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Year6:Cardiology Ben Sharp FY1 Doctor Oxford Menti:55387462Overview 1. Valvular diseases 2. Acute Coronary Syndrome 3. Heart Failure 4. Heart ArrythmiasTestyourknowledge! Menti:55387462 1) A 72 year old male presents to A&E with severe shortness of breath. For the past day he has been coughing up pink, frothy sputum. Upon questioning he has had to sleep upright with 3 pillows for the past month. His past medical history is significant for hypertension, T2DM, and previous NSTEMI. On examination, you hear a pansystolic murmur, loudest over the 5 intercostal space, mid-clavicular line. A CXR is performed which shows bilateral widespread fluffy shadowing. What is the most likely underlying diagnosis? A. Aortic stenosis B. Right heart failure C. Mitral Regurgitation D. Aortic Regurgitation E. Mitral StenosisTestyourknowledge! Menti:55387462 2) An 80-year-old female has suffered progressive dyspnoea, with chest pain on walking up a flight of stairs. She has a PMH of hypertension, hyperlipidaemia, and well controlled T2DM. An ejection systolic murmur was heard on auscultation. An echocardiogram showed aortic stenosis with a VMAX (peak aortic jet volume) of 4.5m/s. What treatment should be offered to her? A. Surgical aortic valve replacement with metal valve B. Watch and wait C. Surgical aortic valve replacement with prosthetic valve D. Percutaneous coronary intervention E. Transcatheter aortic valve replacementTestyourknowledge! Menti:55387462 3) A 68 year old male being treated on the acute medical ward for cellulitis developed central chest pain 15 minutes ago. He describes it as if someone is sitting on him. An ECG is taken which shows ST-Elevation in leads V1-5. A STEMI is diagnosed. What is the definitive management of his condition? A. Coronary artery bypass graft B. Primary percutaneous coronary intervention within 120 minutes C. Dual antiplatelet therapy with Aspirin 300mg + Ticagrelor 180mg, and fondaparinux 2.5mg S/C. D. Primary percutaneous coronary intervention within 240 minutes E. Dual antiplatelet therapy with Aspirin 75mg and Clopidogrel 75mgTestyourknowledge! Menti:55387462 4) A 80 year old female presents to A&E. She is acutely short of breath. She has bibasal crackles on examination. She is breathing very quickly and seems distressed. She has a PMH of previous MI with x2 stents, HTN, T2DM. She is placed on high flow Oxygen. Her sats are 98% with a BP of 130/90. A portable CXR shows bilateral bat wing shadowing. What treatment should be given to this patient? A. IV furosemide infusion, Sublingual GTN, Morphine IV B. ACEi, beta blocker, aldosterone antagonist C. Aspirin 300mg, Ticagrelor 180mg, GTN spray D. IV Labetalol, IV Furosemide injection, GTN spray E. Oral furosemide, IV nitrates, OramorphTestyourknowledge! Menti:55387462 5) A 75 year old male who was admitted for PPCI for a STEMI becomes severely unwell on the ward. He is complaining of severe palpitations. His BP is 50/30 and heart rate 150. His ECG is as below: What should be done next? A. IV amiodarone 150mg infusion B. IV adenosine 6mg C. DC cardioversion D. IV beta-blocker infusion E. IV adrenaline 1mg 1:10000Overview 1. Valvular diseases 2. Acute Coronary Syndrome 3. Heart Failure 4. Heart ArrythmiasOverview 1. Valvular diseases • Aortic stenosis • Mitral regurgitation • Aortic regurgitation 2. Acute Coronary Syndrome 3. Heart Failure 4. Heart ArrythmiasTestyourknowledge! 1) A 72 year old man presents to A&E with severe shortness of breath. For the past day he has been coughing up pink, frothy sputum. Upon questioning he has had to sleep upright with 3 pillows for the past month. His past medical history is significant for hypertension, T2DM, and previous NSTEMI. On examination, you hear a pansystolic murmur, loudest over the 5 intercostal space, mid-clavicular line. A CXR is performed which shows bilateral widespread fluffy shadowing. What is the most likely underlying diagnosis? A. Aortic stenosis B. Left heart failure C. Mitral Regurgitation D. Aortic Regurgitation E. Mitral StenosisTestyourknowledge! 