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Year 4 Mine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

STEMI

A

≥ 20 minutes symptoms AND persistent (> 20 minutes) ECG features in ≥ 2 contiguous leads of:
- 2.5 mm ST elevation in leads V2-3 in men under 40 years, or ≥ 2.0 mm ST elevation in leads V2-3 in men over 40 years
- 1.5 mm ST elevation in V2-3 in women
- 1 mm ST elevation in other leads
- new LBBB

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2
Q

Immeiate management STEMI

A

Give aspirin 300mg and determine PCI availability

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3
Q

PCI in STEMI

A

if present within 12 hours of the onset of symptoms AND PCI can be delivered within 120 minutes
Give prasugel
radial access is preferred to femoral access - give unfractionated heparin and bailout GPI

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4
Q

Fibronlysis in STEMI

A

within 12 hours symptom onset
give alteplase/
also give antithrombin

give ticagrelor after

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5
Q

if high bleeding risk in STEMI

A

give ticagrelor instead of prasugel in PCI
give clopidogrel instead of ticagrelor in fibrinolysis

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6
Q

If patient taking anticoagulants in STEMI

A

swap prasugel for clopidogrel

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7
Q

NSTEMI/unstable angina immediate management

A

aspirin 300mg
if no immediate PCI planned -> fondaparinux
estimate GRACE score

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8
Q

NSTEMI GRACE score <3%

A

give ticagrelor
if high bleeding risk -> give clopidogrel

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9
Q

NSTEMI GRACE score >3%

A

PCI immediately if clinically unstable
otherwise within 72hrs
give prasugrel (ticegralor if high bleeding risk)
give unfractionated heparin

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10
Q

ACEi C/I

A

pregnancy/breastfeeding
renovascular disease
aortic stenosis
K+ >5 ask a specialist

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11
Q

RF for infective endo

A

previous episode (strongest RF)
rheum. valve disease
prosthetic valve
congenital heart
IVDU

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12
Q

Most commonly affected heart valves in infective endocarditis

A

most common: MITRAL VALVE
IVDU: tricuspid

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13
Q

Native valve acute endocarditis most common cause

A

staph aureus

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14
Q

Most common endocarditis bug

A

staph aureus

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15
Q

Native valve subacute endocarditis bugs

A

strep viridans
enterococcus

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16
Q

Prosthetic valve endocarditis bugs

A

in first 2 months: staph epidermidis
after 2 months: staph aureus
MRSA

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17
Q

most common endocarditis bugs in IVDU

A

staph aureus

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18
Q

culture negative causes infective endo

A

antibiotic therapy beforehand
bartonella
brucella
HACEK

19
Q

endocarditis presentation

A

fever
fatigue
night sweats
muscle aches
anorexia

20
Q

Signs of endocarditis

A

murmur
splinter haemorrhages
petechiae
janeway lesions
osler’s nodes
roth spots
splenomegaly and clubbing in long disease

21
Q

Most common cause infective endo with indwelling lines

A

staph epidermidis

22
Q

Endocarditis diagnosis

A

modified Duke criteria:
2 major criteria
OR
1 major and 3 minor
OR
5 minor

23
Q

Modified Duke’s major criteria

A

2 positive blood cultures with typical bacteria
positive echo
new valvular regurgitation

24
Q

Modified Duke’s minor criteria

A

predisposition (IVDU or heart valve probs)
fever >38
vascular signs
immunological signs
microbiological evidence that doesn’t meet major

25
Q

vascular signs of endocarditis

A

major emboli
splenomegaly
clubbing
splinter haemorrhages
Janeway lesions

26
Q

Immunological signs of endocarditis

A

Osler’s nodes
Roth spots
glomerulonephritis

27
Q

Initial native valve endocarditis treatment

A

Amoxicillin +/- low dose gent
pen allergy/MRSA: vancomycin + low dose gent

28
Q

Initial prosthetic valve endocarditis treatment

A

vancomycin + rifampicin + low dose gent

29
Q

native valve confirmed staph treatment

A

flucloxacillin
pen allergic: vancomycin + rifampicin

30
Q

prosthetic valve confirmed staph treatment

A

fluclox + rifampicin + low-dose gent
pen allergy: vancomycin + rifampicin + low dose gent

31
Q

Confirmed strep viridans endocarditis treatment

A

benzypenicillin
pen allergy: vancomycin + low dose gent

32
Q

indications for surgery infective endo

A

severe valvular incompetence
aortic abscess
resistant
cardiac failure
recurrent emboli after abx

33
Q

How long abx treatment for native heart valves

A

4 weeks

34
Q

How long abx treatment for prosthetic heart valves

A

6 weeks

35
Q

Most common cause of death following MI

A

cardiac arrest - ventricular fibrillation

36
Q

What complication can occur 48hrs following MI

A

pericarditis

37
Q

What complication can occur 2-6weeks following MI

A

Dressler’s syndrome -> autoimmune reaction

38
Q

Dressler’s syndrome presentation

A

fever
pleuritic pain
pericardial effusion
raised ESR
treat with NSAIDs

39
Q

What complication can occur 1-2 weeks following MI

A

left ventricular free wall rupture
acute heart failure secondary to cardiac tamponade

40
Q

treatment left ventricular free wall rupture

A

urgent pericardiocentesis and thoracotomy

41
Q

persistent ST elevation and left ventricular failure following myocardial infarction

A

left ventricular aneurysm
thrombus can cause
need anticoagulation

42
Q

What complication can occur in first week following MI

A

VSD
acute HF w/ pan-systolic murmur
needs urgent surgical correction

43
Q

Which type of MI can lead to acute mitral regurgitation

A

infero-posterior infarction more commonly
ischaemia or rupture of papillary muscles
presentation: acute hypotension and pulmonary oedema

Year 4 Mine (14 decks)

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