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Cardiovascular Flashcards

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1
Q

What is the difference between Mobitz type 1 and 2?

A
  • Mobitz Type 1: progressive PR prolongation

- Mobitz Type 2: the PR interval is constant but some P waves are dropped

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2
Q

Name some indications for temporary pacing

A
  • Symptomatic bradycardia

- Prophylactically for severe bradycardia (2nd/3rd degree AV block, posterior MI etc.)

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3
Q

Name some indications for permanent pacing

A
  • Alternating RBBB/LBBB
  • Unexplained syncope with bifascicular/trifascicular block
  • Symptomatic sinus node disease
  • Carotid sinus hypersensitivity/ malignant vasovagal syncope
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4
Q

What is the mechanism of digoxin

A
  • Cardiac glycoside: inhibits the sodium-potassium ATPase pump
  • Improves cardiac contraction
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5
Q

Describe the presentation of digoxin toxicity

A
  • Nausea and vomiting
  • Bradycardia or tachycardia
  • VT/VF
  • Reverse tick appearance in lateral leads
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6
Q

Describe the management of digoxin toxicity

A
  • Stop digoxin

- Digibind

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7
Q

Name the indications for amiodarone

A
  • VT

- Supraventricular tachycardia

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8
Q

What is adenosine used for?

A

Conversion of paroxysmal supraventricular tachycardia

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9
Q

Which factors does warfarin inhibit?

A

II, VII, IX and X

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10
Q

What is the mechanism of action of dabigatran and apixaban?

A

Direct thrombin inhibitors

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11
Q

What is the mechanism of action of rivaroxaban and edoxaban?

A

Factor Xa inhibitors

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12
Q

What investigations might be done to diagnose heart failure?

A
  • ECHO
  • 12 lead ECG
  • BNP
  • Radionucleotide scan
  • Left ventriculogram
  • Cardiac MRI
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13
Q

Name some of the causes of heart failure

A
  • Ischaemic heart disease
  • Valvular heart disease
  • Pericardial constriction or effusion
  • Inherited
  • Cardiomyopathies
  • Hypertension
  • Infections
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14
Q

Name the management options for heart failure

A
  • Diuretics (furosemide/bumetanide)
  • ACE Inhibitors/ARBs
  • Beta blockers
  • ARBs
  • ARNIs (Entresto)
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15
Q

Which heart failure treatments improve symptoms?

A
  • Diuretics
  • Digoxin
  • ACE inhibitors/ARBs
  • Spironolactone
  • Valsartan
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16
Q

Which heart failure treatments improve survival?

A
  • ACE inhibitors/ARBs
  • Spironolactone
  • Valsartan
  • Beta blockers
  • Ivabradine
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17
Q

Name some of the common side effects of furosemide

A
  • Dehydration
  • Hypotension
  • Hypokalaemia
  • Hyponatraemia
  • Gout
  • Impaired glucose tolerance
  • Diabetes
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18
Q

Describe the stages of hypertension

A
  • Stage 1: ABPM 135/85 mmHg
  • Stage 2: ABPM 150/95mmHg
  • Severe: Systolic >180mmHg or diastolic > 110mmHg
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19
Q

What is the first line anti-hypertensive medication for someone aged over 55 years or of Afro-Caribbean descent

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A

Calcium channel blockers (if contraindicated then thiazide like diuretic)

20
Q

What is the second line treatments for hypertension?

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A

Thiazide type diuretic (indapamide etc.)

21
Q

What are the third line options for hypertension?

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A
  • CCB
  • ACEI
  • Diuretic
22
Q

What is the first line management of hypertension in someone <55 years?

23
Q

What is the fourth line management for hypertension

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A
  • Spironolactone if potassium <4.5

- Alpha blocker or beta blocker if potassium >4.5

24
Q

How can stable angina be managed?

