signs and symptoms

Question 1

Signs of RHF

Answer 1

raised JVP
hepatomegaly
ankle oedema
pulmonary stenosis (commonly heard in the second intercostal space along the left sternal boarder)

Question 2

following a thrombolysed inferior myocardial infarction a 72-year-old man develops signs of left ventricular failure. His blood pressure drops to 100/70mmHg. On examination he has a new early-to-mid systolic murmur.

Answer 2

papillary muscle rupture

Question 3

a cardiac arrest two days after being admitted to the hospital following a myocardial infarction

Answer 3

ventricular fibrillation

Question 4

Warfarin mechanism of action

Answer 4

inhibits expoide reductase enzyme which prevents it from turning vitamin K to it’s active form hydroquinone
therefore acts as a cofact for the carboxylation of clotting factor, 2,7,9,10 and protein C

Question 5

indications for warfarin

Answer 5

for mechanical valve ( mitral requires higher INR than aortic )
second line after DOACs
- VTE INR 2.5 if recurrent 3.5
-AF INR 2.5

Question 6

factors that may potentiate warfarin

Answer 6

liver disease
P450 inhibitors - amiodarone and ciprofloxacin
cranberry juice
drugs that displace it from albumin p450
inhibits platelet function NSAIDs