Cardio

Question 1

Ischeamic Heart Disease

Answer 1

Question 2

CAD Pathophysiology

Answer 2

Question 3

CAD etiology

Answer 3

Question 4

CAD Epi and RFs

Answer 4

Question 5

Stable Angina

Answer 5

Question 6

Acute coronary Syndrome

Answer 6

Question 7

Investigations for CAD

Answer 7

Bedside - Vitals , ECG

In acute setting -

FBC looking for anemia or sepsis which can cause T2MI

U/E/Cr - for electrolyte derangement, renal function prior to PCI and prior to starting aspirin and NSAIDs)

Cardiac Trops

CXR - to look for CCF features

Telemetry - for arrythmias

Bedside echo- looking for RWMA or wall rupture from previous MI

Fasting lipids and HbA1c to look for cardiovascular RFs

PT/PTT/INR

LFT prior to starting statins

Ux TRO dissection esp in INferior AMI and to look for complications of AMI ( RWMA, papillary muscle rupture)

Question 8

Subsequent functional testing?

Answer 8

Stress testing of heart either via exercise or dobutamine or dipyridamole

and also Functional omaging

Exercise ECG ( for patients with low likelihood of CAD)

Stress Echo

Myocardial perfusion imaging

Stress Cardiac MRI

And also Anatomical imaging

CT coronary angiogram , coronary angiogram

Question 9

Management of CAD

Answer 9

Non pharm
- statins
- Dual antiplatelet therapy
- Control co-morbids

Drugs for symptomatic relief
1st line- Sublingual GTN and Beta- blockers : biso/metoprolol

2ndline - NON-dihydropyridine CCBs; Verapamil, diltiazem

Dihydropyridine CCB ; Amlodipine, long acting nifedipine

Revasc procedures :

Percutaneous coronary intervention

Coronary artery bypass graft

Question 10

ACS classification

Answer 10

Question 11

Types of MIs

Answer 11

Question 12

Presentation of ACS

Answer 12

Question 13

Complications of MI

Answer 13

Question 14

Investigations FOR ACS

Answer 14

FBC signs of anemia for T2DM and thrombocytopenia

U/E/Cr + Ca, Mg, PO4 to assess renal function in view of CIN from PCI

Capillary blood glucose TRO hyogly

LFTs for baseline liver functiion ivo starting statins

PT/PTT for coag + prior PCI

Cardiac enzymes

12-Lead ECG

CXR TRO other causes of CP and Cx of AMI

Question 15

Risk of AMI

Answer 15

Question 16

Management

Answer 16

Pharm management

Nitroglycerin, PO metoprolol tartrate , DAPT ( aspirin + ticagrelor)

Statins

Question 17

PCI

Answer 17

Question 18

Thrombolytic therapy

Answer 18

Question 19

coronary artery bypass graft

Answer 19

Question 20

POST PCI

Answer 20

Question 21

Answer 21

Question 22

Heart failure definition

Answer 22

Question 23

Pathophysio of HF

Answer 23

Ventricular hypertrophy
- due to myocyte hypertrophy and triggered by catecholamines

Concentric re-modelling
- Generalised increase in LV wall, ventricular dilatation occurs but only with time

Eccentric re-modelling

• Ventricular dilatation with decreased systolic function may result in regurg

Question 24

Consequences

Answer 24

Question 25

Compensation for HF ?

Answer 25

Question 26

Classifications

Answer 26

HFrEF, HFmrEF, HFpEF

Question 27

Low output and high output???

Answer 27

Question 28

LHF vs RHF

Answer 28

Question 29

Etiologies of HF

Answer 29

Question 30

HF diagnostic criteria

Answer 30

Question 31

Investigations

Answer 31

FBCs - to look for anemia U/E/Cr - looking for hyponat indicating severe HF - Baseline renal function before putting the patients on diuretics or ACE-I - TRO electrolyte imablances ( can cause arrythmias) LFTs - looking for hypoalbuminemia reflecting nutrition status - MIldly elevated serum bilirubin due to hepatic congestion in RHF - TRO liver causes of fluid overload - Cardiac enzymes if pateint is complaining of chest pain TRO AMI - Thyroid function test TRO thyroid precipitant - Lipid profile ( fasting lipids ) + diabetes screen (fasting glucose + HbA1c) -NT-proBNP elevated in patients especially with HF Can do ABG TRO acid- base disorders LDH if hemodynamically unstable and Iron panel CXR, echo, ECG

Question 32

Management

Answer 32

Multi-disciplinary team approach encompassing cardiologist, primary care physician and dieticine and therapist Non pharm - Diet, weight,, Smoking and alc cess, Preventive vaccination( influenza and pneumococcal), good control of comorbids Give patient a HF diary ( daily BP+ HR) 2nd line Ivabradine ( use if HR greater than or equal to 70 ) Hydralazine and isosorbide dinitrate - Patients unable to tolerate ACE-i, ARB or ARNI, this is a replacement Drugs for symptomatic relief Diuretics and Digoxin

Question 33

What drugs should you avoid in HF

Answer 33

Non-dihydropyridine CCBs Nsaids, Glitazones, Combination of ACEi+ ARB + MRA --> could cause renal failure

Question 34

Devices

Answer 34

Once EF is less than 35% and symptomatic Implantable cardioverter- defib Cardiac rresynchronisation therapy Left ventrcular assist device Mitral clip