Cardiology Flashcards
(142 cards)
1
Q
What is the anticoagulant regime for PE?
A
Provoked:
- LMWH/fondaparinux for at least 5 days or until INR 2.0 (longer)
- Give Warfarin at the same time, for 3 months
Unprovoked/ those with active cancer:
- As above
- Extend Warfarin to 6 months
2
Q
What would you suspect if there is ST elevation in AvR?
A
Either 3 vessel disease (RCA, LAD, Cirfumflex) or left main stem disease
3
Q
What would a mid-late diastolic murmur suggest?
When would this murmur be heard best?
What is the gold-standard investigation?
A
Mitral stenosis (may also hear a loud S1 and opening snap) Best heard in expiration
Echo
4
Q
Give 5 causes of AS?
Which is the most common in >65 and <65s?
A
> 65: Degenerative calcification < 65: Bicuspid aortic valve - William's syndrome (supravalvular stenosis) - Post-rheumatic disease - Subvalvular: HOCM
5
Q
What is the Mx of AS?
A
If asymptomatic then normally observe, unless valvular gradient > 40 mmHg and features such as left ventricular systolic dysfunction, then consider surgery.
If symptomatic then valve replacement
If not fit for valve replacement then balloon valvuloplasty
6
Q
What are the side effects of warfarin?
A
- Haemorrhage
- Tetratogenic (although okay if breastfeeding)
- Skin necrosis (rare, due to temporary procoagulant state (reduced protein C synth) when first started, especially common in patients with protein C or S deficiency) = why heparin given at same time)
- Purple toes
7
Q
What is the Mx of a regular broad-complex tachycardia?
A
Assume ventricular tachycardia.
Assess if unstable:
- Shock: hypotension, pallor, sweating, confusion
- Syncope
- Myocardial ischaemia
- Heart failure
If stable, give loading dose amiodarone followed by 24 hour infusion.
If not, then synchronised DC shocks should be given.
8
Q
What is the Mx of irregular broad-complex tachycardias?
A
Assess if unstable:
- Shock: hypotension, pallor, sweating, confusion
- Syncope
- Myocardial ischaemia
- Heart failure
If unstable, then synchronised DC shocks should be given.
If stable:
1: AF with BBB: vagal manoeuvres followed by IV adenosine. If unsuccessful consider diagnosis of atrial flutter and control rate (e.g. Beta-blockers)
2: Polymorphic VT (Torsades) - IV magnesium
9
Q
What is the management of regular narrow-complex tachycardias?
A
Assess if unstable:
- Shock: hypotension, pallor, sweating, confusion
- Syncope
- Myocardial ischaemia
- Heart failure
If unstable, then synchronised DC shocks should be given.
If stable:
Vagal manoeuvres followed by IV adenosine. If unsuccessful consider diagnosis of atrial flutter and control rate (e.g. Beta-blockers)
10
Q
What is the Mx of irregular narrow-complex tachycardia?
A
Assess if unstable:
- Shock: hypotension, pallor, sweating, confusion
- Syncope
- Myocardial ischaemia
- Heart failure
If unstable, then synchronised DC shocks should be given.
If stable:
- Probable AF
- If onset <48 hours then consider electrical or chemical cardioversion
- Rate control (BB or digoxin) and anticoagulation
11
Q
What advice should be given regarding driving following PCI?
A
For a private vehicle: Don’t need to tell DVLA, may resume driving after 4 weeks.
For a Bus or Lorry: Patients must notify the DVLA themselves and may not drive for at least 6 week, after which they will be assessed by the DVLA.
12
Q
What advice should be given regarding with HTN?
A
Can drive unless treatment causes unacceptable SE. Group 2 (Bus/lorry), resting BP 180+ systolic or 100+ diastolic would disqualify
13
Q
What advice should be given regarding driving following elective angioplasty?
A
1 week off driving
14
Q
What advice should be given regarding driving following CABG?
A
4 weeks off driving
15
Q
What advice should be given regarding driving following ACS?
