CVS

Question 1

Mx of long term STEMI

Answer 1

DABS
Dual antiplatelet
Aspirin
B-blocker
Statins

STOP CLOPIDEGROL AFTER 1 YEAR

Question 2

Mx of acute MI

Answer 2

Morphine 5 mg PO + antiemetic
Oxygen if sats below 94%
Nitrates 2 puffs
Aspirin 300mg PO

Question 3

Mx of HF

Answer 3

Diuretic –> furesomide 40 -80mg

Ace inhibitor or B-blocker

then combine the both above

then 3rd line add spironolactone

Question 4

5 side effects of B blocker

Answer 4

fatigue
reynauds
bronchospasm
erectile dysfunction
insomnia (nightmares)

Question 5

HF Ix

Answer 5

Pro- BNP

if above 2000ng/L—> send off urgent 2WW for echo
if btw 400-2000ng/L –> routine 6ww wait for ECHO

ECHO

Bedside shit
BLOODS: FBC, U&E, LFT, CRP, TFT, lipid profile, HBA1c
imaging: CXR, ECHO

Question 6

3 lifestyle advice for HF

Answer 6

restrict fluids to 1.5 L a day
one of pneumococcal vaccine
annual influenza vaccine

Question 7

LCircumflex A? leads? type of MI?
RCA
LAD
Posterior MI?

Answer 7

L Circumflex A: 1, AVL, V5-6 –> lateral MI (ra7 alikha sa3a 5-6pm)
RCA: II, III, aVF–> inferior MI (i’m right bc fuck inferior ppl 2 and 3 x)
LAD : V1-V6–> anterospetal MI

It should be remembered that a new left bundle branch block (LBBB) may point towards a diagnosis of acute coronary syndrome.

Question 8

Tx of SVT

Answer 8

1) VAGAL manœuvre
- valsava manœuvre
- carotid sinus massage

2) IV Adenosine 6mg–> fast IV bolus–> 12mg–> 18mg
3) synchronised DC shock up to 3 attempts

Question 9

Tx of bradycardia

Answer 9

1) Atropine 500mcg IV (repeat up to 3mg max)
2) Transcutaneous cardiac pacing (de-fib)
3) Transvenous cardiac Pacing

isoprenaline/adrenaline infusion titrated to response

Question 10

Brugada syndrome

ECG changes

Answer 10

ST elevation in V1

T wave inversion in V2

Question 11

Torsades de pointes Mx

Answer 11

IV magnesium sulfate 2mg

Question 12

cx of long QT

Answer 12

Meds:
AntiArythmitics: amiodarone 
AntiBiotics: Macrolides (eryhtromycin) 
AntiCycotics:
AntiDepressants: SSRI, TCA 
AntiEmetics: ondansetron

Electrolyte imbalances:
↓K, ↓Mg, ↓Ca+ Congenital

Jervell-Lange-Nielsen syndrome, Romano-Ward syndrome

Question 13

AF Mx

Answer 13

Hemodynamically stable

• less than 48hr–> rhythm control 1st line or rate–> flecanide, amiodrone
• more than 48 hr–> rate only–> B-blockers, CCB, digoxin or anticoagulant them for 3weeks before u commence electrical DC cardioversion or do ECHO to exclude LAA thrombus

Hemodynamically unstable
DC cardioversion

Question 14

when to anticoagulant in AF?

Answer 14

CHADSVAS

0 No treatment

1 Males: Consider anticoagulation
Females: No Tx (this is bc their score of 1 is only reached due to their gender)

2 or more Offer anticoagulation

Question 15

Amiodarone SE? monitoring?

Answer 15

CLASS 3 drug inhibitor

Photosensitivity
Pulmonary fibrosis
peripheral neuropathy
hepatitis
Hypothyroidism
steal grey skin
optic neuritis
long QT
thrombophlebitis

increases digoxin levels
reduces excretion of warfarin

Monitor:
FBC, U&E, LFT, TFT CXR–> b4 tx
TFT, LFT–> every 6 mnths

Question 16

Endocarditis IX , Mx

Answer 16

Staphylococcus aureus

Ix
ECG, BC from 3 different sites , ECHO transeospahgeal or trans thoracic

Mx
Initial blind therapy–> amoxicillin, consider adding low-dose gentamicin if pen allergic vancomycin

If native prosthetic valve–> vancomycin + rifampicin+ gentamicin

Prosthetic valve cx by staphylococci–>Flucloxacillin + rifampicin + gentamicin

viridian–> Benzylpenicillin