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MSRA > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

In which cases can a precordial thump be delivered?

A

Witnessed, monitored, unstable VT including pulseless VT if a defibrillator is not available for use

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2
Q

Which drugs are recommended post MI to improve mortality?

A

Dual antiplatelet therapy
Statins
ACE inhibitors
Beta blockers

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3
Q

Which antiplatelet can be given for ACS with ST elevation?

A

Aspirin plus clopidogrel for 1m or ticagrelor for 12m

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4
Q

Which antiplatelet can be given following PCI?

A

Aspirin plus one of the following for 12m:
Clopidogrel
Prasugrel
Ticagrelor

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5
Q

Which drugs are considered safe to use in pregnancy or during lactation to lower cholesterol?

A

Bile acid sequesterants or resins - e.g. colesevelam

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6
Q

What type of anticoagulation may be suitable for those at risk of HIT?

A

Fondaparinux

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7
Q

What is the definition of malignant hypertension?

A

A severe increase in BP to 180/120 with signs of retinal haemorrhage and papilloedema

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8
Q

What is Cheyne-Stokes breathing?

A

Breathing becomes progressively deeper and shallower in cycles, usually a result of brainstem lesions or raised ICP

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9
Q

What is an Ewart sign?

A

An area of dullness and bronchial breath sounds below the level of the left scapula, associated with a large pericardial effusion

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10
Q

What is the “Brugada sign”?

A

Coved ST segment elevation >2mm in >1 of V1 to V3 followed by a negative T wave

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11
Q

What is stage 1 hypertension?

A

ABPM of 135/85 to 149/94

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12
Q

What is the prevalence of 1st degree heart block?

A

7%

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13
Q

How many hours after MI is troponin maximally accurate?

A

12 hours

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14
Q

What is the treatment for medically managed ACS?

A

Aspirin and ticagrelor for 3 months

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15
Q

When is a pericardial friction rub best heard?

A

During expiration, when the patient is supine and leaning forward
Heard best at left lower sternal border

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16
Q

Name some clinical features associated with an aortic arch dissection?

A

Anterior chest pain
Can radiate into neck and jaw

17
Q

In which conditions is rate control not advised for AF?

A

New onset
AF causing heart failure
Atrial flutter suitable for ablation
Reversible causes

18
Q

Which drugs are first line for controlling stable angina?

A

Beta blocker
Calcium channel blocker

19
Q

Name some contraindications for DOACs

A

Weight >120kg
Cr clearance <30ml/min
Significant liver dysfunction

20
Q

What is the management plan for TIAs?

A

Give aspirin 300 mg immediately, unless
1. the patient has a bleeding disorder or is taking an anticoagulant (needs immediate admission for imaging to exclude a haemorrhage)
2. the patient is already taking low-dose aspirin regularly: continue the current dose of aspirin until reviewed by a specialist
3. Aspirin is contraindicated: discuss management urgently with the specialist team

If the patient has had more than 1 TIA (‘crescendo TIA’) or has a suspected cardioembolic source or severe carotid stenosis:
Discuss the need for admission or observation urgently with a stroke specialist
If the patient has had a suspected TIA in the last 7 days:
arrange urgent assessment (within 24 hours) by a specialist stroke physician
If the patient has had a suspected TIA which occurred more than a week previously:
refer for specialist assessment as soon as possible within 7 days

21
Q

What are the features of essential tremor?

A

Postural tremor: worse if arms outstretched
Improved by alcohol and rest
Most common cause of titubation (head tremor)

22
Q

What is the management for essential tremor?

A

Propranolol is first-line
Primidone is sometimes used

23
Q

What may cause an elevated BNP?

A

Left ventricular hypertrophy
Ischaemia
Tachycardia
Right ventricular overload
Hypoxaemia (including pulmonary embolism)
GFR < 60 ml/min
Sepsis
COPD
Diabetes
Age > 70
Liver cirrhosis

24
Q

What may cause a low BNP?

A

Obesity
Diuretics
ACE inhibitors
Beta-blockers
Angiotensin 2 receptor blockers
Aldosterone antagonists

25
Q

What is the antiplatelet regimen following stroke?

A

Aspirin 300 mg daily for 2 weeks should be given immediately after an ischaemic stroke is confirmed by brain imaging. Following this, clopidogrel 75 mg daily should be given long-term -if it can be tolerated and is not contraindicated.

If clopidogrel is contraindicated or not tolerated, then the patient should be given modified-release dipyridamole alongside low dose aspirin.

26
Q

What is the potassium cutoff for introducing spiro?

A

4.5 mmol/l

27
Q

In whom is cardiac resynchronisation therapy effective?

A

Cardiac resynchronisation therapy is indicated in patients with left ventricular dysfunction, ejection fracture <35% and QRS duration >120ms.

28
Q

What is the MOA of nicorandil?

A

Activates guanylyl cylcase which results in increased cGMP

Potassium channel activator

29
Q

Name some SEs of nicorandil

A

headache
flushing
skin, mucosal and eye ulceration
gastrointestinal ulcers including anal ulceration

30
Q

What is the MOA of bupropion?

A

A norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist

31
Q

What are some contraindications to bupropion px?

A

Small risk of seizures (1 in 1,000)
contraindicated in epilepsy, pregnancy and breast feeding. Having an eating disorder is a relative contraindication

32
Q

Name some ECG features of a posterior MI

A

Changes in V1-3

Reciprocal changes of STEMI are typically seen:
horizontal ST depression
tall, broad R waves
upright T waves
dominant R wave in V2

33
Q

What is the 1st line investigation for stable angina?

A

CT coronary angiogram

34
Q

Which score is now used to assess bleeding risk?

A

ORBIT

35
Q

Which drugs should be avoided in HOCM?

A

Inotropes
ACE-i
Nitrates

36
Q

What is the antiplatelet choice in medical NSTEMI management?

A

aspirin, plus either:
ticagrelor, if not high bleeding risk
clopidogrel, if high bleeding risk

MSRA (13 decks)

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