Cardio

Question 1

When would adenosine be contraindicated for treatment of SVT?

Answer 1

In asthmatic patients: first line then would be verapamil

Question 2

What drug should be given prior to fibrinolysis for a STEMI?

Answer 2

Fondaparinoux (anti thrombin drug to prevent the clot getting better)
Fibrinolysis used when PCI cannot be done within 2hrs
Give in addition to MONA tx for all ACS

Question 3

What is the management of supraventricular tachycardia?

Answer 3

Narrow complete tachycardia (QRS<120ms)
If unstable: up to 3 shocks
If stable:
1st: Carotid sinus massage/ vagal manoeuvre
2nd: Adenosine IV (6->12->18mg)

Question 4

How can atrial fibrillation be managed?

Answer 4

<48hrs of onset: cardioversion
>48hrs: DOAC (to avoid atrial thrombus formation), and in 3 weeks cardiovert
Rate control with beta blockers
Digoxin or amiodarone if evidence of heart failure

Question 5

How can a broad complex tachycardia be managed?

Answer 5

If unstable: up to 3 shocks
If stable: Loading dose of amiodarone followed by 24hr infusion

Question 6

What is the management of torsades de pointes?

Answer 6

IV Mg

Question 7

What ECG changes can be seen in hyperkalaemia?

Answer 7

Tented T waves
Loss of P waves
Widened QRS

Question 8

Which heart valve is most commonly affected in infective endocarditis of an IVDU?

Answer 8

Tricuspid valve

Question 9

U waves on ECG indicate what?

Answer 9

HypoK
HypoCa
Hypothermia

Question 10

What ECG changes are seen in hypokalaemia?

Answer 10

U waves
Flattened T waves
Long PR & QT

“U have not Pot and no Tea with a long QR and QT”

Question 11

What is the immediate treatment of bradycardia with signs of shock?

Answer 11

500microgram atropine IV (up to maximum 3mg)

Question 12

What secondary prevention medication should be started following acute coronary syndrome?

Answer 12

DAPT (aspirin lifelong + another anti platelet 1yr)
Statin
ACEi
Beta blocker

Question 13

J waves on an ECG are pathognomic for what?

Answer 13

Hypothermia

Question 14

ST elevation in leads II, III & aVF indicates MI in which territory?

Answer 14

Inferior (right coronary artery)

Question 15

Delta wave on ECG is associated with which condition?

Answer 15

Wolff Parkinson White syndrome
(Pre-excitation of the ventricles due to an accessory pathway which bypassses the AV node)

Delta stroke is slurred upstroke of the QRS

Question 16

GRACE score higher than 3% indicates what?

Answer 16

Should undergo PCI within 72 hours if NSTEMI

Question 17

What is the most common cause of mitral valve stenosis?

Answer 17

Rheumatic fever

Question 18

Mitral stenosis presents with which type of murmur?

Answer 18

Diastolic murmur

Question 19

What ECG changes are seen in pericarditis?

Answer 19

PR depression (most specific)
ST elevation “saddle shaped”

(Widespread)

Question 20

What is the presentation of pericarditis?

Answer 20

Classical chest pain relieved by sitting forwards
Flu symptoms
Dyspnoea
Cough (non productive)
Pericardial friction rub

Question 21

What is the treatment for pericarditis?

Answer 21

Treat underlying causes
1st line is NSAIDs + colchicine

Question 22

What is the best management for NSTEMI with a GRACE score >3%?

Answer 22

Aspirin 300mg and then PCI within 72 hours
(Whereas we aim for 2 hours for a STEMI)

Question 23

What is the ALS algorithm to manage bradycardia?

Answer 23

If no adverse signs: observe

If adverse signs (shock/ syncope/ HF/ MI) or risk of a systole:
1st line is atropine 500mcg IV, can be repeated up to max of 3mg

If unsuccessful other treatments include adrenaline/ isoprenaline/ transcutaneous pacing