Cardiology

Question 1

What are some causes of heart failure?

Answer 1

Ischaemic heart disease, myocarditis, cardiac tamponade

Question 2

What are symptoms of heart failure?

Answer 2

Left sided heart failure will cause pulmonary congestion - SOB on exertion, orthopnoea, paroxysmal nocturnal dyspnoea, nocturnal cough, and cyanosis, prolonged cap refill and hypotension.
Right sided heart failure can result in venous congestion - Ankle swelling, weight gain, abdominal distention, anorexia, raised JVP, pitting oedema, hepatomegaly, ascites, plural effusions

Question 3

What investigations should be done if you suspect heart failure?

Answer 3

• ECG as it may provide clues to the underlying cause such as arrhythmias.
• B natriuretic protein as this is released when there is myocardial stretch. Sensitive diagnosis for heart failure.
• Bloods (U+Es, LFTs, TFTs, glucose)

Question 4

What are the chest X ray findings for heart failure

Answer 4

ABCDEF

• Alveolar oedema (bat wings)
• Kurly B lines (interstitial oedema)
• Cardiomegaly,
• Upper lobe diversion,
• Plural effusions,
• Fluid in horizontal fissure

Question 5

What is the pharmacological management of heart failure?

Answer 5

• ACEi or B blockers, loop diuretics and if that doesnt work then consider alternatives eg, spironolactone
  In acute heart failure (LMNOP) - loop diuretics (furosemide), Morphine, GTN if systolic over 110mmHg, Oxygen, position patient up-right.

Question 6

What are the subtypes of acute coronary syndrome?

Answer 6

Unstable angina, NSTEMI and STEMI

Question 7

Give some examples of non MI chest pain

Answer 7

Cardiac - Myocarditis, pericarditis, valvular disease, aortic dissection.
Pulmonary - PE, pneumonia, pneumothorax.
GI - oesophageal spasm, oesophagitis, peptic ulcer.
MSK - Rib fracture, muscle injury, costochondritis

Question 8

What artery is effected in the following:

• Inferior infarct,
• Anterior infarct,
• Septal infarct,
• Lateral infarct,
• Posterior infarct

Answer 8

• Inferior infarct - RCA
• Anterior infarct - LAD
• Septal infarct - Proximal LAD,
• Lateral infarct - Left circumflex
• Posterior infarct - RCA or Left circumflex

Question 9

What is the management of STEMI/NSTEMI

Answer 9

MMONAC

• Morphine,
• Metoclopramide,
• Oxygen,
• Nitrates (sublingual GTN),
• Aspirin (300mg),
• Clopidogrel
• For STEMI do primary percutaneous coronary intervention
• For NSEMI do anti-thombin treatment (LMWH)

Question 10

All post MI patients should be put on what medications?

Answer 10

SAAB

• Aspirin and second anti-platelet (clopidogrel),
• Beta blocker (bisoprolol),
• ACE inhibitor (ramipril)
• Statin (atorvastatin)

Question 11

What are possible complications of MIs

Answer 11

• Ventricular arrhythmias, recurrent ischaemia, mitral regurgitation, heart failure, heart block

Question 12

What are the symptoms of angina

Answer 12

Constriction like pain in the chest/arm/neck/jaw,
Brough on by physical activity,
alleviated by rest/GTN

Question 13

What are the investigations and management for stable angina?

Answer 13

Investigations - ECG and bloods (FBC for anaemia, TFT for hyperthyroidism)
First line treatment - Lifestyle changes, aspirin, statins, Sublingual GTN and Beta blocker or CCB.

Question 14

What is unstable angina?

Answer 14

Chest pain which occurs either at rest or with minimal exertion which lasts for over 15mins, with new ST depression or T wave inversion but no troponin rise