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Medicine (Y4) > Cardiology > Flashcards

Cardiology Flashcards

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1
Q

Give causes of secondary hypertension.

A

CHAPS - Cushing’s, Hyperaldosteronism, Aortic Coarctation, Pheochromocytoma, Stenosis of renal artery

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2
Q

Give red flags in hypertension.

A
  • Young patient (< 40)
  • Severe hypertension (>180/120)
  • Evidence of organ damage - papilloedema, heart failure, encephalopathy
  • Features of secondary cause eg. cushinoid features, palpitations, renal bruits
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3
Q

What is the gold-standard test for diagnosing hypertension?

A

Ambulatory Blood Pressure Monitoring (ABPM)

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4
Q

What blood pressure cut-off is suggestive of hypertension?

A

> 140/90 in clinic or > 135/85 in ABPM

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5
Q

Which patients with new hypertension would warrant an emergency referrak?

A

> 180/120 or evidence of organ damage (particularly papilloedema)

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6
Q

Which investigations should be performed in a newly diagnosed hypertensive patient?

A

Urinalysis
ECG
Fundoscopy
Blood tests - Us&Es, cholesterol and HbA1C

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7
Q

Mrs R is 45 years old and newly diagnosed with hypertension. What is the first-line anti-hypertensive agent for her?

A

ACEI or ARB

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8
Q

Mrs R is 45 years old and newly diagnosed with hypertension. She completes a trial of Lisinopril but her BP is still 145/95. Which medications could be trialed next?

A

ACEI/ARB and CBB or Thiazide diuretic

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9
Q

Mrs R is 45 years old and newly diagnosed with hypertension. She completes a trial of Lisinopril but her BP is still 145/95. Her GP adds Amlodipine but her BP remains high. Which medications could the GP try now?

A

ACEI/ARB + CCB + Thiazide diuretic

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10
Q

What is the first-line anti-hypertensive agent in patients with T2DM?

A

ACEI/ARB

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11
Q

Mr D is a 60-year-old male who has been newly diagnosed with hypertension. What would be the first-line anti-hypertensive?

A

CCB

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12
Q

Mr D is a 60-year-old male who has been newly diagnosed with hypertension. His GP commences Amlodipine but his BP remains high at 150/100. What would be the next step?

A

CCB + ACEI/ARB or thiazide diuretics

Add ACEI/ARB or a thiazide diuretic

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13
Q

Mr D is a 60-year-old male who has been newly diagnosed with hypertension. His GP commences Amlodipine but his BP remains high at 150/100. After addition of Lisinopril, his BP is still high. What would be the next step?

A

Add a thiazide diuretic

ACEI + CCB + thiazide diuretic

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14
Q

What is the first-line anti-hypertensive agent in patients of African-Caribbean heritage?

A

CCB

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15
Q

Which medications may be considered in resistant hypertension?

A

Spironolactone, beta-blockers or alpha-blockers

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16
Q

What are the first-line medications for stable HF with reduced ejection fraction?

A

ACEI + Beta-blocker

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17
Q

Beta-blockers should not be prescribed with which medications?

A

non-dihydropyridine calcium blockers such as verapamil or diltiazem

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18
Q

Spironolactone causes which electrolyte imbalance?

A

Hyperkalaemia

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19
Q

Inverted T waves may be a sign of…

A

Myocardial ischaemia

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20
Q

Which coronary artery is most likely to be affected in a lateral STEMI?

A

LAD or Left cirumflex

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21
Q

Which coronary artery is most likely to be affected in an inferior STEMI?

A

RCA

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22
Q

What is the treatment for haemodynamically unstable fast AF?

A

DC Cardioversion or IV Amiodarone

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23
Q

What CHADS-VASC score suggests that anti-coagulation is indicated?

