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gphc chapter revision > cardiovascular > Flashcards

cardiovascular Flashcards

(62 cards)

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1
Q

What is the most common type of arrhythmia?

A

Atrial fibrillation (AF) is the most common type of arrhythmia.

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2
Q

How does atrial fibrillation increase stroke risk?

A

AF causes incomplete blood ejection, increasing the risk of clot formation and stroke.

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3
Q

What is the management of life-threatening AF with haemodynamic instability?

A

Immediate electrical cardioversion without delay for anticoagulation.

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4
Q

What is the management of AF with onset <48 hours and no haemodynamic instability?

A

Consider rhythm or rate control.

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5
Q

What is the management of AF with onset >48 hours and no haemodynamic instability?

A

Rate control is preferred.

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6
Q

What drugs are used for pharmacological cardioversion in AF?

A

Flecainide or amiodarone.

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7
Q

What is used in maintenance therapy for rate control in AF?

A

Beta blocker (not sotalol), diltiazem, verapamil, or digoxin for sedentary patients.

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8
Q

When should digoxin be used for AF?

A

For sedentary patients with non-paroxysmal AF.

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9
Q

What is the requirement for cardioversion if AF has lasted more than 48 hours?

A

Patient must be anticoagulated for at least 3 weeks before and 4 weeks after cardioversion.

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10
Q

Which drugs are used to maintain sinus rhythm post-cardioversion in AF?

A

Sotalol, propafenone, amiodarone, or flecainide.

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11
Q

How should paroxysmal AF be treated?

A

Beta blockers; if symptomatic, consider ‘pill-in-pocket’ with flecainide or propafenone PRN.

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12
Q

What is a typical treatment for atrial flutter?

A

Rate or rhythm control, often using beta blockers or CCBs.

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13
Q

What is a definitive treatment for recurrent atrial flutter?

A

Catheter ablation.

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14
Q

How is paroxysmal supraventricular tachycardia managed?

A

Vagal maneuvers, IV adenosine, or IV verapamil; use catheter ablation for recurrent cases.

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15
Q

How is unstable ventricular tachycardia managed?

A

Direct current cardioversion followed by IV amiodarone.

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16
Q

What drugs can cause Torsade de Pointes due to QT prolongation?

A

Amiodarone, sotalol, macrolides, SSRIs, TCAs, antifungals.

French for “twisting of the points” fast heart rhythm in lower chambers

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17
Q

What is the treatment for Torsade de Pointes?

A

IV magnesium sulfate, beta-blocker (not sotalol), AV pacing.

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18
Q

What is the amiodarone loading regimen?

A

200mg TDS for 1 week, 200mg BD for 1 week, then 200mg OD for maintenance.

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19
Q

What are key adverse effects of amiodarone?

A

Thyroid disorders, pulmonary toxicity, hepatotoxicity, corneal microdeposits, photosensitivity.

Please Check Patients Tired Livers

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20
Q

What monitoring is required for amiodarone?

A

Thyroid function, LFTs every 6 months, serum potassium before treatment, CXR baseline, annual eye exam.

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21
Q

What are digoxin toxicity symptoms?

A

Bradycardia, nausea, vomiting, yellow vision, confusion, AV block.

SICK and SLOW

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22
Q

What is the therapeutic range of digoxin?

A

0.7–2.0 ng/mL; toxicity increases above 1.5–3.0 ng/mL.

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23
Q

Which drugs interact with digoxin?

A

Beta blockers, TCAs, drugs causing hypokalaemia, CYP450 inducers/inhibitors.

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24
Q

What is first-line treatment for heart failure?

A

ACE inhibitor and beta blocker.

