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Medicine Finals > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is the initial management of acute coronary syndrome?

A

300mg aspirin
Oxygen if sats below 94%
IV Morphine if severe pain
Nitrates

ECG

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2
Q

What is the criteria for a STEMI on ECG?

A

> 2mm in two or more chest leads
1mm in two or more limb leads
New LBBB

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3
Q

How is a STEMI managed?

A

First decide whether PCI can be done in 120 mins

If yes - give prasugrel + aspirin (clopidogrel + aspirin if already on an anti-coagulant)

During PCI give unfractionated heparin + glycoprotein IIb/IIIa

If not - thrombolyse with alteplase. also give fondaparunix
After the procedure give ticagrelor + aspirin (or clopidogrel + aspirin if already anti coagulated)

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4
Q

How is an NSTEMI managed?

A

300mg loading dose Aspirin
Fondaparunix (unless immediate PCI)

Conduct a risk score e.g. Grace score
If risk = less than 3% - give ticagrelor + aspirin (if already on anticoagulant, clopidogrel + aspirin)

If risk = more than 3% = PCI within 72 hours
Unless haemodynamically unstable then immediate PCI.
+ Give prasugrel/ticagrelor + aspirin (clopidogrel if already on an anticoagulant)
+ Give unfractionated Heparin

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5
Q

What are the two types of tachycardia?

A

Narrow complex and broad complex

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6
Q

Which type of tachycardia is more serious?

A

Broad complex

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7
Q

What are causes of narrow complex tachycardia?

A

Sinus tachycardia
Supraventricular tachycardia
Atrial fibrilliation

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8
Q

What are causes of broad complex tachycardia?

A

If regular - ventricular tachycardia

If irregular - AF + BBB

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9
Q

How is supraventricular tachycardia managed?

A

1st line = Vagal manoeuvre (e.g. valsalva manoeuvre or carotid sinus massage)

2nd line = IV adenosine, 6mg then 12mg then 18mg

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10
Q

How is ventricular tachycardia managed?

A

If hypotensive/chest pain/heart failure - immediate cardioversion

Otherwise - Amiodarone (loading dose + 24 hour infusion)

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11
Q

How does atrial fibrillation present on an ECG?

A

Irregularly irregular rhythm
Absence of P wave
Narrow complex

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12
Q

What are the different types of atrial fibrillation ?

A 
First detected episode
Recurrent episodes
Paroxysmal AF
persistent AF
Permanent AF
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13
Q

What symptoms can atrial fibrillation present with?

A

Palpitations
SOB
Chest pain
Dizzines

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14
Q

What are indications for rhythm control over rate control in AF?

A

First presentation of AF
Coexisting heart failure
Obvious reversible cause

Or, still symptomatic despite rate control

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15
Q

Which medication is used for rate control AF?

A

First line = BB (Atenolol)

Second line = CCB (Verapamil/Diltiazem) - avoid in heart failure (not in combination with BB)

Third line = Digoxin (used for people who also have heart failure)

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16
Q

What drugs are used for pharmacological cardioversion in AF?

A

Amiodarone or Flecainide

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17
Q

When is Flecainide CI?

A

Structural heart disease
Post myocardial infarction
Atrial flutter

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18
Q

When can cardioversion be done immediately and when does it need to be delayed in AF?

A

If AF began less than 48 hours ago - immediate cardioversion

If AF began over 48 hours ago - anticoagulate for 3 weeks then cardioversion

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19
Q

How do you decide which people with AF require anticoagulation?

A

Cha2ds2vasc score

Congestive heart failure
Hypertension 
Age >75 = 2, age 65-74 = 1
Diabetes
History of stroke/TIA/embolism = 2
Vascular disease
Sex (female)

If men - anticoagulants with 1 point
Women - needs 2 points

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20
Q

What is the anticoagulant of choice in people with AF?

