Cardiology

Question 1

What CHAD-VAS score should anticoagulation be recommended for in pAF?

Answer 1

CHADVAS of 2 or over anticoagulation is recommended.

Also important to consider the ORBIT score to consider bleeding risk

Question 2

When should Digoxin levels be taken?

Answer 2

Digoxin levels need to be taken at least 6 hours post-dose to allow time for it to be distributed throughout the body and reach steady state distribution

Question 3

What is the UK screening programme for abdominal aortic aneurysm?

Answer 3

All men regardless of risk factors get an invite for a one-off abdominal ultrasound at aged 65 to screen for AAA.
If a AAA is detected then they are followed up from there.

If AA width is < 3cm = normal
If AA 3-4.4 = small aneurysm - recan every 12 months
If AA 4.5 - 5.4 - medium aneurysm - rescan every 3 months
If AA 5.5+ - large aneurysm - urgent referral to vascular to be seen within 2 weeks for probable surgical intervention

Also need an urgent 2-wk vascular referral if symptomatic or enlarging >1cm per year.

Question 4

For patients that have had a previous TIA or stroke, they are recommended life long Clopidogrel. If they are allergic / unable to have Clopidogrel then what is the alternative for secondary prevention>?

Answer 4

lifelong Aspirin & Dipyridamole.

Question 5

What timing is recommended for the dosing of standard release Isosorbide mononitrate when used in angina ?

Answer 5

NICE recommends asymmetrical timing of doses e.g 8am and 4pm so ensure a 10-14 period overnight that is nitrate free to reduce the risk of the patient developing nitrate tolerance
(this is not relevant for those on OD modified release isosorbide mononitrate)

Question 6

Which group of antibiotics should be avoided for patients on statins?

Answer 6

MACROLIDES - do not give macrolides (erythromycin, azithromycin, clarithyromycin) alongside statins
They ^ the risk of rhabdomyolysis and statin-related myopathy

Need to stop statin therapy while on these abx if no alternatives possible.

Question 7

Which PPI is safe to co-prescribe with Clopidogrel?

Answer 7

There is some evidence to suggest that some of the PPIs may reduce the efficacy of Clopidogrel

Lansoprazole seems to be the safest PPI to use if the patient’s on Clopidogrel

Question 8

Which medication is associated with causing yellow-tinted vision (xanthopsia) when in toxic levels?

Answer 8

Digoxin

Question 9

True or false - obesity can falsely lower NT-proBNP levels?

Answer 9

True!
So if strong clinical suspicion of HF in someone with BMI > 35 then refer to cardio anyway for echo, even if BNP normal

Question 10

Which scoring system is now recommended by NICE to assess bleeding risk prior to commencing anticoagulation for atrial fibrillation?

Answer 10

ORBIT score

(now replaced the HAS-BLED)