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Cardiology Flashcards

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1
Q

At what BP value does hypertension become symptomatic?

A

> 200/120mmHg

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2
Q

What is stage 1 hypertension?

A
  • clinial BP >=140/90

- ABPM/HPBM >=135/85

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3
Q

What is stage 2 hypertension?

A
  • clinial BP >=160/100

- ABPM/HPBM >=150/95

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4
Q

What is severe hypertension?

A

systolic >=180

diastolic >=120

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5
Q

Drug causes of HTN

A
  • leflunomide
  • MAOI
  • corticosteroids
  • NSAIDs
  • pregnancy
  • coarctation of aorta
  • COCP
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6
Q

What do you do if someone has a BP >=180/120mmHg?

A
  • specialist assessment if retinal haemorrhage or papilloedema, life threatening symptoms or suspected phaeochromocytoma
  • urgent investigation for end organ damage
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7
Q

How would you treat someone with a BP of >=140/90?

A
  • repeat reading
  • offer ABPM/HBPM
  • if >=135/85, treat if >80yo and one of factors
  • factors: target organ damage, CVD, renal disease, diabetes, CV risk >=10%
  • if>=150/95, treat regardless of age
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8
Q

What are the blood pressure targets?

A
  • <80yo: 140/90mmHg clinical, 135/85mmHg

- >80yo: 150/90mmHg clinical, 145/85mmHg

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9
Q

ACEi ADR

A
  • hyperkalaemia
  • cough
  • angioedema
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10
Q

Calcium channel blockers ADR

A
  • flushing
  • ankle swelling
  • headache
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11
Q

Thiazide type diuretics ADR

A
  • hyponatraemia
  • hypokalaemia
  • dehydration
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12
Q

A2RB ADR

A

hyperkalaemia

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13
Q

Causes of ejection systolic murmur:

A
  • aortic stenosis
  • aortic sclerosis
  • pulmonary stenosis
  • tetralogy of fallot
  • HOCM
  • atrial septal defect
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14
Q

Causes of pan systolic murmur:

A
  • mitral/tricuspid regurgitation

- ventricular septal defect

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15
Q

Causes of late systolic murmur:

A
  • mitral valve prolapse

- coarctation aorta

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16
Q

Causes of early diastolic murmur:

A
  • aortic regurgitation

- graham steel murmur (pulmonary regurgitation)

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17
Q

Causes of mid-late diastolic murmur:

A
  • mitral stenosis

- Austin-Flint (severe aortic regurgitation)

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18
Q

Clinical signs of aortic stenosis:

A
  • murmur radiates to carotids, decreases with valsalva
  • narrow rising pulse
  • narrow pulse pressure
  • delayed ESM
  • soft/absent S2
  • S4
  • thrill
  • left ventricular hypertrophy (makes murmur quieter)
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19
Q

Clinical signs of aortic regurgitation:

A
  • murmur intensity increased with handgrip manoeuvre
  • collapsing pulse
  • wide pulse pressure
  • Quincke’s sign
  • DeMusset’s sign
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20
Q

Clinical signs of mitral stenosis:

A
  • mid-late diastolic murmur (best hear in expiration)
  • loud S1 opening snap
  • low volume pulse
  • malar flush
  • atrial fibrillation
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21
Q

Most common cause of mitral stenosis?

A

rheumatic fever

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22
Q

Most common cause of aortic stenosis?

A

> 65yo - calcification

<65yo - bicuspid aortic valve

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23
Q

Clinical signs of mitral regurgitation:

A
  • murmur at apex and radiating to axilla
  • S1 may be quiet incomplete closure
  • severe may cause widely split S2/3
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24
Q

Clinical signs of patent ductus arteriosus:

