Cardiology

Question 1

Compensatory mechanism in HF

Answer 1

1. increase ventricular preload with ventricular dilatation & volume expansion
2. Peripheral vasoconstriction, maintains perfusion to vital organis
3. Myocardial hypertrophy to preserve wall stress as the heart dilates
4. Renal sodium and h2o retention to enhance ventricular preload
5. Activation of the adrenergic nervous sys, increase HR & contractile function

Question 2

Common cause of myocarditis

Answer 2

viral
1. Adenovirus
2. Enterovirus (coxsackie group B serotype) 
Bacterial
1. Mycobacterial 
2. Strep
3. Mycoplasma pneumoniae
4. Treponema pallidum
Fungal
1. Aspergillus
2. Candida
Others
Hep C
Giant cell

Question 3

Fulminant myocarditis

Answer 3

Severe hemodynamic compromise
- high dose vasopressor + mechanical circulatory support
Acute HF
Global LV dysfunction

Question 4

Treatment myocarditis

Answer 4

1. Supportive care
2. Usually has HF -> diuretics
3. Follow Mx of LV dysfunction -> ACEi & BBlocker
4. Immunosuppression (azathioprine)

Question 5

Treatment myocarditis

Answer 5

1. Supportive care
2. Usually has HF -> diuretics
3. Follow Mx of LV dysfunction -> ACEi & BBlocker

Question 6

Perhexilline

Answer 6

Rx: HF & refractory angina

• relieves angina, improves exercise tolerance & Increase workload
• no mortality benefit
• SE: Hepatotoxic, peripheral neuropahty, hypoglycaemia
• Metabolised: CYP450 2D6
• 7-10% caucasian (mutation of CYP2D6, hence slow metabolisers)
• T 1/2: 3-12/7; slow mets 30 days

Question 7

Rx of Pericarditis

Answer 7

NSAIDs