Cards cards!

Question 1

Chronic stable angina

Strongest predictor of survival?

Answer 1

LVEF

Question 2

Do you go straight to angio now days?

Answer 2

Not really, try and medically manage first, unless high risk features or symptoms not adequately controlled

Question 3

What type of ca channel blocker do you use for anti angina?

Answer 3

Dihydropyridine!
Amlodipine
Felodipine
Nifedipine SR (NOT fast as increase mortality)
Not neg inotropic 

Dont use nifedipine in severe AS, HOCM, HF

Question 4

Action of dihydropyridine vs non dihydropyridine Ca ch blockers?

Answer 4

Dihydropyr- systemic AND CORONARY vasodilator. Not neg inotropic

Non-dihyro- arteriolar vasodilation
centrally acting to reduce HR, BP, contractility, prolong diastole. Neg inotropes

Question 5

How does nicorandil work?

Answer 5

Arterial and venous vasodilator- systemic and coronary. Acts by stimulating cGMP formation to eventually reduce sensitivity of smooth muscle to calcium

Can use with calcium channel blockers in angina if nitrate intolerant. also reduces CV events!
Flushing and palpitations

Question 6

Perhexiline MOA

Answer 6

favours anaerobic metabolism in active myocytes so reduces myocardial oxygen demand

Inhibits mitocondrial carnitus palmityltransferase

metab via 2D6

Question 7

Is CTCA a viable alternative to exercise testing in people with chest pain?

Answer 7

Yes, non inferior in terms of outcomes

Also reduces number of people who go on to have a normal angiogram

Question 8

Which three things good if TG still high after statins?

Answer 8

Nicotinic acid
Fenofibrate
Fish oil

Question 9

Which three things good if Chol still high after MAX tolerated statin?

Answer 9

add or sub

ezetimibe
nicotinic acid
bile acid binding resin

Question 10

Who would you treat out of moderate risk CV category?

Answer 10

Maouri, south asian, middle eastern
FH CVD premature
BP over 160

Start a statin and BP lowering therapy

Question 11

heart failure is mostly attributable to WHAT according to Framingham?

Answer 11

hypertension

Question 12

Cilostazol in PVD- how work?

Answer 12

Phosphodiesterase 3 inhibitor
Can cause rebound tachy and cannot give in CCF
Have to stop pre-op

In au for rest pain or evidence of necrosis

Question 13

How is carvedilol different from the other beta blockers?

Answer 13

not just Beta 1 but also beta 2, alpha 1, vasodilatory and antioxidant effects

Question 14

Digoxin in heart failure

Answer 14

Decrease hospitalisation
Improve symptoms

need to use at low levels- 0.5-0.8 in heart failure

Question 15

When do you start spiron post MI?

Answer 15

MUST be within 14 days

on PBS if LVEF under 40% within 3-14 days post MI

Question 16

How does spiro give you breasts?

Answer 16

Increases testosterone to oestradiol production
Decreases testosterone production in testes
Displace testosterone from SHBG and so increase clearance

Question 17

How does hydralazine work?

Answer 17

Selective arterial vasodilator–>reduce afterload

Question 18

How does ISMN work?

Answer 18

Converted to NO in cells–>increase cGMP–> veno and vasodilation–>reduce preload and afterload.

Question 19

Is diltiazem dihydro or non dihydro

Answer 19

In between in selectivity

Reduce BP without inducing reflex tachy

Question 20

What E-Eprime is normal?

Answer 20

Less than 8

Question 21

What do alpha 1 receptors do?

Answer 21

all post synaptic
smooth muscle vasoconstriction
skin vasoconstriction
abdominal viscera vasoconstricition
GU/GI sphincter constriction
mydriasis

NORAD more

Question 22

alpha 2 do what?

Answer 22

mixed effects smooth muscle
increase amylase
increase AV node conduction- dromotropic
glycogenolysis, inhibit insulin release

ADRENALINE more

Question 23

Beta 1 receptors do what?

Answer 23

inotrope
chronotrope
increase amylase
dromotropic 
glycogenolysis

ISOPREN more than ADREN

Question 24

Beta2 receptors do what?

Answer 24

ISOPREN more than ADREN
SM relaxation
vasodilation skeletal muscle
hypokalaemia
uterine relaxation

Question 25

When to repair a thoracic aortic aneurysm?

Answer 25

Over 4cm if trying to get preg and marfans
Marfans over 5
Any one else over 5.5

Question 26

In degenerative aortic disease, is there evidence that modifying RF reduces rate of expansion?

Answer 26

No evidence

Question 27

When to repair a triple A?

Answer 27

Over 5.5cm or grows half a cm in a year
NO benefit beta blockers, no data for ACE or statin
Use of macrolide may slow expansion in patients with serological evidence of chlamydia pneumoniae

Question 28

Most common heart thing in turners?

Answer 28

Bicuspid valve

Then coarctation

Question 29

time line of instent thrombosis and restenosis?

Answer 29

Thrombosis usually first month- present as MI
In stent restenosis usually first 3-6 months, present as angina, more likely if renal disease, stent in a venous graft, diabetes

In stent thrombosis 1-2%
Restenosis 5-20%

Question 30

High mortality post MI correlates with…

Answer 30

Killip class which is basically increasing severity of cardiac failure

Question 31

Sustained VT

Answer 31

stable- amiodarone or sotalol or lignocaine

or if no LV dysfunction could use flecanide

Question 32

Torsades mx

Answer 32

if underlying brady- atropine

TTV pacing or mag sulphate or isoprenaline or lignocaine

AVOID AMIODARONE, SOTALOL, DISOPYRAMIDE, FLECANIDE

Question 33

NSVT

Answer 33

atenolol or metoprolol or amiodarone or flecanide or sotalol

Question 34

What things lower BNP and upper BNP?

Answer 34

Basically all antihypertensives (not ca ch bl)
and obesity

LVH, tachy, RV overload, Hypoxaemia, PE, GFR under 60, age over 70, cirrhosis, COPD, diabetes