cardio Flashcards
(312 cards)
1
Q
what is the management of a STEMI if PCI is not possible in 120 mins
A
fibrinolysis
2
Q
what is the conservative management of an NSTEMI
A
ticagrelor
3
Q
which scoring system is used to estimate 6 month mortality of NSTEMI
A
GRACE score
4
Q
what is the immediate management of NSTEMI
A
aspirin 300 mg followed by fondaparinux if no immediate PCI is planned
5
Q
which medications are given alongside PCI ( STEMI)
A
Prasugrel
unfractionated heparin + bailout glycoprotein IIB/IIIA inhibitor
6
Q
name a key difference in the presentation of a Type A aortic dissection vs a type B aortic dissection.
A
chest pain is more common in type A
upper back pain is more common in type B
7
Q
which part of the aorta does
Type A dissection involve
Type B dissection involve
how are they managed
A
Type A : ascending aorta - IV labetalol + surgery
Type B : descending aorta - IV labetalol + medical management
8
Q
most important RF for aortic dissection
A
HTN
9
Q
classical symptoms of dresslers syndrome
A
central pleuritic chest pain
fever
Post MI ( 4 weeks)
10
Q
main investigation for Dresslers syndrome
A
ESR - raised
widespread concave ST elevation + PR depression
11
Q
first line management of SVT
A
Valsalva manouvre
12
Q
what is the most common ECG finding in PE
A
Sinus tachycardia
13
Q
most likely causative organism in Infective endocarditis
A
Staph. aureus
14
Q
what class of drug is indapimide
A
thiazide like diuretic
15
Q
which medication is used as anticoagulation in patients with mechanical heart valves
A
warfarin
16
Q
first line treatment of patients with HF
A
ACEi + Beta blocker
17
Q
which score measures risk of stroke in someone with AF
A
CHA2DS2VASc
18
Q
how does aortic dissection present on CT angiography
A
false lumen of the aorta
19
Q
at what CHADVASC score would you prescribe anticoagulation
A
men > = 1
women > = 2
20
Q
which score is used to measure disease activity in RA
A
DAS28
21
Q
which medications are offered 1st line for reducing stroke risk in AF
A
Rivaroxaban
22
Q
when is thrombolysis indicated in the case of a PE
A
haemo-dynamic instability
23
Q
what is atypical angina ?
A
atypical angina is described as chest pain that only meets 2 out of the 3 criteria for stable angina :
- sharp chest pain
- precipitated by exertion
- relieved by GTN spray
24
Q
what is the 2nd line management of HTN in patient of afro-carribean origin ?
A
ARB
25
first line management of pericarditis
combination of NSAID's and colchicine generally used first line
26
triad of symptoms seen in Takayasu's arteritis
lethargy
dizzy spells
absent left radial pulse
27
which condition is takayasus arteritis associated with
renal artery stenosis
28
what is the management of major bleeding on warfarin
stop warfarin
give IV vitamin K 5 mg
and prothrombin complex concentrate
29
what is the management of minor bleeding ( INR > 8)
stop warfarin
giving IV vitamin K 1-3 mg
repeating dose of vitamin K if INR is still too high after 24h
restarting warfarin when INR < 5
30
what is the diagnostic test for an aortic dissection ? What is a key feature of it
CT angiogram chest abdo pelvis
false lumen
31
what sign is seen on chest xray in aortic dissection
widened mediastinum
32
what is dresslers syndrome and how and when does it present ?
It is pericarditis that tends to occur 2-6 weeks post MI . it is characterized by fever, pleuritic chest pain, pericardial effusion and raised ESR.
33
what are some complications of an MI
Cardiac arrest
cardiogenic shock
chronic HF
Pericarditis
left ventricular free wall rupture
34
what is the most common arrythmia post MI
V fibb
35
how does left ventricular free wall rupture present? How do you treat it ?
acute HF secondary to cardiac tamponade
raised JVP, Pulsus paradoxus, diminished heart sounds. Treat with pericardiocentesis and thoracotomy
36
what is the management of bradycardia with adverse features ?
