CVS - Gen Med

Question 1

What are the causes of acute and constrictive pericarditis?

Answer 1

Acute
radiation therapy
- infection e.g. TB (developing countries), coxsackie
- trauma

The above can also develop to constrictive

Question 2

Pharmacological Management of STEMI

Answer 2

MONA
- Morphine
- O2 for hypoxemic patients
- Nitroglycerin
- DAPT : Aspirin & clopidogrel

Question 3

What are some normal causes of palpitations?

Answer 3

fever (infection) , exercise or anxiety

Question 4

What serious disorders may cause palpitations?

Answer 4

• arrhythmias e.g. AF, Vtach, TDP
• electrolyte disturbance -> hypokalemia, hypomagnesemia, hypoglycemia
• long QT
• WPW

Question 5

If no normal causes, what are the most common cause of palpitations?

Answer 5

• sinus tachycardia -> premature ectopic beat (atrial or venticular) -> gradual HR increase and typically less than 150 bpm
• PSVT -> more sudden and abrupt, typically greater than 150

Question 6

Red flags of palpitations?

Answer 6

• light headedness
• chest pain
• significant underlying cardiac conditions
• fHx

Question 7

According to the vaughan william classification, how are anti-arrhythmatic drugs grouped?

Answer 7

Class I : sodium blockers
Class II: beta blockers
Class III: potassium blockers
Class IV: Calcium blockers

Class Ia: QPD-> quinidine, procainamide and Disopyramide
Class Ib: lidocaine, phenytoin
Class Ic: flecanide, encainide

Question 8

What are the ECG changes in WPW?

Answer 8

• short PR interval
• slurred upstroke before QRS (delta waves)

Question 9

What is the management of PSVT?

Answer 9

• vagal maneuver -> carotid massage not often done due to risk of potential stroke

others: blow in tube, valsava, ice face, face in cold water

• if not -> adenosine 6mg -> if not good -> 12mg after 2 mins -> if not good 18mg in 2 mins
• if still not successful -> verapamil for 2mins or metaprolol over 2mins

*AVOID verapamil if taking beta blockers

Question 9

What effect of adenosine is important to consider?

Answer 9

Adenosine causes less hypotension than verapamil but may cause bronchospasm in asthmatics, as may metoprolol

Use only if narrow QRS and BP >80 mm Hg

Question 9

What is grade 1 HTN? mild
and how often should their BP be rechecked?

Answer 9

140-159/90-99
Confirm within 2 months—lifestyle advice

Question 9

What are the causes of HTN?

Answer 9

• 90% essential or primary HTN
• 10% secondary

Renal: most common causes for secondary
- glomerulonephritis
- renal artery stenosis

Endocrine:
- pheochromocytoma
- cushing disease
- thyrotoxicosis
- primary hyperaldosteronism

Others:
- coarctation of aorta
- drugs e.g. corticosteroids
- pregnancy

Question 9

What is refractory HTN?

Answer 9

• HTN remains after 2 drugs for 3-4 months

Question 10

Difference between urgency and emergency HTN?

Answer 10

urgency HTN
- > 180mmHg systolic and > 120 diastolic
- no end organ failure
- can be treated with antihypertensives to reduce BP over a couple days

emergency HTN
- organ failure
- encephalopathy
- dissection
- ACS
- CHF
- papilledema
- stroke

reduce BP by 25% in minutes to hours
IV NTG, nitroprusside

Question 10

What is grade 2 HTN? moderate
and how often should their BP be rechecked?

Answer 10

160-179/100-109
Evaluate (or refer) within 1 month—lifestyle advice

Question 11

What is grade 3 HTN? severe
and how often should their BP be rechecked?

Answer 11

> 180 / > 110

Further evaluate and refer within 1 week (or immediately depending on clinical situation)

If BP has been confirmed at ≥180 mmHg systolic and/or ≥110 diastolic mmHg (after multiple readings and
excluding ‘white coat’ hypertension), commence drug treatment

Question 12

when ambulatory 24 hr monitoring is it indicated?

Answer 12

patients with fluctuating levels, borderline hypertension or refractory hypertension (especially where the ‘white coat’ effect may be significant)

• unusual variability of office BP
• marked discrepancy between office and home BP resistance to drug treatment
• suspected sleep apnoea
• when two BP readings >140/90

Question 13

Side effects of hydralazine?

Answer 13

Vasodilator -> alpha 1 agonist

• lupus like features -> drug induced, can be check with antihistone ABs in labs
• general malaise, facial rash butterfly like

drug must be stopped is such symptoms occur

similar drugs: procainamide, methyldopa, diltazem

Question 14

Indications for treatment of dyslipidemia?

Answer 14

• any underlying CVD or peripheral vascular disease with any initial lipid level
• diabetes PLUS age > 60 or microalbumineria T or Ab people
  with any initial lipid level
• T or Ab people with HTN
  with lipid levels > 6.5
• Fhx of CAD with lipid levels > 6.5