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MSRA > Cardio > Flashcards

Cardio Flashcards

(68 cards)

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1
Q

Hypokalaemia ECG changes

A

U waves/short T waves/inversion
ST depression
Long PR
Long QT

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2
Q

Pericarditis causes

A

Viral (most commonly Coxsackie)
TB
Uraemia
Post-MI (days is fibrinous, weeks is autoimmune Dressler’s)
Radiotherapy
Lung/breast Ca
Hypothyroidism

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3
Q

Pericarditis Mx

A

Colchicine/NSAIDs
IP if fever or elevated trop
No exercise 3/12

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4
Q

When to treat stage 1 HTN

A

<80yrs +
Target organ damage
Established CVD/QRisk>10%
Renal disease
Diabetes

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5
Q

HTN stages (ABPM)

A

Nil HTN <135/85
Stage I - >= 135/85
Stage II - >= 150/95

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6
Q

Cardiac Tamponade Presentation

A

(Beck’s Triad) Hypotension; Muffled HS; Raised JVP
ECG electrical alternans
Pulsus paradoxus (abnormal BP drop in inspiration)
Absent Y descent on JVP

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7
Q

PKD valve abnormality

A

Mitral valve prolapse (1 in 4 with PKD develop it)

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8
Q

IE abx

A

Native valve - Amox + gent
NVE Pen-allergic/severe/MSRA - vanc + gent
NVE gram -ve - vanc + mero
Prosthetic Valve - vanc + gent + rifampicin

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9
Q

IE organisms

A

Staph aureus most common
Strep viridans after dental
Staph epidermis in lines/valve replacement in 2mths
Strep bovis in colon Ca

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10
Q

IE -ve culture causes

A

SLE
Prev abx
Coxiella
Bartonella
Brucella
HACEK - Haemophilus, Actinobacillus, Cardiobacterium, Eikinella, Kingella

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11
Q

When to stop ACE-I

A

Cr increase >30%
eGFR drop >25%

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12
Q

Statin monitoring

A

LFTs baseline, 3mths, 12mths
Stop if >3x upper limit for ALT/AST

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13
Q

Statin indications

A

All with CV disease (2ry prevention dose)
QRisk>10%
T1DM dx >10yrs ago or >40yrs old or with nephropathy
CKD if eGFR<60

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14
Q

When to increase primary prevention statin dose

A

If non-HDL hasn’t reduced by >=40%

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15
Q

STEMI Mx

A

Aspirin + prasugrel, clopi if on doac

PCI if within 12h and available in 120mins
Unfrac hep + bailout GPI if radial
Bivalirudin + bailout GPI if femoral

Thrombolysis if >2h to PCI, for PCI if ECG not resolved after 90 mins

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16
Q

NSTEMI Mx

A

Aspirin + ticag, clopi if doac
PCI if unstable
PCI in 72h for grace>3
Fonda in delayed angio, unfrac hep in immediate angio

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17
Q

GRACE score includes

A

Age
HR/BP
Cardiac + renal function
?Arrest on presentation
ECG findings
Trops

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18
Q

Medications to avoid HOCM

A

ACE inhibitors - reduce afterload
Inotropes
Nitrates

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19
Q

CI in VT

A

Verapamil

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20
Q

Group 2 drivers (HGV/buses) HTN advice

A

Can drive unless BP >180/100 resting

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21
Q

Aortic stenosis surgery indications

A

Symptomatic
LVSD + valvular gradient >40

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22
Q

AS causes

A

Calcification (most common >65yrs)
Bicuspid aortic valve (1% of population, most common cause <65yrs)
Post-rheumatic disease
Williams syndrome (supravalvular AS)
HOCM

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23
Q

Features severe AS

A

Slow rising pulse
Narrow pulse pressure
Soft/absent S2
S4

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24
Q

AS Mx options

A

Surgical AVR in low surgical risk
TAVR for high risk
Balloon valvuloplasty in kids with no calcification or high risk adults not fit for replacement

