AF, MI, Stroke

Question 1

person with AF has a stroke/TIA, what is the choice of anticoag long term

Answer 1

DOAC, warfarin, or dabigatran (direct thrombin inhibitor)

Question 2

lithium tremor

Answer 2

fine tremor in chronic
coarse tremor in toxicity

Question 3

when is a third heart sound heard

Answer 3

normal if < 30 years
if not:
- left ventricular failure (e.g. dilated cardiomyopathy)
- constictive pericarditis
- mitral regurgitation

to do with slow filling of ventricle in diastole

Question 4

hyperdense collection on CT

Answer 4

heamorrhage !!!

“hyperdense artery” means ischaemic

Question 5

drugs to avoid in renal failure

Answer 5

• tetracycline
• nitrofurantoin
• NSAIDs
• lithium
• metformin

Question 6

major bleed + warfarin

Answer 6

IV vit K and prothrombin

Question 7

INR > 8 minor bleeding

Answer 7

IV vit K
- give warfarin when INR < 5

Question 8

INR > 8
- no bleeding

Answer 8

oral vit K
- give warfarin when INR < 5

Question 9

INR 5-8 minor bleeding

Answer 9

IV vit K
- restart INR when < 5

Question 10

INR 5-8 no bleeding

Answer 10

withold 1 or 2 doses of warfarin

Question 11

what investigation signs for unstable angina

Answer 11

ischaemic symptoms suggestive of an ACS and no elevation in troponins, with or without electrocardiogram changes indicative of ischaemia

NO ELEVATED TROPONINS

Question 12

transfusion threshold for ACS

Answer 12

<80 hb

Question 13

digoxin therapy ECG features

Answer 13

• down sloping ST depression (reverse tick)
• flattened/inverted T waves
• short QT interval

Question 14

new left bundle branch block

Answer 14

ACS!!!!!!!

Question 15

patients on warfarin going for emergency surgery

Answer 15

If surgery can wait for 6-8 hours - give 5 mg vitamin K IV
If surgery can’t wait - 25-50 units/kg four-factor prothrombin complex

Question 16

when would you not do rate control first as management for AF

Answer 16

heamodynamically unstable: cardiovert!

RANCH
reversible cause
atrial flutter
new onset < 48 hours
Clinician thinks rhythm more suitable
Heart failure due to AF

if its a young patient < 65 then usually its delyaed cardioversion (3 weeks anticoag)

Question 17

pharmacological options for cardioversion

Answer 17

flecanide
amiodarone (if they have structural heart disease)

Question 18

presentation of dressler’s syndrome

Answer 18

2-6 weeks following MI
- fever
- pleuritic pain
- pericardial effusion
- raised ESR

Question 19

Mx antiphospholipid syndrome

Answer 19

no event - aspirin
an event - warfarin
pregnancy - LMWH

Question 20

AV block happens following what MI

Answer 20

inferior

Question 21

when can thrombolysis be given for stroke

Answer 21

within 4.5 hours + haemorrhagic stroke excluded

Question 22

management of PE

Answer 22

DOAC

unless hypotension then thrombolyse