A

2 or more

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24
Q

Aortic regurg and ST elevation inferior leads suggests…

A

Proximal aortic dissection

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25
Which electrolyte abnormality is associated with thiazide diuretics?
Hypokalaemia
26
How long after an MI does Dressler syndrome tend to present?
2-3 weeks
27
Give causes of diastolic murmurs.
ARMS - Aortic Regurg & Mitral stenosis
28
Slow-rising pulse suggests...
Aortic stenosis
29
What is the normal cardiac axis?
-30 to 90 degrees
30
Give 3 causes of systolic murmurs.
Aortic Stenosis Mitral Regurg Tricuspid Regurg
31
‘Ejection systolic murmur radiating to carotids’ suggests...
Aortic stenosis
32
‘Pan-systolic murmur radiating to left axilla’ suggests...
Mitral Regurg
33
Which murmur may appear after MI if there is papillary muscle ischaemia?
Mitral regurg
34
'Holosystolic murmur on right side' suggests...
Tricuspid regurg
35
'Early diastolic murmur best heard on expiration sitting forward' suggests...
Aortic regurg
36
'Rumbling mid-diastolic murmur (best heard with patient lying on side)' suggests...
Mitral stenosis
37
Tapping apex beat, malar flush suggests...
Mitral stenosis
38
What grade of murmur have you heard in the OSCE?
Grade 3 (if no thrill)
39
What are the first-line agents for angina prophylaxis?
Beta-blocker and CCB
40
What are the second-line agents for angina prophylaxis?
isosorbide mononitrate, nicorandil, ivabradine
41
What is important to remember about isosorbide mononitrate dosing?
Asymmetric dosing to avoid nitrate tolerance
42
Which medications are recommended in angina to reduce CV risk?
Statin and Aspirin
43
Which ECG change is seen in hypercalcaemia?
Shortened QT interval
44
What are the treatments for bradycardia?
1. Atropine 2. Cardiac pacing wire
45
What are the 1st and 2nd line treatments for SVT?
1. Vagal manoevres | 2. Adenosine
46
What is the treatment for stable acute AF?
Cardioversion with Flecainide
47
What is the treatment for acute atrial flutter?
Amiodarone or electrical cardioversion
48
What is the treatment for VF?
DC Shock
49
What is the treatment for VT with a pulse?
Amiodarone
50
What is the treatment for torsades de pointes?
Magnesium Sulphate... DC Shock if required
51
Which types of heart block are usually treated with a pacemaker?
2nd degree, Mobitz 2 and 3rd degree heart block
52
What monitoring is required for Digoxin?
None required except in suspected toxicity
53
Which gene is faulty in familial hypercholesterolaemia?
LDL receptor
54
Which murmur is associated with rheumatic fever?
Mitral stenosis
55
How should new-onset AF be treated?
Cardioversion with Flecainide or Amiodarone if structural heart disease
56
What 10-year CV risk score indicates a statin should be considered?
> 10%
57
What is the investigation of choice for stable angina?
CT coronary angiogram
58
JVP rising on inspiration suggests...
Constrictive pericarditis
59
Which ECG changes are suggestive of ischaemia?
``` ST elevation ST depression T wave inversion Patholoical Q waves New LBBB ```
60
Which artery is likely affected in ACS with new LBBB?
Proximal LAD or left main stem
61
Which artery is usually affected in anterior MI?
LAD
62
What is the initial management for all ACS?
Morphine Oxygen if hypoxic Nitrates Aspirin & Ticagrelor
63
What is the gold-standard treatment for STEMI?
PCI
64
For how long can treatment for STEMI de delayed to allow for PCI?
90 mins
65
How is treatment for NSTEMI and unstable angina determined?
GRACE score
66
What GRACE score indicated low 6-month mortality?
< 3%
67
What management should be offered to patients with NTSEMI/unstable angina if their GRACE score is low?
Offer conservative management | Can offer coronary angiography (with follow-on PCI if required) if multiple episodes
68
What management should be offered to patients with NTSEMI/unstable angina if their GRACE score is intermediate or high?
Offer coronary angiography (+/- PCI) within 96 hours of admission
69
What is meant by Type 1 MI?
‘typical’ MI due to atherosclerosis
70
What is meant by Type 2 MI?
ischaemia due to insufficient oxygen supply eg. anaemia, hypovolaemia, coronary artery vasospasm
71
How do you calculate rate from an ECG?
Regular: 300/number of large boxes between QRS Irregular: No. of QRS in 30 squares x 10
72
Which leads help to determine the axis on an ECG?
I and aVF
73
When is thrombolysis indicated in MI?
If pt presents within 12 hours of onset but PCI not possible within 120 mins
74
What are the main side effects of Amiodarone?
Thyroid dysfunction Pulmonary fibrosis Hypokalaemia Liver cirrhosis
75
Harsh mid-systolic murmur suggests...
Pulmonary stenosis
76
New widened T waves could suggest...
Hyperacute changes of MI
77
Which anti-hypertensive class is first-line in Afro-Carribean's?
CCBs

Medicine (Y4) (13 decks)

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