A 28-year-old man with hypertrophic obstructive cardiomyopathy is investigated for palpitations. A 24 hour ECG reveals runs of non-sustained ventricular tachycardia.
What is the most appropriate management?
Correct Answer D: Most cardiologists would now proceed to inserting an implantable cardioverter defibrillator to lower the risk of sudden cardiac death.
HOCM: management: Hypertrophic obstructive cardiomyopathy (HOCM) is an autosomal dominant disorder of muscle tissue caused by defects in the genes encoding contractile proteins. The estimated prevalence is 1 in 500.
Management:
Drugs to avoid:
*Although see the 2008 NICE guidelines on infective endocarditis prophylaxis
A 34-year-old man is noted to have a pan-systolic murmur associated with large V waves in the JVP and pulsatile hepatomegaly.
Which one of the following types of congenital heart disease is most associated with tricuspid regurgitation?
Correct Answer B:
Tricuspid regurgitation: Signs:
Causes:
How long should a patient stop driving for following an elective cardiac angioplasty?
Correct Answer B: DVLA advice following angioplasty - cannot drive for 1 week.
The April 2009 AKT feedback report made specific mention of fitness to drive rules. DVLA: cardiovascular disorders.
The guidelines below relate to car/motorcycle use unless specifically stated. For obvious reasons, the rules relating to drivers of heavy goods vehicles tend to be much stricter Specific rules:
A 56-year-old man is admitted to the Emergency Department with headaches, chest pain and confusion. His initial observations show a blood pressure of 250/140 mmHg, pulse 90/min and temperature of 36.4º. On examination the blood pressure is confirmed and is equal in both arms. Blurring of the optic discs is noted on examination. He has no significant medical history and takes no regular medications.
What is the most suitable initial management?
Correct Answer D: This patient has malignant hypertension. The presence of papilloedema is an indication for the use of intravenous agents rather than slower acting oral preparations.
Malignant hypertension:
Basics:
Features:
Each one of the following physiological changes occur during exercise, except:
Correct Answer D:
Exercise: physiological changes:
Blood pressure:
Cardiac output:
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