Cardio Long

Question 1

Cx of AMI to ask about in Hx

Answer 1

Arrhythmia
CCF
Angina
Embolic events

Question 2

Optimal MEdical treatment for stable angina

Answer 2

1. Aspirin +/- Clopidigrel (for one year post ACS)
2. Statin - Target LDL <1.8
3. HTN - ACEi/ARB; Taget BP <130/80
4. HR - BB aiming HR <70
5. Exercise 3x per week for >150 mins/week

Question 3

Specific IE Hx questions

Answer 3

• Presenting Sx - malaise, fever, anaemia
• Embolic phenomena: Brain, viscera, kidneys, haematuria, loin pain
• Recent procedures
• Hx of rheumatic fever, heart disease, or heart operations
• IVDU
• Immunosuppression?

Question 4

CAuses of culture negative IE

Answer 4

1. PRevious ABx use
2. Exotic organism: HAemophilis parainfluenza, histoplasmosis, Brucella, Candida, Q fever
3. Right sided IE (rarely)

Question 5

Dukes Criteria for IE

Answer 5

Two major Criteria, OR 1 major and 3 minor, OR 5 minor

Major:

• Typical organism on 2 separate BCs
• Evidence of endocardial involvement on TTE
• Single positive BC for Coxiella burnettii or anti phase IgG ab >1:800

Minor:

• Predisposing cardiac condition or IVDU
• Fever
• Embolic vascular phenomena
• Serological or acute phase abnormalities

Question 6

DDX for IE

Answer 6

Atrial myxoma
Occult malignant neoplasm
SLE
PAN
Post Strep GN
Pyrexia of unknown origin
Cardiac thrombus

Question 7

Precipitants of CCF

Answer 7

1. Arrhythmia
2. Non-compliance with FR/meds/high salt
3. AMI
4. PE
5. Anaemia
6. Infection/fever
7. Thyrotoxicosis
8. Anaesthesia and surgery
9. Pregnancy

Question 8

Sx of LVF

Answer 8

Dyspnea

ORthopnea/PND

Question 9

Sx of RVF

Answer 9

Oedema
Ascites
Anorexia
Nausea

Question 10

CVS risk factors

Answer 10

MAle
Age
HTN
Chol
Smoking
Diabetes
FHx of early CAD
OCP or premature menopause
Obesity
Low physical activity
Erectile dysfunction

Question 11

RF for dilated cardiomyopathy

Answer 11

ETOH
FHx
HAemochromatosis

Question 12

NYHA classification

Answer 12

I - No limitation of physical activity
II - Angina/dyspnea on moderate activity
III - Angina/dyspnea on mild activity
IV - Angina/dyspnea at rest

Question 13

Ix for cause of hypertriglyceridemia

Answer 13

hypothyroid
DM
ETOH

Question 14

Ix for HTN

Answer 14

UEC
-If K+ low consider hyperaldosteronism: ARR (High)
- OTher causes: Renovascular disease, Cushings, Liddle’s syndrome
24 hour urine catecolamines
Urine ACR PCR
OSA work up
CT Angio -?RAS

CVS Risk:

• BSL
• Chol

Question 15

Causes of uncontrolled HTN

Answer 15

1. Compliance
2. Hyperaldosteronism
3. Cushings
4. Coarctation of the aorta
5. RAS
6. Phaeo

Question 16

Tavi Cx

Answer 16

Heart block
AR
Tavi thrombosis

Question 17

CI to TAVI

Answer 17

Aortic annulus too small
LV apical thrombus
Peripheral vascular access issues
Active endocarditis
Life expectancy <1 yr

Question 18

SEvere AS

Answer 18

Gradient >40 mmHg
Area <1 cm2
Velocity <0.25 DI
Flow 4

Question 19

Moderate AS

Answer 19

Gradient 20-40
Area 1-1.5
Velocity <0.25

Question 20

HASBLED

Answer 20

• Hypertension
• Abnormal renal/liver function
• Stroke
• Bleeding history or predisposition
• Labile INR
• Elderly
• Drugs/alcohol

Question 21

CHADSVASC

Answer 21

• Congestive heart failure / left ventricular dysfunction
• Hypertension
• Age ≥ 75 (x2)
• Diabetes
• Stroke (x2)
• Vascular disease
• Age 65-74
• Sex (female) (x2)

Question 22

Severe MS

Answer 22

Area of <1 cm2

Mean gradient >10 mmHg

Question 23

Indication for PPM

Answer 23

1. SND
   - Only if symptomatic
2. AV block
   - Pace even if symptomatic in Type 2 AV block, high degree AV block, CHB
   - Otherwise only if symptomatic

Question 24

Mx of MS

Answer 24

MEdical therapy
-BB, diuretics if overloaded

Balloon valvuloplasty

Question 25

Indications for Balloon valvuloplasty in MS

Answer 25

Mod to severe MS (<1.5 cm2 area) Symptomatic Asymptomatic + - New AF - PASP >50mmHg at rest

Question 26

Contraindications for balloon valvuloplasty in MS

Answer 26

>mild MR LA thrombus Heavy calcification Predominant subvalvular involvement

Question 27

Indications for AR repair

Answer 27

If Symptomatic - Treat If asymptomatic: - Resting EF <50% - Cardiac surgery/CAGS - Rest EF >50%, but LV Diastolic >70mm or LV systolic >50 mm

Question 28

Indication for ICD

Answer 28

PRimary -1 month post MI with LVEF <35% Secondary - Sustained VT with Hemodynamic compromise - VT with syncope - Cardiac arrest

Question 29

Indication for CRT

Answer 29

LVEF <35%, QRS >150 ms, SR, LBBB

Question 30

Causes of LVF

Answer 30

- Volume Overload: AR, MR, PDA - Pressure overload: HTN, AS - Myocardial disease: Ischaemic, dilated cardiomyopathy

Question 31

Causes of Dilated Cardiomyopathy

Answer 31

``` Idiopathic ETOH Myocarditis Familial Tachycardia induced Peripartum Neuromuscular disease CTD Sarcoid Haemachromatosis Drugs Radiation ```

Question 32

Causes of RHF

Answer 32

- Volume overload: ASD, TR - Pressure overload: PS, Pulmonary HTN - Myocardial disease: Cardiomyopathy secondary to LVF, Right ventricular infarction

Question 33

Signs of Cardiac Tx rejection

Answer 33

- Pericarditis Sx - Decreased LVEF - ECG changes -reduced voltage, atrial arrhythmia

Question 34

Prognosis in Cardiac Tx

Answer 34

10 year survival 50%

Question 35

CAuse of chronic CArdiac Tx failure

Answer 35

Chronic allograft vasculopathy