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MSRA > Cardiology > Flashcards

Cardiology Flashcards

1
Q

ACEi MOA?

A
  1. Inhibit Angiotensin I to II
  2. Activated by Phase 1 metabolism in liver
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2
Q

ACEi s/e?

A
  1. Cough (15%, up to 1yr after starting)
  2. Angioedema (up to 1yr)
  3. Hyperkalaemia
  4. 1st dose hypotension
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3
Q

ACEi cautions and c/i?

A
  1. Pregnancy and breastfeeding
  2. Renovascular disease = renal impairment
  3. Aortic stenosis = may cause hypotension
  4. Hereditary idiopathic angioedema
  5. Specialist advice when starting ACEi with K > 5
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4
Q

ACEi interaction?

A

> 80mg furosemide daily –> increases risk of hypotension

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5
Q

ACEi monitoring?

A
  1. U&E before Rx and after increasing dose
  2. Creatinine 30% baseline and K 5.5 acceptable
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6
Q

HTN ACEi/ARB criteria?

A
  1. <55
  2. T2DM
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7
Q

HTN CCB criteria?

A
  1. > 55 + no T2DM
  2. ACEi + no T2DM
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8
Q

Chronic HF Rx?

A
  1. ACEi + BB (start one at a time)
  2. Alodesterone antagonist
  3. Specialist = Ivabridine/Entresto/Dixogin/Hydralazine/CRT
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9
Q

Ivabridine HF criteria?

A
  1. SR > 75
  2. LVEF < 35%
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10
Q

Sacubitril Valsartan HF criteria?

A
  1. LVEF < 35%
  2. Symptomatic on ACEi or ARB
  3. Should be initiated following ACEi or ARB period
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11
Q

Digoxin HF criteria?

A
  1. Strongly indicated if coexistent AF
  2. May improve symptoms, doesnt reduce mortality
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12
Q

Hydralazine + Nitrate HF criteria?

A
  1. May be particularly indicated in Afro-Caribbean patients
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13
Q

CRT HF criteria?

A
  1. Widened QRS (LBBB)
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14
Q

HF ‘other’ Rx”

A
  1. Annual influenza vaccine
  2. One-off pneumococcal vaccine
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15
Q

Who needs booster pneumococcal vaccine every 5 years?

A
  1. Asplenia
  2. Splenic dysfunction
  3. CKD
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16
Q

HF furosemide mortality effect?

A

No effect

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17
Q

ACEi and BB mortality effect in HFpEF?

A

None

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18
Q

AF post-stroke management?

A
  1. Warfarin or DOAC
  2. Following a TIA, start anticoagulation immediately
  3. In acute stroke, in the absence of haemorrhage, start anticoagulation after 2 weeks (due to risk of haemorrhagic transformation)
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19
Q

Shockable rhythms?

A

VF/Pulseless VT

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20
Q

Non-shockable rhythm?

A

Asystole/PEA

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21
Q

Cardiac arrest in CCU?

A

Up to three quick successive stacked shocks, then CPR

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22
Q

Adrenaline in ALS?

A
  1. 1mg ASAP non-shockable
  2. 1mg after 3rd shock for shockable
  3. Repeat 1mg every 3-5 mins
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23
Q

Amiodarone in ALS?

A
  1. Amiodarone 300mg VF/pulseless VT after 3 shocks
  2. 150mg VF/pulseless VT after 5 shocks
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24
Q

Alternative to amiodarone in ALS?

A

Lidocaine

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25
Q

O2 post-resus?

A

94-98%

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26
Q

4Hs?

A

Hypoxia
Hypovolaemia
Hypothermia
Hypokalaemia,glycaemia,calcaemia

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27
Q

4 Ts?

A

Tension pneumothorax
Tamponade
Thrombus (Coronary/pulmonary)
Toxin

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28
Q

Beck’s triad of cardiac tamponade?

A
  1. Hypotension
  2. Raised JVP
  3. Muffled heart sounds
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29
Q

ECG electrical alternans?

A

Cardiac tamponade

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30
Q

Absent of Y descent in JVP?

A

Tamponade = TampAX

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31
Q

Cardiac tamponade > Constrictive pericarditis?

