cardio

Question 1

How does LHF present

Answer 1

Respiratory symptoms: tachycardia, tachybradia, dyspnoea, nocturnal cough, pink frothy sputum, fatigue, weight loss

Question 2

How does RHF present

Answer 2

Swelling symptoms:
raised JVP, ascites, oedema, weight gain, nocturia

Question 3

first line investigations for heart failure if high BNP

Answer 3

transthoracic electrocardiography with doppler scan

Question 4

Management for acute HF

Answer 4

ABCDE
upright, oxygen (target is 94-98%)
GTN infusion
IV furosemide
CPAP (if in respiratory failure)

Question 5

Medication given if in shock

Answer 5

inotropic agents (dobutamine)

Question 6

What should be stopped if HR below 50, 2nd or 3rd heart block or shock

Answer 6

Beta blockers (end in olol)

Question 7

When can nitrates be dangerous

Answer 7

can cause hypotension

Question 8

What is furosemide

Answer 8

loop diuretic

Question 9

management for chronic HF

Answer 9

ACE inhib - LV dysfunction
Beta blocker

second line - aldosterone agonist
SGLT-2 inhibitor

Question 10

What is an aldosterone agonist

Answer 10

spironolactone, eplerenone

Question 11

symptoms of mitral stenosis

Answer 11

pulmonary venous hypertension - dyspnoea
haemoptysis
malar flush

Question 12

what size of mitral valve can be seen in echocardiography

Answer 12

normal is 4-6
mitral stenosis is less than 1

Question 13

management for atrial fibrillation with mitral stenosis

Answer 13

warfarin
maybe DOACs

Question 14

management for asymptomatic mitral stenosis

Answer 14

regular echocardiograms

Question 15

management for symptomatic mitral stenosis

Answer 15

percutaneous mitral balloon valvotomy

Question 16

how can mitral regurgitation present

Answer 16

usually asymptomatic

Question 17

management for acute mitral regurg

Answer 17

nitrates, diuretics, positive inotropes, intra-aortic balloon pump
heart failure - ACE inhibitors, beta blockers, spironolactone

Question 18

Ace inhibitors

Answer 18

end in pril

Question 19

Presentation of myocarditis

Answer 19

young patient with acute history of chest pain, dyspnoea, arrhythmias

Question 20

How does duration of pericarditis since MI change the reason

Answer 20

1-3 days - fibrinous pericarditis
weeks to months - autoimmune pericarditis (Dressler’s syndrome)

Question 21

history for pericarditis

Answer 21

sharp chest pain worsened when breathing or lying down
dyspnoea, cough

Question 22

signs of constrictive pericarditis

Answer 22

right heart failure signs (hgih JVP, ascites, oedema)
positive kussmaul sign - rise in JVP during inspiration

Question 23

what is constrictive pericarditis so what is the first line investigation

Answer 23

calcified or stiffened pericardium
so chest x-ray is important

Question 24

treatment of pericarditis

Answer 24

Combination of NSAIDS and colchicine

pericardiocentesis

Question 25

Investigations for pericarditis

Answer 25

first line is ECG should also have transthoracic echocardiography

Question 26

treatment of chronic or constrictive pericarditis

Answer 26

pericardiectomy or pericardial window

Question 27

how does intermittent claudication of peripherals present

Answer 27

burning in legs after walking, relieved within minutes, not present at rest

Question 28

How does critical limb ischaemia

Answer 28

rest pain in foot for more than 2 weeks ulceration gangrene -hanging legs out of bed to relieve pain

Question 29

how does acute limb ischaemia present

Answer 29

6 Ps pale pulseless painful paralysed paraesthetic perishing with cold

Question 30

investigations for peripheral vascular disease

Answer 30

duplex ultrasound for intermittent claudication

Question 31

what do the different numbers for ABPI

Answer 31

1 - normal less than 0.5 critical limb ischaemia

Question 32

What investigation has to be done before any intervention for peripheral vascular disease

Answer 32

Magnetic resonance angiography MRA

Question 33

management for peripheral vascular disease

Answer 33

1. thrombolysis - clopidogrel 2. surgical embolectomy 3. angioplasty 4. bypass surgery 5. amputation

Question 34

What can be done for acute ischaemia

Answer 34

IV opioids IV heparin if no surgery

Question 35

What are ARBs

Answer 35

End in -sartan

Question 36

How does ACS present

Answer 36

Chest pain (heavy, central) dyspnoea Sweating Nausea or vomiting

Question 37

general management for ACS

Answer 37

MONA morphine Oxygen if less than 94% Nitrates aspirin

Question 38

Management of STEMI if PCI possible within 120 minutes

Answer 38

aspirin and praugrel unfractioned heparin and IIb/IIIa inhibitor