Cardiology

Question 1

diagnostic criteria for acute MI

Answer 1

rise in troponin or CK-MB
with at least one of the following:
1. typical MI symptoms (retrosternal/arm pain, diaphoresis, SOB etc)
2. development of pathological Q waves on ECG
3. ECG changes indicative of ischaemia (ST-elevation of depression)
4. coronary artery intervention
OR pathological findings of an acute MI

Question 2

when do you do troponins to rule out acute MI

Answer 2

one at presentation and one 6 hours after presentation, if pain/symptoms started within 2 hours of presentation.

Question 3

how long does troponin T stay elevated for?

Answer 3

10-14 days (so if someone comes in with chest pain 6 days after an MI, dont bother doing troponin T, do CK-MB)

Question 4

how long does CK-MB stay elevated for after acute MI

Answer 4

2-3days

Question 5

acute management of MI

Answer 5

aspirin
oxygen?
if not hypotensive give metoprolol (decrease myocardial oxygen demand)
GTN and IV morphine as required
transfer to regional centre for PCI if not already there
continuous cardiac monitoring/telemetry/serial ECGs

Question 6

acceptable time for PCI to be administered

Answer 6

90min since presentation as long as onset of symptoms within 2 hours of presentation.

if not possible: benefit might > risk up to 12 hours from symptom onset.

Question 7

what troponin forms are used for determining myocardial ischaemia

Answer 7

I and T

Question 8

man comes in with sx of acute MI, he has a positive troponin T, at what time is it appropriate to repeat the troponin.

Answer 8

never. don’t repeat if positive result –> organise PCI

Question 9

when is CK-MB more useful than troponin T

Answer 9

when recent MI (3-10 days ago)

Question 10

what ECG features confirm STEMI

Answer 10

>1mm ST-segment elevation in > or = 2 anatomically contiguous LIMB leads
or
>2mm " contiguous chest leads 
or 
new LBBB

Question 11

when would you do CABG instead of PCI/thrombolysis in patients with STEMI

Answer 11

• not suitable for PCI/thrombolysis
• cardiogenic shock
• in conjunction with mechanical repair (e.g. ruptured papillary muscle or ventricular septal defect)

Question 12

what complications of MI cause the highest mortality

Answer 12

VF or sustained VT

ventricular free wall rupture –> tamponade has high mortality within seconds but is far less common

Question 13

if someone has an ACS and present to hospital. what meds should you discharge them with?

Answer 13

aspirin +/- clopidogrel
betablocker (metoprolol)
ACEi 
Statin 
GTN spray PRN

Question 14

medical mx for pulmonary oedema

Answer 14

morphine
loop diuretics
nitrates

Question 15

mechanical mx for pulmonary oedema

Answer 15

BiPAP/CPAP

intubation

Question 16

definition of systolic heart failure

Answer 16

LVEF <40 %

Question 17

Definition of diastolic heart failure

Answer 17

impaired LV relaxation and normal/preserved LV function (>40% LVEF)

Question 18

which Beta-blockers have been shown to prolong survival in patients with CHF?

Answer 18

carvedilol
bisoprolol
extended-release metoprolol

Question 19

standard medical long-term therapy for CHF

Answer 19

ACEi
Beta blocker
Loop diuretic (frusemide)

Question 20

if someone is unable to do EST because they cannot run on a treadmill, what other test can you do?

Answer 20

dobutamine stress test

Question 21

when would you expect to find pulsus paradoxus

Answer 21

severe asthma
pericardial constriction
cardiac tamponade

Question 22

what is pulsus paradoxus

Answer 22

systolic pressure weakening in inspiration by >10mmHg

Question 23

when do you get a slow rising pulse

Answer 23

aortic stenosis

Question 24

when do you get a waterhammer or collapsing pulse

Answer 24

aortic incompetence, AV malformations and patent ductus arteriosus

Question 25

when do you get a bounding pulse

Answer 25

CO2 retention, liver failure and sepsis

Question 26

what characteristic of a pulse could you expect in HCM?

Answer 26

jerky pulses