Quesmed Cardiology

Question 1

When is PCI indicated for STEMI?

Answer 1

Patients presenting within 12 hours of symptom onset, ongoing pain/cardiovascular instability.

Transfer time to a facilitity is less than 120 minutes

Question 2

What is the definitive treatment for STEMI where transfer time is over than 120 minute?

Answer 2

Since PCI is not available, fibrinolytic therapy is ideal to restore coronary blood flow. This should be given with antithrombin at the same time.

ECG should be performed 600-90 minutes post fibrinolytic.

Question 3

What is Type 2 MI?

Answer 3

Myocardial infarction due to low perfusion from sepsis, hypotension, hypovolaemia or ordinary artery spasm. They d not require the typical conventional treatment.

Question 4

Which antii-fibrinolytic therapy is used for STEMI?

Answer 4

Streptokinase and alteplase

Question 5

Which antithrombin drugs are typically used with the anti-fibrinolytic?

Answer 5

Bivalirudin
Dabigatran

Question 6

What is the management post-acute fibrinolytic?

Answer 6

Aspirin should be offered with a P2Y12 receptor inhibtors like ticagrelor unless they have a high bleeding risk.

Question 7

Which drug therapy is used for primary PCI?

Answer 7

Clopidogrel with aspirin

Unfractionated heparin for those haemodynamically unstable

Question 8

What is the loading dose for aspirin?

Answer 8

300mg

Question 9

What guides the management of a non STEMI?

Answer 9

Risk scoring system should be used to assess the risk f cardiovascular events, such as Qrisk or FRACE.

Question 10

What is the GRACE score?

Answer 10

Estimate for 6 month mortality based on age, creatinine, abnormal cardiac enzymes and troponin.

Question 11

How are low risk patients managed with non-STEMI?

Answer 11

Conservative management, which may include ticagrelor with aspirin. Angiography is not necessary unless ischaemia develops.

Question 12

How are high risk patients managed with non-STEMI?

Answer 12

Immediate angiography and follow on PCI.

Ticagrelor or pasugrel should be offered with aspirin.

During PCI, unfractionated heparin is ideal/

Question 13

Why would pasugrel be preferred or=ver clopidogrel for management?

Answer 13

Patients that were not previously on anticoauglaton.

Question 14

What should be given in combination with aspirin for patients with high bleeding risk?

Answer 14

Clopidogrel

Question 15

What is the long0-term medical management post-MI

Answer 15

Aspirin with clopidogrel or ticagrelor
ACE inhibitor and beta blocker
High dose statin

Echocardiogram to assess systolic function and evidence of heart failrue

Question 16

What type of infarct increases risk of heart block?

Answer 16

Inferior infarction involving the right coronary artery which supplies SAN.

Question 17

WHAT IS VENTIRCULAR FREE ALL RUPTRE?

Answer 17

NECROSIS OF VENTIRCULAR WALLS CAN ALLOW RUPTURE AND BLOOD TO ENTER PERICARDIAL SPACE, LEADINGT O TAMPONADE AND CARDIAC ARREST IN SECONDS.

IT HAS AN EXTREMELY POOR PROGNOSIS.

Question 18

Which type of valvular pathology is common post MI?

Answer 18

Acute mitral regurgitation due to papillary muscle ruputre

Question 19

What does bradycardia with signs of STEMI indicate
‘

Answer 19

Occlusion of proximal right coronary artery, supplying AV node.

Question 20

What is a contraindications

Question 21

What is a contraindication to trombolytic therpay?

Answer 21

Hypertension to reduce the risk of intracranial ahemorrahge

Question 22

How does stroke affect eligibility of anti-thromboyltic therapy?

Answer 22

Ischaemic stroke must be in the last 3 months to be a contraindication.

Question 23

Patient presents with chest pain on exertion not relieved by rest and has taken cocaine

Answer 23

Coronary artery vasospasm

Question 24

Which leads are affected in lateral STEMI?

Answer 24

Lead I, avL and V5-6 will have ST elevation

Question 25

What is a left ventiruclar aneurysm?

