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Tomakesense 3 > Cardiology > Flashcards

Cardiology Flashcards

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1
Q

What are the ECG features of hyperkaemia? (3)

A

Tall tented T waves, widening of QRS, small P waves

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2
Q

Management of Fast AF

A

Hypotension/ acutely unwell= DC cardio version
If stable= Rate or Rhythm control However if >48 hours then has to be RATE control.

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3
Q

What are the 2 first line drugs in treating heart failure with reduced ejection fraction?

A

Ace inhibitor and B blocker.

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4
Q

What drug is 2nd line in treating heart failure with reduced ejection fraction if still symptomatic?

A

Mineraolcorticoid receptor antagonist eg Sprinolactone

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5
Q

What drugs need to be avoided in people with heart failure?

A

Avoid calcium channel blockers eg vermapril

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6
Q

What are the components of CHA2DS2-VASc

A

Congestive HF
HTN
Age >75 (2)
Age 65-74
DM
Previous stroke/ TIA (2)
Vascular disease
Sex - female

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7
Q

What scores would indicate anticoagulation in men/ females using CHADSVASC?

A

Males scoring 1 = CONSIDER anticoagulation
Males and Females scoring >2 = anticoagulation

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8
Q

What is the management of stable angina?

A

Aspirin 75mg OD, and Statin if QRisk>10%
GTN PRN
1st line Beta blocker OR Calcium channel blocker
2nd line BB and CCB

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9
Q

What drugs are provided for secondary prevention post STEMI?

A

Dual antiplatlets, Statin, AceI, Beta blocker.

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10
Q

What is an example of a ‘Thiazide- like’ diuretic?

A

Example = indapamide

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11
Q

What score on the wells score = PE likely?

A

Wells score>4 = PE likely and a CTPA is organised.

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12
Q

What is the management if wells score is less than 4? (PE unlikely)

A

Organise D-dimer.
If d-dimer is pos-> CTPA
If d-dimer is neg-> Stop anticoagulation and consider alternative

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13
Q

What drug is used in non shockable rhythms?

A

Adrenaline 1mg ASAP for non shockable rhythms

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14
Q

What are the non shockable rhythms?

A

PEA/ Asystole

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15
Q

What are the ECG features with WPW?

A

Shortened PR interval, wide WRS with a delta wave

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16
Q

What is the 4th line management of hypertension

A

If potassium <4.5 = add Spirnolactone
If pottasium >4.5= Alpha or beta blocker

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17
Q

What is the management of VT ?

A

VT
Medical mx= Amiodarone/ Lidocaine
If unstable = synchronised DC cardiovascular shock

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18
Q

What drug is contraindicated in VT?

A

Veramapril

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19
Q

What is the cardiac deformity associated with Turners? and what murmur?

A

Bicuspid aortic valvue - ejection systolic

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20
Q

What time limit should PCI be delivered in? (for STEMI)

A

120 minutes

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21
Q

If PCI CANNOT be given within 120 minutes, what should be given? (for STEMI)

A

Fibrinolysis

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22
Q

What drugs need to be given on discharge post an MI?

A

Dual antiplatelet therapy (aspirin plus a second Antiplatelet agent)
ACE inhibitor
Beta-blocker
Statin

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23
Q

What is the first line management of patients with T2DM and new diagnosis of hypertension?

A

ACEi or ARB (regardless of age)

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24
Q

What sort of tachycardia is SVT?

