Cardiology

Question 1

Which features score 2 points in the CHADSVASC score?

Answer 1

Age >75
Previous Stroke OR TIA

Question 2

What is the management of stable angina?

Answer 2

1st - Beta blocker
2nd - CCB (not rate limiting)

All patients should have aspirin and statin.

If beta blocker contraindicated, rate-limiting CCB

Question 3

What medical management should everyone have after an ACS?

Answer 3

DAPT - aspirin and clopidogrel
Statin

ACEi and beta blocker (same reason as why they are used in HF - prevents cardiac remodelling and improves systolic function)

Question 4

If someone has symptoms of ACS (chest pain, sweaty etc) and has ST depression V1-V3 on ECG, what’s the likely diagnosis?

Answer 4

Posterior MI

NB// also look out for posterolateral MI, where you would also have ST elevation in lateral leads

Question 5

Complication of RIGHT CORONARY ARTERY STEMI?

Answer 5

AVN affected, therefore 1st degree heart block and bradycardia

Question 6

Which medications are indicated in cardiac arrest VF/pulseless VT after 3 shocks?

Answer 6

BOTH 1g IV Adrenaline and 300mg IV Amiodarone

Question 7

List adverse signs of arrhythmia?

Answer 7

Shock, syncope, chest pain/acute ischaemia, acute HF

Question 8

What are the ECG findings of WPW?
Why is WPW dangerous?
What is the management?

Answer 8

broadened QRS, shortened PR interval, slurred upstroke ?

presence of congenital abnormal conduction pathway can conduct AF to VF (unlike AVN which has speed limit)

Ablation

Question 9

Does spironolactone improve mortality in heart failure?

Answer 9

Yes

Question 10

In HF with co-existent AF, which medication should be prescribed after the 1st/2nd line?

Answer 10

Digoxin

Question 11

Which T2DM drug is contraindicated in HF and why?

Answer 11

Pioglitazone - causes fluid retention

Question 12

How to differentiate familial vs non-familial hypercholesterolaemia?

What is the name of the criteria used?

Answer 12

Raised LDL >5
Xanthomata

Simon Broome Criteria

Question 13

What medication can be started as prophylaxis in someone with repeat episodes of VT? What monitoring is required and why?

Answer 13

Amiodarone

Can cause thyroid dysfunction, lung fibrosis and liver damage

Therefore need CXR, TFTs, LFTs (and Use)

It causes qt prolongation (kinda how it works in first place), so is still proarrythmic in a sense

Question 14

Which common medication does clopidogrel interact with which reduces its own effectiveness?

Answer 14

Omeprazole

Therefore switch to lansoprazole instead

Question 15

Broad QRS, small p waves, Tall T waves?

Answer 15

Hyperkalaemia

Question 16

Which drugs are used in pharmacological cardioversion in AF?

Answer 16

Flecainide if NO STRUCTURAL HEART DISEASE (scar tissue/abnormal tissue/anatomy alters electrical conduction, which can precipitate dangerous arrhythmias with flecainide)

Amiodarone

Question 17

What is the initial ALS algorithm if you witness a patient arresting whilst on cardiac monitoring and it is VF/pulseless VT?

Answer 17

Immediate 3 shocks (these count as 1) then commence CPR

Question 18

In who should you not use the QRISK score in? (and prescribe statins anyway)

Answer 18

T1DM
CKD
Familial hypercholesterolaemia

Question 19

What are the side effects of adenosine?

Answer 19

Bronchospasm (avoid in asthmatics)
Chest pain
Flushing
(impending sense of doom as pause in sinus rhythm)

Question 20

Which patients with AF should be anti coagulated?

Answer 20

If CHADVASC is 2 or more

In men, consider if 1

Question 21

What are the ECG changes in Hypokalaemia?

Answer 21

U have not pot and no T, but a long PR and long QT

ie. U waves (upward deflection at end of T wave)

Prolonged PR interval

Long QT

Question 22

Triad of raised JVP, hypotension and muffled heart sounds? What does ECG show? How to manage?

Answer 22

Pericardial effusion causing cardiac tamponade

ECG - alternating heights of R waves (electrical alternans)

Manage with urgent pericardiocentesis

Note: raised JVP either caused by HF/fluid overload or by cardiac tamponade.

Question 23

Which Abx class do statins interact with?

Answer 23

Macrolides (stop statin while on them)

Question 24

What is nicorandil and what is its side effect?

Answer 24

Nitrate-like drug used in angina

Side effect = mucosal ulceration (eyes, mouth, anus)

Question 25

What is the medical management of STEMI?

Answer 25

DAPT (aspirin + prasugrel if PCI OR ticagrelor if fibrinolysis)

ticagrelor is reversible, given fibrinolysis has high bleeding risk

Question 26

What are the complications of aortic dissection?

Answer 26

Forwards tear = stroke, upper limb ischaemia

Backwards tear = aortic regurgitation, cardiac tamponade

Question 27

Mx of aortic dissection?

Answer 27

Type A = surgical
Type B = conservative

BP control with IV labetolol

Question 28

What are the side effects of ACEi?

Answer 28

dry cough
angiooedema - swelling of mouth, face, tongue)

Question 29

What should the choice of anticoagulation always be in valvular AF?

Answer 29

Warfarin

Question 30

What is the antiplatelet/anticoagulation management post-stroke if it was caused by AF?

Answer 30

After 2 weeks, switch clopidogrel to anticoagulation

Question 31

What is new LBBB most likely to represent?

Answer 31

New LBBB is always pathological

It is most likely to represent an anterior MI

Question 32

What are the complications post-MI?
What is the most common?

Answer 32

Most common = VF

anatomical - pericardium, ventricle wall, septum (pericarditis, Dressler’s, LV anuerysm, LV free wall rupture, VSD)

Functional - Shock, Arrhythmia, chronic HF

Question 33

Choice of anti-HTN medication?

Answer 33

> 55 or Afro-Caribbean = CCB

Otherwise ACEi

Diabetics always get ACEi!

Question 34

What are the side effects of the GTN spray?

Answer 34

Hypotension, dizziness

Headache

(all of these due to vasodilation)