Cardio Flashcards
(95 cards)
1
Q
What ABPM/HBPM value is stage 1 hypertension?
A
135/85 to 149/94mmHg
2
Q
What ABPM/HBPM value is stage 2 hypertension?
A
Over 150/95mmHg
3
Q
Who is guaranteed treatment for HTN?
A
Stage 2 (ABPM over 135/85+, Clinic 140/90)
4
Q
When is treatment considered/suggested for those with stage 1 HTN (or over 80)?
A
- > 80 and clinic BP >150/90
- < 80 and target organ damage/ established CVD/ Renal disease/ diabetes / Q risk >10%
- <60 even with Q risk < 10%
5
Q
What triggers an immediate refferal for a BP of over 180/120? (6)
A
- Signs of retinal haemorrhage
- Signs of pappilloedema
- New onset confusion
- Chest pain
- Signs of HF
- AKI
6
Q
Targets (NB no difference for diabetics)
A
- <80 = 140/90
2. >80 = 150/90
7
Q
Actions after Wells score for suspected DVT?
A
<2 points = d dimer
2+ points = USS (give anticoagulant while awaiting for scan if not within 4h)
If D dimer positive - do scan
8
Q
Management confirmed DVT
A
LMWH
start warfarin on NOAC within 24h
Continue LMWH until INR is >2 for 25h or 5 days (whichever is longest)
9
Q
What is target INR for prevention of clots in patients post DVT?
A
- 5
3. 5 if recurrent
10
Q
DVT treatment with people who have cancer or pregnant?
A
Cancer = 6m LMWH
Preg - LMWH for whole pregnancy
11
Q
Extra investigations for unprovoked DVT?
A
- Rule out malignancy
- Anti-phospholipid screen
- Inherited thrombophilia screen
12
Q
What is done in a malignancy screen for unprovoked DVT? (5)
A
- Physical exam and history
- CXR
- Bloods – FBC, calcium, LFTs
- Urinalysis
- Consider mammogram and CT abdo pelvis
13
Q
How do you calculate ABPI?
A
Highest ankle pressure/ highest arm
14
Q
Important ABPI results?
A
<0.9 PAD
<0.5 Critical limb ischaemia
15
Q
What blood test will indicate level of ischaemia?
A
LACTATE
16
Q
As an F1 what is your initial management of acute limb ischaemia? (
A
- A-E, oxygen and fluids
- Analgesia - Morphine
- Vascular referral
- Consider antiplatelets and Heparin (BMJ BP)
17
Q
What is reperfusion injury?
A
Tissue injury caused when blood supply returns to tissue.
Can get hyperkalamia and acidosis
Can lead to DIC, AKI, chronic pain
18
Q
Which venous junction should surgical ligation and anticoagulation be considered for superficial thrombophlebitis?
A
Saphenopopliteal junction
19
Q
What is the treatment for you common or garden superficial thrombophlebitis?
A
- NSAIDs and Paracetamol
- Practical management
a. compression stockings
b. warm compress
c. keep leg elevated
d. keep mobile
20
Q
What are 3 complications of superficial thrombophlebitis?
A
- Septic thrombophlebitis (gets infected, cellulitis Sx, give fluclox)
- Migratory thrombophlebitis (recurrent thrombophlebitis at multiple sites without clear cause)
- DVT - especially if at saphenofemoral junction
21
Q
What may migratory thrombophlebitis be a sign of?
A
Cancer - particularly Pancreatic cancer
22
Q
What is the biggest risk factor for superficial thromboplhebitis?
A
Varicose veins
23
Q
What scoring sysyen is used to assess cannular related thrombophlebitis?
A
Visual infusion phlebitis score (should be done frequently to assess cannula site)
24
Q
What types of HB need a pacemake?
A
Mobitz T2
Complete/third degree
25
What is the management of bradycardia with adverse features?
Atropine 500mcg
26
What are the risks for asystolein the bradycardia (HR<60) pathway? (4)
1. Ventricular pause >3s
2. Recent asystole
3. Mobitz T2
4. Complete HB with broad QRS
27
What are the neurological causes of postural hypotension?
