Cardio/vasc

Question 1

Peripheral arterial disease management?

Answer 1

Strongly linked to smoking
Treat comorbitidies - HTN, DM, obesity

• Statin (atorvastatin 80mg)
• exercise training

Severe PAD or critical limb ischaemia may be treated by:

• angioplasty
• stenting
• bypass surgery

Amputation should be reserved for patients with critical limb ischaemia who are not suitable for other interventions such as angioplasty of bypass surgery.

Question 2

CHA2DS2-VASc score?

Answer 2

Congestive heart failure - 1
Hypertension (or treated hypertension) - 1
Age >= 75 years - 2
Age 65-74 years - 1
Diabetes	- 1
Prior Stroke or TIA - 2
Vascular disease (including ischaemic heart disease and peripheral arterial disease) - 1
Sex (female) - 1

Question 3

Management of pericarditis?

Answer 3

First line - NSAID and colchicine

Pericarditis reminder

• pleuritic chest pain
• widespread ST elevation (saddle shaped)
• ECG changes are often widespread
• PR depression

All suspected pts with pericarditis - TTE

Question 4

Becks triad? What does it suggest?

Answer 4

Raised JVP
Hypotension
Muffled heart sounds

Suggests cardiac tamponade - urgent pericardiocentesis

May also see - dyspnoea, tachycardia, pulsus paradoxus, absent Y descent, ECG showing electrical alternans. Often Kussmaul sign negative (Kussmaul sign - JVP that doesnt fall with inspiration)

Question 5

What is WPW syndrome? What can you see on ECG?

Answer 5

congenital accessory conducting pathway between the atria and ventricles leading to a atrioventricular re-entry tachycardia (AVRT).

As the accessory pathway does not slow conduction AF can degenerate rapidly to VF

Possible ECG features:

• short PR interval
• wide QRS complexes with a slurred upstroke ‘delta wave’
• left axis deviation if right-sided accessory pathway
• right axis deviation if left-sided accessory pathway

Differentiating between type A and type B

• type A (left-sided pathway): dominant R wave in V1
• type B (right-sided pathway): no dominant R wave in V1

Question 6

Angina pectoris management (stable)

Answer 6

All - aspirin and statin (in absence of contraindications)
Sublingual GTN to abort angina attacks
Beta blocker or CCB based on cormorbidities/contraindications
- if CCB monotherapy use a rate-limiting one such as verapamil or diltiazem (and no b-blocker alongside - risk of complete heart block)

If poor response put to max dose
If still symptomatic after monotherapy with a beta-blocker add a calcium channel blocker and vice versa
If patient on monotherapy and cannot tolerate the addition of a CCB/BB then consider one of the following drugs: a long-acting nitrate, ivabradine, nicorandil or ranolazine

Question 7

Causes of long QT syndrome

Management?

Answer 7

Genetic

Electrolytes

• hypocalcaemia
• hypomagnesaemia
• hypokalaemia

Drugs

• antiarrhythmics
• antibiotics - macrolides, fluoroquinolones
• psychotropic drugs

Other

• myocarditis
• hypothermia
• subarachnoid haemorrhage

MANAGEMENT - IV Mag sulph

Question 8

MI and their corresponding coronary artery/ECG changes?

Answer 8

Anteroseptal: V1-V4 = LAD
Inferior: II, III, aVF = Right coronary
Anterolateral: V4-6, I, aVL = LAD or L circ
Lateral: I, AVL +/- V5/6 = L circ
Posterior: Tall R waves V1-2 = L circ or right coronary

Question 9

HOCM management?

Answer 9

Management
Amiodarone
Beta-blockers or verapamil for symptoms
Cardioverter defibrillator
Dual chamber pacemaker
Endocarditis prophylaxis*

Drugs to avoid
nitrates
ACE-inhibitors
inotropes