A

DOAC - rivaroxaban/apixaban/dabigatran/edoxaban

If valvular AF - Warfarin

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21
Q

If someone with AF has a cha2ds2vasc score of 0 (or 1 in women), what do you need to make sure before not anticoagulating them?

A

Conduct an echo

If they have a valvular heart disease they need to be put on an anticoagulant

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22
Q

ST elevation in leads V3 and V4 indicate what type of MI?

A

Anterior

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23
Q

ST elevation in leads I, avL, V5 and V6 indicate an MI in which territory?

A

Lateral

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24
Q

ST elevation in leads II, III and avF indicate a MI in which territory?

A

Inferior

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25
Q

ST elevation in leads V1 and V2 indicate an MI in which territory?

A

Septal

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26
Q

What are the main causes of chronic heart failure?

A

Coronary heart disease or hypertension

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27
Q

How does chronic heart failure present ?

A 
Dyspnoea
Frothy pink sputum
Orthopnoea 
Paroxysmal nocturnal Dyspnoea 
Pitting oedema
Wheeze
Weight loss

Bibasal crackles on examination
Raised JVP
Hepatomegaly

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28
Q

What is the first line investigation in chronic heart failure?

A

NT-proBNP

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29
Q

What is classed as a high NT-proBNP

A

> 2000

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30
Q

What is classed as a raised NT-proBNP?

A

> 400

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31
Q

What do we do with a raised/high NT-proBNP?

A

Raised - echo within 6 weeks (>400)

High - echo within 2 weeks (>2000)

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32
Q

What ECG changes can be seen in chronic heart failure?

A

Left axis deviation

P wave abnormalities

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33
Q

What chest X-ray signs are seen in chronic heart failure?

A 
ABCDE
Alveolar oedema
Kerley B lines
Cardiomegaly
Dilated upper lobe vessels
Pleural effusion
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34
Q

What is the first line management for CHF?

A

Beta blocker (usually Bisoprolol) + ACEi

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35
Q

Which drugs may you need to consider stopping in CHF?

A

Calcium channel blockers - can depress cardiac function and exacerbate symptoms

Tricyclic antidepressants

NSAIDs - risk of decompensation

Corticosteroids

QT prolonging medication

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36
Q

What condition causes pleuritic pain, pleural effusion and fever 2-6 weeks after an MI?

A

Dressler’s Syndrome

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37
Q

How is Dressler’s Syndrome managed?

A

NSAIDs

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38
Q

How does a left ventricular free wall rupture present?

How is it managed?

A

Raised JVP, pulsus paradoxus, diminished heart sounds

1-2 weeks after MI

Urgent pericardiocentesis + thoracotomy

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39
Q

How is left ventricular free wall rupture managed?

A

Urgent pericardiocentesis + thoracotomy

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40
Q

How is angina managed?

A

Prescribe everyone a statin and aspirin 75mg daily (secondary prevention)

Consider ACEi if diabetes + angina (secondary prevention)

Prescribe GTN spray to use when needed

First line treatment = BB or CCB (for the angina)

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41
Q

How does acute heart failure present?

A

Symptoms:
Breathlessness
Oedema
Fatigue

Signs:
Cyanosis
Tachycardia 
Tachypnoea 
Raised JVP
Displaced apex beat
Bibasal crackles
Wheeze
S3 heart sound
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42
Q

How is acute heart failure managed?

A

IV Furosemide
If oxygen sats below 94% - oxygen
respiratory failure - CPAP

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43
Q

What is stage 1 hypertension?

A

A reading of >140/90 in clinic or >135/85 on home average

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44
Q

What is stage 2 hypertension?

A

A clinic reading of >160/100 or home average reading of >150/95

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45
Q

What is classed as severe hypertension?

A

A systolic of 180 or a diastolic of 110

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46
Q

When should you offer drug treatment for stage 1 hypertension?