Atropine up to a maximum of 3 mg
37
what are life threatening signs associated with bradycardia ?
shock
syncope
myocardial ischaemia
HF
38
what is the definitive management of WPW
accessory pathway ablation
39
what score is used in the diagnosis of infective endocarditis
Duke criteria
40
what is the major criteria needed for the diagnosis of IE
positive blood cultures
evidence of endocardial involvement ( +ve echo, new valve regurg))
41
what is the minor criteria needed for the diagnosis of IE
-predisposing heart condition or intravenous drug use
-microbiological evidence does not meet major criteria
-fever > 38ºC
-vascular phenomena: major emboli, splenomegaly, clubbing, splinter haemorrhages, Janeway lesions, petechiae or purpura
-immunological phenomena: -glomerulonephritis, Osler's nodes, Roth spots
42
which antibiotic should be avoided in Long QT syndrome
Erythromycin
43
which is the preferred method of anticoagulation for those with heart valves
warfarin
44
which HF medications improve mortality
ACEi, BB's , spironolactone
45
what is the first line medication offered to reduce stroke risk in AF
Rivaroxaban
46
which score is now used to assess Bleeding risk in patients with AF on anticoag
ORBIT
47
which are non shockable rhythm
Asytole, Pulseless electrical activity
48
which medications do you give in non shockable rhythm
IV Adrenaline
49
when would you give amiodarone in adult advanced life support
Amiodarone 300 mg in patients in VF/ pulseless VT after 3 shocks
50
what features of HTN would suggest specialist assessment
BP > 180/120
signs of retinal haemorrhage
life threatening symptoms - confusion, chest pain, AKI, HF
51
2 features of malingnant HTN
severe HTN
Bilateral retinal haemorrhages and exudate
52
when is a new LBBB normal
never, always pathalogical
53
what dose of adrenaline is given in advanced ALS
1mg
54
how does hypothermia present on an ECG
J-Waves
55
which angina medication requires an asymmetrical dosing regime
Isosorbide mononitrate
56
when would you add a third agent in the management of stable angina
if ccb and bb together fail
57
which vaccines are offered to HF Patients
annual influenza vaccine
one off pneumococcal vaccine
58
common signs of PE on ECG
Sinus tachycardia and in some cases S1Q3T3
59
which condition is associated with an early diastolic murmur
aortic regurgitation
60
what signs would you expect to see on a chest xray in heart failure
dilated upper lobe vessels
alveolar oedema
kerley b lines
cardiomegaly
pleural effusion
61
what is the most common cause of a pansystolic murmur in a patient with HF
Mitral regurgitation
62
how does left bundle branch block present on ECG
W in V1 and M in V6
63
how do you manage adult bradycardia with life threatening signs ?
atropine 500 mcg IV
64
give 4 risk factors for asystole
complete heart block with broad complex QRS
recent asystole
Mobitz type II AV block
Ventricular pause > 3 seconds
65
what signs are used to classify patients as unstable during tachycardia
-Shock : Hypotension ( Sbp < 90 mm Hg), pallor, sweating, cold, clammy extremities, confusion.
- Syncope
-MI
- HF
66
what is the management of unstable tachycardia
Synchronized DC shock ( up to 3)
67
what medication can be used to assist DC Cardioversion after 1st unsuccessful shock
Amiodarone 300 mg IV over 10-20 mins
68
How do you differentiate between broad complex and narrow complex tachycardia ?
Broad complex QRS > 0.12 seconds
Narrow complex QRS < 0.12 seconds
69
how do you manage polymorphic VT
magnesium 2 mg over 10 mins
70
how do you manage Regular ventricular tachycardia
Amiodarone 300 mg IV over 10-60 mins
71
how do you manage regular narrow complex tachycardia ( steps)
- vagal manoeuvres
- adenosine
- verapamil / BB's
72
how does hypercalcaemia present on ECG
shortened QT interval
73
what electrolyte abnormalities can loop diuretics cause ?
Hyponatraemia, hypokalaemia, hypomagnesaemia , hypocalcaemia
74
how do you manage major bleeding on warfarin ?
stop warfarin
give IV Vitamin K 5 mg and Prothrombin complex concentrate
75
how do you manage INR > 8 with minor bleeding on warfarin
stop warfarin
IV vitamin K 1-3 mg
repeat Vit K if INR still too high after 24h
restart warfarin when INR < 5
76
how do you manage INR > 8 no bleeding
stop warfarin
give Vit K 1-5 mg by mouth using IV preperation
repeat vit K if INR still too high after 24h
restart warfarin when INR < 5
77
How do you manage INR 5-8 minor bleeding
stop warfarin
IV vit K 1-3 mg
restart warfarin when INR < 5
78
how do you manage INR 5-8 no bleeding
withhold 1/2 doses of warfarin and reduce subsequent maintenance dose
79
what is the first line management of bradycardia with signs of shock
atropine 500 mcg IV to be repeated up to 3 times
80
what is the first line medication to control rate in AF
beta blocker / rate limiting calcium channel blocker
81
what is the most common cause of infective endocarditis ?
Staph. aureus
82
what is the first line management of pericarditis
Ibuprufen and colchicine
83
which anticoagulation is recommended for patients with mechanical heart valves
Warfarin
84
what sign is seen on echocardiography in Takotsubo cardiomyopathy?
Apical ballooning of myocardium ( resembling an octopus pot)
takotsubo is a fat octopus with balloon tentacles
85
what is the action of dabigatran ?
