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fourth year > cardio high yield > Flashcards

cardio high yield Flashcards

(106 cards)

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1
Q

QRISK above 10% primary prevention

A

atorvastatin

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2
Q

secondary prevention after an atherosclerotic event

A

Antiplatelet (aspirin, clopidogrel)
Atorvastatin
Atenolol (or other BB)
Ace inhibitor

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3
Q

what is the dual antiplatelet treatment after MI

A

aspirin indefinetely
clopidogrel or ticagrelor for 12 months

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4
Q

diagnostic test for angina

A

CT coronary angiography
-invasive is gold standard

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5
Q

treatment of angina

A

all patients: aspirin and statin
GTN spray for attacks
1) beta blocker or CCB (rate limiting like verapamil or diltziem)
2) if CCB with BB then cannae be rate limiting one (has to be like amlodipine)
3) if after monotherapy + dual therapy still symptoms: isosorbide mononitrate, ivabradine, nicorandil, ranolazine

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6
Q

NSTEMI ECG changes

A

ST depression
T wave inversion

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7
Q

STEMI ECG changes

A

ST elevation
LBBB

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8
Q

general treatment of ACS

A

MONA
Morphine (+metoclopramide)
Oxygen (if sats below 94)
Nitrates (if hypertensive or acute LVF)
Aspirin

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9
Q

STEMI treatment

A

within 12 hours
PCI if available within 2 hours
fibrinolysis if not

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10
Q

NSTEMI/unstable angina treatment

A

ASPIRIN
fondaparinux if no PCI planned + not high bleeding risk

GRACE < 3
-give ticagrelor (clopidogrel if high bleeding risk)

GRACE > 3
-PCI within 72 hours
-give ticagrelor or prasgurel (clopidogrel if on anticoag)
-give unfracitoned heparin

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11
Q

antiplatelets prior to PCI for a STEMI

A

this is termed ‘dual antiplatelet therapy’, i.e. aspirin + another drug
- if the patient is not taking an oral anticoagulant: prasugrel
- if taking an oral anticoagulant: clopidogrel

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12
Q

drug therapy during PCI

A

unfractionated heparin with bailout glycoprotein IIb/IIIa inhibitor (GPI)

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13
Q

what patients with NSTEMI/unstable angina should have coronary angiography

A

immediate: patient who are clinically unstable (e.g. hypotensive)
within 72 hours: patients with a GRACE score > 3%

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14
Q

Ix and Mx dressler’s syndrome

A

ECG: global ST elevation and T wave inversion
Echo: pericardial effusion

Mx: NSAIDs

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15
Q

AAA initial investigation

A

USS
CT angio then gives u clearer picture

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16
Q

who gets EVAR for AAA

A

symptomatic
growing more than 1cm a year
above 5.5cm

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17
Q

aortic dissection Ix

A

CT angio
if unstable: transoesophageal echo

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18
Q

venous ulcer position

A

above ankle
-more superficial than arterial
(think veins are more superficial)

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19
Q

arterial ulcer position

A

toes and heel
-deep punched out lesions

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20
Q

management of AF < 48 hours and haemodynamically unstable

A

DC Cardioversion

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21
Q

management of AF if haemodynamically stable and onset < 48 hours

A

rate or rhythm

rate: BB or rate limiting CCB

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22
Q

managment of AF > 48 hours

A

rate control
1. beta blocker (atenolol)
2. CCB (diltiazem, not in heart failure)
3. digoxin (only in sedentary people)
4. AV node ablation