A

If the patient is over 80 plus has one of the following:
Target organ damage
Established cardiovascular disease
Renal disease
Diabetes
10 year cardiovascular risk of 10% or over

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47
Q

What murmur is associated with aortic regurgitation?

A

Early diastolic murmur

Heard best with patient leaning forwards

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48
Q

What other features are seen in aortic regurgitation?

A

Collapsing pulse
Wide pulse pressure
Quincke’s sign (pulsation of nail bed)
de Musset’s sign - Head bobbing

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49
Q

What murmur is seen in aortic stenosis?

A

Crescendo-decrescendo ejection systolic murmur

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50
Q

What other features are seen in aortic stenosis?

A 
Narrow pulse pressure
Slow rising pulse
Slow or absent S2
S4 sound
Thrill

(Ejection systolic crescendo decrescendo murmur)

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51
Q

What is the most common cause of aortic stenosis in young patients under 60 years of age?

A

A bicuspid aortic valve

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52
Q

What is the most common cause of aortic stenosis in older patients over 60 years of age?

A

Degenerative calcification of the aortic valve

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53
Q

What is the most common cause of mitral stenosis?

A

Rheumatic fever

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54
Q

What murmur is characteristically seen in mitral stenosis?

A

A mid to late diastolic murmur of rumbling character

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55
Q

What other features are seen in mitral stenosis?

A

Loud S1 with opening snap
Low volume pulse
Malar flush
Atrial fibrillation

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56
Q

What ECG signs are seen in mitral stenosis?

A

P mitrale(bifid P wave)

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57
Q

What murmur is characteristically seen in mitral regurgitation?

A

Pansystolic murmur with a blowing/whistling character

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58
Q

What other features are seen in mitral regurgitation?

A

Soft S1
Widely split S2
S3 sound

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59
Q

What is rheumatic fever?

A

Reaction to a recent strep pyogenes infection (2 to 6 weeks ago)

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60
Q

How is rheumatic fever diagnosed?

A

Evidence of recent strep infection + either..
2 major criteria
OR 1 major + 2 minor criteria

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61
Q

What classes as evidence of recent strep infection in rheumatic fever?

A

Increased strep antibodies

Positive throat swab

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62
Q

What are the major criteria in rheumatic fever?

A

JONES - Joints, carditis, nodules, erythema marginatum, Sydenham’s chorea

Erythema marginatum (rash on body in shape of rings)

Sydenham’s chorea (muscle jerking)

Polyarthritis

Carditis and valvulitis

Subcutaneous nodules

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63
Q

What are the minor criteria in rheumatic fever?

A

Raised CRP or ESR
Pyrexia
Arthralgia
Prolonged PR interval

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64
Q

How is rheumatic fever managed?

A

Oral penicillin V and NSAIDs

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65
Q

What murmur is seen in a ventricular septal defect?

A

Ventricular septal defect has a pansystolic murmur

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66
Q

What is the most common form of cardiomyopathy?

A

Dilated cardiomyopathy

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67
Q

What can cause a broad QRS complex ?

A

Ventricular tachycardia

Bundle branch block (left or right)

Wolff-Parkinson White Syndrome

Hyperkalaemia

Hypothermia

Tricyclic poisoning

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68
Q

What is electrical alternans and what is the main cause of this?

A

QRS complexes alternate in height

Main cause = massive pleural effusion and cardiac tamponade

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69
Q

What is torsades de pointes?

A

A polymorphic ventricular tachycardia caused by long QT

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70
Q

What can cause torsades de pointes? (I.e. what can cause long QT?)

A

Low calcium

Low potassium

Low magnesium

Hypothermia

Raised ICP

Medications - tricyclic antidepressants, erythromycin

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71
Q

What can cause a short QT?

A

Hypercalcaemia

Digoxin

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72
Q

What are causes of RBBB?

A

Right ventricular hypertrophy

PE

MI

73
Q

How are palpitations investigated?