Oral anticoagulant that works by being a direct thrombin inhibitor.
86
what use is Dabigatran licensed for ?
-Prophylaxis of VTE following hip / knee replacement surgery
-Prevention of stroke in patients with non-valvular atrial fibrillation
87
what medication can be used to reverse the effects of Dabigtran ?
Idarucizumab
88
what is the major adverse side effect of dabigatran ?
Haemorrhage
89
what is the commonest association for aortic dissection?
Hypertension
90
what type of pulse deficit is seen in aortic dissection
weak/ absent carotid brachial or femoral pulse + variation in arm BP
91
what 4 DOACs are recommended by NICE for reducing stroke risk in AF
Apixaban
Dabigatran
Edoxaban
Rivaroxaban
92
give 4 ECG features of Hypokalaemia
Small / absent T waves
Prolonged PR interval
ST depression
Long QT
93
does PE show up on CXR
No- normal
94
which condition presents with widespread ST elevation
Acute pericarditis
95
what is starlings law
It states that when the myocardium stretches due to blood pooling, the force of contraction increases to preserve the stroke volume and thus - cardiac output
96
what are important contraindications to thrombolysis
pregnancy
bleeding
recent stroke / surgery
uncontrolled severe HTN
GI malignancy
Prolonged CPR
97
what is the qrisk score at which a statin is prescribed
over or equal to 10%
98
what is the preferred statin for cardiovascular risk reduction
Atorvastatin
99
what medications should be prescribed in the management of stable angina
GTN spray
beta blocker or CCB ( verapamil / diltiazem) first line
aspirin
statin
100
what are the features of aortic regurgitation
early diastolic murmur, collapsing pulse and wide pulse pressure
Quincke's sign ( nail bed pulsation) and de Musset's sign ( head bobbing)
Mid diastolic Austin Flint murmur
( severe)
101
causes of Aortic regurgitation
bicuspid aortic valve
ankylosing spondylitis
marfans, Ehlers danlos
102
What is the most common cause of mitral stenosis
Rheumatic fever
Infective endocarditis
103
how do you manage suspected PE if D DImer negative
stop anticoagulation and consider alternative diagnosis
104
what ECG changes are considered normal in an athlete
sinus bradycardia
junctional rhythm
1st degree HB
Mobitz Type 1 Weckebach phenomenon
105
most common cause of mitral stenosis
rheumatic fever
106
first line therapy for chronic HF
ACEi
BB ( bisoprolol)
107
2nd line therapy for chronic HF
Aldosterone antagonist
108
what vaccines are offered to chronic HF patients
Annual influenza vaccine
one off pneumococcal vaccine
109
what medication can be used to reverse bleeding effects of dabigatran ?
Idarucizumab
110
how do you manage a patient with AF whos CHADVASC suggests no anticoagulation
transthoracic echo to exclude valvular heart disease
111
what type of murmur is seen in mitral stenosis
mid-diastolic low pitched rumbling murmur
112
give the step wise management of bradycardia with adverse signs
atropine 500 mcg IV
followed by
atropine up to a maximum of 3 mg
transcutaneous pacing
isoprenaline / adrenaline infusion
travsvenous pacing
113
which valve is most commonly affected in infective endocarditis
Mitral valve
114
infective endocarditis in IVDU most commonly affects which valve
tricuspid valve
115
which part of the renal tract does bumetanide act upon
inhibition of Na-K-Cl cotransporter in thick ascending limb of the loop of Henle
116
how do you interpret BNP
if levels are 'high' arrange specialist assessment (including transthoracic echocardiography) within 2 weeks
if levels are 'raised' arrange specialist assessment (including transthoracic echocardiography) echocardiogram within 6 weeks
117
what are the target values for INR when patient has mechanical valves
aortic -3
mitral 3.5
118
which score is used to assess bleeding risk in patients with AF who are anticoagulated
ORBIT
119
criteria for patient with AF to be cardioverted
must be anticoagulated
must have had symptoms for < 48 h
120
what is the NYHA classification
1 . no symptoms
2. mild symptoms / slight limitation of physical activities
3. moderate symptoms : marked limitation of physical activity ( comfortable at rest but ordinary activities cause discomfort)
4. severe - cant do anything without symptoms
121
at what CHADVASC score would you offer anticoagulation
2 - women
1.- men
122
what is takotsubo cardiomyopathy ? how does it present and what are its triggers?