A
4 weeks off driving, unless successfully treated by angioplasty- then 1 week
16
Q
What advice should be given regarding driving and angina?
A
Must not drive if symptoms occur at rest/whilst driving
17
Q
What advice should be given regarding driving following pacemaker insertion?
A
1 week off
18
Q
What advice should be given regarding driving following ICD insertion?
A
If for sustained ventricular arrhythmia: cease driving for 6 months.
If implanted prophylatically then cease driving for 1 month.
Having an ICD results in a permanent bar for Group 2 drivers
19
Q
What advice should be given regarding driving following successful catheter ablation for an arrhythmia?
A
2 days off
20
Q
What advice should be given regarding driving following aortic aneurysm of 6cm or more?
A
Notify DVLA.
Licensing will be permitted, subject to annual review.
Aortic diameter or 6.5cm or more = disqualify
21
Q
What advice should be given regarding driving following heart transplant?
A
Can drive as normal. DVLA do not need to be notified
22
Q
What is Kussmaul sign? What condition is this seen in?
A
A rise in JVP on inspiration (normally: falls - venous BF to heart increases)
Pericarditis (heart fails to relax)
23
Q
What are the features constrictive pericarditis?
A
= thickened, fibrotic pericardium. (rare, but more common after TB, cardiac surgery, radiation)
- Dyspnoea
- Right heart failure: elevated JVP, ascites, oedema, hepatomegaly
- JVP shows prominent x and y descent
- Pericardial knock (loud S3)
- Kassmaul’s sign
24
Q
How would you differentiate between constrictive pericarditis and cardiac tamponade?
A
Constrictive:
- Pericardial calcification on CXR
- Kussmaul’s sign
- JVP: X + Y present
Tamponade:
- No Y descent on JVP (TAMponade = TAMpaX)
- Pulsus paradoxus (abnormally large decrease in stroke volume, systolic blood pressure and pulse wave amplitude during inspiration)
25
What are the associations of coarctation of the aorta?
- Turner's syndrome
- Bicuspid aortic valve
- Berry aneurysms
- Neurofibromatosis
26
What is coarctation of the aorta?
| Features?
Congenital narrowing of the descending aorta, more common in males.
- Infancy: HF
- Adult: HTN
- Radio-femoral delay
- Mid-systolic murmur, maximal over back
- Apicial click from aortic valve
- Notching of the inferior border of the ribs (collateral vessels) - not seen in young children.
27
What would be the most likely cause of ST elevation in leads V1-V4 with reciprocal changes in inferior leads?
100% occlusion of the LAD
28
What is Prinzmetal angina?
Non-exertional chest pain, typically cyclical with most episodes occurring the in the early hours. Normal exercise tolerance.
Due to coronary artery spasm.
29
What are the 9 absolute CI to thrombolysis?
- Active internal bleeding
- Recent haemorrhage, trauma or surgery (inc dental extraction)
- Coagulation and bleeding disorders
- Intracranial neoplasm
- Stroke <3 months
- Aortic dissection
- Recent head injury
- Pregnancy
- Severe HTN
30
What are the side-effects of thrombolysis? Which drug causes these more commonly?
- Haemorrhage
- Hypotension (more common with streptokinase)
Allergic reactions may occur with streptokinase
31
What are the side effects of B blockers?
- Bronchospasm
- Cold peripheries
- Fatigue
- Sleep disturbances inc nightmares
- Erectile dysfunction
32
Why wouldn't you prescribe B blockers to someone also taking verapamil?
May precipitate severe bradycardia
33
CI to B blockers?
Uncontrolled HF
Asthma
Sick sinus syndrome
Verapamil use
34
What doses of simvastatin are used in primary and secondary prevention?
Primary: Atorvastatins 20mg OD
Secondary: Atorvastatin 80mg OD
35
When during the day should statins be taken?
At night, as this is when the majority of cholesterol synthesis occurs. (Esp for simvastatin as this has a short HL)
36
What blood test monitoring should be undertaken with statins?
