Cardiology treatment

Question 1

Hypertension

Answer 1

1st line:
If <55 ACEI or ARB
If >55 or afrocarribean CCB

Add on: ACEI/ARB + CCB

Add on: Thaizde diuretic

If resistant: low dose spironolactone

NEVER ARB AND ACEI
ARB is 2nd step for afrocarribean patient

Question 2

CHD

Answer 2

Manage underlying cause
GTN
Secondary prevention: aspirin, ACEI, statin
B blocker/CCB
B blocker + amplodipine
If contraindicated then: Isosorbide mononitrate/Ivabradine/Nicorandil
Revascularisation procedures: PCI (antiplatelets and anticoagulants before) , CABG

Question 3

Unstable Angina

NSTEMI

Answer 3

MONA + T

Revascularisation (PCI, thrombolysis, CABG)

Question 4

STEMI

Answer 4

MONA + T

PCI/thrombolysis

Question 5

Stable angina

Answer 5

GTN
Secondary prevention: aspirin, ACEI, statins
B blockers/CCB
Isosorbide mononitrate/ivabradine
CABG/PCI angioplasty

Question 6

Heart Failure (acute)

Answer 6

Sit up
Oxygen
IV Furosemide
IV Diamorphine

Question 7

Heart Failure (chronic)

Answer 7

Lifestyle
Frusemide
ACEIs + B blockers
Spiralactone
Digoxin, Ivabradine
Other vasodilators - nitrates, hydralazine
CABG

Question 8

Supraventricular Tachycardia

Answer 8

Vagal manoeuvres - valsava manoeuvre, carotid massage

IV adenosine

IV verapamil

Question 9

Atrial Fibrillation

Answer 9

Digoxin + CCB/B blocker
Disopyramide + amiodarone
DC cardioversion
If permanent AV node ablation or pacine for older patients
Anti-coagulate for stroke risk

Question 10

Atrial flutter

Answer 10

Amiodarone
DC cardioversion
Radiofrequency ablation
Anticoagulation

Question 11

Ventricular tachycarida

Answer 11

Unstable - DC cardioversion

Pulseless - defibrillation

Stable - disopyramide + amiodarone

Life threatening - ICD

Question 12

Ventricular fibrillation

Answer 12

Defibrillation
IV magnesium chloride
ICD

Question 13

Torsades de points

Answer 13

IV magnesium chloride
Isoprenaline
Pacemaker

Question 14

Sinus bradycardia

Answer 14

IV atropine

Pacing

Question 15

1st degree heart block

Answer 15

No block medications

Question 16

2nd degree heart block

Answer 16

Mobitz I: Stop block medications

Mobitz II: Pacemaker (+atropine)

Question 17

3rd degree heart block

Answer 17

Pacemaker + atropine

Question 18

Bundle branch block

Answer 18

IV atropine

Pacemaker

Question 19

Mitral regurgitation

Answer 19

Diuretics and ACEI
Surgical repair (prolapse)
Surgical replacement

Question 20

Mitral stenosis

Answer 20

Diuretics, B blockers, digoxin (treat AF)

Valve replacement

Question 21

Aortic regurgitation

Answer 21

Diuretics and ACEI

Valve replacement

Question 22

Aortic stenosis

Answer 22

Valve relacement

Balloon valvotomy

Question 23

Acute lower limb ischaemia

Answer 23

Herapin, warfarin if severe
Angioplasty
Graft thrombolysis
Bypass grafting
Embolectomy

Question 24

AAA >5.5 cm

Or >1cm/year/symptomatic

Answer 24

Lifestyle advise
Fitness testing
Endovascular stenting
Open surgery

Question 25

DVT

Answer 25

Anticoag | Compression

Question 26

Varicose veins

Answer 26

Compression stockings Foam scleropathy Endovenous ablation

Question 27

Stroke

Answer 27

ABCDE, oxygen Thrombolysis Hemicraniectomy Address risk factors

Question 28

Hypertrophic cardiomyopathy

Answer 28

Low risk: amiodarone Med risk: b blocker + verapamil High risk: ICD

Question 29

Arrythmogenic right ventricular cardiomyopathy

Answer 29

Non-life threatening: B-blockers | Symptomatic: Amiodarone, Sotalol

Question 30

Myocarditis

Answer 30

Treat underlying cause | ACEI, B blocker, spronolactone, digoxin

Question 31

Pericarditis

Answer 31

NSAIDS

Question 32

Chagas disease

Answer 32

Benzidazole