CVS

Question 1

Resistant hypertension

Answer 1

> 140/90 mmhg
+
Pt on >3 drugs (one diuretic)

Question 2

B/L crepts
Hepatomegaly
Systolic murmur

Answer 2

COPD
Cor pulmonale
RA and RV enlargement
TV separation - systolic murmur

Question 3

HOCM

Answer 3

Pulsus bisferiens
Double apex
ESM at erb’s area
↑murmur on ↓blood flow
Mcc of SCD in youth: HOCM→severe angina→Ventricular arrhythmias
DOC: β blockers
To ↓ sudden cardiac death:
Device: Implantable cardioverter defibrillator
Drug: Amiodarone

Question 4

ECG lead placement

Answer 4

Lead I:
+ve: left arm
-ve: right arm

Lead II:
+ve: left leg
-ve: right arm

Lead III:
+ve: left leg
-ve: left arm

Ground - Right leg

Question 5

Cholesterol control in post MI pts

Answer 5

High dose statins
Atorvastatin 80 mg
Rosuvastatin 20 - 40 mg

Question 6

Neurogenic shock

Answer 6

↓sympathetic activity

Hypotension
Bradycardia

Question 7

Corrected reticulocyte count

Answer 7

Retic count x (Pt.Hb/Normal hb)

Question 8

Subclinical acute myocarditis

Answer 8

Palpitations - sinus tachycardia
Elevated pro BNP, trop T - necrosis
Low LVEF on 2D echo - ↓ systolic function
Global wall abnormality

Question 9

Atrial fibrillation

Answer 9

Irregularly irregular Tachycardia
No P waves

Treatment: RACE
Rate control - IV Esmolol/ Verapamil
Anticoagulation - CHA2DS2VASc
Chemical cardioversion - IV ibutilide/Amiodarone
Electrical cardioversion - DC shock 25 - 50 J Biphasic

Question 10

Drugs in heart failure

Answer 10

Reduced EF - glifozins

Biological - Canakinumab - against IL 1β