LFTs at baseline, 3 months and 12 months (discontinue if transaminase conc rise to and persist at 3x upper limit)
37
What are the side effects of statins?
Myopathy: myalgia, myositis, rhabdomyolysis and asymptomatic raised CK.
(additional RF: advanced age, female sex, low BMI, DM)
Liver impairment
38
What are the two non-shockable rhythms?
| What would you do instead?
Pulseless electrical activity and asystole
Give 1mg of intravenous adrenaline + CPR
Identify and treat cause.
Further 1mg IV adrenaline every 3-5 min
39
What ECG changes would you expect in pericarditis?
```
Widespread 'saddle-shaped' ST elevation
PR depression (most specific)
```
40
In which patients would you start anti-HTN treatment if one ABPM reading 135/85 or over (but under 160/100)?
```
This is stage 1 HTN. Treat if:
Aged less than 80 with 1+ of:
- Target organ damage
- Established CVD
- Renal disease
- DM
- 10 year cardiovascular risk of 20% or more
```
41
Why should amiodarone be given into central veins?
It causes thrombophlebitis
42
What is the monitoring of patients taking amiodarone?
TFT, LFT, U&E, CXR prior to treatment
TFT, LFT every 6 months
43
What territory and coronary artery is V1-V4?
Anteroseptal
| LAD
44
What territory and coronary artery is II, III, aVF?
Inferior
| RC
45
What territory and coronary artery is V4-6, I, aVL?
Anterolateral
| LAD or Left circumflex
46
What territory and coronary artery is I, aVP, +/- V5-6?
Lateral
| Left circumflex
47
What territory and coronary artery would tall R waves in V1-2 suggest?
Posterior
| Usually left circumflex (also right coronary)
48
What are the common causative organisms in bacterial endocarditis?
Gram positives:
- Strep viridans
- Staph aureus (IVDU or prosthetic valves)
- Staph epidermis (prosthetic valves)
49
What is the empirical abx therapy in:
- Native valve endocarditis
- NVE with severe sepsis, penicillin allergy or MRSA
- NVE with severe sepsis and RF for gram negative infection
- Prosthetic valve endocarditis
- Native valve endocarditis: Amox + Gent
- NVE with severe sepsis, penicillin allergy or MRSA: Vanc + Gent
- NVE with severe sepsis and RF for gram negative infection: Vanc + meropenem
- Prosthetic valve endocarditis: Vanc, gent + rifampacin
Can alter once culture results available.
Courses are normally 4-6 weeks.
50
What are the adverse effects of loop diuretics?
- Hypotension
- Hyponatraemia
- Hypokalaemia
- Hypochloraemic alkalosis
- Ototoxicity
- Hypocalcaemia
- Renal impairment (dehydration and direct toxic effect)
- Hyperglycaemia (less common than with thiazides)
- Gout
51
What are the 2 pansystolic murmurs?
| Difference?
Mitral regurg - high-pitched and 'blowing'
| VSD - 'harsh'
52
What factors would favour rate control in AF?
Older than 65
| Hx IDH
53
What factors would favour rhythm control in AF?
```
<65
Symptomatic
First presentation
Lone AF or AF secondary to corrected precipitant (e.g. alcohol)
CHF
```
54
What would be first line for rate control in AF?
| What if they also have heart failure?
B-blocker or CCB (RATE limiting, not amlodipine)
If HF: Digoxin
55
What are the most common 3 agents used in rhythm control in AF?
Sotalol
Amiodarone
Flecainide
56
How does subclavian steal syndrome characteristically present?
Mx?
Posterior circ symptoms, such as dizziness and vertigo during exertion of an arm. (subclavian A steno-occlusive disease proximal to the origin of the vertebral artery -> flow reversal in the vertebral artery.)
Mx: percutaneous transluminal angioplasty or a stent.
57
What is the Mx of stable angina?
All should receive aspirin and a statin in the absence of CIs
- Sublingual GTN
- BB or CCB first line
- If ineffective then increase dose, then swap/add in the other one.