A

Narrow complex tachycardia

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25
How to manage SVT?
If unstable- DC cardioversion If stable- vagal manoevures followed by adenosine
26
What is the first line treatment of DVT?
DOAC (apxiban or rivroxaban)
27
Treatment of unprovoked vs provoked DVT?
Provoked- 3 months of DOAC Unprovoked- 6 months
28
What is the secondary prevention of a stroke?
Need to be commenced on clopidogrel monotherapy +/- statin
29
What is the ALS management of bradycardia?
Atropine IV AND if resistant to atropine then external pacing
30
What Q risk score should statins be considered?
10% or over- statins should be considered
31
Post an MI what drugs are required for 2ndary prevention?
dual antiplatelet therapy (aspirin plus a second antiplatelet agent) ACE inhibitor beta-blocker statin
32
If patient has reduced ejection fraction post an MI which drug should be considered?
Aldosterone anatagonist eg. eplerenone
33
What is the management of bradycardia with shock?
Atropine is 1st line Followed by either further dose of Atropine OR trasncutaneous pacing
34
Inheritance of HOCM?
Autosomal dominant
35
Death from HOCM is as a result of..?
Ventricular arrythmias
36
What are the age categories to get you points in CHADSVASC2?
Age 65-74= 1 point >75= 2 points
37
Management of HTN in diabetic regardless of age?
ACEi/ ARB
38
How does left ventricular free wall rupture present ? ( post MI)
2 weeks post MI- presentation in acute heart failure
39
What is the management for a patient who presents with AF present >48 hours?
Rate control Start on anticoagulation Bring back for DC cardioversion in 3 weeks Continue anticoagulation for 4 weeks
40
What are the drugs for secondary prevention after MI?
AceI, BB, statin, and DAPT (aspirin and clopidogrel)
41
Management of torsades de points?
IV Magnesium sulphate
42
Acute mitral regurgitation - what is the presentation post MI?
Occur hours- day post MI. New mumur (systolic). Acute hypotension and pulmonary oedema.
43
What electrolytes caused prolonged QT?
Hypokaemia, hypocalcaemia, hypomagnesium
44
What are some of the third line drug management options for heart failure?
Ivabradine, sacubitril-valsartan, hydralazine in combination with nitrate, digoxin and cardiac resynchronisation therapy
45
What is first and second line management of stable angina?
Beta blocker or calcium channel blocker 2nd line- use both together!
46
Which drugs can cause QT prolongation ?
SSRIs/ Tricyclic antidepressants
47
What are the rules around driving after a successful coronary angio?
1 week with no driving and no need to tell DVLA
48
What drugs need to be avoided in HOCM?
ACE inhibitors avoid in HOCM
49
Drugs for symptom control in Angina? (3)
GTN spray BB Calcium channel blocker
50
What are the causes of an ejection systolic murmur?
Aortic stenosis, pulmonary stenosis, aortic sclerosis.
51
What causes a pan systolic murmur?
Mitral valve regurgitation Tricuspid regurgitation VSD
52
What are the measurements and management of AAA?
4.5cm and above- refer to secondary care. 5.5 and above- urgent 2ww
53
What are the 2 main causes of a broad complex tachycardia?
VT (AF with bundle branch)
54
How does an atrial myoxema present?
pan systolic murmur, dizziness, syncope. more commonly Left sided.
55
What are the causes of a right bundle branch block?
Normal variant, cor pulmonale, or PE
56
What ECG changes are seen with hypokalemia?
Flattened T waves and U waves.
57
What ECG changes with hypocalacemia/ hypercalacemia?
Hypo- Prolongation of QT Hyper- Shortened QT
58
What are the lateral leads on an ECG?
1, AVL, V5 and V6
59
What type of murmur does aortic regurgitation have?
Soft S1, early diastolic murmur.
60
Following a STEMI if not suitable for PCI, what is the medical management?
Ticagrelor with Aspirin (if bleeding risk is low)
61
What anti platelets are given prior to PCI?
Prasugrel and Aspirin
