Cardio - recap

Question 1

STEMI - Mx

• acute
• secondary prevention

Answer 1

acute

• PCI if present <12hrs after onset and transfer within 120mins
• • give aspirin, praugrel and unfractionated hep first
• thrombolysis with IV alteplase/ tenelectase if presemnt <12hrs after onset
• • give antithrombin first
• MONA - morphine, oxygen, IV nitrates unless hypotensive, aspiring 300mg

secondary - 6As

• atenolol
• aspirin 75mg od
• atorvastatin 80mg o.n
• ACEi
• angiotensin-R antagonist if HF
• another antiplt - ticagrelor or clopidogrel (high bleed risk)

Question 2

NSTEMI - Mx

• acute
• secondary

Answer 2

acute - BATMAN
- b-blocker - atenolol
- aspirin 300mg
- ticagrelor 180mg - clop if high bleed risk
- morphine IV
- anticoag - foundaparinoux 
- nitrates IV
\+ oxygen if <94%

GRACE score - >3% - risk of MI/ death in 6months high
- elective PCI within 4D

secondary - 6As
secondary - 6As
- atenolol
- aspirin 75mg od
- atorvastatin 80mg o.n
- ACEi
- angiotensin-R antagonist if HF
- another antiplt - ticagrelor or clopidogrel (high bleed risk)

Question 3

stable angina - Mx

Answer 3

symptomatic - GTN spray, repeat after 5 mins and call 999

LT symptom - BB/ CCB (verapamil/ diltazem if mono and dihydropyridine if with BB)
- 2nd - LA nitrate, ivobradine, nicorandil, ranolazine

secondary prevention - 4As - atenolol, ACEi, atorvastatin, aspirin

Question 4

ASD - Mx

Answer 4

percutaneous transvenous catheter closure
or open heart surgery

anticoag - warfarin, aspirin, DOAC

Question 5

VSD - Mx

Answer 5

percutaneous transvenous catheter closure or open heart surgery
IN risk of infective endo - abx prophylaxis

Question 6

coarctation of aorta - Mx

Answer 6

severe - emergency surgery at birth
percutaneous balloon angioplasty with stent
open surgery
mx of HTN

Question 7

posterior STEMI

Answer 7

V1-3 - ST depression, tall broad R waves, upright T weaves, dominant R wave in V2
ST elevation in V7-9

Question 8

CCF - Mx

Answer 8

a

Question 9

pulmonary oedema - Mx

Answer 9

a

Question 10

valve disease - Mx

• AS
• MR
• AR
• MS
• PS
• PR
• TS
• TR

Answer 10

a

Question 11

infective endocarditis - Mx

Answer 11

4 week IV benzyl pen

surgery if

• haem instability
• severe HF
• uncontrolled sepsis
• valvular obstruction
• large vegetation
• prosthetic valve
• persistent bacteraemia
• repeat emboli
• aortic root abscess

Question 12

complications - STEMI

- LT

Answer 12

DREAD

death
rupture - septum (VSD), papillary muscles - 1W
eodema, emboli
aneurysm, arrhythmia
dresslers - pericarditis 2-3W, mx with NSAIDs and steroids if severe

Question 13

complications - STEMI

- immediate

Answer 13

arrythmia after reperfusion

bradycardia, AV block

Question 14

stable angina - Ix

Answer 14

1st - CT coronary angiogram
2nd - MI perfusion scintigraphy, stress test echo, first pass contrast enhanced MRI, MR imaging
3rd - invasive coronary angriography

Question 15

causes clubbing

Answer 15

cardio - IE
resp - Pulmonary fibrosis, lung cancer, asbestosis, CF
liver - liver failure

Question 16

Ix - acute LVF

Answer 16

obs
cardio (3rd HS, bibasal crep), resp exam (tachypnoeic, tachycardic)
bloods - BNP, trop
ECG, CXR (kerley b lines)
ECHO

start treatment before echo and bnp

Question 17

mx - acute LVF

Answer 17

POUR SOD
pour - stop IV fluids, fluid balance (UEs, daily body weight, fluid intake)
Sir up
O2
Diuretics - IV furosemide 40mg stat
monitor

Question 18

mx - renal stones

Answer 18

WW if <5mm
shockwave lithotripsy - analgesia, <2cm
ureteroscopy - if pregnant and lithotripsy CI or complex stone, leave stent for 4W after (<2cm and pregnant)
perc nephrolithotomy - complex renal, staghorn calculi, under GA, if hydronephrosis

Question 19

recurrent renal stone - mx

Answer 19

increase oral intake
fresh lemon juice in  water - citric acid binds urinary calcium
avoid carbonated drinks
reduce salt (<6g/day)
normal calcium intake

calcium stones - reduce oxalate food e.g. spinach, beetroot, nuts, rhubarb, black tea
uric acid - meat, liver, anchovies, sardines, spinach
limit dietary protein

Question 20

ix - renal stones

Answer 20

obs - ?sepsis
fluid balance
exam - abdo
urine dip, bloods
axr - shows calcium but not uric acid
non contrast CT-KUB
- uss if pregnant

Question 21

pancreatic pseudocyst - present

Answer 21

peripancreactic fluid in fibrous/ granulation tissue
persistent mild evelated amylase
ix - CT, ERCP, MRI, endo uss
mx - 50% resolve by 12W, endoscopic or surg cystogastrotomy or aspiration