cardiology

Question 1

what are the causes of myocarditis?

Answer 1

viral: coxsackie B, HIV
bacteria: diphtheria, clostridia
spirochaetes: Lyme disease
protozoa: Chagas’ disease, toxoplasmosis
autoimmune
drugs: doxorubicin

Question 2

what medications can be used to treat WPW?

Answer 2

definitive treatment: radiofrequency ablation of the accessory pathway

medical therapy: sotalol***, amiodarone, flecainide
sotalol should be avoided if there is coexistent atrial fibrillation as prolonging the refractory period at the AV node may increase the rate of transmission through the accessory pathway, increasing the ventricular rate and potentially deteriorating into ventricular fibrillation

Question 3

what is the tx for prosthetic valve endocarditis?

Answer 3

IV vancomycin + rifampicin + low-dose gentamicin

Question 4

What are the indications for surgery in IE?

Answer 4

severe valvular incompetence
aortic abscess (often indicated by a lengthening PR interval)
infections resistant to antibiotics/fungal infections
cardiac failure refractory to standard medical treatment
recurrent emboli after antibiotic therapy

Question 5

What are the features that make an ECG more convincing of a VT than a SVT with abberant conduction?

Answer 5

Absence of typical RBBB or LBBB morphology
Extreme axis deviation (‘northwest axis’): QRS positive in aVR and negative in I and aVF
Very broad complexes > 160ms
AV dissociation
Capture beats
Fusion beats
Positive concordance throughout the precordial leads
Negative concordance throughout the precordial leads
RSR’ complexes with an R>R’

Question 6

what are drugs that extend QT intervals?

Answer 6

amiodarone, sotalol, class 1a antiarrhythmic drugs
tricyclic antidepressants, selective serotonin reuptake inhibitors (especially citalopram)
methadone
chloroquine
terfenadine**
erythromycin
haloperidol
ondanestron

Question 7

what medications can cause VT in patients with WPW?

Answer 7

digoxin, adenosine, diltiazem, verapamil, other calcium channel blockers and beta blockers

Question 8

what is the testing that is needed to decide if someone needs aortic valve replacement?

Answer 8

if asymptomatic then observe the patient is a general rule

if symptomatic then valve replacement

if asymptomatic but valvular gradient > 40 mmHg and with features such as left ventricular systolic dysfunction then consider surgery

if asymptomatic but valvular gradient > 40 mmHg and with no LV failure - exercise testing

Question 9

What are the side effects of ivabradine?

Answer 9

visual disturbance including the phenomenon of phosphenes, or ‘flashing lights

Other visual symptoms described include green discolouration of visual field, blurring of vision and scintillating scotomata.

Question 10

what medication do you start for pulmonary hypertension if they have a positive response to acute vasoedilator testing?

Answer 10

calcium channel blockers

Question 11

what are the indications for MR surgery?

Answer 11

1. EF < 60%
2. Left ventricular end systolic diameter > 40mm
3. New onset of AF or
4. High likelihood of durable repair with low surgical risk and absence of risk factors