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Flashcards in Cardiology Deck (58):
1

What are the general mechanisms of action of vaughan williams classes 1-4?

Class 1 block sodium channels to reduce threshold
Class 2 block beta adrenoceptors to reduce sympathic input to the heart
Class 3 block potassium channels to prolong repolarisation and reduce re-entry
Class 4 block calcium channels to slow repolarisation and reduce re-entry

2

Give an example of a vaughan williams class 1a drug

Quinidine

3

Give an example of a vaughan williams class 1b drug

Lidocaine

4

Give an example of a vaughan williams class 1c drug

Flecainide

5

Give an example of a vaughan williams class 2 drug

Bisoprolol

6

Give an example of a vaughan williams class 3 drug

Amiodarone

7

Give an example of a vaughan williams class 4 drug

Verapamil

8

What are the three main causes of a microcytic anaemia?

Sideroblastic anaemia
Iron deficiency
Thalassemia

9

What iron study results will be found in iron deficiency anaemia?

Low iron
Low ferritin (unless infection)
High Total Iron Binding Capacity
High transferrin receptors

10

What will be seen on a blood film in iron deficiency anaemia?

Target cells
'Pencil' Poilcilocytes

11

How will thalassaemia appear on an FBC?

Low Mean cell volume
High red cell count

12

How is thalassaemia managed?

Folate supplements
Regular transfusions
Iron chelators

13

What is sideroblastic anaemia?

Inability to properly form haem. Iron accumulates in the mitochondria

14

What are three causes of sideroblastic anaemia?

Congenital
Lead
Anti-TB drugs
Alcohol

15

How will sideroblastic anaemia appear on a blood film?

High iron
Normal TIBC
High ferritin

16

How is sideroblastic anaemia treated?

Remove cause, if possible
Pyridoxine

17

Give 4 causes of normocytic anaemia

Haemolytic anaemia
Sickle cell anaemia
Anaemia of chronic disease
Acute blood loss
Chronic kidney disease
Hypothyroidism

18

Give three conditions which are associated with anaemia of chronic disease

Rheumatoid arthritis
Vasculitis
TB
Osteomyelitis
Malignancy
CKD

19

How does anaemia of chronic disease appear on iron studies?

Normal or raised ferritin
Low TIBC
Low iron

20

What investigations show the presence of haemolytic anaemia?

FBC with normal or riased MCV and raised reticulocytes
LFTs show raised bilirubin
Raised serum LDH
Raised urinary urobilinogen

21

What investigations can be done to establish the cause of haemolytic anaemia?

Blood film
Coombs' test
Osmotic fragility test
Hb electrophoresis

22

Give three inherited causes of haemolytic anaemia

Thalassaemia
Sickle cell anaemia
Spherocytosis
G6PD deficiency

23

Give three acquired causes of haemolytic anaemia

TTP
Uraemia
DIC
Microangiopathic haemolytic anaemia (MAHA)
Malaria
Drugs eg penicillin or quinine
Autoimmune

24

What are the megaloblastic causes of macrocytic anaemia?

B12 deficiency
Folate deficiency

25

What are the non-megaloblastic causes of macrocytic anaemia?

Pregnancy
Alcohol
Liver disease
Reticulocyosis
Hypothyroidism
Cytotoxic drugs

26

What pathologies can cause B12 deficiency?

Pernicious anaemia
Gastrectomy
Crohn's disease
Bacterial overgrowth
Ileal resection

27

Which sites of the GI tract are important in B12 metabolism?

Stomach is site of intrinsic factor production and so binding of B12
Terminal ileum is site of B12 absorption

28

How can pernicious anaemia be tested for?

Parietal cell antibodies
Intrinsic factor antibodies

29

Give three causes of folate deficiency

Poor diet
Malabsorption
pregnancy
Drugs eg AEDs

30

What drugs should be used as rate control in AF?

Either a beta blocker (not sotalol) or verapamil (not both)
Or digoxin if sedentary and non-paroxysmal AF

31

What are the features of acute sarcoidosis?

