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Year 5 notes > Cardio > Flashcards

Cardio Flashcards

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1
Q

what electrolyte disturbance can be a poor prognostic factor in ACS

A

hyperglycaemia

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2
Q

when does troponin (T and I) increase, peak and decrease after MI

A
  • increases within 3-12 hours after MI
  • peaks at 24-48 hours
  • decreases at 5-14 days
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3
Q

type of MI which can cause hypotension vs hypertension

A
  • hypotension = inferior MI

- hypertension = anterior MI

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4
Q

dose of morphine in MI

A

2.5-10mg slow IV bolus

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5
Q

when is PCI given in STEMI

A

if on-going ischaemia and within 12 hours of onset

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6
Q

when is thrombolysis given in STEMI

A

if PCI can’t be delivered within 120 mins

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7
Q

examples of thrombolysis for STEMI

A
  • streptokinase/ tenecteplase/ reteplase
  • or LMWH, fondaparinux

do ECG 90 minutes after to assess if >50% resolution of ST elevation - if not might consider rescue PCI

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8
Q

when is CABG indicated in STEMI

A

if PCI fails

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9
Q

how is GRACE score used in STEMI

A

if >3% = undergo coronary angiography within 96 hours of admission
- otherwise will have at a lower date

also give fondaparinux - LMWH if angiography likely within 24 hours

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10
Q

ECG criteria for PCI

A
  • chest pain AND
  • ST elevation >1mm in 2 limb leads OR
  • ST elevation >2mm in 2 contiguous chest leads OR
  • new LBBB in presence of typical history of acute MI
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11
Q

artery for inferior MI

A

right coronary artery (II, III aVF)

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12
Q

artery for anterior MI

A

left anterior descending (V1-V4)

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13
Q

artery for lateral MI

A

left circumflex artery (I, V5, V6)

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14
Q

drugs to take after ACS

A
  • dual platelet therapy (aspirin plus clopidogrel/ticagrelor for up to 12 months)
  • beta blocker
  • statin
  • ACE inhibitor
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15
Q

when to NOT do ABPM/HBPM in diagnosis of HTN

A

if severe - >180/110

treat on day

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16
Q

definition of isolated systolic HTN

A

> 160/<90

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17
Q

how to do HBPM

A
  • twice a day for 7 days
  • each must be done twice at least 1 min apart
  • discard readings for day 1
  • take average of rest
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18
Q

electrolyte disturbances in thiazide-like diuretics (indapamide)

A
  • hyponatraemia

- hypokalaemia

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19
Q

when can you use spironolactone as a 4th line antihypertensive option

A

if K+ level <4.5mmol/l

if >4.5mmol/l = give higher dose thiazide-like diuretic or add alpha/beta blocker

