Cardiology Acute Management Quiz

<p>Constricting discomfort in the chest, precipitated by exertion, and relieved by rest (B)</p> Signup and view all the answers

<p>Perform a full assessment with ECG and troponin measurement (A)</p> Signup and view all the answers

<p>Simvastatin and atorvastatin (D)</p> Signup and view all the answers

<p>If serum transaminase concentrations rise to and persist at 3 times the upper limit of the reference range (A)</p> Signup and view all the answers

<p>Patients with a history of intracerebral hemorrhage (A)</p> Signup and view all the answers

<p>In both arms (D)</p> Signup and view all the answers

<p>Calcium channel blocker (D)</p> Signup and view all the answers

<p>Use an asymmetric dosing interval with a nitrate-free time (A)</p> Signup and view all the answers

<p>Statin and lifestyle modifications (B)</p> Signup and view all the answers

<p>Patients with signs of heart failure and left ventricular systolic dysfunction (D)</p> Signup and view all the answers

<p>Switch to a Mediterranean style diet (B)</p> Signup and view all the answers

<p>Macrolides (B)</p> Signup and view all the answers

<p>Dual antiplatelet therapy and other medications (B)</p> Signup and view all the answers

<p>Beta-blocker or calcium channel blocker based on comorbidities (B)</p> Signup and view all the answers

<p>If the difference between readings is greater than 20 mmHg. (C)</p> Signup and view all the answers

<p>Admit for specialist assessment if specific alarming signs are present. (B)</p> Signup and view all the answers

<p>Both an ACE-inhibitor and a beta-blocker. (B)</p> Signup and view all the answers

<p>Spironolactone. (B)</p> Signup and view all the answers

<p>Loop diuretics. (A)</p> Signup and view all the answers

<p>Administer intravenous vitamin K and stop warfarin. (B)</p> Signup and view all the answers

<p>Initiation usually requires a specialist's involvement. (B)</p> Signup and view all the answers

<p>Two measurements per hour during waking hours. (B)</p> Signup and view all the answers

<p>Afro-Caribbean patients. (D)</p> Signup and view all the answers

<p>Supravalvular aortic stenosis. (B)</p> Signup and view all the answers

<p>Stiglitazone. (C)</p> Signup and view all the answers

<blockquote> <p>= 140/90 mmHg. (C)</p> </blockquote> Signup and view all the answers

<p>Turner's syndrome. (A)</p> Signup and view all the answers

<p>Haemorrhage (C)</p> Signup and view all the answers

<p>Calcium supplements (A)</p> Signup and view all the answers

<p>Ejection systolic murmur (D)</p> Signup and view all the answers

<p>4 weeks (C)</p> Signup and view all the answers

<p>Chest pain at rest (A)</p> Signup and view all the answers

<p>Beta blocker (other than sotalol) (C)</p> Signup and view all the answers

<p>Rapid rising pulse (A)</p> Signup and view all the answers

<p>Valve replacement surgery (D)</p> Signup and view all the answers

<p>Class IV (D)</p> Signup and view all the answers

<p>Skin necrosis (A)</p> Signup and view all the answers

<p>Asymmetric hypertrophy (C), Systolic anterior motion of the mitral valve (D)</p> Signup and view all the answers

<p>Notify DVLA (B)</p> Signup and view all the answers

<p>Skin necrosis (A)</p> Signup and view all the answers

<p>CT coronary angiography (C)</p> Signup and view all the answers

<p>Rhabdomyolysis (D)</p> Signup and view all the answers

<p>10% (D)</p> Signup and view all the answers

<p>Clinic BP &gt;= 160/100 mmHg (C)</p> Signup and view all the answers

<p>ACE inhibitor or ARB (B)</p> Signup and view all the answers

<p>Add a low-dose spironolactone (C)</p> Signup and view all the answers

<p>Losartan (C)</p> Signup and view all the answers

<p>Quit smoking (A)</p> Signup and view all the answers

<p>Increased cardiovascular risk (A)</p> Signup and view all the answers

<p>Statins (C)</p> Signup and view all the answers

<p>Myopathy (B)</p> Signup and view all the answers

<p>Calcium channel blocker (D)</p> Signup and view all the answers

<p>Systolic BP &gt;= 180 mmHg (A)</p> Signup and view all the answers

<p>Calcium channel blocker as first-line (C)</p> Signup and view all the answers

<p>Magnetic resonance angiography (MRA) or CT angiography (CTA) (C)</p> Signup and view all the answers