1) A 72 year old man presents to A&E with severe shortness of breath. For the past day he has been coughing up pink, frothy sputum. Upon questioning he has had to sleep upright with 3 pillows for the past month. His past medical history is significant for hypertension, T2DM, and previous NSTEMI. On examination, you hear a pansystolic murmur, loudest over the 5 intercostal space, mid-clavicular line. A CXR is performed which shows bilateral widespread fluffy shadowing. What is the most likely underlying diagnosis? A. Aortic stenosis B. Right heart failure C. Mitral Regurgitation D. Aortic Regurgitation E. Mitral StenosisTestyourknowledge! Menti:55387462 2) An 80-year-old female has suffered progressive dyspnoea, with chest pain on walking up a flight of stairs. She has a PMH of hypertension, hyperlipidaemia, and well controlled T2DM. An ejection systolic murmur was heard on auscultation. An echocardiogram showed aortic stenosis with a VMAX (peak aortic jet volume) of 4.5m/s. What treatment should be offered to her? A. Surgical aortic valve replacement with metal valve B. Watch and wait C. Surgical aortic valve replacement with prosthetic valve D. Percutaneous coronary intervention E. Transcatheter aortic valve replacementTestyourknowledge! Menti:55387462 2) An 80-year-old female has suffered progressive dyspnoea, with chest pain on walking up a flight of stairs. She has a PMH of hypertension, hyperlipidaemia, and well controlled T2DM. An ejection systolic murmur was heard on auscultation. An echocardiogram showed aortic stenosis with a VMAX (peak aortic jet volume) of 4.5m/s. What treatment should be offered to her? A. Surgical aortic valve replacement with metal valve B. Watch and wait C. Surgical aortic valve replacement with prosthetic valve D. Percutaneous coronary intervention E. Transcatheter aortic valve replacement TheHeartSounds Systole S1-----S2 “Lub-Dub” Closure of Closure of atrioventricular semilunar valves (mitral) valves (aortic) AorticStenosis Crescendo - decrescendo Systole Complications: due ---------S1-----S2-------- ➢ to outflowaortic to be forced fill, “Lub-Dub” ➢ through aasses ➢ sRthrough MVy as dspecialistsed Closure of Closure of p pitations, MI, atrioventricular semilunar ➢ heart failuret valves (mitral) valves can pass (aortic) ➢ throughry = EJECTION SYSTOLIC murmur loudest over aortic region, which may radiate to carotidsAorticStenosis-Treatment Open heart surgery vs TAVI • If symptomatic, consider surgical intervention • Otherwise:AorticStenosis-Treatment Open heart surgery vs TAVI SAVR = surgical aortic valve replacement Mitralregurgitation Systole Management: CMV should closeExam ---------S1|||||||2-------- tbut remains of ➢ blood backroughll, “Lub-Dub” ➢ towards lung =ve through MV pulmonaryis Closure of Closure of ➢ oedema = SOB,’ atrioventricular semilunar orthopnoeae valves (mitral) valves mitral valve, (aortic) creating ➢ tu?Surgeryblood flow. = PANSYSTOLIC murmur loudest over mitral area Aorticregurgitation Systole Complications:e,ria -------- Afte➢ normally, aortic ---------S1-----S2||||||| aortic va vef “Lub-Dub” doesn’t closart fill, ➢ullRefer toood is ‘regspeci listV back into the LV Closure of Closure of ➢ compensate for atrioventricular semilunar failure valves (mitral) valves ➢ bl?Surgeryng (aortic) back = EARLY (blowing) DIASTOLIC murmur loudest over left sternal edge 3 ICSAorticregurgitationsignsAorticregurgitationsignsTestyourknowledge! 