Cardio

Question 1

ECG changes of MI

Answer 1

Phase 1 - hyper acute T waves 
Phase 2 - ST elevation 
Phase 3 - inverse T waves 
phase 4 - Deep Q waves 
(NSTEMI can have widespread ST depression )

Question 2

When to avoid nitrates in ACS?

Answer 2

Avoid in suspected RV infarction such as inferior STEMI, or SBP < 90.

(Vasodilation reduces preload in heart, less blood being supplied to inferior artery) - hence II, III, aVF don’t give nitrate!

Question 3

Four line of managements for STABLE angina

Answer 3

1. 1st line: SNAP + aspirin (100mg)
2. Nitrates - GTN (GTN isorbide sublingual/ patch)
3. BB
4. DHP CCB - e.g. amlodipine

Question 4

What two doses of aspirin

Answer 4

100mg for stable angina - 1 tablet

300mg - 3 tablets in ACS

Question 5

Management of HTN

Answer 5

1. 6W diet/lifestyle change - skip if 
either 
- low CVD risk with BP >160/100
Medium risk - 149/90
high cvd risk with bp >120 OR signs of end organ damage 

2. Low dose anti HTive
   - ACEi/ARB – DM choose this
   - DHP CCB - amlodipine — angina or Reynaud’s choose this
   - thiazide diuretic — HF choose this
3. add another anti HTive (rather than increase dose)
4. increase dosages OR add K+ve sparing diuretic, alpha blocker (BPH), central acing anti adrenergic, direct acting vasodilator
5. Target < 140/90. unless high risk <120

Question 6

Hypercholesterolaemia

Answer 6

1. 6 week diet/ lifestyle change - Skip if:
   - symptomatic CVD
   - DM in ATSI/ elderly/ microalbuminuria
   - Fhx of early onset IHD
2. Statin
   - atorvastatin - cheapest
3. ezetimibe
4. other - vibrate, cholestyramine, nicotinic acid.

Question 7

Common outcome of mitral stenosis

Answer 7

mitral stenosis –> left atrial dilation –> atrial fibrillation.

Left atrial dilation - bifid P wave –> also known as P mitral
`

Question 8

PR intervals - two pathologies

Answer 8

1st degree heart block

Widening PR for Wenkebach

Question 9

Narrow QRS - 
Wide QRS -
Electrical alternans - 
Deep Q wave -
Deep broad V shaped R wave in V1 V2 -
M shaped R wave in V1 or V2 -
Deep S in V1 + Tall R wave in V6 -
Tall R  in V1 + Deep S in V6 - 
Slurred upstroke -

Answer 9

Narrow QRS - SVT 
Wide QRS - VT
Electrical alternans - pericardial effusion 
Deep Q wave - Past AMI 
Deep broad V shaped R wave in V1 V2 - LBBB
M shaped R wave in V1 or V2 - RBBB
Deep S in V1 + Tall R wave in V6 - LVH
 (left goes low in V1)
Tall R  in V1 + Deep S in V6 - RVH-
(right goes upright in V1)
Slurred upstroke - WPW

Question 10

ST interval

Answer 10

elevated - STEMI, pericarditis

Depressed - NSTEMI, reciprocal change, digoxin effect

Question 11

QT interval

Answer 11

if prolonged - risk of VT - Torsades.

< 1/2 of R to R is normal

Question 12

T wave

• peaked
• hyperacute
• flattened
• inverted

Answer 12

peaked- hyperkalaemia
hyper acute - STEMI
flattened - hypokalaemia
inverted - ischaemia (acute or past AMI)

Question 13

Management of AF

Answer 13

1. Paroxysmal (acute) - anticoags + cardioversion if within 48h, if after 3w anticoags, or if echo excludes LV thrombus
2. Persistent (recurrent) - anticoags + rate/rhythm control (long term)
3. Permanent (chronic) - anticoags + rate/rhythm control (long term)

Question 14

Acute medical management of a PE and DVT

Answer 14

LMWH for 5-10 dys - then warfarin for 3m or IVC filter