CHD & HF

Question 0

Angina Vs MI

Answer 0

Pain less severe, <20 mins
Relieved by nitrates
No sweating, nausea, vomiting (early on)
May get nitrate HA and hypotension
No fear of impending doom

Question 1

Complications of MI

Answer 1

Sudden death on PRAED street
P- pump failure
R- rupture of papillary muscle or septum
A- arrhythmias or aneursyms
E- embolism (walk of ventricle or mural infarct)
D- Dressler’s syndrome (1/200, late post-MI syndrome)

Question 2

Causes of pressure overload to left ventricle

Answer 2

HTN
Aortic stenosis
Coarctation of aorta
Hypertrophic cardiomyopathy (w/ LV outflow tract obstruction) infundibular stenosis

Question 3

Features of pericardial pain

Answer 3

2 like pleurisy, 2 like angina, 2 of its own

Pleurisy: Sharp, worse on inspiration
Angina: Central, radiates to left shoulder or left arm
Own: worse lying down, eased sitting forward

Question 4

Signs & symptoms Acute LVF

Answer 4

Pt looks unwell- pale & grey
Cold, clammy peripheries
Frothy blood stained sputum
Orthopnoeic, using accessory muscles
May have wheeze (cardiac asthma) reason: bronchial veins drain into the pulmonary congestion
Sinus tachycardia or AF
Systolic hypotension
Signs of cardiomegaly (displaced apex, signs of valve disease)
3rd & 4th HS
Right sided or bilateral pleural effusions

Question 5

Radiographic changes in left ventricular failure

Answer 5

Cardiomegaly
Upper lobe diversion
Diffuse mottling of lung fields particularly costophrenic angles
Prominent hilar shadows (bats wings)
One bat wing = pseudotumour of heart, usually right hilum
Small pleural effusions
Fluid in fissures

Question 6

Txt of acute left ventricular failure

Answer 6

High dose O2
Txt significant arrhythmias
IV diuretics
IV Vasodilators
IV opiates if chest pain or distress

Question 7

ECG changes of Hyperkalemia

Answer 7

Low flat p wave
Broad, bizarre QRS
Slurring into ST segment
Tall tented t waves