1) A 72 year old man presents to A&E with severe shortness of breath. For the past day he has been coughing up pink, frothy sputum. Upon questioning he has had to sleep upright with 3 pillows for the past month. His past medical history is significant for hypertension, T2DM, and previous NSTEMI. On examination, you hear a pansystolic murmur, loudest over the 5 intercostal space, mid-clavicular line. A CXR is performed which shows bilateral widespread fluffy shadowing. What is the most likely underlying diagnosis? A. Aortic stenosis B. Right heart failure C. Mitral Regurgitation D. Aortic Regurgitation E. Mitral Stenosis Testyourknowledge! Symofoms 1) A 72 year old man presents to A&E with severe shortness of pulmonary breath. For the past day he has been coughing up pink, frothy oedema Risk factors sputum. Upon questioning he has had to sleep upright with 3 for pillows for the past month. His past medical history is developing disease significant for hypertension, T2DM, and previous NSTEMI. On examination, you hear a pansystolic murmur, loudest over the 5 intercostal space, mid-clavicular line. A CXR is performed which shows bilateral widespread fluffy shadowing. What is regurg the most likely underlying diagnosis? murmur Confirmation A. Aortic stenosis of pulmonary oedema B. Right heart failure C. Mitral Regurgitation D. Aortic Regurgitation E. Mitral StenosisTestyourknowledge! 2) An 80-year-old female has suffered progressive dyspnoea, with chest pain on walking up a flight of stairs. She has a PMH of hypertension, hyperlipidaemia, and well controlled T2DM. An ejection systolic murmur was heard on auscultation. An echocardiogram showed aortic stenosis with a VMAX (peak aortic jet volume) of 4.5m/s. What treatment should be offered to her? A. Surgical aortic valve replacement with metal valve B. Watch and wait C. Surgical aortic valve replacement with prosthetic valve D. Percutaneous coronary intervention E. Transcatheter aortic valve replacement Testyourknowledge! >75 yrs old so should be offered TAVI Symptoms of Aortic2) An 80-year-old female has suffered progressive dyspnoea, Stenosis with chest pain on walking up a flight of stairs. She has a PMH of hypertension, hyperlipidaemia, and well controlled T2DM. Aortic An ejection systolic murmur was heard on auscultation. An Stenosis echocardiogram showed aortic stenosis with a VMAX (peak Murmur aortic jet volume) of 4.5m/s. What treatment should be offered to her? Below echo criteria defined in NICE guidelines. However, is symptomatic, so should be offered surgical intervention A. Surgical aortic valve replacement with metal valve B. Watch and wait C. Surgical aortic valve replacement with prosthetic valve D. Percutaneous coronary intervention E. Transcatheter aortic valve replacementOverview 1. Valvular diseases • Aortic stenosis • Mitral regurgitation • Aortic regurgitation 2. Acute Coronary Syndrome 3. Heart Failure 4. Heart ArrythmiasOverview-ACS 1. Valvular diseases 2. Acute Coronary Syndrome • STEMI • NSTEMI • Unstable Angina 3. Heart Failure 4. Heart ArrythmiasTestyourknowledge! Menti:55387462 3) A 68 year old male being treated on the acute medical ward for cellulitis developed central chest pain 15 minutes ago. He describes it as if someone is sitting on him. An ECG is taken which shows ST-Elevation in leads V1-5. A STEMI is diagnosed. What is the definitive management of his condition? A. Coronary artery bypass graft B. Primary percutaneous coronary intervention within 120 minutes C. Dual antiplatelet therapy with Aspirin 300mg + Ticagrelor 180mg, and fondaparinux 2.5mg S/C. D. Primary percutaneous coronary intervention within 240 minutes E. Dual antiplatelet therapy with Aspirin 75mg and Clopidogrel 75mgTestyourknowledge! Menti:55387462 3) A 68 year old male being treated on the acute medical ward for cellulitis developed central chest pain 15 minutes ago. He describes