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1
Q

Duke’s criteria? (BE TIMER)
Most common murmur?

A

BE (major) TIMER(minor)
Blood culture x2 12 hrs apart
Echo
Temp 38+
Immunological signs (roth spots, osler’s)
Embolic diease (conjuctivial,
RF
DX: 2 major or 1 major+3minor or 3
Aortic regurg/ new murmur. early diastolic decrescendo murmur

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2
Q

Dressler’s syndrome?

A

2 -3 weeks post MI/ trauma. pericarditis (ST elevation and PR depression)- friction rub, low fever, pleuritic chest pain worse lying down, TX NAIDS/steroids.

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3
Q

Post MI complications?
structural ?
RF?

A

Arrhythmias (VT, VF, total AV block)
ISchaemia (CK-MB, recurrent chest pain)
LV dysfunction, heart failure - killip’s classifcation
Free wall rupture (bleeding into pericardium, tamponade)
Ventricle septal rupture (harsh pansystolic murmur left sternal edge, hypotension, shock, pulmonary oedema, do TOE)
Acute Mitral regurg (post infero-posterio MI, papillary muscle rupture/ necrosis)
Left ventricular outflow obstruction
dressler’s (2 to 4 weeks after)
DVT/PE (systemic)

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4
Q

RF for ventricle septal rupture/ free wall rupture post MI?

A

RF: female, non smoker, HTN, anterior infarction, first MI, 2-7 days after

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5
Q

HTN with t2DM first line drug?
after triple therapy?

A

ACEi/ ARB
already on ARB/ACIe and CCB and thiazide diuretic, give spironolactone if K <4.5 or alpha blocker/ BB if K5.5+

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6
Q

Hyperkalaemia ECG

A

Tall T waves, small p waves, wide QRS

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7
Q

Hypokalaemia ECg

A

small/ inverted T waves, U waves, long PR, depressed ST.

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8
Q

systolic murmur at apex of heart radiating to left axilla.

If person complains of dysopnoaa at rest?

A

MR, most common worldwide. LV blood backflows to LA
ACute MR (post MI/ rupture of chordae tendonae) presents as reduced CO, shock, dysopnoae at rest.

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9
Q

HF classification/ BNP values/ EF values?

TX summary?
BASSSHED

A

BNP refer at: 2000 - 2ww, 400-2000 6ww. , <200 - not confirmed
EF - preserved 50+, <40 severe, 41-49 mild to mod.

TX: acei (ARB candesartan i not toelrate) (UEs at baseline and 1-2 weeks), BB, then spironolactone (U-Es at 7 days)
Others: ivabradine, SGLT2i, digoxin, hydralazine, nitrate, valsartan/ sacubritil

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10
Q

post MI drugs TX?

A

dual antiplatelet (aspirin lifelong, pasugrel P2Y12 i 12 months)
ACE i (lifelong, reduced cardiac vascular resistance and afterload, lower preload.
BB 12 months 9lfielong (LV EF reduced)

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11
Q

DVT/ PE TX summary?
Risks/ complications of DVT

A

wells<2 do dimer. 2+ do USS.
TX: LMWH 5/7 and then dabigatran (crcl 30+)/edoxaban
Crcl 15-50 - apixaban/riveroxaban
<15- LMWH/ UFH (Risk HIT)
warfarin - preferred if 120kg+/liver dysfunction/ egfr <30.
Risk: post thrombotic syndrome (chronic venous hypertension pain swelling, lipodermatosclerosis within 2 yrs)

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12
Q

Flash pulmonary oedema post MI?

A

Post MI/MR

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13
Q

Cx of Heart block?
2nd degree HB?

A

flecanaide, BB, digoxin,
High K, Mg, Addisons,
SLE, scleroderma, RF, sarcoid, endocarditis

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14
Q

Post cardiac cauterization complication?

A

femoral pseudoaneurysm: pulsatile mass, bruit, compromised distal pulses

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15
Q

CI to exercise stress testing?

A

MI in last 2 days, severe AS, uncontrolled angina/ arrhythmias, HF, acute PE/ pericarditis, acute dissection

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16
Q

Aortic dissection pain and areas association?
neck and jaw?
anterior chest pain?
intracapsular region?

A

jawand neck: aortic arch
anterior chest: aortic arch or aortic root
intracapsular: descending aorta,

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17
Q

DVT TX
DOAC not recommended in?

When would you use fondaparinux?

when would you use warfarin instead of DOAC?

If rapid reversal needed/ high risk of bleeding?

