Cardiac Pathology :)

ACE inhibitors work by:

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?

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?

The ECG shows an antero-lateral STEMI. Which coronary artery is most likely to have been occluded?

Which of the following will be observed in a patient that has mitral regurgitation

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?

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?

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?

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?

A [blank_start]heart[blank_end] [blank_start]murmur[blank_end] is an extra or unusual sound heard during a heartbeat.

Murmurs can either be [blank_start]systolic[blank_end] (S1) or [blank_start]diastolic[blank_end] (S2). Valvular murmurs: 2 main reasons [blank_start]Stenosis[blank_end]: Valve is too narrow for the blood to pass through. [blank_start]Regurgitation[blank_end] (Incompetence): Valve does fully shut so there is backflow

Fill in the Table.

Non-valvular murmurs also exist.

Label the different valves.

[blank_start]Calcification[blank_end] of the aortic valves (due to naturally [blank_start]aging[blank_end]) mainly causes [blank_start]aortic[blank_end] [blank_start]stenosis[blank_end]. The most common cause of [blank_start]mitral[blank_end] [blank_start]stenosis[blank_end] is rheumatic heart disease due to the bacteria of group [blank_start]A[blank_end] Streptococcus.

What is the correct ordering of the heart layers?

What is true regarding endocarditits?

What is true regarding pericarditits?

What are these clinical symptoms?

[blank_start]Unstable[blank_end] angina is due to problems in blood supply. It comes about at [blank_start]rest[blank_end] or [blank_start]minimal[blank_end] [blank_start]exertion[blank_end], like walking.

Stable angina is due to [blank_start]myocardial[blank_end] [blank_start]ischemia[blank_end]. It is a [blank_start]central[blank_end] chest tightness or heaviness, which is relieved by [blank_start]rest[blank_end]. It may radiate to one or both [blank_start]arms[blank_end], the neck, jaw or [blank_start]teeth[blank_end].

GRAB to treat stable angina: [blank_start]Glycerol[blank_end] [blank_start]Trinitrate[blank_end] spray for symptomatic relief [blank_start]Risk[blank_end] Factor modification like stop smoking and reduced cholesterol [blank_start]Aspirin[blank_end] reduces mortality by 34% (fact) [blank_start]Beta[blank_end] [blank_start]blockers[blank_end] to reduce symptoms unless contraindicated

Unstable angina, NSTEMI and STEMI are a group of conditions that occur due to decreased blood flow in the [blank_start]coronary[blank_end] arteries, leading to heart muscle [blank_start]ischemia[blank_end]. This is known as [blank_start]acute[blank_end] [blank_start]coronary[blank_end] [blank_start]syndrome[blank_end].

How does ACS (acute coronary syndrome) present?

Which is NSTEMI and which is STEMI?

Acute management of ACS: MONA IV [blank_start]Morphine[blank_end] Oxygen (if Sats < 94%) [blank_start]Nitrates[blank_end] [blank_start]Aspirin[blank_end]

Secondary management of ACS is [blank_start]revascularization[blank_end]: STEMI [blank_start]reperfusion[blank_end] therapy--> [blank_start]primary[blank_end] PCI ([blank_start]percutaneous[blank_end] [blank_start]coronary[blank_end] intervention) If this cannot be achieved within [blank_start]2[blank_end] hours of diagnosis or PCI is not available, [blank_start]thrombolytic[blank_end] therapy such as streptokinase is to be done.

Secondary prevention of myocardial infarction: AAABC [blank_start]Aspirin[blank_end] (antiplatelet) [blank_start]ACE[blank_end] inhibitor [blank_start]Atorvastatin[blank_end] Beta-blocker [blank_start]Clopridogrel[blank_end] (antiplatelet)

What morphology is shown below? (2 words)

Which leads are lateral?

Which leads are anterior?

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?

What are side effects of ACE inhibitors?

Hydrochlorothiazide and Metolazone are examples of thiazide-like diuretics.

[blank_start]Angiotenisin[blank_end] [blank_start]Receptor[blank_end] [blank_start]Blockers[blank_end] end in “sartan” e.g. [blank_start]Losartan[blank_end] They're given if side effects of ACE inhibitors are experienced.

Beta blockers reduce the [blank_start]cardiac[blank_end] [blank_start]output[blank_end] by reducing heart rate and force of contraction (hence the [blank_start]stroke[blank_end] [blank_start]volume[blank_end]). They end in -lol like [blank_start]metoprolol[blank_end].

What is true regarding beta blocker side effects?

If the patien is younger than 8o years, treatment for stage [blank_start]1[blank_end] hypertension is given if: [blank_start]End[blank_end] [blank_start]organ[blank_end] damage [blank_start]Cardiovascular[blank_end] disease (or significant risk of developing it) Renal disease [blank_start]Diabetes[blank_end]

NSTE-ACS refers to Unstable Angina and NSTEMI.

Cardiac markers: [blank_start]Troponin[blank_end] I/T They are the most specific/sensitive tests for [blank_start]MI[blank_end].

Fill in the diagram. (ABREVIATIONS WHERE APPROPRIATE)

WHICH are side-effects of calcium channel blockers?

CCBs used to treat hypertension end in –dipine such as [blank_start]nifedipine[blank_end]