Cardiovascular Conditions A

Question 1

Stable Angina Pectoris - Description

Answer 1

chest pain during exertion or stress due to myocardial ischaemia

Question 2

Stable Angina Pectoris - Causes (2)

Answer 2

1) atherosclerosis

2) anaemia (rare)

Question 3

Stable Angina Pectoris - Risk Factors (9)

Answer 3

1) age
2) male
3) family history
4) hypertension
5) hypercholesterolaemia
6) diabetes mellitus
7) smoking
8) obesity
9) sedentary lifestyle

Question 4

Stable Angina Pectoris - Pathophysiology (2)

Answer 4

1) coronary atherosclerosis

2) myocardial ischaemia

Question 5

Stable Angina Pectoris - Symptoms (5)

Answer 5

1) heavy, tight, central chest pain
2) pain radiates to arms, neck, jaw
associated
3) dyspnoea
4) nausea
5) diaphoresis

Question 6

Stable Angina Pectoris - Signs (3)

Answer 6

1) brought on by exertion
2) relieved by rest
3) relieved by GTN spray

Question 7

Stable Angina Pectoris - Complications (4)

Answer 7

1) myocardial infarction
2) heart failure
3) stroke
4) depression

Question 8

Stable Angina Pectoris - Investigations (4/4)

Answer 8

initial
1) ECG (depressed ST segment, inverted T wave)
2) FBC (<90g/L if anaemia)
3) fasting blood glucose
4) fasting lipid profile
consider
1) coronary angiogram*
2) coronary CT angiogram
3) stress ECG (depressed/elevated ST segment)
4) stress echocardiogram

Question 9

Stable Angina Pectoris - Management (4/4/2)

Answer 9

conservative
1) dietary advice
2) regular exercise
3) weight loss
4) smoking cessation
medical
1) GTN spray (symptomatic relief)
2) antiplatelet (aspirin or clopidogrel)
3) antihypertensive (βB or CCB)
4) statin
surgery
1) percutaneous coronary intervention (PCI)
2) coronary artery bypass graft (CABG)

Question 10

Unstable Angina Pectoris - Description

Answer 10

chest pain during rest due to myocardial ischaemia

Question 11

Unstable Angina Pectoris - Causes (2)

Answer 11

1) atherosclerosis

2) anaemia (rare)

Question 12

Unstable Angina Pectoris - Risk Factors (9)

Answer 12

1) age
2) male
3) family history
4) hypertension
5) hypercholesterolaemia
6) diabetes mellitus
7) smoking
8) obesity
9) sedentary lifestyle

Question 13

Unstable Angina Pectoris - Pathophysiology (2)

Answer 13

1) coronary atherosclerosis

2) myocardial ischaemia

Question 14

Unstable Angina Pectoris - Symptoms (5)

Answer 14

1) heavy, tight central chest pain
2) pain radiates to arms, neck, jaw
associated
3) dyspnoea
4) nausea
5) diaphoresis

Question 15

Unstable Angina Pectoris - Signs (2)

Answer 15

1) relieved by GTN spray

2) S4 heart sound

Question 16

Unstable Angina Pectoris - Complications (4)

Answer 16

1) myocardial infarction
2) heart failure
3) stroke
4) depression

Question 17

Unstable Angina Pectoris - Investigations (5/4)

Answer 17

initial
1) ECG (depressed ST segment, inverted T wave)
2) FBC (<90g/L if anaemia)
3) troponin assay (unelevated)
4) fasting blood glucose
5) fasting lipid profile
consider
1) coronary angiogram*
2) coronary CT angiogram
3) stress ECG (depressed/elevated ST segment)
4) stress echocardiogram

Question 18

Unstable Angina Pectoris - Management (4/4/2)

Answer 18

conservative
1) dietary advice
2) regular exercise
3) weight loss
4) smoking cessation
medical
1) GTN spray (symptomatic relief)
2) antiplatelet (aspirin or clopidogrel)
3) antihypertensive (βB or CCB)
4) statin
surgery
1) percutaneous coronary intervention* (PCI)
2) coronary artery bypass graft

Question 19

Non-ST-Elevated Myocardial Infarction - Description

Answer 19

myocardial infarction due to narrowing of coronary artery

Question 19

Non-ST-Elevated Myocardial Infarction - Causes (2)

Answer 19

1) atherothrombosis

2) emboli (rare)

Question 19

Non-ST-Elevated Myocardial Infarction - Risk Factors (9)

Answer 19

1) age
2) male
3) family history
4) hypertension
5) hypercholesterolaemia
6) diabetes mellitus
7) smoking
8) obesity
9) sedentary lifestyle

Question 20

Non-ST-Elevated Myocardial Infarction - Pathophysiology (3)

Answer 20

1) coronary thrombosis
2) narrowing of coronary artery
3) myocardial infarction

Question 21

Non-ST-Elevated Myocardial Infarction - Symptoms (6)

Answer 21

1) heavy, tight, central chest pain (>20 minutes)
2) radiates to arms, neck, jaw
associated
3) dyspnoea
4) nausea
5) diaphoresis
6) palpitations

