Cardio

Question 1

HF
Ix first line ?
definative

Answer 1

B type natriuretic peptide BNP
NT-proBNP if high then arrange specialist assessment
within 2 weeks

echo

Question 2

if NT-proBNP is raised?

Answer 2

echo within 6 weeks

Question 3

ACS Ix

Answer 3

troponin

ECG

Question 4

MI mx

nstemi and unstable angina

Answer 4

calculate GRACE
>3 within 72 hours PCI
give fondaparinux and tricelogpr

Question 5

post MI mx?

Answer 5

aspirin 75mg OM and clopidogrel /tricagrelor 90
beta blocj
acei
high dose statin - 80mg

echo
and cardiac rehab

Question 6

inferior MI ecg

Answer 6

ii , iii and avf

Question 7

lateral MI

Answer 7

V5,v6

lead 1

Question 8

when can you interpret a Troponin for Mi

Answer 8

> 3 hours
then repeat in 6-12 if raising or raised then MI confirmed

if falling no Mi

Question 9

ECG findings WPW

Answer 9

delta waves - slurred upstroke in the QRS
short PR interval <120
broad QRS
narrow complex tachycardia

Question 10

how do you diagnose WPW

Answer 10

ecg 
24 hour 
TFTs routine bloods
echo - ventricular function 
intracardiac electrophysiological studies to map the location of the accessory pathway

Question 11

Mx of WPW

Answer 11

Radiofrequency ablation of the accessory pathway
Drug treatment (such as amiodarone or sotalol) to avoid further tachyarrhthmias. These are contraindicated in structural heart disease.

Question 12

cause of HF in central and south america?

Answer 12

Chagas

Question 13

The NYHA Classification system

Answer 13

Class I - no limitation in physical activity, and activity does not cause undue fatigue, palpitation or dyspnoea.
Class II - slight limitation of physical activity, and comfort at rest. Ordinary physical activity causes fatigue, palpitation and/or dyspnoea.
Class III - marked limitation in physical activity, but comfort at rest. Minimal physical activity causes fatigue (less than ordinary).
Class IV - inability to carry on any physical activity without discomfort, with symptoms occurring at rest. If any activity takes place, discomfort increases

Question 14

what is the echo findings for Heart failure with preserved ejection fraction

Answer 14

EF >40% but raised BNP

Question 15

Mx of HF
NyHAclass 3/4 what medication do you consider?
if in sinus rhythm but impaired EF

those with AF?

Answer 15

spironoloactone /epelerone - improves mortality

if afro-caribbean ?
hrdralazine and nitrate

ivabradine

ARB

Digoxin - worsens mortality

Question 16

ICDs are indicated if the following criteria are fulfilled: HF

Answer 16

QRS interval <120ms, high risk sudden cardiac death, NYHA class I-III
QRS interval 120-149ms without LBBB, NYHA class I-III
QRS interval 120-149ms with LBBB, NYHA class I

Question 17

Mx of mitral stenosis if asymptomatic?

if pliable and non calcified?

Answer 17

no treatment just review

balloon valvuloplasty

moderate disease= percutaneous mitral valvotomy

Open valve repair/replacement - for patients with severe disease who are not too high risk for surgery but are not candidates for percutaneous intervention, due to valve morphology or otherwise. Valves are more likely to be metal than bioprosthetic.

Question 18

cannon A waves on JVP are a sign of?

Answer 18

complete heart block

Question 19

WPW ECG findings

Answer 19

pr interval is shortened
rapid ventricular rate
and DELTA wave which is pathogenomic

Question 20

what is a delta wave and what is it associated with?

Answer 20

slurring if the upstroke of QRS - due to early depolarisation of myocardium

pathogenomic of WPW

Question 21

how does acute myocarditis differ to pericarditis

Answer 21

myocarditis causes a much bigger rise in troponin and presents with a more MI type presentation

Question 22

when does cardiac resynchronisation therapy device indicated in HF

Answer 22

if EF <35 and QRS is wide

Question 23

management of type B stanford aortic dissection

Answer 23

IV labetalol

Question 24

most appropriate diagnostic tool for aortic dissection?

Answer 24

trans oesophageal echocardiography

Question 25

best diagnostic investigation for infective endocarditis?

Answer 25

3 sets of blood cultures from 3 different sites

Question 26

stanford type A mx?

Answer 26

IV labetalol

IV morphine and open surgery

Question 27

stanford type b surgical option?

Answer 27

endovascular repair if unstable

Question 28

aortic stenosis Mx?

Answer 28

TAVI is favoured with patients with severe comorbidities, previous heart surgery, frailty, restricted mobility, and those older than 75 years of age.

SAVR is favoured for patients who are low risk and less than 75 years of age.

Question 29

when is an aortic balloon pump utilised?

Answer 29

acute mitral regurgitation

Question 30

ECG findings in Hypertrophic cardiomyopathy

Answer 30

Abnormal Q waves
Deeply inverted T waves
Left ventricular hypertrophy

Question 31

HOCM which gene

echo finding

Answer 31

mutation in gene encoding b myosin

Mitral regurgitation

Question 32

what is the most common type of cardiomyopathy

what are the causes

Answer 32

dilated

most common cause; idiopathic
Inflammation; sarcoidosis, haemochromatosis
infection; coxsackie virus, HIV myocarditis

toxins; alcohol, cocaine

inherited; duchene muscular dystrophy

Question 33

dilated cardiomyopathy on xray

Answer 33

balloon

Question 34

dilated cardiomyopathy ix findings?

Answer 34

heart failure signs
systolic murmur - mitral / tricuspid regurg
S3

cxr balloon apppearance

Question 35

HOCM manahgement?

Answer 35

amiodarone
beta block/verapamil 
cardioverter defib
dual chamber pacemaker
endocarditis prophylaxis

Question 36

what is the most common cause of restrictive cardiomyopathy

Answer 36

amyloidosis