A
  • left subclavicular thrill
  • continuous machinery murmur
  • large volume
  • bounding
  • collapsing pulse
  • wide pulse pressures
  • heaving apex beat
  • reverse split S2
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25
How do you treat patent ductus arteriosus?
indomethacin or ibuprofen
26
What is tetralogy of fallot?
- ventricular septal defect - right ventricular hypertrophy - right ventricular outflow obstruction, pulmonary stenosis - overriding aorta
27
Clinical signs of tetralogy of fallot:
- cyanosis - right to left shunt - ejection systolic murmur due to pulmonary stenosis - right sided aortic arch - boot shaped heart
28
What bacteria most commonly causes rheumatic fever?
strep pyogenes
29
What type of reaction is rheumatic fever?
type II hypersensitivity
30
What are the major criteria of rheumatic fever?
- erythema marginatum - sydenham's chorea - polyarthritis - carditis and valvulitis - subcutaneous nodules
31
What are the minor criteria of rheumatic fever?
- increased ESR or CRP - pyrexia - arthralgia - prolonged PR interval
32
Factors favouring rate control in AF
- over 65yo | - Hx of ischaemic heart disease
33
Factors favouring rhythm control in AF
- younger than 65yo - symptomatic - first presentation - lone AF or secondary to corrected precipitant (e.g. alcohol) - congestive heart failure
34
Explain the ALS procedure for someone in VT/VF arrest:
- 3 shocks with each shock followed by 2 min CPR | - adrenaline 1mg after 3 shocks, then every 3-5 minutes
35
What is the ALS procedure when a cardiac arrest is witnessed in a monitored patient?
up to 3 quick successive shocks without CPR in between
36
Explain the ALS procedure in systole or pulseless EA:
- adrenaline 1mg ASAP | - 2 min CPR before reassessment
37
What are the ECG signs of digoxin toxicity?
- ST depression - reverse tick - flattened/inverted T waves - short QT - arrhythmias e.g. AV block, bradycardia
38
What are the ECG signs of hypokalaemia?
- U waves - small/absent T waves - long PR - ST depression - long QT
39
What are the ECG signs of hyperkalaemia?
- peaked/tall tented T waves - loss of P waves - broad QRS - sinusodial wave pattern - VF
40
What are the ECG signs of hypothermia?
- bradycardia - J waves - 1st degree HB - long QT - ventricular and atrial arrhythmias
41
What are the coronary territories?
anteroseptal: V1-V4 (LAD) inferior: II, III, aVF (right coronary) anterolateral: V4-V6, I, aVL (LAD or left circumflex) lateral: I, aVL, V5-V6 (left circumflex) posterior: tall R waves V1-V2 (usually left circumflex or right coronary)
42
ECG signs of myocardial ischaemia:
``` acute: -hyperacute T waves for few minutes -STE -T waves inverted within 24hrs -pathological W waves posterior MI: ST depression ```
43
Management of acute heart failure:
- O2 - IV loop diuretics - opiates - vasodilators - inotropic agents - CPAP - ultrafiltration - mechanical circulatory assistance e.g. intra-aortic balloon counter pulsation or ventricular assist devices - discontinue beta blockers short term
44
CXR signs of heart failure
``` Alveolar oedema kerley B line Cardiomegaly Dilated prominent upper lobe vessels Effusion ```
45
Potassium sparing diuretics (types, MOA, indications)
- epithelial sodium channel blockers (amiloride and triamterene) - amiloride works in distal convoluted tubule - aldosterone antagonists (spironolactone and eplerenone) - work in cortical collection duct - used for HF, ascites (cirrhosis causing secondary hyperaldosteronism), nephrotic syndrome, Conn's syndrome
46
Loop diuretics (examples, ADR)
- furosemide, bumetanide - hypokalaemia, hypotension, hyponatraemia, hypomagnesaemia, hypocalcaemia - hypochloraemic alkalosis - gout - ototoxicity - real impairment - hyperglycaemia
47
Thiazide diuretics (ADR)
- postural hypotension - dehydration - hyponatraemia, hypokalaemia, hypercalcaemia - gout - impaired glucose tolerance - impotence - rare: agranulocytosis, thrombocytopenia, pancreatitis, photosensitivity rash
48
Nitrates (ADR)
- hypotension - tachycardia - headache - flushing
49
How can you avoid nitrate tolerance?
- second dose isosorbide mononitrate after 8 hours | - or use modified release isosorbide mononitrate
50
Use of nicotinic acid and ADR
- treatment for hyperlipidaemia - reduced cholesterol and triglycerides and increases HDL - ADR: flushing (prostaglandins), impaired glucose tolerance, myositis
51
Use of nicorandil and ADR
- vasodilatory drug for angina - ADR: flushing, headache, anal ulceration - CONTRA: left ventricular failure
52
Use of ivabradine and ADR
- anti-anginal - works on If funny current to decrease pacemaker activity in SAN - ADR: headache, bradycardia, heart block, visual effects (luminous phenomena)
53
Dabigatran (MOA, indications, ADR)
- direct thrombin inhibitor - for venous thromboembolism prophylaxis after hip or knee replacement - non-valvular AF with one of (see notes) - ADR: haemorrhage (reverse with idracizumab), reduce dose if CKD and not if creatinine clearance <30ml/min
54
What is bivalirudin?
- direct thrombin inhibitor | - anticoag in ACS
55
Beta blockers (ADR, CONTRA)
- ADR: bronchospasm, cold disease, fatigue, sleep disturbances, erectile dysfunction - CONTRA: asthma, uncontrolled HF, sick sinus syndrome, concurrent verapamil use
56
Amiodarone (MOA, monitoring, ADR)
- class III anti-arrhythmic administered in central vein (risk of thrombophlebitis) - check LFTs, TFTs, U&Es and CXR before Tx - check TFT and LFTs every 6 months - ADR: thyroid dysfunction, pulmonary fibrosis/pneumonitis, liver fibrosis/hepatitis, slate grey appearance, corneal deposits, peripheral neuropathy, photosensitivity, thrombophlebitis and injection site reactions, bradycardia, lengthens QT interval
57
Adenosine (MOA, ADR)
- to terminate SVT - enhanced by dipyridamole and blocked by theophylline - avoid in asthmatics (bronchospasm) - agonist of A1 receptor in AV node - half life: 8-10 seconds (use large calibre cannula) - ADR: chest pain, bronchospasm, transient flushing, enhances conduction down accessory pathways
58
Caution and CONTRA of ACEi
- avoid in pregnancy and breastfeeding - renovascular disease - aortic stenosis - hypotension - hereditary idiopathic angioedema - specialist advice if K+ >=5mmol/L
59
Statins ADR and CONTRA
- myopathy: myalgia, myositis, rhabdomyolysis and asymptomatic rise in creatinine kinase (more common lipophilic statins) - liver impairment: check LFTs at baseline, 3mo and 12mo, discontinue if AST conc 3x reference range - CONTRA: macrolides, pregnancy
60
Examples of glycoproteins IIb/IIIa receptor antagonists
- abciximab - eptifibatide - tirofiban
61
Warfarin in emergency surgery:
If surgery can wait for 6-8 hours - give 5 mg vitamin K IV | If surgery can't wait - 25-50 units/kg four-factor prothrombin complex
62
Investigation for cardiac tamponade:
echocardiogram
63
What is PERC criteria used for?
ruling out PE for patients with low (<15%) pre-test possibility

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