Diseases

Question 1

Presentation of Angina

Answer 1

Central chest pain on exertion + autonomic features

Question 2

4 rare causes of angina

Answer 2

Anaemia
Tachyarrhythmia
Vasculitis
HCM

Question 3

Cause of Prinzmental angina

Answer 3

Coronary artery spasm

Question 4

1st -> 4th line maintenance therapy for angina

Answer 4

1st - Beta-blocker!! or CCB
2nd - other
3rd - + isosorbide mononitrate
4th - + nicorandil or ivabradine (decreases HR)

Question 5

2 add on therapies for all angina patients

Answer 5

GTN spray

Aspirin

Question 6

3 diagnostic tools for ACS

Answer 6

Cardiac biomarkers
Symptoms of ischaemia
ECG changes

Question 7

3 cardiac biomarkers used for ACS - peak times

Answer 7

Troponin - high within 30 mins peak = 24-48hrs, baseline = 5-14d - if not +ve in 6hrs - not MI

CK-MB - cardio specific - high within 45 mins, peak = 24hrs, base = 72hrs

Myoglobin - highly sensitive, not specific

Question 8

4 key ECG changes in ACS - general

Answer 8

ST elevation
T wave inversion
Q waves
New onset BBB

Question 9

3 ECG criteria for STEMI

Answer 9

=/> 1mm in 2 adjacent limb leads
=/> 2mm in 2 contiguous precordial leads
New onset bundle branch block

Question 10

2 people get silent MI’s

Answer 10

Elderly

Diabetics

Question 11

4 abnormal MI presentations

Answer 11

Syncope
Epigastric pain + vomiting
Stroke
Acute confusion

Question 12

4 lateral ECG leads + artery affected

Answer 12

I, aVL, V5 and V6

Left circumflex

Question 13

3 inferior ECG leads + artery affected

Answer 13

II, III, aVF

Right coronary artery

Question 14

2 septal ECG leads + artery affected

Answer 14

V1, V2

Left anterior descending

Question 15

4 anterior ECG leads + artery affected

Answer 15

V1, V2, V3, V4

Left anterior descending

Question 16

3 signs of HF

Answer 16

3rd HS
Raised JVP
Basal crepitations

Question 17

9 DDx for MI

Answer 17

Angina
Pericarditis
Myocarditis
Aortic dissection
PE
Reflux
Peptic ulcer
MSK
Anxiety

Question 18

Overview of STEMI management

Answer 18

MONA+T, PCI or fibrinolysis

Question 19

PCI or fibrinolysis guidelines

Answer 19

Both within 12 hrs of symptom onset
PCI within 120 mins of presentation
Fibrinolysis if not within 120 mins of presentation

Question 20

MONA+T

Answer 20

Morphine + anti-emetic (metoclopramide or cyclizine)
Oxygen - target 94-98% (88-92%
Aspirin - 300mg immediately
Nitrates - if BP >90
Ticagerol 150mg with aspirin if STEMI

Question 21

6 fibrinolysis contraindications

Answer 21

<3 weeks trauma/surgery/head injury
PHx intracranial haemorrhage
Intracranial malignancy
<6 wks stroke
Non-compressible punctures (liver biopsy, LP)
Bleeding disorders 
GI bleed

Question 22

1st line fibrinolysis

Answer 22

Tissue plasminogen activators (i.e. Alteplase)

Question 23

Discharge MI drugs

Answer 23

ACEi
Beta-Blocker - as soon as haemodynamically stable
Dual antiplatelet therapy - aspirin + ___
Statin

Question 24

3 NSTEMI management

Answer 24

Aspirin + anti-thrombin (IV eptifibatide or tirofiban) asap

PCI within 96 hrs

Question 25

Driving advice - ACS

Answer 25

Angioplasty - 1wk MI - 4 wks (no DVLA) MI + bus, coach, lorry - 6wks + DVLA

Question 26

Back to work after MI

Answer 26

2 months

Question 27

10 MI complications - List

Answer 27

``` Cardiac arrest - VF Cardiogenic shock Tachyarrhythmia - VF/VT Bradyarrhythmia - AV node block Mitral regurgitation LV aneurysm Pericarditis LV free wall rupture Ventricular septal defect Dressler's ```

Question 28

Post-MI cardiogenic shock management

Answer 28

Inotropes | Intra-aortic balloon

Question 29

MI causing bradyarrythmias

Answer 29

Inferior - AV node ischaemia

Question 30

Post-MI ST elevation persistance + LV failure

Answer 30

LV aneurysm

Question 31

LV aneurysm complication

Answer 31

Clot formation => stroke

Question 32

Post-MI Mitral regurgitation cause

Answer 32

Posterio-inferior MI - papillary muscle rupture

Question 33

Post-MI early-to-mid systolic murmur

Answer 33

Mitral regurgitation

Question 34

LV free wall rupture - presentation and %

Answer 34

``` Cardiac tamponade (raised JVP, pulsus paradox, diminished HS) 1-2 wks post-MI 3% ```

Question 35

Ventricular septal defect - presentation and %

Answer 35

Pan systolic murmur + HF | 1-2% in 1st week

Question 36

Dressler's syndrome presentation + management

Answer 36

Fever, pleuritic pain, pericardial effusion + raised ESR | NSAIDs