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Which of the following hormone is responsible for growth promotion, vasoconstriction and sodium and water retention in heart failure patients?
What is the most common cause of diastolic heart failure?
Which of the following medication has been proven to reduce the risk of sudden cardiac death in patients with heart failure?
What is the mechanism of action of Ivabradine?
Which of the following advise should not be recommended for patients suffering from heart failure?
A patient with moderate to severe chronic heart failure treated with erythropoetin will most likely achieve:
Which of the following inotropic agent is least likely to have arrythmogenic potential?
Which of the following population group has the highest incidence of sudden cardiac death?
The following interventions commenced within 7 days following a myocardial infarction reduces mortality in sudden cardiac death except?
A patient presents with an anterior non-ST elevation myocardial infarction with transient T-wave inversion in V3-6. There is a typical rise in CK-MB (creatine kinase myocardial tissue) (2 x URL at 12 hr and 5 x URL at 24 hrs) and Troponin T (2 x URL at 12 hr and 20 x URL at 24 hrs).
72 hours after the onset of the first episode, the patient experiences recurrent chest pain.
*Levels are expressed as a multiple of the upper reference limit (URL).
If present, which of the following BEST indicates that the patient has had a recurrent myocardial infarct?
A 70-year-old man presents to the emergency department with prolonged chest pain which is relieved by morphine and sublingual nitrates. He has a three-week history of frequent exertional and nocturnal chest pain. Three years ago he suffered an uncomplicated inferior myocardial infarction. Coronary angiography at that time revealed a 30% proximal left anterior descending artery stenosis, a long 90% right coronary artery stenosis and a 70% stenosis of the proximal circumflex artery.
As he was asymptomatic at that time, he was treated with aspirin, a beta-blocker and a hydroxy-methylglutarylcoenzyme A (HMG CoA) reductase inhibitor. He was also treated with an angiotensin converting enzyme (ACE) inhibitor for mild hypertension.
His current ECG shows Q waves in the inferior leads and 1 mm ST segment depression in leads V4-V6. A chest X-ray shows pulmonary venous congestion.
Emergency staff have initiated heparin therapy and have continued his usual medications. On review two hours later, he is asymptomatic, the ST changes have resolved and his serum troponin I level is 2.5 mg/L [<0.1].
Which one of the following management strategies would be most appropriate for this patient?
A 65-year-old man with one hour of central chest pain returns to the same hospital where he had percutaneous coronary intervention performed four weeks ago. He had stopped clopidogrel one week earlier. He is hypotensive with 3mm ST elevation in antero-septal leads.
Which of the following is the most appropriate management?
A patient presents to ED with central retrosternal chest pain. The onset of symptom was 16 hours ago.
His ECG shows 2mm ST elevation in lead II, III and aVF. His serum troponin is marginally raised.
However, he is now currently asymptomatic and hemodynamically stable.
What is the next step?
A patient presents to a rural hospital with an ST elevation MI and is thrombolysed with tenectaplase.
Which of the following medication should not be given as an adjuvant therapy with tenectaplase?
A patient develops an ST elevation MI and was urgently transferred to the cath lab for an urgent percutaneous coronary intervention. A drug eluting stent is placed over his left anterior descending artery and he was commenced on dual anti-platelet therapy.
Following stent placement, how long should the patient remain on clopidogrel if a single anti-platelet therapy is chosen?
A 48-year-old woman presents to the emergency department of a large rural hospital with severe chest pain. An ECG shows 3-4 mm ST elevation in the anteroseptal leads. The risk of major haemorrhage complicating thrombolysis therapy is greatest in a patient who:
You are working in a rural hospital where the percutaneous coronary intervention capable hospital is located 6 hours from your hospital. A paramedic faxes you an ECG showing 2mm ST elevation in lead V2 to V6 on a patient who presented with chest pain 1 hour ago. There is no contraindication to fibrinolytic therapy. They are currently one hour away from your hospital.
What would be the most appropriate advise?
In patients with significant left main coronary artery disease (>50% stenosis) along with high complexity coronary artery disease (SYNTAX score of >33), which of the following intervention is the most appropriate management strategy to improve their survival?
Which of the following intervention is the most definitive treatment in preventing sudden death in patients with Hypertrophic Cardiomyopathy?
A patient undergoes urgent percutaneous cardiac intervention (PCI) with a drug eluting stent following an acute presentation with ACS. He has since made a good recovery from this.
What would be the most appropriate timing for an elective non-cardiac surgery to be performed after his PCI?
Which of the following is the strongest indication for stopping antiplatelet therapy prior to surgery in a patient with prior coronary artery stenting?
Which of the following is least consistent with the diagnosis of metabolic syndrome?
What is the mechanism of action of ezetimibe?
You review a diabetic patient in your clinic. He is obese and has an LDL of 3.0mmol/L and TG of 3mmol/L.
Besides commencing him on statins, which of the following intervention should be added to reduce his cardiovascular risk ?
Which one of the following feature is most suggestive of autosomal dominant familial hypercholesterolaemia rather than other causes of hypercholesterolaemia?
Which of the following provides the greatest rationale for the use of drug eluting stent?
Which of the following is the most sensitive test of cardiac function?
Which of the following is not an anti-platelet agent?
A 50-year-old man with fasting lipid profile A was started on lipid modifying treatment. Now, three months later, he has fasting lipid profile B with no other lifestyle change.
The treatment most likely to have been commenced was:
A 36-year-old woman has a very strong family history of premature coronary disease. Physical examination is normal.
Her fasting lipid profile reveals:
Which abnormality is most likely to be present?
A 25 year old man presents with recurrent syncope.His brother and uncle died suddenly in their 30’s. A 12 lead ECG is normal.However, signal averaged ECG shows late potentials in V1. The most likely diagnosis is:
In a patient presenting with chronic stable coronary artery disease following recent angiography showing 2 vessel disease (80% stenosis left circumflex,60% LAD) Currently on atorvastatin 10mg, metoprolol 47.5mg, aspirin 100mg and enalapril 10mg daily.
Which of the following intervention will likely improve cardiac event free survival?
A 58-year-old woman presents to a Rural Centre with chest pain and vomiting. Her blood pressure is 80/50 mmHg. Her ECG is shown below.
What is the next step in management?
Which of the following feature is the most characteristic of Takotsubo cardiomyopathy?
Which one of the following medications is not considered an antihypertensive agent of choice in patients with bicuspid aortopathy?
A 50-year-old man with a BMI of 35 has a clinic blood pressure (BP) measurements of 148/90 mm Hg and 150/94 mm Hg. However, BP measurements at his local pharmacy have been consistently lower. You organized for him to a 24-hour ambulatory BP monitor which has now revealed an average blood pressure of 142/88 mm Hg. He remains asymptomatic.
At his current clinic visit, his BP is 142/90 mm Hg, and his heart rate is 75 beats per minute.
What is the next most appropriate step?
A 70 year old man with a known history of chronic heart failure presents to ED with acute angioedema. His ECHO from last year demonstrates a left ventricular ejection fraction of 30 percent. His current treatment includes cilazapril, carvedilol and spironolactone. In addition, he also informs that his GP had recently started him on Sacubitril-valsartan two days ago in an attempt to further improve his heart failure management.
You suspect that his angioedema is most likely due to the concomitant use of an ACE-inhibitor and an Angiotensin Receptor Neprilysin Inhibitor (ARNI).
What could have been done to prevent this adverse outcome?