Cardio

Question 1

Give 2 shockable cardiac arrest rhyhms

Answer 1

Ventricular tachycardia

Ventricular fibrilation

Question 2

Give 2 non-shockable caridac arrest rhthms

Answer 2

Asystole

Pulseless electrical activity

Question 3

Unstable tachycardia patient- treatment options?

Answer 3

consider 3 synchronised shocks

consider amiodarone infusion

Question 4

Give 3 examples of narrow complex tachycardias in a stable patient?

Answer 4

Atrial Fibrilation
Atrial Flutter
SVT

Question 5

Give 2 examples of broad complex tachycardias in a stable patient?

Answer 5

Ventricular tachycardia

SVT with bundle branch block

Question 6

Atrial flutter causes a narrow or broad QRS complex tachycardia?

Answer 6

Atrial flutter= Narrow complex tachycardia

Question 7

What is the pathophysiology behind atrial flutter?

Answer 7

Re-entrant rhythm

Extra electrical pathway causing self-perpetuating electrical signal loop

Question 8

ECG shows “Saw Tooth Appearance”- likely diagnosis and management?

Answer 8

Atrial Flutter

Rate/rhythm control- BB / Cardioversion
Tx underlying cause e.g HTN / Thyrotoxicosis
Anti-coagulate if CHA2DS2VASc high risk
Radio-frequency ablation

Question 9

What is the most definitive treatment of Atrial Flutter?

Answer 9

Radio-frequency ablation

Question 10

Potential causes/ associations with atrial flutter

Answer 10

Ischaemic heart disease
Hypertension
Thyrotoxicosis

Question 11

Three types of AF

Answer 11

Paroxysmal <48hrs
Persistent > 7 days
Permanent (cannot restore to normal)

Question 12

Which is the commonest arrhythmia

Answer 12

AF (10% over 80yos)

Question 13

What is the pathophysiology of AF?

Answer 13

single re-entrant circuit or ectopic foci

Question 14

What clinical picture may indicate AF?

Answer 14

Palpitations, SOB, fatigue
Increased HR, Decreased BP,
Irregularly irregular pulse

Question 15

Patient has absent P waves and an irregularly irregular RR interval on ECG. Likely diagnosis? They are stable, how would you acutely manage this patient?

Answer 15

Rhythm- electrical/chemical cardioversion

Rate- BB/CCB/Digoxin

Question 16

Derek is an 82 year old gentleman with a history of AF. What is the long term management plan for derek?

Answer 16

Rhythm control- amiodarone
Rate control- BB/CCB/Digoxin
Anti-coagulation if CHA2DS2VASc high risk
Consider catheter ablation

Question 17

What is the definitive management of AF?

Answer 17

Catheter ablation

Question 18

Patient presents to A&E with SOB, palpitations and an irregularly irregular pulse. It is uncertain from the history how long the patient has been like this. Your colleague is about to cardiovert the patient, what should you do?

Answer 18

Warn them that if it has been >48hrs since onset they may have clot formation in atria, cardioversion will dislodge this and cause stroke.

Perform transthoracic/transoesophageal echo or anti-coagulate for 4 weeks before cardioverting

Question 19

What are the causes of AF?

Answer 19

PIRATES 
Pulmonary= PE , COPD, Lung CA
Ischaemia= IHD, MI, HTN, HF 
Rheumatic valve disease 
Alcohol 
Thyrotoxicosis 
Electrolytes (low K+/Mg2+)
Sugar (DM) / Sepsis

Question 20

patient has stable angina, what should you prescribe them?

Answer 20

Bisoprolol (lower rate)
Aspirin or Clopidogrel (give single antiplatelet in stable angina)
Statin (lower cholesterol)
GTN spray (reliever)

Question 21

What is metaclopromide? When might you give it?

Answer 21

anti-emetic

ACS, when giving morphine (prevent sickness from morphine)

Question 22

What is the purpose and what are the components of CHA2DS2-VASc Score?

Answer 22

Risk of stroke in patients with AF

Congestive heart failure 
Hypertension 
Age (>65, >75)
Diabetes 
Stroke/TIA/VTE hx (2)
Vascular disease hx e.g. MI, PAD
Sex (female)

Question 23

Mangement of ventricular tachycardia

Answer 23

DC cardioversion

Question 24

Name 3 cardio drugs which can increase serum potassium

Answer 24

ACEi
BB
Spironolactone

Question 25

``` Describe the coronary arteries involved in.... Anterior MI Inferior MI Posterior MI Lateral MI ```

Answer 25

``` Anterior= LAD Inferior= Right coronary Posterior= Circumflex / Right coronary Lateral= circumflex / diagonal branch LAD ```

Question 26

CPAP is given to patients in LVF, how does CPAP help these patients?

Answer 26

Improves oxygenation by recruiting lung units, improved V/Q mismatch Improves lung compliance, decreases work of breathing therefore decreases myocardial demand Increased intrathoracic pressure decreases venous return (preload), this decreases LV systolic pressure and therefore decreased afterload

Question 27

What are the 3 diagnostic features of stable angina? Number of features needed for stable angina? for atypical angina? for non-cardiac/anginal pain?

Answer 27

1) Chest pain/dicomfort 2) Exacerbated by exercise / emotion / big meals 3) Relieved by rest / GTN All 3= stable angina Any 2/3= atypical angina =1= non-anginal pain

Question 28

Gary, a 62 year old male, suffered a heart attack 3 days ago. On cardiovascular examination you auscultate a loud pansystolic murmur at the base of the left sternal edge. What has occured and what other sign might you elicit in your CV exam?

Answer 28

Ventricular Septal Defect (post-MI complication) Other sign= check for ankle oedema

Question 29

Patients with suspected MI presents to A&E, a number of investigations are ordered including a troponin. When should the troponin levels be re-tested?

Answer 29

12 hours after symptoms started (more reliable result at 12 hours than initial)

Question 30

What cardiovascular presentation would warrant a carotid sinus massage/table tilt test? Describe the test, what equipment is needed and what constitutes a positive result?

Answer 30

Vasovagal syncope Massage one carotid sinus then the other for ~5 seconds First with patient lying flat then on table 30 degrees up Need beat to beat BP measurement, need continuous ECG and print strip Positive test if systolic BP drops >50mmHg with symptoms or asystole >5 seconds

Question 31

Atrio-ventricular nodal reentrant tachycardia is a common arrhythmia in what patient group?

Answer 31

young women (~5%)

Question 32

What are the 3 Ps indicative of uncomplicated syncope e.g vasovagal?

Answer 32

Posture/prolonged standing Provoked Prodromal sx