1. Parkinsons (big cause) (also MSA)
| 2. Diabetic neuropathy
28
What are some non neurological causes of postural hypotension?
1. Old age
2. Dehydration
3. Drugs - Indapimide, Tamsulosin
29
Definition of postural hypotension?
Drop of 20/10 from lying to standing
30
What is the drug treatment for angina?
1. GTN
2. Beta blocker
3. Aspirin
4. Statin
5. Anti-hypertensice if neccessary
Possible add ons non rate-limiting CCB eg amlodipine or Nitrate
More complex therapeis thereafter such as Ivabradine, Ranolazine
31
Causes of AF - (PIRATES)
```
PE
Ischaemia
Resp disease
Atrial enlargement
Thyroid disease
Ethanol
Sepsis/sleep apnoea
```
32
Stepwise management of narrow QRS tachycardia without adverse features?
Rate >100bpm, QRS <0.12
1. Vagal manoevres
2. Adenosine 6mg - 6mg - 12mg
3. Synchronised cardioversion
33
Management of narrow QRS tachycardia without adverse features?
1. Synchronised cardioversion
2. If fails - Amiodarone 300mg over 20 mins
3. Another shock
4. Amiodarone 900mg over 24h
34
Definition of VT
>3 premature ventricular contractions and HR >100
35
What are the different types of causes of VT?
1. Cardiac - ischaemia/MI, cardiomyopathy, long QT syndrome
2. Electrolyte imbalance - particularly hypokalaemia, hypocalcaemia, hypomagnesia
3. Long QT drugs - lithium, TCAs, citalopram, erythromycin, haloperidol
36
What are the two different types of VT?
1. Monomorphic (similar QRS complexes) - ischaemia/scarring
| 2. Polymorphic (differing QRS complexes) - usually caused by abnormal ventricular repolarisation - the long QT causess
37
What organism is the most common cause of endocarditis?
Staph aureus
38
Which organism causing endocarditis is associated with dental procedures?
Strep viridans
39
If strep bovis is found as the organism for endocarditis, what may this suggest?
undiagnosed colorectal cancer
40
What are the most common causes of endocarditis on prosthetic valves?
Cogagulase negative staph - staph epidermidis or staph saprophyticus
41
What side of the heart are you more likely to get endocarditis if you are an IVDU?
R sided
42
What is the presentation of endocarditis, the exam 2 things)
Non specific but in exams NEW MURMUR + fever
43
What are the FROM JANE symptoms/signs for endocarditis?
Fever
Roth spots
Oslers nodes
Murmur
Janeway lesions
Anaemia
Nail bed haemmorgahes
Emboli (septic emboli)
44
What is the name of the criteria for endocarditis?
Dukes criteria
45
How does Duke's criteria work?
Must have:
2 major OR
1 major and 3 minor
5 minor
46
What is in Dukes criteria?
Major:
Positive blood cultures
Evidence from echo
```
Minor:
Predisposition
Microbiology evidence
Fever
Vascular phoenomena
```
47
What is the treatment for uncomlicated endocarditis of a natural valve?
IV abx for 4 weeks
48
When is surgery needed for endocarditi?
1. Prosthetic valve
2. HF
3. Sepsis
There are others.
49
What is the most common ECG change in PE?
Sinus tachycardia
50
What is the (rarely seen) specific ECG changes for PE
S1 - large S wave in 1
Q3 - Q waves in lead 3
T3 - inverted T wave in lead 3
51
What ECG change do you get in 17% of PE patients?
RBBB
52
What is the gold standard investigation for endocarditis?
Trans-oesophageal-USS
53
What is the difference between a true aneursym and false aneursym?
```
True = all 3 layers
False = 2 layers
```
54
What are the two most common sites for an aneurysm?
Brain
| Abdominal
55
What is the most common site for a brain aneurysm?
Circle of Willis
56
What are the possible symptoms of brain aneurysm is prior to rupture?
