ACE inhibitors work by:
Blocking the sympathetic effect of noradrenaline on blood vessels.
Preventing the conversion of angiotensin I to angiotensin II.
Blocking angiotensin II receptors
Rapid degradation of angiotensin II.
A 53-year-old man complains of erection difficulty. He recently had some transient angina and was given some medications. His symptoms started soon after the consultation. Which drug is likely to be causing his symptoms?
Nifedipine
Ramipril
Labetalol
Spironolactone
Bendroflumethiazide
An older man arrives at ED with swollen lips. Not anaphylactic shock. His regular prescriptions are nifedipine, simvastatin, warfarin, lansoprazole and Ramipril. Which is causing this angioedema?
A 65-year-old man presents with central crushing angina for the first time. He is transferred immediately to the closest cardiac unit to undergo a primary percutaneous coronary intervention. There is thrombosis of the left circumflex artery only. Angioplasty is carried out and a drug-eluding stent is inserted.
What are the most likely changes to have occurred on ECG during admission?
ST elevation in leads V1–4
ST elevation in leads V1–6
ST elevation in leads I, aVL, V5, V6
ST elevation in leads II, III and aVF
The ECG shows an antero-lateral STEMI. Which coronary artery is most likely to have been occluded?
Left Circumflex artery
Left anterior descending artery
Right main coronary artery.
Right posterior descending artery
Left main coronary artery
Which of the following will be observed in a patient that has mitral regurgitation
Diastolic murmur, 5th intercostal space, left midclavicular line
Diastolic murmur, 4th intercostal space, left midclavicular line
Diastolic murmur, apex of the heart
Systolic murmur, apex of the heart.
Systolic murmur, 2nd intercostal space, right sternal border.
A murmur is heard just to the left of the sternum in the 2nd intercostal space during systole, what kind of murmur do you suspect?
Aortic Stenosis
Aortic regurgitation
Pulmonary stenosis
Pulmonary regurgitation
mitral stenosis
A 25-year-old woman with known mitral valve prolapse develops a low-grade fever, malaise and night sweats after a couple of weeks of a major dental procedure. Examination reveals tender vasculitic lesions on the finger pulps and microscopic haematuria. Which is the most appropriate initial step in management?
Give antibiotics
Chest X-ray.
Give NSAIDs
Sputum sample
Get blood cultures
A middle aged female has central retrosternal angina. The pain is worse lying flat and when she takes a deep breath. It is relieved by sitting up, and leaning forward. An ECG is performed as below. What is the most likely diagnosis?
The ECG
Acute STEMI
Endocarditis
NSTEMI
Pulmonary embolism
Pericarditis
A 54 years old man presents to the emergency department with chest pain which does not go away with GTN spray. He sits down and the pain persists and he begins to feel an ache in his arm, and feels extremely sweaty. An ECG is performed.
At ED, an elderly woman with Type 2 diabetes mellitus, Hypertension and BMI of 33.6 was admitted to your department via ambulance after experiencing an episode of central crushing chest pain that radiated to her left arm. It came on while she was watching TV and has not been relieved despite rest and GTN spray. Vital signs: RR: 35; BP:105/62; SpO2:90%; Temperature: 37.0oC Based on the ECG, what is the most appropriate initial management for this?
IV morphine, GTN, aspirin
Percutaneous coronary intervention (PCI)
Arrange a CTPA
Coronary artery bypass graft (CABG)
IV morphine, 15L high flow O2, GTN, aspirin
A is an extra or unusual sound heard during a heartbeat.
Murmurs can either be (S1) or (S2).
Valvular murmurs: 2 main reasons : Valve is too narrow for the blood to pass through.
(Incompetence): Valve does fully shut so there is backflow
Fill in the Table.
Non-valvular murmurs also exist.
Label the different valves.
of the aortic valves (due to naturally ) mainly causes .
The most common cause of is rheumatic heart disease due to the bacteria of group Streptococcus.