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23
Q

presenting > 48 hours, stable, has tried BB, CCB + digoxin

A

delayed cardioversion
-anticoagulated for 3 weeks prior

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24
Q

long term rhythm control in AF

A

1) BB
2) Dronedarone if previous cardioversion
3) amiodarone if HF or LVF

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25
who do you offer rhythm control to in AF first line
new onset (<48 hours) reversible cause of AF HF caused by AF symptoms despite effective rate control
26
what drugs can be used for pharmacological cardioversion
flecainide (NOT in structural heart disease) amiodarone
27
echo results for HOCM
MR SAM ASH -mitral regurgitation -systolic anterior motion of the anterior mitral valve leaflet -asymmetric hypertorphy
28
pericarditis ECG changes
saddle shaped ST elevation PR depression chest pain worse on lying down
29
treatment of pericarditis
1) NSAIDs and colchicine
30
management of chronic HFrEF
1) ACEi + BB 2) aldosterone antagonits/ SGLT-2 inhibitor 3) ivabradine: HR > 75 + EF < 35% 4) sacubitril valsartan: need ACEi and ARb washout period, EF < 35% 5) digoxin (good for AF) 6) hydralazine + nitrate
31
what drugs improve symptoms of HF but not necessarily survival
digoxin furosemide (loop diuretics)
32
acute heart failure management
SODIUM - for LVF Sit up Oxygen Diuretics - furosemide or bumetanide (loop) Intravenous fluids STOPPED Underlying cause identified and treated Monitor fluid balance
33
what blood supply and view of heart in leads II, III, aVF
INFERIOR -right coronary artery
34
leads I and aVL : region of heart and artery
lateral, left circumflex
35
leads V1-4 artery and region
left anterior descending -anterior
36
V5, V6 leads: artery and region
circumflex artery
37
bradycardia following an inferior MI (right coronary artery)
AV block
38
most common cause of death following an MI
ventricular fibrillation
39
young patient with chest pain, pulmonary oedema and ST elevation with a recent flu
myocarditis
40
janeway lesions
infective endocarditis
41
what is the mitral stenosis murmur
mid-late diastolic heard best on expiration heard loudest over the apex
42
symptoms of mitral stenosis
dyspnoea (pulmonary venous hypertension) heamoptysis (due to pulmonary pressures) malar flush atrial fibrillation neck vein distension
43
adverse effects of thiazide diuretics
dehydration postural hypotension hypokalaemia hyponatraemia hypercalcaemia gout impaired glucose tolerance impotence
44
pan systolic murmur
mitral regurgitation
45
slow rising pulse
aortic stenosis
46
what is cor pulmonale
pulmonary hypertension causes right sided heart failure -usually caused by COPD
47
aortic reguritation murmur
early diastolic
48
hypotension, raised JVP, muffled heart sounds
cardiac tamponade
49
ECG changes for hypothermia
J waves J = Junkie
50
major criteria in dukes for infective endocarditis
positive blood cultures evidence of endocardial involvement
51
minor criteria for dukes infective endocarditis
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
52
major bleeding INR above 8 what do u do
stop warfarin give vitamin K give prothrombin complex
53
statins in pregnancy?
NO
54
what is stage 1 hypertension and when do you treat it
>= 135/85 treat if: - under 80 AND - target organ damage - cvd - renal disease - diabetes - 10-year risk 10% or more
55
which artery for PCI
radial
56
treatment of torsades de pointes (polymorphic ventricular tachy)
IV magnesium sulphate
57
if there is persistent ST elevation after an MI what does this indicate
left ventrical aneurysm -thrombus can form within the aneurysm increasing risk of stroke
58
Cha2dsVasc score
Congestive heart failure - 1 Hypertension - 1 Age >=75 - 2 Age 65-74 -1 Stroke/TIA/VTE - 2 Vascular disease - 1 Sex = Female - 1
59
who is anticoagulated in AF
from chadvasc 1 point - females yes, males consider it 2 points - YES if chadvasc is 0 then do a trasnthoracic echo to see if there's valvular heart disease as this + AF = ANTICOAG
60
ORBIT score
to determine bleeding risk Haemoglobin < 130 males <120 females - 2 points Age > 74 years - 1 point Bleeding history - 2 points Renal Impairment (GFR < 60) - 1 point Treatment with antiplatelet - 1
61
what orbit score is moderate and high risk of bleeding
mod 3 high over 4
62
managment of aortic dissection
Type A (ascending aorta) - surgery and control BP Type B (descending aorta) - control BP
63
initial blind infective endocarditis treatment
native valve: amoxicillin pencillin allergy/MRSA/severe sepsis: vanc + gent prosthetic valve: vanc + rifampicin + low dose gent
64