Usually asynptomatic
Can cause focal neurological deficits due to mass effect
Visual disturbance, numbness, weakness, headaches
57
When would you screen for a brain aneurysm?
Only If 2 plus relatives with subarachnoid haemorrhage or
autosomal dominant polycystic kidney disease
58
What is the best imagery to view a brain aneurysm?
MR angiography
59
What is a atrophe Blanche?
Atrophic white scar from poor healing due to bad blood supply
60
What are the three most common interventional management for varicose veins?
Endothermal ablation (Radio frequency or laser)
USS guided foam sclerotherapy
Truncal vein stripping surgery
61
What must you always do before giving compression stockings?
ABPI to screen for peripheral arterial disease
62
What is stage 1 Fontaine classification of PAD?
Asymptomatic ABPI
63
What is stage 2 of Fontaine’s classification of PAD?
Intermittent claudication
A) walk over 200m
B) walk less 200m
64
What is stage 3 of Fontaine’s classification of PAD?
Rest/nocturnal pain
65
What is stage 4 of Fontaine’s classification of PAD?
Necrosis and gangrene
66
What is the definition of an abdominal aortic aneurysm?
Dilation of 1.5 times normal size aorta.
Normal = 2cm
AAA = 3cm+
67
What is the gold standard agnostic test for AAA?
Abdominal USS
68
What is the surgicl management of AAA?
EVAR (endovascular or open repair)
69
What should you do with AAA 3 - 4.5cm?
USS every 2 years (NICE)
70
What should you do with an AAA 5 - 6.5cm?
USS every 3m
71
What should you do with AAA >6.5cm?
Surgical repair (EVAR)
72
Chest pain better on leaning forwards, worse on lying down?
Pericarditis
73
Management for uncomplicated pericarditis?
NSAIDs
74
What is Beck's Triad for cardiac tamponade?
1. Muffled HS
2. Raised JVP
2. Hypotension
75
What is pulsus paradoxus?
an abnormally large decrease in stroke volume, systolic blood pressure and pulse wave amplitude during inspiration. The normal fall in pressure is less than 10 mmHg. When the drop is more than 10 mmHg, it is referred to as pulsus paradoxus.
76
What is the management for cardiac tamponade?
Pericardiocentesis
77
What is the gold standard investigation for aortic dissection?
CT angiography (if patient is stable)
78
What blood test is an important marker fro mesenteric ischaemia?
Lactate (v high in mesenteric ischaemia)
79
What imagery is best for mesentieric ischaemia?
CT
80
What is the main test for lymphoedema?
Lymphoscintigraphy
81
What sign is pathognomic for lymphoedema?
Stemmer's sign - failure pick up a fold of patient skin at base of second toe
82
What is the management for lymphoedema? (3)
Exercise
Compression using graduated stockings
Specialist massage
83
What are the ECG changes in hyperkalaemia? (3)
Peaked T waves (earliest sign)
Flattened P waves
Prolonged QRS with bizzare complexes (BAD)
84
What are the ECG changes in hypokalaemia
Prominent U waves (best seen in precordial leads)
Prolonged PR
Flattened T wave/inversion
Flattened ST wave
85
What are the ECH changes in hypercalcaemia?
```
Short QT (most common)
Wide/flattened T wave
```
86
What is the AS murmur?
Ejection systolic
87
What is the AR murmur?
Early diastolic
88
What is the MR murmur?
Pan systolic
89
What is the MS murmur?
Mid diastolic
90
What are the features of an AR pulse?
Wide pulse pressure
| Collapsing pulse/waterhammer pulse
91
What are the features of AS pulse?
Slow rising
Narrow pulse pressure
May have split second heart sound
92
When do you hear 3rd heart sound?
Heart failure (most common)
93
When do you hear a 4th heart sound?
Cardiomyopathy - HOCM
94
What are the 4 Ts?
Thrombus
Tension Pnumothorax
Tamponade
Toxins
95
What the 4 Hs?
Hypoxia
Hypovolaemia
Hypothermia
Hyper/hypokalaemia
