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cardio Flashcards

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1
Q

clopidogrel

  1. mechanism of action
  2. which drug makes it less effective?
A
  1. antagonist of the P2Y12 adenosine diphosphate (ADP) receptor, inhibiting the activation of platelets
  2. omeprazole (and other PPIs)
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2
Q

statin & dose for cardiac:

  1. primary prevention
  2. secondary prevention
A
  1. atorvastatin 20mg
  2. atorvastatin 80mg
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3
Q

in T1DM without CVD offer primary prevention statin (20mg atorvastatin) if:

(4)

A

> 40y
have had T1DM >10yrs
have nephropathy
have other CVD RF

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4
Q

adverse effects of statins (2):

A
  1. myopathy
  2. liver impairment (thus LFTs at baseline, 3 months and 12 months)
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5
Q

contra-indication to statins (2):

A
  1. macrolide therapy
  2. pregnancy
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6
Q

who should receive a statin?

A

all people with established cardiovascular disease (stroke, TIA, ischaemic heart disease, peripheral arterial disease)
following the 2014 update, NICE recommend anyone with a 10-year cardiovascular risk >= 10%
patients with type 2 diabetes mellitus should now be assessed using QRISK2 like other patients are, to determine whether they should be started on statins
patients with type 1 diabetes mellitus who were diagnosed more than 10 years ago OR are aged over 40 OR have established nephropathy

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7
Q

MI secondary prevention drugs (5):

A
  • dual antiplatelet (aspirin + another)
  • ACEI
  • B blocker
  • statin
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8
Q

beta blocker side effects (5):

A

bronchospasm
cold peripheries
fatigue
sleep disturbances, including nightmares
erectile dysfunction

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9
Q

normal ECG variants in the SPORTY: (4)

A
  1. sinus bradycardia
  2. junctional rhythm
  3. first degree heart block
  4. Mobitz type 1 (Wenkebach)
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10
Q

beta blocker contra-indications (4):

A
  1. uncontrolled heart failure
  2. asthma
  3. sick sinus syndrome
  4. concurrent verapamil use (may precipitate severe bradycardia)
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11
Q

adenosine

  1. what’s it used to treat?
  2. who should it be avoided in?
  3. adverse effects (4)
A
  1. SVT
  2. asthmatics
  3. chest pain
    bronchospasm
    transient flushing
    can enhance conduction down accessory pathways, resulting in increased ventricular rate (e.g. WPW syndrome)
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12
Q

loop diuretics (e.g. furosemide)

adverse effects:

A

HYPO:
hypotension
hyponatraemia
hypokalaemia, hypomagnesaemia
hypochloraemic alkalosis
hypocalcaemia

ototoxicity

renal impairment (from dehydration + direct toxic effect)

hyperglycaemia (less common than with thiazides)

gout

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13
Q

angina medical mgt:

A

all pts:
- aspirin
- statin
- GTN

  1. BB or CCB (rate limiting e.g. verapamil/ diltiazem*)
  • if CCB + BB use longer acting CCB e.g. amlodipine/ MR nifedipine
  1. add CCB/ BB

if on monotherapy and cannot tolerate addition of CCB/ BB consider one of:
- long acting nitrate
- nicorandil
- ranolazine

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14
Q

which drug offers no PROGNOSTIC benefit in chronic heart failure?

A

furosemide

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15
Q

which drug is beneficial to LT survival in heart failure

A

ramipril

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16
Q

chronic heart failure mgt: -

A

for all:
- annual influenza vaccine
- once-off pneumococcal vaccine

  1. ACE (have no effect on mortality in heart failure with preserved ejection fraction) &BB
  2. aldosterone antagonist (e.g. spironolactone, eplerenone)

?SGLT-2 inhibitors (if reduced ejection fraction) _GLIFOCIN

  1. ivabradine, sacubitril-valsartan, hydralazine in combination with nitrate, digoxin and cardiac resynchronisation therapy
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17
Q

thiazide diuretics SE: (7)

