Cardiology

Question 1

HEART score

Answer 1

1-history: not suspicious, moderately suspicious, highly suspicious
2-ecg: normal, non-specific changes, significant st segment deviation
3-age: <45, 45-64, >=65
4-risk factors: none, 1-2, >=3 or hx of atherosclerotic disease
5-troponin: normal, 1-3 x upper limit, >3 x upper limit

Each category scores 0, +1,+2 respectively

Question 2

Low risk features for ACS in chest pain

Answer 2

Age < 40
Normal ECG
Normal cardiac biomarkers 
Pain free at time of assessment 
Absence of high/intermediate risk features 
Features atypical for ACS

Question 3

High risk features for ACS in chest pain

Answer 3

• ECG:persistent or dynamic ST depression or T wave inversion, transient ST elevation, wellen’s
• Raised troponin
• Recurring or prolonged chest pain
• Sweating
• Syncope
• Association with cardiac failure, mitral regurgitation or hemodynamic instability
• LVEF < 0.4
• Previous MI, PCI or CABG
• Sustained ventricular tachycardia!!

Question 4

Features that allows discharge within 3 hours following presentation with chest pain

Answer 4

• No further chest pain
• Normal ECG
• Normal troponin at 0, 2
• Other serious causes excluded
• No syncope
• Hemodynamic stability
• No heart failure
• No previous MI, PCI or CABG
• LVEF >0.4

Question 5

Steps of emergent transcutaneous pacing for haemodynamically unstable bradycardia or AV block

Answer 5

• Attach pads(AP or left/right)
• Attach ECG monitoring, through the pacemaker or slave cable from the patient’s monitor
• Set to demand mode, >30 of intrinsic rate
• Start with 70 mAmp under increase gradually by 10 until there is electrical and mechanical capture
• Maintain current at 10 mAmp above capture threshold
• Analgesia and/or sedation as required

Question 6

Factors that would favor rhythm control approach in atrial fibrillation

Answer 6

• younger patient
• symptomatic
• lone fibrillation
• secondary to a treated or corrected precipitant
• cardiac failure

Question 7

Factors that would favor rate control approach to treat atrial fibrillation

Answer 7

• age >65
• sedentary life style
• coronary artery disease
• hypertension
• no cardiac failure
• unlikely to revert or stay in sinus rhythm, such as contra-indications to anti-arrhythmic drugs or structurally abnormal heart

Question 8

Situations to use electrical cardioversion for AF treatment

Answer 8

• time to reversal is important
• haemodynamically unstable
• florid APO
• associated myocardial ischemia
• known resistance to other therapies

Question 9

Situations to use flecainide to treat AF

Answer 9

• Onset < 48 hours or Ix showing no atrial thrombus
• no structural abnormalities of the heart
• normal QTc
• LVEF >40%

Question 10

Situations to use amiodarone for treatment of AF

Answer 10

Older patient 
Mild to moderate CCF
Structural abnormalities of the heart
High risk for sedation
Previously effective treatment

Question 11

When to cardiovert AF

Answer 11

Onset < 48 hours
Or
TOE shows no atrial thrombus
Or
TTE shows
-no atrial thrombus 
-no spontaneous echo contrast 
-no structural abnormalities of the heart 
Or
Gated multi detector CT shows no atrial thrombus