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Finals Difficult Topics > Cardiology > Flashcards

Cardiology Flashcards

1
Q

SE of ACE inhibitors

A

cough: occurs in around 15% of patients and may occur up to a year after starting treatment. Thought to be due to increased bradykinin levels
angioedema: may occur up to a year after starting treatment
hyperkalaemia

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2
Q

Dose of adenosine for Narrow Based Supraventricular Tachy

A

6 mg, 6mg, 12 mg

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3
Q

The cause of difference in blood pressure between leg and arm

A

aortic coarctation

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4
Q

SOB, bibasal creps, bilateral pitting oedema. How would you treat?

A

Bradycardia algorithm:

  • Atropine 0.5 mg IV
  • Isoprenaline IV
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5
Q

the emergency management of haemorrhage in patients on warfarin. This patient has an INR greater than 8 and is actively bleeding, major hemmorhage

A

Stop warfarin
Give intravenous vitamin K 5mg
Prothrombin complex concentrate - if not available then FFP*

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6
Q

A 43-year-old lady presents with severe chest pain. Investigations demonstrate a dissecting aneurysm of the ascending aorta which originates at the aortic valve. What is the optimal long term treatment?

A

Proximal aortic dissections are generally managed with surgical aortic root replacement. The proximal origin of the dissection together with chest pain (which may occur in all types of aortic dissection) raises concerns about the possibility of coronary ostial involvement (which precludes stenting). There is no role for attempted suture repair in this situation.

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7
Q

You are doing the discharge summary for a 56-year-old man who is being discharged following a ST-elevation myocardial infarction (MI) for which he was treated with a percutaneous coronary intervention. He has no past medical history of note. Following NICE guidance, which of the following best describes the medications which he should be taking?

A

dual antiplatet
Beta Blocker
ACE inbitor
Statin

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8
Q

The vast majority of cases of bacterial endocarditis are caused

A

by gram positive cocci.
Common causes:
Streptococcus viridans
Staphylococcus aureus (in intravenous drugs uses or prosthetic valves)
Staphylococcus epidermidis (in prosthetic valves)

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9
Q

Systemic inflammatory response syndrome (SIRS)

A

at least 2 of the following
body temperature less than 36°C or greater than 38.3°C
heart rate greater than 90/min
respiratory rate greater than 20 breaths per minute
blood glucose > 7.7mmol/L in the absence of known diabetes
white cell count less than 4 or greater than 12

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10
Q

Indications INR

A

venous thromboembolism:

target INR = 2.5, if recurrent 3.5

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11
Q

Indications INR AF

A

atrial fibrillation, target INR = 2.5

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12
Q

Which drug should not be used concurrently with clopidrogel?

A

This drug is omeprazole, it should not be used concurently with clopidrogel.

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13
Q

GTN side effects

A

Hypotension, Tachycardia, Hedeache, Flishing

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14
Q

low K plus hypertension

A

Conn’s syndrome

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15
Q

Loop diuretics SE

A

Furosemide and bumetanide are loop diuretics that act by inhibiting the Na-K-Cl cotransporter (NKCC) in the thick ascending limb of the loop of Henle, reducing the absorption of NaCl.

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16
Q

Which one of the following best describes the most characteristic side-effects of angiotensin-converting enzyme inhibitors?

A

cough plus hyperkalemia

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17
Q

A 68-year-old lady is due to have a cholecystectomy for gallstone disease. She is on warfarin and her last INR two weeks ago was 2.7.

When should you advise her to stop taking her warfarin?

A
  • Warfarin is usually stopped 5 days before planned surgery, and once the person’s international normalized ration (INR) is less than 1.5 surgery can go ahead.
  • Warfarin is usually resumed at the normal dose on the evening of surgery or the next day if haemostasis is adequate.
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18
Q

What is the mechanism of action of dipyridamole?