A
  1. Absent Y descent
  2. Pulsus paradoxus present
  3. Kussmaul’s sign present
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32
Q

Constrictive pericarditis > Cardiac tamponade?

A
  1. X + Y present
  2. Pulsus paradoxus absent
  3. Kussmaul’s sign present
  4. Pericardial calcification on CXR
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33
Q

Kussmaul’s sign?

A

Paradoxical sign in JVP on inspiration present in constrictive pericarditis

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34
Q

Cardiac tamponade Rx?

A

Urgent pericardiocentesis

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35
Q

ARB examples?

A
  1. Candesartan
  2. Losartan
  3. Irbesartan
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36
Q

ARB MOA?

A

Blocks effect of Angiotensin II at AT1 receptor

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37
Q

Immediate management of suspected ACS?

A
  1. GTN
  2. Aspirin 300mg
  3. O2 if SpO2 < 92%
  4. ECG ASAP
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38
Q

Acute chest pain referral?

A
  1. Abnormal ECG in past 12 hours = Emergency admission
  2. 12-72 hours ago = same day hospital assessment
  3. > 72 hours ago = ECG and troponin
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39
Q

Anginal Pain?

A
  1. Constricting discomfort in front of chest, neck, shoulders, jaw, arms
  2. Precipitated by physical exertion
  3. Relieved by rest or GTN in 5 mins

All 3 = Typical Angina
2 = Atypical angina
1 = Non-anginal chest pain

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40
Q

Possible stable angina Ix?

A
  1. CT coronary angiography
  2. Non-invasive functional imaging
  3. Invasive coronary angiography
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41
Q

Non-invasive functional imaging examples?

A
  1. MPS with SPECT
  2. Stress echo
  3. 1st pass contrast MRI
  4. MR for stress-induced WMA
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42
Q

Stage 1 HTN?

A

Clinic BP >= 140/90 mmHg and subsequent ABPM daytime average or HBPM average BP >= 135/85 mmHg

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43
Q

Stage 2 HTN?

A

Clinic BP >= 160/100 mmHg and subsequent ABPM daytime average or HBPM average BP >= 150/95 mmHg

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44
Q

Severe HTN?

A

Clinic systolic BP >= 180 mmHg, or clinic diastolic BP >= 110 mmHg

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45
Q

Stage 1 HTN treatment criteria?

A

< 80 y/o AND 1 of the following
1. Target organ damage
2. Established CVD
3. Renal disease
4. Diabetes
5. 10yr risk >10%

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46
Q

Reducing salt intake by 6g/day BP effect?

A

Lowers by 10mmHg

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47
Q

Pt < 40 y/o HTN?

A

Refer to specialist to exclude secondary causes?

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48
Q

HTN flowchart steps?

A
  1. A OR C
  2. A+C/A+D OR C+A/C+D
  3. A+C+D
  4. If K < 4.5 add low dose spironolactone, if K > 4.5 add alpha/beta blocker
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49
Q

BP targets?

A
  1. < 80 y/o = clinic 140/90, ABPM 135/85
  2. > 80 y/o = clinic 150/90, ABPM 145/85
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50
Q

Aliskiren?

A

Direct renin inhibitor

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51
Q

Raynaud’s phenomenon with extremity ischaemia?

A

Buerger’s disease

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52
Q

Buerger’s disease?

A
  1. AKA Thrombangitis obliterans
  2. Small and medium vessel vasculitis strongly associated with smoking
  3. Features = extremity ischaemia (intermittent claudication, ischaemic ulcers), superficial thrombophlebitis, Raynaud’s phenomenon
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53
Q

Angina pectoris Rx?

A
  1. Conservative
  2. Medical
  3. PCI
  4. Surgical
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54
Q

Angina pectoris medical Rx?

A
  1. Aspirin + Statin
  2. Sublingual GTN to abort attackd
  3. BB or CCB 1st line
  4. BB + CCB 2nd line
  5. If on monotherapy and cannot tolerate the other = long-acting nitrate/ivabridine/nicorandil/ranolzine
  6. If on BB + CCB, only add a third drug whilst a pt is awaiting assessment for PCI or CABG
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55
Q

Nitrate tolerance mushkies?