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20
Q

ejection fraction in systolic vs diastolic heart failure

A
  • systolic = <40%

- diastolic = >50%

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21
Q

BNP results in heart failure

A

> 400 = high

<100 = consider alternative diagnosis

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22
Q

New York classification of heart failure

A

1 = heart disease, no undue dyspnoea from normal activity

2 = comfortable at rest, dyspnoea on normal activity

3 = less than ordinary activity causes dyspnoea

4 = dyspnoea at rest, all activity causes discomfort

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23
Q

when to use a beta blocker in heart failure

A

in all with a LVEF <40%

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24
Q

management of acute heart failure

A

PODMAN

  • position
  • O2
  • diuretics (furosemide)
  • morphine
  • antiemetic
  • nitrates (GTN infusion if SBP>110, 2 puffs spray if SBP>90)
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25
first line management for chronic heart failure
ACEi and beta blocker
26
second line management for chronic heart failure
aldosterone antagonist also ARB/hydralazine + nitrate if still having symptoms
27
when to consider implantable cardiac devices for chronic heart failure
if <35% EF
28
when to always do an USS doppler regardless of Wells score in DVT
pregnant | IVDU
29
what to do if DVT likely (Wells 2+)
USS within 4 hours if can't be carried out within 4 hours = D dimer and LMWH while waiting (within 24h) if unlikely - do D dimer (if positive do USS)
30
surgery for acute limb ischaemia
must be within 6 hours
31
management for acute limb ischaemia
- surgery/angioplasty within 6 hours - anticoagulation - atorvastatin 80mg
32
what drug increases risk of thrombophlebitis
amiodarone
33
management of superficial thrombophlebitis
compression stockings
34
first and second line medications for postural hypotension
- 1st = fludrocortisone | - 2nd = milodrine (alpha receptor antagonist)
35
drugs which can cause postural hypotension
- diuretics - antihypertensives - sedatives - vasodilators - anti-depressants - levodopa
36
how often should QRisk2 be assessed in people age 40-85
every 5 years
37
medication for stable angina
beta blocker/CCB - if CCB used alone = verapamil/diltiazem - if used with BB = nifedipine also give: - anti platelet (low dose aspirin or clopidogrel) - atorvastatin 20mg - ACEi if also has diabetes
38
when to give atorvastatin 80mg to people with stable angina (whereas usually is 20mg)
- previous MI/CHD - T2DM - current ACS symptoms
39
how often to check LFTs when on a statin
before treatment, at 3 months and at 12 months
40
what is usually curative of atrial flutter
radiofrequency ablation of tricuspid valve isthmus
41
PR interval in first degree heart block
>0.2 seconds
42
most common cause of complete heart block
myocardial fibrosis
43
ECG findings of proximal heart block
narrow QRS at around 50/min
44
ECG findings of distal heart block
broad QRS at around 30/min
45
drugs which can cause SVT
``` alcohol caffeine salbutamol amphetamines digoxin ```
46
most well-known type of AV re-entrant tachycardia (AVRT)
WPW syndrome
47
dose of adenosine to give in SVT (after vagal manoeuvres)
IV adenosine 6mg, 12mg, 12mg
48
what to give instead of adenosine in asthmatics
verapamil
49
what can be done to help prevent episodes of SVT
- beta blockers - radio frequency ablation - valsalva manoeuvre can be taught to patients
50
drugs which can cause polymorphic VT (torsades de pointes)
- TCA - fluoxetine - amiodarone - erythromycin
51
dose of amiodarone to give in VT
300mg IV over 60 mins then 900mg over 24 hours ideally give through a central line
52
what to do in VT if drug therapy fails
implantable cardioverter-defibrillator
53
murmur in mitral regurgitation
pansystolic murmur - best heard at apex and radiates to axilla
54
what might be shown on ECG with mitral regurgitation and stenosis
bifid p waves - atrial enlargement
55
autoimmune conditions which can cause mitral stenosis (but rheumatic fever and IE most common)
SLE | RA
56
murmur heard in mitral stenosis
mid-late rumbling DIASTOLIC murmur
57
features of mitral stenosis
- loud S1 - malar flush - AF - raised JVP - laterally displaced apex beat
58
when to do surgery in mitral stenosis
percutaneous mitral commissurotomy (PC) for symptomatic patients with severe mitral stenosis/pulmonary hypertension - not if mitral valve area >1.5cm^2
59
most common cause of aortic regurgitation
bicuspid aortic valve other causes = rheumatic fever, infective endocarditis, RA/SLE, spondyloarthropathies, HTN, syphilis, Marfan's, EDS
60
murmur heard in aortic regurgitation
early diastolic murmur - high pitched and 'blowing'
61
pulse pressure in aortic regurgitation
wide pulse pressure collapsing pulse
62
what is Quinke's sign
nailed pulsation - aortic regurgitation
63
what is de Musset's sign
head bobbing - aortic regurgitation
64
most common cause of aortic stenosis in people age >65
degenerative calcification
65
most common cause of aortic stenosis in people age <65
bicuspid aortic valve
66
what does a S4 heart sound indicate
aortic stenosis
67
modified Duke criteria for diagnosis of infective endocarditis
- 2 major - 1 major and 3 minor - 5 minor
68
difference between true aneurysm and pseudo aneurysm
- true = all 3 layers of artery wall (intima, media and adventitia) - pseudo = collection of blood held around vessel by wall of connective tissue, doesn't involve vessel wall
69
infection which can cause an aneurysm
syphilis
70
most common site of peripheral aneurysms (outside of intracranial)
popliteal (70%) femoral second most common peripheral
71
type of ulcer associated with varicose veins
venous ulcers
72
Fontaine classification of chronic lower limb ischaemia
- stage 1 = asymptomatic - stage 2 = intermittent claudication - stage 3 = ischaemic rest pain - stage 4 = ulceration/gangrene or both
73
type of ulcers associated with lower limb ischaemia
arterial ulcers
74
what is Buerger's test
angle at which limb with ischaemia goes pale <20 degrees = severe ischaemia
75
normal, mild, moderate and severe ABPI
- normal >0.9 - mild 0.8-0.9 - moderate 0.5-0.8 - severe <0.5
76
what can you find on AXR in an AAA
calcium deposits where the AAA is (but do USS or CT for diagnosis)
77
prophylactic antibiotics to give in ruptured AAA
IV cef and met
78
scanning for stable AAA based on size
3-4.4cm = rescan annually 4.5-5.4cm = rescan every 3 months >5.5 = refer within 2 weeks to vascular surgery (endovascular stent repair EVAR)
79
what is arrhythmogenic right ventricular dysplasia
type of cardiomyopathy - RV myocardium replaced by fatty tissue (AD genetic)
80
what aortic complication can occur was a result of cardiac tamponade
ascending aortic dissection
81
what to use to reduce BP in aortic dissection
IV labetalol
82
artery usually with the embolus in mesenteric ischaemia
superior mesenteric artery - supplies small bowel
83
investigation to do to diagnose mesenteric ischaemia
CT
84
conditions associated with Raynaud's
SLE RA scleroderma
85
medical management of Raynaud's
CCB e.g. nifedipine

Year 5 notes (10 decks)

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