Cardiology

Question 1

Major criteria of Rheumatic Fever

Answer 1

In history - Migratory Polyarthritis
In PE- Erythema Nodosum, Sydenham’s Chorea, Subcutaneous nodules
In Invg - Acute Carditis ( Cardiomegaly)

Question 2

Minor criteria for Rheumatic Fever

Answer 2

1. Arthralgia
2. Fever,
3. Invg - FBE with ESR & CRP

Question 3

COST VMPF
for DVT and PE

Answer 3

C = Contraception (OCP)
O = Obesity
= Occupation
S = Surgery
= Smoking
T = Travel
= Tumour
V = Varicose veins
M = Malignancy
P = Past medical history
F = Family history of DVT or cancers

Question 4

27 year old woman came to the GP with leg pain.

What are the causes of leg pain/calf pain?

Answer 4

1. DVT
2. PVD
3. Insect bite/Cellulitis
4. Diabetic foot
5. Neuropathic pain
6. Trauma/fractures
7. Gout/psuedogout

Question 5

Management of DVT

Answer 5

1. Admit to the hospital immediately to be seen by specialists
2. Investigations:
   - FBE with ESR and CRP
   - UEC
   - LFT
   - Coagulation profile with Thrombophilia screening
   - INR
   -Doppler USG of the legs
   - CTPA to check PE
3. Start on anticoagulants- Newer anticoagulants (Apixaban)
   Duration will depend on the cause

Side effects of NOAC:
- heavy periods
- nose bleeds
- dark stools
- bleeding even after minor injuries

4. Advice:
   
   • Stop OCP, use any other contraceptioon
   • inform other doctors before starting any other medication because they might interact with the NOAC and decrease their efficacy
     - before you travel, meet the doctor for travel advice

Question 6

Management of PVD

Answer 6

Condition: Peripheral vascular disease
It is the condition where the blood pipes in your legs can become occluded with deposition of fatty substances and reducing the blood supply to your legs. That’s why you have pain while walking

Causes: risk factors
- high blood pressure
- high blood sugar
- high cholesterol level
- smoking
- medications like beta blockers

1. Investigations :
   - Full blood count with ESR and CRP
   - urea, electrolyte and creatinine,
   - liver function test
   - Coagulation profile with thrombophilia screening
   - serum lipid profile
   - blood sugar level
   - ECG
   - doppler ultrasound of the legs to show the level and degree of the obstruction
2. Stop the beta blocker
3. Lifestyle modifications- SNAP
4. Refer to a specialist who will decide on further management.

Question 7

Management of Angina

Answer 7

1. Admit to the hospital where you will be seen by specialists
2. Secure an IV access and send blood for Investigations:
   - FBE with ESR and CRP
   - UEC
   - Iron profile
   - S. Lipid profile
   - BSL
   - LFT
   - Cardiac markers and troponin
   - Coagulation profile with thrombophilia screening
   - ECG
   - ECHO (by specialist)
3. MONA
4. Angiogram by cardiac specialists
5. Colonoscopy and gastroscopy by the gastroenterologist
6. B blocker for heart rate
   ACEi for HTN
   Statins for High cholesterol
7. Lifestyle modifications- SNAP
8. Angina Action Plan
   - Take a GTN spray and rest for 5 mins
   - If doesn’t decrease- take another spray and inform a friend that you are having a chest pain
   - If still doesn’t decrease- take another spray and call an ambulance and say I’m having a heart attack.