<p>Less than 80 mmHg (D)</p> Signup and view all the answers

<p>Refer to a vascular service for interventional treatment (D)</p> Signup and view all the answers

<p>Compression stockings as the primary treatment (D)</p> Signup and view all the answers

<p>Renal artery stenosis (B)</p> Signup and view all the answers

<p>If they are sedentary. (D)</p> Signup and view all the answers

<p>Amiodarone (A)</p> Signup and view all the answers

<p>Bradycardia (D)</p> Signup and view all the answers

<p>Bronchospasm (A)</p> Signup and view all the answers

<p>Antagonism of the P2Y12 receptor (B)</p> Signup and view all the answers

<p>Thyroid dysfunction (A)</p> Signup and view all the answers

<p>Inhibiting sodium reabsorption at the distal convoluted tubule. (C)</p> Signup and view all the answers

<p>Propranolol (A)</p> Signup and view all the answers

<p>Sickle cell disease (A)</p> Signup and view all the answers

<p>Lengthens the QT interval. (A)</p> Signup and view all the answers

<p>2nd Degree Block, Type 2 (C)</p> Signup and view all the answers

<p>Angiotensin-converting enzyme inhibitors (C)</p> Signup and view all the answers

<p>Cough (D)</p> Signup and view all the answers

<p>Concurrent use of proton pump inhibitors. (B)</p> Signup and view all the answers

<p>5.5 mmol/L (A)</p> Signup and view all the answers

<p>Uncontrolled heart failure (A)</p> Signup and view all the answers

<p>Offer anticoagulation (C)</p> Signup and view all the answers

<p>Corneal deposits (D)</p> Signup and view all the answers

<p>Acute heart failure (B)</p> Signup and view all the answers

<p>Apixaban (A)</p> Signup and view all the answers

<p>Bleeding risk factors (D)</p> Signup and view all the answers

<p>2.5 (D)</p> Signup and view all the answers

<p>Concurrent diuretic therapy (D)</p> Signup and view all the answers

<p>It evaluates bleeding risk in patients on anticoagulants. (D)</p> Signup and view all the answers

<p>Warfarin (B)</p> Signup and view all the answers

<p>Fetal kidney damage (B)</p> Signup and view all the answers

<p>It assesses the need for outpatient management. (D)</p> Signup and view all the answers

<p>Bleeding complications (C)</p> Signup and view all the answers

<p>Apixaban (D)</p> Signup and view all the answers

<p>CHA2DS2-VASc score of 3 (A), Female patients with a score of 2 (B)</p> Signup and view all the answers

<p>3 months (D)</p> Signup and view all the answers

<p>Provoked vs. unprovoked VTE (A)</p> Signup and view all the answers

<p>Thrombolysis (D)</p> Signup and view all the answers

<p>LMWH followed by dabigatran or edoxaban (C)</p> Signup and view all the answers

<p>They are likely to benefit from continuing treatment. (C)</p> Signup and view all the answers

<p>Taking aspirin regularly (A)</p> Signup and view all the answers

<p>Structural deterioration over time (D)</p> Signup and view all the answers

<p>ORBIT score (C)</p> Signup and view all the answers

<p>Increased use of DOACs as initial treatment. (C)</p> Signup and view all the answers

<p>Hemodynamic stability and lack of comorbidities (C)</p> Signup and view all the answers

<p>It is related to a specific triggering event. (C)</p> Signup and view all the answers

<p>Increased risk of thrombosis requiring long-term anticoagulation (C)</p> Signup and view all the answers

<p>Xanthelasma (B), Tendon xanthoma (D)</p> Signup and view all the answers

<p>Intravenous adenosine (D)</p> Signup and view all the answers

<p>Sydenham's chorea (D)</p> Signup and view all the answers

<p>Taking modified release isosorbide mononitrate (D)</p> Signup and view all the answers

