Cardio recap

Question 1

What drug should be prescribed to every patient with clinical syndrome of heart failure?

Answer 1

SGLT2i
(contraindicated in T1DM)

Question 1

Patient factors favouring rhythm control in AF:

Answer 1

Symptomatic
Age <65
1st presentation

Question 2

Indications for referral in HTN (5):

Answer 2

1. > 160/100 despite 3 drug management
2. Malignant HTN (urgent)
3. eGFR <30
4. Age <30, could be secondary cause
5. proteinuria + haematuria

Question 3

You should consider early dual therapy in a lot of patients when managing their hypertension. When should you consider monotherapy in the first instance?

Answer 3

Age >80 / frail patients
Grade I patients who are very low risk

Question 4

BP treatment targets:

Answer 4

<140/90 in all patients

Patients <65 target should be 130/80 if patients are tolerating treatment well

Question 5

Thresholds for grade I,II,III hypertension:

Answer 5

I = 140-159/90-99
II = 160-179/100-109
III = >180/>110

Question 6

Common complications post MI:

Answer 6

Death
Arrhythmia
Rupture (free wall, septum, papillary muscle)
Tamponade
Heart failure
Valve disease
Aneurysm
Dressler’s
Embolus
Recurrence, mitral regurg

Question 7

VSD, LV aneurysm, LV free wall rupture and acute mitral regurg features:

Answer 7

VSD = heart failure Sx with pansystolic murmur - echo to differentiate from mitral regurg.

LV aneurysm = due to weakness in myocardium. Persistent st elevation post MI. Risk of thrombus in the aneurysm, so anticoagulate.

LV free wall rupture = cardiac tamponade causing acute heart failure

Mitral regurg = pansystolic murmur

Question 8

When is cardioversion considered in AF?

Answer 8

Adverse features

Question 9

Contraindications to anticoagulant therapy:

Answer 9

Active bleeding, hepatic disease resulting in coagulopathy.

Relative - pregnancy, bleeding risk e.g. active peptic ulcer or recent head injury in last 12 months.

Question 10

Essential investigations in AF:

Answer 10

FBC for anaemia
TFTs for hyperthyroidism
ECG
TOE to exclude mitral stenosis
LFTs if alcohol abuse suspected

Question 11

HR targets in AF:

Answer 11

<110 all patients
<80 is still symptomatic

Question 12

Difference between the chadsvasc score and orbit score:

Answer 12

chadvasc is risk of stroke, orbit is risk of bleeding

Question 13

What type of murmur is seen in aortic stenosis? + symptoms

Answer 13

Ejection systolic radiating to carotids.

Chest pain, SOB, syncope.

Narrow pulse pressure, LVH

Question 14

Causes of aortic stenosis:

Answer 14

Degenerative calcification (>65)

Bicuspid aortic valve (<65)

HOCM (subvalvular)

Question 15

Classic cause of mitral stenosis:

Answer 15

Rheumatic fever

Mid to late diastolic murmur heard best on expiration.

Question 16

Features of mitral stenosis:

Answer 16

Rheumatic fever
Mid to late diastolic murmur, snap S1 due to mitral leaflets still moving

SOB and haemoptysis due to pulmonary hypertension

AF secondary to LA enlargement

Question 17

What is Kussmaul’s sign and what does it indicate?

Answer 17

JVP increase on inspiration - can be a sign of constrictive pericarditis.

(JVP should normally fall with inspiration due to reducing pressure in the thoracic cavity)

Question 18

Discuss heart rate responses in causes of orthostatic hypotension.

Answer 18

Anaemia and hypovolaemia: will have a increased HR response to reduced blood pressure.

POTS: an excessive HR response to reduced BP - >30 or up to >120.

Diabetes / Parkinson’s: autonomic neuropathy causes minimal or flat heart rate response.

Question 19

Features of aortic regurgitation:

Answer 19

Early diastolic murmur (hang grip manouevre)

Nail bed pulsation = Quincke’s sign

Wide pulse pressure

Question 20

Causes of AR due to valve disease (acute and chronic):

Answer 20

Acute = IE

Chronic = rheumatic fever, calcification, CTD and bicuspid aortic valve

Question 21

Causes of AR due to aortic root disease:

Answer 21

Acute = aortic dissection

Chronic = bicuspid aortic valve, Ank spond, syphilis, Marfan’s, ED

Question 22

Cyanotic vs non cyanotic congenital heart defects:

Answer 22

Cyanotic includes:
TGA
Fallot
Tricuspid atresia

Non-cyanotic:
VSD
ASD
PDA
coarctation of the aorta
Aortic valve stenosis

Question 22

Types of murmurs:

Answer 22

MR = pansystolic

AS = Ejection systolic radiating to carotids.

MS = mid to late diastolic

AR = early diastolic.