Question 22

Non-ST-Elevated Myocardial Infarction - Symptoms (Silent Myocardial Infraction) (3)

Answer 22

1) epigastric pain
2) syncope
3) vomiting

Question 23

Non-ST-Elevated Myocardial Infarction - Signs (4)

Answer 23

1) anxiety 2) pallor 3) bradycardia/tachycardia 4) hypotension/hypertension

Question 24

Non-ST-Elevated Myocardial Infarction - Complications (6)

Answer 24

1) arrhythmia 2) heart failure 3) pericarditis 4) cardiac tamponade 5) systemic embolism 6) depression

Question 25

Non-ST-Elevated Myocardial Infarction - Investigations (2/3)

Answer 25

``` initial 1) ECG (depressed ST segment, inverted T wave) 2) troponin assay* (elevated) consider 3) chest x-ray 4) coronary angiogram 5) echocardiogram ```

Question 26

Non-ST-Elevated Myocardial Infarction - Management (Initial) (5)

Answer 26

``` 1) thrombolysis (<4 hours within MI) MONA 2) morphine 3) oxygen 4) nitrates 5) aspirin ```

Question 27

Non-ST-Elevated Myocardial Infarction - Management (4/5/2)

Answer 27

``` conservative 1) dietary advice 2) regular exercise 3) weight loss 4) smoking cessation medical 1) antiplatelet (aspirin or clopidogrel) 2) anticoagulation (warfarin) 3) antihypertensive (βB or ACEi/ARB) 4) statin 5) spironolactone surgery 1) percutaneous coronary intervention* (PCI) 2) coronary artery bypass graft (CABG) ```

Question 28

ST-Elevated Myocardial Infarction - Description

Answer 28

myocardial infarction due to blockage of a coronary artery

Question 29

ST-Elevated Myocardial Infarction - Causes (2)

Answer 29

1) atherothrombosis | 2) emboli (rare)

Question 30

ST-Elevated Myocardial Infarction - Risk Factors (9)

Answer 30

1) age 2) male 3) family history 4) hypertension 5) hypercholesterolaemia 6) diabetes mellitus 7) smoking 8) obesity 9) sedentary lifestyle

Question 31

ST-Elevated Myocardial Infarction - Pathophysiology (3)

Answer 31

1) coronary thrombosis 2) blockage of coronary artery 3) myocardial infarction

Question 32

ST-Elevated Myocardial Infarction - Symptoms (6)

Answer 32

1) heavy, tight, central chest pain (>20 minutes) 2) pain radiates to arms, neck, jaw associated 3) dyspnoea 4) nausea 5) diaphoresis 6) palpitations

Question 33

ST-Elevated Myocardial Infarction - Symptoms (Silent Myocardial Infarction) (3)

Answer 33

1) epigastric pain 2) syncope 3) vomiting

Question 34

ST-Elevated Myocardial Infarction - Signs (4)

Answer 34

1) anxiety 2) pallor 3) hypotension/hypertension 4) bradycardia/tachycardia

Question 35

ST-Elevated Myocardial Infarction - Complications (6)

Answer 35

1) arrhythmia 2) heart failure 3) pericarditis 4) cardiac tamponade 5) systemic embolism 6) depression

Question 36

ST-Elevated Myocardial Infarction - Investigations (2/3)

Answer 36

``` initial 1) ECG (elevated ST segment, inverted T waves, pathological Q wave) 2) troponin assay* (elevated) consider 1) chest x-ray 2) coronary angiogram 3) echocardiogram ```

Question 37

ST-Elevated Myocardial Infarction - Management (Initial) (5)

Answer 37

``` 1) thrombolysis (<4 hours within MI) MONA 2) morphine 3) oxygen 4) nitrates 5) aspirin ```

Question 38

ST-Elevated Myocardial Infarction - Management (4/5/2)

Answer 38

``` conservative 1) dietary advice 2) regular exercise 3) weight loss 4) smoking cessation medical 1) antiplatelet (aspirin or clopidogrel) 2) anticoagulation (warfarin) 3) antihypertensive (βB + ACEi/ARB) 4) statin 5) spironolactone surgery 1) percutaneous coronary intervention* (PCI) 2) coronary artery bypass graft (CABG) ```

Question 39

Heart Failure - Description

Answer 39

inadequate cardiac output for body’s requirements

Question 40

Heart Failure - Categories (4)

Answer 40

1) right heart failure 2) left heart failure 3) diastolic failure (preserved ejection fraction, LVEF>50%) 4) systolic failure (reduced ejection fraction, LVEF<40%)

Question 41

Heart Failure - Causes (Left Heart Failure) (6)

Answer 41

1) ischaemic heart disease (S) 2) hypertension (S, D) 3) dilated cardiomyopathy (S) 4) hypertrophic cardiomyopathy (D) 5) restrictive cardiomyopathy (D) 6) aortic stenosis (D)

Question 42

Heart Failure - Causes (Right Heart Failure) (5)

Answer 42

1) left heart failure 2) atrial septal defect 3) ventricular septal defect 4) cor pulmonale (RHF 2nd to pulmonary disease)

Question 43

Heart Failure - Risk Factors (6)