Takotsubo cardiomyopathy is a type of non ischaemic cardiomyopathy associated with a transient apical ballooning of the myocardium
it is triggered by stress
features are chest pain, ECG showing widespread ST Elevation and features of HF
supportive management
123
which medications are contraindicated with statins
macrolides like erythromycin and clarithromycin - reduction in kidney function
pregnancy
124
give 3 features of left ventricular free wall rupture
raised JVP
Pulsus paradoxus
diminished heart sounds
125
what is the mechanism of action of statin
inhibits HMG-CoA reductase the rate limiting enzyme in hepatic cholesterol synthesis
126
what are the features of hypokalaemia on ECG
U waves ( u have no pot)
small / absent T waves
prolonged PR
ST Depression
long QT
127
what is the investigation of choice for aortic dissection
CT angiography
128
For a patient with symptomatic stable angina on a calcium channel blocker but with a contraindication to a beta-blocker, the next line treatment should be _____________
isosorbide mononitrate ( long acting nitrate, ivabradine, nicorandil, ranolazine)
129
what murmur is mitral stenosis associated with
mid diastolic murmur loudest over the apex
130
which CCB should be prescribed in the management of stable angina ?
for monotherapy : rate limiting one such as verapamil or diltiazem
for combination with beta blocker : long acting like amlodipine or modified release nifedepine
131
what are the indications for patient with NSTEMI to have coronary angiography
immediate : hemodynamically unstable
within 72 h : GRACE SCORE > 3%
132
what type of murmur is seen in aortic stenosis
Ejection systolic murmur classically radiating to the carotids.
133
when are nitrates contraindicated
Hypotension
aortic stenosis
134
when would you stop beta blocker in HF
HR < 50 / Min
2nd / 3rd HB
Shock
135
why does hypertrophic obstructive cardiomyopathy cause sudden death in young atheletes
ventricular arrythmia
136
how to distinguish mitral from tricuspid regurgitation
tricuspid regurgitation : becomes louder during inspiration
137
most common cause of infective endocarditis in patients who have undergone prosthetic valve surgery
Staph. Epidermis
138
explain monitoring of fibrinolysis
give antithrombin drug
repeat ECG after 60-90 mins and perform PCI if myocardial ischaemia persists.
139
what is the first line investigation for stable chest pain of suspected coronary artery disease
CT coronary angiogram with contrast
140
what electrolyte imbalances do thiazide diuretics cause
hypokalaemia
hyponatraemia
hypercalcaemia
hypocalciuria in urine
impaired glucose tolerance
141
what are the contraindications to ACEi
pregnancy and breastfeeding
renal disease
aortic stenosis
142
what is the diagnostic test for cardiac tamponade
Echocardiogram
143
MI due to first degree HB is generally seen in which leads
MI due to first degree HB is generally seen in which leads
144
when would you consider a third heart sound to be normal
considered normal if < 30
145
which conditions can present with a third heart sound
Left ventricular failure ( dilated cardiomyopathy)
Constrictive pericarditis
Mitral regurgitation
146
what is becks triad
Hypotension
raised JVP
muffled heart sounds
147
Explain the interpretation of a Wells score when PE is suspected.
PE likely : > 4 points
arrange immediate CTPA // interim therapeutic anticoagulation until the scan is performed
PE unlikely 4 points or less
arrange D Dimer
positive : CTPA with interim therapeutic anticoagulation
negative : Stop anticoagulation + consider alternative diagnosis
148
what is S1Q3T3 classical of
PE
149
which pulse is most likely to be present in a patient with an early diastolic murmur louder on expiration
Collapsing pulse
150
what is the most specific finding on ECG in acute pericarditis ?
PR depression
151
which medication is preferred in patents with AF who have structura heart disease for rhythm control
amiodarone
152
how long after a stroke should secondary prevention medication be started in a patient with AF? What medications suitable
2 weeks
Warfarin
Direct thrombin
factor Xa inhibitor
153
to what wave is electrical cardioversion synchronized to
R wave
154
what is the management of aortic stenosis ?
symptomatic : Valve replacement
asymptomatic but valvular gradient > 40 mm Hg : valve replacement
asymptomatic : observation
155
what is Torsades de Pointes and how does it present ?
How is it managed
Polymorphic ventricular tachycardia with long QT
Managed with IV Magnesium sulphate
156
how does a posterior MI present
ST depression
Tall, broad R-waves
Upright T-waves
157
what is the conservative management of NSTEMI?
Aspirin 300 mg + Fondaparinux + ticagrelor
158
what is the intermediate / high risk management of NSTEMI ?
aspirin + prasugrel / ticagrelor + unfractionated heparin + PCI
159
what is the management of a STEMI when PCI is possible?
prasugrel + unfractionated heparin + bailout glycoprotein IIb / IIIa inhibitor
160
what is the management of STEMI when Fibrinolysis is planned?
Antithrombin
ticagrelor
161
what is the management of a shockable rhythm ?
1 shock followed by resumption of CPR for 2 minutes
amiodarone 300 mg for patients who are in VF/ pulseless VT and 3 shocks have been administered.
adrenaline 1 mg once chest compressions have started after the third shock
162
what is the management of a non-shockable rhythm?
