Cardiovascular Examination

Question 1

Stroke Investigations?

Answer 1

1. Baseline Observations (BP, Oxygen saturations and BPM, RR and Temp)
2. Blood Tests
   - FBC - anaemia which can worsen a stroke , white cell count to suggest infection which complicates stroke , platelets low suggest bleed risk
   - Coag screen (Prothrombin time , apt and iNR)
   - U& E - baseline electrolytes and renal function
   - lipid profile - hypercholesterolaemia
   - HbA1c - diabetes contribution to stroke

embolic? - d-dimer, troponin if cardiogenic

systemically unwell vBG/ABG

4. ECG to rule out arrhythmia
5. imaging

non-contrast CT head rule out bleeding

ischaemiac = CT Angio

Question 2

Stroke Management?

Answer 2

1. MUST ALWAYS EXCLUDE HAEMORRHAGIC STROKE FIRST

2.alteplase/tenectaplase

3.clopidogrel or aspirin unless aspirin contra-indicated

4. PPI for aspirin

clop to be taken for 3 months post admission.

BP medication to be done also

Question 3

Congestive Heart Failure investigations?

Answer 3

1. Basic Observations (BP, Ox saturation, BPM, RR, Temp)
2. ECG
3. Bloods
   - Fbc ( anaemia, bcc infection, platelets)
   - U&E (electrolyte imbalances and renal function)
   - LFT (liver congestion)
   - BNP (stretching heart muscles)

Question 4

why is hyponatraemia indicated in CHF and why is it important to find?

Answer 4

can cause arrhythmia and happens due to the amount of water loss

Question 5

CHF imaging?

Answer 5

CXR - pulmonary oedema, cardiomegaly

Echocardiogram = Ejection fracture

Question 6

CHF management?

Answer 6

1. dietary advice = salt restriction and fluid restriction
2. ABAL
   - Ace inhibitors
   - beta blockers
   - Aldosterone antagonist
   - Loop diuretic

Question 7

ACS investigations

Answer 7

1. Bediside Observations (BP, HR, O2, TEMP RR)
2. ECG
3. bloods
   - FBC (anaemia, infection)
   - U&E, LFT (basic metabolic panel renal function and electrolytes for arrhythmia)
   - Coag profile (if suspected embolus)
   - BNP (suspected hF?)
   - troponin

CXR, Echo but CORONARY ANGIO

Question 8

ST elevation in leads V1-4 is what?

Answer 8

anterior MI

LAD - left anterior descending

Question 9

ST elevation in leads II, III, aVF is what?

Answer 9

inferior MI

RC/LCF - Right coronary artery or left circumflex

Question 10

ST elevation in leads I, aVL, V5, V6 is what?

Answer 10

lateral wall MI

Lcx - left circumflex

Question 11

ST elevation in V7,V8,V9 is what?

Answer 11

posterior wall MI

right coronary artery

Question 12

what ECG findings are seen on a NSTEMI?

Answer 12

T wave inversion
ST-depression

Question 13

Acute STEMI management?

Answer 13

1. Aspirin 300mg
2. PCI if presented with symptoms recently (within 12 hours) and it can be done in 120mins of presentation

3.clopidogrel if on DOAC, ticagrelor/prasugrel if not

4. unfractioned heparin

if not available then fibronlysis, add antithrombin aspirin and clop

Question 14

abdominal bruit is suggestive of what?

Answer 14

chronic mesenteric ischaemia