Answer 25

Damage to the left ventircle after a previous STEMI results in an aneurysm, resulting in blood stasis that can lead to thrombus formation and result in ischaemic stork

Question 26

When is a PCI given for non-STEMI?

Answer 26

Only for haemodynamically unstable patients

Question 27

What is the most common cause of death in an acute MI?

Answer 27

Ventircular fibrillaiton

Question 28

What is a requirement for complete heart block?

Answer 28

Infarction of right coronary artery so ST elevation in inferior limb leads.

Question 29

How does papillary muscle rupture present?

Answer 29

Pan-systolic murmur with pulmonary oedema

Question 30

What is the reccomended dose for statin as secondary prevention?

Answer 30

80mg for high dose therapy but reduce to 40mg if not tolerated

Question 31

What is the reccomended dose for statin for primary prevention?

Answer 31

20mg

Question 32

Which part of the heart does the right coronary artery supply?

Answer 32

Left ventricle inferior and posterior aspect

Question 33

How do patients present with inter Ventircular septal rupture?

Answer 33

New pan-systolic murmur Acute heart failure

Question 34

What is the criteria for contacting the DVLA after an MI?

Answer 34

Left ventiruclar ejection fraction is less than 40% before discharge Urgent revascularisation within the next 4 weeks

Question 35

What is a. Valvular complication with ventricualr septal defect?

Answer 35

Acute mitral regurgitation, which is more common in inferno-posterior infarction. Causes pansystolic mrumur over the apex, and acute left ventiruclar failur

Question 36

What are the causes of left axis deviation?

Answer 36

Left ventricular hypertrophy Inferior wall myocardial infarction, as the inferior wall loses an extensive amount of tissue so the heart depolarises away from the inferior leads

Question 37

How is ventricular septal rupture managed post MI?

Answer 37

Intra-aortic balloon pump

Question 38

How is pericarditis or Dressler’s syndrome managed?

Answer 38

High dose aspirin post MI

Question 39

How does pericarditis present? On ECG

Answer 39

Widespread ST elevation, PR depression AvR will show reciprocal ST depression and pR elevation

Question 41

What are the reciprocal changes in anterior MI?

Answer 41

ST depression in lead II

Question 42

What is primary prevention?

Answer 42

Initiating patient on statin for Q risk below 10% which is 20mg

Question 43

What is secondary prevention?

Answer 43

Dose of statin when patient has already experienced a vascular event, which is 80mg.

Question 44

How does digoxin affect the ECG?

Answer 44

Downsloping ST depression

Question 45

How does Dressler’s syndrome present?

Answer 45

Pleuritic chest pain at rest, worse on lying flat

Question 46

What causes T wave inversion in inferior leads?

Answer 46

Occlusion of right coronary artery so

Question 47

How does myocarditis present?

Answer 47

Stabbing chest pain, troponin raised and abnromal ECG. No tenderness on palpation

Question 48

Which marker is importsnt to detect reinfarction?

Answer 48

Creatine kinase-MB found in the myocardium. It has a high rate of clearance and preferred over troponins, whih can be elevated up to 2 weeks post infarction.

Question 49

What is the initial management for a non-STEMI?

Answer 49

Aspirin 300mg Clopidogrel 400mg GTN spray

Question 50

What is fondaparinux?

Answer 50

Factor X inhibtiors which is an anticoagulant that should be avoided in patients with a bleeding risk.

Question 51

How. does occlusion of left main coronary artery present?

Answer 51

ST depression in Leads 1, II and V4-6 ST elevation in AVR

Question 52

Which medication should be added for patinets who have had an acute MI with symptoms of heart failure?

Answer 52

Eplerenone

Question 53

How do nitrates work?

Answer 53

activate CGMP for vasodilation

Question 55

What is the modified duke’s criteria for?

Answer 55

Infective endocarditis

Question 56

Non cardiac Causes of atrial fibrillation

Answer 56

Alcohol intake Dehydration