GP - Cardio

Question 1

Describe chronic coronary syndrome

Answer 1

Stable angina - relieved by rest/GTN spray

Question 2

Describe acute coronary syndrome

Answer 2

Unstable angina

Non-ST-elevation myocardial infarction = elevated troponin, CK, myoglobin

ST-elevation myocardial infarction = elevated troponin, CK, myoglobin + ST elevations on ECG

Question 3

What is the management for stable angina?

Answer 3

• Lifestyle changes
• Medication (aspirin + statin + BB/CCB)
• Percutaneous coronary intervention
• Surgery

Question 4

What is the immediate management for acute coronary syndrome?

Answer 4

• ECG
• Aspirin 300mg
• O2 if sats <94%
• Morphine (pain)
• Nitrate (pain/HTN)

Question 5

What is the management for a STEMI?

Answer 5

• Aspirin 300mg

Percutaneous coronary intervention (PCI):
- Within 2 hours of onset of sx
- Praugrel
- Unfractionated heparin and bailout glycoprotein IIb/IIIa inhibitor
- Drug-eluting stent

Fibrinolysis:
- Antithrombin
- Ticagrelor after

Question 6

What is the management for a NSTEMI?

Answer 6

• Aspirin 300mg
• Fondaparinux (if no immediate PCI planned)
• Estimate 6 month mortality (GRACE)

Low risk = ticagrelor

Moderate/high risk = PCI, prasugrel/ticagrelor, unfractionated heparin, drug-eluting stents

Question 7

What is the management for widespread coronary disease/recurrent MIs?

Answer 7

Coronary artery bypass graft (CABG)

Question 8

What is heart failure?

Answer 8

A clinical syndrome where the heart is unable to pump enough blood to meet the metabolic needs of the body usually as a result of structural or functional heart disease

Question 9

What are the stages of HTN?

Answer 9

Stage 1 = 140/90
Stage 2 = 160/90
Stage 3 = 180/120 (malignant)

Question 10

What is heart failure?

Answer 10

Heart is unable to pump enough blood to meet the metabolic needs of the body

Question 11

What is the main cause of acute heart failure?

Answer 11

Dressler’s syndrome - swelling/inflammation of sac around heart post MI

Question 12

What is the management for acute heart failure?

Answer 12

OMFG:
- Oxygen
- Morphine
- Furosemide
- GTN spray

Question 13

What are the main causes of chronic heart failure (diastolic)?

Answer 13

• Hypertrophic obstruction cardiomyopathy
• Restrictive cardiomyopathy
• Cardiac tamponade
• Constrictive pericarditis

Question 14

What are the main causes of chronic heart failure (systolic)?

Answer 14

• Ischaemic heart disease
• Dilated cardiomyopathy
• Myocarditis
• Arrhythmias

Question 15

What are the causes of left/right sided heart failure?

Answer 15

Left = hypertension/aortic stenosis/aortic regurgitation/etc.

Right = usually occurs after left-sided/pulmonary HTN/OSA

Question 16

What are the features of left sided heart failure?

Answer 16

• Pulmonary oedema
• Dyspnoea/orthopnoea/paroxysmal nocturnal dyspnoea
• Bibasal fine crackles
• Cyanosis
• Reduced capillary refill

Question 17

What are the features of right sided heart failure?

Answer 17

• Weight gain
• Peripheral oedema
• Raised JVP
• Hepatomegaly
• Weight gain

Question 18

What is the first investigation for heart failure?

Answer 18

NT-proBNP - released when cardiomyocytes are stretched

<400pg/ml = normal
400-2000pg/ml = moderate
>2000pg/ml = severe

Question 19

What are other investigations for heart failure?

Answer 19

• Echo
• CXR - ABCDEF
• ECG
• Bloods

Question 20

What features on a chest x-ray would indicate heart failure?

Answer 20

ABCDEF:
- Alveolar oedema
- Kerley B lines (interstitial oedema)
- Cardiomegaly
- Dilated upper lobe vessels of lung
- Effusion (pleural)
- Fluid in horizontal fissure

Question 21

What is the management for chronic heart failure?

Answer 21

• FIRST LINE = ACE-inhibitor and beta blocker
• Aldosterone antagonist (spironolactone)
  ^ ACEis and spironolactone can both cause hyperkalaemia
• Hydralazine
• Digoxin
• Furosemide