- If on monotherapy and cant tolerate addition of BB or CCB then add a long-acting nitrate, ivabradine, nicorandil or ranolazine.
- If on BB and CCB only add 3rd drug while awaiting assessment for PCI or CABG.
Avoid Verapamil in patients with known HF.
NB. CCB choice:
- If mono therapy then use verapamil or diltiazem
- In combo with a BB use MR nifedipine
58
What is the Mx of bradycardia?
Only treat if haemodynamic compromise (shock, syncope, MI, HF)
1: Atropine, if this fails or pt risk of aystole then
2: TransCUTANEOUS pacing
59
What factors would indicate a potential risk of asystole and therefore CI atropine in bradycardia?
What would you therefore do?
- complete heart block with broad complex QRS
- recent asystole
- Mobitz type II AV block
- ventricular pause > 3 seconds
TransVENOUS pacing
60
What are the 3 drugs used in the emergency treatment of anaphylaxis?
Adrenaline, hydrocortisone, chlorphenamine
61
What is the step-wise treatment of HF?
1: BOTH ACE-i and BB
2: Aldosterone antagonist (or angiotensin II receptor blocker or hydralazine + a nitrate)
3: Cardiac resynch, digoxin or ivabradine
Also give diuretics for fluid overload
62
What are the criteria for giving ivabradine in HF?
Must already be taking suitable therapy - i.e. a BB, CCB and aldosterone antagonist.
- HR >75
- LVEF <35%
63
What vaccines should be offered in HF?
Annual flu
| One-off pneumococcal vaccine (unless asplenia, splenic dysfunction or CKD - give booster every 5 years)
64
What BBs are licensed to treat HF?
- Bisoprolol
- Carvedilol
- Nebivolol
65
When might you give digoxin to a patient with HF?
If there is also AF.
66
What type of murmur is associated with collagen disorders, such as Marfans; and Ehlers-Danlos?
Mitral regurgitation
| Pan-systolic. Soft S1, split S2
67
What anti-anginal would you avoid in a patient with known HF?
Verapamil
68
What anti-anginal would be CI in a patient already prescribed atenolol?
Verapamil - risk of complete heart block
69
What is the step-wise treatment of HTN?
1: If under 55 or diabetic: ACE-i
If over 55 or afro-Caribbean: CCB
2: ACE-i and CCB
3: ACE-I and CCB and Thiazide-LIKE diuretic (chlortalidone or indapamide)
4: If K+ <4.5 add spironolactone
If K+ >4.5 add higher dose thiazide-like treatment
5: See specialist. Consider alpha/beta-blocker
70
What is bifascicular block?
RBBB with left anterior or posterior hemiblock (e.g. RBBB with left axis deviation)
71
What is trifascicular block?
Bifascicular block + 1st degree heart block.
72
What are the drug causes of long-QT -> Polymorphic ventricular tachycardia?
- Antiarrhythmics (e.g. amiodarone, sotalol)
- Antibiotics (e.g. erythromycin, clarithromycin, ciprofloxacin)
- Psychotropic drugs (e.g. serotonin reuptake inhibitors, tricyclic antidepressants, neuroleptic agents)
73
Would you treat stage 1 HTN in a diabetic?
| What would be the BP target?
Yes!
If end-organ damage then <130/80
Otherwise <140/80
74
What class of drugs may cause angiodema?
= swelling due to fluid build up in the deep layers of the skin. Typically in the face, also in the genital , hands or feet.
ACE-i (e.g. ramipril)
75
What are the adult doses of adrenaline, hydrocortisone and chlorphenamine in anaphylaxis?
Adrenaline:
500mcg i.e. 0.5ml of 1 in 1000
Hydrocortisone: 200mg
Chlorph'ten'amine: 10mg
Remember: rule of 20!
0.5mg, 10mg, 200mg
76
What is the mode of inheritance of hypertrophic cardiomyopathy?
What is the most common cause of sudden death?
AD
| Ventricular arrhythmias
77
What would you see on Echo in HOCM?
