Cardio 4

Question 1

pulmonary stenosis
heard loudest?

Answer 1

second intercostal space on the left sternal border
> right sided heart failure

Question 2

Triad of symptoms for right sided heart failure?

Answer 2

JVP
hepatomegaly
ankle oedema

Question 3

amiodarone IV has one common injection side effect?

Answer 3

thrombophlebitis
> ensure given into ventral veins

Question 4

amiodarone is a class?

Answer 4

class III anti arrhythmic agent

blocks potassium channels

Question 5

amiodarone interaction with which commonly used anticoagulant ?

Answer 5

decreases metabolism of warfarin

Question 6

what are u waves?

Answer 6

u waves appear as small + deflections after t wave

lead V2 and V3

caused by hypokalaemia

Question 7

short QT interval?

Answer 7

QT interval prolongation

Question 8

J waves are what?

Answer 8

osborn waves

hypotrhermia

hypercalcaemia

junction between QRS and ST segment

Question 9

Raynauds with extremity ischaemia?

Answer 9

buerger’s disease

Question 10

other name for buergers disease?

Answer 10

thromboangitis obliterans

Question 11

how to differentiate between myocarditis and pericarditis

Answer 11

Myocarditis is more likely to show a focal ECG changes
> also more likely to show acute congestive HF signs / Left ventricular failure signs

pericarditis is widespread

Question 12

why does myocarditis present with left ventricular dysfunction signs?

Answer 12

inflammation reducing contractile strength of the heart

Question 13

causes of myocarditis?

Answer 13

viral : coxsackie
bacterial : diphtheria, clostridia
fungal : toxoplasmosis

Question 14

mx of angina?

Answer 14

First line : beta blocker

or if not tolerated / contraindicated
first line : CCB NDHP - verapamil / diltiazem

2nd line: Beta blocker and Dihydropyridine CCB - amlodipine / nifedipine

3rd line - add 3rd drug but awaiting PCI / CABG

Question 15

other angina medications?

Answer 15

a long-acting nitrate
ivabradine
nicorandil
ranolazine

Question 16

Stage III HF

Answer 16

pain on less vigorous studd

like daily activities impacted
but no pain at rest

Question 17

stage 1 HF?

Answer 17

Stage I - No limitation on ordinary physical activity (incorrect)

Question 18

PKD is associated with what valve abnormality?

Answer 18

mitral valve prolapse

Question 19

management of cardiac tamponade?

Answer 19

pericardiocentesis

Question 20

when should you take statins?

Answer 20

at night- increases efficacy

Question 21

beta blockers licensed for HF?

Answer 21

bisoprolol, carvedilol, and nebivolol.

Question 22

2nd line HF?

with reduced ejection fraction

Answer 22

beta blocker, ACEi, + mineralocorticioid receptor antagonist

> be wary of hyperkalaemia

role of SGLT-2 drugs inhibitors

Question 23

SGLT-2 inhibitors

Answer 23

reduce glucose reabsorption and increase urinary glucose excretion

dapagliflozin

Question 24

sacubitril-valsartan

criteria?

Answer 24

3rd line
left ventricular fraction < 35%

reduced ejection fraction who are symptomatic on ACE inhibitors or ARBs

initiated after a washout period

Question 25

role of digoxin

Answer 25

very helpful w symptoms t is strongly indicated if there is coexistent atrial fibrillation

Question 26

major bleed and on warfarin mx?

Answer 26

stop warfarin IV vitamin K 5mg and prothrombin concentrate complex

Question 27

Ivabradine is used in? MOA? S/E?

Answer 27

inhibition of IF channels I current F = funny mixed na+/K+ in heart like Sinoatrial node angina management transient luminous phenomenon

Question 28

what is the MOA of ivabradine?

Answer 28

inhibits channels = delay in depolarisation = slows down heart rate

Question 29

HTN management? when should you start antihypertensives?

Answer 29

if more than 150/95 stage 2

Question 30

>135/85 on ABPM / HBPM when to start anti hypertensives?

Answer 30

<80 + target organ damage CVD disease renal disease DM QRISK >105

Question 31

black african or african-caribbean ethnicity first line anti hypertensives? second line?

Answer 31

CCB > CCB + ACEi / ARB > CCB +thiazide like diuretic (indapamide)

Question 32

<55 or T2DM first line antihypertensive?

Answer 32

ACEi / ARB

Question 33

acute HF management with hypotension?

Answer 33

high dependency unit inotropes considered for reversible cardiogenic shock

Question 34

HF acute management?

Answer 34

IV loop diuretic - furosemide O2 - if needed Vasodilate > contraindicated if hypotensive Respiratory support CPAP Inotropic agent vasopressor agent mechanical circulatory assistance

Question 35

Acute mx of HF summarised if hypotensive?

Answer 35

IV furosemide O2 Vasodilation CPAP Iv furosemide O2 HDU with inotropic support vasopressor > norepinephrine Mechanical circulatory support

Question 36

breathing problems with a clear chest ?

Answer 36

pulmonary embolism

Question 37

differentials for acute breathlessness?

Answer 37

COPD exarcebations : wheeze and crackles Pneumothorax : absent breath sounds astham attack - wheeze

Question 38

which murmur gets louder during inspiration lower left sternal edge

Answer 38

tricuspid regurgitation venous blood flow into right atrium and ventricle are increased > stroke volume of right ventricle during systole

Question 39

murmurs at lower left sternal edge?

Answer 39

Tricuspid regurgitation / mitral regurgitation HOCM VSD

Question 40

HOCM murmur?

Answer 40

harsh ejection systolic loudest on expiration

Question 41

side effect of indapamide

Answer 41

hypokalaemia erectile dysfunction dehydration hyponatraemia hypercalcaemia impaired flucose tolerance gout

Question 42

antihypertensives which cause hyperkalaemia

Answer 42

spironolactone ACEi

Question 43

angina pectoris triad

Answer 43

chest discomfort triggered by exertion alleviated with rest

Question 44

angina pectoris first line mx?

Answer 44

beta blocker CCB - rate limiting one > diltiazem / verapamil

Question 45

s/e of beta blockers?

Answer 45

bronchospasm cold peripheries fatigue sleep disturbances erectile dysfunction

Question 46

tachyarrhythmia management if not stable narrow complex

Answer 46

signs of shock DC cardioversion 1) Midazolam large bore IV - sedate 2) pads places ; synchronised take blood at same time potassium magnesium calcium

Question 47

irregular broad complex tachycardia management?

Answer 47

seek expert help atrial fibrillation with bundle branch block > ventricular pre excitation > torsades de pointes

Question 48

loop diuretic mechanism of action?

Answer 48

inhibition of Na-K-Cl transporter in the thick ascending limb of the loop of henle

Question 49

mx post ischaemic stroke?

Answer 49

300mg aspirin for 2 weeks 75mg clopidogrel for life