Cardiology Flashcards
(90 cards)
1
Q
Give 2 things atherosclerotic plaques cause
A
Hypertension
Angina
ACS (MI/stroke)
2
Q
Give 2 modifiable risk factors for CVD
A
Smoking Exercise Diet Alcohol Sleep Stress Obesity
3
Q
Give 2 non-modifiable risk factors for CVD
A
Age
FH
Male
4
Q
What is primary prevention?
A
Interventions before any CVD
5
Q
What is secondary prevention?
A
Interventions when patients have CVD
6
Q
What score do you use in the primary prevention of CVD?
A
QRISK3
7
Q
What does the QRISK3 calculate?
A
Percentage risk of patient having a stroke/MI in the next 10 years
8
Q
What do you do if the QRISK3 is >10%?
A
Statin (atorvastatin 20mg)
9
Q
What is the secondary prevention of CVD?
A
4As Aspirin (+clopidogrel) Atorvastatin 80mg Atenolol (/other BB) ACEi
10
Q
What is the gold standard investigation for angina?
A
CT coronary angiography
11
Q
Immediate symptomatic relief in angina
A
GTN spray
12
Q
Long term symptomatic relief in angina
A
BB or CCB
13
Q
Secondary prevention of angina
A
Aspirin
Atorvastatin
ACEi
BB
14
Q
Surgical management of angina
A
PCI or CABG
15
Q
Give 2 parts of the heart the RCA supplies
A
RA
RV
Inferior LV
Posterior septum
16
Q
Give 2 parts of the heart the circumflex artery supplies
A
LA
Posterior LV
17
Q
Give 2 parts of the heart the LAD supplies
A
Anterior LV
Anterior septum
18
Q
ECG in STEMI
A
ST elevation
New LBBB
19
Q
ECG in NSTEMI
A
ST depression
T wave inversion
Pathological Q waves
20
Q
ECG in unstable angina
A
No pathological changes
21
Q
Symptoms of ACS (MI/unstable angina)
A
Central constricting chest pain N&V Sweating Feeling of impending doom SOB Palpitations Pain radiating to jaw/arms
22
Q
LCA ECG leads
A
I, aVL, V3-6
23
Q
LAD ECG leads
A
V1-4
24
Q
Circumflex ECG leads
A
I, aVL, V5-6
25
RCA ECG leads
II, III, aVF
26
What does a rise in troponin mean?
Myocardial ischaemia
27
What are troponins?
Proteins found in cardiac muscle
28
What is the downside of using troponins?
They are non-specific
29
Give 2 non-ACS causes for raised troponins
```
CRF
Sepsis
Myocarditis
Aortic dissection
PE
```
30
What is the treatment for an acute STEMI?
PCI <2 hours
| Thrombolysis (alteplase) <6 hours
31
What is the treatment for an acute NSTEMI?
```
BATMAN
BB
Aspirin 300mg
Ticagrelor 180mg (/clopidogrel 300mg)
Morphine
Anticoagulant (LMWH)
Nitrates
```
32
What score gives a 6 month risk of death or repeat MI after having an NSTEMI?
GRACE score
33
What is Dressler's syndrome?
2-3 weeks after MI there is a localised immune response and pericarditis happens
Pleuritic chest pain, low grade fever, pericardial rub
ECG, echo, inflammatory markers
NSAIDs +/- steroids
34
Secondary prevention of ACS
```
6As
Aspirin 75mg
Antiplatelet (clopidogrel)
Atorvastatin 80mg
ACEi
Atenolol
Aldosterone antagonist (clinical heart failure)
```
35
What does LVF cause?
Pulmonary oedema
36
Give 2 triggers for acute LVF
Iatrogenic (IV fluids)
Sepsis
MI
Arrhythmias
37
Symptoms of acute LVF
SOB, worse on lying flat
Unwell
Cough (frothy white/pink sputum)
38
What type of respiratory failure does acute LVF cause?
Type 1
| Low O2, normal CO2
39
Signs of acute LVF
```
Increased RR
Reduced O2
Tachycardia
3rd heart sound
Bilateral basal crackles on auscultation
Hypotension
Raised JVP or peripheral oedema if also RVF
```
40
What blood test do you do for suspected Lacute VF?
BNP
41
What is BNP?
B-type natriuretic peptide
Hormone that is released from the ventricles when the myocardium is overstretched
Its action is to relax the smooth muscle in blood vessels
42
What is the downside of using BNP?
Non-specific
43
Give 2 non-HF causes of raised BNP
```
Tachycardia
Sepsis
PE
Renal impairment
COPD
```
44
What does an echo look for in acute LVF?
