Cardio

Question 1

Midline sternotomy

Causes?

Answer 1

CABG
(Open) valve replacement
Congenital cardiac defect repair

Heart & lung transplant

Question 2

Infraclavicular scar

Answer 2

Pacemaker

Previous central line insertion

Question 3

Dextrocardia

Causes?

Answer 3

Kartagener’s
Situs inversus

Question 4

Indications for AS valve replacement

Answer 4

Symptomatic

Asymptomatic but evidence of LVEF <40% OR valve gradient >40mmHg OR valve area <1cm2

Question 5

Types of aortic valve replacement

Answer 5

Open

TAVI - Trans catheter aortic valve implantation
Balloon valvuloplasty - children with no calcification OR critical stenosis in adult not fit for surgery

Question 6

Investigations for AS / ejection systolic murmur

Answer 6

Full history, examination

Bedside:
Obs - narrow pulse pressure
ECG - look for evidence of LVH

Bloods:
FBC, CRP - rule out acute murmur due to IE
Lipids, HbA1c - baseline cardiovascular risk status
U&E - baseline, renovascular disease
BNP - if signs of HF (oedema)

Specialist
CXR
Echo

Question 7

Management of aortic stenosis

Answer 7

Refer for cardiology opinion

Conservative
- modify RF e.g. smoking cessation
- exercise

Medical
- statin
- anti hypertensive
- metformin if diabetic
- anti anginal?

Surgical
- valve replacement or repair

Question 8

Management of heart failure - ACUTE

Answer 8

A-E approach
Oxygen if sats low

IV access, take bloods (as per Ix, IV furosemide)
- STOP, beta blocker if HR <50 or hypotension OR 2/3rd degree AV block

Refractory
- CPAP
- Isotropes, vasopressin’s
- Intra aortic balloon counter pulsation

Question 9

Management of heart failure - CHRONIC

Answer 9

Conservative
- modify RF e.g. smoking cessation
- gentle exercise as appropriate
- salt, fluid restrict
- 1 off pneumococcal, annual influenza vaccine

Medical
- ACEi
- beta blocker
- SGLT-2 inhibitor (dapagliflozin), Spironolactone, digoxin
- monitor frequently especially U&E
- RF: statin

Surgical
- if LBBB: CRT +/- ICD
- intra aortic balloon counter pulsation
- LV assist device (bridge to transplant)
- heart transplant

Question 10

Indications for CABG

Answer 10

To improve survival
Left main stem disease
Triple vessel disease
Multiple severe stenoses

To relieve sx
Pts unsuitable for angioplasty or failed angioplasty

Anginal sx refractory to optimal medical management

Question 11

Sites for vessel harvesting in CABG

Answer 11

Saphenous vein
Mammary artery (lasts longer, but may cause chest wall numbness)