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25
What is second-line for persistent heart failure symptoms?
Add aldosterone antagonist like spironolactone or eplerenone.
26
Which diuretics relieve breathlessness in HF?
Loop diuretics such as furosemide.
27
Which drugs reduce hospitalisation in worsening HF?
Ivabradine, sacubitril/valsartan, dapagliflozin, digoxin.
28
What combination of drugs is used in ACS?
Dual antiplatelet therapy (aspirin + clopidogrel/prasugrel/ticagrelor), ACE inhibitor, beta blocker, statin.
29
What is the strongest statin for secondary prevention?
Atorvastatin 80mg OD.
30
What statin monitoring is required?
Baseline lipids, LFTs at baseline, 3 and 12 months, CK if muscle pain.
31
Which food/drugs interact with statins?
Macrolides, grapefruit juice, fusidic acid, CYP450 modulators.
32
What are ACE inhibitor side effects?
Cough, hyperkalaemia, angioedema, renal impairment, dizziness.
33
Which drugs increase hyperkalaemia with ACE inhibitors?
ARBs, NSAIDs, potassium-sparing diuretics, heparins.
34
What side effect makes ARBs preferred over ACE inhibitors?
No cough or angioedema with ARBs.
35
Which side effects are associated with beta blockers?
Bradycardia, blunted hypoglycaemia response, bronchospasm, fatigue.
36
Which drugs interact with beta blockers?
Digoxin, other antihypertensives.
37
What are side effects of rate-limiting CCBs? (Verapamil and diltiazem)
Flushing, headache, ankle oedema, AV block, gingival hyperplasia.
38
How is hypertension managed in pregnancy?
Labetalol first-line, then nifedipine or methyldopa.
39
How is stable angina managed acutely?
GTN sublingual up to 2 doses, 5 minutes apart, then call emergency services.
40
Which drugs prevent stable angina?
Beta blockers or CCBs first-line, followed by long-acting nitrates, nicorandil, ivabradine, or ranolazine.
41
How should GTN tablets be stored?
Discard 8 weeks after opening.
42
What are GTN side effects?
Headache, flushing, dizziness, hypotension, especially in elderly.
43
What is the initial management for suspected STEMI?
300mg aspirin, GTN, morphine, and PCI within 2 hours.
44
What is used for secondary prevention after MI?
Aspirin + prasugrel/clopidogrel/ticagrelor, ACEi, BB, statin.
45
what medication should not be used to manage htn following a stroke?
Beta-blockers such as bisoprolol should not be used to manage hypertension following a stroke, unless it is already being used for an existing condition.
46
which beta blockers are prefered in patients experiencing nightmares
Beta-blockers may cause nightmares due to crossing the blood-brain barrier. Water soluble beta-blockers are less likely to cross the blood brain barrier and cause nightmares. Water soluble beta-blockers include Celiprolol Atenolol Nadolol Sotalol (Water CANS)
47
what is dose of tranexamic acid for menorrhagia
Tranexamic acid should be taken at a dose of 1g three times a day for up to four days. The maximum daily dose can be increased to 4 grams daily, but still only for up to 4 days
48
how soon should alteplase be given after onsent of stroke?
Alteplase should be administered as soon as possible, but within 4.5 hours. Intracranial haemorrhage should be ruled out with imaging before administering it.
49
what colour urine can be caused by triamterene
Triamterene may cause urine to turn a fluorescent blue colour under certain lights but this is harmless.
50
two types of hypertension in pregnancy?
before pregnancy or in first 20 weeks = chronic hypertension new onset after 20 weeks = gestational hypertension or it can occur after 20 weeks gestation with features of multi organ involvement = pre-ecamplsia
51
when is referal needed in pregant ladies with hypertension
all pregnant hypertension. If first episode of HTN (>140/90) refer to secondary care to be seen within 24 hours. if >160/110 urgent same day referal
52
symptoms of pre-eclampsia
Advise all pregnant women to seek immediate medical review if they experience symptoms of pre-eclampsia (including during the first 4 weeks postpartum), such as: Severe headache. Problems with vision, such as blurring or flashing before the eyes. Severe pain just below the ribs. Vomiting. Sudden swelling of the face, hands, or feet. | BP higher than 140/90
53
what should be done at each antenatal visit for pregnant ladies | relating to BP
For all pregnant women, dipstick the urine for protein and measure blood pressure at each antenatal visit. If dipstick screening is positive [1+ or more], use albumin:creatinine ratio or protein:creatinine ratio to quantify proteinuria in pregnant women.
54
risk factors of pre-examplsia
CKD, DM, autoimmune disease, chronic HTN, or HTN during prev pregnancy
55
if severe pre-eclampsia and birth is planned within 24 hours what should you give?
IV magnesium Sulphate
56
what are the recommendations for females at risk of pre eclampsia
unlicenced = take aspirin from week 12 until baby is born (75-150mg)
57
moderate risk factors for developing pre-eclampsia
high risk of pre-eclampsia if they have: One of the following high-risk factors: A history of hypertensive disease during a previous pregnancy. Chronic kidney disease. Autoimmune disease, such as systemic lupus erythematosus or antiphospholipid syndrome. Type 1 or type 2 diabetes. Chronic hypertension. **Two or more of the following moderate risk** factors: First pregnancy. Aged 40 years or older. Pregnancy interval of more than 10 years. Body mass index (BMI) of 35 kg/m2 or greater at the first visit. Family history of pre-eclampsia. Multiple pregnancy.
58
if a female has HTN and gets pregnant what drugs should you stop?
ACE, ARB, Thiazide like diuretics due to increased risk of congenital abnormalities - 1st line is labetolol, if unsuitable offer nifedipine (unlicenced) and if unsuitable offer methyldopa (unlicenced)
59
what should you give in severe pre-eclampsia if early birth is considered likely in 7 days
antenatal corticosteroids for fetal lung maturation
60
what is 1st line in women who have HTN and want to breastfeed
enalapril maleate for post-natal period - monitor renal function and serum potassium
61
what is the antidote for LMWH and heparin
Protamine would be the antidote for unfractionated and low molecular weight heparin
62

gphc chapter revision (8 decks)

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