A

phosphodiesterase inhibitor, inhibits phosphodiesterase, elevating platelet cAMP levels which in turn reduce intracellular calcium levels

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19
Q

Beta-blockers side effects:

A

Side-effects:

  • bronchospasm
  • cold peripheries
  • fatigue
  • sleep disturbances, including nightmares
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20
Q

Factors favouring rate control for AF patients

A

Older than 65 years

History of ischaemic heart disease

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21
Q

Factors favouring rhythm control

A 
Younger than 65 years
Symptomatic
First presentation
Lone AF or AF secondary to a corrected precipitant (e.g. Alcohol)
Congestive heart failure
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22
Q

What is torsades des pointes?

A

Torsades de pointes (‘twisting of the points’) is a rare arrhythmia associated with a long QT interval. It may deteriorate into ventricular fibrillation and hence lead to sudden death

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23
Q

What is the mechanism of action of bosentan?

A

Bosentan - endothelin-1 receptor antagonist - used in pulmonary hypertension

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24
Q

The drugs used in the management of heart failure

A

1st line: ACE inhibitor plus beta-blocker
2nd line: Spironolactone, ARII blocker, hydralazine with nitrate
3rd: cardiac re-synchronisation therapy
Digoxin
Ivabridine ( funny current in SA node)

Diuretics should be given for fluid overload
Annual Influenza Vaccine
Pneumococcal Vaccine

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25
Q

What are the beta blockers used to treat heart failure?

A

Bisosporol and carvedilol

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26
Q

Why digoxin is used in heart failure patients?

A

It had inotropic properties

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27
Q

What is blood pressure target for patients below the 80s?

A

140/90

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28
Q

Statins should not be given with which drugs leading to increase in creative kinase?

A

Statins plus erythromycin/clarithromycin. This is a common interaction leading to increase in creative kinase.

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29
Q

What could cause atrial flutter?

A

Atrial flutter could be caused by Pulmonary Disease and increase in RA pressures

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30
Q

What is the formula for corrected QT

A

Start if QRS (380-420)

Corrected QT= QT/square root of R-R

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31
Q

What are the drugs causing LONG-QT

A 
Anti fun gals-ketonzacole
Antiaarythmic: class I a Verapamil
TCA: citalopram
Amiodorone: drugs which interfere with K channels
Macrolides: erythromycin
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32
Q

What are the causes of long QT

A 
TIMME
Toxins
Inhertited - causing SOD
Mitrial valve prolapse
Myocarditis
Everything low: low K, low Mg, low Ca, hypothermia
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33
Q

What are the criteria for synchronised cardioversion?

A 
Shock
Cold clammy extremities, confusion, impaired consiuossness
Syncope
MI
Heart failure
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34
Q

How does bumetanide and frusemide work?

A

Furosemide and bumetanide are loop diuretics inhibiting Na-K-Cl cotransporter in thick’s ascending loop of Henly

35
Q

What are the side effects of Na-K-Cl inhibitors such as frusemide, bumetanide?

A 
Hyponatremia
Hypokalemia
Hypochlermicnalkalosis
Ototoxicity
Hypocalcemia
Rental Impairment
Hyperglycemia
Gout
36
Q

Vomiting, thoracic pain, subcutaneous emphysema. Associated alcohol abuse

A

Boerhave Syndrome

37
Q

Aortic regurgitation plus ST elevation in leads II, III and aVF

A

This is proximal aortic root dissection

38
Q

How should diabetes be managed in diabetic patients?

A

The metformin and glycaside should be stopped. The IV insulin should be started.

39
Q

Who should be given glycoproteins IIa/IIIa?

A

GRACE score and weather percutaneous coronary intervention is to be performed.

  • high risk of cardiovascular events
  • the ones who are scheduled to undergo angiography within 96h of admissions
40
Q

What is the main sign to look for in hypokalemia?

A

U waves! In hypokalemia no P no T just U , PR and long QT

41
Q

What is the mechanism of action of this drug?

A

The mechanism of action if tirofiban is glycoprotein IIb/IIa receptor antagonist.