it as if someone is sitting on him. An ECG is taken which shows ST-Elevation in leads V1-5. A STEMI is diagnosed. What is the definitive management of his condition? A. Coronary artery bypass graft B. Primary percutaneous coronary intervention within 120 minutes C. Dual antiplatelet therapy with Aspirin 300mg + Ticagrelor 180mg, and fondaparinux 2.5mg S/C. D. Primary percutaneous coronary intervention within 240 minutes E. Dual antiplatelet therapy with Aspirin 75mg and Clopidogrel 75mgAcuteCoronarySyndrome STEMI Symptoms NSTEMI • Central crushing chest pain, Unstable Angina radiating to jaw and left arm • Sweating, pale, SOB • N+V, dizziness, syncope • Signs of cardiogenic shock Investigations: • ECG!! • TroponinSTEMI MONA BASH <12 hour symptoms? Yes No Primary PCI available within Coronary angiography if still ongoing 120 mins? evidence of myocardial Yes No ischaemia PPCI FibrinolysisMONABASH M – Morphine B – Beta blockers O – Oxygen if Sats A – ACEi, Antiplatelets <92% (long term)* N – Nitrates (GTN S – Statin (high dose) spray or IV) H – Heparin A – Antiplatelets (Fondaparinux) (Aspirin 300mg + Ticagrelor/ Clopidogrel) *Aspirin 75mg lifelong, Clopidogrel 75mg for 12mNSTEMI ECG: MONA BASH • No changes Calculate GRACE score (mortality from ACS) – if • ST depression high, consider • T wave inversion angiography • New LBBB Troponin = elevated or dynamic changesMONABASH M – Morphine B – Beta blockers O – Oxygen if Sats A – ACEi, <92% Antiplatelets* N – Nitrates (GTN S – Statin (high dose) spray or IV) H – Heparin A – Antiplatelets (Fondaparinux) (Aspirin 300mg + Ticagrelor 180mg/ Clopidogrel 300mg) *Aspirin 75mg lifelong, Clopidogrel 75mg for 12mUnstableAngina Can have ECG changes (not ST-elevation) but no rise or change in TroponinTestyourknowledge! 3) A 68 year old male being treated on the acute medical ward for cellulitis developed central chest pain 15 minutes ago. He describes it as if someone is sitting on him. An ECG is taken which shows ST-Elevation in leads V1-5. A STEMI is diagnosed. What is the definitive management of his condition? A. Coronary artery bypass graft B. Primary percutaneous coronary intervention within 120 minutes C. Dual antiplatelet therapy with Aspirin 300mg + Ticagrelor 180mg, and fondaparinux 2.5mg S/C. D. Primary percutaneous coronary intervention within 240 minutes E. Dual antiplatelet therapy with Aspirin 75mg and Clopidogrel 75mg Testyourknowledge! sounding 3) A 68 year old male being treated on the acute medical ward chest paifor cellulitis developed central chest pain 15 minutes ago. He describes it as if someone is sitting on him. An ECG is taken which shows ST-Elevation in leads V1-5. A STEMI is Diagnosed with STEMI diagnosed. What is the definitive management of his condition? Asking for definitive management which is PPCI A. Coronary artery bypass graft B. Primary percutaneous coronary intervention within 120 minutes C. Dual antiplatelet therapy with Aspirin 300mg + Ticagrelor 180mg, and fondaparinux 2.5mg S/C. D. Primary percutaneous coronary intervention within 240 minutes E. Dual antiplatelet therapy with Aspirin 75mg and Clopidogrel 75mgOverview-ACS 1. Valvular diseases 2. Acute Coronary Syndrome • STEMI • NSTEMI • Unstable Angina 3. Heart Failure 4. Heart ArrythmiasOverview–Heartfailure 1. Valvular diseases 2. Acute Coronary Syndrome 3. Heart Failure • Medical management • Pulmonary oedema management 4. Heart ArrythmiasTestyourknowledge! Menti:55387462 4) A 80 year old female presents to A&E. She is acutely short of breath. She has bibasal crackles on examination. She is breathing very quickly and seems distressed. She has a PMH of previous MI with x2 stents, HTN, T2DM. She is placed on high flow Oxygen. Her sats are 98% with a BP of 130/90. A portable CXR shows bilateral bat wing shadowing. What