What is the correct ordering of the heart layers?
fibrous pericardium, parietal serous pericardium, pericardial cavity, pericardial fluid, visceral serous pericardium, epicardial fat, myocardium, endocardium
fibrous pericardium, epicardial fat, visceral serous pericardium, pericardial cavity, pericardial fluid, parietal serous pericardium, myocardium, endocardium
fibrous pericardium, parietal serous pericardium, visceral serous pericardium, pericardial cavity, pericardial fluid, epicardial fat, emyocardium, endocardium
epicardial fat, fibrous pericardium, parietal serous pericardium, visceral serous pericardium, pericardial cavity, pericardial fluid,endocardium, myocardium
What is true regarding endocarditits?
Inflammation of the endocardium
common cause: Staph Aureus
common cause: Strep viridans
New murmur
Fever
Splinter Hemorrhage
Janeway lesions and Osler nodes
Diagnosis: Echocardiograms and electrocardiograms
Diagnosis: Blood culture and echocardiograms
Manage: antibiotics and NSAIDS
What is true regarding pericarditits?
inflammation of pericardium
Common cause: Coxsackie B virus
Chest pain which feels better when sitting forward
Auscultation: pericardial friction rub audible
Widespread saddle shaped ST-elevation on ECG = diagnosis
1-2 weeks course of NSAIDs
complication: cardiac tamponade
Auscultation: crackles
Chest pain better from lying down
dispersed ST-elevation on ECG leads = diagnosis
What are these clinical symptoms?
angina is due to problems in blood supply. It comes about at or , like walking.
Stable angina is due to . It is a chest tightness or heaviness, which is relieved by . It may radiate to one or both , the neck, jaw or .
GRAB to treat stable angina:
spray for symptomatic relief
Factor modification like stop smoking and reduced cholesterol
reduces mortality by 34% (fact)
to reduce symptoms unless contraindicated
Unstable angina, NSTEMI and STEMI are a group of conditions that occur due to decreased blood flow in the arteries, leading to heart muscle . This is known as .
How does ACS (acute coronary syndrome) present?
Angina pectoris pain
noticeable sweating
tachypneia
nausea
vomiting
progresses--> radiating pain
Which is NSTEMI and which is STEMI?
Acute management of ACS: MONA
IV Oxygen (if Sats < 94%)
Secondary management of ACS is :
STEMI therapy--> PCI ( intervention)
If this cannot be achieved within hours of diagnosis or PCI is not available, therapy such as streptokinase is to be done.
Secondary prevention of myocardial infarction: AAABC
(antiplatelet) inhibitor Beta-blocker (antiplatelet)
What morphology is shown below? (2 words)
Which leads are lateral?
AVF
AVL
AVR
II
I
III
V1 and V2
V3 and V4
V5
V6
Which leads are anterior?
lead I
lead II
lead III
V1 AND V2
V3 AND V4
Which of these leads is not inferior?
Fill in what each abbreviation in the table stands for.
Which of these could result from severe or untreated hypertension?
stroke
MI
blindness
renal failure
pulmonary disease
aneurysms
ovarian cancer
What are side effects of ACE inhibitors?
Dry cough
Angioedema
Hypotension
Hyperkalemia
Hypercalcemia
Hypoglycemia
Hydrochlorothiazide and Metolazone are examples of thiazide-like diuretics.
end in “sartan” e.g.
They're given if side effects of ACE inhibitors are experienced.
Beta blockers reduce the by reducing heart rate and force of contraction (hence the ).
They end in -lol like .
What is true regarding beta blocker side effects?
bronchoconstriction
bradycardia
heart failure
hypotension
AV nodal conduction block
polyuria
dehyrdation
vertigo
If the patien is younger than 8o years, treatment for stage hypertension is given if: damage disease (or significant risk of developing it) Renal disease
NSTE-ACS refers to Unstable Angina and NSTEMI.
Cardiac markers: I/T
They are the most specific/sensitive tests for .
Fill in the diagram. (ABREVIATIONS WHERE APPROPRIATE)
WHICH are side-effects of calcium channel blockers?
peripheral edema
flushing
headache
severe hypotension
angina
hidrosis
miosis
CCBs used to treat hypertension end in –dipine such as
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