42
Q

What is the mechanism of action of alteplase?

A

Activates plasminogen to form plasmin

43
Q

What is the common side effect of ivabridine?

A

is transient luminous phenomenon (reported by up to 15% of patients), such as bright spots appearing in their field of vision. Less commonly blurred vision is reported.

44
Q

What is the mechanism of action of adenosine?

A

agonist of the A1 receptor which inhibits adenylyl cyclase thus reducing cAMP and causing hyperpolarization by increasing outward potassium flux

45
Q

What are adverse effects of adenosine?

A
  • Bronchospasm
  • Chest Pain
  • Conduction down accessory pathways, resulting in increased ventricular rate (e.g. WPW syndrome)
46
Q

Which one of the following may reduce the effects of adenosine?

A

Aminophylline reduces effect

47
Q

Which one of the following may enhance the effects of adenosine?

A

Dipyridamole enhances effect

48
Q

Agents used to control rate in patients with atrial fibrillation

A

beta-blockers
calcium channel blockers
digoxin (not considered first-line anymore as they are less effective at controlling the heart rate during exercise. However, they are the preferred choice if the patient has coexistent heart failure)

49
Q

Agents used to maintain sinus rhythm in patients with a history of atrial fibrillation

A

sotalol
amiodarone
flecainide

50
Q

Factors favouring rhythm control

A 
Younger than 65 years
Symptomatic
First presentation
Lone AF or AF secondary to a corrected precipitant (e.g. Alcohol)
Congestive heart failure
51
Q

What is bifasicular block?

A

Combination of RBBB with LAD

52
Q

Which scoring system is used for prescription of Warfarin?

A

HASBLED

53
Q

Four weeks following the event, which combination of drugs should he be taking?

A

ACE inhibitor + Beta-blocker + Statin + Aspirin + Clopidogrel 63%

54
Q

Allows passage of an embolus from the right-sided circulation to the left causing a stroke

A

Ostium secundum atrial septal defect: 37%

55
Q

ECG changes for thrombolysis or percutaneous intervention:

A
  • ST elevation of > 2mm (2 small squares) in 2 or more consecutive anterior leads (V1-V6) OR
  • ST elevation of greater than 1mm (1 small square) in greater than 2 consecutive inferior leads (II, III, avF, avL) OR
  • New Left bundle branch block
56
Q

Complete heart block following a MI?

A

This patient has developed complete heart block secondary to a right coronary artery (RCA) infarction. The atrioventricular node is supplied by the posterior interventricular artery, which in the majority of patients is a branch of the RCA.

57
Q

Four weeks after an anterior myocardial infarction a 69-year-old presents with pulmonary oedema. The ECG shows persistent ST elevation in the anterior leads.

A

Left ventricular aneurysm

The ischaemic damage sustained may weaken the myocardium resulting in aneurysm formation. This is typically associated with persistent ST elevation and left ventricular failure. Thrombus may form within the aneurysm increasing the risk of stroke. Patients are therefore anticoagulated.

58
Q

What is stage II hypertension?

A

Clinic: 160/100 or home 150/90

59
Q

Which anti-anginal agent should be avoided in patients with known heart failure?

A

Verapamil should be avoided in patients with known heart failure.

60
Q

What’s the mechanism of action of clopidrogel?

A

P2Y12 adenosine diphosphate (ADP) receptor antagonist, inhibiting the activation of platelets

61
Q

what is bisfrens pulse?

A

‘double pulse’ - two systolic peaks

mixed aortic valve disease

62
Q

what are the side effects of beta-blockers?

A
  • bronchospasm
  • cold peripheries
  • fatigue
  • sleep disturbances, including nightmares
63
Q

What is hydrocrotisone dose in anaphylaxis? (adults)

A

200 mg

64
Q

What is chlophenamine dose in anaphylaxis? (adults)

A

10 mg

65
Q

Which one of the following antiplatelet medications should he be given following the stroke?