treatment should be given to this patient? A. IV furosemide infusion, Sublingual GTN, Morphine IV B. ACEi, beta blocker, aldosterone antagonist C. Aspirin 300mg, Ticagrelor 180mg, GTN spray D. IV Labetalol, IV Furosemide injection, GTN spray E. Oral furosemide, IV nitrates, OramorphTestyourknowledge! Menti:55387462 4) A 80 year old female presents to A&E. She is acutely short of breath. She has bibasal crackles on examination. She is breathing very quickly and seems distressed. She has a PMH of previous MI with x2 stents, HTN, T2DM. She is placed on high flow Oxygen. Her sats are 98% with a BP of 130/90. A portable CXR shows bilateral bat wing shadowing. What treatment should be given to this patient? A. IV furosemide infusion, Sublingual GTN, Morphine IV B. ACEi, beta blocker, aldosterone antagonist C. Aspirin 300mg, Ticagrelor 180mg, GTN spray D. IV Labetalol, IV Furosemide injection, GTN spray E. Oral furosemide, IV nitrates, OramorphHeartFailure Heart failure is a condition in which the heart is unable to generate a cardiac output sufficient to meet the demands of the body. Split into 3 categories based on LVEF: • Heart failure with reduced ejection fraction (HFrEF) – LVEF <40% • Heart failure with mid-range ejection fraction (HFmrEF): LVEF 40% to 49% • Heart failure with preserved ejection fraction (HFpEF): LVEF >50% Symptoms include progressive SOB, Oedema, Orthopnoea, PND. Diagnosis from History, Exam, BNP, ECG, CXR, EchoMedicalManagement Symptomatic control – Diuretics (furosemide) Disease modifying medication in HFrEF • Vasodilators – ACEi, ARB – first line • Beta-blockers • Aldosterone antagonists New drugs • SGLT-2 inhibitors (Dapagliflozin, empagliflozin) • Sacubitril with Valsartan – start at beginning instead of ACEi Devices • ICD – if suffered from VF/VT with symptomsAcuteHeartFailureexacerbation-pulmonaryoedema CXR: • Upper lobe blood diversion • Interstitial oedema (Kerley B lines) • Alveolar oedema (bat wing appearance) • Pleural effusion • Cardiomegaly Treatmentofpatientwithacutepulmonaryoedema Initial: • Monitor vitals • IV access - basic bloods, troponin, ABG • Sit patient up • O2 – 12-15L non re-breathe mask • ECG/CXR Drugs Furosemide 40-80mg IV over 5 minutes Nitrates – sublingual initially then IV Assess urine output over 3- Only if BP is >110 systolic 4hrs Results in vaso and If poor, can double dose or Morphine 2.5mg-10mg IV venodilation give infusion 10mg/hr Helps for breathlessness in distressed pts (+ metoclopramide)Testyourknowledge! 4) A 80 year old female presents to A&E. She is acutely short of breath. She has bibasal crackles on examination. She is breathing very quickly and seems distressted. She has a PMH of previous MI with x2 stents, HTN, T2DM. She is placed on high flow Oxygen. Her sats are 98% with a BP of 130/90. A portable CXR shows bilateral bat wing shadowing. What treatment should be given to this patient? A. IV furosemide infusion, Sublingual GTN, Morphine IV B. ACEi, beta blocker, aldosterone antagonist C. Aspirin 300mg, Ticagrelor 180mg, GTN spray D. IV Labetalol, IV Furosemide injection, GTN spray E. Oral furosemide, IV nitrates, Oramorph Testyourknowledge! Signs and symptoms 4) A 80 year old female presents to A&E. She is acutely short of pul of breath. She has bibasal crackles on examination. She is oedema breathing very quickly and seems distressed. She has a PMH PMH of previous MI with x2 stents, HTN, T2DM. She is placed on for morphine fore indicated high flow Oxygen. Her sats are 98% with a BP of 130/90. A the heart failure described here portable CXR shows bilateral bat wing shadowing. What SBP above treatment should be given to this patient? CXR confirms 110 so can poedemary have nitrates A. IV furosemide infusion, Sublingual GTN, Morphine IV B. ACEi, beta blocker, aldosterone antagonist C. Aspirin 