MR SAM ASH
- Mitral regurgitation (MR)
- Systolic anterior motion (SAM) of the anterior mitral valve leaflet
- Asymmetric hypertrophy (ASH)
78
What would you see on ECG in HOCM?
LVH (tall R waves in L leads: I, aVL and V4-6) + (deep S in R leads: III, aVR, V1-3)
Progressive T wave inversion
Deep Q waves
(+AF occasionally)
79
What is the most common cause of death following an MI?
Ventricular fibrillation
80
What is Takayasu's arteritis?
| Mx?
Large vessel vasculitis, typically causing occlusion of the aorta - questions commons refer to an absent pulse. More common in females and Asian people.
Mx: Steroids
81
What is the Mx of long-QT?
```
Avoid drugs prolonging QT
B blockers (not sotalol)
Implantable cardioverter defibrillator in high risk (previous cardiac arrest, or QTc >500ms)
```
82
```
What are the doses of adrenaline for anaphylaxis in:
<6 months
6 months - 6 years
6 - 12 years
>12 and adults
```
<6 months: 150mcg (0.15ml 1 in 1000)
6 months - 6 years: 150mcg (0.15ml 1 in 1000)
6 - 12 years: 300mcg (0.3ml 1 in 1000)
>12 and adults: 500mcg (0.5ml 1 in 1000)
83
What coronary artery would have been affected if a patient developed complete heart block following an MI?
Right coronary (branch supplies AVN)
84
What ECG changes might you see in hypothermia?
- Bradycardia
- J wave (hump at end of QRS)
- 1st degree HB
- Long QTc
- Atrial and ventricular arrhythmias
85
Where do furosemide and bumetanide act within the kidney?
Ascending loop of Henle. (inhibit the Na-K-Cl cotransporter)
86
When would you offer a statin as primary prevention in T1DM?
- Older than 40
- Have had diabetes for more than 10 years
- Established nephropathy
- Other CVD RF (HTN, obesity etc)
NB. 20mg OD atorvastatin
87
What can you test to establish if a reaction is anaphylaxis?
Serum tryptase (elevated for up to 12 hours)
88
What is a common reason ACE-i are not tolerated?
| What would you give for HTN instead in someone <55?
Dry, persistent cough.
Give angiotensin receptor blocker (ARB) e.g. candesartan.
89
What would you do if a patient had a Wells score 4+, but there was a delay in waiting for CTPA or V/Q?
Treat as if PE confirmed - LMWH
90
What would you do if a patient had a Wells score <4 but you still suspected a PE?
D-dimer. If this is positive -> immediate CTPA.
91
What is the gold standard for investigating PE? Why is this not done normally?
Pulmonary angiography
| High complication rate
92
What are the two shockable rhythms?
VF
| Pulseless VT
93
When do you give adrenaline/amiodarone in cardiac arrest?
Give adrenaline 1 mg IV and amiodarone 300 mg IV once chest compressions have restarted after the 3rd shock, then repeat adrenaline every 3-5 mins during alternate cycles of CPR
94
When would you give stacked shocks?
If the cardiac arrest is witnessed in a monitored patient, e.g in CCU. Give up to 3 quick, successive shocks rather than 1 shock followed by CPR.
95
What is Dressler's syndrome?
Features?
Mx?
An autoimmune reaction against antigenic proteins formed as myocardium recovers following an MI.
Occurs 2-6 weeks following MI.
- Fever
- Pleuritic pain
- Pericardial effusion
- Raised ESR
Mx: NSAIDs
96
How common is left ventricular free wall rupture following an MI?
Features?
3% MIs, occurs around 1-2 weeks after.
```
Acute HF - secondary to cardiac tamponade:
- Raised JVP
- Pulsus paradoxus
- Diminished heart sounds
Sudden onset.
```
97
What type of MI would commonly lead to bradycardia? Why?
Inferior (Right coronary)
| AVN supplied by branch
98
Why might you get a left ventricular aneurysm following an MI?
What would you see on ECG?
Mx?
