What are the features of Tetralogy of Fallot?
Right ventricular hypertrophy
Ventricular septal defect
What is the first line treatment for hypertension?
< 55 years
ACE-I or ARB
>55 or African/caribbean
What is the second line treatment for hypertension?
Add in whichever of ACE-I/ARB or Calcium channel blocker patient is not current taking
What is the third line treatment for hypertension?
Which vessels are commonly used for coronary artery bypass?
Long saphenous vein
Internal mammary artery
What is intermittent claudication?
Angina like pain of the lower leg on exercise
How is intermittent claudication investigated?
Ankle brachial pressure index
Duplex ultrasound scanning
Magnetic resonance angiography
What is critical limb ischaemia?
Pain in toe/foot on rest
What is the definition of an arterial aneurysm?
50% increase in normal diameter
What are the main structural complications that can arise from MI?
Ventricular septal defect
Mitral valve regurgitation
What are the four stages of the killip classification?
I - no sign of heart failure
II - crepitations <50% of lung fields
III - crepitations >50% of lung fields
IV - cardiogenic shock
At what blood pressure should ambulatory monitoring be offered?
How many measurements should be taken for ambulatory BP monitoring?
2 per hour during normal waking hours
What are the two types of stroke?
What is the definition of stroke?
Acute onset of focal neurological symptoms and signs due to disruption of blood supply
What is the pathology of haemorrhagic stroke?
Raised blood pressure
Weakened blood vessel wall due to:
arteriovenous malformation (AVM)
vasculitis (inflammation of vessel wall)
What are the three types of ischaemic stroke?
After which types of stroke should a patient be given statin therapy?
Not for haemorrhagic stroke.
Which modifiable risk factors carry the highest risk for stroke?
Give some examples of conditions that can mimic stroke.
Seizure - postictal states
How can haemorrhagic and ischaemic stokes be differentiated?
CT +/- angiography
MRI with DWI +/- angiography
MRI with GRE (look for old bleeds - haemosiderin)
What investigations should be carried out in ischaemic stroke?
Glucose, lipids, thrombophilia - young patients
Atheroembolisms - carotid scanning, CT/MR of aortic arch
Cardioembolism - ECG, Echo
What is the difference between atheroembolism and cardioembolism?
Atheroembolism infarcts in the same side as the carotid artery
Cardioembolism infarcts in more than one arterial territory - bilateral
What is the definition of a TIA?
Focal neurological symptoms that resolve within 24 hours
What is the medical management for ischaemic stroke?
Aspirin 75mg OD
Dipyridamole 200mg BD/Clopidogrel 75mg OD
Anticoagulation if AF
What surgical management is appropriate in stroke?
Relief of raised intercranial pressure
What is the emergency treatment for ischaemic stroke?