300mg, Ticagrelor 180mg, GTN spray D. IV Labetalol, IV Furosemide injection, GTN spray E. Oral furosemide, IV nitrates, OramorphOverview–Heartfailure 1. Valvular diseases 2. Acute Coronary Syndrome 3. Heart Failure • Medical management • Pulmonary oedema management 4. Heart ArrythmiasOverview 1. Valvular diseases 2. Acute Coronary Syndrome 3. Heart Failure 4. Heart ArrythmiasHeartArrythmias • Atrial fibrillation • Atrial flutter • Supraventricular Tachycardia (AVRT, AVNRT) • Ventricular Tachycardia/FibrillationTestyourknowledge! Menti:55387462 5) A 75 year old male who was admitted for PPCI for a STEMI becomes severely unwell on the ward. He is complaining of severe palpitations. His BP is 50/30 and heart rate 150. His ECG is as below: What should be done next? A. IV amiodarone 150mg infusion B. IV adenosine 6mg C. DC cardioversion D. IV beta-blocker infusion E. IV adrenaline 1mg 1:10000Testyourknowledge! Menti:55387462 5) A 75 year old male who was admitted for PPCI for a STEMI becomes severely unwell on the ward. He is complaining of severe palpitations. His BP is 50/30 and heart rate 150. His ECG is as below: What should be done next? A. IV amiodarone 150mg infusion B. IV adenosine 6mg C. DC cardioversion D. IV beta-blocker infusion E. IV adrenaline 1mg 1:10000Tachyarrythmias 1. Is it regular Y/N? • Irregular = AF 2. Narrow or broad? • Narrow » Atrial flutter, atrial tachy, AVNRT, AVRT » Sinus tachy • Broad » VT » SVT with accessory pathwayBroadcomplextachycardias 1. What percentage of all broad complex tachycardias are VT? • 80% 2. In IHD/LV dysfunction, what percentage of all broad complex tachycardias are VT? • 95% 3. Is there independent p wave activity present? • Yes = must be VTAtrialfibrillationAtrialfibrillationwithLBBBSVT(AVNRT)SVT(AVNRT)Atrialflutter Saw toothed pattern 150bpm 2:1VentricularTachycardiaVentricularTachycardiaVentricularfibrillationManagementofatrialfibrillation Reverse underlying cause (if there is one) and anticoagulation depending on CHADS-VASC and HAS-BLED score. Rate Control Rhythm Control B C DManagementofatrialfibrillation Reverse underlying cause (if there is one) and anticoagulation depending on CHADS-VASC and HAS-BLED score. Rate Control Rhythm Control B – Beta Blocker B C – Calcium Channel BlockeS (Verapamil or Diltiazem) A D – Digoxin F EManagementofatrialfibrillation Reverse underlying cause (if there is one) and anticoagulation depending on CHADS-VASC and HAS-BLED score. Rate Control Rhythm Control B – Beta Blocker B – Beta blockers C – Calcium Channel Blocker S – Sotalol (Verapamil or Diltiazem) A – Amiodarone D – Digoxin F – Flecainide E - ElectricitySVTmanagement Haemodynamically stable non- idiopathic sustained ventricular tachycardia Adenosine: 6 mg intravenously initially, followed by 12 mg every 1-2 minutes for up to 2 doses according to response Valsalva manoeuvre while drawing up adenosine! 2nd line - amiodarone: 150 mg intravenous infusion given over 10 minutes initially, followed by 1 mg/minute for 6 hours, followed by 0.5 mg/minute for 18 hoursTestyourknowledge! 5) A 75 year old male who was admitted for PPCI for a STEMI becomes severely unwell on the ward. He is complaining of severe palpitations. His BP is 50/30 and heart rate 150. His ECG is as below: What should be done next? A. IV amiodarone 150mg infusion B. IV adenosine 6mg C. DC cardioversion D. IV beta-blocker infusion E. IV adrenaline 1mg 1:10000Testyourknowledge! 