Cardiovascular conditions

Question 1

What is acute coronary syndrome?

Answer 1

Refers to any group of symptoms attributed to obstruction of the coronary arteries including STEMI, NSTEMI and unstable angina

Question 2

What is often seen on ECG in NSTEMIs?

Answer 2

Tall tented T waves or inverted T waves

Question 3

Rises in which 3 enzymes are seen after an ACS episode?

Answer 3

Troponin, CK-MB, myoglobin

Question 4

Management of MI?

Answer 4

Morphine, Oxygen, Nitrates (GTN), Aspirin
STEMI: primary angioplasty or thrombolysis. iv beta blocker, ACE-i, clopidogrel
NSTEMI: iv beta blocker, iv nitrates, antithrombotic fondaparinux or LMWH, consider clopidofrel

Question 5

What are some causes of angina pectoris?

Answer 5

Atheroma, anaemia, tachyarrhythmias, hypertrophic cardiomyopathy, arteritis/small vessel disease.
Other precipitating factors: cold weather, emotion

Question 6

What is seen on ECG in angina pectoris?

Answer 6

Usually normal, may show ST depression/flat or inverted T waves/Q waves indicate previous MI

Question 7

What test confirms the diagnosis of angina pectoris?

Answer 7

Exercise ECG, also shows severity of the CAD

Question 8

Causes of Atrial Fibrillation?

Answer 8

Idiopathic, heart failure/ischaemia, HTN, MI, PE, mitral valve disease, pneumonia, hyperthyroidism, caffeine, alcohol, post-op, low K+, low Mg++

Question 9

Atrial flutter, a differential for A.Fibrillation, produces what appearance on ECG?

Answer 9

Saw-toothed ECG

Question 10

What is seen on ECG in atrial fibrillation?

Answer 10

Irregularly irregular, no p waves, irregular baselines, narrow QRS complexes

Question 11

Management of AF?

Answer 11

Acute AF: if very ill give oxygen, emergency cardioversion, LMWH
Paroxysmal AF: pill in pocket (flecainide PRN)
Chronic AF: Rate control (beta blocker or Ca+ channel blocker), rhythm control (cardioversion), anticoagulation (warfarin/aspirin/dabigatran)

Question 12

What is the blood pressure of someone with essential hypertension?

Answer 12

At least 140/90mmHg

Question 13

What percentage of hypertension is essential/primary/idiopathic?

Answer 13

95%

Question 14

What drugs can cause HTN?

Answer 14

OCP, NSAIDs, cyclosporin, steroids

Question 15

What are the blood pressure targets for those being treated for HTN?

Answer 15

140/90mHg
Diabetes: 130/80
>80 years old: 150/90

Question 16

What tends to make up the thrombus in veins?

Answer 16

RBCs and fibrin

Question 17

Risk factors for VTE?

Answer 17

Increasing age, pregnancy, synthetic oestrogen, trauma, surgery, past DVT, cancer, obesity, immobility, thrombophilia

Question 18

What is the name of the scoring system that can help to determine the likelihood of the problem being a DVT?

Answer 18

Wells score

Question 19

What measures are taken to help prevent DVTs occurring?

Answer 19

Stop OCP 4 weeks pre-op, mobilize early after op, prophylactic LMWH for at-risk patients, stockings, Fondaparinux

Question 20

Defeine Cardiac Failure

Answer 20

Cardiac output is inadequate to meet body’s requirements. Can be due to a number of things including IHD, cardiomyopathy, cardiac tamponade, heart block, exercise-induced, HTN and aortic stenosis

Question 21

Symptoms of left sided heart failure?

Answer 21

Dyspnoea, tachypnoea, paroxysmal noctrunal dyspnoea, fatigue, orthopnoea, haemoptysis, wheeze, nocturia, cold peripheries, weight loss, muscle wasting

Question 22

Symptoms of right sided heart failure?

Answer 22

Peripheral/sacral oedema, nocturia, ascites, nausea, anorexia, facial engorgement, pulsation in neck/face, epistaxis

Question 23

Symptoms of congestive heart failure?

Answer 23

Paroxysmal nocturnal dyspnoea, neck vein distension, crepitations, acute pulmonary oedema, S3 gallop, hepatojugular reflex, cardiomegaly, increased central venous pressure

Question 24

Management of heart failure?

Answer 24

Lifestyle changes, treat underlying cause and any exacerbating factors, avoid NSAIDs and verapamil
Drugs: 1. Diuretics 2. ACE-i 3. beta blockers 4. spironolactone 5. Digoxin 6. vasodilators

Question 25

The presence of which 2 things constitutes infective endocarditis until proven otherwise?

Answer 25

Fever and new murmur

Question 26

What is the most common cause of infective endocarditis?

Answer 26

S.aureus Strep viridans (35%) Staph epidermis, diphtheroids, microaerophilic streps

Question 27

Which valves are most often affected by infective endocarditis?

Answer 27

In order: 1. Mitral 2. Aortic 3. Combined mitral and aortic 4. Tricuspid 5. Pulmonary

Question 28

What is the mnemonic to remember signs of infective endocarditis?

Answer 28

``` F - Fever R - Roth's spots O - Osler's nodes M - Murmur J - Janeway lesions A - Anaemia N - Nail (splinter) haemorrhage E - Emboli ```

Question 29

Management of infective endocarditis?

Answer 29

Iv Abx - adjust according to blood culture, surgery indicated in some cases

Question 30

What test confirms postural hypotension?

Answer 30

Tilt-table testing

Question 31

Why is valvular disease more common on the left side of the heart than the right?

Answer 31

Higher pressures on left

Question 32

Mitral stenosis is most often caused by what?

Answer 32

Rheumatic heart disease. | It is the most common valvular disease in pregnancy

Question 33

What is the most commoin valvular heart disease in the Western world?

Answer 33

Aortic stenosis

Question 34

What is the most common valvular heart disease worldwide?

Answer 34

Mitral regurgitation

Question 35

What is the type of murmur heard in each of mitral stenosis, aortic stenosis, mitral regurg and aortic regurg?

Answer 35

Mitral stenosis: Mid-diastolic Aortic stenosis: Ejection systolic Mitral regurg: Pansystolic Aortic regurg: Early diastolic murmur