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A
  • Address risk factors
  • Statins
  • ACE Inhibitors
  • Aspirin 75mg or Clopidogrel
  • Beta blockers
  • Calciun channel blockers
  • Ivabridine
  • GTN
  • Nicorandil (K+ channel blocker)
  • PCI or CABG
25
Name the drugs used for thrombolysis in an MI
- Tenecteplase - Alteplase - Streptokinase
26
How can an MI be managed acutely?
-Oxygen if sats <94% -GTN -Opiates -Aspirin 300mg -Clopidogrel 300mg or Ticagrelor 180m -Fondaparinux/LMWH -GIIb/IIIa receptor blockers -Prasugrel -
27
How can MIs be prevented by secondary prevention
- Aspirin 75mg - Clopidogrel 75mg or Ticagrelor 90mg - Beta blockers - Statins - ACE inhibitors
28
How does dilated cardiomyopathy present?
- Dyspnoea - Fatigue - Orthopnoea - Ankle swelling - Cough - Narrow pulse pressure - Elevated JVP - MR murmur
29
Which drugs can be used to treat dilated cardiomyopathy?
- ACEIs - Diuretics - Beta blockers - Spironolactone - Cardiac transplant
30
How does hypertrophic cardiomyopathy present?
- Fatigue - Dyspnoea - Angina - Pre-syncope and syncope - Notched pulse pattern - Thrills and murmurs
31
How can hypertrophic cardiomyopathy be managed?
- Avoid heavy exercise or dehydration - Genetics - Beta blockers or verapamil - Surgery or alcohol septal ablation
32
How can pericarditis be managed?
- NSAIDs and colchicine | - Drainage
33
How does cardiac tamponade present?
- SOB and dizziness and chest pain - Low BP - Pulsus paradoxus
34
How can constrictive pericarditis be managed?
- Limited diuretics | - Pericardectomy
35
Which organism is the most common cause of infective endocarditis?
Strep viridans (staph aureus is 2nd)
36
How does infective endocarditis present?
- Fever - New heart murmur - Splenomegaly - Petechiae - Osler nodes - Janeway lesions - Splinter haemorrhages
37
Which antibiotics should be used for infective endocarditis?
- Amoxicillin +/- gentamicin - Severe: vancomycin + gentamicin - Prosthetic valve: vancomycin + gentamicin
38
How does mitral stenosis present?
- Dyspnoea - Haemoptisis - Systemic embolisation - IE - Chest pain - Mitral facies - Diastolic thrill and RV heave - Rumbling diastolic murmur at apex
39
How does mitral regurgitation present?
- Acute: SOB, pulmonary oedema and cardiogenic shock - Chronic: dyspnoea, exhaustion and RHF - High pitched blowing holosystolic murmur
40
How does aortic stenosis present?
- Chest pain - Syncope - Breathlessness on exertion - Heart failure - Harsh cresendo-decrescendo systolic murmur
41
How does aortic regurgitation present?
- Exertional breathlessness - Collapsing pulse - Wide pulse pressure - Soft high pitched early diastolic murmur
42
How does acute limb ischaemia present?
- Pale - Pulseless - Painful - Paralysed - Paraesthetic - Perishingly cold
43
How can acute limb ischaemia be managed?
- Urgent reconstruction for trauma - Fasciotomy for compartment syndrome - Embolectomy - Anticoagulation - Thrombolysis - Amputation
44
How can chronic limb ischaemia be managed?
- Antiplatelets - Statin - BP control - Smoking cessation - Exercise - Diabetic control - Angioplasty, stent, surgical bypass and endovascular reconstruction - Amputation`
45
How can varicose veins be managed?
- Prevention - Referral for bleeding varicose veins or venous ulcers - Endothermal ablation, ultrasound guided foam sclerotherapy and striping of the vein
46
How can venous ulcers be managed?
- Graduated compression - Debridement and cleaning - Dressing - Antibiotics only if infected - Pentoxifylline if chronic - Topical steroid for surrounding venous dermatitis

Finals (18 decks)

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