Cardiology workbook

Question 1

What is the ECG diagnosis

Answer 1

Inferior STEMI, RCA

Question 2

Immediate management of STEMI patient before cardiologist arrives and after

Answer 2

Before: MONA IV
Morphine, O2 if sats <94%, nitrates, Aspirin 300mg loading and anti nausea (ondansetron), secure IV access
A-E assessment

After: transfer to cath lab

Question 3

What long term medications should be prescribed following MI, prior to hospital discharge, to improve outcomes

Answer 3

ATABS
Aspirin 75mg OD for life, Ticagrelor (or prasugrel or clopidogrel), ACEi/ARB (LV remodelling), B blocker, Statin

Question 4

Features of CXR suggestive of heart failure

Answer 4

Cardiomegaly, alveolar oedema, perihilar shadowing

Question 5

Why do patients with heart failure develop ankle oedema

Answer 5

Heart cannot pump effectively, blood backs up into veins, increased pressure pushes fluid out due to higher hydrostatic pressure,causes swelling

Question 6

Treatment for acute presentation of heart failure vs chronic

Answer 6

Acute: loop diuretics, O2 or CPAP, nitrates

Long term: ACEi, B blocker, (aldosterone antagonist?)

Question 7

What does this ECG show

Answer 7

A fib, irregularly irregular

Question 8

Acute treatment for A fib

Answer 8

Cardio version (electrical or flecainide) + amiodarone

Question 9

Example of indication for electrical DC cardioversion

Answer 9

Haemodynamic instability

Question 10

3 commonest causes of A fib and investigation for that

Answer 10

Heart failure (e.g. post MI): ECG
Valvular disease: echo
Acute infection: FBC,CRP,blood cultures

Question 11

What is WPW syndrome

Answer 11

Re entry loops

Question 12

What drugs cannot be used in WPW

Answer 12

No rate control e.g. beta blockers, no adenosine, no CCB or digoxin

Question 13

What drugs are used in long term treatment of permanent AF

Answer 13

Anticoagulation e.g warfarin/DOAC, rate control e.g. B blockers/CCB/digoxin, rhythm control e.g. cardioversion

Question 14

What scoring systems are used to decide if a patient with AF should be taking long term anticoagulation

Answer 14

CHADSVASC and HAS-BLED

Question 15

Clinical features of aortic stenosis

Answer 15

Slow rising pulse, narrow pulse pressure, heaving apex beat, ejection systolic 2nd ICS RHS heart murmur radiating to neck/carotids loudest on expiration, reduced or absent S2

Question 16

What are common differentials for systolic murmur

Answer 16

Aortic stenosis!
Pulmonary stenosis, VSD, mitral regurgitation

Question 17

Investigations relevant for murmur diagnosis

Answer 17

Echo and ECG

Question 18

Common complications of severe aortic stenosis

Answer 18

Heart failure, stroke, blood clots

(Endocarditis, arrhythmia, haemolytic anaemia)

Question 19

Symptoms of severe aortic stenosis

Answer 19

Syncope, chest pain, breathlessness

Question 20

Management of aortic stenosis

Answer 20

Aortic valve replacement and anti coagulants

(TAVI via femoral artery more likely if elderly)

Question 21

Common causes of valvular heart disease

Answer 21

Congenital heart disease, rheumatic fever, cardiomyopathy, heart attack

Question 22

Clinical signs of aortic regurgitation

Answer 22

Diastolic murmur LHS sternal edge, collapsing pulse, head bobbing (De Musset’s sign)

Question 23

Clinical signs of mitral stenosis

Answer 23

Murmur (low pitched mid diastolic)
irregularly irregular pulse
Malar flush
Loud SI

Question 24

Clinical signs of mitral regurgitation

Answer 24

Holosytolic murmur (heard best at apex)
Radiation to axilla
Displaced apex beat

Question 25

Clinical signs in infective endocarditis

Answer 25

Pyrexia, tachycardia, heart murmur new and regurgitating, splinter haemorrhages, clubbing, Jane way lesions, emboli, sepsis (History of tiredness)

Question 26

Common pathogens causing infective endocarditis

Answer 26

Viridans strep, Staph Aureus, enterococcal

Question 27

How is a definitive diagnosis of infective endocarditis made

Answer 27

Blood cultures and TOE (echocardiogram)

Question 28

What antibiotic therapy is indicated if infective endocarditis is expected

Answer 28

If strep/enterococci: Benzylpenicillin (vancomycin is penicillin allergic) and low dose gentamicin If Staph: flucloxacillin and gentamicin

Question 29

Clinical signs for high BP

Answer 29

None Hypertensive retinopathy Enlarged palpable kidneys Renal artery stenosis causing bruits Moon face, abdominal purple striae Radiofemoral delay Coarctation

Question 30

Common secondary causes of high BP

Answer 30

Cushing’s syndrome, PCK disease, renal bruits, coarctation, radio-femoral delay, cocaine, oral contraceptive, pregnancy

Question 31

investigations for hypertension

Answer 31

Test for protein in urine and haematuria Plasma glucose, electrolytes, creatinine, eGFR, serum total cholesterol and HDL 12 lead ECG Fundoscopy Echocardiography Pregnancy test

Question 32

3 common drug classes used to treat hypertension and side effects

Answer 32

ACEi - dry cough headaches ARB - dizziness, headaches, fatigue CCB - ankle swelling, flushing, palpitations Diuretic - dizziness, tiredness, headache, gout, ED, cramps

Question 33

Common complications of untreated hypertension

Answer 33

Heart attack, stroke, TIA, heart failure, kidney failure, dementia

Question 34

What is a feature of hypertensive retinopathy

Answer 34

Flame haemorrhages