62
What are the signs of Digoxin toxicity?
N+V, bradycardia, green/ yellow vision. AV node block
63
What are the non shockable rhythms? and how are they managed?
PEA/ Systole Non shockable- CPR and adrenaline every 3-5 mins
64
Management of paryoxsmal SVT?
1. Carotid sinus manoeuvres 2. Adenosine
65
What is Dressler's syndrome?
2-6 weeks post MI Fever, Pain, Pericarditis.+/- effusion
66
Torsades de pointes is associated with which condition and what is the mx?
A/w long QT syndrome and management is with magnesium.
67
What are the ECG features of WPW?
short PR interval wide QRS complexes with a slurred upstroke - 'delta wave'
68
What criteria is used to diagnose rheumatic fever?
Jones criteria
69
Thalssemia can result in what type of heart failure?
High output cardiac failure
70
What are the ejection systolic murmurs?
Aortic stenosis Pulmonary stenosis
71
What are the pansystolic murmurs?
Tricuspid regurgitation Mitral regurgitation
72
What is an early diastolic mumur?
Aortic regurgitation
73
What is mid-late diastolic murmur?
Mitral stenosis
74
What are the causes of restrictive cardiomyopathy? (3)
Amyloidosis, Post radiotherapy/
75
AAA rules and driving..
6cm- inform DVLA 6.5cm and over- cannot drive 5.5cm if lorry driver/ bus driver
76
Narrow complex tachycardia- what are the management principles?
If unstable- SHOCK Stable Regular- Vagal manoeuvres/ ADENOSINE 6mg Iv bolus Irregular - AF
77
How to tell the difference between transposition of great arteries/ tetrology of fallot?
Tetrology of fallot- more common. presents 1-2 months. Transposition of great arteries- at birth and less common!
78
What are the two cardiac malformations in Turners?
Coarctation of aorta AND Biscuspid aortic valve
79
What is the management of aortic stenosis in children and which 2 conditions is it associated with?
A/w Williams and Turners Management in children is with balloon valvuloplasty
80
What are the features of aortic regurgitation ? And when is it loudest?
Early diastolic pressure LOUDEST IN EXPIRATION! Wide pulse pressure Collapsing pulse Pulsating nail beds Head bobbing
81
Aortic stenosis vs aortic sclerosis?
Sclerosis is an ejection systolic but it won't radiate to the cartoids!
82
When is Troponin the most sensitive?
12 hours. Most accurate.
83
What ECG sign is characteristic of Hypothermia?
J Waves
84
When should stage 1 hypertension be referred?
Stage 1 hypertension without evidence of end organ damage + UNDER 40 should be referred to secondary care!
85
What is stage 1 hypertension?
Clinic BP >= 140/90 mmHg and subsequent ABPM daytime average or HBPM average BP >= 135/85 mmHg
86
What is stage 2 hypertension?
Clinic BP >= 160/100 mmHg and subsequent ABPM daytime average or HBPM average BP >= 150/95 mmHg
87
What is stage 3 hypertension?
Clinic readings >180/120
88
Becks triad for cardiac tamponade?
Hypotension Muffled heart sounds Elevated JVP
89
What is first line statin for primary prevention?
Atorvostatin 20mg
90
What is the first line statin for secondary prevention?
Atorvostatin 80mg
91
What are the rules for diabetics and statins?
If over 40, T1DM do not need risk assessment but should be on statins!
92
Nicotinic Acid- what is it used for and what are the side effects?
Lowers cholesterol Side effect: severe flushing
93
What are the features of CCF on CXR?
Kerly B lines Bilateral pleural effusions Pulmonary oedema Upper lobe diversion
94
What are the 4 New York classifications of heart failure?
1. No symptoms and no limitations 2. Mild symptoms and comfortable at rest 3.Moderate symptoms and limitations of physical activity 4. Severe- symptoms at rest.
95
When can the Q risk score NOT be used?
T1DM Renal disease with egfr less than 60 Familial hypercholestaemia
96
If statins are not having desired affect on lipid levels- what is next step?
Increase dose of statin (NICE do not recommend Fibrates/ Nicotonic acid/ Bile acid sequestratants routinely)
