Cardiology

Question 1

Causes of an elevated troponin

Answer 1

• Trauma
• Cardioversion
• Rhabdomyolysis
• Pulmonary embolism
• Pulmonary hypertension
• Hypertension
• Hypotension, especially with arrhythmias
• Hypertrophic obstructive cardiomyopathy
• Myocarditis including Kawasaki’s disease
• Sepsis
• Burns
• Subarachnoid haemorrhage and stroke
• Infiltrative/autoimmune disorders including sarcoidosis, amyloidosis, haemochromatosis and scleroderma
• Drugs including Adriamycin, Herceptin and 5-fluorouracil

Question 2

Drugs that should be avoided in heart failure

Answer 2

• Antiarrhythmic drugs
• Non-dihydropyridine calcium antagonists, e.g. verapamil, diltiazem in patients with systolic chronic heart failure
• Tricyclic antidepressants
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Cyclooxygenase 2 inhibitors
• Corticosteroids
• Doxorubicin and trastuzumab
• Thiazolidinediones

Question 3

Factors decreasing BNP levels

Answer 3

• Obesity
• Diuretics
• ACE inhibitors
• Angiotensin 2 receptor blockers
• Beta-blockers
• Aldosterone antagonists

Question 4

Factors increasing BNP levels

Answer 4

• Left ventricular hypertrophy
• Right ventricular overload
• Diastolic dysfunction
• Tachycardia, AF
• Aortic stenosis
• Ischaemia
• ACS, stable angina
• Hypertension, Diabetes
• Sepsis
• Hypoxaemia (including pulmonary embolism)
• COPD, cor pulmonale
• Age > 70, women > men
• GFR < 60 ml/min (Acute & CRF)
• Liver cirrhosis
• Hyperaldosteronism, Cushing’s Syndrome

Link

Question 5

AV nodal blocking drugs

Answer 5

• Adenosine
• Verapamil
• Diltiazem
• Beta blockers
• Digoxin
• Amiodarone

Question 6

Medications safe to use in acute atrial fibrillation with preexcitation and the Wolff-Parkinson-White syndrome

Answer 6

• Procainamide
• Ibutilide
• Class IC antiarrhythmics like Flecainide, Propafenone
• Amiodarone can be considered when there is a structural heart disease

Question 7

Drugs that increase the risk of torsades de pointes (TdP)

Answer 7

• sotalol
• haloperidol
• methadone
• erythromycin
• procainamide

Notes:
Amiodarone prolongs QT interval, but it is considered to have a low risk for triggering TdP.

Question 8

Differentials for immediate post cardiac transplant cardiogenic shock

Answer 8

• Primary graft dysfunction (PGD)
• exacerbation of pulmonary hypertension
• cardiac tamponade
• hyperacute rejection

MCQs