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1
Q

Main causes of heart failure? (4)

A

Ischaemic heart disease
Dilated cardiomyopathy
Hypertension
Valvular heart disease

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2
Q

Heart sounds in heart failure?

A

May be S3 gallop rhythm

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3
Q

Management of heart failure:

a) first line
b) second line
c) third line

A

a) ACEi + BB
b) + one of spironolactone, ARB, hydralazine+nitrate
c) digoxin, cardiac resynchronization, ivabradine

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4
Q

Management of stable angina? (4)

A

GTN
B blockers +/- calcium blocker
Angioplasty + stent
CABG

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5
Q

Calcium blockers in angina used for a) monotherapy b) combination with beta blocker

A

a) rate-limiting- verapamil, diltiazem

b) dihydropiridine- modified release nifedipine

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6
Q

Indication for CABG?

A

Extensive three-vessel disease

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7
Q

ACS secondary prevention? (4)

A

Aspirin + clopidogrel
ACE inhibitor
Beta blocker
Statin

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8
Q

Commonest cause of death following MI?

A

Arrest -V. fib

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9
Q

DDx of new early-to-mid systolic murmur, post-MI? (2)

A

Acute mitral regurgutation secondary to papillary muscle rupture

Ventricular septal rupture

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10
Q

Persistent ST elevation weeks after MI, signs of heart failure?

A

LV aneurysm

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11
Q

Tall R waves in V1-V2 +/- ST depression in V1-V3

A

Posterior MI

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12
Q

Treatment of NSTEMI/unstable angina (4)

A

Aspirin 300mg, clopidogrel 300mg

Nitrates/morphine PRN for chest pain

Antithrombin treatment (fondaparinux) if not contraindicated

Intravenous tirofibban if undergoing angiography in next 96 hrs

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13
Q

When would fondaparinux be contraindicated in NSTEMI and what is given instead?

A

Patient having angiography within 24 hrs; creatinine greater than 265umol/l

Unfractionated heparin

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14
Q

Management of STEMI? (4)

A

Aspirin + P2Y12 receptor antagonist

Unfractionated heparin (if undergoing PCI)

Oxygen if hypoxic

PCI/thrombolysis

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15
Q

Chest pain in first 48 hours following MI, worse when lying down, associated with pericardial rub?

A

Pericarditis

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16
Q

1-2 week post MI: acute heart failure, raised JVP, dimished heart sounds, pulsus paradoxus?

A

Left ventricular wall rupture causing tamponade

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17
Q

Ischaemia/infarction/fibrosis of the sinus node, presenting with bradycardia and intermittent tachycardia

A

Sick sinus syndrome

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18
Q

Rate control options in AF? (3)

A

Beta blockers
Verapamil/diltiazem
Digoxin (if co-existent heart failure)

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19
Q

Low potassium enhances the toxicity of…

A

Digoxin

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20
Q

Management of acute atrial fibrillation (less than 48 hrs since onset)

a) if adverse features present
b) no adverse features

A

a) synchronized DC shock as for any other tachyarrythmia

b) Electrical or chemical cardioversion; or rate control

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21
Q

Drugs used for chemical cardioversion in AF? (2)

A

Amiodarone (use if evidence of structural/ischaemic heart disease)
Flecainide

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22
Q

Regular narrow-complex tachycardia that DOES NOT respond to vagal manouevres/adenosine

A

Atrial flutter

23
Q

Management of atrial flutter? (2)

A

Rate control as for AF

Sinus node catheter ablation

24
Q

Heart block:

a) prolonged PR interval, constant
b) progressive lengthening of PR interval
c) intermittent dropped QRS complexes
d) complete dissociation between atrial and ventricular activity

A

a) 1st degree
b) 2nd degree Mobitz 1
c) 2nd degree Mobitz 2
d) CHB

25
Syncope as a result of asystole?
Stokes Adams attacks
26
When should heart block be treated with permanent pacing?
Symptomatic Mobitz 1 | Mobitz 2 and CHB
27
Secondary causes of hypertension? (5)
``` Renal parenchymal disease Renal artery stenosis Primary aldosteronism Phaeochromocytoma Cushing's syndrome ```
28
The treatment target for BP in under 80 year olds and over 80 year olds?
Under- 140/90 | Over- 150/90
29
Step 1 in hypertension treatment algorithm?
Patients under 55- ACE inhibitor or ARB (A) Patients over 55/Caribbean- Calcium blocker (C)
30
Hypertension algorithm: Step 2 Step 3
A + C A + C + D
31
Thiazide diuretics of choice?
Indapamide
32
Complete heart block following an MI- vessel affected?
Right coronary artery
33
What are the two main differentials of a tachycardia with wide QRS?
Ventricular tachycardia | A supraventricular tachycardia with aberrant conduction e.g. AF with BBB
34
If any patient with tachycardia has adverse signs, what treatment is indicated?
Synchronized DC shock (cardioversion)
35
Wide QRS with slurred upstroke
Wolff-parkinson White
36
Management of SVT? (3)
Vagal manouevres Adenosine Cardioversion
37
Management of regular broad complex tachycardia with no adverse signs?
Amiodarone- loading dose followed by infusion over 24hrs
38
Treatment of polymorphic VT?
IV magnsium/cardioversion
39
Why does ventricular tachycardia need to be treated immediately?
Potential to precipitate ventricular fibrillation causing cardiac arrest
40
What is the most important metabolic cause of ventricular tachycardia?
Hypokalaemia
41
Continuous machinery murmur + left subclavicular thrill
Patent ductus arteriosus
42
Notching of the inferior margins of the ribs + diminished lower limb pulses
Coarctation of the aorta
43
Management of bradycardia with adverse signs/risk of asystole?
Atropine
44
Central chest pain relieved by sitting forward + saddle shaped widespread ST elevation
Pericarditis
45
Management of anaphylaxis (5)
Secure airway and support oxygenation IV fluids 500mcg of 1:1000 adrenaline IM Chlorphenamine + Hydrocortisone
46
Causative organisms in endocarditis? (4)
Strep viridans Staph aureus Staph epidermidis HACEK bacteria
47
Criteria used for diagnosis in infective endocarditis?
Duke criteria
48
Retinal haemorrhages with a pale centre?
Roth spots
49
Painful infarcts on finger pulps?
Oslers nodes
50
Painless macules on palms/soles?
Janeway lesions
51
STEMI ECG changes: area and vessel? II, III and aVF
Inferior; RCA
52
STEMI ECG changes: area and vessel? I, V5, V6
Lateral; circumflex artery
53
STEMI ECG changes: area and vessel? V1/V2
Septal; LAD
54
STEMI ECG changes: area and vessel? V3/V4
Anterior; LAD

Cardiology (21 decks)

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