CPR for 2 mins
adrenaline 1 mg as soon as possible for non shockable rhythms
163
what is Buerger's disease ? What is it associated with? What are it's features?
Known as thrombo-angiitis obliterans and is a small + medium vessel vasculitis that is associated with smoking
Feature's include :
extreme ischaemia
claudication and ulcers
raynauds
thrombophlebitis
164
which medication is contra-indicated in ventricular tachycardia
verapamil
165
what are rules regarding combination antiplatelet and anticoagulation therapy
in stable cvd : anticoagulation monotherapy
post ACS / PCI : 2 platelets and 1 anticoagulant for 4-6 weeks after event and dual therapy 1 platelet 1 anticoagulant to complete 12 months
166
what is the DVLA advice post MI
Cannot drive for 4 weeks
167
how does ventricular septal defect present in a patient post MI
acute heart failure, new pan-systolic murmur
168
what score helps identify patients with a PE that can be managed as an outpatient
PESI : Pulmonary embolism severity index
169
what is the investigation choice in suspected PE when the patient has renal failure ?
VQ scan
170
what is Kussmaul's sign? What condition is it present in?
rise in JVP during inspiration
constrictive pericarditis
171
how do you manage a choking patient depending on if they have mild / severe airway obstruction?
mild
ask patient to cough
severe and conscious
5 back blows
followed by 5 abdominal thrusts
continue cycle
unconscious
call for ambulance
start CPR
172
how long is treatment continued in a patient with VTE
provoked : 3 months
unprovoked : 6 months in total
173
what causes sudden death in Hypertrophic cardiomyopathy
ventricular arrythmias
174
what is the first line investigation of episodic arrhythmias ?
Holter monitoring
175
what type of an arrhythmia is svt ? How is it managed?
it is a narrow complex tachycardia.
management :
vagal manouvres such as valsalva manouvre.
IV adenosine
electrical cardioversion
176
which beta blockers reduce mortality in stable HF ?
Bisoprolol and carvedilol
177
what is the standard drugs offered to a patient post MI ?
Dual anti-platelet therapy ( aspirin + 1 more)
ACEi
BB
Statin
178
which score can be used to assess anxiety in a patient?
HAD
179
above what GRACE score should coronary angiography be considered?
> 3 %
180
what biochemical marker is raised in Dressler's syndrome?
ESR
181
what abdo findings are seen in tricuspid regurgitation
pulsatile liver
ascites
182
what is the most common cause of death post MI
ventricular fibrillation
183
what type of MI precedes an AV block
inferior MI
184
what is the investigation of choice in suspected pericarditis
transthoracic echo
185
when is a carotid artery endarterectomy recommended in the management of TIA
if carotid stenosis 70 %
186
what imaging is performed in the investigation of TIA
MRI preferred
urgent carotid doppler
187
what is the immediate assessment and referral guidelines for suspected TIA
aspirin 300 mg - unless bleeding disorder/anticoagulation in which case admission is needed
in the last 7 days - immediate assessment by stroke physician
more than 7 days - refer for specialist assessment asap in 7 days
188
what is the secondary prevention of TIA
clopidogrel
aspirin + dipyradamole if clopidogrel not tolerated
189
which anti-anginal medication do patients commonly develop tolerance to? How do you prevent this ?
standard release isosorbide mononitrate
Assymetric dosing interval
190
what are the three types of ischaemia to the lower GI tract ?
acute mesenteric ischaemia
chronic mesenteric ischaemia
ischaemic colitis
191
what are the common features of bowel ischaemia ? what investigation is used for diagnosis ?
abdominal pain
rectal bleeding
diarrhoea
fever
bloods show lactic acidosis
investigation : CT
192
what are the preceding factors, symptoms and management of acute mesenteric ischaemia
occlusion of artery such as superior mesenteric artery with a background of AF
presents with severe, sudden onset abdominal pain, required to be managed with urgent surgery
193
what is ischaemic colitis ? what areas does it affect? what are its complications + investigations and management
acute + transient compromise in the blood flow to the large bowel leading to inflammation, ulceration and haemorrhage.
areas - watershed areas like splenic flexures
investigations - thumbprinting on abdo xray
management - supportive, surgery
194
what medications are used in the management of shockable vs non shockable rhythms
adrenaline - 1mg asap for non- shockable rhythms
to be repeated every 3-5 mins whilst ALS continues
amiodarone - 300mg to be given to patients in VF/VT after 3 shocks
195
what is the management of atrial flutter ? what is curative ?
similiar to AF - medications less effective
more sensitive to cardioversion
radiofrequency ablation of tricuspid isthmus is curative
196
what is the management of Torsades de pointes?