A
  1. NICE advises that patients who take standard-release isosorbide mononitrate should use an asymmetric dosing interval to maintain a daily nitrate-free time of 10-14 hours to minimise the development of nitrate tolerance
  2. This effect not seen in pts who take OD modified-release ISMN
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56
Q

Angina pectoris drug management mushkies?

A
  1. If CCB monotherapy use rate-limiting e.g. verapamil or diltiazem
  2. If used in combination with BB –> long-acting dihydropyridine e.g. amlodipine, modified release nifedipine (do NOT prescribe BB with verapamil due to risk of complete heart block)
  3. If poor response to initial treatment then increase medication to maximum tolerated dose
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57
Q

Rate-limiting CCBs?

A

Verapamil or diltiazem

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58
Q

When in DM is BP target 130/80?

A

Adult with T1DM has albuminuria or 2 or more features of metabolic syndrome

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59
Q

ACEi vs. ARB for African?

A

ARB

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60
Q

Torsades de pointes?

A

Polymorphic VT with prolonged QT

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61
Q

Congenital Long QT?

A
  1. Jervell-Lange-Nielsen syndrome
  2. Romano-Ward syndrome
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62
Q

Abx causing torsades?

A

Macrolides

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63
Q

Torsades Rx?

A

IV Magnesium sulphate

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64
Q

Statin adverse effects?

A
  1. Myopathy
  2. Liver impairment
  3. Intracerebral haemorrhage in pts who have had a stroke
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65
Q

Statin liver impairment monitoring?

A
  1. LFTs at baseline, 3m, and 12m
  2. Discontinue if serum transaminase rise and persist at 3x upper limit of normal
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66
Q

Statin Contraindications?

A
  1. Macrolides
  2. Pregnency
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67
Q

Statin indications?

A
  1. All with established CVD
  2. 10 yr risk > 10%
  3. T1DM diagnosed more than 10 years ago OR are aged over 40 OR have established nephropathy
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68
Q

When to increase atorvastatin 20mg primary prevention dose?

A

If non-HDL has not reduced for >=40%

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69
Q

Acute AF Rx?

A
  1. Haemodynamically unstable = electrical cardioversion
  2. Haemodynamically stable < 48h = rate or rhythm control
  3. Haemodynamically stable > 48h/uncertain = rate control
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70
Q

If pt considered for long term rhythm control?

A

Delay cardioversion until they have been maintained on therapeutic anticoagulation for a minimum of 3 weeks

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71
Q

When is rate control not offered as 1st line Rx strategy in AF?

A
  1. AF has reversible cause
  2. HF primarily caused by AF
  3. New-onset AF (<48h)
  4. Atrial flutter whose condition is considered suitable for an ablation strategy to restore sinus rhythm
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72
Q

Rate control agents in AF?

A
  1. BB
  2. CCB
  3. Digoxin (only if person does no or very little physical exercise or other rate‑limiting drug options are ruled out because of comorbidities)
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73
Q

Rhythm control agents in AF?

A
  1. BB
  2. Dronedarone: 2nd line in pts following cardioversion
  3. Amiodarone: particularly if coexisting HF
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74
Q

Catheter ablation indication for AF?

A

Not responded to or wish to avoid, antiarrhythmic medication.

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75
Q

Anticoagulation before catheter ablation?

A

4 weeks before and during the procedure

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76
Q

Does catheter ablation reduce stroke risk?

A

No

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77
Q

Catheter ablation complications?

A
  1. Cardiac tamponade
  2. Stroke
  3. Pulmonary vein stenosis
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78
Q

Fleicanide patient?

A

Those without evidence of structural heart disease

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79
Q

Loop diuretic indications?

A
  1. HF (acute and chronic)
  2. Resistant HTN, particularly in pts with renal impairment
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80
Q

Loop diuretic s/e?

A
  1. Ototoxicity
  2. Hypocalcaemia
  3. Hyperglycaemia
  4. Gout
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81
Q

Grapefruit juice CYP3A4 effect?

A

Potent inhibitor

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82
Q

CHA2DS2-VASc score?

A

Congestive HF
HTN
Age >=75 (or 64-74)
DM
Stroke/TIA/Embolism
Vascular disease (IHD/PAD)
Sex (Female)

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83
Q

CHA2DS2-VASc score interpretation?

A

0 = no treatment
1 = consider in male, no treatment in females
2 = offer anticoagulation

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84
Q

AF + valvular heart disease?

