CVS investigations

Question 1

What is an ECHO? & what does it show us? (3 things)

Answer 1

A scan that uses sound waves to visualise the heart.

It shows us:

• Size
• Shape
• How well the heart is pumping

Question 1

What is PCI? When is it indicated?

Answer 1

Percutaneous Coronary Intervention is a procedure used to open narrowing within the arteries that supply blood to the heart.

Indications:

• MI
• Angina?
• Atherosclerotic plaque

Question 2

What advice should be told to a patient after a PCI procedure? (4 things)

Answer 2

1. Don’t drive for 1/52
   (special licence drivers 6/52)
2. Take 1 week off work
3. Avoid heavy lifting for 1-2/52
4. Will be see in outpatient clinic in 4-6 months following procedure.

Question 3

What is the most common method of fitting a pacemaker?

Answer 3

Transvenous implantation.

Pacing leads are guided into the hearts chamber using an X-ray. Carried out via local anaesthetic

Question 4

When is an Implantable cardioverter defibrillator indicated? (2 things)

Answer 4

1. Ventricular arrhythmia

2. L sided EF heart failure

Question 5

What are the shockable rhythm’s ? (2 things)

How would you manage this?

Answer 5

1. Ventricular fibrillation
2. Pulseless ventricular tachycardia

Defibrillation and CPR + if persistent amioderone 300mg IV and adrenaline 1mg IV

Note:
Amioderone is given as a one off dose but adrenaline can be given every other cycle of defibrillation

Question 6

What are the non- shockable rhythm’s ? (2 things)

Answer 6

1. Pulseless electrical activity

2. Asystole

Question 7

What must patients have the day before and on the day of a stent placement procedure?

Answer 7

Aspirin (300mg) +Clopidogrel (4x75mg) the day before and on the day of

Question 8

What is the gold standard for an MI if the patient presents within 2 hours?

Answer 8

PCI – a.k.a angioplasty

Question 9

What is BNP?

Answer 9

A hormone that is released by stretched cardiaomyocytes

Question 10

What is troponin?

Answer 10

A sensitive test done to identify if theres cardiac injury. If the troponin is high, you need to repeat it at 24 hrs.

Question 11

What is an exercise tolerance test?

Answer 11

A test to identify CHD. It shows whether the heart is getting enough blood during physical exercise.

Indication:

• Chest pains (on exertion)
• Those with CAD

Question 12

What is a stress ECHO?

Answer 12

An ECHO done to assess how well the heart works under stress.

(stress is induced by treadmill)

Question 13

What is a transoesophageal (TOE) ECHO?

Answer 13

A thin flexible tube is passed through the mouth and down the throat to produce images of the heart

Question 14

What does a baseline wander on ECG indicate?

Answer 14

That the patient is sweaty/clammy

Question 15

How do you confirm a diagnosis of atrial fibrillation? (2 things)

Answer 15

1. ECG

2. Palpate radials

Question 16

In a RBBB will v1 be pointing upwards or downwards?

Answer 16

Upwards

Way to remember this:
If you’re “right” you’ll put your hand up

Question 17

How is a diagnosis of angina confirmed? what findings would you see?

Answer 17

ECG.

Findings (indicate Ischaemia or previous MI):

• Pathological Q wave
• LBBB
• ST depression

Question 18

What would you do if a patient presents with an MI after more than 2 hours of symptoms starting?

Answer 18

Thrombolysis

1. Ticagrelor + Aspirin
2. Do an ECG in 60-90mins

Question 19

What medication should be. given to patients undergoing PCI?

Answer 19

1. Aspirin +
2. Prasugrel if >75yrs old.
   otherwise= Ticagrelor or clopidogrel

Question 20

What score is done to assess bleeding risk?

Answer 20

ORBIT

score of >3 = high risk

Question 21

Which ACS conditions cause a rise in troponin ?

Answer 21

STEMI and NSTEMI