what is treatment of endocarditis if pencillin allergic
vanc + low dose gent (add rifampicin if MRSA) apart from native valve staph is vanc + rifampicin
65
staph endocarditis treatment
native valve: flucloxacillin prosthetic valve: fluclox + rifampicin + gent
66
endocarditis caused by streptococci
benzylpenicillin (add gent if its not fully sensitive)
67
what do broad P waves indicate
atrial enlargement
68
diagnosis of SVT
-narrow complex tachy -QRS < 0.125 seconds -however the QRS is regular just very fast -usually can't see the p waves
69
treatment of SVT stable patients
1) Valsalva manoeuvre 2) carotid sinus massage 3) adenosine (CI: asthma, COPD, HF, hypotension - give verapamil) 4) electrical cardioversion
70
unstable patient managment of SVT
synchronised cardioversion?
71
if patient systolic < 90/chest pain/heart failure/syncope and is tachy
DC cardioversion
72
if patient VT and doesn't have factors for cardioversion then what?
seek expert help! antiarrythmics then DC cardioversion 1) amiodarone 2) lidocaine 3) procainamide DO NOT USE VERAPAMIL = VERAPAKILL
73
atrial flutter treatment
radiofrequency ablation of the tricuspid valve isthmus is curative for most patients anticoagulation to reduce risk of stroke
74
cause of torsades de pointes
causes of QT prolongation -inherited medications -hypokalaemia/hypomagnesaemia/hypocalcaemia -SAH the long QT just causes depolarisations to happen in the middle then it spirals out of control
75
what are the heart blocks
FIRST) simple PR prolongation (>0.2 seconds) Mobitz 1) increasing PR until no QRS follows Mobitz 2) dropped QRS, PR normal Third degree) no relationship between P and QRS - rly bad
76
shockable rhythms
ventricular fibrillation pulsless VT
77
non shockable rhythms
asystole pulseless electrical activity
78
after 3 shocks, what drug is given to patients in VF, pulseless VT
amiodarone -given another dose after 5 shocks
79
BP >=180/120 what investigations
ADMIT IF: papilloedema, retinal haemorrhage, confusion, chest pain, HF, AKI -or if phaeochromocytoma suspected if not - urine ACR (renal artery stenosis), bloods, ECG so do a urine dipstick
80
aortic stenosis heard loudest on...
EXPIRATION ayeee
81
pulmonary stenosis heard loudest on...
INSPIRATION pulmonary = breath in
82
p-mitrale on ecg
left atrial enlargement -mitral stenosis
83
most common cause of mitral stenosis
rheumatic fever
84
treatment of symptomatic bradycardia
ATROPINE -keep giving atropine up to 3mg -transcutaneous pacing -adrenaling infusion if no response to these then transvenous pacing which requires a specialist
85
massive PE + hypotension
thrombolyse
86
how do you combat nitrate tolerance in angina
asymmetric dosing interval to maintain a daily nitrate free time of 10-14 hours
87
quincke's sign -what is it and what is it seen in
nailbed pulsation -seen in aortic regurgitation
88
delta waves
WPW
89
electrical alternans
cardiac tamponade it is when QRS complexes alternate in height due to the heart swinging back and forth in a fluid filled pericardium
90
JVP that rises on inspiration
constrictive pericarditis -kussmaul's sign
91
acute heart failure not responding to treatment (with respiratory failure)
CPAP
92
what is indapamide
thiazide like diuretic
93
management of hypertension after A+C
thiazide LIKE diuretic
94
blood pressure target for type 2 diabetics
< 140/90
95
mitral regurgitation murmur
pan systolic - soft S1
96
what is atrial myxoma
primary benign heart tumour in the left atrium
97
difficulty breathing upright, mid diastolic murmur that changes with position, syncope and loud S1 at cardiac apex
atrial myxoma
98
what should be assessed before giving amiodarone
electrolytes - amiodarone can interact with them: potassium, calcium and magnesium and can predispose to arrythmias
99
what arrythmia does long QT predispose to
ventricular tachy ---> torsades de pointes
100
paroxysmal SVT
episodes of SVT followed by sinus rythm
101
what are the only PANSYSTOLIC murmurs
MR TR VSD MR Theodore Roosevelt VSD
102
which hypertension drug causes peripheral oedema
amlodipine - CCB
103
how do you figure out if there's left ventricular hypertrophy on an ECG
add height of S wave is V1 with the R wave in V5 or V6 - if the sum is more than 7 big boxes, then left ventricular hypertophy is present
104
Mobitz type 2
constant PR interval then a dropped QRS
105
if chest pain and troponin done within 3 hours onset and is normal, what do u do
admit and do it again: - has to be 3 hours after onset of chest pain - 1 hour after last troponin if a rise of > 20% from initial level then probs ACS
106

fourth year (29 decks)

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