Cardiology

Question 1

Management of Angina (Pectoris)

Answer 1

1. ) Pharmacological
   - aspirin + statin + ß-blocker (atenolol up to 100mg)
   - can add CCB (nifedipine), if CCB for monotherapy should be verapamil or diltiazem
   - if cannot tolerate dual BB + CCB, can add one of: isosorbide mononitrate, ivabradine, nicorandil
   - triple therapy only whilst awaiting PCI or CABG

Question 2

Infective Endocarditis

Answer 2

1. ) Risk Factors
   - rheumatic valve disease, prosthetic valves
   - congential heart defects, IV drug users, poor dental hygiene
2. ) Organisms
   - S. aureus (most common), esp in IV drug users
   - coagulase -ve Staph e.g. S. epidermidis: within 2 months of prosthetic valves
   - viridans strep (S. mitis/sanguinis): poor dental hygiene
   - S. bovis: associated with colorectal cancer
   - culture negative causes: prior Abxs, Coxiella, HACEK
3. ) Clinical Features
   - low grade fever, pancystolic murmr
   - can cause a stroke (emboli from vegetation)
   - splinter haemorrhages, osler nodes, janeway lesions