<p>Eruptive xanthoma (D)</p> Signup and view all the answers

<p>Clarithromycin and amiodarone (D)</p> Signup and view all the answers

<p>Endocarditis evidence with regurgitant murmur (D)</p> Signup and view all the answers

<p>Acute myocardial infarction (B), Normal variant with age (D)</p> Signup and view all the answers

<p>3.5 (D)</p> Signup and view all the answers

<p>IV adenosine (D)</p> Signup and view all the answers

<p>Surgical excision (D)</p> Signup and view all the answers

<p>Long-term management of mechanical heart valves (C)</p> Signup and view all the answers

<p>Electric cardioversion (B)</p> Signup and view all the answers

<p>Photosensitivity rash (B)</p> Signup and view all the answers

<p>Determining the need for anticoagulation in atrial fibrillation (B)</p> Signup and view all the answers

<p>In patients without heart failure or atrial flutter (B)</p> Signup and view all the answers

<p>It may help reduce the incidence of renal stones (A)</p> Signup and view all the answers

<p>Digoxin (B)</p> Signup and view all the answers

<p>Only provide rate control (D)</p> Signup and view all the answers

<p>2 months (B)</p> Signup and view all the answers

<p>CURB-65 (C)</p> Signup and view all the answers

<p>Continue anticoagulation for 4 weeks prior and during the procedure (A)</p> Signup and view all the answers

<p>Asthma (C)</p> Signup and view all the answers

<p>Initiate anticoagulation therapy and monitor (C)</p> Signup and view all the answers

<p>Cardiac tamponade (C)</p> Signup and view all the answers

<p>To assess the risk of developing pressure sores (D)</p> Signup and view all the answers

<p>DAS28 (B)</p> Signup and view all the answers

<p>Primary hyperaldosteronism (B)</p> Signup and view all the answers

<p>Aspirin &amp; prasugrel (C)</p> Signup and view all the answers

<p>Acute myocardial infarction (C)</p> Signup and view all the answers

<p>Clopidogrel (C)</p> Signup and view all the answers

<p>Short PR interval (C)</p> Signup and view all the answers

<p>Consider stopping the antiplatelets (A)</p> Signup and view all the answers

<p>Obstructive sleep apnea (D)</p> Signup and view all the answers

<p>12 months (A)</p> Signup and view all the answers

<p>Verapamil (D)</p> Signup and view all the answers

<p>Radiofrequency ablation (B)</p> Signup and view all the answers

<p>Increased risk of bleeding (C)</p> Signup and view all the answers

<p>Hypomagnesaemia (A)</p> Signup and view all the answers

<p>For 4-6 weeks after the event (C)</p> Signup and view all the answers

<p>Fatigue (D)</p> Signup and view all the answers

In suspected ACS cases, immediately administer glyceryl trinitrate, aspirin (300mg), and monitor oxygen saturation. ECG and hospital transfer should follow, prioritizing transfer over ECG if needed. Oxygen is only given if saturation is <94%

Stable angina is characterized by chest pain (front of chest, neck, shoulders, jaw, or arms), triggered by exertion, and relieved by rest or glyceryl trinitrate (GTN) within 5 minutes.

For chest pain, referral urgency depends on the timing relative to the onset of pain. Immediate admission is needed for current/recent (within 12 hours) chest pain with abnormal ECG. 12-72 hours past onset warrants same-day referral. Pain >72 hours requires full assessment (ECG, Troponin) before further action.

Routine oxygen administration isn't recommended for suspected ACS. Supplemental oxygen is only recommended if oxygen saturation (SpO2) is below 94%, or for specific chronic obstructive pulmonary disease (COPD) patients at risk of hypercapnia to an 88-92% target.

Angina can be classified as 'typical', 'atypical', or 'non-anginal' based on the presence of specific symptoms. This classification helps to decide if the pain could be caused by a heart attack/chest pain.

Symptoms consistent with typical or atypical angina, or ECG changes.

First-line imaging test for suspected angina.

Non-invasive tests that check for reversible myocardial ischaemia.

Medications that promote fluid loss in the body.

Loop diuretics are useful for acute and chronic heart failure.

High blood pressure not controlled by medication, especially in those with kidney issues.

