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GP FELLOWSHIP RNZGP > Cardiology > Flashcards

Cardiology Flashcards

(55 cards)

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1
Q

Blood pressure causes for elevations (8)

A
  • Non compliance
  • Whitecoat
  • Recent weight gain
  • drugs (methamphetamines)
  • Renal failure
  • Anxiety
  • Wrong cuff size
  • Smoking
  • OSA
  • Sedentary lifestyle
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2
Q

HOCM major symptom

A

Exertional Dyspnoea

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3
Q

ECG findings in HOCM

A

High voltage QRS
ST changes and T wave repolarisation abnormalities

May be hard to distinguish from athletic young person

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4
Q

HOCM ECHO findings (and what they are assessing for)

A
  • LV thickness >11mm raises concern

Looking for
- LV function
- LVOT
- Pattern and degree of LVH
- Presence and degree of mitral regurg

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5
Q

Investigations for HOCM

A
  • ECHO
  • Stress ECHO (looking for exercise induced LVOT)
  • ECG
  • 24 hour holter monitor
  • Cardiac MRI
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6
Q

Diagnosis of CCF

A

Transthoracic ECHO
BNP

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7
Q

CCF management (general)

A
  • ACEi low dose (perindo 2.5-5mg)
  • Spironolactone (25mg)
  • Frusemide (up to 40mg)
  • Cardio-selective beta blocker (bisoprolol 1.25mg) (NOT in decompensated HF)
  • Low salt diet (<5g)
  • Fluid restrict 1-1.5L
  • Daily weights
  • Review 48 hours
  • Cardiac rehab
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8
Q

How much exercise per week

A

150-300 mintues moderate intensity/week

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9
Q

Angina episodic treatment

A

GTN spray 400mcg

Repeat every 5 min up to 3 doses
(note: if pain persists >10mins despite 2 doses –> ED)

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10
Q

Pharmacological management to prevent angina (broad categories)

A

USE TWO FROM DIFFERENT CLASSES

-Beta blocker (Metoprolol tartrate)

-Long acting nitrate (GTN 14 hour patch)

-Nondihydropyridine CCB (Diltiazem, verapamil)

-Dihydropyridine CCB (Amlodipine, nifedipine)

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11
Q

Pharmacological management to prevent angina: Betablocker dose.

A

Beta blocker:
Metoprolol tartrate 25mg BD (max 100mg BD)

(HFREF: use bisoprolol or metoprolol succinate)

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12
Q

Pharmacological management to prevent angina: Non-dihydropyridine calcium channel blocker

A

Diltiazem MR 180mg daily (up to 360mg)

OR

Verapamil MR 120mg daily ( up to 480mg)

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13
Q

Cautions with nondihydropyridine calcium channel blocker

A

Do not use with beta blocker (severe bradycardia and HF)

Avoid with ejection fraction <40 %

Do not use with dihydropyridine CCB (amlodipine or nifedipine)

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14
Q

Pharmacological management to prevent angina: Dihydropyridine calcium channel blocker

A

Amlodipine 2.5mg (up to 10mg)

Nifedipine MR 30mg (up to 60mg)

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15
Q

Pharmacological management to prevent angina: Long acting nitrate

A

Glyceryl trinitrate 5mg patch (14 hours/day)

max dose 15mg

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16
Q

Pharmacological management to prevent angina - refractory angina

A

Nicorandil 5mg BD
Max dose 20mg BD

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17
Q

History for HOCM

A
  • Exertional dyspnoea
  • non- exertional dyspnoea
  • Chest pain
  • palpitations
  • Presyncope

Rule out differentials
- Wheeze
- Cough or coryzal symptoms
- Fever
- VTE: immobilisation, calf pain

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18
Q

HOCM management following diagnosis

A
  • URGENT referral to cardiologist
  • Stop competitive sport (high intensity) until cardiology review
  • Any chest pain, presyncope to attend ED
  • Family will need testing
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19
Q

Metabolic syndrome diagnostic criteria

A
  • Waist circumference >88
    (>80 for asian, african, mediterranean)
  • Triglycerides >1.7
  • HDL-C <1
    (1.3 in women)
  • HTN: >130 or >85
  • Fasting glucose >5.5
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20
Q

Most common cause of Mitral Stenosis

A

Rheumatic heart disease

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21
Q

Clinical features of MITRAL STENOSIS (general and murmur findings)

A
  • Mitral Facies: flushed cheeks
  • Crackles due to pulmonary oedema
  • Advanced: RHF

Murmur:
- Opening snap
- Low pitched diastolic rumble
- At APEX
- Best heard with bell with patient lying on left side (held expiration)