A

APLS, pregnancy, breastfeeding, liver impairment, prosthetic heart valves, <40kg/120kg+ (use LMWH/UHF)

riveroxaban has increased risk of GI bleed compared to warfarin

fondap - reserved for people with known HIT

wardarin - if GFR <30, liver dysfunction or 120kg+

high bleeding risk - IV UFH (short half life and reversed with protamine)

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18
Q

61 YO female collapses after 1st MI with distended neck veins

A

Left ventricular free wall rupture (cardiac tamponade - low bp, JVP distended, muffled HS)

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19
Q

High K drug causes?

A

ACEi, BB, ARB, trimethoprim, heparin, digoxin

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20
Q

elderly women, Crushing retrosternal chest painr adiating to jaw, intermittent for 3 yrs. normal cardio ix

A

Oesophageal spasm - corckscrew appearance on barium swallow.

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21
Q

How to hear pericardial friction rub?

A

Sat forward, left sternal border on expriation.
https://youtu.be/-DB_8zyg9W8

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22
Q

ACS contraindication to thrombolytic?

A

Bleeding , recent haemorrhage, trauma, dental extraction, aortic Dissection, neoplasm (intracranial) HTN, stroke <3 months, pericarditis, dissection, endocarditis bacterial,

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23
Q

ST depression, V5, v6 inverted T waves?

A

digoxin toxicity

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24
Q

RAD, RBB, RV strain ECG signs?
St depression, t wave inversion

A

PE. RV strain - ST depression, T wave inversion on leads 1, 2, AVF, V1, V2
in PE. S1Q3T3 is rarer

