Cardiology

Question 1

STEMI

Answer 1

≥ 20 minutes symptoms AND persistent (> 20 minutes) ECG features in ≥ 2 contiguous leads of:
- 2.5 mm ST elevation in leads V2-3 in men under 40 years, or ≥ 2.0 mm ST elevation in leads V2-3 in men over 40 years
- 1.5 mm ST elevation in V2-3 in women
- 1 mm ST elevation in other leads
- new LBBB

Question 2

Immeiate management STEMI

Answer 2

Give aspirin 300mg and determine PCI availability

Question 3

PCI in STEMI

Answer 3

if present within 12 hours of the onset of symptoms AND PCI can be delivered within 120 minutes
Give prasugel
radial access is preferred to femoral access - give unfractionated heparin and bailout GPI

Question 4

Fibronlysis in STEMI

Answer 4

within 12 hours symptom onset
give alteplase/
also give antithrombin

give ticagrelor after

Question 5

if high bleeding risk in STEMI

Answer 5

give ticagrelor instead of prasugel in PCI
give clopidogrel instead of ticagrelor in fibrinolysis

Question 6

If patient taking anticoagulants in STEMI

Answer 6

swap prasugel for clopidogrel

Question 7

NSTEMI/unstable angina immediate management

Answer 7

aspirin 300mg
if no immediate PCI planned -> fondaparinux
estimate GRACE score

Question 8

NSTEMI GRACE score <3%

Answer 8

give ticagrelor
if high bleeding risk -> give clopidogrel

Question 9

NSTEMI GRACE score >3%

Answer 9

PCI immediately if clinically unstable
otherwise within 72hrs
give prasugrel (ticegralor if high bleeding risk)
give unfractionated heparin

Question 10

ACEi C/I

Answer 10

pregnancy/breastfeeding
renovascular disease
aortic stenosis
K+ >5 ask a specialist

Question 11

RF for infective endo

Answer 11

previous episode (strongest RF)
rheum. valve disease
prosthetic valve
congenital heart
IVDU

Question 12

Most commonly affected heart valves in infective endocarditis

Answer 12

most common: MITRAL VALVE
IVDU: tricuspid

Question 13

Native valve acute endocarditis most common cause

Answer 13

staph aureus

Question 14

Most common endocarditis bug

Answer 14

staph aureus

Question 15

Native valve subacute endocarditis bugs

Answer 15

strep viridans
enterococcus

Question 16

Prosthetic valve endocarditis bugs

Answer 16

in first 2 months: staph epidermidis
after 2 months: staph aureus
MRSA

Question 17

most common endocarditis bugs in IVDU

Answer 17

staph aureus

Question 18

culture negative causes infective endo

Answer 18

antibiotic therapy beforehand
bartonella
brucella
HACEK

Question 19

endocarditis presentation

Answer 19

fever
fatigue
night sweats
muscle aches
anorexia

Question 20

Signs of endocarditis

Answer 20

murmur
splinter haemorrhages
petechiae
janeway lesions
osler’s nodes
roth spots
splenomegaly and clubbing in long disease

Question 21

Most common cause infective endo with indwelling lines

Answer 21

staph epidermidis

Question 22

Endocarditis diagnosis

Answer 22

modified Duke criteria:
2 major criteria
OR
1 major and 3 minor
OR
5 minor

Question 23

Modified Duke’s major criteria

Answer 23

2 positive blood cultures with typical bacteria
positive echo
new valvular regurgitation

Question 24

Modified Duke’s minor criteria

Answer 24

predisposition (IVDU or heart valve probs)
fever >38
vascular signs
immunological signs
microbiological evidence that doesn’t meet major

Question 25

vascular signs of endocarditis

Answer 25

major emboli splenomegaly clubbing splinter haemorrhages Janeway lesions

Question 26

Immunological signs of endocarditis

Answer 26

Osler's nodes Roth spots glomerulonephritis

Question 27

Initial native valve endocarditis treatment

Answer 27

Amoxicillin +/- low dose gent pen allergy/MRSA: vancomycin + low dose gent

Question 28

Initial prosthetic valve endocarditis treatment

Answer 28

vancomycin + rifampicin + low dose gent

Question 29

native valve confirmed staph treatment

Answer 29

flucloxacillin pen allergic: vancomycin + rifampicin

Question 30

prosthetic valve confirmed staph treatment

Answer 30

fluclox + rifampicin + low-dose gent pen allergy: vancomycin + rifampicin + low dose gent

Question 31

Confirmed strep viridans endocarditis treatment

Answer 31

benzypenicillin pen allergy: vancomycin + low dose gent

Question 32

indications for surgery infective endo

Answer 32

severe valvular incompetence aortic abscess resistant cardiac failure recurrent emboli after abx

Question 33

How long abx treatment for native heart valves

Answer 33

4 weeks

Question 34

How long abx treatment for prosthetic heart valves

Answer 34

6 weeks

Question 35

Most common cause of death following MI

Answer 35

cardiac arrest - ventricular fibrillation

Question 36

What complication can occur 48hrs following MI

Answer 36

pericarditis

Question 37

What complication can occur 2-6weeks following MI

Answer 37

Dressler's syndrome -> autoimmune reaction

Question 38

Dressler's syndrome presentation

Answer 38

fever pleuritic pain pericardial effusion raised ESR treat with NSAIDs

Question 39

What complication can occur 1-2 weeks following MI

Answer 39

left ventricular free wall rupture acute heart failure secondary to cardiac tamponade

Question 40

treatment left ventricular free wall rupture

Answer 40

urgent pericardiocentesis and thoracotomy

Question 41

persistent ST elevation and left ventricular failure following myocardial infarction

Answer 41

left ventricular aneurysm thrombus can cause need anticoagulation

Question 42

What complication can occur in first week following MI

Answer 42

VSD acute HF w/ pan-systolic murmur needs urgent surgical correction

Question 43

Which type of MI can lead to acute mitral regurgitation

Answer 43

infero-posterior infarction more commonly ischaemia or rupture of papillary muscles presentation: acute hypotension and pulmonary oedema