Ischaemia weakens the myocardium -> aneurysm
Persistant ST elevation and LVF. Thrombus -> increased stroke risk.
Mx: Anticoagulation
99
How often does a VSD occur following an MI?
| What would be the clinical features?
1-2%
Usually occurs in the first week.
Acute HF, pan-systolic murmur (Echo to exclude acute MR)
100
What is the first-line treatment for HF with reduced ejection fraction?
What is normal LVEF?
BB (bisoprolol, carvedilol or nebivolol) and ACE-i (ramipril)
Normal LVEF: 45-60%
101
What would a QRisk score over 10 mean?
| Mx?
>10% risk of CVD event over the next ten years,
| Give primary prevention- i.e. statin. (Atorvastatin 20mg OD)
102
What are the classic ECG changes in Wolff-Parkinson White?
- Short PR
- Wide QRS complexes with a slurred upstroke
- Left axis deviation if right-sided accessory pathway (majority)
- Right axis deviation if left-sided accessory pathway*
103
How often can you repeat adrenaline in anaphylaxis?
Every 5 minutes
104
What ECG changes might you see in hypokalaemia?
- U waves
- Small/absent T waves
- Prolonged PR
- Long QT
- ST depression
105
What are the 4 NHYA classifications of HF?
1: None. No exercise limitations
2: Mild. Comfortable at rest, ordinary activity results in fatigue.
3: Moderate. Comfortable at rest. Less than ordinary activity results in symptoms.
4: Severe. Present at rest. Increased discomfort with any physical activity.
106
Why is BNP measured?
| What is the physiology underlying this?
To rule out a diagnosis of HF in a acutely dyspneic patient (<100), or for prognosis in patients with CHF (if they haven't had a previous MI)
pro-BNP released in response to LV strain.
BNP actions: Vasodilator, diuretic and natriuretic. Supresses symp tone and RAAS.
107
What might give a falsely low and falsely high BNP level in a patient?
Falsely low: ACE-i, ARB, BB, diuretics, obesity.
High: Myocardial ischaemia, valvular disease, diabetes, COPD, CKD (reduced excretion)
108
What would you do if a patient had a BNP level >400?
2-week wait referral for urgent Echo.
109
Give 4 common and 3 rare causes of LBBB?
- IHD
- HTN
- Aortic stenosis
- Cardiomyopathy
Rare:
- Idiopathic fibrosis
- Digoxin toxicity
- Hyperkalaemia
110
How long before surgery should you discontinue clopidogrel if necessary?
7 days.
111
What two drugs are used in cardioversion of AF?
```
Amiodarone
Flecainide (if no structural HD)
```
112
What is the Mx if someone on warfarin has an INR of 5-8 with no bleeding?
Withhold 1-2 doses of warfarin and reduce maintenance doses.
113
What is the Mx of major bleeding in someone on warfarin?
Stop warfarin
Give IV vitamin k 5mg
Prothrombin complex conc (Beriplex) or FFP if not available.
114
What is the Mx of minus bleeding with INR >8 in someone on warfarin?
Stop warfarin
Give IV vit K 1-3mg
Repeat dose vit K if INR still raised after 24 hours.
Restart warfarin when INR <5
115
What is the Mx INR>8 with NO bleeding in someone on warfarin?
Stop warfarin
Give vit K 1-5mg orally (use IV prep orally)
Repeat dose vit K if INR still raised after 24 hours.
Restart warfarin when INR <5
116
What is the Mx of minor bleeding in someone on warfarin with INR 5-8?
Stop warfarin.
IV vit K 1-3mg
Restart when INR <5
117
What treatment would you give initially in a afro-carribean diabetic?
ACE-i plus either:
- Thiazide diuretic or
- CCB
118
What would be the specific ECG ST changes for urgent thrombosis or PCI?
ST elevation of >2mm (2 small squares) in 2 or more consecutive anterior leads (V1-V6)
or
ST elevation of >1mm (1 small square) in >2 consecutive inferior leads (II, III, avF, all)
or
New LBBB
119
What drugs should all patients be given as secondary prevention following an MI?