A

First line = ECG and bloods (U+Es, FBC, TFTs)

2nd line = Holter monitoring

74
Q

How is acute Bradycardia managed?

A

If in shock/syncope - IV 500 micrograms Atropine (up to max 3mg)

If atropine fails -

1) transcutaneous pacing
2) isoprenaline/adrenaline infusion
3) transvenous pacing

75
Q

What are causes of acute bradycardia?

A

Sinus or AV node disease

Drug induced - beta blockers, CCB

Electrolyte abnormalities

Hypothyroidism

76
Q

How does an “innocent murmur” present?

A

Asymptomatic

Systolic

Loudest in pulmonary area

Blowing

Vary with position

77
Q

Which anticoagulant is used in a patient with a prosthetic heart valve?

A

Warfarin

DOACs are contraindicated

78
Q

Which congenital conditions are associated with a ventricular septal defect?

A

Down’s Syndrome

Edward’s syndrome

Patau syndrome

79
Q

What murmur is seen in an atrial septal defect?

A

Ejection systolic murmur loudest on inspiration

Widely fixed splitting of S2

80
Q

Murmur: ejection systolic murmur loudest on inspiration, fixed splitting of S2

A

Atrial septal defect

81
Q

Murmur: ejection systolic murmur, crescendo-decrescendo

A

Aortic stenosis

82
Q

Which murmur is associated with a narrow pulse pressure and a slow rising pulse?

A

Aortic stenosis

83
Q

Murmur: early diastolic murmur, collapsing pulse and wide pulse pressure

A

Aortic regurgitation

84
Q

Murmur: rumbling mid to late diastolic murmur with opening snap

A

Mitral stenosis

85
Q

Which facial sign is seen in mitral stenosis?

A

Malar flush

86
Q

Murmur: whistling pan systolic murmur with soft S1 and widely split S2

A

Mitral regurgitation

87
Q

Which valve is most commonly affected by infective endocarditis?

A

Mitral valve

In IVDU - tricuspid valve

88
Q

What are risk factors for infective endocarditis?

A

History of rheumatic heart disease

Prosthetic valve

Congenital heart defects

IV drug user

89
Q

What is the most common causative organism of infective endocarditis?

A

Staph aureus

In patients who have had recent valve surgery in last 2 months - staph epidermidis

90
Q

Which criteria is used to diagnose infective endocarditis?

A

Modified Duke Criteria

Need 2 major OR 1 major + 3 minor OR 5 minor

91
Q

What are the 2 major criteria in infective endocarditis?

A

Positive blood culture

Evidence of endocardial involvement (positive echo or new valvular regurgitation)

92
Q

What skin signs can be seen in infective endocarditis?

A

Splinter haemorrhages

Janeway lesions

Petechiae

Osler’s nodes

93
Q

What are the minor criteria of infective endocarditis? (5)

A

Predisposing heart condition or IVDU

Fever

Vascular phenomena (petechiae, Janeway lesions)

Immunological phenomena (glomerulonephritis, osler’s nodes, Roth spots)

Microbiological evidence which does not meet major criteria

94
Q

What is the antibiotic management used in infective endocarditis?

A

Initial (no blood cultures): Native valve = amoxicillin, prosthetic valve = vanco + rifampicin + gent

Staph aureus: native valve = flucloxacillin, prosthetic valve = flucloxacillin + rifampicin + gentamicin

MRSA: Vanc + Gent

95
Q

What is the most common form of cardiomyopathy overall?

A

Dilated cardiomyopathy

96
Q

What is seen on CXR in dilated cardiomyopathy?

A

Balloon appearance of heart

97
Q

What are features of dilated cardiomyopathy?

A

Features of heart failure - breathlessness, oedema, raised JVP, paroxysmal nocturnal dyspnoea, orthopnoea

Systolic murmur

S3 sound

98
Q

What is the most common congenital cardiomyopathy ?

