Cardiology

Question 1

Signs of cardiac failure on CXR (5)

Answer 1

1. Alveolar edema
2. kerley-B line
3. Cardiomegaly
4. Dilaterd upper lobe
5. Effusion

Question 2

Management of acute cardiac failure (10)

Answer 2

1. Sit patient upright
2. Oxygen support
3. Treat underlying arrhytmia
4. 2 large bore (morphine, anti emetic)
5. Urgent investigation (ECG, CXR, ABF, BUSE, creat, echo, CBP)
6. Fluid resuscitation
7. Diuretics: furosemide
8. Vasodilator: nitroglycerin
9. Inotrophic agents (dopamine -> dobutamine -> norad)
10. Mechanical ventillator

Question 3

Management of chronic cardiac failure (10)

Answer 3

1. Strict bed rest: upright
2. Daily weight monitoring
3. Stirict I/O
4. CBD
5. Vital sign
6. DVT prophylaxis: heparin 5000 U TDS & TED
7. Treat causes
8. Avoid exacerbating
9. Stop smoking, less salt, ROF
10. Specific: Diuretic furosemide 40mg OD, ACE-I, B-blocker Carvedilol then Digoxin (careful), vasodilator Hydralazine

Question 4

American College of Cardiology/American Heart Association (ACC/AHA) staging for heart failure (4)

Answer 4

Stage A: High risk of heart failure, but no structural heart disease or symptoms of heart failure;

Stage B: Structural heart disease, but no symptoms of heart failure;

Stage C: Structural heart disease and symptoms of heart failure;

Stage D: Refractory heart failure requiring specialized interventions.

Question 5

NYHA functional classification (4)

Answer 5

Class I: HF does not cause limitations to physical activity; ordinary physical activity does not cause symptoms.

Class II: HF causes slight limitations to physical activity; the patients are comfortable at rest, but ordinary physical activity results in HF symptoms.

Class III: HF causes marked limitations of physical activity; the patients are comfortable at rest, but less than ordinary activity causes symptoms of HF.

Class IV: HF patients are unable to carry on any physical activity without HF symptoms or have symptoms when at rest.