Cardio

Question 1

What does chest pain with tenderness suggest?

Answer 1

Tietze’s syndrome (inflammation of the costchondral cartilage with swelling)

Question 2

What is the cause of angina?

Answer 2

Angina is caused by corornary artery disease - and also by aortic stenosis, hypertrophic cardiomyopathy, paroxysmal SVT. Angina can be exacerbated by anaemia.

Question 3

What three classic symptoms are assoc. w/ heart failure?

Answer 3

Orthopnoea, PND and peripheral oedema

Question 4

What are the risk factors for DVT?

Answer 4

Older age, pregnancy, synthetic oestrogen (pill), recent surgery (espec. pelvic/orthopaedic), cancer, obesity, immobility(long haul flights), thrombophillia

Question 5

Which scoring system is used to determine clinical probability of a DVT?

Answer 5

The Wells Score

Question 6

D-dimer tests are sensitive but not specific. Name 4 causes of increased D-dimer other than a DVT?

Answer 6

Infection, pregnancy, malignancy and post op

Question 7

Name seven differentials of palpitations

Answer 7

1) Anxiety
2) AF
3) ectopics
4) SVT
5) VT
6) thyrotoxicosis
7) Phaeochromocytoma

Question 8

What type of drug is amiodarone?

Answer 8

An anti-arrhythmic

Question 9

What class of drug is digoxin and what is it prescribed for?

Answer 9

• A cardiac glycoside

- Fast AF, atrial flutter and heart failure

Question 10

Name an ejection systolic murmur

Answer 10

aortic stenosis

Question 11

Name an early diastolic murmur

Answer 11

aortic regurgitation

Question 12

Name a pan-systolic murmur

Answer 12

mitral regurgitation

Question 13

Name a mid-diastolic murmur

Answer 13

mitral stenosis

Question 14

Name a classic feature of mitral stenosis

Answer 14

malar flush

Question 15

What type of murmur is describe as: Loud S1, normal S2, opening snap and pre-systolic accentuation

Answer 15

mid-diastolic murmur

Question 16

What is the immediate medical treatment for an MI?

Answer 16

MONAC:

• Morphine (5-10mg IV)
• Oxygen
• Nitrates (GTN spray sublingual)
• Aspirin (300mg chewed)
• Clopidogrel (trade name - Plavix. It is an anti-platelet agent)

Extra…
Also, an anti-emetic e.g. metoclopramide should be given IV (not IM due to risk of bleeding with thrombolysis)

Question 17

What diagnosis would you consider in a 26 year old male presenting with chest pain, fever, SOB raised WCC and ST elevation on ECG?

Answer 17

Acute pericarditis

Other DDx:

• MI - cocaine induced?
• Prinzmetals angina

Question 18

What is ST depression on ECG associated with?

Answer 18

Ischaemic heart disease

Question 19

What are the two commonest causes of LV hypertrophy?

Answer 19

Hypertension and aortic valve disease

Question 20

Following a MI, when would you expect troponin levels to:

a) rise?
b) peak?

Answer 20

a) serum levels rise 3 to 12 hrs following the onset of chest pain
b) peak at 24-48 hrs

…(then return to baseline over 5-14 days)

Question 21

When do CK-MB levels peak following an MI

Answer 21

They peak within 24 hrs. (rise from 3-12hrs)

Question 22

Where is cholesterol metabolized?

Answer 22

Liver

Question 23

Which cholesterol is an indicator of coronary artery disease and which is protective?

Answer 23

LDL - indicator of CAD

HDL is protective

Question 24

What ratio of LDL:HDL is considered high risk of coronary artery disease?

Answer 24

A ratio of > 4

Question 25

How does lowering LDL levels lower risk of CAD?

Answer 25

Lowering LDL levels reduces cholesterol deposition into atherosclerotic plaques. Lowering cholesterol therefore stabilises the plaques and reduces the risk of acute plaque rupture.

Question 26

How do statins lower cholesterol?

Answer 26

They are HMG-CoA reductase inhibitors. They inhibit intracellular cholesterol biosynthesis which increases hepatic cholesterol uptake.

Question 27

Bile acid sequestrants ('resins') lower cholesterol levels by binding cholesterol in the GI tract, therefore increasing cholesterol secretion. Name one drug that comes under this class.

Answer 27

Cholestyramine

Question 28

What is Prizmental angina due to? How is it treated?

Answer 28

It is due to coronary artery spasm and treated with calcium channel blockers +/- long acting nitrates

Question 29

What is the chief causative organism of infective endocarditis?

Answer 29

S.Aureus

Question 30

What are the risk factors for infective endocarditis in patients with normal heart valves?

Answer 30

Dermatitis, IV injections, renal failure, organ transplantation, diabetes mellitus and post-op wounds.

Question 31

What are the risk factors for infective endocarditis in patients with abnormal heart valves?

Answer 31

Aortic/mitral valve disease, Tricuspid valves in IVDUs, coarctation, patent ductus arteriosus, ventricular septal defects and prosthetic valves.

Question 32

What is the action of renin?

Answer 32

Renin causes the conversion of angiotensinogen (which is released by the liver) to angiotensin I

Question 33

Where is the enzyme ACE found? What does ACE do?

Answer 33

It's secreted in the lungs and kidneys. ACE converts angiotensin I to angiotensin II

Question 34

What is the action of Angiotensin II

Answer 34

Angiotensin II causes vasoconstriction of blood vessels and also stimulates the secretion of aldosterone

Question 35

What is the action of aldosterone?

Answer 35

Aldosterone increases the reabsorption of sodium and water into the blood, therefore increased blood volume and thus BP.

Question 36

What type of drug is Ezetimibe

Answer 36

Ezetimibe is a cholesterol lowering drug that inhibits cholesterol absorption at the small intestine brush border

Question 37

Explain CHADS2 scoring system

Answer 37

Whilst warfarin decreases the risk of embolic stroke, it increases the risk of haemorrhage, thus the scoring system (CHADS2) has been devised to determine when the benefits outweigh the risks. The CHADS2 score is calculated as follows:- ``` Cardiac failure (1 point) Hypertension (1 point) Age >75 years (1 point) Diabetes mellitus (1 point) Stroke or TIA history (2 points) ``` A CHADS2 score of ≥2 warrants warfarin, as the benefits outweigh the risks.