IV Magnesium sulphate
197
what medications cause long QT
antibiotics- macrolides
antipsychotics - clozapine, haloperidol
antidepressants - TCAs
antiemetics- ondansetron
198
what diseases can cause torsades de pointes
myocarditis
hypothermia
sah
electrolyte imbalance - hypocalcaemia, hypokalaemia, hypomagnesaemia
subarachnoid haemorrhage
199
what is the referral guidelines for AAA
asymptomatic and aortic diameter < 5.5 cm - low rupture risk, so abdominal ultrasound surveillance depending on size.
if the aneurysm is symptomatic or the aortic diameter > 5.5 cm or rapidly enlarging : refer within 2 weeks to vascular surgery for probable intervention, and management with elective endovascular repair.
200
how often is an abdominal aortic aneurysm scanned
3-4.4 cm = every 12 months
4.5-5.4 = 3 months
5.5 - referral within 2 weeks for probable intervention
201
explain acute mitral regurgitation post MI
infero-posterior infarction may be due to ischaemia or rupture of the papillary muscle leading to acute hypotension and pulmonary oedema
202
what is the management of ischaemic stroke ?
aspirin 300 mg rectally or orally if haemorrhagic stroke has been excluded
thrombolysis if patient has presented within 4.5 hours of onset + haemorrhage has been definitely excluded
thrombectomy - offer with thrombolysis within 4.5 hours .or just thrombectomy within 6 hours. Extended target time upto 24h considered if there is potential to salvage brain tissue - CT/ MRI showing limited core infarct core volume
203
what is the secondary prevention of stroke
clopidogrel
aspirin + mr dipyradimole - if clopidogrel c/i
204
what is the most specific finding on ecg in acute pericarditis
pr depression
205
what are the most common causes of endocarditis
staph aureus
staph epidermis if < 2 months post valve surgery
206
mx of irregular broad complex tachy
seek cardiology input
207
post mi drugs
dual antiplatelet therapy (aspirin plus a second antiplatelet agent)
ACE inhibitor
beta-blocker
statin
208
ptn of myocarditis
young patient with acute history
chest pain
dyspnoea
arrhythmias
ST elevation and acute pulmonary oedema
recent flu like illness
209
how does left ventricular aneurysm post MI present
persistent ST elevation in anterior leads
pulmonary oedema
features of acute heart failure such as -
SOB
Cough
crackles on auscultation
occuring 2 weeks post MI
210
when do you offer pharmacological management of hypertension to those over 80
if ABPM > 150/95 mmHg
211
what is the guidelines surrounding anticoagulation in patient with AF who has had a stroke
aspirin daily, start anticoagulation after 2 weeks
212
what are poor prognostic features for ACS ?
age
development of HF
peripheral vascular diseases
reduced systolic BP
cardiac arrest
ST segment deviation
Killip class - crackles, pulmonary oedema, cardiogenic shock
213
what indicates mobility of mitral valves
opening snap
214
what are the features of post MI ventricular septal defect
acute HF associated with a pan-systolic murmur
usually seen in the first week after an MI
215
what is the management of a cardiac arrest witnessed on monitor
3 successive shocks before CPR
216
what is a side effect of the following medications ?
Nicorandil
Isosorbide mononitrate
beta blockers
Nicorandil - ulcers , risk of bowel perforation during diverticular disease
isosorbide mononitrate - development of tolerance
bisoprolol- sexual dysfunction
217
what type of disease is a pansystolic murmur associated with
tricuspid and mitral regurg- murmur louder on inspiration in tricuspid
218
what is the biggest cause of mitral stenosis
rheumatic fever
219
what are features of severe MS ?
length of murmur increases
opening snap becomes closer to S2
220
what is the management of mitral stenosis
asymptomatic - regular echos
symptomatic - Percutaneous mitral balloon valvotomy
221
whats the very first thing u do in stroke suspected
hypoglycaemia
ROSIER
222
what is the first line investigation for stroke? what is a characteristic sign of :
acute ischaemic stroke
acute haemorrhagic stroke
CT head - non contraaat
acute - hyperdense artery sign and may show areas of low density in the grey and white matter
acute haemorrhagic - hyperdense material surrounded by low density
223
what tests are used to investigate cause of stroke in young ppl
thrombophilia
autoimmune
under 55 with no cause of stroke
224
what is the ABPM definition of stage 1 HTN
bp 135/85
225
what is the definition of stage 2 htn
what is the definition of severe htn
stage 2- clinical bp >=160/100 mmHg and subsequent ABPM >= 150/95
stage 3 = clinic systolic BP >= 180 mmHg , clinic diastolic BP > 120 mmHg
226
what are the dietart modifications recommended for the management of HTN
low salt diet - aiming for < 6 g / day , ideally 3 g a day
227
which artery is the preferred site for insetion of a catheter for PCI
radial artery
228
what medication causes reflex tachycardia
nifedipine
229
how and when is amiodarone administered in management of VF/ pulseless VT ?
