if on third drug / uncontrolled or Under 40 with stage 1 HTN and no evidence of target organ damage.

Cardiology Flashcards by Saqib Ali

steps of Hypetension

A if under 55
C if over 55.

then A+C / A+D. C+A / C+D

THEN A+C+D (Thiazide like diuretic

Then if k+ >4.5 - a/b blocker
if k+ under 4.5 spiranolactone

see specialist.

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what are the cut offs for blood pressure

140/90in clinic the give home reading.

135/85 at home means stage 1

150/95 means stage 2 - treat regardless

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when to treat stage 1 of HTN

If <80 AND Any of
Target organ damage
Established CVD
Renal disease
Diabetes
10 year cardiorisk

TERD 10.

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well score more than 4 or less than 4

more than 4 PE likely - do CTPA if you can’t do anticoagualte.
less than 4 PE unlikely - do dimer

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Angina Management

Aspirin and Statin
GTN to abort attacks

Nice recommend B-blocker or C-blocker first line.

Ca blocker is mono therapy (Diltiazam / Verapamil)

if used with beta blocker (have to use long acting dihdropyridine (nifedipine to avoid heart block)

if no benefits increase both doses

next step is nicorandil/ranolozine/ivabradine

refer to PCI /CABG.

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what is next step for Afrocarribean taking Amlodipine for BP

ARB losartan or. candesartan as NICE say is more effective that ACE.

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When to refer HTN

if on third drug / uncontrolled

Under 40 with stage 1 HTN and no evidence of target organ damage.

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angina and abdominal pain what med is causing

nicorandil can cause GI ulcers. Don’t use in diverticulitis.

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Which HTN drug causes Low libido and ED.

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driving post MI and PCI according to DVLA

IF NO other PCI planned
EF <40% drive within 1 week
don’t need to inform the DVLA

if taxi.lorri.bus then inform DVLA and 6 week’s.

if not successful PCI then 4 weeks.

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what do you see on ECG for WPW wolf Parkinson white

Short PR INTERVAL and Upsloping of ST. sometimes called delta wave.

axis deviation away from the side that is affect ed.

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when do you stop statins

s/e
if on macrocodes (mycin)
pregnancy

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what side effects can you have with ACE inhibitors and with which drug / medical condition

Hypotension you can have with High dose loop diuretics (furosemide 80mg)
or with Aortic stenosis

You don’t really get it with Bendroflumethiazide (thiazide ) as its a weak diuretic prescribed commonly with ACEi .

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How soon after an MI can you have sex

4 weeks

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Give me 3 lifestyle advices after MI

Advise Mediterranean diet - butter and cheese swap for oil based products - don’t recommend omega 3 or oily fish

exercise 20-30 mins a day or until slight breathless

No sex for 4 weeks after MI - avoid Sildenafil for 6 months or avoid if taking nicoradil/ nitrates.

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What drugs following MI

Dual antiplatelet therapy
ACEi
B blocker
Statin.

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Acute MI and have symptoms of Heart Failure which drug should be added

Aldosterone Antagonist - Eplerenone.

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who should get primary statin prevention

10 year cardiovascular risk >10%
T1DM more than 10 years
EGFR <60

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who should get primary statin prevention

10 year cardiovascular risk >10%
T1DM more than 10 years
EGFR <60

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acute mi DRIVING ADVICE

If ACS - 4 weeks off driving

1 week if successfully treated with PCI

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acute mi DRIVING ADVICE

If ACS - 4 weeks off driving

1 week if successfully treated with PCI

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what resting BP does group 2 drivrrs need

under 180 s or 100 d

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CABG driving

4 weeks

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PPM driving post

1 week

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ICD driving

if arythmia - 6 months if prophylaxis - 1 month any ICD bars group 2 license

catheter ablation for arrhythmia post driving

2 days

AAA more than 6cm - DVLA

inform DVLA - need annual review more than 6.5 ban from driving

heart transplant driving

6 weeks don't need to inform

which calcium channel blockers used in Angina as dual therapy with beta blocker and which as mono therapy

dual - nifidepine, felodipine mono - verapamil and diltiazam

when NOT to use rate control in AF

If reversible cause heart failure caused by AF Atrial Flutter - that could be ablated

Chads vasc what are the results

0 - 2 months anticoagulation more than 1 - lifelong.

Chads vasc what are the results

0 - 2 months anticoagulation more than 1 - lifelong.

Chads vasc what are the results

0 - 2 months anticoagulation 2 or more- lifelong. if woman 1 or more life long if. man

ChadsVasc 2 scoring

CCF Hypertension or treated A2ge - 75 = 2, 65=1 Diabetes S2troke or TIA. =2 Vascular disease S ex - female. 1 for everything but you can score 2 on age or stroke.

has-bled stand for and scoring

hB 130 M. / 120 F (2) Age 74 bleeding history (2) Renal impairment - EGFR <60 anti platelet - 1 0-2 low 3 med 4-7 high

warfarin management of high INR. Major Bleeding

Stop Warfarin IV Vit K 5mg Prothrombin complex concentrate if not then FFP

Warfarin Management of high ins INR >8 minor bleed

Stop warfarin Give intravenous vitamin K 1-3mg Repeat dose of vitamin K if INR still too high after 24 hours Restart warfarin when INR < 5.0

INR > 8.0 No bleeding

Stop warfarin Give vitamin K 1-5mg by mouth, using the intravenous preparation orally Repeat dose of vitamin K if INR still too high after 24 hours Restart when INR < 5.0

INR 5 - 8 Minor Bleeding

Stop warfarin Give intravenous vitamin K 1-3mg Restart when INR < 5.0

INR 5-8 no bleeding.