A

postural hypotension
HYPOkalaemia (increased sodium delivery to distal convuluted tubule–>: increased sodium absorption in exchange for potassium and hydrogen ions)
HYPOnatraemia
HYPERcalcaemia
gout
impaired glucose tolerance
impotence

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18
Q

cardiac tamponade presentation

A

Beck’s triad
1. hypotension
2. raised JVP
3. muffled heart sounds

dyspnoea
tachycardia
an absent Y descent on the JVP - this is due to the limited right ventricular filling
pulsus paradoxus - an abnormally large drop in BP during inspiration
Kussmaul’s sign - much debate about this
ECG: electrical alternans (variability in amplitude of QRS)

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19
Q

1st degree heart block definition:

A

PR prolongation (PR>0.2s)

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20
Q

2nd degree heart block definition:

A

type 1 (Mobitz I/ Wenckebach)
- PR prolongation until dropped beat occurs

type 2 (Mobitz II)
- constant PR but p wave often not followed by QRS

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21
Q

3rd degree heart block definition:

A

no association between p waves and QRS complex

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22
Q

complete heart block following MI
–> which coronary artery is most likely to be affected?

A

Right coronary artery
(as this supplies AV node)

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23
Q

HOCM sx:

A

(asx)
exertional SOB
angina
syncope (typically post exercise)
jerky pulse

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24
Q

HOCM murmurs: (2)

A

ESM - ventricular outflow tract obstruction
increased by valsalva
decreased by squatting