A

Hypertrophic obstructive cardiomyopathy

99
Q

What inheritance pattern does hypertrophic cardiomyopathy have?

A

Autosomal dominant

100
Q

What murmur is seen in hypertrophic cardiomyopathy?

A

Ejection systolic murmur loudest at the lower left sternal edge

101
Q

What signs are seen in hypertrophic cardiomyopathy?

A

Ejection systolic murmur

Jerky pulse

Displaced apex beat

Apical thrill

102
Q

Which medications should be avoided in hypertrophic cardiomyopathy? Why?

A

ACEi

Nifedipine

Nitrates

These medications reduce preload or afterload and can possible aggravate outflow tract obstruction

103
Q

What is Brugada syndrome?

A

A genetic condition caused by sodium channelopathies - common cause of sudden cardiac death

104
Q

What is the diagnostic criteria for Brugada syndrome?

A

VF / polymorphic VT (torsades de pointes)

Family history of sudden cardiac death

Syncope

Nocturnal agonal breathing (sounds like gasping/snorting)

105
Q

What are risk factors for sudden cardiac death in Brugada syndrome?

A

Fever

Excess alcohol intake

Dehydration

Hypokalaemia

Hypomagnasaemia

106
Q

What is pericarditis?

A

Inflammation of the pericardium

107
Q

What are features of pericarditis?

A

Pleuritic chest pain (relieved by leaning forwards)

Pericardial rub

Fever

Tachycardia

Tachypnoea

108
Q

What are causes of pericarditis?

A

Viral infections (e.g. Coxsackie)

TB

Trauma

Post-MI

Dressler’s Syndrome

Hypothyroidism

Malignancy

109
Q

What ECG changes are seen in pericarditis?

A

Saddle shaped ST elevation

PR depression

ECG changes are global (not in a specific territory)

110
Q

How is pericarditis diagnosed?

A

Transthoracic echo

111
Q

How is pericarditis managed?

A

NSAIDs + colchicine

Treat any underlying cause

112
Q

What is constrictive pericarditis?

A

The pericardium becomes hard and thickened - this then interferes with ventricular filling

113
Q

What causes constrictive pericarditis?

A

Any cause of pericarditis but especially TB

114
Q

What are features of constrictive pericarditis?

A

Can present with symptoms of right sided heart failure - Dyspnoea, elevated JVP, Hepatomegaly, oedema

Pericardial knock (loud S3)

Positive Kussmaul’s sign (raised JVP that doesn’t fall on inspiration)

115
Q

How is constrictive pericarditis managed? What if the initial management doesn’t work?

A

NSAIDs + colchicine

If no improvement -> pericardiectomy

116
Q

What is a pericardial effusion?

A

Collection of fluid within the pericardial sac - commonly occurs with pericarditis

Can be blood, fluid, exudate, air

117
Q

What is a cardiac tamponade?

A

An accumulation of fluid in the pericardium which is putting pressure on the ventricles

Associated with pericarditis

118
Q

What triad is seen in cardiac tamponade?

A

Beck’s triad

Hypotension, raised JVP, muffled heart sounds

119
Q

What are signs of cardiac tamponade?

A

Hypotension

Raised JVP

Muffled heart sounds

Dyspnoea

Tachycardia

Absent Y descent on JVO

Pulsus paradoxus (abnormally large drop in BP during inspiration)

120
Q

What ECG change is seen in cardiac tamponade?

A

Electrical alternans (alternating QRS amplitude)

121
Q

How is cardiac tamponade managed?

A

Pericardiocentesis

122
Q

Which DOAC can be reversed and what is used for reversal?

A

Dabigatran

Reversed with Idarucizumab

123
Q

What are contraindications to adenosine?

A

Asthma/COPD

Heart failure

Heart block

Severe hypotension

124
Q

How is torsades de pointes treated?

A

IV Magnesium sulfate, Cardioversion

125
Q

How can raised ICP show on an ECG?