High blood pressure readings (clinic, ABPM, HBPM) between 135/85 mmHg and 140/90 mmHg (depending on method).

High blood pressure readings (clinic, ABPM, HBPM) between 150/95 mmHg and 160/100 mmHg (depending on method).

Treat if 10-year cardiovascular risk is over 10% or other specific factors (target organ damage).

Treat if blood pressure is above 150/90 mmHg, clinic, or equivalent ABPM/HBPM average.

ACE inhibitors or ARBs (angiotensin receptor blockers) for younger patients or diabetes.

If taking an ACE-i or ARB, add a calcium channel blocker or thiazide-like diuretic.

Aim for blood pressure readings below 135/85 mmHg (Age <80) and 145/85 mmHg (Age >80).

Muscle pain, damage, or breakdown linked to statin use.

If blood pressure measurements from both arms differ by more than 20 mmHg, record the higher reading and consider potential underlying conditions.

For blood pressure readings >= 140/90 mmHg, consider repeat measurements, ambulatory or home blood pressure monitoring (ABPM/HBPM).

If blood pressure reaches >= 180/120 mmHg and specific symptoms or signs are present, refer urgently for specialist assessment.

If target organ damage is identified during urgent investigations for high blood pressure, consider immediate antihypertensive treatment.

During ABPM, at least 14 measurements should be taken over waking hours, and the average value is used for interpretation.

For HBPM, take two consecutive measurements at least 1 minute apart, twice daily, ideally morning and evening, for at least 4 days.

Management for warfarin overdose depends on the INR level and presence of bleeding. Intravenous vitamin K and other interventions may be needed.

First-line treatment for chronic heart failure includes both an ACE inhibitor and a beta-blocker. Initiate one drug at a time.

Aldosterone antagonists are standard second-line treatment for chronic heart failure. Be mindful of potential hyperkalemia.

SGLT-2 inhibitors play an increasing role in heart failure with reduced ejection fraction by reducing glucose reabsorption.

Third-line treatment for heart failure includes options like ivabradine, sacubitril-valsartan, digoxin, hydralazine, and cardiac resynchronisation therapy.

Coarctation of the aorta describes a congenital narrowing of the descending aorta, more common in males and associated with Turner's syndrome.

Lipophilic statins (like simvastatin and atorvastatin) are more likely to cause myopathy (muscle problems) than hydrophilic statins (like rosuvastatin and pravastatin).

Liver function tests (LFTs) should be checked at baseline, 3 months, and 12 months when someone takes statins, and treatment should be stopped if transaminase levels are 3x the upper limit of normal.

Some evidence suggests that statins may increase the risk of intracerebral hemorrhage in patients with a history of stroke. This is not a concern in primary prevention.

Statins should be stopped temporarily during treatment with macrolide antibiotics (e.g., erythromycin, clarithromycin) due to potential interactions.

Statins are contraindicated during pregnancy.

People with established cardiovascular disease (e.g., stroke, heart disease) should generally take statins.

Individuals with a 10-year cardiovascular risk of 10% or greater should consider statin therapy according to NICE guidelines.

Patients with type 2 diabetes should be assessed with QRISK2 to determine if they need statins.

Patients with type 1 diabetes, diagnosed over 10 years ago, over 40 years old, or with nephropathy should be considered for statins.

Statins are often taken at night as that's when most cholesterol synthesis occurs, especially shorter-acting statins like simvastatin.

All patients with stable angina should receive aspirin and a statin, unless contraindicated.

Beta-blockers or calcium channel blockers are initial treatment options for stable angina based on patient comorbidities, contraindications and preference.

Patients taking standard-release isosorbide mononitrate should use asymmetric dosing intervals to ensure a daily nitrate-free period (10-14 hrs) to reduce tolerance.

Measure blood pressure in both arms. If readings differ by more than 20 mmHg, repeat measurements in each arm.

Turner's syndrome is often associated with a bicuspid aortic valve, berry aneurysms, and neurofibromatosis.

A bicuspid aortic valve can cause a mid-systolic murmur loudest at the back, an apical click from the valve closing, and a radio-femoral delay.

