Cardiovascular

Question 1

Definition of typical angina

Answer 1

• Constricting discomfort in the front of the chest, in the neck, shoulder, jaw or arms
• Precipitated by physical exertion
• Relieved by GTN
  (Atypical only 2 symptoms)

Question 2

Treatment of uncomplicated, stable angina?

Answer 2

GTN (symptom relief)

beta-Blocker (or CCB)

Question 3

Treatment for atrial fibrillation?

Answer 3

beta-Blocker (or CCB)

If CHA2DS2VASc score =>2…anticoagulate

Question 4

Signs & symptoms of AF?

Answer 4

Irregular pulse obvs!
And
Breathlessness
Palpitations
Chest discomfort
Syncope or dizziness

Question 5

Diagnosis of ACS?

Answer 5

Chest/arm or other myocardial ischaemia type pain
ECG changes
Troponin rise

Question 6

General terms what does STEMI vs NSTEMI mean?

Answer 6

STEMI - complete coronary artery occlusion

NSTEMI - incomplete occlusion

Question 7

Immediate treatment for ACS?

Answer 7

GTN + Aspirin (+ opoid) in primary care

+ anticoagulants in secondary

Question 8

Long term treatment after ACS?

Answer 8

ACE inhibitor
Beta-blocker
Statin
Anti-platelet therapy
(Aldosterone antagonist if LV dysfunction)

Question 9

Example of discharge medicines post-ACS?

Answer 9

Clopidogrel (anti-platelet)
Ramipril (ACEi)
Simvastatin 
Bisoprolol (beta-blocker)
(Eplerenone/Spironolactone)

Question 10

Example of angiotensin II receptor blocker and when it is used?

Answer 10

Candesartan
Eprosartan
Losartan
Used when ACEi contraindicated or not tolerated

Question 11

Changes on ECG initially with ACS?

Answer 11

Tenting T waves…followed by ST elevation (and possible T wave inversion)

Question 12

Other ECG changes of ACS?

Answer 12

New LBBB

Pathological Q waves (hours-days) - MI

Question 13

Mechanism of action of heparin?

Answer 13

Binds to antithrombin III, which inactivates thrombin and factor Xa

Question 14

Mechanism of action of eptifibatide/tirofiban

Answer 14

Glycoprotein IIb/IIIa inhibitors, inhibit platelet aggregation (as the drugs bind to glycoprotein receptors)

Question 15

What is vWF?

Answer 15

von-Willebrand Factor, found in subepithelial matrix of blood vessel, binds to glycoprotein Ib on platelets, activating platelets (upon endothelial injury, which exposes vWF)

Question 16

Henoch-Schonlein pupura symptoms (and signs)?

Answer 16

Classic triad: Purpura; arthralgia (arthritis); abdo pain

Signs include proteinuria and haematuria

Question 17

Henoch Schonlein purpura pathophysiology?

Answer 17

Immune complexes of IgA and complement C3 are deposited on veins, arteries, capillaries, therefore a vasculitis essentially

Question 18

Diagnosis of hypertension?

Answer 18

BP >140/90, and confirmed with ABPM (>135/90)

Or BP>180/110

Question 19

1st line Treatment for HTN age <55

Answer 19

ACEi (or ARB)

Question 20

1st line Treatment for HTN age > 55, or black any age?

Answer 20

Ca channel blocker

Question 21

2nd step treatment for HTN? any age

Answer 21

Add either ACEi or Ca channel blocker (whichever wasn’t added at step 1)

Question 22

3rd step treatment for HTN? any age

Answer 22

ACEi + Ca blocker

Add thiazide diuretic e.g. indapamide or chlortalidone

Question 23

4th step treatment for HTN?

Answer 23

ACEi + CCB + thiazide diuretic

Add low dose spironolactone

Question 24

Collapsing pulse sign of…?

Answer 24

Aortic Regurgitation

Question 25

When to give apixaban instead of warfarin?

Answer 25

``` Confirmed eGFR 30-50 and AF and one of: Age > 75 Hypertension Diabetes Previous stroke/TIA ```

Question 26

Treat simple HTN in pregnancy?

Answer 26

Labetalol or Methyldopa

Question 27

Wolff-Parkinson-White syndrome pathophysiology?

Answer 27

Accessory pathway from atria to ventricles - Bundle of Kent, not AV node, so conduction isn't slowed, hence delta waves on ECG, and tachycardia

Question 28

Antiplatelet therapy post ACS?

Answer 28

NSTEMI-ACS: dual platelet therapy for 12 months post then keep on single therapy long term (aspirin). STEMI-ACS: dual platelet therapy for >1 months (asp + clop) post then keep on single therapy long term (aspirin). Or ticag and aspirin for upto 12 months. Aspirin clopidogrel Ticagrelor

Question 29

Drug for bradycardia?

Answer 29

Atropine 500mcg further use of 500mcg up to max 3mg

Question 30

Regular narrow complex tachycardia algorithm?

Answer 30

1. Vagal maneuvers 2. Adenosine 6mg rapid IV bolus 3. 12mg adenosine twice more max

Question 31

Regular broad complex tachycardia algorithm?

Answer 31

if regular: - VT = amiodarone 300mg IV over 20-60 mins then 900mg over 24hrs - SVT = give adenosine as for regular narrow complex tachycardia

Question 32

Secondary prevention drugs for angina

Answer 32

Statin Aspirin 75mg OD - if low bleeding risk Antihypertensive

Question 33

Warfarin indications

Answer 33

Atrial Fibrillation Venous thromboembolism Mechanical heart valves

Question 34

Target INR on warfarin

Answer 34

AF - 2.5 VTE - 2.5 if recurrent VTE - 3.5 Heart valves depending - mitral valves higher INR than aortic