Cardiovascular

Question 1

risk of stroke in non-rheumatic AF

Answer 1

CHADS2 (risk of stroke in non-rheumatic AF)

Congestive heart failure
Hypertension
Age ≥ 75
Diabetes mellitus
Prior stroke/TIA/thromboembolism

6 gives it 18.2% chance of stroke

0 = low risk; none or aspirin daily
1 = moderate; aspirin daily or warfarin (raise INR to 2.0-3.0), depending on patient preference
2+ = moderate/high; warfarin, raise INR to 2.0-3.0 unless contraindicated

Question 2

causes of secondary hypertension

Answer 2

CHAPS (causes of secondary hypertension)

Cushing’s syndrome
Hyperaldosteronism (Conn’s)
Aorta coarctation
Phaeochromocytoma
Stenosis of renal arteries

Question 3

sequence of elevated enzymes after MI

Answer 3

C-AST-LE “castle” (sequence of elevated enzymes after MI)

CK-MB first
AST second
LDH third
Also: can use the last ‘E’ for ESR.

Question 4

Beck’s triad for cardiac tamponade

Answer 4

D3 (Beck’s triad for cardiac tamponade)

Distant heart sounds
Distended jugular veins
Decreased arterial pressure

Question 5

signs of cor pulmonale

Answer 5

Please Read His Text (signs of cor pulmonale)

Peripheral oedema
Raised JVP
Hepatomegaly
Tricuspid incompetence

Question 6

ECG signs in RH strain or acute cor pulmonale, eg. large PE

Answer 6

S1Q3T3 (ECG signs in RH strain or acute cor pulmonale, eg. large PE)

Large S wave in Lead 1
Large Q wave in Lead 3
Inverted T wave in Lead 3

Question 7

causes of cor pulmonale

Answer 7

PuLmonary HTN (causes of cor pulmonale)

Pulmonary vascular disease
• Primary pulmonary hypertension
• Pulmonary embolism ( Acute massive PE or Chronic recurrent PE )
• Pulmonary vasculitis
• Sickle cell anemia
• ARDS
• Parasite infestation

Lung disease
• COPD
• Asthma ( Severe, Chronic)
• Bronchiectasis
• Cystic fibrosis
• Interstitial lung disease
• Loss of lung tissue following lung trauma or surgery
• Sarcoidosis
• Pneumoconiosis

Hypoventilation
• Obstructive sleep apnea
• Cerebrovascular disease
• Adenoids enlargements in children

Thoracic abnormality
• Kyphosis
• Scoliosis

Neuromuscular disease
• Polioymyelitis
• Motor neurone disease
• Myasthenia gravis

Question 8

JVP vs carotids

Answer 8

POLICE (JVP vs carotids)

Palpable (JVP isn’t)
Occludable
Location between 2 heads of SCM
Inspiration (lowers JVP)
Contours (double bump)
Erect (affects position of JVP)

Question 9

features of apex beat

Answer 9

PLS-AD-TT “please add me T_T” (features of apex beat)

Presence
Location
Size

Amplitude
Duration

Type
Thrill

Question 10

causes of absence of apex beat

Answer 10

DR POPE (causes of absence of apex beat)

Physiological:
Dextrocardia
Apex behind a Rib (turn patient to left lateral positin)

Pathological:
Pericardial effusion
Obesity and thick chest wall
Pleural effusion (left sided)
Empyema

Question 11

treatment of ACS

Answer 11

MONA LISA (treatment of ACS)

M- morphine
O- oxygen
N- nitrates
A- aspirin

L – loop diuretic
I – IV access – for bloods, for IV GTN etc
S – streptokinase (thrombolysis) / PCI - if STEMI
A – antiplatelets (e.g. clopidogrel)

Question 12

secondary prevention in ACS

Answer 12

COBRA-A (secondary prevention in ACS)

C – Clopidogrel – antiplatelets
O – Omacar – Omega 3
B – Bisoprolol – β-blocker
R – Ramipril – ACE-i
A – Aspirin

A – Atorvastatin – very potent statin!

Question 13

Tetralogy of Fallot

Answer 13

PRAVeen has heart problems (Tetralogy of Fallot)

Pulmonary infundibular stenosis
Right ventricular hypertrophy
Overriding Aorta
VSD

Question 14

Angina management through lifestyle alterations

Answer 14

Angina management through lifestyle alterations

Mnemonic: SLEW
S Smoking cessation
L Low-fat diet
E Exercise
W Weight loss

Question 15

Management of acute unstable angina

Answer 15

Management of acute unstable angina
Mnemonic: 2 As and BALI
A Admit, bed rest, high-flow oxygen
A Analgesia
A Aspirin and clopidogrel

B Beta blockers
A Angiography with or without angioplasty/CABG if symptoms fail to improve
L Low molecular weight heparin (LMWH)
I Infusion of nitrates

Question 16

Angina presentation

Answer 16

Angina presentation
Mnemonic: SCAR
S Sudden central pain, ʻtearingʼ in nature, may radiate to the back
C Coronary artery occlusion can lead to chest pain, MI or angina pectoris/Carotid obstruction can lead to hemiparesis, dysphasia or blackouts
A Anterior spinal artery can be affected leading to paraplegia
R Renal artery can be affected leading to anuria or renal failure

Question 17

Cardiac arrest management, Advanced Life Support (ALS)

Answer 17

Cardiac arrest management, Advanced Life Support (ALS)

Mnemonic: CDE (with A after every step)
C Cardiac monitor and defibrillator should be attached to the patient
A Assess rhythm and pulse
D Defibrillate x 3 if VF or pulseless VT, CPR for 1 min
A Assess rhythm and pulse
E EMD (no cardiac output despite ECG showing electrical activity) or asystole warrants CPR for 3 min
A Assess rhythm and pulse

Question 18

strong risk factors for atherosclerosis

Answer 18

CD MASH up of songs (strong risk factors for atherosclerosis)

Cholesterol (by far the most)
Diabetes mellitus

Male
Age
Smoking
Hypertension

Question 19

less strong risk factors for atherosclerosis

Answer 19

FLOSS your teeth for better health (less strong risk factors for atherosclerosis)

Family history
Low birth weight
Obesity
Sedentary
Socioeconomic status