Berry aneurysms are fragile, balloon-like outpouchings in blood vessels, often found in the brain.

ACE inhibitors are less effective in treating hypertension in Afro-Caribbean patients compared to other populations.

ACE inhibitors are used to treat diabetic nephropathy and have a role in preventing ischemic heart disease.

ACE inhibitors are contraindicated during pregnancy and breastfeeding.

A persistent cough can be a side effect of ACE inhibitors, occurring in around 15% of patients and possibly up to a year after treatment initiation.

Angioedema, a swelling in the face and throat, can happen as a side effect of ACE inhibitors, sometimes occurring up to a year after starting treatment.

Anticoagulation should be considered for any patient with a history of atrial fibrillation, even if they are currently in sinus rhythm.

The CHA2DS2-VASc score assesses risk factors for stroke in atrial fibrillation to determine the need for anticoagulation.

A score of 0 indicates no need for treatment, 1 suggests considering anticoagulation for males, 2 or more warrants offering anticoagulation.

The ORBIT score assesses an individual's bleeding risk to determine the best approach for anticoagulation.

DOACs are the first-line anticoagulants for patients with atrial fibrillation, offering advantages over warfarin.

Warfarin is now used second-line for atrial fibrillation, only when DOACs are contraindicated or not tolerated.

Achieving a stable INR (international normalized ratio) with warfarin, which has a long half-life, may take several days.

Various loading regimes are available to quickly achieve the desired therapeutic effect of warfarin. Computer software can also help tailor doses.

Certain factors can enhance the effects of warfarin, increasing the risk of bleeding.

Liver disease can potentiate warfarin's effects due to reduced metabolism.

Drugs that inhibit certain liver enzymes (like amiodarone, ciprofloxacin) can increase warfarin levels.

Cranberry juice can potentiate warfarin due to its interaction with certain enzymes.

Nonsteroidal anti-inflammatory drugs (NSAIDs) can displace warfarin from albumin, increasing free levels.

NSAIDs can further increase bleeding risk by inhibiting platelet function.

The most serious side effect of warfarin is haemorrhage, or excessive bleeding.

Warfarin can have teratogenic effects, causing birth defects, but can be used in breastfeeding mothers.

Rarely, warfarin can cause skin necrosis, due to a temporary procoagulant state at the start of treatment.

Symptomatic aortic stenosis can cause chest pain, shortness of breath, and syncope or presyncope, especially with exertion.

A classic finding in aortic stenosis is an ejection systolic murmur that radiates to the carotid arteries.

Severe aortic stenosis is characterized by a narrow pulse pressure, slow-rising pulse, delayed murmur, and soft/absent second heart sound.

Management of aortic stenosis depends on symptom severity and the degree of valve narrowing.

A rare inflammatory disease affecting the aorta and its major branches, causing narrowing and blockage. It primarily affects young women and can lead to various symptoms, from headaches and malaise to weakened pulses and claudication.

Vascular imaging, like magnetic resonance angiography (MRA) or CT angiography (CTA), is essential to diagnose Takayasu's arteritis by visualizing the affected blood vessels.

Steroids are the primary treatment for Takayasu's arteritis, aiming to reduce inflammation and improve blood flow.

Referral to a vascular service for varicose veins is recommended if symptoms include lower limb pain, skin changes, venous ulcers, superficial vein thrombosis, or recurrent varicose veins.

Lifestyle modifications for varicose veins include losing weight, moderate physical activity, elevating legs frequently, and avoiding prolonged standing or sitting.

Amiodarone blocks potassium channels, prolonging the action potential and slowing heart rate. It also has class I sodium channel blocking activity.

Amiodarone can cause thyroid dysfunction, corneal deposits, pulmonary fibrosis, liver abnormalities, neuropathy, photosensitivity, blue-grey skin discoloration, thrombophlebitis, bradycardia, and QT prolongation.

Digoxin monotherapy is suitable for sedentary patients with non-paroxysmal atrial fibrillation.

Beta-blockers are now a mainstay in heart failure treatment, despite previously being avoided, as they improve symptoms and mortality.

Clopidogrel is a P2Y12 ADP receptor antagonist, preventing platelet activation and blood clotting.