pansystolic murmur - mitral regurg

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25
HOCM associations: (2)
Friedrich's ataxia WPW
26
HOCM echo findings:
MR SAM ASH mitral regurgitation (MR) systolic anterior motion (SAM) of the anterior mitral valve leaflet asymmetric hypertrophy (ASH)
27
HOCM ECG features: (5)
LVH non-specific ST segment and T-wave abnormalities, progressive T wave inversion may be seen deep Q waves AF (sometimes)
28
HOCM mgt
ABCDE Amiodarone Beta-blockers or verapamil for symptoms Cardioverter defibrillator Dual chamber pacemaker Endocarditis prophylaxis*
29
drug classes to avoid in HOCM (3)
nitrates ACEi inotropes
30
new AF mgt (<48hrs of onset of sx) : -
anticoagulate lifelong if RF for ischaemic stroke cardioversion, either: - electrical (DC) - pharmacological - amiodarone (if structural heart disease) (or flecainide if no evidence of structural heart disease)
31
new AF (onset >48hrs)
- anticoagulate for at least 3 weeks prior to cardioversion OR TOE to exclude left atrial appendage (LAA) thrombus. if -ve can heparinise and cardiovert immediately. electrical cardioversion If high risk of cardioversion failure (e.g. Previous failure or AF recurrence) then it is recommend to have at least 4 weeks amiodarone or sotalol prior to electrical cardioversion then anticoagulate for at least 4 weeks
32
amioderone monitoring:
TFT, LFT, U&E, CXR prior to rx TFT, LFT every 6 months
33
amioderone adverse effects:
- thyroid dysfunction (hypo&hyperthyroid) - corneal deposits - pulmonary fibrosis/pneumonitis - liver fibrosis/hepatitis - peripheral neuropathy, myopathy - photosensitivity '- slate-grey' appearance - thrombophlebitis and injection site reactions - bradycardia - lengths QT interval
34
valve most commonly affected in infective endocarditis: i. generally ii. IVDU
i. mitral valve ii. tricuspid valve
35
NSTEMI antiplatelets:
aspirin: + ticagrelor if not high risk of bleeding + clopidogrel if high risk of bleeding should be based on 6 month mortality risk: if >1.5% clopidogrel for 12 months if >3% angio within 96hrs
36
CHA2DS2VS
C - CCF (1) H - HTN (or treated HTN (1) A- age >75 (2) 65-75 (1) D - diabetes (1) S - stroke/ TIA/ VTE (2) V - vascular disease (IHD/ PAD) (1) S - sex (1 if female)
37
CHA2DS2VS when to offer anticoagulation
in males consider if 1+ 2+ offer anticoagulation
38
hypercalcaemia ECG changes
short QT
39
GTN SE: (4)
hypotension tachycardia headache flushing
40
cx post MI:
cardiac arrest (VF) cardiogenic shock chronic heart failure arrhythmias pericarditis (Dresslers' syndrome) left ventricular aneurysm LV free wall rupture VSD acute mitral regurg
41
Dresslers' syndrome i. what is it? ii. presentation iii. rx
= pericarditis 2-6 weeks post MI (thought to be autoimmune reaction to recovering myocardium) ii. fever pleuritic pain pericardial effusion raised ESR iii. NSAIDs
42
LV aneurysm post MI i. ECG changes
i. persistent ST elevation
43
LV free wall rupture post MI i. how long after MI ii. presentation iii. mgt
i. 1-2 weeks ii. raised JVP, pulsus paradoxus, diminished heart sounds i.e. acute heart failure secondary to cardiac tamponade iii. pericardiocentesis
44
VSD post MI: i. how long after MI ii. presentation iii. ddx (1)
i. 1-2 weeks ii. acute heart failure + PANSYSTOLIC MURMUR iii. acute mitral regurgitation
45
acute mitral regurgitation post MI i. following which type of MI is it most common ii. type of murmur
i. infero-posterior ii. early/mid SYSTOLIC murmur
46
ACEi SE (4)
cough angioedema hyperkalaemia 1st dose hypotension
47
ACEi inhibitor rx --> what change of renal function acceptable?
creatinine increase by 30% from baseline
48
WPW ECG changes: (4)
short PR wide QRS with slurred upstroke - delta wave left axis deviation in R sided accessory pathway right axis deviation in L sided accessory pathway
49
WPW mgt:
definitive = radiofrequency ablation of accessory pathway sotalol (avoid in co-existant AF) amioderone flecainide
50
aortic stenosis presentation
SAD Syncope Angina Dyspnoea ESM radiation to carotids decreased following Valsalva
51
features of severe aortic stenosis (8)
narrow pulse pressure slow rising pulse delayed ESM soft/absent S2 S4 thrill duration of murmur left ventricular hypertrophy or failure
52
aortic stenosis causes (5)
calcification (most common in >65) bicuspid valve (most common in <65) William's syndrome rheumatic HOCM
53
aortic regurgitation presentation: (7)
early diastolic murmur: intensity of the murmur is increased by the handgrip manoeuvre collapsing pulse wide pulse pressure Quincke's sign (nailbed pulsation) De Musset's sign (head bobbing) mid-diastolic Austin-Flint murmur in severe AR - due to partial closure of the anterior mitral valve cusps caused by the regurgitation streams
54
mitral stenosis features:
dyspnoea ↑ left atrial pressure → pulmonary venous hypertension haemoptysis mid-late diastolic murmur (best heard in expiration) loud S1 opening snap low volume pulse malar flush atrial fibrillation (secondary to ↑ left atrial pressure → left atrial enlargement)
55
mitral stenosis causes
rheumatic fever
56
bradycardia + signs of shock mgt
atropine 500mcg (up to 3mg) then transcutaneous pacing +/- isoprenaline/ adrenaline infusion then transvenous pacing + specialist help
57
nicorandil i. adverse effects (3) ii. CI
i. headache flushing skin/ mucosal/ eye ulceration (including anal ulceration) ii. severe hypotension
58
HTN mgt
59
SVT i. mgt ii. prevention
i. 1. Vagal manoeuvres 2. iv adenosine 6mg--> 12mg--> 18mg (CI in asthma, give verapamil instead) 3. cardioversion ii. BBs radio-frequency ablation
60
ECG territories
61
PE --> findings on blood gas
respiratory alkalosis

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