A

Absolute indication for anticoagulation

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85
Q

Bleeding risk consideration with anticoagulants in AF?

A

ORBIT score (prev. HAS-BLED)

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86
Q

LQT1?

A

Swimming

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87
Q

LQT2?

A

Syncope following emotional stress, exercise or auditory stimuli

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88
Q

LQT3?

A

At night or at rest

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89
Q

LQTS Rx?

A
  1. BB
  2. ICD
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90
Q

How do drugs usually prolong QT?

A

Blockage of potassium channels

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91
Q

Non-sedating antihistamine that is a classical cause of prolonged QT?

A

Terfenadine

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92
Q

Bradycardia with adverse signs Rx?

A
  1. Atropine 500mcg IV
  2. Atropine up to maximum 3mg
  3. Transcutaneous pacing
  4. Isoprenaline/adrenaline infusion titrated to response
  5. Specialist help for transvenous pacing
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93
Q

Potential risk of asystole conditions?

A
  1. Complete heart block with broad complex QRS
  2. Recent asystole
  3. Mobitz Type II AV Block
  4. Ventricular pause > 3 seconds
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94
Q

ABCD2?

A

Risk stratifying patients with suspected TIA

95
Q

Ranson criteria?

A

Acute pancreatitis

96
Q

Acute pericarditis causes?

A
  1. Infection = Viral (Coxsackie), TB
  2. Inflammation = Uraemia, CTD
  3. Malignancy
  4. Metabolic = Hypothyroidism
  5. Post-MI, Dressler’s syndrome
  6. Trauma
97
Q

Acute pericarditis ECG?

A
  1. Saddle shaped ST elevatiob
  2. PR depression (most specific ECG marker for pericarditis)
98
Q

Acute pericarditis Rx?

A
  1. Underlying cause
  2. NSAIDs + Colchicine
99
Q

BB licensed for HF?

A
  1. Bisoprolol
  2. Carvedilol
  3. Nebivolol
100
Q

Warfarin indications?

A
  1. Mechanical heart valves (mitral valves usually require higher INRs)
  2. Second line after DOACs (recurrent VTE target = 3.5)
101
Q

Warfarin potentiators?

A
  1. Liver disease
  2. P450 inhibitors
  3. Cranberry juice
  4. NSAIDs (displace warfarin from plasma albumin, inhibit platelet function)
102
Q

Warfarin s/e?

A
  1. Haemorrhage
  2. Teratogenic (can be used in breastfeeding)
  3. Skin necrosis
  4. Purple toes
103
Q

PE most common features?

A
  1. Tachypnoea
  2. Crackles
  3. Tachycardia
  4. Fever
104
Q

PE rule-out criteria?

A

PERC score = all the criteria must be absent to have a negative PERC result (should be done when low pre-test probability of PE <15%, but want more reassurance) –> if -ve, probability of PE <2%

105
Q

If PE is suspected, what score?

A

2 level Wells score
1. PE likely = > 4
2. PE likely = 4 points or less

106
Q

High risk of stroke post-cardioversion anticoagulation?

A

Lifelong

107
Q

Low risk of stroke post-cardioversion antivoagulation?

A

4 weeks

108
Q

Cardioversion in AF indications?

A
  1. Electrical cardioversion if haemodynamically unstable
  2. Electrical or pharmacological cardioversion as an elective procedure where a rhythm control strategy is preferred
109
Q

What is electrical cardioversion synchronised to?

A

R wave to prevent delivery of a shock during the vulnerable period of cardiac repolarisation when ventricular fibrillation can be induced

110
Q

Pharmacological cardioversion?

A
  1. Amiodarone if structural heart disease
  2. Fleicanide or amiodarone in those w/o structural heart disease
111
Q

Anticoagulation following electrical cardioversion if AF is confirmed as being less than 48 hours duration?

A

Unnecessary

112
Q

If high risk of cardioversion failure e.g. previous failure or AF recurrence what should be done?

A

At least 4 weeks amiodarone or sotalol prior to electrical cardioversion

113
Q

Chronic HF Dx?

A

NT-proBNP first line –> if high arrange TOE within 2 weeks, if raised arrange specialist assessment incl. TOE within 6 weeks

114
Q

NT-proBNP levels?

