ACS/HEART FAILURE QUESTION FAVOURITES

Three Favourite Exam Topics on ACS/Heart Failure...
 
1.   Angina vs Myocardial Infarction - pain is less severe in angina and lasts <20mins

•    STEMI Treatment Options --> MONARCHS (Morphine, Oxygen if hypoxic, Nitrates, Aspirin/Atenolol (or betablocker), Reperfusion and Ramipril, Clopidogrel, Heparin/Enoxaparin, Simvastatin

2.   Complications of an MI - SPARED (Sudden Death, Pump Failure, Aneurysm/Arrythmia, Rupture of papillary muscle or septum, Embolism, Dressler's Syndrome 1 in 300-400, immune response/ESR+CRP raised/pericardial pain) + Early Pericarditis (19/20 will have no 'rub' though)
 
3.   Principles of treatment of an acute left ventricular failure & it's signs - "This patient would look ill"
 
·      Sinus tachy/AF, Systolic HTN, Cardiomegaly on CXR, 3rd and 4th Heart Sounds, RHS or bilat pleural effusions
·      What are the SIGNS on a CXR? ABCD - Alveolar Oedema (Bat Wing Oedema), B-Lines (Kerley), Cardiomegaly, Dilated Upper Lobe Vessels, Effusion (Pleural)
·      TREATMENT = High dose oxygen if hypoxia present, Treat significant arrhythmias, IV diuretics ?furosemide, IV opiates like diamorph are pulmonary venodilators and reduce preload on the heart)
·      Consider repeat diuretics, and vasodilators like isosorbide infusions.
·      What is the New York Heart Association Classification? (Buzz Word - "Functional  Capacity)
 
Others
·      What are the features of pericardial pain?
·      What are the features of acute LVF on inspection of the patient? 
·      (Bronchial veins --> Pulmonary veins --> Venous congestion = Bronchial Congestion - 'Cardiac Asthma?')
·      What is a gallop rhythm? (It is hard to hear with a HR >100)