A

Aspirin 300 mg daily for 2WKS plus

clopidrogel 75 mg

66
Q

Drugs used in heart failure

A

first-line treatment for all patients is both an ACE-inhibitor and a beta-blocker
second-line treatment is now either an aldosterone antagonist, angiotensin II receptor blocker or a hydralazine in combination with a nitrate
if symptoms persist cardiac resynchronisation therapy or digoxin* should be considered. An alternative supported by NICE in 2012 is ivabradine. The criteria for ivabradine include that the patient is already on suitable therapy (ACE-inhibitor, beta-blocker + aldosterone antagonist), has a heart rate > 75/min and a left ventricular fraction < 35%
diuretics should be given for fluid overload
offer annual influenza vaccine
offer one-off** pneumococcal vaccine

67
Q

What is the important interaction between clopidorgel and other commonly prescribed medication?

A

Omeprazole interacts with Clopidrogel

68
Q

Which beta-blockers are used in heart failure?

A

Carvedilol and Bisoprolol

69
Q

A 52-year-old male presents with tearing central chest pain. On examination he has an aortic regurgitation murmur. An ECG shows ST elevation in leads II, III and aVF.

A

Proximal aortic dissection. An inferior myocardial infarction and AR murmur should raise suspicions of an ascending aorta dissection rather than an inferior myocardial infarction alone. Also the history is more suggestive of a dissection. Other features may include pericardial effusion, carotid dissection and absent subclavian pulse.

70
Q

What is mechanism of action of nicoradil?

A

Nicoradil is K channel activator, used in againa in combination with if a patient is on monotherapy and cannot tolerate the addition of a calcium channel blocker or a beta-blocker then consider one of the following drugs: a long-acting nitrate, ivabradine, nicorandil or ranolazine

71
Q

A 30-year-old woman presents to the Emergency Department with a one-day history of central chest pain. The pain is described as severe, non-radiating and eases on expiration. Clinical examination of her cardiorespiratory system is unremarkable other than a heart rate of 96 / min. An ECG shows widespread ST elevation associated with PR segment depression in the anterior, inferior and lateral leads. Bloods show the following:

A

Acute Pericarditis

72
Q

Differential diagnosis for ejection systolic murmur?

A 
AS
Ascleriosis
VSD
HOCM
High output states: Pregnacy, Anemia, Thyrotoxicosis
73
Q

Factors favouring rhythm control

A 
Younger than 65 years
Symptomatic
First presentation
Lone AF or AF secondary to a corrected precipitant (e.g. Alcohol)
Congestive heart failure
74
Q

Factors favouring rate control

A

Older than 65 years

History of ischaemic heart disease

75
Q

Agents used to control rAte in patients with atrial fibrillation

A

Beta-blockers
Calcium channel blockers
Digoxin (not considered first-line anymore as they are less effective at controlling the heart rate during exercise. However, they are the preferred choice if the patient has coexistent heart failure)

76
Q

Agents used to maintain sinus rhythm in patients with a history of atrial fibrillation

A

Sotalol
Amiodarone
Flecainide

77
Q

Adenosine Mechanism of action

A

agonist of the A1 receptor which inhibits adenylyl cyclase thus reducing cAMP and causing hyperpolarization

78
Q

What is the mechanism of action of alteplase?

A

Activates plasminogen to plasmin

79
Q

ST-elevation myocardial infarction

A

Aspirin + ticagrelor + IV heparin + immediate percutaneous coronary intervention
48%

80
Q

What is the mechanism of action of fondaparinux?

A

activates anti-thrombin III

81
Q

A 28-year-old who is 10 weeks pregnant is noted to be hypertensive on her booking visit. Blood show a potassium of 2.9 mmol/l.

A

Primary hyperaldosteronism

82
Q

Complete heart block following a MI?

A

right coronary artery lesion

83
Q

A mid diastolic murmur at the apex is?

A

Mitrial Stenosis

Finals Difficult Topics (3 decks)

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