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25
Hypocalcaemia spot causes? ECG features?
Acute panc, panc surgery, alkalosis (hyperventilation), rhabdomylisis, scepticaemia, osteolytic mets, Parathyroid gland surgery, bisphosponates, calcitonin, phenytoin, foscarnet, phosphate substitution prolonged St and QT interval
26
Cardiac tamponade features? Normal pericardial space- 20-50ml fluid
Beck's triad - hypotension, distended JVP, muffled hs, pulsus paradoxus kussmal sign, ewart/pin's sign - bronchial sounds below angle of left scapula CXR: bottle shaped heart. RF: surggery, mets, end stage renal disease, trauma, TB
27
ALS: stable narrow complex, regular tachycardia?
likely SVT - trial vagal manouvers, then 6mg iv bolus adenosine, then 12mg, then 12mg, escalate
28
Stable patient, Broad complex, regular tachy?
IV amiodarone 300mg
29
Points when counselling on Af anticoagulation? Do you offer anti-coagulation to <65YO with no other RF?
anticoagulation reduced risk by 2/3. Risk of stroke is x5 higher with AF and risk of severity is higher. No dont offer if only score is for sex
30
Driving advice for Mi/ CABG/pacemaker/ angio?
no driving for 1 week after angio, pacemaker, successful angio no driving for 4 weeks after STEMI/ NSTEMI/ CABG Return to work within 2 months no sex for 1 month
31
Cheyne stokes breathing?
progressively deeper and shallower in brainstem stroke/ raised ICP
32
30YO male south eastern patient with collapse? ECG shows?
Brugada sign - ST elevation 2mm+ in V1-3 and T wave negative
33
pansystolic murmur post MI?
Mitral regurg (damage to papillary muscle) - can be 3-5 days after/ VSD - can present1-2 weeks post mi
34
Features of mitral stenosis?
rumbling mis-diastolic murmur loud on expiration with patient on left side., malar flush, AF, fatiuge, SOB, palpatations
35
Causes of IE?
Staph A Staph A (coagulase negative) Streptococci (viridans, subacute) Group D streptococcus (acutre and subacute) strept intermedius A, C, G - acute, high mortality GBS - pregnancy, elderly HACEK fungi enterococci
36
ECG: J waves, long PR, long QRS, long QT, AF
Hypothermia
37
24 YO footballer, LAD, sinus brady, LVH, SOB, chest pain, dizziness after training, systolic murmur on left sternal edge
Hypertrophic cardiomyopahty AUtosomal D,exercsie testing to see severity, Digoxin contraindicated in aF, anticoagulate, counsel, amiodarone for arrhythmias, outflow obstruction - BB/verapamil. prophylactic abx bc raised risk of IE/
38
pulseless paradoxus seen in?
12+ raise in BP on inspiration (abnormal) PE, constrictive pericarditis, rapid and laboured breathing, RV infarction with shock, restrictive cardiomyopathy, severe obstructive pulmonary disease,
39
Lone AF?
AF in <60 with no evidence of cardiac conditon
40
Advice to give when someone has 1st degree HB?
reassure, caution when using BB/ diltiazem, digoxin, declare on driving/ health insurance. small risk of aF developing.
41
Angina TX? If using CCB with BB/ ivabradine?
1) BB or CCB (DHP, rate limiting verapamil/ diltiazem) if CI 2) Beta blocker + CCB (non-DHP - amlodipine/felodipine/nifedipine) 3) Add nitrate, ivabradine, nicorandil (ulceration risk) or ranolazine Amlodipine can be used if HF Verpamil and BB = very bad
42
Post Mi complications timing of conditions?
0-4hrs - Cardiogenic Shock, CHF, arrhythmia 4-24hrs - Arrhythmia 1-3 days - Pericarditis 4-7 days - Rupture of ventricular free wall, interventricular septum, or papillary muscle Months - Dressler syndrome, aneurysm, mural thrombus
43
67 YO man, home BP is 145/95, QRISK is 8%. MX? what if BP is 150/100?
stage 1 HTN - treat if end organ damage/ QRISK 10%, known CVD/DM. If stage 2 treat regardless of age. (150/95+ at home)
44
PERC rule to rule out PE?
if all abscent can rule out: age 50+, HR100+, unilateral swelling, on HRT/ COCP, o2<94, previous DVT/PEsurgery/ trauma in 4 weeks, haemoptysis
45
75 nocturnal sob, occasional palpitations and tight chest pain. collapsing pulse and a laterally shifted apex beat. head bobs in time with his pulse
Quincke's sign (nailbed pulsation) De Musset's sign (head bobbing) Aortic regurgitation, early diastolic murmur increased when squeezing hand. (backflow during ventricular diastole)
46
Causes of AR?
RF (common, developing world) Marfans/ SLE/EDS/ ank spond/ bicuspid Aortic valve Acute: infective endocarditis/ aoritc dissection
47
SE and CI of nicorandil?
headache flushing skin, mucosal and eye ulceration gastrointestinal ulcers including anal ulceration Contraindications left ventricular failure
48
HF MX summary?