5) A 75 year old male who was admitted for PPCI for a STEMI becomes severely unwell on the ward. He is complaining of IHD = VT severe palpitations. His BP is 50/30 and heart rate 150. His likely Haemodynamically ECG is as below: unstable = Shock What should be done next? A. IV amiodarone 150mg infusion B. IV adenosine 6mg C. DC cardioversion D. IV beta-blocker infusion E. IV adrenaline 1mg 1:10000 Broad complex, IHD, p waves = VTOverview 1. Valvular diseases 2. Acute Coronary Syndrome 3. Heart Failure 4. Heart ArrythmiasSummaryquestions Menti:55387462 6) An 82-year-old female presents to A&E with severe shortness of breath. She is also complaining of chest pain. An ECG performed is normal, but troponins are taken which are markedly elevated. As a result, she is diagnosed with a NSTEMI and undergoes PCI. On the ward the following day she is examined and an S1 and S2 are heard but with a murmur that radiates to the carotids. Which of the following statements is true for aortic stenosis? A. It causes an early diastolic murmur B. The main cause of AS is rheumatic fever C. It causes a pansystolic murmur that is loudest on expiration D. A common complication is left ventricular hypertrophy due to outflow obstruction E. It causes a decrescendo-crescendo systolic murmurSummaryquestions Menti:55387462 6) An 82-year-old female presents to A&E with severe shortness of breath. She is also complaining of chest pain. An ECG performed is normal, but troponins are taken which are markedly elevated. As a result, she is diagnosed with a NSTEMI and undergoes PCI. On the ward the following day she is examined and an S1 and S2 are heard but with a murmur that radiates to the carotids. Which of the following statements is true for aortic stenosis? A. It causes an early diastolic murmur B. The main cause of AS is rheumatic fever C. It causes a pansystolic murmur that is loudest on expiration D. A common complication is left ventricular hypertrophy due to outflow obstruction E. It causes a decrescendo-crescendo systolic murmurSummaryquestions Menti:55387462 7) A 68-year-old male presents to clinic. He is complaining of progressively worse shortness of breath while walking to the shops every week. He now must stop and catch his breath when he goes up a flight of stairs. He sleeps with 3 pillows at night. He has a PMH of a triple CABG, HTN, hyperlipidaemia. An echocardiogram confirms heart failure with a left ventricular ejection fraction of 38%. What medication offers the best prognostic value in this form of heart failure? A. Loop diuretic B. Aldosterone antagonist C. Thiazide diuretic D. Beta blocker E. ACE inhibitorSummaryquestions Menti:55387462 7) A 68-year-old male presents to clinic. He is complaining of progressively worse shortness of breath while walking to the shops every week. He now must stop and catch his breath when he goes up a flight of stairs. He sleeps with 3 pillows at night. He has a PMH of a triple CABG, HTN, hyperlipidaemia. An echocardiogram confirms heart failure with a left ventricular ejection fraction of 38%. What medication offers the best prognostic value in this form of heart failure? A. Loop diuretic B. Aldosterone antagonist C. Thiazide diuretic D. Beta blocker E. ACE inhibitorSummaryquestions 8) A 74-year-old male presents to A&E feeling not quite right. His apple watch advised him to come into hospital due to an irregular heart rhythm. He has a PMH of vertigo, asthma, and acid reflux. His HR is 132bpm, BP 135/85, Sats 98% on RA. An ECG is taken which is shown below: What management option would be suitable for this patient? A. Bisoprolol 2.5mg B. Amiodarone 150mg IV infusion C. Adenosine 6mg IV D. DC cardioversion E. Verapamil 40mgSummaryquestions 8) A 74-year-old male presents to A&E feeling not quite right. His apple watch advised him to come into hospital due to an irregular heart rhythm. He has a PMH of vertigo, asthma, and acid reflux. His HR is 132bpm, BP 135/85, Sats 98% on RA. An ECG is taken which is shown below: What management option would be suitable for this patient? A. Bisoprolol 2.5mg B. Amiodarone 150mg IV infusion C. Adenosine 6mg IV D. DC cardioversion E. Verapamil 40mgThanksandfeedback!