Cardio things

Question 1

Angina treatments order

Answer 1

1. BB (atenolol)
2. Ca2+ (verapamil)
3. long acting nitrate
4. Ranolazine
5. Nicorandil, Ivrabradine

+ GTN + Statin + ACE

Question 2

Stage 1 hypertension

Answer 2

Clinic: 140/90 mmHg
Home: 135/85 mmHg

Question 3

Stage 2 hypertension

Answer 3

Clinic: 160/100 mmHg
Home: 150/95 mmHg

Question 4

Stage 3 hypertension

Answer 4

Clinic: 180mmHg systolic or 110mmHg diastolic

Question 5

Targets for hypertension

Answer 5

below 140/90 if under 80, below 150/90 if over 80

Question 6

post MI

Answer 6

ACEi
A
Betablocker
Statin

Question 7

Angina treatment

Answer 7

if under 55 and caucasian:

1. ACEi - lisinopril, ramipril
2. add Ca2+ blocker - verapamil, diltiazem
3. add Diuretic (thiazide) - bendrofluazide
4. add alpha blocker (prazosin), beta blocker (atenolol), more diuretic

if over 55/afro-caribbean

1. Ca2+ blocker
2. add ACEi
3. add Diuretic
4. add alpha blocker, beta blocker, more diuretic

• change ACE for ARB (losartan) if suffering from dry cough

Question 8

SVT

Answer 8

1. vagal manouvre
2. IV Adenosine
3. IV Verapamil
4. Radiofrequency ablation

Question 9

Sinus tachycardia

Answer 9

Betablocker after treating underlying cause

Question 10

Chronic HF

Answer 10

LVF -

1. ACE or ARB
2. add ARB
3. Digoxin
4. ICD

Preserved ejection -
1. Furosemide (loop diuretic)

Question 11

Acute HF

Answer 11

Sit up, O2, IV Furosemide, IV Diamorphine

Question 12

Torsades de Pointes

Answer 12

Magnesium sulphate then ventricular pacing

Question 13

1st Degree AV block

Answer 13

long PR but normal P waves
common in athletes and young people

no treatment needed

Question 14

2nd Degree AV block - mobitz type 1

Answer 14

• P waves are irregular
• R waves are irregular
• PR intervals are irregular; they have cyclic lengthening until a QRS is dropped

need ventricular pacing

Question 15

3rd Degree AV block

Answer 15

Atrium and ventricles no longer working together, they are completely independent

P waves have no relation to the QRS

need permanent pacemaker/ventricular pacing

Question 16

2nd Degree AV block - mobitz type 2

Answer 16

• P waves are regular
• but QRS (R waves) irregular
• some P waves followed by QRS, some not

need ventricular pacing

Question 17

S3

Answer 17

blood will be turbulent and hit off the EDV producing a sound as the blood enters the ventricle

Present in mitral regurg, dilated cardiomyopathy, constrictive pericarditis ‘pericardial knock’ - anything that causes left V failure. Can be normal sometimes in people under 30

Question 18

S4

Answer 18

late diastole when atria is squeezing the last bit of blood into the ventricle, this causes ventricular vibration against a stiff, hypertrophic ventricle and makes a sound.

Heard in HOCM (can cause a double apex beat), hypertension, aortic stenosis (because LV has to pump harder to get through stenosed valve, so ends up becoming hypertrophic and stiff)

ALWAYS abnormal