Swinging fever
Polyarthralgia
Erythema nodosum
Bilateral hilar lymphadenopathy

32

What are the CXR features of sarcoidosis?

Bilateral hilar lymphadenopathy
Peripheral pulmonary infiltrates
Honeycombing
Pleural involvement

33

How is stage 1 hypertension defined?

Clinic BP of >140.90
ABPM of >135/85

34

How is stage 2 hypertension defined?

Clinic BP of >160/100
ABPM of >150/95

35

How is severe hypertension defined?

>180/>110

36

What is the target blood pressure in diabetes?

If end organ damage then <130/80
If no end organ damage then <140/90

37

When should hypertension be medically managed?

If stage 2 at any age
If stage 1 and <80 years old and one of:
End organ damage
Established cardiovascular disease
Diabetes
10 year cardiovascular risk >/=20%

38

How is chronic heart failure managed?

ACE inhibitor and Beta blocker but dont's start at same time
Add aldosterone antagonist or ARB or hydralazine with nitrate
Cardiac resynchronisation or digoxin or ivabradine
Diuretic if fluid overload

39

What is NYHA classification grade 1?

No symptoms and no limitation of normal exercise

40

What is NYHA classification grade 2?

Mild symptoms and slight limitation. Ordinary activity causes fatigue, dyspnoea or palpitations

41

What is NYHA classification grade 3?

Moderate symptoms and marked limitation. Less than ordinary activity leads to symptoms

42

What is NYHA classification grade 4?

Severe symptoms. Discomfort at rest and worsened by any activity

43

Give 5 causes of hyperlipidaemia

Hypothyroidism
Cushing's
CKD
Obesity
Alcohol abuse
Pregnancy
Steroids
Ciclosporin
Obstructive jaundice
Anorexia nervosa
Diabetes mellitus
Thiazide diuretics
Antiretrovirals
Beta blockers
COCP
Atypical antipsychotics

44

When should statins be given?

As primary prevention in people with 10 year CVD risk of at least 10% or T1DM or CKD stage 2 and above
As secondary prevention in all patients with cardiovascular disease and no contraindications

45

Other than statins, what drugs can be used to treat dyslipidaemia?

Fibrates
Ezetimibe
Nicotinic acid
Cholestyramine

46

What is the mechanism of action of ezetimibe?

Reduces the absorption of cholesterol in the small intestine

47

What is the mechanism of action of nicotinic acid in dyslipidaemia?

Reduces hepatic secretion of vLDLs

48

What is the mechanism of action of fibrates in dyslipidaemia?

Increases the expression of lipoprotein lipase

49

What is the mechanism of action of cholestyramine in dyslipidaemia?

Reduces the reabsorption of bile acids in the small intestine so increases the conversion of cholesterol into bile acids

50

When should a person with ?ACS be admitted to hospital?

If current chest pain
Signs of complications
Pain within 12 hours and an abnormal ECG

51

When should a person with ?ACS be referred to hospital?

Same day if pain free but pain was within 12 hours and they have a normal ECG and no complications or if pain was 12-72 hours ago with no complications
2WW if pain over 72 hours ago and no complications

52

Name three ways in which cardiomyopathy may present?

Heart failure
Thromboembolism
Arrhythmia
Genetic screening
Sudden death

53

What are the two main inherited cardiomyopathies?

Hypertrophic obstructive cardiomyopathy
Arrythmogenic right ventricular dysplasia

54

What are the features of a dilated cardiomyopathy?

Normal ventricular wall thickness but ventricular enlargement and abnormal contractility
Causes congestive heart failure and embolic disease

55

What are the features of a restrictive cardiomyopathy?

Ventricular chamber is a normal size and has normal systolic function but it has increased myocardial stiffness leading to incompliance and reduced diastolic filling

56

What is the main cause of dilated cardiomyopathy?

Alcohol

57

What is the main cause of restrictive cardiomyopathy?

Amyloidosis

58

How is acute pulmonary oedema managed?

Controlled oxygen
IV furosemide (loop)
IV nitrates if BP>110
LMWH
COnsider opiates for anxiety
CPAP if Resp rate >20