Cardiology

Question 1

stable angina investigation

Answer 1

coronary angiogram

Question 2

treatment of stable angina

Answer 2

dual antiplatelet therapy

Question 3

Investigation for a STEMI

Answer 3

already done an ECG so straight to angiogram as a troponin would take so long to come back

Question 4

stable angina

Answer 4

ORBIT trial between PCI and medical therapy is on going.

stent if 70% stenosed with PCI

Question 5

IHD investiation in stable

Answer 5

functional and anatomical

functional test for ischaemia like ETT
Anatomical Coronary angiogram

Question 6

IHD ivx acute or unstable IHD

Answer 6

Serial ECG
Blood markers
Further tests

Question 7

if no ST elevation and normal trop what could it be still and what would you do

Answer 7

unstable angina

aspirin/clopi/LMWH

Question 8

no st elevation and raised trop

Answer 8

NSTEMI

Question 9

IHD STABLE management catergories

Answer 9

Lifestyle
Medical Therapy
Revascularisation

Question 10

Medical Therapy of STABLE IHD further categories

Answer 10

Preventative - antiplatelet
Symptoms - GTN spray, long acting nitrates
Alternative antianginals - BB

Question 11

Types of revascualrisaiton of heart

Answer 11

PCI - baloons and stents

CABG

Question 12

UNSTABLE IHD Mx

Answer 12

Pain - analgesia + oxygen
Ischaemia - aspirin and clopi plus antithrombotic treatment LMWH
Serial ECG

Question 13

HF - Reduced ejection fraction is what type of failure

Answer 13

Systolic

HFrEF

Question 14

Preserved ejection fraction is what type

Answer 14

HFpEF

diastolic failure

Question 15

Chronic Heart Failure causes

Answer 15

Myocardial
Pressure
Arrhythmias

Question 16

Myocardial causes of HF

Answer 16

IHD
Tocins
Infectious
INfiltrative
metabolic
genetic

Question 17

Pressure causes for HF

Answer 17

HTN
valvular disease
pericardial disease
high output
volume overload

Question 18

importance of diastolic heart failure

Answer 18

with something like AF where this no atrial contraction it relies on sucking from ventricles relaxing. This won’t happen! Need BB to slow AF?

Question 19

How IHD causes HF

Answer 19

Frank starling mechanism - increasing end diastolic pressure to try and increase output

hypertrophy from La Place relationship due to increase wall stress. More muscle fibre.

This hits a limit

then heart dilates

heart can’t maintain blood pressure with cardiac output so increasing Total preipheral resistance

salt and water retention to increase pre load.

RAAS - angiotenisin II to retain water and aldosterone release
Anit diuretic hormone from baroreceptors due to decreased BP

Adrenergic response to increase Peripheral vasculature through increased sympathetic tone of blood vessels

continuous sympathetic stimulation to increase HR - more cell death from ischaemia

eventually prelkoad is too much for heart - congested

the high levels of angiotensin/aldosterone increase cytokine production and get adverse heart remodelling

Question 20

signs of CHF

Answer 20

JVP
Hepatojugular reflux
Gallop
Displaced apex
Murmur