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Cardio Flashcards

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1
Q

What’s the physiology of Eisenmenger’s?

A

Associated with septal defects and patent DA. In a VSD, a left to right shunt exposes right ventricle to left v higher pressures, till the R ventricle hypertrophies enough that the shunt is reversed. This causes cyanosis and pulmonary hypertension.

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2
Q

Features of Eisenmenger’s and mx

A

Cyanosis, clubbing, murmur that disappears. Tx with heart-lung transplant

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3
Q

What is a globular heart a sign of?

A

ASD

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4
Q

What murmur does a VSD cause?

A

Blowing pan-systolic murmur

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5
Q

What psych drugs cause prolonged QT?

A

Anti-psychotics: haloperidol
TCAs: imipramine, noratriptylline, amitryptilline
SSRIs: citalopram
Seratonin receptor antagonists: ondansetron (also anti-emitic)

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6
Q

What AB can cause prolonged QT?

A

Erythromycin

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7
Q

What anti-arrhythmics can cause prolonged QT?

A

Amiodarone, sotalol

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8
Q

What electrolyte imbalances can prolong QT?

A

HYPOMg, Ca, K

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9
Q

Other causes of long QT

A

Hypothermia, subarachnoid haem

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10
Q

Mx of long QT

A

Beta blocker, avoid strenuous activity (can precipitate). Defib if high risk (implantable).

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11
Q

What investigation would you order for a patient with frequent collapse but normal resting ECG?

A

24 hour tape

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12
Q

What does long QT risk causing?

A

VT, then torsades (mono to polymorphic). Monomorphic VT is typically caused by MI.

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13
Q

Mx of VT

A 
Adverse signs (CP, heart failure, hypotensive): immediate cardioversion.
Stable: amiodarone. If drugs fail- DC shocks.
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14
Q

Is VT broad or narrow complex QRS?

A

Broad. SVT = narrow (s for small)

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15
Q

HOCM- demographic and inheritance pattern

A

Young, athletic individuals.
Autosomal dominant.
Causes thickened myocardium. LVH = reduced cardiac output.

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16
Q

Warfarin rules and targets for surgery

A

Stop warfarin 5 days prior to surgery. INR should be below 1.5.
Target for VTE and AF = 2.5
Target for recurrent VTE = 3.5

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17
Q

What can potentiate warfarin?

A

P450 inhibitors (amiodarone, ciprofloxacin).
Liver disease.
Anti-platelets.

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18
Q

Signs of heart failure

A 
Third heart sound
Displaced apex beat
Bibasal crackles
Pink, frothy sputum
Raised JVP
Oedema
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19
Q

Sx of heart failure

A

Sob, reduced exercise tolerance, swollen ankles/calves, fatigue.

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20
Q

Inv. for heart failure

A

ECG, bloods, BNP, echo, CX

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21
Q

Left V aneurysm appearance on ECG

A

Persistent ST elevation. Anticoagulate- stroke risk.

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22
Q

List complications after MI

A

VF (most common cause of death following CA)
Pericarditis, Dressler’s
LV Aneurysm or free wall rupture
Papillary muscle rupture (can cause mitral regurg and thus a murmur).
Cardiogenic shock

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23
Q

How does orlistat work?

A

Inhibits pancreatic and gastric lipase to reduce digestion of fat.

