coronary arteries, highlighting any narrowing
what are the instructions for taking GTN?
spray under tongue when symptoms start, then repeat 5 mins after if required
if there is still pain after 5 mins - call 999
what is the long term symptomatic relief for angina?
5mg bisoprolol and 5mg amlodipine
what is PCI?
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
what is CABG?
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
what does the left coronary artery become?
the circumflex and LAD
where does he RCA curve and what does it supply?
- 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
where does the cicrumflex artery curve and what does it supply?
- left atrium
- posterior aspect of left ventricle
where does the LAD travel and what does it supply?
- anterior aspect of the left ventricle
- anterior aspect of the septum
what do you do if someone is suspected of ACS symptoms but not ST elevation?
- perform troponin blood tests
which ECG leads are affected in left coronary artery and which heart area
I, aVL, V3-6
anterolateral
LAD leads and heart area
V1-4
anterior
circumflex leads and heart area
I, aVL, V5-6
lateral
right coronary artery and heart area
II, III, aVF
inferior
how is a diagnosis of dressler’s syndrome made?
ECG (global ST elevation + T wave inversion)
echocardiogram (pericardial effusion)
raised inflammatory markers (CRP and ESR)
what are the 4 types of MI?
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
explain process of acute left ventricular failure
- 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
what is the presentation of acute LVF
rapid onset breathlessness which is exacerbated by lying flat and improves on sitting up
- type 1 resp failure
what is BNP
- 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
an ejection fraction above X% is normal..?
50%
what is cardiomegaly defined as
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)
which specific test can be done for chronic heart failure?
NT-proBNP
>2000 = urgent referral
first line medical treatment for chronic heart failure
ABAL ACEi Beta blocker Aldosterone antagonist Loop diuretic
what is cor pulmonale?
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
what is the most common cause of cor pulmonale?
COPD
what kind of drug is indapamide and which condition is it used in?
thiazide like diuretic
hypertension (2.5mg)
when is a potassium sparing drug (spironolactone) used and how does it work?
when thiazide diuretics cause hypokalaemia
it works by blocking the action of aldosterone in the kidneys, resulting in Na+ excretion and K+ reabsorption
why is S3 normal in young patients but represents heard failure in older patients?
- 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
where is Erb’s point and what can be heard here?
in the 3rd ICS on the left sternal border
S1 and S1
which special move is done for mitral stenosis?
patient lies on left hand side
which special move is done for aortic regurg?
patient sat up, leaning forward and holding exhalation
how long do bioprosthetic valves last?
limited - 10 years
how long do mechanical valves lasts and what is the con?
20+ years
lifelong anticoagulation with warfarin
what is TAVI?
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
why is AF and embolism related?
tendency for blood to collect in the atria
what does AF look like on ECG?
absent P waves
narrow QRS
irregularly irregular rhythm
most common causes of AF - MRS SMITH
sepsis mitral valve pathology (stenosis or regurg) ischaemic heart disease thyrotoxicosis hypertension
when SHOULDNT rate control be first line in AF?
- reversible AF
- new onset AF (<48 hours)
- AF is causing heart failure
which system affects warfarin?
cytochrome P450 in the liver
what is the CHA2DS2VASC score
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)
what do chadvasc results tell us?
0 = no anticoagulation 1 = consider >1 = offer
what are the 2 cardiac arrest (pulseless) shockable rhythms?
ventricular tachycardia
ventricular fibrillation
what are the 2 cardiac arrest (pulseless) unshockable rhythms?
pulseless electrical activity
asystole
how to treat an unstable tachycardia patient?
consider up to 3 synchronised shocks
consider an amiodarone infusion
how to treat stable narrow complex (<0.12s) tachycardia
AF - rate control with bblocker or dilitiazem
Aflutter - control rate with bblocker
SVT - treat with vagal manoeuvres and adenosine
how to treat stable broad complex (>0.12s) tachycardia?
VT / unclear = amiodarone infusion
SVT with BBB = treat as normal SVT
irregular - seek help
what causes atrial flutter?
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
what does atrialflutter look like on ECG
sawtooth
what causes SVT
the electrical signalling re-entering the atria