Ejection fraction
45
What is a normal ejection fraction?
>50%
46
Give 2 CXR findings in acute LVF
Cardiomegaly
Upper lobe venous diversion
Possible pleural effusions, Kerley lines
47
What is the management for acute LVF?
Sit upright
Oxygen
Diuretics (IV furosemide 40mg)
Monitor fluid balance
48
What are the 2 types of chronic heart failure?
Impaired LV contraction (systolic)
| Impaired LV relaxation (diastolic)
49
Give 3 symptoms of chronic heart failure
```
SOBOE
Cough (frothy pink/white sputum)
Orthopnoea
PND
Peripheral oedema
```
50
Give 2 investigations for chronic heart failure
Presentation
NT-proBNP
Echo
ECG
51
Give 2 causes of chronic heart failure
IHD
Valvular disease
HTN
Arrhythmias
52
What is the medical management of chronic heart failure?
ACEi
BB
+/- aldosterone antagonist
Loop diuretics
53
What is cor pulmonale?
RHF caused by respiratory disease (pulmonary hypertension)
54
Give 2 causes of cor pulmonale
```
COPD
PE
ILD
CF
Primary pulmonary HTN
```
55
Give 2 signs of cor pulmonale
```
Hypoxia
Cyanosis
Raised JVP
Peripheral oedema
3rd HS
Murmurs
Hepatomegaly
SOBOE
```
56
What is the management of cor pulmonale?
Treat symptoms and cause
57
Give 2 causes of HTN
Renal disease
Obesity
Pregnancy induced/pre-eclampsia
Endocrine
58
Give 2 complications of HTN
```
IHD
CVA
Retinopathy
Nephropathy
HF
```
59
What BP diagnoses HTN?
>140/90 in clinic or >135/85 at home
60
What are the BP readings for stage 2 and stage 3 HTN?
2: >160/100 clinic >150/95 home
3: >180/120 clinic
61
What are the 5 main medications for HTN?
```
ACEi
BB
CCB
Thiazide like diuretic
ARB
```
62
Talk through the steps of HTN management
1: If <55 and non-black use A, if >55 or black use C
2: A + C or A + D or C + D (ARB > A if black)
3: A + C + D
4: A + C + D + additional
63
Give 2 additional medications for uncontrolled HTN
Potassium sparing diuretic
Alpha blocker
Beta blocker
64
Give an example of an ACE inhibitor
Ramipril
65
Give an example of a beta blocker
Bisoprolol
66
Give an example of a CCB
Amlodipine
67
Give an example of a thiazide like diuretic
Indapamide
68
Give an example of an ARB
Candesartan
69
Give an example of a potassium sparing diuretic
Spironolactone
70
Give an example of an alpha blocker
Doxazosin
71
What can spironolactone increase the risk of?
Hyperkalaemia
72
Give 2 symptoms of AF
Palpitations
SOB
Syncope
73
Give 2 features of AF on ECG
Absent P waves
Narrow QRS
Tachycardia
Irregularly irregular
74
Give 2 causes of AF
```
Sepsis
Mitral valve pathology
Ischaemic heart disease
Thyrotoxicosis
HTN
```
75
What is the first line treatment for AF?
Rate control with a beta blocker
76
Describe pharmacological cardioversion
Anticoagulate for >3 weeks prior
| Flecanide/amiodarone
77
Describe electrical cardioverson
Anticoagulate for >3 weeks prior
| Cardiac defibrillator
78
Give 2 medications used in long term rhythm control in AF
BB
Dronedarone
Amiodarone
79
What is paroxysmal AF and what is the management?
Infrequent episodes of AF
| Flecanide
80
Why anticoagulant in AF?
Risk of stroke due to stagnating blood in atrium
81
How does warfarin work?
Vitamin K antagonist
| Prolongs PT
82
How do we measure warfarin?
INR (PT of patient compared to normal adult, 1=normal)
83
What INR do we aim for in AF?
2-3
84
What can impact warfarin?
Cytochrome P450
| Vitamin K foods
85
Give an example of a DOAC
Apixaban
| Rivaroxaban
86
What is a disadvantage of a DOAC?
Cannot be reversed
87
What is an advantage of a DOAC?
Shorter half life
| No monitoring
88
What tool is used for assessing whether a patient with AF needs anticoagulation?
CHA2DS2-VASc (score of >1=give anticoagulation)
89
Describe CHA2DS2-VASc
```
Congestive HF
HTN
Age >75
Diabetes
Stroke/TIA
Vascular disease
Age >65
Sex (F)
```
90
What tool is used for assessing a patient's risk of major bleeding whilst on anticoagulation?
HAS-BLED