Answer 43

1) age 2) male 3) myocardial infraction 4) hypertension 5) hypercholesterolaemia 6) diabetes mellitus

Question 44

Heart Failure - Pathophysiology (Congestive Heart Failure) (14)

Answer 44

1) heart failure 2) decreased kidney perfusion 3) RAAS activated 4) increased fluid retention (Na+, H2O) 5) increased preload 6) increased SNS activation 7) increased heart rate 8) peripheral vasoconstriction 9) increased afterload 10) left ventricular hypertrophy 11) increased contraction strength 12) inadequate O2 supply 13) myocyte atrophy 14) worsening heart failure

Question 45

Heart Failure - Symptoms (Left Heart Failure) (8)

Answer 45

1) dyspnoea 2) orthopnoea 3) paroxysmal nocturnal dyspnoea 4) chest pain 5) fatigue 6) weight loss 7) muscle weakness 8) cold peripheries

Question 46

Heart Failure - Symptoms (Right Heart Failure) (3)

Answer 46

1) nausea 2) anorexia 3) epistaxis

Question 47

Heart Failure - Signs (Left Heart Failure) (5)

Answer 47

1) cardiomegaly* 2) S3 heart sound* 3) rales (abnormal crackling lung sounds) 4) tachycardia 5) hypotension

Question 48

Heart Failure - Signs (Right Heart Failure) (11)

Answer 48

1) cardiomegaly 2) S3 heart sound 3) rales (abnormal crackling lung sounds) 4) tachycardia 5) hypotension 6) high JVP 7) neck vein distension* 8) hepatojugular reflex* (neck vein distension when pressure applied on liver) 9) hepatomegaly 10) ascites 11) peripheral oedema (esp. ankles)

Question 49

Heart Failure - Complications (7)

Answer 49

1) cardiogenic shock 2) arrhythmia 3) pleural effusion 4) pulmonary oedema 5) acute kidney injury/chronic kidney disease 6) anaemia 7) death (25-50% in 5 years)

Question 50

Heart Failure - Investigations (7/0)

Answer 50

``` initial 1) echocardiogram* 2) chest x-ray 3) serum BNP (high) 4) ECG 5) FBC 6) UnE 7) LFT normal BNP and ECG exclude heart failure ```

Question 51

Heart Failure - Classification (New York Heart Association) (4)

Answer 51

I) no physical activity limitation II) slight physical activity limitation III) marked physical activity limitation IV) extreme physical activity limitation

Question 52

Heart Failure - Diagnosis (Framingham Criteria) (7/6)

Answer 52

``` 2 majors OR 1 major, 2 minors major 1) cardiomegaly 2) S3 heart sound 3) pulmonary oedema 4) rales 5) dyspnoea or paroxysmal nocturnal dyspnoea 6) neck vein distension 7) hepatojugular reflex minor 1) tachycardia 2) pleural effusion 3) exertional dyspnoea 4) nocturnal cough 5) hepatomegaly 6) ankle oedema ```

Question 53

Heart Failure - Management (5/6/3)

Answer 53

``` conservative 1) dietary advice (e.g. low dietary sodium) 2) regular exercise 3) weight monitoring 4) smoking cessation 5) screening medical 1) antihypertensive (βB + ACEi/ARB) 2) diuretic 3) digoxin 4) hydralazine (arterial vasodilator) 5) isosorbide nitrate (venous vasodilator) 6) spironolactone surgery 1) implantable cardiac defibrillator (LVEF<35%, no LBBB) 2) pacemaker (LVEF<30%, LBBB) 3) heart transplant ```

Question 54

Hypertension - Description

Answer 54

high blood pressure

Question 55

Hypertension - Causes (6)

Answer 55

1) primary (unknown, 95%) 2) chronic kidney disease 3) endocrine disorders (e.g. Cushing’s, Conn’s, acromegaly, hyperparathyroidism) 4) coarctation of aorta 5) pregnancy 6) iatrogenic (steroids, oral contraceptive pill, antidepressants)

Question 56

Hypertension - Risk Factors (10)

Answer 56

1) age (>65 years old) 2) male 3) family history 4) Afro-Caribbean 5) sleep apnoea 6) diabetes mellitus 7) metabolic syndrome 8) smoking 9) obesity 10) sedentary lifestyle

Question 57

Hypertension - Symptoms (3)

Answer 57

1) asymptomatic 2) headache (malignant) 3) visual disturbances (malignant)

Question 58

Hypertension - Investigations (1/1)

Answer 58

initial 1) clinic BP (>140/90 - stage 1, >160/100 - stage 2, >180/110 -severe) consider 1) ABPM (>135/85 - stage 1, >150/95 - stage 2)

Question 59

Hypertension - Management (5/3/0)

Answer 59

conservative 1) dietary advice (low dietary fat, salt) 2) regular exercise 3) weight loss (5-10kg loss = 1 medication) 4) smoking cessation 5) alcohol control medical QRISK2>20%/10 years or end organ failure 1) ACEi/ARB (<55 years old) 2) CCB/thiazide diuretic (>55 years old or Afro-Caribbean) 3) +ACEi/ARB/CCB/thiazide diuretic as necessary