Cardiology

Question 0

What is bifascicular block?

Answer 0

“R-wing LAD is bi”

RBBB + LAD on ECG.

RBBB with L hemifascicular block.

Question 1

Constrictive pericarditis

1. Clinical features
2. Aetiology

Answer 1

1. Rare, presents as heart failure.
   Prominent x and y descends on JVP, S3 heart sound.
2. TB, other viral and bacterial infections
   CTD (eg. Rheumatoid, SLE etc.)
   Chronic renal failure

Question 2

Hypertension - when to use CCBs?

Answer 2

Blacks of all ages, or >55y/o

If there are no contraindications, eg. Oedema, intolerance, high risk of heart failure.

Question 3

Hypertension: when to use thiazide-like diuretics, and name a few

Answer 3

When contraindicated to CCBAs

Chlortalidone, indapamide

Question 4

Step 1 treatment of HTN

1. When to use it
2. What does it include?

Answer 4

1. Stage 1 hypertension with one of following:
   End organ damage
   Renal failure
   Diabetes
   Established CVS disease
   Risk of cardiovascular event in 10yr of >20%
2. ACEi for young people without contraindications, or ARB
3. CCB for >55y/o and Africans
4. Thiazide-like diuretic

Question 5

When to use beta-blockers as anti hypertensives

Answer 5

“ACS”

ARBs/ACEi contraindicated in young people
Child-bearing age woman (eg. Labetalol in pre-eclampsia)
Evidence of Sympathetic overdrive.

Step 4 treatment (basically when nothing else seems to control it)

Avoid in COCAINE and AMPHETAMINE users!! (Unopposed alpha-stimulation)

Question 6

Hypertension treatment

Step 2

Step 3

Step 4

Answer 6

2. Add either ACEi or CCB/thiazide if they are not already on it
3. All 3
4. Plus spironolactone if not hyperkalaemic, try other stuff like alpha-agonists or beta-blockers.

Question 7

What is unopposed alpha-adrenergic stimulation, and when does it occur?

Answer 7

Cocaine, amphetamine or other alpha-agonist drugs.

Should NOT give beta-blockers in these cases, as will vasoconstrict and peripherally shut down

Question 8

Management of malignant hypertension

Answer 8

1. PO long-acting CCB
2. IV nitroprusside
3. IV phentolamine (mainly for phaeochromocytoma)

Question 9

When to use flecainide to cardiovert AF

Answer 9

No structural heart disease
<55y/o
No previous IHD
No hospital admissions