Passmed - Cardio

Question 1

Angina not controlled by beta-blocker?

Answer 1

a longer-acting dihydropyridine calcium channel blocker should be added (amlodipine)

Question 2

Verapamil should never be used in conjugation with…

Answer 2

a beta-blocker as it is a rate-limiting calcium-channel blocker
Doing so could lead to severe bradycardia and precipitate a patient into heart failure.

Question 3

Angina drug management

Answer 3

All should receive aspirin and a statin
sublingual glyceryl trinitrate to abort angina attacks
a beta-blocker or a calcium channel blocker first-line based

if a patient is taking both a beta-blocker and a calcium-channel blocker then only add a third drug whilst a patient is awaiting assessment for PCI or CABG

Question 4

Acute pericarditis

Answer 4

inflammation of the pericardium
Sharp central chest pain, aggravated lying flat, eased leaning forward, ST elevation
Risk factors - auto-immune inflammatory conditions such as SLE, scleroderma and rheumatoid arthritis. Other causes include myocardial infarction, viral infection, TB and uraemia

Question 5

Stage 1 hypertension (clinic reading)?

Answer 5

140/90

Question 6

Acute heart failure not responding to treatment?

Answer 6

Consider CPAP

Question 7

Heart failure acute management?

Answer 7

For all patients - IV loop diuretics (furosemide, bumetanide)

(Possibly oxygen and vasodilators)

Question 8

Angina management: if a patient has an inadequate response to verapamil?

Answer 8

Adding long-acting nitrates is suitable (isosorbide mononitrate)

Question 9

Angina medication?

Answer 9

All - aspirin and statin
Acute - sublingual glyceryl trinitrate
NICE - beta blocker or calcium channel blocker

Question 10

Common cardio drugs contraindicated in pregnancy?

Answer 10

ACEi (e.g. ramipril)

Question 11

Pulmonary embolism triad?

Answer 11

Pleuritic chest pain
Dyspnoea
Haemoptysis

Question 12

2 level PE Wells score?

Answer 12

Clinical signs and symptoms of DVT - 3
Alternative diagnosis is less likely than PE - 3
Immobile for more than 3 days or surgery in last 4 weeks - 1.5
Previous DVT/PE - 1.5
Haemoptysis - 1
Malignancy - 1

Question 13

PE likely on Wells?

Answer 13

More than 4 points

4 or less = PE unlikely

Question 14

If PE is likely?

Answer 14

CTPA
(Give anticoagulant if CTPA is delayed)

CTPA +ve = PE diagnosed
CTPA -ve = proximal leg vein USS if DVT suspected

Question 15

If PE is unlikely?

Answer 15

Arrange D-dimer

If +ve = immediate CTPA
If -ve = stop anticoagulant, PE unlikely

Question 16

ECG in hypothermia

Answer 16

bradycardia
‘J’ wave (Osborne waves) - small hump at the end of the QRS complex
first degree heart block
long QT interval
atrial and ventricular arrhythmias

Question 17

Myocardial infarction complications?

Answer 17

Cardiac arrest
Cardiogenic shock
Chronic heart failure
Tachyarrhythmias
Bradyarrhythmias
Pericarditis
Left ventricular free wall rupture
Left ventricular aneurysm
Ventricular septal defect
Acute mitral regurgitation

Question 18

Investigating suspected PE: if the CTPA is negative then consider what investigation?

Answer 18

a proximal leg vein ultrasound scan if DVT is suspected

Question 19

Clinical features of aortic stenosis

Answer 19

-chest pain
-dyspnoea
-syncope / presyncope (e.g. exertional dizziness)
-an ejection systolic murmur (ESM); radiates to the carotids (is decreased following the Valsalva manoeuvre)

Question 20

Features of severe aortic stenosis

Answer 20

narrow pulse pressure
slow rising pulse
delayed ESM
soft/absent S2
S4
thrill
duration of murmur
left ventricular hypertrophy or failure

Question 21

Causes of aortic stenosis

Answer 21

-degenerative calcification (most common cause in older patients > 65 years)
-bicuspid aortic valve (most common cause in younger patients < 65 years)
-William’s syndrome (supravalvular aortic stenosis)
-post-rheumatic disease
-subvalvular: HOCM

Question 22

Aortic stenosis management?

Answer 22

Symptomatic - valve replacement
Asymptomatic - discharge
Asymptomatic but valvular gradient > 40 mmHg and with features such as left ventricular systolic dysfunction - consider surgery
(Balloon valvuloplasty (in children with no aortic valve calcification or adults with critical AS and not fit for surgery)

Question 23

options for aortic valve replacement (AVR) include:

Answer 23

-surgical AVR - young, low/medium operative risk patients. Cardiovascular disease may coexist. For this reason, an angiogram is often done prior to surgery so that the procedures can be combined
-transcatheter AVR (TAVR) is used for patients with a high operative risk

Question 24

ACS management

Answer 24

-aspirin 300mg
-oxygen (only be given if the patient has oxygen saturations < 94%)
-morphine (only be given for patients with severe pain)
-nitrates (should be used in caution if patient hypotensive)

Percutaneous coronary intervention
Fibrinolysis

Question 25

Infective endocarditis in intravenous drug users most commonly affects which valve?

Answer 25

Tricuspid

Question 26

STEMI management

Answer 26

PCI if presents within 12 hours of onset AND PCI can be delivered within 120 minutes of the time when fibrinolysis could have been given
If PCI delayed, consider fibrinolysis first