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25
Angina mx
1. Beta blocker/CCB 2. Both of above 3. ISMN/ivabradine/nicorandil/ranolazine + refer for PCI/CABG
26
Aortic regurg causes
Chronic causes: Rheumatic fever (most common cause developing world) Calcification Connective tissue disease Bicuspid AV HTN Syphilis Acute: IE Aortic dissection
27
AR signs
Quincke's (nailbed pulsation) De Musset's (head bobbing) Wide pulse pressure Collapsing pulse Early diastolic murmur Mid-diastolic Austin-Flint
28
AR mx
AVR in symptomatic or LVSD
29
Beta blocker SEs
Poor glycaemic awareness Sleep disturbance Bronchospasm Cold peripheries Erectile dysfunction
30
Falsely elevated BNP causes
Sepsis/ischaemia COPD LVH Hypoxaemia eGFR<60 Diabetes Lives cirrhosis RV overload
31
Long QT drugs
Haloperidol Ondansetron Methadone Erythromycin Mind drugs (antipsychotics) Amiodarone TCAs/SSRIs (especially citalopram) Chloroquine Heart slower (sotalol)
32
Hereditary Long QT types
1 - exertional syncope 2 - emotional syncope 3 - at night/rest
33
HF acute mx
Diuretics Inotropes Vasopressors Mechanical circulatory assistance e.g. intra-aortic baloon/ventricular assist device
34
MRA evidence HF
NYHA III/IV pts already on ACEi
35
HF chronic Mx 3rd line (specialist only)
Ivabradine (NSR>75, LVEF<35%) Sacubitril-valsartan (LVEF<35%, following ACEi/ARB washout period) Digoxin (no mortality benefit, good if AF) Hydralazine + nitrate (especially in black pts) CRT (wide QRS)
36
HF vaccines
Annual flu One-off pneumococcal (asplenia or CKD need booster every 5yrs)
37
When to start DOAC after stroke for AF
2wks
38
Target INR for mechanical valves
Aortic 3.0 Mitral 3.5
39
MI Complications
VF arrest Cardiogenic shock Pericarditis (acute or Dressler's autoimmune if weeks after) LV aneurysm (persistent ST elevation and LV failure) VSD (acute HF with pansystolic murmur) Papillary muscle rupture
40
Acute mitral regurgitation post-MI cause, presentation and management
Papillary muscle rupture/ischaemia Acute hypotension +/or pulmonary oedema Early-mid systolic murmur Treated with vasodilators +/- surgery
41
HOCM Echo
MR SAM ASH Mitral regurgitation Systolic anterior motion of anterior mitral valve leaflet Asymmetric hypertrophy
42
HOCM ECG
LVH ST abnormalities Deep Q waves
43
HOCM signs
Jerky pulse Large A waves Double apex beat ESM worse with Valsalva due to LVOT obstruction Pansystolic murmur from mitral regurgitation
44
Adenosine SEs
Chest pain Flushing Bronchospasm Exacerbates accessory pathways
45
Non-drug causes of Torsades
HypoK, hypoCa, hypoMg Hypothermia SAH
46
S3 causes
Sound of ventricular diastolic filling Physiological in men <30, women <50 LV failure e.g. DCM Constrictive pericarditis Mitral regurg
47
S4 causes
Sound of atrial contraction against stiff ventricle AS HOCM HTN
48
ECG normal variants
Sinus bradycardia RBBB 1st degree/Mobitz I AV block Junctional rhythm
49
Nicorandil SEs
Skin/mucosal/eye ulceration Headache Flushing
50
Nicorandil CI
LV failure
51
PESI
For severity of PE, can aid with OP vs IP mx
52
2ry HTN causes
Conn's (most common, 5-10% of all HTN) Renal disease (PKD, renal art stenosis, pyelo, glomerulonephritis) Endo - phaeochromocytoma, Cushing's, Liddle's, CAH, acromegaly Drugs - steroids, MAOIs, COCP, NSAIDs, Leflunomide
53
When to use anticoagulant and antiplatelet
If stable CVD starting anticoag, stop anti-plt Post-ACS, 3 for 4wks-6mths, 2 for 12mths then just anticoag In VTE already on anti-plt, keep anti-plt if ORBIT score low risk
54
Driving post-MI/angina
4wks off post-MI 1wk off if angioplasty (elective or emergency) and success no need to inform Stop driving if unstable/occurs at the wheel in angina
55
No driving post-CABG
4wks
56
Driving post PPM
1wk off post-insertion 6mths off if ICD post-VT Prophylactic ICD needs 1mth off No more driving for Group 2 if ICD
57
Driving post-catheter ablation
2d if successful
58
Heart transplant no driving
6mths, no need to notify
59
AAA driving
6 or more inform DVLA 6.5cm or more, no driving
60
Amiodarone monitoring
TFT, U&Es, LFTs and CXR prior TFT + LFTs every 6mths
61
Amiodarone SEs
Hypothyroidism/Hyper-thyroidism Corneal deposits Pulmonary fibrosis/pneumonitis Liver fibrosis/hepatitis Peripheral neuropathy, myopathy Photosensitivity 'Slate-grey' appearance Thrombophlebitis and injection site reactions Bradycardia Lengthens QT interval
62
Thrombolysis CIs
active internal bleeding recent haemorrhage, trauma or surgery (including dental extraction) coagulation and bleeding disorders intracranial neoplasm stroke < 3 months aortic dissection recent head injury severe hypertension
63
Anti HTN CI in renovascular disease
ACEi
64
ACEi monitoring
Baseline 2wks post-dose change 1, 3, 6 mths
65
Diastolic murmur in AF
Mitral stenosis (LA enlargement -> AF)
66
Coarctation of aorta associated conditions
More common in men Turner's Bicuspid aortic valve Neurofibromas Berry aneurysms
67
Coarctation of aorta features
HF in infancy HTN in adults Radio-femoral delay Mid-systolic murmur loudest at back Apical click from AV Notching of inferior border of ribs (only in adults)
68
HOCM most common cause of sudden death
Ventricular arrhythmia

MSRA (3 decks)

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