100 Questions in Cardiology

100 Questions in Cardiology

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Table of Contents

Contributors                                       xii
Introduction xvii
What are the cardiovascular risks of 1 (2)
hypertension?
Is 24 hour blood pressure monitoring 3 (2)
necessary, and what do I do with the
information?
Who should be screened for a cause of 5 (2)
secondary hypertension? How do I screen?
What blood pressure should I treat, and what 7 (3)
should I aim for when treating a 45 year old,
a 60 year old, a 75 year old or an 85 year
old?
Is one treatment for hypertension proven to 10 (2)
be better than another in terms of survival?
It was once suggested that calcium channel 12 (2)
blockers might be dangerous for treating
hypertension. Is this still true?
How can I outline a management plan for the 14 (1)
patient with essential hypertension?
How do I manage the patient with malignant 15 (2)
hypertension?
Which asymptomatic hypercholesterolaemic 17 (1)
patients benefit from lipid-lowering therapy?
What cholesterol level should I aim for?
Which patients with coronary disease have 18 (2)
been proven to benefit from pharmacological
intervention? What lipid levels should I aim
for?
What drugs should I choose to treat 20 (2)
dyslipidaemia, and how should I monitor
treatment?
What are the side effects of lipid-lowering 22 (2)
therapy, and how should they be monitored?
Is there a role for prescribing antioxidant 24 (1)
vitamins to patients with coronary artery
disease? If so, who should get them, and at
what dose?
What is the sensitivity, specificity and 25 (2)
positive predictive value of an abnormal
exercise test?
What are the risks of exercise testing? What 27 (2)
are the contraindications?
What are the stratification data for risk 29 (2)
from exercise tests in patients with angina?
Which patterns of response warrant referral
for angiography?
Who should have a thallium scan? How does it 31 (2)
compare with standard exercise tests in
determining risk?
What are hibernating and stunned myocardium? 33 (2)
What echocardiographic techniques are useful
for detecting them? How do these methods
compare with others available?
Which class of antianginal agent should I 35 (2)
prescribe in stable angina? Does it matter?
What is the role of troponin T in the 37 (4)
diagnosis and risk stratification of acute
coronary syndromes?
What are the risks of myocardial infarction 41 (2)
and death in someone with unstable angina
during hospital admission, at six months and
one year?
What medical treatments of unstable angina 43 (2)
are of proven benefit?
Under what circumstances should the patient 45 (3)
with unstable angina undergo PTCA or CABG?
What new approaches are there to prevent 48 (3)
restenosis following PTCA?
Which thrombolytics are currently available 51 (4)
for treating acute myocardial infarction? Who
should receive which one? What newer agents
are there?
Is angioplasty better than thrombolysis in 55 (2)
myocardial infarction? Which patients should
receive primary or ``hot'' angioplasty for
these conditions?
What are the contraindications to 57 (2)
thrombolytic therapy for acute myocardial
infarction? Is diabetic retinopathy a
contraindication?
Exercise testing after myocardial infarction: 59 (2)
how soon, what protocol, how should results
be acted upon?
What are the risks of recurrent ischaemic 61 (2)
events after myocardial infarction:
prehospital, at 30 days and at 1 year?
What is appropriate secondary prevention 63 (3)
after acute myocardial infarction?
What advice should I give patients about 66 (2)
driving and flying after myocardial
infarction?
What is the mortality rate for cardiogenic 68 (2)
shock complicating myocardial infarction? How
should such patients be managed to improve
outcome and what are the results?
What is the risk of a patient dying or having 70 (2)
a myocardial infarction around the time of
surgery for coronary artery disease and for
valve replacement?
Which patients with post-infarct septal 72 (1)
rupture should be treated surgically, and
what are the success rates?
What patterns of coronary disease are 73 (3)
associated with improved short and long term
survival after CABG compared with medical
therapy?
Coronary artery bypass grafting: what is the 76 (3)
case for total arterial revascularisation?
How common are neuropsychological 79 (3)
complications after cardiopulmonary bypass
(CPB)? How predictable and severe are they?
Can they be prevented?
Are there benefits to switching from 82 (2)
sulphonylureas to insulin after coronary
artery bypass grafting?
How does recent myocardial infarction affect 84 (2)
the perioperative risks of coronary artery
bypass grafting?
How soon before cardiac surgery should 86 (1)
aspirin be stopped?
When should we operate to relieve mitral 87 (2)
regurgitation?
When to repair the mitral valve? 89 (3)
What is the Ross procedure? When is it 92 (2)
indicated and what are the advantages?
What is the risk of stroke each year after a) 94 (1)
tissue or b) mechanical MVR or AVR? What is
the annual risk of bacterial endocarditis on
these prosthetic valves?
When and how should a ventricular septal 95 (2)
defect be closed in adults?
How should I treat atrial septal defects in 97 (2)
adults?
How do I follow up a patient who has had 99 (2)
correction of aortic coarctation? What should
I look for and how should they be managed?
How should I investigate a patient with 101 (2)
hypertrophic cardiomyopathy (HCM)?
What is the medical therapy for patients with 103 (2)
hypertrophic cardiomyopathy, and what
surgical options are of use?