Withhold 1 or 2 doses of warfarin Reduce subsequent maintenance dose

biggest factor for resistant hypertension

Raised BMI

when to use bio prosthetic valve and what to give post op

>65 aortic or >70 mitral long term anticoagulation not needed. give aspirin long term and warfarin for 3 months.

blood monitoring of LFT

baseline 3 month 12 month

4 side effects of GTN

Hypotension , Tachycardia , Headache. , flushing

DVLA for ICD insertion or shock of ICD

Group 1 - 6 months can't drive group 2 - can't drive for life.

first Line investigation for angina - stable

CT coronary angiography. then its non invasive stuff then invasive angio

side effect of thiazide like diuretic and gout

raises serum rate levels.

new BP 180/120 and no worrying signs what is next step management

Carry out investigations for target organ damage - ECG, Urine and bloods.

if Patient taking high dose furosemide 80mg and you want to start ACEi WHAT DO YOU DO

Refer to secondary care.

bendroflumethiazide has what side effect on blood sugar control

causes hyperglycaemia

when not to use indapamide for HTN

if hyponatremia

if k+ > 4.5 what to do for step 4 HTN

use alpha blocker or beta blocker (alpha = doxazocin)

what bloods to check before starting anti-arrythmic drug

Hypokalemia. Amiodarone causes hypokaelima .

Amiodarone Monitoring

TFT, LFT , UE , CXR prior to treatement TFT, LFT every 6 months.

if ABPM at home is stable - what is next course of action

recheck every 5 years.

what medication do you stop in left atrial appendage closure.

anticoagulation.

what blood tests do you check for with statins and when do you stop statin

LFT - if Serum ALT/AST go 3x the upper limmit.

Patient with CVD and now new AF - chadsvasc score high what med do you start and what med do you stop - why

stop antiplatet if CVD stable start DOAC.

S/E of thiazide diuretics 5

Hypokalemia hypercalcemia Impotence Impaired Glucose tolerance GOUT (not pseudogout)

which drugs reduce mortality in LVF heart failure

ACE BB ARB Aldosterone Antagonists Hydralazine / Nitrates.

at what step do you refer to Cardio in ANGINA

step 3 - adding in nitrates.

what should target home readings be for BP

135/85

nicorandil has what side effect

ULCERATION of anal, mouth , eye or GI.

if patient has stage 1 HTN ( >135/85 BUT LESS THAN 150/95) What is management plan O

Over 80 start meds Under 80 AND any of following - start meds - Target organ damage - renal disease - DM - CVD Qrisk >10 %

Common cause of Secondary HTN

Conns

HOCM is what type of inheritance

Autosomal dominant - you have one variant you're fooooked.

HOCM is what type of inheritance

Autosomal dominant - you have one variant you're fooooked.

Features of Echo findings in hocm

MR (Mitral regurgitation) SAM( systolic anterior motion of anterior mitral valve leaflet) ASH(ASymmetric hypertrophy)

Myopathy is more common in which types of statins

Lipopholic - Simvastatin atorvastatin not as common in hydrophobic like rosuva and prava.

iF UNDER 60 AND STAGE ONE HTN WITH NO END ORGAN DAMAGE HOW TO MANAGE

LIFESTYLE MONITOR ANNUALY CONSIDER STARTING meds.

how to record HMBP

2 readings - BD 4-7 days discard first day.

clinic reading above what to trigger HTN pathway

140/90

normotensive amount stage 1 criteria stage 2 criteria SEVERE HTN when do we treat stage 1

<135/85 >135/85 >150/95 >180 >120 IF UNDER 80 AND TARGET END ORGAN DAMAGE CVD RENAL DISEASE DIABETES 10 YEAR RISK 10%

WHAT IS AIM FOR HTN UNDER TREATMENT

140/90 Clinic 135/85 at home.

how to maintain nitrate free period

take second dose before 12 hour mark.

when to inform DVLA about HTN

if Group B and Above 180/110.

When checking UE after starting ACEi - what to do with results

If Creatinine doubles/more than 300 or K+ goes >5.5

which juices affect which drugs/meds

Cranberry - red like blood - warfarin Grapefruit - yellow like fat - statin

Takayyasu Arteritis demographic

10-40 asian women (sounds asian) absent pulse manage with steroids

BP target for >80

150/90

T1DM blood pr3ssure target

135.85 iF ANY Albuminuria 130/80.

why do we need to be cautious using BB in Diabetics

Beta-blockers can theoretically suppress all of the adrenergically mediated symptoms of hypoglycemia and thus can lead to unawareness of hypoglycemic events.

Cardiology Flashcards

(82 cards)