A
  1. < 400 = normal
  2. 400 - 2000 = raised
  3. > 2000 = high
115
Q

Stable CVD combination anticoagulation and antiplatelent therapy?

A

Stop antiplatelet, only anticoagulation necessary

116
Q

Post-ACS/PCI combination anticoagulation and antiplatelet therapy?

A
  1. Triple therapy (2 antiplatelets + 1 anticoagulant) for 4 weeks-6 months after the event and dual therapy (1 antiplatelet + 1 anticoagulant) to complete 12 months
117
Q

VTE combination anticoagulation and antiplatelet therapy?

A

Calculate ORBIT score, if low risk of bleeding then antiplatelets can be continued

118
Q

ACS classification?

A
  1. STEMI
  2. NSTEMI/UAP
119
Q

Common management of ACS?

A
  1. Morphine for severe pain
  2. Oxygen if <94%
  3. Nitrates
  4. Aspirin 300mg
120
Q

STEMI criteria?

A

Clinical symptoms consistent with ACS (generally of ≥ 20 minutes duration) with persistent (> 20 minutes) ECG features in ≥ 2 contiguous leads of:
1. 2.5 mm (i.e ≥ 2.5 small squares) ST elevation in leads V2-3 in men under 40 years, or ≥ 2.0 mm (i.e ≥ 2 small squares) ST elevation in leads V2-3 in men over 40 years
2. 1.5 mm ST elevation in V2-3 in women
3. 1 mm ST elevation in other leads
4. New LBBB (LBBB should be considered new unless there is evidence otherwise)

121
Q

STEMI and PCI not possible within 120 mins?

A
  1. Fibrinolysis = give antithrombin
  2. Ticagrelor
  3. Consider PCI
122
Q

STEMI and PCI possible within 120 mins and onset within 12h?

A
  1. Prasugrel (ticagrelor if high bleeding risk, if already on anticoagulants give clopidogrel)
  2. Unfractionated heparin + bailout glycoprotein IIb/IIIa inhibitor
  3. Drug eluting stents should be used in preference
123
Q

ECG 90 mins after fibrinolysis shows failure of resolution of ST elevation?

A

Transfer for PCI

124
Q

NSTEMI/UAP management?

A
  1. Aspirin 300mg
  2. Fondaparinux if no immediate PCI planned
  3. GRACE score –> low risk (<3%) vs. high risk >3%)
125
Q

NSTEMI/UAP GRACE low risk Rx?

A

Ticagrelor

126
Q

NSTEMI/UAP GRACE high risk Rx?

A
  1. PCI immediately if unstable, otherwise within 72 hours
  2. Give prasugrel or ticagrelor
  3. Give unfractionated heparin
127
Q

HOCM mushkies?

A

An autosomal dominant disorder of muscle tissue caused by defects in the genes encoding contractile proteins. The estimated prevalence is 1 in 500. HOCM is important as it is the most common cause of sudden cardiac death in the young.

128
Q

HOCM pathophysiology?

A
  1. Most common defects involve a mutation in the gene encoding β-myosin heavy chain protein or myosin-binding protein C
  2. Results in predominantly diastolic dysfunction
  3. Characterized by myofibrillar hypertrophy with chaotic and disorganized fashion myocytes (‘disarray’) and fibrosis on biopsy
129
Q

HOCM associations?

A
  1. Friedrich’s ataxia
  2. WPW
130
Q

Broad complex, regular tachycardia Rx?

A

Loading dose of amiodarone followed by 24 hour infusion

131
Q

Irregular broad complex tachycardia Rx?

A

Seek expert help (AF with BBB, AF with ventricular pre-excitation, torsades)

132
Q

Narrow complex tachycardia Rx?

A
  1. Vagal manoeuvres
  2. IV Adenosine
  3. If above unsuccessful consider dx of atrial flutter and control rate e.g. beta blockers
133
Q

Can low risk PE pts be treated at home?

A

Yes

134
Q

First line Rx for PE?

A

Apixaban or Rivaroxaban

135
Q

Other PE treatment options?

