finals cardio

Question 1

how long are unprovoked PEs treated for?

Answer 1

6 months

Question 2

what does a 3rd HS indicate?

Answer 2

(diastolic filling of ventricle)
- normal if <30 y
- LV failure (eg dilated cardiomyopathy) #
- constrictive pericarditis
- mitral regurg
»> Sthreee hard to breeeeath

Question 3

what does a 4th HS indicate?

Answer 3

atrial contraction against stiff ventricle
- aortic stenosis
- HOCM
- hypertension
»> Sfouuur hit the floooor

Question 4

which biomarker would be most useful to confirm a reinfarction 4-10 days post initial MI?

Answer 4

CK-MB (creatine kinase myocardial band)

Question 5

how should a patient with new LBBB be managed?

Answer 5

new LBBB = always pathological
> urgently contact nearest primary percutaneous coronary intervention centre

Question 6

what type of murmur is associated with VSD?

Answer 6

pansystolic

Question 7

how does an ASD present (in adulthood)?

Answer 7

fatigue, breathlessness
O/E - ejection systolic murmur louder on inspiration

Question 8

which class of medication should not be prescribed with verapamil?

Answer 8

beta blockers
> bradycardia and asystole

Question 9

what is the most common cause of death in patients following an MI?

Answer 9

ventricular fibrillation

Question 10

which common medication should be suspended when prescribing erythromycin/clarithromycin?

Answer 10

statins

Question 11

what medication is used for angina prophylaxis?

Answer 11

beta blockers
-> if on verapamil then nicorandil

Question 12

should chest compressions continue while the defib is charging?

Answer 12

yes

Question 13

what is the management for patients with NSTEMI and a grace score >3%?

Answer 13

coronary angiography within 72h of admission

Question 14

what does electrical alternans on ecg indicate?

Answer 14

cardiac tamponade

Question 15

what can be prescribed if angina is not controlled with a beta blocker?

Answer 15

CCB eg amlodipine

Question 16

how is acute heart failure managed?

Answer 16

1. IV loop diuretics
2. oxygen (94-98%)
3. vasodilators (nitrates), if concomitant myocardial ischaemia, severe htn, or regurgitant aortic or mitral valve disease
   »> contraindicated in hypotension

Question 17

how do you manage warfarin therapy in patients having emergency surgery?

Answer 17

give four-factor prothrombin complex concentrate 25-50units/kg

Question 18

what is shown on ECG in hypokalaemia?

Answer 18

• U waves
• small or absent T waves
• prolonged PR
• ST depression
• long QT
  in hypokalaemia, U have no Pot(assium) and no T, but a long PR and a long QT, and you’re depressed

Question 19

what ecg changes are seen in acute pericarditis?

Answer 19

widespread saddle shaped st elevation
PR depression

Question 20

what can give a falsely low BNP result?

Answer 20

being on ramipril for BP

Question 21

what is the management for native valve endocarditis?

Answer 21

IV amoxicillin