What is an alternative ?
300 mg amiodarone after 3 shocks
further 150 mg after 5 shocks have been given
alternative : Lidocaine
230
when is adrenaline given in an VF/VT cardiac arrest
once chest compressions have restarted after the third shock - to be repeated every 3 - 5 mins
231
what heart murmur can present with haemoptysis
mitral stenosis
232
what are the surgical options for aortic stenosis
surgical AVR for low/medium operative risk patients
transcatheter AVR for high operative risk patients
233
when is balloon valvuloplasty used in the management of aortic stenosis
may be used in children with no aortic valve calcification
in adults limited to patients with critical aortic stenosis who are not fit for valve replacement
234
when does anticoagulation start after a TIA in patients with atrial fibrillation ?
how does this differ in acute stroke ?
anticoagulation should start immediately once a haemorrhage has been excluded
in acute stroke - anticoagulation should be commenced in 2 weeks once haemorrhage has been ruled out
235
what is the first line investigation for acute mesenteric ischaemia ?
raised lactate
236
broad complex tachy following MI is always
ventricular tachy
237
what is the time frame within which pericarditis and dresslers syndrome occur post mi
pericarditis - 1st 48 h
dresslers- 2-6 weeks post Mi
238
How does a Pontine haemorrhage present ? What is it a complication of ?
complication secondary to chronic HTN
reduced GCS
Quadriplegia
miosis
absent horizontal eye movements
239
what arteries does a Lacunar infarct involve ? how can it present
perforating arteries around internal capsule, thalamus and basal ganglia and one of -
unilateral weakness and or sensory deficit of face and arm, arm and leg or all 3
pure sensory stroke
ataxic hemiparesis
240
which arteries does a posterior circulation infarct involve
vertebrobasilar arteries presenting with one of -
cerebellar or brainstem syndromes
loc
isolated homonymous hemianopia
241
how does a posterior cerebral artery stroke present
contralateral homonymous hemianopia with macular sparing and visual agnosia
242
what heart condition can conditions like ankylosing spondylitis and connective tissue disorders pre-dispose you to
aortic regurgitation
243
what is the first line medication used in the management of PAD
clopidogrel
244
what lifestyle factor has significant benefit in PAD
exercise training
245
what makes an aortic stenosis murmur quieter
left ventricular systolic dysfunction
246
what medication is given along with fibrinolysis
antithrombin - fondaparinaux
247
what is the criteria for open bypass graft in PAD A
critical limb ischaemia - for long segment lesion > 10 cm
248
what is the criteria for admitting patient in htn
bp > 180/120
signs of retinal haemorrhage + papilloedema
life threatening symptoms such as new onset confusion , chest pain, signs of HF, aki
249
what is the first line investigation for suspected acute limb threatening ischaemia
handhend arterial doppler
250
what is the investigation of choice in clinically unstable patients with suspected aortic dissection
transoesophageal echo
251
what is the management of patients anticoagulation when they have had catheter ablation
continue anticoagulation because stroke risk remains the same
252
summarise the management of broad complex tachycardias
any adverse signs : synchronized DC shocks ( upto , before asking for specialist input)
regular - ventricular tachy
loading dose of amiodarone followed by 24h infusion
irregular -specialist input
253
how long should CPR continue when thrombolytic drugs are given
60-90 min
254
which 2 medications should a patient take post ischaemic stroke and discharge
clopidogrel and statin
255
what are the most common clinical causes of ventricular tachycardia
Hypokalaemia
256
give the stepwise management of supraventricular tachycardias
vagal manouvres - valsalva ( blowing into an empty plastic syringe)
carotid sinus massage
iv adenosine
rapid IV bolus of 6 mg - if unsuccessful give 12 mg -- if further unsuccessful give further 18 mg
electrical cardioversion
257
what can be used in the prevention of supraventricular tachycardias
beta blockers
radiofrequency ablatiin
258
summarise the stepwise management of heart failure
ACEi and Beta blocker
2nd line -aldosterone antagonist, SGLT2 can be used in management with reduced ejection fraction
3rd line =
digoxin = symptoms / co-existing AF
hydralazine w nitrate = black ppl
cardiac resynchronized therapy- widened QRS ( LBBB)
ivabradie = LVF< 35, sinus rhythm > 75 / min
sacubitral-valssartan LVF< 35% ; symptomatic on ACEI. ARB and symptomatic ( initiated following ACEi or ARB wash out period)
259
when do u use unsynchronized DC cardioversion?
