Cardiology

Question 1

Bloods when starting ACEi

Answer 1

Check U+E before + at 2 weeks

• Allowed a 30% increased in creatinine
• Allowed K up to 5.5

Question 2

Significant renal impairment after starting ACEi

Answer 2

Bilateral renal artery stenosis

Question 3

Which hypertensive drug if <55 or T2DM?

Answer 3

ACEi or ARB

Question 4

Which hypertensive drug if >55 + no T2DM or Afro Carib + no T2DM

Answer 4

CCB

Question 5

2nd line hypertensive

Answer 5

ARB/ACEi + CCB or ARB/ACEi + thiazide diuretic

Question 6

3rd line hypertensive

Answer 6

ARB/ACEi + CCB + thiazide like diuretic

Question 7

4th line hypertensive

Answer 7

If K < 4.5 - add spironolactone
If K > 4.5 - add BB or AB

If BP not controlled with 4 steps then specialist review

Question 8

1st degree heart block

Answer 8

Consistent prolongation of the PR interval

Question 9

2nd degree heart block - Mobitz type I (Wenkebach)

Answer 9

Progressive prolongation of the PR interval until eventually the QRS complex is dropped

Question 10

2nd degree heart block - type II

Answer 10

Consistent PR interval with intermittently dropped QRS complexes. Typically repeats after every 3rd or 4th p wave (3:1 or 4:1)

Question 11

3rd degree heart block

Answer 11

No electrical communication between atria and ventricles due to failure of conduction
P waves + QRS have no association with each other

Question 12

Stoke adams attack

Answer 12

Collapse without warning
Pallor followed by flushing on recovery
Bradycardic
Usually lasts 10-30s - some seizure like activity occurs if attack is prolonged
Rapid recovery but maybe some slight confusion

Question 13

What heart block is typically seen on ECG during a stokes adams attack?

Answer 13

3rd degree

Question 14

QRS complex for a supra ventricular tachyarrythmia

Answer 14

Regular - narrow

Question 15

QRS complex for a ventricular tachyarrythmia

Answer 15

Wide e.g. VT, VF, torsades de pointe

Exception = WPW - supra ventricular but has wide QRS due to ventricular preexcitation

Question 16

Treatment for bradycardia

Answer 16

Atropine

Question 17

WPW ECG

Answer 17

Short PR interval

Wide QRS with delta wave

Question 18

Torsades de pointes

Answer 18

Form of VT with a long QT syndrome
Usually drug induced but also caused by hypoK
Can progrèss to VF/death

Tx = IVI Mg usually effective
- Don’t give anti arrhytmics - they worsen it

Question 19

Treatment for PSVT

Answer 19

1st = vagal manoeuvres 
2nd = IV adenosine (CI in severe asthma)

Long term = ablation
2nd line = medical tx
- AVNRT = BB, verapamil, diltiazem
- AVRT = fleicanide (digoxin + verapamil CI in WPW)

Question 20

Treatment for sustained VT with HD stable

Answer 20

Amiodarone

Question 21

Doses of IV adenosine

Answer 21

6mg then 12mg then 12mg

Question 22

Which drug can you not prescribe with beta blockers?

Answer 22

Verapamil

- Risk of complete heart block

Question 23

Stable angina management

Answer 23

All get statin + aspirin
S/L GTN to abort 
Use either a BB or CCB 
- If CCB alone - use verapamil or diltiazam
- If with BB - then use amlodipine 
If still sx then use dual BB + CCB

Question 24

Valvular heart disease + AF = absolute need to… ?

Answer 24

Anticoagulate

If CHA2DS2VASc score suggests no need to anticoagulant - need to do an echo to check for any valvular heart disease

Question 25

HASBLED score

Answer 25

HTN - 1
Abnormal renal function (Cr > 200 or dialysis)
OR
Abnormal liver function (cirrhosis, BR 2x normal, ALT/AST/ALP 3x normal) - 1 for both so worth 2
Stroke - 1
Bleeding, hx of bleeding, tendency to bleed - 1
Labile INRs - 1
Elderly >65 - 1
Drugs predisposing to bleeding (APs or NSAIDs)
OR
Alcohol use (>8 drinks/week) - 1 for each so worth 2

Score >3 indicates high bleeding risk