Heart Disease

Question 1

What are risk stratification in ischemic heart disease?

Answer 1

1. History taking
   - symptoms of chest pain, dyspnea, oprthopnea, PND, pedal edema, palpitations, presyncope or syncope, METs (metabolic equivalent tasks)
2. Assoc systemic dz such as hyperlipidemia, diabetes, hypertension
3. Medications
   - beta blockers
   - aspirin/ other anticoags
   - ace inhibitors
   - statins
4. Social history - sedentary lifestyle, stress, depression, anxiety
5. Family history
6. Examination
   - vital signs (esp BP)
   - auscultation, heart sounds, lungs
   - JVP
   - Peripheral pulses
7. Investigations
   - ECG + stress test
   - Bloods (esp cholesterol level, cardiac markers)
   - Echocardiogrpahy
   - Myocardial perfusion with labeled radioisotope
   - Cardiac catheterization

Question 2

What are perioperative mx of surgical patients undergoing elective intermediate surgery under sedation/LA?

Answer 2

Refer to cardiologist for risk stratification

• to continue meds?
• to withhold elective surgery?

Continuous close monitoring (ASA 1 monitoring)

• ECG
• BP
• HR
• Pulse oximeter

Question 3

What are signs and symptoms of acute MI

Answer 3

Agitation
Chest tightness
Tachypneic
Tachycardic
Pale
Diaphoresis (sweating)
N&V

Question 4

Immediate mx of AMI

Answer 4

Oxygen 100% 8-12L/min
Sublingual GTN
Aspirin 375mg chew
Morphine

Question 5

Findings on ECG in ischemic heart disease

Answer 5

ST elevation - acute MI
St depression - Non transmural myocardial infarct/ischemia
Inverted T wave - ischemia
Q wave - MI

Leads II,III,AvF - inferior
Leads v1 - v6 - anterior wall

Question 6

What are cardiac markers

Answer 6

Troponin I, T - more specific and sensitive (4-8hrs)

CK, CK-MB - peaks at 24hrs, return to normal at 48-72hrs

Question 7

What are presenting symptoms of CHF?

Answer 7

Dyspnea/orthopnea
Crackles at base of lung
Pitting edema
Hepatojugular reflex
Increased JVP
Use of accessory muscle for breathing
Hepatomegaly

Question 8

What is Kerley B lines?

Answer 8

Thin short perpendicular lines extending towards the pleura at the base of lungs on a CXR indicating pleural effusion or pulm edema

Question 9

Echo findings on CHF

Answer 9

Ejection fraction <55%

Question 10

When a maxillofacial trauma ptn with a hx of CAD/IHD comes with shortness of breath/ difficulties in breathing. Whats ur diff dx?

Answer 10

Injury to the face leading to obstruction of airway (bilat mandibular fracture, posteriorly displaced maxilla fracture, direct laryngeal injury, foreign body in the airway)
Acute exacerbation of heart failure
Acute coronary syndrome

Question 11

Treatment of chf?

Answer 11

Triad of tx:

1. Diurectics (loop - thiazide)
2. ACEi / ARBs
3. Beta blocker

Question 12

Chest xray of CHF

Answer 12

Earliest sign: cephalization of pulmonary vessels

1. Heart size
2. Interstitial pulmonary edema/ infiltration
   - kerley b lines
   - bat wings
   - train tracks