A

Long QT

126
Q

What ECG change can be seen in rheumatic fever?

A

Prolonged PR interval

127
Q

How does acute mitral regurgitation after an MI present? And what causes it?

A

Caused by ischaemia or rupture of the papillary muscle

Can present with acute hypotension and pulmonary oedema

Early to mid systolic murmur

128
Q

If a patient has persistent ST elevation after their myocardial infarction what complication have they sustained?

A

Left ventricular aneurysm

129
Q

Which medications can decrease INR in a patient taking warfarin?

A

Phenytoin, carbamazepine

Rifampicin

St John’s wort

Chronic alcohol intake

Smoking

130
Q

Which medications can increase INR in a patient taking warfarin?

A

Ciprofloxacin

Clarithromycin/erythromycin

Isoniazid

Omeprazole

Amiodarone

Allopurinol

Ketoconazole/fluconazole

SSRIs

Sodium valproate

Acute alcohol intake

131
Q

What are indications for a pacemaker in a patient with acute bradycardia?

A

Complete heart block with broad complex QRS

Recent asystole

Mobitz type II AV block

Ventricular pause of more than three seconds

132
Q

Which murmur is associated with Marfan’s?

A

Aortic regurgitation

Early diastolic murmur

Collapsing pulse

Wide pulse pressure

133
Q

What ECG changes are suggestive of hypertrophic cardiomyopathy?

A

Left Ventricular hypertrophy

Non-specific T-wave inversions and ST segment abnormalities

Deep Q waves

134
Q

What echocardiogram findings are found in hypertrophic cardiomyopathy?

A

MR SAM ASH

Mitral regurgitation

Systolic anterior motion

Asymmetric hypertrophy

135
Q

How does hypertrophic cardiomyopathy usually present?

A

May be asymptomatic

Can be - exertional Dyspnoea, syncope typically following exercise, sudden death

136
Q

What are the conditions is hypertrophic cardiomyopathy associated with?

A

Friedrichs ataxia

Wolff-Parkinson white

137
Q

What further drugs can you consider adding in heart failure?

A

Aldosterone antagonist (spironolactone) - symptomatic relief only

Hydralazine + nitrate (especially in black/Caribbean)

Digoxin

Invabradine (if in sinus rhythm >75bpm and left ventricular fraction <35%)

138
Q

What heart failure drug can be considered in black and Caribbean patients?

A

Hydralazine plus nitrate

139
Q

What criteria must be met to prescribe ivabradine in heart failure?

A

> 75bpm

Left ventricular fraction <35%

140
Q

Which vaccinations do those with heart failure require?

A

Annual influenza vaccine

One-off pneumococcal vaccine

141
Q

When do beta blockers need to be stopped in heart failure?

A

Heart rate less than 50 BPM

2nd or 3rd degree AV block

Shock

142
Q

What are adverse affects of adenosine?

A

Adenosine is used to treat supraventricular tachycardia

Adverse effects include chest pain and bronchospasm

Also transient flushing

Feeling of impending doom

143
Q

Which patients is adenosine contraindicated in?

A

Asthmatics due to bronchospasm

144
Q

How is stable angina treated?

A
  1. Beta blocker or Verapamil

2. Beta blocker + Nifedipine

145
Q

How is AV block managed?

A

2nd degree heart block Mobitz type II and complete heart block both need transcutaneous pacing

1st degree + Mobitz type I = no treatment needed

146
Q

What type of cardiomyopathy are alcoholics at risk of?

A

Dilated cardiomyopathy

147
Q

Which leads does left circumflex artery affect?

A

I, aVL, +/- V5 and V6

148
Q

What are the main side effects of ACE inhibitors?

A

Cough

Hyperkalaemia

149
Q

What needs monitoring in patients taking ACE inhibitors and what are acceptable changes?