97
Rheumatic Fever- what organism? What treatment?
Strep pyogenes (Group A strep) Mx: IM Ben Pen + PO Penicillin
98
Pulsus paradoxus is seen in which conditions?
Severe Asthma, Cardiac tamponade
99
What is sinus arrhythmia and how does it present?
Normal finding in fit individuals Pulse increases during inspiration and decreases with expiration.
100
What are the numbers to remember for AAA?
3-4.5cm= repeat scan in 12 months 4.5-5.5= repeat in 3 months >5.5cm= vascular surgeon Driving- tell DVLA at 6cm, and stop driving at 6.5cm Coach 5.5cm STOP DRIVING
101
Digoxin toxicity does what to an ECG?
(Yellow vision) ST depression with inverted T waves V5/ V6
102
Hypocalcaemia - clinical features and ECG features?
Prolonged QT (trousseau/ chokekeu signs) INCREASED reflexes
103
What valvular pathology may occur post MI
Mitral regurgitation
104
Lone AF Paroxysmal AF Persistant AF Permanent AF
Lone AF- isolated episode and no trigger Paroxysmal AF - less than 7 days and SELF TERMINATE Persistent AF - OVER 7 days and doesn't self terminate Permanent AF- continuous and resistant
105
Management of NSTEMI/ Unstable Angina
Grace score less than 3% - Ticagrelor with aspirin if low bleeding risk - Clopidogrel with aspirin if high bleeding risk Grace score >3% - Angiography +/- PCI + Prasugrel - Ticagrelor with aspirin
106
HTN guidelines for afro-carbribean?
C is first line C+ A or D *ARB is first line rather than ACE inhibitors in afrocaribeean populations*
107
Secondary prevention for NSTEMI
DAPT follows whatever is started in acute phase EG: Low risk grace score less than 3% - Ticagrelor and aspirin (low risk bleeding) - Clopidogrel and aspirin (high risk bleeding) High risk grace score (PCI) -Prasugrel and Aspirin
108
Driving rules after ACS, Angio, CABG, Heart transplant
ACS (STEMI/NSTEMI) 1 month Successful angio including PCI for STEMI- 1 week CABG - I month Heart transplant- 6 weeks
109
After ACS how long before return to work, return to sexual intercourse and reminder of the driving rules?
Driving rules- stop driving for 1 month. unless successful angio in which case no driving for 1 week No sex for 1 month Return to work after 2 months
110
How does Left ventricular free wall rupture present?
5 days after MI, elevated JVP. Cardiac tamponade - diminished heart sounds.
111
Pan systolic murmur following MI? Early to mid systolic murmur following MI?
Ventricular septal defect Mitral regurgitation (early to mid systolic)
112
What is the dose for Adenosine for SVT?
SVT Narrow complex tachycardia (REGULAR) 1st: Vagal manoeuvres 2nd line: 6mg IV Adenosine 12mg Adenosine 18mg Adenosine
113
What are some examples of rate controlling drugs for AF?
Beta Blockers Calcium channel Blocker Digoxin
114
Verapamil is an example of what type of drug?
Calcium channel blocker for rate control in AF
115
Management of PAD.
Clopidogrel 75mg OD If Q risk >10% then STATIN!
116
Features of constrictive pericarditis
Presents with raised JVP/ heart failure Calcification of pericardium 'pericardial calcification'
117
2,3, AVF is which ECG territory and which artery?
Inferior RAD AVF for F= failure = inferior aspect of the heart
118
V1-V4
Anterioseptal LAD v1-v4 are the main leads therefore ladddy!
119
V1-6, I, aVL
AVL is LATERAL. (Anteriolateral) Left circumflex/ Proximal left anterior descending L for lateral
120
V1-V3
Posterior left circumflex, also right coronary
121
What is the energy used for shockable rhythms?
150-200j on first shock, and then 150-360j on subsequent shocks
122
What drugs improve survival in HF?
ACEi and BB!!!
123
What drugs to avoid in HF?
Calcium channel blockers! and (pioglitazone - fluid retention)
124
How might pulsus paradoxus be described in a question?
Absent or faint pulse in inspiration Seen in cardiac tamponade and severe asthma.

Tomakesense 3 (15 decks)

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