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24
Q

Unstable AF

A

Emergency: Immediate synchronised DC cardioversion

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25
Bradycardia mx
Atropine 500mcg If unsuccessful, repeat atropine or do transcutaneous pacing. Beware of asystole.
26
What valve disease is PKD associated with?
Mitral valve prolapse. Beware of mitral regurg and arrhythmias
27
Side effects of amiodarone and baseline investigations
Pulmonary fibrosis, pneumonitis - CX Hepatitis and fibrosis - LFTs Thyroid issues either way- TFTs Us and Es- can prolong QT so make sure they don’t have hypokalaemia
28
ECG changes for pericarditis
Saddle shaped ST elevation | PR depression
29
Investigations for pericarditis
ECG and echo if suspect
30
Mx of pericarditis
NSAIDs and colchine
31
Symptoms of pericarditis
CP relieved by sitting forwards, can be pleuritic. | May have flu-like symptoms, sob, np cough.
32
Pericarditis signs
Pericardial rub | Tachypnoe and cardia
33
ALS mx for asystole/pulseless-electrical activity
Adrenaline 1mg + 2 mins compressions. Rhythm check.
34
Reversible causes of cardiac arrest- The Ts
Thrombus (cardio or pulmonary) Toxins Tamponade (cardiac) Tension pneumothorax
35
Tx pathway for hypertension
A (under 55 or T2DM) or C (55 or Afro) A + C / A + D (A = ACE or aldosterone antagnoist). If Afro, aldosterone antag is preferable to ACE. A + C + Thiazide Diuretic Add beta/alpha blocker if k above 4.5, otherwise spiranolactone.
36
What is the most common cause of mitral stenosis? | What is the murmur associated with it?
Rheumatoid disease | Opening snap, followed by low pitched rumble.
37
Most common causative agent of infective endocarditis
``` Staph Aureus (especially among IVDU) Staph epidermis = prosthetic valve surgery, think indwelling lines ```
38
Anticoagulation post stroke with AF
300mg aspirin daily for two weeks, then lifelong anticoagulation.
39
Statin side effects and CI
Myopathies and liver impairment. | CI: pregnancy, macrolides like erythromycin and clarithromycin.
40
Statin doses for primary and secondary intervention
Atorvastarin 20mg 80mg for secondary Indicated for established CVD or if QRISK is 10.
41
What factors favour rate vs. rhythm control?
RAte: A for AGE. Over 65, ischaemic heart disease. Rhythm: under 65, first presentation, CCF, symptomatic, correctable precipitant like alcohol.
42
Drugs for rate control
Beta-blocker unless asthma Ca blocker Digoxin (first choice if heart failure)
43
Drugs for rhythm control
Sotalol, amiodarone, flecanide, catheter ablation last resort- doesn't reduce stroke risk though so still need to anti-coag.
44
When would you cardiovert AF?
1) emergency | 2) elective procedure
45
Af > 48 hours
3 weeks anticoagulation Cardiovert (electrical preferred in this case) 4 week anticoagulation
46
AF < 48 hours
Heparin and early Cardioversion
47
Life threatening signs of hypertension
CP, new confusion, heart failure, AKI. | Others: pappiloedema or retinal harm
48
Stage 3 hypertension: mx options
1) Life-threatening signs: ED and admit 2) No sx: urgent end-organ damage investigations like fundoscopy, urine ACR,ECG 3) Phaechromacytoma?
49
Mx of angina
Give all patients GTN, statin and aspirin (unless CI) 1st line: beta or rate limiting Ca block (verapamil/diltiazem). Titrate to max dose. 2nd line: beta + Ca blocker (switch to long acting like nifedipine). 3rd) can't tolerate above, use ivabradine or LA nitrate. Only add 3rd drug if on combo if awaiting PCI/CABG.
50
Advice for timing doses of standard-release isosorbide mononitrate
``` Asymmetric dosing (e.g. 6am, 10pm) Minimises development of nitrate tolerance ```
51
Characteristic sign of tamponade
Pulsus paradoxus
52
What is Beck's triad? What investigation should you performed first if present?
C.tamponade: falling bp, muffled heart sounds, rising JVP. Perform echo.
53
Secondary prevention of MI
``` 5 drugs Ace Beta Statin Dual anti-platelet ```
54
What should you use as an alternative if ACE aren't tolerated in hypertension mx?
Angiotension blocker e.g. losartan
55
First line inv for heart failure
NT-proBNP
56
What does cor pulmonale describe?
Right sided heart failure (RVH) caused by pulmonary artery hypertension. Related to COPD causing pulmonary vasoconstriction.
57
Signs of RHF
Raised JVP, hepatomegaly, ankle oedema.
58
Signs of LHF
Dyspnoea on exertion, orthopnea, paroxysmal nocturnal dyspnoea, wheeze, cough.
59
Mx of heart failure
1) Ace + Beta (start one at a time) 2) Add aldosterone antagonist (spiranolactone) 3) Ivabradine, valsartan (both EF <35) , digoxin (AF, ionotropic), hydralazine with nitrate (for Afros), cardiac resync Can use loop diuretics like furosemide but they don't improve mortality. One off pneumococcal, annual influenza.
60
What ventilation should be considered in acute heart failure/pulmonary oedema not responding to tx?
CPAP
61
Which beta blockers reduce mortality in heart failure?
Bisoprolol, carvedilol
62
What drug should be used to mx anxiety and dyspnoea in acute heart failure? + mechanism
Morphine- opioid with vasodilator properties, reduces sympathetic drive.
63
Mx options for acute heart failure
``` O's and I's O2 Opioids IV loop diuretics Ionotropes CPAP ```
64
What investigations should be performed prior to/with every dose increase of spiranolactone?
With any mineralocorticoid receptor antagonist, Na, K, renal function and bp should be performed.
65
Mx of major haemorrhage on warfarin
Stop warfarin. PT complex concentrates (don't give if INR under 8) IV Vit K.
66
NSTEMI mx
Aspirin + GTN + morphine Determine 6 month mortality risk (GRACE) Ticagrelor (not high risk of bleeding) + fondaparinux Clopi (intermediate/high risk > 3%) + unfractionated heparin Coronary angiography + PCI if required: - immediate if unstable - within 72 hours if immediate risk/+
67
Differentiating ACS from pericarditis on ECG
``` Pericarditis = global changes, saddle shaped possibly. Ischaemia = territory changes ```
68
What ECG waves are seen in hypokalaemia and hypothermia?
Hypok - U waves | Hypothermia - J waves
69
Atypical presentation of a.dissection
Neurological sx

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