Cardio

Question 1

Management for confirmed aortic dissection?

Answer 1

Beta-blocker (labetalol) or non-dihydropyridine CCB (verapamil/diltiazim)
Opioid (morphine)

Open surgery/endovascular repair

Uncomplicated type B can be managed with the drugs mentioned above

Question 2

Investigations for heart failure?

Answer 2

NT-proBNP first, if > 400:
- Transthoracic echo + Doppler US (diagnostic)

Clinically:
Framingham criteria (2 major/1 major +2 minor)

Question 3

Chronic HF management?

Answer 3

ACE inhibitor
Beta-blocker
Spironolactone

Symptom management:
- furosemide
- digoxin (AF)
- ivabradine (sinus rhythm > 75/min + LVEF < 35%)
- sacubitril/valsartan (LVEF < 35%)
- hydralazine + nitrate (black ppl)

Question 4

Acute HF management

Answer 4

Sit patient upright
60-100% O2
IV diamorphine
GTN infusion
IV furosemide (pulmonary oedema)

Question 5

Pericarditis management

Answer 5

NSAIDs + PPI prophylaxis + exercise restrict

If no improvement after 7 days:
- colchicine/steroids

Question 6

Pericardial effusion management

Answer 6

Pericardial tap (diagnostic for pathogen)

Haemodynamically unstable:
- pericardiocentesis

Pericardiectomy is refractory

Question 7

Myocarditis management

Answer 7

Treat underlying cause

Haemodynamically stable:
- supportive care
- LV systolic dysfunction —> ACEi/ARB

Unstable:
- IV vasodilator e.g. nitroprusside

Question 8

Mitral stenosis management

Answer 8

Asymptomatic: monitor with regular echo

Symptomatic: percutaneous mitral balloon valvotomy, surgery (valve replacement, commissurotomy)

Question 9

Aortic stenosis management

Answer 9

Asymptomatic: observe
Symptomatic: valve replacement (AVR)

If asymptomatic but valvular gradient > 40 mmHg or features of systolic dysfunction consider surgery

Surgical AVR for healthy patients
TAVR for patients with high risk

Question 10

Management for all peripheral arterial disease patients

Answer 10

In clinic:
- Statin e.g. atorvastatin
- Clopidogrel

ALI: unfractionated heparin + thrombolysis/embolectomy

CLI: bypass/angioplasty

Amputation for non viable: fixed mottling, no sensation/motor

Question 11

Management for hypercholesterlaemia

Answer 11

Lifestyle
Statins
Omega 3 fatty acids
Fibrates

Question 12

What does a posterior MI cause on ecg

Answer 12

St depression V1-3
Hyperacute R waves V1-3

Question 13

Investigations for infective endocarditis

Answer 13

Blood cultures - 3 sets from different venepuncture sites at 30min intervals before ABs

Echocardiography - TOE better than TTE