Cardiology

Question 1

ACE inhibitor monitoring:
Which blood test:
Acceptable rise in creatinine?
Acceptable rise of K+

Answer 1

Urea and electrolytes checked prior to treatment and after an increase in dose.

30% from baseline

5.5

Question 2

MI: secondary prevention standard therapy: 5 drugs

Answer 2

Aspirin
Clopidogrel (or other anti-platelet)
Beta-blocker
ACE inhibitor
Statin

Question 3

Adenosine: adverse effects

Answer 3

Chest pain: fear of impending doom
Bronchospasm: to be avoided in asthmatics
Transient flushing
Can enhance conduction down accessory pathways -> increased ventricular rate

Question 3

Acute pericarditis management

Answer 3

Majority managed as outpatients (patients with fever or elevated troponin should be managed as IP)

Combination of NSAIDS and colchicine -> 1-2 weeks until resolution of inflammatory markers

Question 3

Aortic dissection: Type A vs type B
Investigations:
Treatment:

Answer 3

Type A - ascending aorta. 2/3 cases
Type B - descending aorta 1/3 cases

A for ascending.

CXR: Widened mediastinum
CT angiography
TOE may be suitable for those who are too risky to tae to CT scan.

Type A: Surgical: Blood pressure should be controlled to a target systolic of 100-200 mmHg whilst awaiting intervention
Type B: conservative management -> IV labetalol to prevent progression.

Question 4

AF:
2 Key parts of management
Rate control methods:

Answer 4

1) Rate/rhythm control
2) Reducing stroke risk

Beta-blocker or CCB (rate-limiting) first line
can add digoxin if not controlled.

Question 5

Conditions to achieve rhythm control in AF

Scoring system for anticoagulation:

Answer 5

Patient must be anti-coagulated for at least 3 weeks prior to rhythm control method or have short duration (<48 hours) symptoms.

CHADS2VASC

Question 6

AV blocks - define and
1st
2nd (Mobitz 1, Mobitz 2)
3rd

Answer 6

1st: PR interval > 0.2 secs
2.I - progressive prolongationof the PR interval until a dropped beat occurs
2.II PR interval constant but P wave often not associated with QRS
3 No association with P wave and QRS

Question 7

Contraindications of beta blockers

Answer 7

Asthma
Uncontrolled heart failure
Sick sinus syndrome
Concurrent verapamil use: May precipitate severe bradycardia

Question 8

Beck’s triad
Seen in:

Answer 8

Hypotension
Raised JVP
Muffled heart sounds
Cardiac tamponade

Question 9

HOCM main findings

Answer 9

Echo: MR, systolic anterior motion of anterior mitral valve and asymmetric septal hypertrophy

Question 10

Types of secondary cardiomyopathy
Causes of each

Answer 10

Dilated and Restrictive

Dilated: Alcohol, Coxsackie B, Wet Beri Beri, doxorubicin

Restrictive: Amyloidosis, post-radiotherapy

Question 11

Causes of increased BNP:

Answer 11

Left ventricular hypertrophy
Ischaemia
Tachycardia
Right ventricular overload
Hypoxaemia
GFR <60
sepsis
COPD
Diabetes
Age > 70
Liver cirrhosis