A
  1. If neither apixaban or rivaroxaban are suitable then either LMWH followed by dabigatran or edoxaban OR LMWH followed by a vitamin K antagonist (VKA, i.e. warfarin)
  2. If renal impairment is severe (e.g. < 15/min) then LMWH, unfractionated heparin or LMWH followed by a VKA
  3. If the patient has antiphospholipid syndrome (specifically ‘triple positive’ in the guidance) then LMWH followed by a VKA should be used
136
Q

Provoked VTE treatment duration?

A

3 months (3-6 months for active cancer)

137
Q

Unprovoked VTE treatment duration?

A

6 months

138
Q

PE with haemodynamic instability Rx?

A

Thrombolysis

139
Q

Recurrent PE despite anticoagulation Rx?

A

IVC filter

140
Q

Angioplasty driving?

A

1 week off

141
Q

CABG driving?

A

4 weeks off

142
Q

ACS driving?

A

4 weeks off (1 week if successfully treated by angioplasty)

143
Q

Pacemaker driving?

A

1 week off

144
Q

ICD driving?

A
  1. If implanted for sustained ventricular arrhythmia: cease driving for 6 months
  2. If implanted prophylactically then cease driving for 1 month. Having an ICD results in a permanent bar for Group 2 drivers
145
Q

Heart transplant driving?

A

6 weeks

146
Q

Successful catheter ablation for an arrhythmia driving?

A

2 days off

147
Q

Aortic aneurysm >6cm driving?

A

Notify DVLA, >6.5cm disqualifies from driving

148
Q

Antithrombin medication?

A

Fondaparinux

149
Q

Hypokalaemia ECG?

A
  1. U waves
  2. Small or absent T waves
  3. Prolonged PR interval
  4. ST depression
  5. Long QT
150
Q

J wave?

A

Hypercalcaemia

151
Q

Rate control for AF?

A
  1. BB
  2. CCB
  3. Digoxin
152
Q

ST elevation and Q waves in posterior leads V7-9?

A

Posterior infarction

153
Q

Athlete ECG variants?

A
  1. Sinus bradycardia
  2. Junctional rhythm
  3. 1st degree HB
  4. Mobitz Type 1
154
Q

WPW associations?

A
  1. HOCM
  2. Mitral valve prolapse
  3. Ebstein’s anomaly
  4. Thyrotoxicosis
  5. Secundum ASD
155
Q

WPW Rx?

A
  1. Definitive = RFA of accessory pathway
  2. Medical = Sotalol, amiodarone, flecainide
156
Q

Nicorandil MOA?

A

A vasodilatory drug used to treat angina. It is a potassium-channel activator with vasodilation is through activation of guanylyl cyclase which results in increase cGMP

157
Q

Anal ulcer?

A

Nicorandil

158
Q

Nicorandil s/e?

A
  1. Headache
  2. Flushing
  3. Skin, mucosal and eye ulceration (GI ulcer including anal ulceration)
159
Q

Nicorandil C/I?

A

LV failure

160
Q

Aortic dissection classifications?

A
  1. Stanford
  2. De Bakey
161
Q

Stanford Aortic Dissection classification?

A
  1. A = Ascending aorta, 2/3
  2. B = Descending aorta, distal to left subclavian origin, 1/3
162
Q

DeBakey Aortic Dissection classification?

A
  1. Type I = originates in ascending aorta, propagates to at least the aortic arch and possibly beyond it distally
  2. Type II = originates in and is confined to the ascending aorta
  3. Type III = originates in descending aorta, rarely extends proximally but will extend distally
163
Q

Aortic Dissection Ix?

A
  1. Definitive = CT angiography CAP
  2. TOE = unstable pts too risky to take to CT scanner
164
Q

Type A AD Rx?

A

Surgical management, but blood pressure should be controlled to a target systolic of 100-120 mmHg whilst awaiting intervention

165
Q

Type B AD Rx?

A
  1. Conservative
  2. Bed rest
  3. Reduce blood pressure, IV labetalol to prevent progression
166
Q

Causes of LBBB?

A
  1. MI
  2. HTN
  3. AS
  4. Cardiomyopathy
  5. Rare = idiopathic fibrosis, digoxin toxicity, hyperkalaemia
167
Q

HOCM Rx?

A

ABCDE
Amiodarone
BB or Verapamil for Sx
Cardioverter defibrillator
Dual chamber pacemaker
Endocarditis prophylaxis

168
Q

Medications to be avoided in HOCM?