- Dual anti platelet i.e. aspirin plus clopidogrel
- ACE-i
- BB
- Statin
120
What is the gold standard treatment of STEMI?
| What drugs should they be given?
Primary PCI
- Aspirin
- P2Y12-R antag (1: Ticagrelor, 2: Clopidogrel)
- Unfractionated heparin/LMWH
121
What is the physiological cause of an S3 and S4?
S3 = sudden tensing of the chordae tendinae - when there is increased volume in the ventricle (e.g. dilated cardiomyopathy)
S4 = atria contracting against a stiff ventricle (LVH or HOCM)
122
What baseline Ix would you do before starting amiodarone?
TFT, LFT, U&E + CXR
| Risk of pulmonary fibrosis/pneumonitis
123
The addition of which 2 drugs may precipitate statin-induced myopathy?
Erythromycin or clarithromycin
124
Outline the scoring used in CHA2DS2Vs?
```
CHD: 1
HTN/Treated :1
A2: >74: 2, 65-74: 1
Diabetes: 1
S2: Prev stroke or TIA: 2
Vascular disease (IHD or peripheral): 1
Sex: F: 1
```
125
How do you decide between giving a bioprosthetic or mechanical valve?
Prosthetic:
Older patients (deterioration and calcification)
>65 for aortic
>70 for mitral
NB. Don't normally need LT anti-coag. Aspirin LT.
Mechanical:
Low failure rate.
Need LT anticoag. (Target INR 3 for aortic, 3.5 for mitral).
Only give aspirin if additional indication.
126
Name one drug that enhances and one drug that reduces the effect of adenosine?
Enhances: Dipyridamole
Reduces: Aminophylline
127
What is the Jones criteria used for?
| How can you use this to remember the major criteria?
Diagnosing rheumatic fever. (Need evidence of recent strep infection + 2 major criteria or 1 major + 2 minor criteria)
```
J oints (migrating polyarthritis)
O bviously heart involved
N odules (subcutaneous)
E rythema marginatum
S ydenham's chorea
```
128
What is the mechanism of action of Aspirin?
Antiplatelet - inhibits the production of thromboxane A2
129
What is the mechanism of action of clopidogrel?
Antiplatelet - inhibits ADP binding to its platelet receptor
130
What is the mechanism of action of enoxaparin?
Activates antithrombin III - which potentiates inhibition of Xa
131
What is the mechanism of action of fondaparinux?
Activates antithrombin III - which potentiates inhibition of Xa
132
What is the mechanism of action of bivalirudin?
Reversible direct thrombin inhibitor
133
What is the mechanism of action of abciximab, eptifibatide and tirofiban?
Glycoprotein IIb/IIIa receptor antagonists
134
What type of murmur is mitral regurgitation?
| Where is it best heard?
Pansystolic
| Best heard at the apex in left lateral decubitus position. (APTM)
135
What type of murmur is common in IDVU?
Tricuspid regurgitation (2 to infective endocarditis)
136
What is the mechanism of action of alteplase?
Activates plasminogen to form plasmin.
137
What is the mechanism of action of dipyridamole?
Phosphodiesterase inhibitor
138
What is the most common side effect caused by ivabradine?
Transient luminous phenomenon (up to 15%)
139
What is the step-wise mx of HF?
1: ACE-i AND BB (carvediol or bisoprolol)
2: Add: Aldosterone antagonist (= spironolactone or eplerenone, esp if MI 1/12) or ARB (NOT in combo with ACE-I) or hydrazine + nitrate (esp if afro-caribbean)
3: Cardiac resynch, digoxin or ivabradine
Give diuretics for relief of congestions.
140
What is pulses alternans?
| In that patients is it seen?
When the upstroke of the pulse alternates between strong and weak.
Indicates systolic dysfunction, seen in patients with heart failure.
141
If an ACE-i is not tolerated in HTN what would you do?
Switch to ARB (-sartan)
142
What three antibiotics can cause long QT?
Erythro
Clarithro
Cipro