1st line: ACEi/BB(Bisoprolol, Carvedilol) 2nd line Aldosterone antagonist(Spironolactone, Eplerenone)/ SGLT2i 3rd line: involve a specialist for -Ivabradine(SR, HR>75+ EF <35%) -Sacubitril-valsartan( EF 35%+ Symptoms despite ACEi/ARB) -Digoxin( if coexistent AF) - Hydralazine+Nitrate( in Afro-Caribbean) -Cardiac resynchronization therapy( Widened QRS e.g. LBBB) Role of SGLT2i in preservd EF
49
Orthostatic hypotension - DX? TX?
BP > 20 mmHg or diastolic BP > 10 mmHg or decrease in systolic BP < 90 mmHg is considered diagnostic fludrocortisone, midodrine, compression, salt intake, head elevation
50
When to give 20 mg atorvastatin to t1dM?
40+, DM for 10 yrs+ Have established nephropathy Have other CVD risk factors (such as obesity and hypertension)
51
Statin SE monitoring CI other drugs?
Myopathy, LFTs, CI- macroglides (clarithromycin) and pregnancy,LFTs at baseline, 3 months and 12 months - stop if 3x upper limit
52
History of asthma, Marfan's etc Sudden dyspnoea and pleuritic chest pain
pneumothorax
53
Central crushing pain with absent distal pulse? If patient is too unstable for this imaging unequal arm pulses?
Dissecting aorta CXR - wide mediastinum CT angio CAP TOE - if unstable to get to CT scanner Risk of backward tear - inferior MI/ AR Risk of forward tear- unequal arm pulses, stroke, renal failure Standford and debakey classification
54
Syncope, chest pain, SOB, ES murmur that reduces with valsalva manouver?
AS. CX: <65 - bicuspid, >65 - degenerative calcification, post rF, HOCM chjildren - balloon Surgical AVR - if 40mmHG +/ symptomatic TAVR - for high risk (transcatheter AVR)
55
CX of IE associated with colorectal cancer? AF with indwelling lines?
Streptococcus bovis staph epidermis
56
TX of IE for native valve? suspected MRSA/ penicillin allergy or sepsis? NVE with severe sepsis/ RF for gram negative? Prosthetic valve endocarditis?
NVE): amoxicillin + gentamicin sepsis/allergy/MSRA: vancomycin + gentamicin NVE with severe sepsis and risk factors gram negative infection: vancomycin + meropenem Prosthetic valve endocarditis: vancomycin, gentamicin + rifampicin
57
What drug reduced efficacy of clopidogrel?
omeprazole
58
PE causes resp acidosis or alkalosis?
alkalosis (hyperventilation)
59
NSTEMI tx?
DAPT ticegralor and aspirin 12 months
60
persistent ST elevation post MI, no chest pain?
left ventricular aneurysm do echo after as thrombus can developFc
61
Post MI 2-5 days inferior MI, pulmoary oedaema sx?
papillary muscle rupture
62
2 weeks after MI, ST elevation with PR depression widespread, pleuritic chest pain, fever?
dressler's syndrome
63
factors that can icnrease BNP?
LVH, ischaemia, PE, GFR <60, sepssi, COPD, DM, 70YO+, liver cirrhoris
64
factors that reduce BNP?
obestity, diuretics, Acie, BB, ARB, aldosterone antagonists
65
BB SE: HF tx that causes ototoxicity?
nightmares, sleep disturbances, ED, cold peripheries, fatigue, CI: verapamil, asthma, uncontrolled hf furosemide - ototoxic
66
Post MI, pansystolic murmur, reduced hs. after 1-2 weeks?
VSD 9do echo to exclude MR
67
posterior/ inferior MI with new pulmonary oedema, HTN post MI 3-5 days?
acute MR. due to papillary muscle rupture/ischaemia
68
most common cx of death inpost MI?
ventricular fibrillation
69
Conditions that predispose to pericarditis? Dr Is TRUMP
DR Is TRUMP Dressler, Radiotherapy, infection (coxsackie), SLE, TB, RA, Uraemia, Malignancy, Post MI
70
HCOM: most likely cx of death? ECHO features? MR SAM ASH ECG features?
ventricular arrhtymias, echi: MR, systolic anterior motion of anterior mitral valve leaflet, asymmetric hypertrophy ECG: LVH - deep ST depression, T waves inversions,
71
ace i SE:
angiodaema, CI b/l RAS, pregnancy, creatine rise 30%+ baseline
72
STEMI mx? time for PCI anticoagulation? radial/femoral access? fibrinolysis?
aspirin,PCI within 12 hrs of sx and 120 mins faster than med give pasugel (if no other anticoagulant), chlopi (if on other blood thinners) radial access - give UFH, with GIP bailout. femoral access - give bivalirudin with bailout GPI fibrinolysis - antithrombin and repeat ecg in 60 mins-90 mins. pci if still MI
73
NSTEMI MX for immediate PCI? for not immediate PCI? conservative mx? PCI MX? - what to give before which one better for raised bleeding risk/ on other antivoagulants?
aspirin fondaparinux - if not having PCI immediately, not at high risk of bleed unfractionated heparin - if creatin 265+, immediate PCI plan Conservative mx: DAPT with ticegralor/ chlopidogrel PCI within 72 hrs: UFH before and DAPT after
74
STEMI dx values?
ACS sx 20 mins+ 2ECG leads : 2.5 mm (i.e ≥ 2.5 small squares) STEMI in V2-3 in men under 40 years, ≥ 2.0 mm (40 M +) women: 1.5 mm STEMI V2-3 1 mm ST elevation in other leads new LBBB
75
HTN Mx summary?
140/90+ do Home tx stage 1 - if <80/ t2dm/ckd/end organ dysfunction 2) 150/90 at home/ 160/100 in clinic tx whatever age 3)180/120+ <55YO/ T2DM/ not black - give A over CCB
