Cardiology

Question 1

What findings are seen in acute pericarditis?

Answer 1

1. fever, recent upper respiratory infection
2. pleuritic chest pain
3. diffuse ST segment elevation/PR depression on ECG
4. Triphasic systolic and diastolic rub - pericardial friction rub

Question 2

Why is a permanent pacemaker indicated in
Third degree AV block (complete heart block)?

Answer 2

In complete heart block there is atrioventricular dissociation, where the atria and ventricles contract independently.

An escape rhythm originating from an accessory pacemaker in the lower chambers activates the ventricles at a slow rate of around 30 bpm.

Question 3

What is the definitive management of STEMI

Answer 3

Percutaneous coronary intervention - PCI to provide revascularisation

Question 4

What are the “adverse signs” in ventricular tachycardia?

Answer 4

syncope
myocardial ischaemia/chest pain
heart failure
depressed conscious level

Question 5

When is sedation and synchronised direct current (DC) shock indicated in VT?

Answer 5

When there are adverse signs

Question 6

VT management if there are no adverse signs

Answer 6

Loading dose of intravenous (iv) amiodarone 300 mg

Question 7

What is the initial treatment of acute pericarditis?

Answer 7

Ibuprofen

Question 8

CABG (Coronary artery bypass) indications

Answer 8

when a coronary angiogram shows significant stenosis (> 50%) in the presence of severe angina

ST depression on exercise ECG

left main stem stenosis, severe triple-vessel disease

angina with left ventricular dysfunction.

Question 9

What is a normal QT interval in women?

Answer 9

360 to 460 ms

Question 10

What is a normal QT interval in men?

Answer 10

350 to 450 ms

Question 11

What ECG changes may be seen in hypokalaemia?

Answer 11

U waves following T waves
Amplified and widened p WAVES
ST depression
QT prolongation

Question 12

What is the most common cause of death post-MI?

Answer 12

Lethal arrhythmias e.g. ventricular fibrillation

Question 13

ECG findings in Second degree heart block - Mobitz type 1

Answer 13

progressive lengthening of the PR interval over several complexes before a non-conducted P-wave would occur

Question 14

What is the definitive management for Cardiac tamponade?

Answer 14

Treatment is urgent pericardiocentesis, with a 20-ml syringe and 18G needle, to aspirate the pericardial fluid.

The safest way to perform this procedure is under echocardiographic guidance.