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22
Q

What makes you Automatic CVD high risk ?
HINT 6

A
  • Diabetes & >60
  • Diabetes & microalbuminuria (ACR >2.5men/3.5women)
  • Mod-severe CKD
  • Familial hypercholesterolaemia
  • SPB >180 or diastolic >110
  • Total cholesterol >7.5
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23
Q

4 first line betablockers in HFrEF

Study These Flashcards
A

Bisoprolol 1.25 daily (inc to 10mg)

Carvedilol

Metoprolol succinate 23.75mg daily

Nebivolol 1.25 daily (up to 10mg)

24
Q

Contrindications to stress testing

Study These Flashcards
A
  • Unstable angina
  • Severe AS
  • AMI/ new LBBB
  • Unstable HF
  • Haemodynamic instability
  • Uncontrolled arrhythmia
25
Atrial Fibrillation management (non-pharmalogical)
- Smoking cessation - etOH <3 std/week - Aerobic exercise 210/week - Weight loss to BMI <27
26
Cut off for diagnosis of HTN for ambulatory BP
ABPM over 24 hrs >130
27
LDL-C not sufficiently reduced on statin... What to add?
- Ezetimibe - Bile acid binding
28
Triglycerides not sufficiently reduced on statin... What to add?
- Fenofibrate 145mg (90 if EGFR <60) * - fish oil 2-4g ** * Triglygcerides >4 ** Triglygcerides >10
29
HFrEF when to change ACEi to ARNI ?
If at 3 -6 monthly ECHO the LVEF <40 then change
30
Additional treatment options for HFrEF?
- Cardiac device therapy (<35%) - Ivabradine if sinus rhythm >70 BPM and LVEF <35% - If ACEi,ARB and ARNI not tolerated then use nitrates or hydralazine - Consider nitrates and digoxin if refractory symptoms
31
Causes of Hypertension (Secondary)
OSA Renal parenchymal disease Primary aldosteronism Renal artery stenosis NSAIDS Corticosteroids stimulants Phaeochromocytoma Cushing's syndrome
32
Resistant hypertension options
Indapamide 2.5mg Max Atenolol 25mg or Metoprolol 25mg BD Spironolactone 12.5mg
33
Valvular AF: what conditions constitute this?
- Mitral valve stenosis (mod-severe) - mechanical heart valve
34
Valvular AF anticoagulation
WARFARIN
35
Metabolic syndrome qualifiers
Waist circ high triglycerides >1.7 reduced HDL <1 BP >130 Impaired fasting glucose >5.5
36
Moderate CVD Risk: which features makes medications necessary
ATSI BP persistently >160 Family hist of premature CVD
37
Premature CVD age cut offs
F <55 M < 60
38
Mobitz type 1 action
If asymptomatic, nothing
39
Mobitz type 2 action
Referral for pacing and pacemaker insertion
40
When is it suitable to do a precordial thump?
Monitored pulseless VT (not VF) when defib not readily available
41
Examples of broad complex tachycardia (three)
- VT - AF with BBB - Torsades de pointes
42
Examples of narrow complex tachycardia (three) Hint: Irregular & regular
Irregular: - AF Regular - WPW - SVT - AT - AF - SInus tachy
43
Conscious VT & haemodynamically stable - what to do ?
- Amiodarone 300mg IV over 10-20mins mins, then 900mg over 24hrs
44
Narrow complex & regular QRS what to do?
Vagal manoeuvres then ADENOSINE CHALLENGE 6mg rapid bolus
45
A) ? B) ?
Atrial flutter Atrial fibrillation
46
What to suspect with narrow complex tachycardia at 150BMP
FLUTTER with 2:1 block
47
Best analgesic for acute coronary syndrome
Fentanyl (morphine reduces absorption of antiplatelet agents)
48
Complication of inferior STEMI
3rd degree heart block
49
Wide QRS (more than three squares) what does this usually indicate
BBB
50
Investigations for HTN for all people
- UA - Urine ACR - Fasting BGL - Fasting Cholesterol - EUC - Hb - ECG
51
Post AMI medication regime
- Perindopril 2.5-5mg - Atorvatstatin 80mg - Bisoprolol 1.25- 2.5mg - aspirin 100mg - clopidogrel (12months) 75mg
52
Driving restriction post AMI ?
2 weeks
53
3 types of options for SVT cardioversion before you get to adenosine
- Modified valsalva maneouver - Unilateral carotid sinus massage - Immersion of the face in cold water
54
SVT 2nd line
Adenosine 6mg IV stat push
55
Investigations for HOCM
- ECHO - Stress ECHO (looking for exercise induced LVOT) - ECG - 24 hour holter monitor - Cardiac MRI

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