Proton pump inhibitors (PPIs) may reduce clopidogrel's effectiveness. Lansoprazole is preferred over omeprazole and esomeprazole.

Higher BNP levels indicate worse heart failure. Referral is required if BNP is 400-2000 within 6 weeks or >2000 within 2 weeks.

The PR interval is prolonged (greater than 0.2 seconds) indicating a delay in the conduction of the electrical signal through the AV node.

Progressive lengthening of the PR interval until a QRS complex is dropped. The pattern then repeats.

Regular PR interval and R-R interval, but with dropped QRS complexes. More serious than type 1.

Complete dissociation between atrial and ventricular activity, no connection between P waves and QRS complexes.

Thiazide diuretics block the thiazide-sensitive Na+-Cl symporter in the distal convoluted tubule, leading to sodium and water excretion.

Thiazides are useful for mild heart failure, but loop diuretics are more effective in severe cases.

Regular heart rhythm with a consistent PR interval, one P wave for every QRS complex.

Patients with a new diagnosis of PE who are deemed low-risk are now increasingly managed as outpatients, especially if they are haemodynamically stable, lack comorbidities, and have support at home.

NICE recommends using a validated risk stratification tool to determine the suitability of outpatient treatment for PE, but does not specify what tool should be used.

The 2018 British Society guidelines support the use of the Pulmonary Embolism Severity Index (PESI) score for PE risk stratification.

The cornerstone of VTE management is anticoagulant therapy. This was historically done with warfarin, but the development of DOACs and evidence supporting their efficacy has changed modern management.

Apixaban or rivaroxaban (both DOACs) are now recommended first-line for the diagnosis of PE.

NICE now advocates using a DOAC once a diagnosis of PE is suspected, with this continued if the diagnosis is confirmed.

If apixaban or rivaroxaban are not suitable, alternatives include LMWH followed by dabigatran or edoxaban, or LMWH followed by a VKA (warfarin).

The new guidelines recommend using a DOAC for PE in patients with active cancer, unless contraindicated. Previously, LMWH was recommended.

LMWH, unfractionated heparin, or LMWH followed by a VKA is recommended for severe renal impairment (<15 ml/min) in PE.

LMWH followed by a VKA is recommended for PE in patients with 'triple-positive' antiphospholipid syndrome.

All patients with PE should have anticoagulation for at least 3 months.

A provoked VTE is due to a precipitating event (e.g., immobilisation after surgery). An unprovoked VTE occurs without an obvious cause, suggesting underlying risk factors.

Anticoagulation is typically stopped after 3 months for a provoked VTE (3 to 6 months for people with active cancer).

Anticoagulation is typically continued for up to 6 months for an unprovoked VTE.

The ORBIT score can be used to help assess the risk of bleeding in PE patients.

Bendroflumethiazide was widely used for hypertension, but recent NICE guidelines recommend other thiazide-like diuretics like indapamide and chlortalidone.

Common side effects include dehydration, postural hypotension, hypokalaemia, hyponatraemia, and hypercalcaemia.

A side effect of these drugs is hypocalciuria (reduced calcium excretion), which can be useful for preventing kidney stones.

Used to assess the risk of stroke in patients with atrial fibrillation, guiding the need for anticoagulation.

A system for classifying the severity of heart failure.

Rate control aims to slow the heart rate, while rhythm control seeks to restore a regular heartbeat.

Rate control is the first-line choice unless the AF is reversible, caused by heart failure, new-onset (<48 hours), or suitable for ablation.

Beta-blockers, calcium channel blockers, and digoxin are used to slow the heart rate.

Beta-blockers, dronedarone, and amiodarone are used to maintain a regular heartbeat.

A procedure to ablate (destroy) the electrical pathways responsible for atrial fibrillation.

Anticoagulation is still necessary after ablation, as it only controls rhythm, not stroke risk.

Potential complications include cardiac tamponade, stroke, and pulmonary vein stenosis.

Around 50% recurrence within 3 months, but long-term success is about 55-80% depending on the number of procedures.

DOACs are now first-line treatment for most PE patients, replacing low-molecular weight heparin.

Low-risk PE patients can be treated as outpatients, similar to deep vein thrombosis.