pulseless VT/AF
unstable polymorphic VT
260
what is the management of AF if there is co-existent HF, first onset HF, or reversible case
rhythm control
261
what patterns of presentation may be present in PAD
intermittent claudication
critical limb ischaemia
acute limb threatening ischaemia
262
features of acute limb threatening ischaemia
pale
pulseless
painful
paralysed
paraesthetic
'perishing with cold'
263
management of acute limb threatening ischaemia
ABCDE
IV opioids used
vascular review
264
main causes of acute limb threatening ischaemia
thrombus
embolus due to AF
265
Chronic vs acute limb threatening ischaemia
chronic - symptoms have to be present for 2 weeks
266
most common cause of congenital heart disease
ventricular septal defect
267
classical signs of VSD
failure to thrive, pan-systolic murmur
268
what can cause orthostatic hypotension
venous pooling, post meal, prolonged bed rest, pregnancy
primary autonomic failure - Parkinsons and Lewy body
secondary - diabetic neuropathy, amyloidosis and uraemia
drug induced - diuretics, alcohol, vasodilators
volume depletion - haemorrhage, diarrhoea
269
which is a useful marker to detect re-infarction
CK-MB
270
coarctation of the aorta
mid systolic murmur, radio-femoral delay
271
definition of orthostatic hypotension
drop in SBP of at least 20 mmHg or drop in DBP of at least 10 mmHg after 3mins of standing
272
which conditions can cause a raised BNP ( apart from hf)
CKD
MI
valvular disease
273
what ECG changes suggest ischaemia
Q wave abnormality
T wave changes
274
ventricular septal defect on cardiac catheterisation
jump in oxygen from right atrium to right ventricle
275
main cause of rheumatic fever
Streptococcus pyogenes
276
features of rheumatic fever
erythema marginatum
Sydenham's chorea
polyarthritis
carditis and valvulitis
277
management of rheumatic fever
antibiotics - oral Penicillin V
NSAID's
278
what can be a cause of global T wave inversion
Head injury
279
causes of inverted T waves
MI
Digoxin toxicity
SAH
PE
brugada
280
early sound of HF
loud S3
281
which condition is hypertrophic cardiomyopathy likely to have
WPW
282
features of digoxin toxicity
unwell, lethargy, nausea and vomiting, anorexia, confusion
gynaecomastia
283
what precipitates digoxin toxicity
hypokalaemia
age
renal failure
drugs like amiodarone, verapamil, diltiazem, ciclosporin, diuretics
284
mx of digoxin toxicity
digibind
285
ECG: digoxin
down sloping ST depression
flattened / inverted T waves
286
what heart sound is hypertrophic cardiomyopathy associated with
S4
ejection systolic murmur that increases with valsalva manouvre and decreases on squatting
287
Notching of the inferior border of the ribs
coarctation of the aorta
288
pathophysiological cause of long QT
loss of function of K+
289
3 key side effects of GTN spray
hypotension, tachycardia, headache
290
wellen's syndrome
ECG pattern caused by high grade stenosis in LAD
minimal ST elevation and deep T wave inversion
291
atrial septal defect
ejection systolic murmur louder on inspiration
292
late systolic murmur
mitral valve prolapse
coarctation of the aorta
293
pulmonary stenosis
ejection systolic murmur louder on inspiration
294
what sign favours cardiac resynchronisation therapy
widened QRS
295
Signs of hypertrophic cardiomyopathy on Echo
mitral regurgitation ( MR)
systolic anterior motion of anterior mitral valve leaflet ( SAM)
asymmetric hypertrophy ( ASH)
296
Ccauses of loud S2
pulmonary HTN
297
which vein is used for venous cut down in cases where vascular access is difficult
long saphenous vein
298
which meds should be avoided in patients with HOCM
acei
299
coarctation of the aorta murmur
mid systolic , maximal over the back
300
key side effect of nicorandil
gastrointestinal ulcers
301
lifestyle cause of dilated cardiomyopathy
chronic alcoholism
302
how should hyperglycaemia be managed in ACS
low dose insulin infusion with regular monitoring of blood glucose levels to glucose below 11 mmol/l
303
what happens to pulmonary pressure in cardiogenic shock
high
304
what happens to cardiac output in septic shock
high cardiac output and low systemic vascular resistance
305
where are right sided and left sided murmurs heard best
right - inspiration
left side -expiration
RILE
306
causes of S3
dilated cardiomyopathy
constrictive pericarditis
mitral regurgitation
307
causes of S4
aortic stenosis
HOCM
HTN
308
which condition causes a bisferiens pulse
mixed aortic valve disease
309
key sign of digoxin therapy on ECG
scooped ST depression in leads II,III, aVF v5,v6
310
what wave represents strain in mitral stenosis
P mitrale
311
ECG changes associated with bradycardia
J waves
312