What is the role of permanent pacing in 105 (1)
hypertrophic cardiomyopathy?
How do I investigate the relative of a 106 (2)
patient with hypertrophic cardiomyopathy? How
should they be followed up?
What investigation protocol should a patient 108 (3)
with dilated cardiomyopathy undergo?
Which patients with impaired ventricles 111 (3)
should receive an ACE inhibitor? What are the
survival advantages? Do AT1-receptor
antagonists confer the same advantages?
What is the role of vasodilators in chronic 114 (2)
heart failure? Who should receive them?
Should I give digoxin to patients with heart 116 (2)
failure if they are in sinus rhythm? If so,
to whom? Are there dangers to stopping it
once started?
Which patients with heart failure should have 118 (2)
a beta blocker? How do I start it and how
should I monitor therapy?
What is mean and model life expectancy in 120 (3)
NYHA I-IV heart failure?
What are LVADs and BIVADS, and who should 123 (2)
have them?
Who is eligible for a heart or heart-lung 125 (3)
transplant? How do I assess suitability for
transplantation?
What are the survival figures for heart and 128 (1)
heart-lung transplantation?
What drugs do post-transplant patients 129 (2)
require, and what are their side effects? How
should I follow up such patients?
Can a cardiac transplant patient get angina? 131 (2)
How is this investigated?
What drugs should be used to maintain someone 133 (2)
in sinus rhythm who has paroxysmal atrial
fibrillation? Is there a role for digoxin?
Which patients with paroxysmal or chronic 135 (2)
atrial fibrillation should I treat with
aspirin, warfarin or neither?
Which patients with SVT should be referred 137 (2)
for an intracardiac electrophysiological
study (EP study)? What are the success rates
and risks of radiofrequency (RF) ablation?
What drugs should I use for chemically 139 (2)
cardioverting atrial fibrillation and when is
DC cardioversion preferable?
How long should someone with atrial 141 (2)
fibrillation be anticoagulated before DC
cardioversion, and how long should this be
continued afterwards?
What factors determine the chances of 143 (2)
successful elective cardioversion from atrial
fibrillation?
What are the risks of elective DC 145 (2)
cardioversion from atrial fibrillation?
Are patients with atrial flutter at risk of 147 (2)
embolisation when cardioverted? Do they need
anticoagulation to cover the procedure?
How do I assess the risk of CVA or TIA in a 149 (2)
patient with chronic atrial fibrillation and
in a patient with paroxysmal atrial
fibrillation?
How sensitive are transthoracic and 151 (2)
transoesophageal echocardiography for the
detection of thrombus in the left atrium?
What are the roles of transthoracic and 153 (2)
transoesophageal echocardiography in patients
with a TIA or stroke?
Which patient with a patent foramen ovale 155 (2)
should be referred for closure?
5 How should I investigate the patient with 157 (4)
collapse? Who should have a tilt test, and
what do I do if it is positive?
What are the chances of a 24 hour tape 161 (3)
detecting the causes for collapse in a
patient? What other alternative monitoring
devices are now available?
Should the patient with trifascicular disease 164 (2)
be routinely paced? If not, why not?
Who should have VVI pacemakers and who should 166 (2)
have dual chamber pacemakers? What are the
risks of pacemaker insertion?
Can a patient with a pacemaker touch an 168 (2)
electric fence? have an MRI scan? go through
airport metal detectors? use a mobile phone?
What do I do if a patient has a pacemaker and 170 (1)
needs cardioversion?
What do I do about non-sustained ventricular 171 (2)
tachycardia on a 24 hour tape?
How do I treat torsades de pointes at a 173 (2)
cardiac arrest?
How do I assess the patient with long QT? 175 (2)
Should I screen relatives, and how? How do I
treat them?
How do I investigate the relatives of a 177 (2)
patient with sudden cardiac death?
What percentage of patients will suffer the 179 (3)
complications of amiodarone therapy, and how
reversible are the eye, lung, and liver
changes? How do I assess thyroid function in
someone on amiodarone therapy?
Who should have a VT stimulation study? What 182 (2)
are the risks and benefits?
What are the indications for implantable 184 (4)
cardioverter defibrillator (ICD) implantation
and what are the survival benefits?
How do I manage the patient with an ICD? 188 (2)
How do I follow up the patient with the 190 (2)
implantable cardioverter defibrillator?
What do I do if an ICD keeps discharging? 192 (2)
How do I manage the pregnant woman with 194 (2)
dilated cardiomyopathy?
How do I manage the pregnant woman with valve 196 (2)
disease?
Which cardiac patients should never get 198 (2)
pregnant? Which cardiac patients should
undergo elective Caesarean section?
A patient is on life-long warfarin and wishes 200 (2)
to become pregnant. How should she be managed?
How should the anticoagulation of a patient 202 (2)
with a mechanical heart valve be managed for
elective surgery?
What are the indications for surgical 204 (2)
management of endocarditis?
What is the morbidity and mortality of 206 (1)
endocarditis with modern day management (and
how many relapse)?
What percentage of blood cultures will be 207 (1)
positive in endocarditis?
Which patients should receive antibiotic 208 (2)
prophylaxis for endocarditis, and which
procedures should be covered in this way?
Which patients should undergo preoperative 210 (2)
non-invasive investigations or Coronary
angiography?
Which factors predict cardiac risk from 212 (4)
general surgery and what is the magnitude of
the risks with each factor?
Index 216