76
Acute HF Mx?
HF with BP< 85 - inotropic agents in ITU if respiratory failrue - CPAP continue regular meds unless BB - stop if HR <50
77
Post MI MX?
echo at 3 months (immediately after mi can giv efalse low EF) give BB, ACe, high statin dose, DAPT - aspirin lifelong, other for 1 month
78
Vasculitis AF smoking and raynaud's phenomenon/ intermittent claudication/ ischaemic ulcers/ superficial thrombophlebitis?
buerger's disease
79
Major bleeding with warfarin - IC bleed? mx if any bleeding? if INR 8+ INR 5-8? no bleeding?
regardless of INR, give iv vit K, prothrombin complex if bleeding , give iv vit K, repeat in 24 hrs restart when <5. INR 8+ - no bleed, give Po 5-8 - with-hold or give iv if bleeding.
80
when to start Af anticoagulaion in TIA and stroke?
TIA - start DOAC of warfarin asap stroke - wait 2 weeks
81
post inferior MI, sx of left ventricular failur, drop in BP, eary-mid systolic murmur?
papillary muscle rupture causing acute mitral regurg
82
4 weeks post anterior MI with pulmonary oedema, persistent STEMI in anteiror leads?
left ventricular aneurysm
83
AS features?
narrow pulse oressure, slow rising pulse, LVH, soft S2, thrill over cardiac apex ESMurmur decreased post valsalva manouver
84
ST change leads 2, 3 , AVF
RCA, inferior MI AVN supply - also present with arrhythmia
85
ST changes anterolateral MI>
V1-6, lead 1, AVL
86
ST changes in V1-4?
LAD, anteroseptal
87
Left circumflex A ST changes?
1, AVL, V5-6
88
HF drugs that actually reduce mortality?
BB.ACEi/ARB, alodsterone antagonist, hydralazine and nitrates
89
Heart Block mneumonic?
longer longer, drop, wenchebech if some Ps dont get through, you've got mobitz 2, if Ps and Qs dont agree, you've got 3rd degree
90
normal variant in athelete? warrents urgent referral on ECG?
1st HB, mobitz 1 (wenchebach, junctional rhythm, sinus bradycardia HCOM ECG:
91
secondary HTN CX: pregnant 10 weeks with K+ of 3.1?
primary hyperaldosteronism (most common cx of secondayr htn)
92
HTn, headahce,s excessive sweating, bitemp hemianopia?
acromegaly
93
HTN with asymmetrical kidney disease and IHD cx?
B/L renal artery stenosis
94
drug cx of secondary THN?
leflun0mide, NSAIDs, COCP, seeroids, MOAi
95
medical cardioversion of AF? Structual?
flecainide amiodarone - if any structural heart disease
96
Conservative mx of NSTEMI?
fondaparinux, ticegralor and aspirin 2nd line is chlopidogrel if high bleeding risk
97
BP targets for 80YO+ <80
150/90 at home: 145/85 <80: 140/0 (at home: 135/85)
98
if statin 20mg is started for primary prevention when would you increase it to 80mg?
if non HDL has not fallen by 40%
99
central chest pain with diastolic murmur. what is shown on angiogrpahy?
ascending aorta - giving AR. aortic dissection shows false lumen
100
post tx of SVT, sudden chest pain after resolution?
adenosine used for SVT. SE: flushing, chest pain, bronchospasm (CI asthma)
101
HTN already on indapamide, amlodipine, acie,. K is 4.5+ what can be added
doxazosin/ BB if K <4.5, can add spironolactone
102
Low voltage QRS causes?
pericardial effusion, obesity, emphysema, pneumothorax, myxoedema, restrictive cardiomyopathy, scleroderma, constrictive pericarditis, MI previously
103
criteria used to diagnose familial hypercholesterolaemia?
TC 7.5+/ LDL 4/9+ tendon xanthomata in patient/ 1st/2nd degree relative simon broome criteria
104
when should you stop statin before trying to conceive?
3 months before
105
definition of prolonged pericarditis?
recurrent - 4-6 weeks after fist ep chronic - 3 months admit after 1 week
106
when to admit for pericarditis?
fever, tamponade (risk), troponin, trauma, on anticoagulants, nsaids dont work, immunosuppression
107
pericarditis ECG changes?
saddle shapes ST elevtaion/ concave and PR depression acutely with reciprocal changes then late stage t waves inversions
108
ejection systolic murmur that diappears when squatting
HCOM (auto. dom) most common cardio genetic condition
109
ECG of HCOM?
LVh (increased voltages), dagger life deep narrow Q waves, left atrial enlargment (p mitrale), arrhythmias
110
IX for HTN?
ECG urinalysis,, hba1c, 12 lead ecg, U+Es
111
black person with HTn, no other sx and obese?
essential HTN
112
east asian man, intverted t waves in right pericordial leads and ST elevation? FH early death during day time car crash?
brugada syndrome (AF sudden unexplained noctunal dath syndrome/
113
sick sinus syndrome definition?
abnormal SAN function, bradycardia, cardiac insufficiency.
114
peripheral arterial disease tx? level of ABPI?
structured exercise. offer naftidrofuryl oxalate ABPI <0.9 <0.5 is critical limb 1.4+ suggests calcification/ vascultiis/ dm

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