A
  1. Nitrates
  2. Inotropes
  3. ACEi
169
Q

SVT Rx?

A
  1. Vagal manoeuvres
  2. IV Adenosine (6–>12–>18), C/I in asthmatics (verapamil is a preferable option)
  3. Electrical cardioversion
170
Q

SVT prevention?

A
  1. BB
  2. RFA
171
Q

Hypothermia ECG?

A

J wave

172
Q

HTN and asymmetrical kidneys?

A

Renal artery stenosis

173
Q

Most common cause of secondary hypertension?

A

Primary hyperaldosteronism (incl. Conn’s)

174
Q

Complete heart block following MI lesion location?

A

Right coronary artery

175
Q

Ototoxic diuretic?

A

Loop diuretics e.g. Furosemide

176
Q

IE in IVDU which valve?

A

Tricuspid

177
Q

Most affected valve by IE?

A

Mitral valve

178
Q

Most common cause of IE?

A

Staphylococcus aureus

179
Q

IE Following dental procedure?

A

Streptococcus viridans

180
Q

IE in pt following prosthetic valve surgery?

A

CoNS e.g. Staphylococcus epidermidis

181
Q

IE in pt with indwelling line?

A

CoNS e.g. Staphylococcus epidermidis

182
Q

IE in pt with colorectal cancer?

A

Streptococcus bovis (gallolyticus subtype)

183
Q

Culture negative causes of IE?

A
  1. HACEK
  2. Coxiella
  3. Bartonella
  4. Brucella
184
Q

Dressler’s syndrome features?

A
  1. Fever
  2. Pleuritic pain
  3. Pericardial effusion
  4. Raised effusion
  5. 2-6 weeks after MI
185
Q

Dressler’s syndrome Rx?

A

NSAIDs

186
Q

Post-MI LV Aneurysm ECG?

A

Persistent ST elevation

187
Q

What medication should NOT be used in VT?

A

Verapamil

188
Q

VT possible drug therapies?

A
  1. Amiodarone
  2. Lidocaine (use with caution in severe LV impairment)
  3. Procainamide
189
Q

AR features?

A
  1. Early diastolic murmur
  2. Collapsing pulse
  3. Wide pulse pressure
  4. Quincke’s (nailbed pulsation)
  5. De Musset’s (headnodding)
  6. Mid-diastolic Austin-Flint murmur in severe AR - due to partial closure of the anterior mitral valve cusps caused by the regurgitation streams
190
Q

Aortic regurgitation Rx?

A
  1. Medical management of any associated heart failure
  2. Surgery indications = symptomatic with severe AR, asymptomatic with severe AR who have LV systolic dysfunction
191
Q

ACS antiplatelets?

A

Aspirin lifelong and Ticagrelor 12m

192
Q

PCI antiplatelets?

A

Aspirin lifelong and prasugrel/ticagrelor 12m

193
Q

TIA antiplatelets?

A

Lifelong clopidogrel

194
Q

Ischaemic stroke antiplatelets?

A

Aspirin 300mg 2 weeks, Clopidogrel 75mg lifelong

195
Q

Clopidogrel interactions?

A

PPIs make them less effective

196
Q

Statin LFT monitoring?

A

Baseline, 3m and 12m

197
Q

AF and Chronic HF helpful medication?

A

Digoxin

198
Q

Late diastolic murmur?

A

Mitral stenosis

199
Q

Early diastolic murmur?

A

Aortic regurgitation

200
Q

HF and wide QRS helpful management?

A

CRT

201
Q

Drugs shown to reduce mortality in HF?

A
  1. ACEi, ARB
  2. BB
  3. Spironolactone
  4. Hydralazine and nitrates
202
Q

Aortic stenosis symptoms?

A
  1. Syncope
  2. Angina
  3. Dyspnoea on exertion
203
Q

Symptomatic aortic stenosis Rx?

A

Valve replacement

204
Q

Asymptomatic aortic stenosis Rx?

A
  1. If asymptomatic but valvular gradient > 40 mmHg and with features such as left ventricular systolic dysfunction then consider surgery
  2. Aortic valve replacement
  3. Balloon valvuloplasty
205
Q

Aortic valve replacement for AS options?