Mechanical heart valves can increase the risk of blood clots forming (thrombosis), requiring long-term blood thinners like warfarin.

Aortic valve: Target INR of 3.0. Mitral valve: Target INR of 3.5.

Palmar xanthomas are associated with remnant hyperlipidemia and may less commonly occur with familial hypercholesterolemia.

Eruptive xanthomas are multiple red/yellow bumps appearing on the extensor surfaces (elbows, knees) due to high triglyceride levels.

Tendon xanthomas are yellow lumps found in tendons, often associated with familial hypercholesterolemia and remnant hyperlipidemia.

Xanthelasma are yellowish papules and plaques caused by localized lipid deposits commonly found on the eyelids.

Options for managing xanthelasma include surgical excision, topical trichloroacetic acid, laser therapy, or electrodesiccation.

Diagnosis requires evidence of recent streptococcal infection along with two major criteria or one major and two minor criteria.

Elevated streptococcal antibody levels, positive throat swab, or positive rapid group A streptococcal antigen test.

Erythema marginatum, Sydenham's chorea, polyarthritis, carditis/valvulitis, subcutaneous nodules.

Elevated ESR or CRP, fever, arthralgia (not arthritis), prolonged PR interval.

Management involves oral penicillin, anti-inflammatory medications, and treatment of complications.

Right bundle branch block (RBBB) can be a normal variant, linked to right ventricular hypertrophy, increased right ventricular pressure, pulmonary embolism, myocardial infarction, atrial septal defect, cardiomyopathy, or myocarditis.

SVT refers to a rapid heart rate originating above the ventricles. Common types include AV nodal re-entry tachycardia (AVNRT), AV re-entry tachycardias (AVRT), and junctional tachycardias.

Acute management includes vagal maneuvers (Valsalva, carotid massage), intravenous adenosine, or electrical cardioversion.

Prevention of SVT episodes involves beta-blockers and radiofrequency ablation.

Diagnosing a myocardial infarction in patients with existing LBBB can be challenging due to the altered ECG pattern. The Sgarbossa criteria can help determine the likelihood of an infarction.

Patients with stable cardiovascular disease often require both antiplatelet and anticoagulant medications. In these cases, anticoagulant monotherapy is usually preferred without the addition of antiplatelets.

After an acute coronary syndrome or percutaneous coronary intervention, there is a stronger indication for antiplatelet therapy. Patients may receive triple therapy (two antiplatelets and one anticoagulant) for 4-6 months, followed by dual therapy (one antiplatelet and one anticoagulant) for a total of 12 months.

If a patient on antiplatelet medication develops a VTE, they often receive anticoagulants for 3-6 months. The ORBIT score assesses bleeding risk, and in low-risk patients, antiplatelets may be continued.

Secondary hypertension, where the cause is identifiable, is often due to underlying conditions like primary hyperaldosteronism, renal disease, or endocrine disorders.

Primary hyperaldosteronism, including Conn's syndrome, is the most common cause of secondary hypertension, affecting 5-10% of diagnosed hypertensive patients.

Renal disease is a significant contributor to secondary hypertension, with conditions like glomerulonephritis, pyelonephritis, adult polycystic kidney disease, and renal artery stenosis being common culprits.

Various endocrine disorders besides primary hyperaldosteronism can cause elevated blood pressure, including phaeochromocytoma, Cushing's syndrome, Liddle's syndrome, congenital adrenal hyperplasia, and acromegaly.

Long QT syndrome is an inherited condition characterized by delayed repolarization of the ventricles, increasing the risk of ventricular tachycardia, torsade de pointes, and sudden death.

Prolonged QT intervals can be caused by congenital factors (e.g., Jervell-Lange-Nielsen syndrome, Romano-Ward syndrome), drugs like amiodarone and sotalol, or other factors like electrolyte abnormalities, acute myocardial infarction, and hypothermia.

WPW syndrome is caused by an extra electrical pathway between the atria and ventricles, leading to atrioventricular re-entry tachycardia (AVRT). It can be associated with various heart conditions.

ECG features of WPW syndrome include a short PR interval, wide QRS complexes with a slurred upstroke (delta wave), and axis deviation (left or right depending on the pathway location).