Cardiology

Question 1

what do you see on ECG in angina

Answer 1

normal ECG, no ST elevation
ST depression
T wave inversion
transient ST elevation

Question 2

acute and ongoing Mx for unstable angina

Answer 2

Acute: aspirin 300mg + clopidogrel 300mg
Ongoing: bisoprolol, atorvastatin if at risk of CVD. managing risk factors

Question 3

treatment protocol for STEMI

Answer 3

ECG, cardiac enzymes
Acute Mx: aspirin 300mg. PCI in 2 hours. if not available, do fibrinolysis (alteplase)
Ongoing management: dual platelet, bisoprolol, ACEI, statin

Question 4

Mx for NSTEMI

Answer 4

High/intermediate risk = PCI within 72 hours
Low risk = dual anti platelet therapy

Question 5

Pericarditis - 2 main causes + respective management

Answer 5

Viral (coxsackie virus) - NSAIDS, Colchicine
Dresslers syndrome (pericarditis at least 2 weeks post-MI)

Question 6

Dresslers syndrome triad

Answer 6

fever
pleuritic pain
pericarditis

Question 7

Pericarditis Dx

Answer 7

ECG: widespread saddle shaped ST elevation & PR depression
Exam: pericardial friction rub

Question 8

Central chest pain worse on inspiration, relieved when sitting forwards

Answer 8

Pericarditis presentation

Question 9

Beck’s triad used for?

Answer 9

cardiac tamponade
1. hypotension
2. raised JVP
3. quiet heart sounds

Question 10

Constrictive pericarditis

Answer 10

the pericardium become less elastic, constricts the heart.
Signs: raised JVP, hepatomegaly, oedema (signs of RHF)

Question 11

presents with fever and new murmur?

Answer 11

consider infective endocarditis. drug users

Question 12

ejection systolic murmur, radiates to carotid = ?
doesn’t radiate to carotid = ?

Answer 12

aortic stenosis radiates to carotid
aortic sclerosis doesn’t

Question 13

aortic dissection!
2 types, causes/Rx, presentation

Answer 13

Type A = ascending aorta
type B = descending aorta

Rx: hypertension!! smoking

presents with tearing chest pain

Question 14

Chest pain new onset. what do you do?

Answer 14

relieved by GTN/rest? yes, its stable angina
do ECG within ten mins
do troponin + repeat after 3 hrs

normal ECG, normal troponin = unstable angina
raised troponin? MI
ECG normal? = NSTEMI
ST elevation in contiguous leads? STEMI

Question 15

east asian female, attacks of chest pain in the night.
migraine/cocaine use
what is the pathology + Mx?

Answer 15

Prinzmetal Angina
Vasospasm of the coronary arteries
Mx: modify lifestyle factors, meds: nifedipine (calcium channel blocker)

Question 16

pulses paradoxus is seen in and what is it

Answer 16

cardiac tamponade

exaggerated fall in systolic bp ( >10mmHg) during inspiration