A
  1. TAVI for high operative risk
  2. Surgical AVR is the treatment of choice for 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
206
Q

Balloon valvuloplasty for AS options?

A
  1. May be used in children with no aortic valve calcification
  2. In adults limited to patients with critical aortic stenosis who are not fit for valve replacement
207
Q

HTN alpha blocker example?

A

Doxazosin

208
Q

T1DM offered statin if?

A
  1. > 40 y/o
  2. DM for > 10y
  3. Established nephropathy
  4. Other CVD risk factors (obesity and hypertension)
209
Q

Antibiotic prophylaxis for IE before dental procedure?

A

Not needed

210
Q

Boerhaaves syndrome mushkies?

A
  1. Spontaneous rupture of the oesophagus that occurs as a result of repeated episodes of vomiting
  2. Severe sepsis occurs secondary to mediastinitis
  3. Diagnosis is CT contrast swallow
  4. Treatment is with thoracotomy and lavage, if less than 12 hours after onset then primary repair is usually feasible, surgery delayed beyond 12 hours is best managed by insertion of a T tube to create a controlled fistula between oesophagus and skin
211
Q

U waves?

A

Hypokalaemia

212
Q

MI secondary prevention?

A
  1. DAPT
  2. ACEi
  3. BB
  4. Statin
213
Q

GRACE score criteria?

A
  1. Age
  2. ECG
  3. Troponin
  4. Renal function
  5. BP, HR
  6. Cardiac arrest on presentation
214
Q

Causes of palpitations?

A
  1. Stress
  2. Increased awareness of normal heart beat/extrasystoles
  3. Arrhythmias
215
Q

Palpitations 1st line Ix?

A
  1. 12 lead ECG
  2. FBC, U&E, TFTs
216
Q

Capturing episodic arrhythmias?

A

Holter monitor

217
Q

Effects of BNP?

A
  1. Vasodilator
  2. Diuretic and natriuretic
  3. Suppresses both sympathetic tone and the RAAS
218
Q

BNP use in chronic HF?

A
  1. Useful marker of prognosis
  2. Guiding treatment (effective treatment lowers BNP levels)
219
Q

When INR high and warfarin held, when is INR typically restarted?

A

When INR <5

220
Q

Warfarin and Major bleeding?

A
  1. Stop warfarin
  2. IV 5mg Vitamin K
  3. PCC (if not available then FFP)
221
Q

INR > 8 and minor bleeding?

A
  1. Stop warfarin
  2. IV Vitamin K 1-3mg
  3. Repeat dose of Vitamin K if INR still too high after 24 hours
  4. Restart warfarin when INR < 5.0
222
Q

INR > 8 and no bleeding?

A
  1. Stop warfarin
  2. Oral Vitamin K 1-5mg
  3. Repeat Vitamin K if INR still too high after 24 hours
  4. Restart warfarin when INR < 5.0
223
Q

INR 5-8 and no bleeding?

A
  1. Withhold 1 or 2 doses warfarin
  2. Reduce subsequent maintenance dose
224
Q

Antihypertensive causing both hyponatraemia and hypokalaemia?

A

Bendroflumethiazide

225
Q

Thiazide effect on calcium?

A

Hypercalcaemia (causes hypercalciuria)

226
Q

Persistent ST elevation following recent MI, no chest pain?

A

LV aneurysm

227
Q

Syncope definition?

A

TLOC due to global cerebral hypoperfusion with rapid onset, short duration and spontaneous complete recovery

228
Q

Pharmacological options for treatment of orthostatic hypotension?

A

Fludrocortisone and midodrine

229
Q

Xanthelasma Rx?

A
  1. Surgical excision
  2. Topical trichloroacetic acid
  3. Laser therapy
  4. Electrodesiccation
230
Q

Additional Rx for Acute MI and HF/LV systolic dysfunction?

A

Aldosterone antagonist

231
Q

Native valve endocarditis Rx?

A

Amoxicillin + Gentamicin

232
Q

Native valve endocarditis (NVE) with severe sepsis/pen allergy/MRSA?

A

Vancomycin + Gentamicin

233
Q

NVE with severe sepsis and risk factors for gram negative infection?

A

Vancomycin + Meropenem

MSRA (25 decks)

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