Cardiology

Question 1

Define Angina

Answer 1

Restricted perfusion of heart due to atherosclerosis. Stable and unstable forms.
Stable - pain on exertion

Question 2

Name the symptoms of angina

Answer 2

Pain or chest discomfort- tight, dull or heavy and passes within a few minutes.
Can radiate to left arm, neck, jaw, back.
Normally following exertion or stress, after a meal or cold weather.

Question 3

Name the causes of angina

Answer 3

Atherosclerosis (due to hypertension, hyperlipidaemia, smoking, diabetes, age, sex)

Question 4

How would you diagnose angina?

Answer 4

Symptoms based
Blood pressure tests 
Weight/height measured - BMI
Diabetic tests 
Urinalysis
ECG
Exercise tolerance test 
Coronary Angiography
Myocardial perfusion scintigraphy

Question 5

How would you treat angina with medication?

Answer 5

RELIEF: GTN or sublingual nitrate
PROPHYLAXIS: aspirin, beta-blocker, calcium channel blockers, long acting nitrates, ivabradine, nicorandil

Question 6

How would you treat angina with surgery?

Answer 6

coronary bypass or percutaneous coronary invasion

Question 7

Name the compilations of angina

Answer 7

Heart attack
Stroke
Depression

Question 8

How are the complications of angina preventable preventable

Answer 8

To reduce risk of heart attack and stroke: Statins, antiplatelets, ACEI

Lifestyle changes

Question 9

Define an acute MI

Answer 9

The ischaemic necrosis of a tissue of myocardium secondary to occlusion/reduction of the coronary blood supply

Question 10

Describe the symptoms of an acute MI

Answer 10

Severe crushing, heavy, central chest pain, radiates to jaw and arms, not relieved by GTN, associated with sweating, nausea/vomiting, dizziness

> 20 mins pain duration.

Question 11

What causes a MI

Answer 11

Artherosclerosis of coronary arteries

Question 12

How would you diagnose an MI

Answer 12

Symptoms based
ECG showing: ST elevation, T wave inversion, Q waves (but may be normal)
cardiac enzymes (troponin levels)

Question 13

How do you treat an acute MI

Answer 13

Morphine + anti-emetic
Oxygen
Nitrates
Aspirin 300mg + Clopigogrel

Reperfusion therapy: thrombolysis, percutaneous coronary intervention, coronary artery bypass
Angiogram

Question 14

What are the complications of an acute MI

Answer 14

Death, arrhythmia,

structural: aneurysm, inflammation
functional: acute LVF, cardiogenic shock

Question 15

How can you prevent an acute MI

Answer 15

Lifestyle changes (diet/exercise/smoking/alcohol consumption)

Question 16

Define Left sided heart failure

Answer 16

Low cardiac output from left side of heart. Can be acute or chronic.

Question 17

Name the symptoms of Left Sided Heart Failure

Answer 17

Pulmonary oedema
Orthopnoea
Paroxysmal nocturnal dysponea

Question 18

Name the signs you would find on examination for left sided heart failure

Answer 18

tachycardia
fine crepitations 
pleural effusion (more common in chronic)
third heart sound 
cardiomegaly
bat wing shades in lower zones on CXR

Question 19

Name the causes of left heart failure

Answer 19

Ischaemic heart disease
Cardiomyopathy
Valvular disease

Question 20

How would you diagnose left sided heart failure

Answer 20

Echo
ECG
Natriuretic peptide test