Aortic stenosis

Question 1

What is the triad of ACS?

Answer 1

STEMI, NSTEMI, unstable angina

Question 2

What is the mechanism of action of metformin?

Answer 2

Decreasing intestinal absorption of glucose, impairing hepatic glucose production, improves insulin sensitivity

Question 3

What is the mechanism of action of glimepride?

Answer 3

Acts as an insulin secretagogue. It lowers blood sugar by stimulating the release of insulin by pancreatic b cells.

Question 4

What is the mechanism of action of linagliptin?

Answer 4

DPP4 inhibitor. DPP4 breaks down incretin levels which reduce glucagon levels. Therefore inhibiting DPP4 allows incretins to reduce glucagon

Question 5

What is the mechanism of action of doxasozin?

Answer 5

Doxazosin is a quinazoline-derivative that selectively antagonizes postsynaptic α1-adrenergic receptors. It may be used to mild to moderate hypertension. Antagonism of these receptors leads to smooth muscle relaxation in the peripheral vasculature.

Question 6

What is the mechanism of action of furosemide?

Answer 6

Furosemide, like other loop diuretics, acts by inhibiting the luminal Na-K-Cl cotransporter in the thick ascending limb of the loop of Henle, by binding to the chloride transport channel, thus causing sodium, chloride, and potassium loss in urine.

Question 7

What is the mechanism of action of solifenacin?

Answer 7

Solifenacin is a competitive cholinergic receptor antagonist, selective for the M3 receptor subtype. The binding of acetylcholine to these receptors, particularly M3, plays a critical role in the contraction of smooth muscle. By preventing the binding of acetylcholine to these receptors, solifenacin reduces smooth muscle tone in the bladder, allowing the bladder to retain larger volumes of urine and reducing the number of micturition, urgency and incontinence episodes.

Question 8

What is the mechanism of action of eplenerone?

Answer 8

Eplerenone binds to the mineralocorticoid receptor and thereby blocks the binding of aldosterone (component of the renin-angiotensin-aldosterone-system, or RAAS). Aldosterone synthesis, which occurs primarily in the adrenal gland, is modulated by multiple factors, including angiotensin II and non-RAAS mediators such as adrenocorticotropic hormone (ACTH) and potassium. Aldosterone binds to mineralocorticoid receptors in both epithelial (e.g., kidney) and nonepithelial (e.g., heart, blood vessels, and brain) tissues and increases blood pressure through induction of sodium reabsorption and possibly other mechanisms.

Question 9

What is the mechanism of action of apixaban?

Answer 9

Apixaban is a highly selective, orally bioavailable, and reversible direct inhibitor of free and clot-bound factor Xa. Factor Xa catalyzes the conversion of prothrombin to thrombin, the final enzyme in the coagulation cascade that is responsible for fibrin clot formation.[10] Apixaban has no direct effect on platelet aggregation, but by inhibiting factor Xa, it indirectly decreases clot formation induced by thrombin.

Question 10

How does AS present OE?

Answer 10

 Delayed and weak pulse (pulsus parvus et tardus)
 Palpable systolic thrill over the bifurcation of the carotids and aorta.
 Harsh descend-crescendo late systolic ejection murmur that’s radiates bilaterally to the carotids.

Question 11

What is the New York classification of heart failure?

Answer 11

 I- Heart disease present, but no undue dyspnoea from ordinary activity
 II- Comfortable at rest; dyspnoea during normal activities
 III- Less than ordinary activity causes dyspnoea, which is limiting
 IV- Dyspnoea present at rest; all activities cause discomfort

Question 12

How does heart failure present on chest x-ray?

Answer 12

	A- Alveolar oedema- perihilar bat wings
	B- Kerley B lines
	C- Cardiomegaly
	D- Dilated prominent upper lobe veins
	E- Pleural effusions

Question 13

What are the ejection fraction percentages associated with normal physiology, slight pathology and severe pathology?

Answer 13

Normal EF: > 55%
Reduced EF: 30–44%
Extremely reduced EF: < 30%

Question 14

What is a thrill vs a heave?

Answer 14

Parasternal heave: a heaving motion felt over the left parasternal area (palpate with right hand and straightened elbow)
Suggests RV hypertrophy (e.g., pulmonary hypertension)
Thrills: a palpable murmur, usually over the region where the heart murmur is heard best