A

U&Es should be checked before treatment and after increasing dose

Rise in creatinine and potassium may be seen

Acceptable creatinine = 30% increase from baseline

Acceptable eGFR = 25% decrease

Acceptable potassium = up to 5.5mmol

150
Q

What does significant renal impairment after starting an ACE inhibitor suggest?
How would that be diagnosed?

A

Undiagnosed bilateral renal artery stenosis

CT angio

151
Q

What affect does ACE inhibitors have on the kidneys?

A

Vasoconstriction of afferent arteriole - Reduces glomerular blood flow

Not directly nephrotoxic but should be stopped in an AKI

Reno-protective in CKD

152
Q

What is the major contraindication to Verapamil?

A

Ventricular tachycardia

153
Q

Which valve is most commonly affected in infective endocarditis? What about in IVDUs?

A

Mitral valve

or Tricuspid valve in IVDUs

154
Q

What is the mitral valve?

A

Valve from left atrium to the left ventricle

155
Q

What is the aortic valve?

A

Valve from left ventricle to the Aorta

156
Q

What is the tricuspid valve?

A

Valve from right atrium to the Right ventricle

157
Q

What is the pulmonary valve?

A

Valve from right ventricle to the pulmonary artery

158
Q

What is Kussmaul’s sign and what is it seen in?

A

Raised JVP which rises or doesn’t fall on inspiration

Seen in constrictive pericarditis

159
Q

What is Beck’s triad and what condition is it seen in?

A

Raised JVP, muffled heart sounds, hypotension

Seen in cardiac tamponade

160
Q

What is pulsus paradoxus and which heart problem is associated with this?

A

Abnormally large decrease in BP during inspiration
Cardiac tamponade
Also can be seen in obstructive lung disease e.g. Asthma/COPD

161
Q

What should you consider in someone with a stroke/TIA/PE and a fever?

A

Infective endocarditis

162
Q

How does a ruptured papillary muscle post-MI present?

A

Acute hypotension
Pulmonary oedema
Mitral regurg murmur

163
Q

Which position is an aortic regurgitaton murmur heard best?

A

Patient leaning forwards

164
Q

What is Quincke’s sign and what is it a sign of?

A

Nailbed pulsation

Seen in aortic regurgitation

165
Q

What is De Musset’s sign and what is it a sign of?

A

Head bobbing

Seen in aortic regurgitation

166
Q

What should you consider in a patient with tachycardia and tachypnoea but no other signs?

A

PE

167
Q

What should be given instead of Adenosine for SVT in asthmatics?

A

Verapamil

168
Q

Which condition is associated with differences in BP in each arm? How is it investigated?

A

Aortic dissection – CT angiogram showing a false lumen

169
Q

What is the first line treatment for HTN in diabetes?

A

Black – ARB

Non-black – ACEi

170
Q

What marker is raised in Dressler’s syndrome?

A

ESR

171
Q

How does coarctation of the aorta present?

A

Systolic murmur loudest at LLSE
Weak pulses in the lower extremity

In adults can present with hypertension and notching of the inferior border of the ribs

172
Q

What to do after fibrinolysis in STEMI?

A

Repeat ECG in 60-90 mins

If ST elevation not resolved – urgent PCI

173
Q

Which artery is associated with a lateral MI?

A

Left circumflex/LAD

174
Q

How to differentiate between Mobitz type 2 and complete heart block?

A

In Complete heart block – P-P interval and R-R interval will always be the same
In Mobitz type 2 – R-R interval will not be the same

175
Q

How to manage a patient who has received a PCI but is still experiencing pain or haemodynamic instability?

A

Urgent CABG

176
Q

When does infective endocarditis need surgical management?

A

If it is causing congestive cardiac failure

177
Q

When does aortic stenosis require valve replacement?

A

Symptomatic

Asymptomatic + valvular gradient >40 + left ventricular systolic dysfunction

178
Q

How to treat acute heart failure not responding to treatment?

A

Consider CPAP

Medicine Finals (32 decks)

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