Cardiology

Question 1

Most commonly affected arteries by atherogenesis

Answer 1

1. LAD
2. Circumflex
3. RCA

Question 2

Difference between anginas and STEMIS

Answer 2

No troponin in anginas, increased in STEMIs

Question 3

Ischaemic heart disease diagnosis

Answer 3

• Resting ECG, exercise ECG
• Gold standard - CT CORONARY ANGIOGRAPHY
• Biological markers- troponin, myoglobin, CK

Question 4

Ischaemic heart disease treatment

Answer 4

• Standard treatment BANS - betablocker (e.g. bisoprolol), antiplatelets (aspirin + clopidogrel), nitrate (GTN spray), statins (simvastatin)
• Acute presentation (UA/NSTEMI) BMOAN - b-blocker, morphine, oxygen, aspirin, nitrate
• Acute STEMI - PERCUTANEOUS CORONARY INTERVENTION (PCI)
• If not available within 120 minutes then fibrinolysis (alteplase, streptokinase)

Question 5

Cor pulmonale def

Answer 5

Abnormal enlargement of right side of heart as result of disease of lungs or pulmonary vessels

Question 6

Heart failure diagnosis

Answer 6

• Gold standard blood test - INCREASED BRAIN NATRIURETIC PEPTIDE (BNP) levels
• ECG
• CXR for cardiomegaly, B-lines, alveolar oedema

Question 7

Heart failure treatment

Answer 7

Acute - OMFG - oxygen, morphine, furosemide, GTN spray

• Chronic:
• Lifestyle
• Medical - AABCDD
• 1st line - Ace-i + B-blocker
• 2nd line - ARB + nitrate
• 3rd line - cardiac resynchronisation or digoxin
• Diuretics - furosemide (symptom relief)

Question 8

B-blocker and ACE-i contraindications

Answer 8

• B-blockers contraindicated for asthma

- ACE-i contraindicated for pregnant patients, general anaesthetic and renal failure

Question 9

Antihypertensive treatment

Answer 9

• 1st line - ACE-i
• 2nd line - ACE-i + CCB OR ACE-i + diuretic
• 3rd line - ACE-i + CCB + diuretic
• For diabetics, ACE-i ALWAYS 1st line
• For black patients, start with CCB as not responsive to ACE-i

Question 10

Pericarditis causes

Answer 10

Infectious
- Viral (common) - COXSACKIEVIRUS
- Bacterial - MYCOBACTERIUM TUBERCULOSIS
Non-infectious
- Trauma (common)

Question 11

Pericarditis presentation

Answer 11

• Chest pain, relieved by sitting forward, worsened by inspiration
• Fever/shortness of breath - sign of infection
• Pericardial friction rub

Question 12

Pericarditis investigation/treatment

Answer 12

• ECG (diagnostic) gold standard and 1st line - SADDLE SHAPED ST ELEVATION, PR DEPRESSION
• NSAIDs (ibuprofen) + colchicine

Question 13

Cardiac tamponade def/pres/investigation/treatment

Answer 13

• Complication of pericarditis, accumulation of fluid in pericardial space compressing heart chambers which overall reduces cardiac output
• BECKS TRIAD - falling BP, rising JVP, muffled heart sound
• ECHOCARDIOGARM
• Pericardiocentesis (removal of fluids in pericardial space)

Question 14

Infective endocarditis organisms

Answer 14

• Staph aureus - IVDU
• Strep viridans - non-IVDU/oral surgery
• Staph epidermidis - prosthetic valves

Question 15

Infective endocarditis pres/diagnosis

Answer 15

• Fever, fatigue, loss of appetite
• If someone comes in with FEVER AND NEW MURMUR, suspect IE
• Modified Duke’s criteria
• Gold standard - echocardiogram

Question 16

Infective endocarditis treatment

Answer 16

Antibiotics (4-6 weeks)

• If staph - flucloxacillin + rifampicin + gentamicin
  
  • MRSA - Vancomycin + rifampicin + gentamicin
• Not staph - Benzylpenicillin + gentamicin
• Not sure (1st line) - FAG - flucloxacillin + ampicillin + gentamicin

Question 17

Heart failure symptoms

Answer 17

SOFA PC

• Shortness of breath
• Orthopnoea (difficulty breathing lying down)
• Fatigue
• Ankle swelling
• Pulmonary oedema (due to backflow from decreased CO; produced cough with pink frothy sputum)
• Cold peripheries
• Raised JVP
• End respiratory crackles