Cardio

Question 1

Acute coronary syndrome

Answer 1

Term used for spectrum of presentations due to acute MI
Includes - STEMI, N-STEMI, unstable angina
PATH:
Stable angina - progressive narrowing, stable fibrous cap
Unstable angina - progressive narrowing, acute worsening due to thrombus formation
NSTEMI - acute worsening, sub occlusive thrombus w myocardial necrosis
STEMI - acute rupture of thin fibrous cap, myocardial necrosis, occlusive thrombus

SYMPTOMS:
Pain - radiates to left shoulder, arm, neck. ABSENT in patients with prior cardiac, stroke, age >75, DM
Others - anxiety, nausea, vomiting, breathlessness, syncope

SIGNS:
Ischemic - re infarction, angina
Mechanical - cardiogenic shock, mitral regurgitation
Arrhythmic- atrial/ventricular arrhythmia
Thromboembolic- left ventricular mural thrombus
Inflammatory- pericarditis

COMPLICATIONS:
Arrhythmia
Cardiogenic shock
Left ventricular failure
Embolism
Ventricular aneurysm
Pericarditis

INVESTIGATIONS:

ECG
Cardiac bio markers
Chest X-ray
Echocardiography
Radionuclide scanning

MANAGEMENT:
General- MONAC- Morphine, Oxygen, NTG, Aspirin, Clopidogrel
Specific - b blockers, treat complications, coronary interventions
Analgesics
Anti platelet therapy - aspirin, clopidogrel,
Prophylactic anticoagulants - heparin, LMW heparin, direct thrombin inhibitors
Statins

Question 2

Coronary artery disease

Question 3

Hypertension

Answer 3

CLASSIFICATION:
Normal - <120/80 mmhg
Pre - 120-139/80-89 mmhg
Stage 1 - 140-159/90-99 mmhg
Stage 2 - >160/100 mmhg
HTN Urgency - 180/120 mmhg + no organ damage
HTN Emergency- 200/130 mmhg + organ damage

PATH:
Genetic
Environmental - obesity, high salt intake, alcohol, smoking, stress, insulin resistance
Fetal cause - IUGR

CAUSE:
Primary - idiopathic, family history
Secondary-
Renal- CKD, renal artery stenosis, polycystic kidney disease
Endoc - hypothyroidism (inc PVR), thyrotoxicosis (inc HR), Pheochromocytoma, CONN syndrome
CNS - sleep apnea, porphyria, lead poisoning
CVS - aortic dissection, coarctation of aorta, aortic regurgitation

INVESTIGATIONS:

1. Ambulatory BP Monitoring
2. ECHO - LV Hypertrophy
3. FBS, lipid profile, serum electrolytes
4. TSH
5. Urine - creatinine, albumin

MANAGEMENT:

1. DASH - decrease salt, healthy diet
2. Exercise
3. No alcohol
4. No smoking
5. Medical -
   ACE inhibitors
   B blockers
   Diuretics
   CCBs
   Peripheral vasodilators
   Alpha blockers

Question 4

Myocardial infarction

Question 5

STEMI

Question 6

Subacute bacterial endocarditis

Question 7

Acute infective endocarditis

Question 8

Stable angina

Question 9

Unstable angina

Question 10

Cor pulmonale

Question 11

Left ventricular failure

Question 12

Congestive cardiac failure

Question 13

Acute rheumatic fever

Question 14

Supraventricular tachycardia

Question 15

Atrial tackyarrhythmia

Question 16

Atrial fibrillation

Question 17

Constructive pericarditis

Question 18

Mitral stenosis

Question 19

Aortic regurgitation

Question 20

Mitral regurgitation

Question 21

Syncope

Question 22

Dilated cardiomyopathy